Assessing children's emotional responses to surgery: a multidimensional approach

The impact of digital storytelling for children during paediatric day surgery on anxiety and negative emotional behaviors: Randomized controlled trial

PURPOSE

The aim of the study was to examine the effectiveness of digital storytelling as a therapeutic care intervention in paediatric day surgery.

DESIGN AND METHODS

his study was conducted in a randomized controlled experimental design. Seventy-two voluntary children who were scheduled for day surgery and met the inclusion criteria for the study were included. Research data were collected using the Child's Descriptive Information Form, the Children's Emotional Manifestation Scale, and the State Anxiety Inventory for Children. The study group used digital storytelling to prepare for day surgery.

RESULTS

State anxiety scores decreased over time in the study group. The digital storytelling intervention was found to be effective in reducing anxiety scores. In the control group, state anxiety scores were highest on the day of the surgery. Children in the control group experienced higher levels of anxiety on the day of the surgery compared to those in the study group. The high anxiety levels in the control group continued at a higher level even two weeks after surgery. Children in the control group exhibited more negative emotional behaviors on the day of the surgery.

CONCLUSION

The digital storytelling intervention implemented in this research was found to be effective in reducing children's anxiety and negative emotional behaviors.

PRACTICE IMPLICATIONS

Digital storytelling should be applied and adapted to various other areas of paediatric surgery. Its utilization is significant for nurses working in the field of day surgery.

Psychometric Testing of the Turkish Version of Children's Emotional Manifestation Scale

AIMS AND OBJECTIVES

This study was conducted to determine the Turkish validity-reliability of the Children's Emotional Manifestation Scale (CEMS).

DESIGN

A methodological study design was used.

METHODS

The research was comprised 100 children aged between 7 and 12 who underwent a surgical operation. To ensure the reliability of the scale, necessary permissions were obtained from the creator of the scale and the ethical committee. Language, content, and structure were validated for the validity of the scale.

RESULTS

Content validity index was calculated as 0.96. Confirmatory factor were performed for construct validity. The scale was found to have relatively good model fit indicators. To determine the reliability of the scale, internal consistency coefficient and compliance between observers were evaluated. The Cronbach Alpha coefficient of the scale was found to be 0.94, and the ICC coefficient evaluated among the observers ranged between 0.970 and 0.981.

CONCLUSION

As a result, CEMS was identified as a simple, objective, valid and reliable measurement tool that can be used to evaluate the emotional indicators of children in the Turkish population.

PRACTICE IMPLICATIONS

CEMS is appropriate clinical research tool to use in evaluating the children response to stressful medical procedures and effectiveness of interventions directed towards minimizing anxiety and bolstering coping mechanisms in children undergoing surgery.

Children and parents perspectives on children's dental treatment under general anesthesia: a narratology from Saskatoon, Canada

Aim

This study aimed to explore the emotional and psychological effects of dental treatment under general anesthesia (DTGA) on children and parents in Saskatoon city, Saskatchewan, Canada.

Design

Semi-structured interviews, video diaries, drawings, and a questionnaire were used to collect data. The study used a narrative perspective and thematic analysis to analyze data.

Results

The findings from children and their parents (N = 25) indicated DTGA is disconcerting from both views. Parental guilt and the desire of both parents and children to not have to go through the experience again fueled at least short-term compliance with brushing, flossing, and changes in dietary habits.

Conclusion

The children participants provided valuable information to augment that gathered from parents. As the study revealed that the DTGA is psychologically and emotionally troubling for both children and their caregivers, it is imperative to explore ways to ease the GA experience. Specific recommendations were provided for optimizing dental and health services for those children and their families.

I'm afraid! Children's experiences of being anesthetized

INTRODUCTION

Children experience anesthetization as stressful, and many preoperative measures have been tested for reducing their anxiety. There is, however, little research about children's own experiences and thoughts about being anesthetized.

AIMS

The aim of the present study was thus to explain and understand the meaning of being anesthetized as experienced by children.

METHODS

A qualitative lifeworld hermeneutic approach was used. Data were collected through nonparticipant video observations, field notes, and interviews. The participants were children (n = 28) aged 4-13 years who required general elective minor surgery performed in four Swedish hospitals.

RESULTS

The four interpreted themes describe the children's experiences of being anesthetized: Being powerless, Striving for control, Experiencing an ambiguous comprehensibility, and Seeking security. The children struggled with anxiety as a result of their inability to protect themselves from perceived external threats while being anesthetized. In order to meet their needs, it would be beneficial for them to receive appropriate information in a calm, supportive, and protective environment.

CONCLUSION

The reasons for children experiencing anxiety when being anesthetized are multifaceted, and this study highlights the importance of listening to each child's own voice and striving to create an individually adapted caring and safe environment with as much protection as possible.

Certified Child Life Specialists Lessen Emotional Distress of Children Undergoing Laceration Repair in the Emergency Department

OBJECTIVE

The objective of this study is to evaluate the impact of certified child life specialists (CCLSs) on the emotional responses of children undergoing laceration repair in the emergency department (ED).

METHODS

Patients 4 to 12 years of age who required laceration repair by suturing were prospectively enrolled at an urban tertiary pediatric ED. Certified child life specialists are not available at all times in our institution, allowing for a priori categorization of subjects into 2 comparison groups, those with and those without CCLS involvement. Subjects requiring anxiolysis, pharmacologic sedation, narcotics, or physical restraint were excluded. The Children's Emotional Manifestation Scale, a previously validated Likert-like tool, was used to quantify the patients' distress, with a higher score reflecting a more emotional child. Just before placement of the first suture, subjects were scored by trained independent observers. Baseline data included age, sex, race, type of local anesthetic, length and location of laceration, and analgesics administered. The primary endpoint of emotional score was compared with a 2-tailed Mann-Whitney U test, with a P < 0.05 considered statistically significant.

RESULTS

Two hundred one patients constituted the final study cohort, with 103 (51%) having CCLS involvement. Study groups did not differ in regards to any baseline demographic or clinical characteristics. The median emotional score for patients with child life services was 7 (interquartile range, 6-9) versus 9 (interquartile range, 7.5-12) for those without (P < 0.0005).

CONCLUSIONS

Certified child life specialist involvement is associated with less emotional distress for children undergoing laceration repair in the ED.

Efficacy of Non-pharmacological Methods of Pain Management in Children Undergoing Venipuncture in a Pediatric Outpatient Clinic: A Randomized Controlled Trial of Audiovisual Distraction and External Cold and Vibration

PURPOSE

Venipuncture generates anxiety and pain in children. The primary aim of the study was to evaluate two non-pharmacological techniques, vibration combined with cryotherapeutic topical analgesia by means of the Buzzy® device and animated cartoons, in terms of pain and anxiety relief during venipuncture in children.

DESIGNS AND METHODS

150 children undergoing venipuncture were randomized into four groups: the 'no method' group, the Buzzy® device group, the animated cartoon group and the combination of Buzzy® and an animated cartoon group. Children's pain and anxiety levels along with parents' and nurses' anxiety levels were evaluated by means of validated grading scales.

RESULTS

Overall children's pain increased less in the non-pharmacological intervention groups as compared to the group without intervention. Notably, the difference was statistically significant in the animated cartoon group for children's perception of pain. Children's anxiety and parents' anxiety decreased more in non-pharmacological interventions groups as compared to the group without intervention.

CONCLUSIONS

The study showed the effectiveness of non-pharmacological methods of pain management during venipuncture. Notably, distraction with animated cartoons was superior in terms of children's perception of pain when compared to Buzzy®, and to the combination of cartoons and Buzzy®. Buzzy® was significantly effective at the secondary analysis for children younger than 9. Children's and parents' anxiety is decreased by non-pharmacological methods. Furthermore, nurses' involvement in pediatric care can be enhanced.

PRACTICE IMPLICATIONS

Non-pharmacological methods of pain management during venipuncture represent an easy way to achieve an increased level of compliance among children and parents.

Development of a Virtual Reality Exposure Tool as Psychological Preparation for Elective Pediatric Day Care Surgery: Methodological Approach for a Randomized Controlled Trial

Background

Preoperative anxiety in children is highly prevalent and is associated with adverse outcomes. Existing psychosocial interventions to reduce preoperative anxiety are often aimed at distraction and are of limited efficacy. Gradual exposure is a far more effective way to reduce anxiety. Virtual reality (VR) provides a unique opportunity to gradually expose children to all aspects of the operating theater.

Objective

The aims of our study are (1) to develop a virtual reality exposure (VRE) tool to prepare children psychologically for surgery; and (2) to examine the efficacy of the VRE tool in a randomized controlled trial (RCT), in which VRE will be compared to care as usual (CAU).

Methods

The VRE tool is highly realistic and resembles the operating room environment accurately. With this tool, children will not only be able to explore the operating room environment, but also get accustomed to general anesthesia procedures. The PREoperative Virtual reality Intervention to Enhance Wellbeing (PREVIEW) study will be conducted. In this single-blinded RCT, 200 consecutive patients (aged 4 to 12 years) undergoing elective day care surgery for dental, oral, or ear-nose-throat problems, will be randomly allocated to the preoperative VRE intervention or CAU. The primary outcome is change in child state anxiety level between baseline and induction of anesthesia. Secondary outcome measures include child’s postoperative anxiety, emergence delirium, postoperative pain, use of analgesics, health care use, and pre- and postoperative parental anxiety.

Results

The VRE tool has been developed. Participant recruitment began March 2017 and is expected to be completed by September 2018.

Conclusions

To our knowledge, this is the first RCT evaluating the effect of a VRE tool to prepare children for surgery. The VRE intervention is expected to significantly diminish preoperative anxiety, postoperative pain, and the use of postoperative analgesics in pediatric patients. The tool could create a less stressful experience for both children and their parents, in line with the modern emphasis on patient- and family-centered care.

Trial Registration

Netherlands Trial Registry: NTR6116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6116 (Archived by WebCite at http://www.webcitation.org/6ryke7aep)

Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: a quantitative systematic review

AIMS

To examine the relationship between perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures and the differences in children's perioperative anxiety and postoperative pain among subgroups of demographics.

BACKGROUND

While anxiety and pain are regarded as two common problems experienced by children and adolescents perioperatively and the relationship between them has been reported in previous studies, there has been no review paper examining this phenomenon.

DESIGN

A quantitative systematic review.

DATA SOURCES

Nine electronic databases were searched for studies published in English from the inception date of the databases to December 2010, using various combinations of search terms of 'adolescents', 'anxiety', 'child', 'pain', 'surgery' and 'correlation/relationship'.

REVIEW METHODS

Using the Joanna Briggs Institute's comprehensive systematic review strategies, relevant studies were independently appraised and extracted by two reviewers using the standardized critical appraisal instruments and data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument.

RESULTS

Ten studies were included in this review from 943 studies initially retrieved. Children and adolescents who had higher level of perioperative anxiety experienced a higher level of postoperative pain. Inconclusive evidence was found regarding differences of perioperative anxiety and postoperative pain between demographic subgroups of gender, age and past surgical experience.

CONCLUSION

Results of this review inform healthcare providers of the role perioperative anxiety plays on children's and adolescents' postoperative pain and indicate the need to use interventions to reduce perioperative anxiety and, therefore, optimize their postoperative pain management during the perioperative period.

Exploring influencing factors of postoperative pain in school-age children undergoing elective surgery

PURPOSE

The purpose of this study was to examine the influencing factors of postoperative pain among children undergoing elective surgery.

DESIGN AND METHODS

A survey was conducted in 2011 with a convenience sample of 66 children, 6 to 14 years old, in a tertiary hospital in Singapore.

RESULTS

Children experienced moderate preoperative anxiety and postoperative pain. Gender, preoperative anxiety, and negative emotional behaviors were significant influencing factors for postoperative pain. Boys reported less postoperative pain than girls.

PRACTICE IMPLICATIONS

Effective strategies for assessing and managing children's preoperative anxiety are needed to achieve an optimal postoperative pain management outcome.

Preprocedural Distress in Children With Cancer

Children diagnosed with cancer experience many invasive procedures throughout diagnosis and treatment of their disease. These procedures, oftentimes a source of distress in children, can elicit a variety of anticipatory symptoms prior to the actual procedure. Although there have been efforts to develop approaches to alleviate this distress through use of distraction, relaxation, sedation, guided imagery, and hypnosis, there has not been a combination treatment that merged relaxation techniques and biofeedback within a pediatric framework. A group of 12 children diagnosed with cancer participated in a 4-session intervention combining relaxation and biofeedback. This feasibility study suggests that the combination intervention offered in a clinical setting may be beneficial to children experiencing procedural distress as a novel coping strategy.

Assessing Children's Anxiety Using the Modified Short State-Trait Anxiety Inventory and Talking Mats: A Pilot Study

Background. Preoperative anxiety complicates treatment and requires assessment by nurses in children. Children, with or without disability, are helped when pictures are used to support communication. The purpose of this pilot study was to test the reliability and validity of the modified short State-Trait Anxiety Inventory (STAI) using a modified Talking Mats method in children undergoing day surgeries. Method. A modified short STAI with pictorial support along the lines of the Talking Mats method was pre- and postoperatively administered to 42 typically developing children aged three to nine years. The parents assessed the children's anxiety, simultaneously and independently, by scoring the short STAI by proxy. Results. The modified short STAI showed moderate internal consistency and good construct validity in the age group seven to nine years. Conclusions. The results of this study support the use of the instrument for self-reports in children aged seven to nine years. Future research will explore the possibilities of also using this instrument for children with cognitive and communicative difficulties.

Anxiety and pain in children undergoing elective surgical procedures: a systematic review

BACKGROUND

Anxiety and pain are two significant problems experienced by children undergoing elective surgical procedures, which may lead to suboptimal postoperative outcomes. Previous studies have shown a correlation between perioperative anxiety and pain in children.

OBJECTIVES

This review aimed to present the best available evidence on the correlation between perioperative anxiety and pain in children undergoing elective surgical procedures, and to determine the relationship between children's demographics, their anxiety and pain level in the perioperative period.

INCLUSION CRITERIA

Participants were children aged between five to 18 years old who were scheduled for an elective surgical procedure in the hospital setting.No specific intervention was of interest. So long as the primary studies examined correlation of children's anxiety and pain in the perioperative period, they were considered for inclusion.This review focused on children's preoperative level of anxiety; children's postoperative level of anxiety; children's postoperative pain intensity; and/or children's postoperative behavioural changes.This review included quantitative research studies, such as randomised-controlled trials, cohort studies, and descriptive studies which addressed the correlation between perioperative anxiety and perioperative pain in children undergoing elective surgical procedures.

SEARCH STRATEGY

A three-step search strategy was utilised in this review. The following databases were searched for articles published in English from the inception date of databases to December 2010: CINAHL, PubMed, Scopus, PsycINFO, Mednar, Trip Database, ProQuest Dissertations and Theses, Scirus ETD and Web of Science.

METHODOLOGICAL QUALITY

Papers selected for retrieval were assessed independently by two reviewers for methodological quality prior to inclusion in the review using standardised critical appraisal tools from Joanna Briggs Institute. There were no disagreements between the two reviewers, so the third reviewer was not required.

DATA EXTRACTION

Data were extracted using the standardised data extraction tools: the Joanna Briggs Institute Meta-Analysis Statistics Assessment and Review Instrument (JBI-MAStARI) for randomised-controlled trials, cohort studies, and descriptive/case series.

DATA SYNTHESIS

Since the ten included studies used various study designs and outcome measures for the levels of anxiety and pain, this made meta-analysis impossible and therefore the findings were summarised and presented in narrative form.

RESULTS

This review included two randomised-controlled trials, two cohort studies, five observational descriptive studies and one descriptive survey study. Eight studies revealed that children who had higher levels of pre- and post-operative anxiety experienced a higher level of post-operative pain. Pearson correlation coefficients of these eight studies were reported in the findings, with coefficients ranging between r = 0.29 (p < 0.05) to r = 0.57 (p < 0.001). There is no conclusive evidence supporting the relationships of children's demographics characteristics (i.e. gender, age and past surgical experience) and their perioperative anxiety and pain.

CONCLUSION

Children who had higher levels of pre- and post-operative anxiety experienced a higher level of post-operative pain. The review results inform healthcare providers of the role perioperative anxiety plays on paediatric postoperative pain.This evidence serves to generate implications for clinical practice and future studies in order to better manage children's perioperative anxiety and eventually improve their postoperative pain management. However, this review revealed insufficient evidence supporting the correlation between children's demographic data, namely gender, age and past surgical experience and their perioperative anxiety and pain.

IMPLICATIONS FOR PRACTICE

Children's perioperative anxiety should be routinely assessed prior to procedures in the clinical setting. This review also recommends that interventions be developed and implemented so as to reduce pain and anxiety for children during the perioperative period.

IMPLICATIONS FOR RESEARCH

Future studies are needed to examine the effectiveness of different interventions in reducing children's perioperative anxiety and pain, and to examine the relationship between anxiety and pain in other settings and countries. Future research should also be directed towards developing a reliable, shorter and practical anxiety assessment tool.

Relationships among mental health, self-esteem and physical health in Chinese adolescents: an exploratory study

This study explored the relationships among mental health, self-esteem and physical health in Hong Kong Chinese adolescents. Chinese students (N = 1945) between the ages of 12 and 19 from four secondary schools of different regions were invited to participate in the study. This study revealed that a significant number of adolescents in Hong Kong are experiencing depressive symptoms. The overall results indicated that self-esteem of adolescents was correlated to and a predictor of their physical and mental health. Health care professionals should take a more assertive role in promoting relevant health education to the community with emphasis on helping adolescents develop positive self-esteem.