Play interventions to reduce anxiety and negative emotions in hospitalized children

Strategies for Managing Pediatric Fracture Pain: Assessment, Pharmacological, and Non-Pharmacological Interventions

Fractures are prevalent among the pediatric population, with approximately 1 in 3 children experiencing at least 1 fracture during childhood. Children are not just little adults; they have unique needs in pain management. With a lack of knowledge in pediatric pain management, medical staff primarily focus on the fractures, often overlooking and inadequately addressing pain. There is a scarcity of literature on acute fracture pain for children, while a wealth of literature summarizes chronic and tumor-related pain in children, which is not suitable for addressing pain caused by fractures. Therefore, a pain management literature review grounded in clinical experience is essential to provide guidance to doctors and parents on safely and effectively reducing the pain associated with children's fractures. We conducted a thorough review of existing literature and summarized treatment experiences into the 3 areas of pain assessment, non-pharmacological treatments, and pharmacological treatments. First, we evaluated and analyzed existing pain assessment methods, identifying the most suitable tools for different age groups. Second, we explored non-pharmacological treatments suitable for children with fractures to alleviate mild to moderate pain and reduce the need for analgesics. Lastly, we reviewed pharmacological treatments. For moderate pain, we recommend administering non-steroidal anti-inflammatory drugs. For severe pain, we suggest opioid medications, providing detailed information on usage and contraindications for different age groups. Therefore, this article aimed to review the evaluation and management of pain in children with bone fracture, and covers aspects of pediatric pain characteristics, pain assessment tools, pharmacological therapy, and non-pharmacologic therapy.

Non-Pharmacological Pain and Stress Management (N-PPSM) in Pediatric Wards: A Nurses' Perspective

PURPOSE

To describe the nurses' use of non-pharmacological pain and stress management (N-PPSM) in pediatric wards and their perceptions of the benefits and perceived barriers that encourage and limited their use of these methods.

METHODS

This was a descriptive cross-sectional study involving 125 nurses working in the pediatric ward of an Indonesian hospital. Data collection utilized modified non-pharmacological method questionnaires, and data analysis involved t-tests and ANOVA.

RESULTS

The most widely used N-PPSM by nurses are cognitive methods such as providing education (48%), physical methods by positioning (40%), emotional support (36%), environmental support (45%), and family support (60%). Nurses stated that N-PPSM had few side effects (50.4%), were inexpensive (49.6%), could be performed independently (51.2%), and were easy to use (52.8%). However, during its implementation, there were several obstacles including lack of experience (42.4%), lack of training (48%), lack of equipment (45.6%), nurse belief (36.8%), lack of time (44%), patient unwilling (47.2%), and patient belief (41.6%). Work experience influences the overall utilization of N-PPSM (p-value = .043).

CONCLUSION

The findings from this research emphasize the significance of enhanced training for nurses working in the utilization of N-PPSM in pediatric wards.

CLINICAL IMPLICATIONS

Findings from this study can enhance nurses' knowledge and competence in using N-PPSM in pediatric wards, thus improving patient care. Hospitals may consider implementing new policies, education, training, and infrastructure to support N-PPSM. Educational institutions can also incorporate these methods into nursing curricula, increasing nurses' awareness and skills in using N-PPSM in pediatric patients.

The effects of preoperative therapeutic play on anxiety and fear levels in preschool children

PURPOSE

The aim of this study is to examine the effects of preoperative therapeutic play on fear and anxiety levels in preschool children.

DESIGN AND METHODS

The study had an experimental pre-intervention-post-intervention design with a control group. The study was carried out with 37 children aged 3-6 years who were brought for surgical procedures at XX Research and Training Hospital between July 2020 and January 2021. While a therapeutic play intervention was performed with the children in the experimental group (n = 20), routine preoperative practices were performed in the control group (n = 17). Data were analyzed using chi-squared tests, the Mann-Whitney U test, and the Wilcoxon test. p < 0.05 was considered significant.

RESULTS

The fear and anxiety levels of the children in the experimental and control groups were similar pre-intervention (p > 0.05). In the post-intervention, the mean anxiety and fear scores of the experimental group were 2.15 ± 1.63 and 1.15 ± 0.58, their mean ranks were 10.80 and 12.65, while the mean anxiety and fear scores of the control group were 7.94 ± 2.07 and 2.53 ± 1.00, their mean ranks were 28.65 and 26.47, respectively, and the difference between the groups was statistically significant (respectively, MU = 6.00 p = 0.000, MU = 43.00 p = 0.000).

CONCLUSION

It was determined that the therapeutic play method applied before surgery reduced the anxiety and fear levels of children. Considering this situation, improving the skills of nurses in therapeutic play and increasing the number of personnel certified for interactive therapeutic games can reduce the risk of preoperative emotional trauma in children.

PRACTICE IMPLICATIONS

The therapeutic play method applied before surgery reduced the anxiety and fear levels of children. The routine use of therapeutic play in pediatric surgery clinics is recommended.

The impact of virtual reality exposure on anxiety and pain levels in pediatric patients: A systematic review and meta-analysis

PROBLEM

Virtual reality (VR) is used as a novel intervention technique to alleviate uncomfortable experiences such as anxiety and pain in children. Recently, VR distraction has gained prominence in pediatric medical procedures. However, no studies have yet conducted a further quantitative analysis of the intervention effects of virtual reality exposure (VRE). This systematic review aims to analyse the effect of VRE on anxiety and pain levels in paediatric patients undergoing medical procedures.

ELIGIBILITY CRITERIA

Relevant studies were searched from four databases, including PubMed, Cochrane Library, Embase, and Web of Science. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO).

RESULTS

The meta-analysis incorporated a total of 11 articles, encompassing 1,099 pediatric patients. The results showed that VRE relieved children's anxiety [SMD = -0.61, 95% CI (-0.93, -0.28), p < 0.001], but there was no significant difference in alleviating pain in children [SMD = -1.48, 95% CI (-3.40, 0.44), p = 0.131].

CONCLUSIONS

The results suggest that VRE is effective in reducing children's anxiety during medical procedures. However, 7 of the 11 original studies included in this review were from the same research project, which may increase the risk of reporting bias. Also, more high-quality studies are needed in the future to verify its effectiveness for pain levels.

IMPLICATIONS

VRE can help children become familiar with the medical environment, overcome anxiety and fear, and learn about medical procedures in advance. This can enhance their cooperation during medical process, leading to a more positive medical experience.

Association of Obstructive Sleep Apnea With Unanticipated Admission Following Nonotolaryngologic Pediatric Ambulatory Surgery

BACKGROUND

Approximately 2% of ambulatory pediatric surgeries require unanticipated postoperative admission, causing parental dissatisfaction and suboptimal use of hospital resources. Obstructive sleep apnea (OSA) occurs in nearly 8% of children and is known to increase the risk of perioperative adverse events in children undergoing otolaryngologic procedures (eg, tonsillectomy). However, whether OSA is also a risk for unanticipated admission after nonotolaryngologic surgery is unknown. The objectives of this study were to determine the association of OSA with unanticipated admission after pediatric nonotolaryngologic ambulatory surgery and to explore trends in the prevalence of OSA in children undergoing nonotolaryngologic ambulatory surgery.

METHODS

We used the Pediatric Health Information System (PHIS) Database to evaluate a retrospective cohort of children (<18 years) undergoing nonotolaryngologic surgery scheduled as ambulatory or observation status from January 1, 2010, to August 31, 2022. We used International Classification of Diseases codes to identify patients with OSA. The primary outcome was unanticipated postoperative admission lasting ≥1 day. Using logistic regression models, we estimated the odds ratio (OR) and 95% confidence intervals (CIs) for unanticipated admission comparing patients with and without OSA. We then estimated trends in the prevalence of OSA during the study period using the Cochran-Armitage test.

RESULTS

A total of 855,832 children <18 years underwent nonotolaryngologic surgery as ambulatory or observation status during the study period. Of these, 39,427 (4.6%) required unanticipated admission for ≥1 day, and OSA was present in 6359 (0.7%) of these patients. Among children with OSA, 9.4% required unanticipated admission, compared to 5.0% among those without. The odds of children with OSA requiring unanticipated admission were more than twice that in children without OSA (adjusted OR, 2.27; 95% CI, 1.89-2.71; P < .001). The prevalence of OSA among children undergoing nonotolaryngologic surgery as ambulatory or observation status increased from 0.4% to 1.7% between 2010 and 2022 ( P trends < .001).

CONCLUSIONS

Children with OSA were significantly more likely to require unanticipated admission after a nonotolaryngologic surgery scheduled as ambulatory or observation status than those without OSA. These findings can inform patient selection for ambulatory surgery with the goal of decreasing unanticipated admissions, increasing patient safety and satisfaction, and optimizing health care resources related to unanticipated admission.

Home-like care: Collaboration between parents and nurses in everyday situations when children are hospitalized

When children are hospitalized, parents and nurses need to collaborate. This study aims to investigate how parents and nurses experience collaborating and sharing responsibilities and tasks when providing home-like care for hospitalized children in everyday situations. This qualitative study used a hermeneutic phenomenological approach with observations and interviews and was conducted in a general medical pediatric unit. Twelve parents of eleven hospitalized children between the ages of 1 and 6 years with various medical diagnoses and seventeen nurses who cared for those children participated in the study. Parents and nurses collaborated and shared responsibilities and tasks to provide home-like care for hospitalized children in everyday situations by making mealtimes seem familiar, maintaining customary sleeping patterns, adapting washing and dressing routines, and facilitating play and activity. Parents and nurses collaborated to maintain a familiar rhythm in an unfamiliar environment to enhance the children's well-being. The nurses' degree of involvement in the children's everyday situations varied from little to moderate to strong, with parents assuming the main responsibilities. Nurses' involvement in children's everyday situations was variable, depending on the complexity of the situations.

The effect of therapeutic play on fear, anxiety, and satisfaction levels of pediatric oncology patients receiving chemotherapy

OBJECTIVE

This study aimed to examine the effect of therapeutic play on the levels of fear and anxiety towards chemotherapy in pediatric oncology patients and evaluate the satisfaction of children and parents regarding therapeutic play.

METHODS

The study was conducted with a one-group pretest-post-design and was developed as a prospective quasi-experimental study. The study was conducted with 40 pediatric oncology patients aged 5-12 and their parents. Data were collected by Child Information Form, Child Fear Scale (CFS), Child State Anxiety (CSA), and Visual Satisfaction Scale.

RESULTS

The mean age was 8.98 ± 2.76, 65% were males. The CSA score was decreased at the end of the second cycle compared to the first (p < 0.001). The CFS score was reduced at the end of the second cycle compared to the first (p < 0.001). There was a statistically significant decrease in CFS scores at the end of the first cycle compared to the beginning (p < 0.001). The decrease in CFS scores at the end of the second cycle compared to the beginning was statistically significant (p < 0.001).

CONCLUSION

The results of the study show that there was a significant decrease in the fear and anxiety levels of children against chemotherapy in the pre-and post-treatment evaluations. Children and their families were satisfied with the therapeutic play intervention.

PRACTICE IMPLICATIONS

Therapeutic play may be an effective method to reduce fear and anxiety levels against chemotherapy in pediatric oncology patients. The use of therapeutic play from the moment of diagnosis is recommended to reduce children's fear and anxiety related to chemotherapy.

Play for hospitalized children: A qualitative enquiry of behaviour and motivation of nurses in a secondary level healthcare setting in Ghana

BACKGROUND

The World Health Organization recommends that healthcare workers, specifically doctors and nurses, utilize play within treatment and care to promote recovery and overall well-being of hospitalized children. This recommendation has extended the roles of nurses in pediatric settings to include play in their routine care for children hospitalized for various childhood illnesses. Nurses need to draw on their skills to use play as an essential tool to aid communication, assessment, diagnosis, and care of the hospitalized child. This study explored the behaviour and motivation of Ghanaian nurses towards the utilization of play for hospitalized children.

METHODS

Exploratory qualitative design was utilized and 12 registered nurses from the pediatric unit of a secondary-level health institution were selected purposively and interviewed using a semi-structured interview guide. Thematic analysis was done with two themes namely behaviour towards play and motivation to use play emerging with their corresponding sub-themes.

FINDING

In the study setting, play has not been formalized or fully integrated into the routine care of the sick child. Nurses have a positive attitude and believe in the positive impact of play on the sick child. Participants utilize play as and when there is a need, and they derive satisfaction and fulfilment anytime they engage in play activities with their patients. Lack of administrative support and resources for play interventions affect their motivation to use play for the children.

CONCLUSION

Formalization of play and integration of play into the routine care of the sick child is needed to motivate nurses to engage hospitalized children in play activities to help them derive the full benefits that play offers to the sick and hospitalized child.

IMPLICATIONS TO PRACTICE

The positive attitudes and behaviour towards play as demonstrated in this study calls for Ghanaian nurses in general to be empowered through the formalization and integration of play into routine nursing care.

Effect of a musical toy used during peripheral venous access on children's pain, fear and parental satisfaction: Randomized controlled trial

PURPOSE

This research was completed to determine the effect of a musical toy (xylophone) on pain and fear in children and parental satisfaction during peripheral venous access in children.

DESIGN AND METHODS

This research was completed as a randomized controlled trial study. The sample for the research comprised 70 children (control: 35, experiment: 35) aged 3-6 years with peripheral venous access who were admitted to the Pediatric ward and their parents abiding with case selection criteria.

RESULTS

The mean Children's Emotional Manifestation Scale score for children in the experiment group was found to be statistically significantly lower than in the control group (p < 0.05). Children in the experiment group had statistically significantly different mean Children's Fear Scale scores, which were found to be low (p < 0.05). No statistically significant difference was found between the pain scores of the experimental and control groups (p > 0.05). There was a statistically significant difference present for patient cooperation with the nurse in the experiment group (p < 0.05).

CONCLUSION

Though the use of a musical toy during the peripheral venous access procedure had positive impacts on fear and emotional symptoms in the child, it did not appear to have any effect on the child's pain level or parental satisfaction.

PRACTICE IMPLICATIONS

The use of a xylophone during painful procedures performed on children is recommended in terms of reducing the negative impact of the procedure on children by ensuring the child and parent focus on each other during the procedure and the parent contributes to care.

Using non-pharmacological interventions to manage medical procedure-induced anxiety in children: a framework to guide best practice

Medical procedure-induced anxiety in children can have short- and long-term negative effects. Research shows that children's anxiety can be affected by non-pharmacological interventions and adults' behaviours in a complex manner. This article presents a scoping review of the literature on non-pharmacological interventions to manage medical procedure-induced anxiety in children. Based on this review, the authors propose a framework comprising six strategies for effective non-pharmacological management of medical procedure-induced anxiety in children. A real-life, and anonymised, example is used to illustrate this framework in practice.

The Relationship Between Perceived Parenting Practices and Anxiety in Adults With Congenital Heart Disease

BACKGROUND

Patients with congenital heart disease (CHD) and their parents face challenges throughout their lives that can lead to anxiety lasting into adulthood. We aim to assess the association between perceived parenting practices and anxiety beyond paediatric medical-surgical histories in adults with CHD.

METHODS

A cross-sectional study of adults with CHD was conducted at the Montreal Heart Institute (MHI). Perception of parental practices during childhood was retrospectively assessed with the use of validated self-report questionnaires, and anxiety in adulthood was assessed with the use of the Hospital Anxiety and Depression Scale. Sociodemographic and medical information were collected from a questionnaire and medical records. Hierarchic multiple linear regression was conducted.

RESULTS

Of the 223 participants, the mean age was 46 ± 14 years and 59% were female. Perceived parenting practices explained more variance (11%) in the anxiety score than paediatric medical-surgical history (2%). In our final model, anxiety was significantly associated with age, parental history of anxiety, and positive parenting practices, but not with overprotection.

CONCLUSIONS

Parenting practices are associated with anxiety in adults with CHD beyond paediatric medical-surgical history and sociodemographic. Positive parenting practices may be protective against anxiety in adulthood. Longitudinal studies are needed to determine causality.

Enhancing sibling support in oncology: Collaborative care for families facing cancer in young people

Purpose

This study investigates the support systems and needs of siblings of young people with cancer, shedding light on the emotional and informational challenges siblings face. This topic area has had relatively little attention.

Design and methods

Qualitative interviews were conducted, and thematic analysis was employed to gain in-depth insights into the experiences and perspectives of siblings. While the study's relatively small sample size and participant homogeneity are acknowledged limitations, the approach offers several strengths, including relevance and participant diversity across age cohorts.

Results

The findings underscore the essential role of healthcare professionals, particularly nurses, in providing emotional and informational support to siblings. Family-centred care, psychosocial support, tailored interventions, and ongoing research and education are recommended to address the unique needs of siblings effectively.

Conclusion

Overall, this study highlights the importance of recognizing and addressing the support needs of siblings in pediatric oncology care, emphasizing their role as a vital component of the family system and advocating for holistic support throughout the cancer journey and beyond.

Soutien des frères et sœurs d’un jeune touché de cancer: soins collaboratifs pour les familles

Objectif

Cette étude examine les systèmes de soutien et les besoins des frères et sœurs des jeunes touchés par un cancer, mettant en lumière les défis émotionnels et informationnels auxquels les frères et sœurs sont confrontés. Ce domaine a reçu relativement peu d’attention.

Devis et méthodologie

Des entretiens qualitatifs ont été menés et une analyse thématique a été utilisée pour obtenir des perspectives approfondies sur les expériences et les points de vue des frères et sœurs. Bien que la taille relativement petite de l’échantillon de l’étude et l’homogénéité des participants soient reconnues comme des limites, l’approche présente plusieurs forces, notamment la pertinence et la diversité des participants dans les cohortes d’âge.

Résultats

Les résultats soulignent le rôle essentiel des professionnels de la santé, en particulier des infirmières pour fournir du soutien émotionnel et informationnel aux frères et sœurs. Une approche centré sur la famille, un soutien psycho-social, et des interventions personnalisées sont recommandés pour répondre de manière efficace aux besoins spécifiques de la fratrie.

Conclusion

Dans l’ensemble, cette étude met en lumière l’importance de reconnaître et de répondre aux besoins de soutien des frères et sœurs dans les soins en oncologie pédiatrique, en mettant en avant leur rôle en tant que composante essentielle du système familial. Cette étude souligne l’importance de fournir un soutien à la fratrie pendant et après l’expérience du cancer.

Effectiveness of Occupation-Based Nursing Program on Chemotherapy-Related Symptoms and Satisfaction Among Pediatric Oncology Patients: A Randomized Controlled Trial

OBJECTIVES

This study aimed to determine the effect of an occupation-based nursing program (OBaNuP) on chemotherapy-induced symptoms and satisfaction in pediatric oncology patients.

DATA SOURCES

This study was a randomized controlled trial. The study sample consisted of 60 hospitalized children with cancer who were aged 7 to 12. Participants were randomly assigned to an OBaNuP (intervention group, n = 30) or clinical routine care only (control group, n = 30). The intervention group participated in an OBaNuP for an average of 30 minutes per day for 5 days. The Memorial Symptom Assessment Scale 7-12 and Psychosocial Symptoms in Hospitalized Children and Child Satisfaction Questionnaire were completed by participants at baseline, the first meeting immediately after intervention, and 7 days and 14 days after the intervention.

CONCLUSION

The average scores of chemotherapy-related symptoms differed over time between the intervention and control groups (P < .05). The psychosocial symptom score averages of the children in the intervention group significantly decreased at all time points compared to the control group (P < .05). The satisfaction mean scores of the children in the intervention group increased significantly at all time points compared to the control group (P < .05).

IMPLICATIONS FOR NURSING PRACTICE

The OBaNuP initiative supported the decrease of chemotherapy-related and psychosocial symptoms, while also promoting an increase in satisfaction among children undergoing cancer treatment at the hospital consistently over all observed time periods.

The effect of the distraction methods used before the COVID-19 test on the fear and anxiety levels of children: a RCT study

The current study aimed to investigate the effect of the distraction methods employed before nasopharyngeal swab sampling from children within the scope of the COVID test on their anxiety and fear levels. The study was an RCT with parallel groups conducted according to the CONSORT statement at the pediatric emergency unit of a hospital in Turkey. Children aged 5-10 years were randomized into three groups: Kaleidoscope, Visual Illusion Cards, and control. Data were collected by the researchers using the Descriptive Characteristics Form, the Children's Anxiety Meter-State, and the Children's Fear Scale. According to the reports of the children, the parents, and the nurse, the mean anxiety score and the mean fear score in the experimental groups were significantly lower after the nasopharyngeal swab procedure compared to the control group (p < .05). Fear and anxiety were observed less in the visual illusion cards group and the kaleidoscope group.

Nature-based mindfulness programs using virtual reality to reduce pediatric perioperative anxiety: a narrative review

Over 75% of pediatric surgery patients experience preoperative anxiety, which can lead to complicated recoveries. Current interventions are less effective for children over 12 years old. New interventions, like mindfulness-based ones (MBIs), are needed to address this issue. MBIs work well for reducing mental health symptoms in youth, but they can be challenging for beginners. Virtual reality (VR) nature settings can help bridge this gap, providing an engaging 3-D practice environment that minimizes distractions and enhances presence. However, no study has investigated the combined effects of mindfulness training in natural VR settings for pediatric surgery patients, creating a significant gap for a novel intervention. This paper aims to fill that gap by presenting a narrative review exploring the potential of a nature-based mindfulness program using VR to reduce pediatric preoperative anxiety. It begins by addressing the risks of anxiety in children undergoing surgery, emphasizing its impact on physical recovery, and supporting the use of VR for anxiety reduction in hospitals. The review then delves into VR's role in nature and mindfulness, discussing theoretical concepts, clinical applications, and effectiveness. It also examines how the combination of mindfulness, nature, and VR can create an effective intervention, supported by relevant literature. Finally, it synthesizes the existing literature's limitations, findings, gaps, and contradictions, concluding with research and clinical implications.

Arts therapies for mental disorders in COVID-19 patients: a comprehensive review

Background and objective

The COVID-19 global pandemic has necessitated the urgency for innovative mental health interventions. We performed a comprehensive review of the available literature on the utility and efficacy of arts therapies in treating mental health problems, with special emphasis on their deployment during the COVID-19 pandemic, aiming to provide some evidence for the application of this therapy.

Methods

The potential studies were systematically sourced from five authoritative databases: PubMed, Embase, the Cochrane Library, Web of Science, and the CNKI database. The evaluation of these studies was conducted based on stringent criteria, including validity, suitability, therapeutic potential, and consistency. Each piece of included literature was meticulously scored in accordance with these criteria, thus ensuring the inclusion of only the most robust studies in this review. The data from these Randomized Controlled Trials (RCTs) were carefully extracted using the PICO(S) framework, ensuring a comprehensive and systemic approach to data collection. In order to emphasize the variability in the effects of differing arts therapies on COVID-19-induced psychiatric disturbances, the sourced literature was systematically categorized and scrutinized based on distinct modalities.

Results

Out of the 7,250 sourced articles, 16 satisfied the inclusion conditions. The therapies were predominantly meditation (n = 7), supplemented by individual studies on color therapy (n = 3), music therapy (n = 2), and single studies on horticultural therapy, dance therapy, mindfulness and music therapy, and yoga and music therapy (n = 4 collectively). These various forms of arts therapies had a positive short to medium-term impact on the mental health of COVID-19 patients. Besides improving patients' physical and mental health, these therapies can also be employed to mitigate mental health issues among healthcare professionals.

Conclusion

The COVID-19 pandemic has profound and long-lasting implications for public mental health. Diverse forms of arts therapies are potentially effective in addressing related psychiatric symptoms. The integration of artificial intelligence might further enhance the efficacy and scalability of arts therapies in future implementations.

Child's Play: Examining the Association Between Time Spent Playing and Child Mental Health

It is theorised that adventurous play offers learning opportunities that help to prevent mental health problems in children. In this study, data from two samples is used to examine associations between the time that children aged 5-11 years spent playing adventurously and their mental health. For comparison, time spent playing unadventurously and time spent playing outdoors are also examined. Study 1 includes a sample of 417 parents, Study 2 includes data from a nationally representative sample of 1919 parents. Small, significant associations between adventurous play and internalising problems, as well as positive affect during the first UK-wide Covid-19 lockdown, were found; children who spend more time playing adventurously had fewer internalising problems and more positive affect during the Covid-19 lockdown. Study 2 showed that these associations were stronger for children from lower income families than for children from higher income families. The results align with theoretical hypotheses about adventurous play.

A Review of Creative Play Interventions to Improve Children's Hospital Experience and Wellbeing

CONTEXT

Being in the hospital can be stressful for children and caregivers. Evidence-based play interventions to reduce this stress, such as play therapy or Child Life services, have been introduced in hospitals globally, with growing awareness of potential benefits.

OBJECTIVES

To evaluate the impact of nonmedical/illness-specific creative or play-based programs in hospital settings on children's (<18 years) and their caregivers' hospital experiences, wellbeing, and other health outcomes.

DATA SOURCES

PubMed, CINAHL, Google Scholar.

METHODS

We conducted a systematic review of original articles published since 2011, screening 2701 de-duplicated articles.

RESULTS

We identified 25 eligible articles, representing 1629 children (57% male), 422 caregivers, and 128 health professionals. Included studies most commonly evaluated professional children's entertainers (n = 8 studies), music therapy (n = 4), unstructured play (n = 3), and humanoid/animal robots (n = 3). Most studies evaluated the impact on the child's level of anxiety (n = 14/25), mostly supporting a reduction (n = 13/14 studies). Several studies provided evidence for a reduction in children's pain (n = 4/6), and negative emotional/behavioral outcomes (eg, sadness, anger, irritability; n = 5/6 studies). There was mixed evidence for the impact of the included interventions on physiologic outcomes (eg, systolic pressure, heart frequency; n = 3/5 studies) and fatigue (n = 1/2 studies). Evidence on caregiver outcomes and the impact on health care services was limited.

CONCLUSIONS

The findings of our review generally supported the value of play-based interventions on children's' wellbeing while in the hospital, particularly reducing anxiety and pain. Further evaluation of their impact on caregivers' outcomes and the health care system is needed.

Hospital classroom experiences of hospitalized school-age pediatric oncology patients: A qualitative study

PURPOSE

In this study, it was aimed to examine the hospital classroom experiences of school-age children who received treatment and care at a pediatric oncology-hematology clinic in Turkey.

METHODS

The study was conducted using the in-depth interview method with the participation of 17 children who were hospitalized in the pediatric oncology-hematology clinic of a research and training hospital in the Ankara province of Turkey. The data were collected using a "Semi-Structured Interview Form". The interviews started with the question "How do you perform the assignments given by your teacher while you are hospitalized?", and the interviews were recorded as audio with the consent of the children and their parents.

RESULTS

As a result of the interviews, three main themes, (1) Learning, (2) Maintaining normalcy, and (3) Expectations, and 9 subthemes (teacher, continuation of learning, learning through play, feeling good, continuation of routines, peer interaction, communication with the school-teacher, basic sport activity, and tablet/internet access) were generated from the data.

CONCLUSIONS

Hospital classrooms had a significant role in increasing the children's adaptation to hospital conditions and ensuring the continuation of school/learning.

PRACTICE IMPLICATIONS

Pediatric nurses can refer children with long and repeated hospitalizations (e.g., pediatric oncology patients and children with chronic diseases) to hospital classrooms. Thus, children can adapt more easily to the procedures performed in the hospital.

The effectiveness of play therapy in children with leukemia: A systematic review

PROBLEM

Leukemia is the most common form of childhood cancer worldwide. Children living with leukemia experience various problems because of the disease's progression, harmful effects of treatment, and prolonged hospitalization process. To increase their well-being and alleviate their problems, these children require ongoing support. One solution that both parents and professionals can use is play therapy. This systematic review aimed to identify the type and effectiveness of play therapy in children living with leukemia.

ELIGIBILITY CRITERIA

We searched PubMed, Scopus, ScienceDirect, and ProQuest databases. Additionally, we performed manual searches on Google Scholar, Google Web, and grey literature. Inclusion criteria comprised: 1) Studies that implemented play therapy on leukemia children, 2) Full-text articles available in English or Indonesian languages from January 2000 to December 2021 and updated until July 2023, and 3) Intervention studies employing quasi-experimental or randomized controlled trial (RCT) designs.

SAMPLE

From 1099 articles, 16 studies were selected. Several forms of play therapy were found, including pretend, music, art, and sand play therapy.

RESULTS

Of the sixteen studies in this systematic review, fifteen demonstrated beneficial effects on psychological issues, particularly anxiety, despair, stress, and physical problems (fatigue and pain).

CONCLUSION

Play therapy effectively alleviates some physical and psychosocial problems in children living with leukemia.

IMPLICATION

Nurses can utilize play therapy as an intervention for children living with leukemia. Additionally, comparative research is recommended with a similar research strategy concerning studies with the same design.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022318549.

Development of Hospital Perception Scale for Healthy Children (HPSHC) and Investigation of Its Psychometric Properties

(1) Aim: The aim of the study was to develop and analyze the psychometric properties of a hospital perception scale for healthy children aged 8 to 10 years. (2) Methods: A methodological design was employed. The scale's validity was investigated using the approaches of content validity, face validity, item analysis, and construct validity. The scale's reliability was evaluated utilizing the approaches of internal consistency reliability, measurer reliability, and measurement invariance. (3) Results: In total, 330 children took part in this study. The scale is composed of six factors. Factor loads range from 0.42 to 0.79. The item-total score correlation coefficients were 0.42 and 0.79, respectively, while the Cronbach alpha reliability coefficient was 0.87. (4) Conclusions: The HPSHC is a valid and reliable tool. It can be used to determine how healthy or sick children in their middle childhood are perceived when going to the hospital and being hospitalized.

The Effect of Hand Massage on Preoperative Anxiety Level and Hemodynamic Variables in Children: A Randomized Controlled Trial

PURPOSE

The study was conducted to determine the effect of hand massage applied to preoperative children on anxiety level and hemodynamic variables.

DESIGN

This research study is a randomized controlled trial with control and study groups, pre- and post-tests.

METHODS

This study was conducted between April and September 2017 with 84 children who were planned to receive an operation by applying general/local anesthesia in a province in the south of Turkey. The population of the research was composed of children between the ages 9 and 12 (study group = 42 and control group = 42). The data were collected through "Child and Parent Information Form," "State-Trait Anxiety Inventory for Children," "Physical Symptoms Follow-up Form for Anxiety," and "Satisfaction Evaluation Scale."

FINDINGS

The state-trait anxiety mean after hand massage was found to be 25.78 ± 5.90 in the study group, and 31.80 ± 6.51 in the control group (P < .05). There was a statistically significant difference (P < .05) between the systolic blood pressures and heart rate averages of the children in the study group after hand massage. There was a negative correlation between the satisfaction hand massage and state-trait anxiety means of the study group children (P < .05).

CONCLUSIONS

Hand massage was found to have a positive effect on reducing anxiety, systolic blood pressure and heart rate. No effect was found on diastolic blood pressure, respiratory rate and SpO2. We recommend that more extensive studies on hand massage are performed.

Psychoneuroimmunological Markers of Psychological Intervention in Pediatric Cancer: A Systematic Review and New Integrative Model

PURPOSE

Pediatric cancer is a serious problem and still becomes a global challenge today. Various complex stressors due to diagnosis, disease symptoms, and various side-effects from the treatment that children with cancer undergo will cause problems in the child's psychoneuroimmunological aspects. Psychological interventions designed to modulate the stress response include psychoneuroimmunological markers. Unfortunately, there is little evidence to support the effect of psychological interventions on psychoneuroimmunological markers. This systematic review aims to assess the effectiveness of psychological interventions on psychoneuroimmunological markers in children with cancer and to provide a new integrative model for further research.

METHODS

This systematic review uses four main databases (Scopus, PubMed, ScienceDirect, and ProQuest). The guideline used Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Selecting articles used the Rayyan application. The quality study was conducted using Joanna Briggs Institute (JBI)'s critical appraisal tools. The data were analyzed using the population, intervention, comparison, outcome, and study design (PICO) Synthesis based on similarities and differences in study characteristics to interpret the results.

RESULTS

The search results in this systematic review found 1653 articles, 21 of which matched the predetermined inclusion and exclusion criteria. Most of the designs used were randomized controlled trials (57.1%). Massage therapy was the most common type of psychological intervention (14.2%). Almost half of the studies measured psychological responses (38.0%), and psycho-physiological responses (42.9%), and only a small proportion assessed the effectiveness of psychological interventions on neuroimmunological markers in pediatric cancer.

CONCLUSIONS

We recommend the use of psychological interventions as an additional intervention in managing psychoneuroimmunological markers of pediatric cancer. This study offers a new integrative model demonstrating the interaction between stress and psychological intervention involving neuroendocrine and immune mechanisms. However, future researchers need to test all domains of these new integrative models. This will reveal the complex interactions among these components and understand their relevance to health outcomes.

The impact of COVID-19 lockdown on child and adolescent mental health: systematic review

COVID-19 was declared a pandemic in March 2020, resulting in many countries worldwide calling for lockdowns. This study aimed to review the existing literature on the effects of the lockdown measures established as a response to the COVID-19 pandemic on the mental health of children and adolescents. Embase, Ovid, Global Health, PsycINFO, Web of Science, and pre-print databases were searched in this PRISMA-compliant systematic review (PROSPERO: CRD42021225604). We included individual studies reporting on a wide range of mental health outcomes, including risk and protective factors, conducted in children and adolescents (aged ≤ 19 years), exposed to COVID-19 lockdown. Data extraction and quality appraisal were conducted by independent researchers, and results were synthesised by core themes. 61 articles with 54,999 children and adolescents were included (mean age = 11.3 years, 49.7% female). Anxiety symptoms and depression symptoms were common in the included studies and ranged 1.8-49.5% and 2.2-63.8%, respectively. Irritability (range = 16.7-73.2%) and anger (range = 30.0-51.3%), were also frequently reported by children and adolescents. Special needs and the presence of mental disorders before the lockdown, alongside excessive media exposure, were significant risk factors for anxiety. Parent-child communication was protective for anxiety and depression. The COVID-19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with previous or current mental health difficulties. Supporting the mental health needs of children and adolescents at risk is key. Clinical guidelines to alleviate the negative effects of COVID-19 lockdown and public health strategies to support this population need to be developed.

The impact of music, play, and pet therapies in managing pain and anxiety in paediatric patients in hospital: a rapid systematic review

Background

Hospitalized children face pain and anxiety associated with the environment and procedures.

Objective

This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible.

Methods

Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies.

Results

A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety.

Conclusion

Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.

Investigating Non-Pharmacological Stress Reduction Interventions in Pediatric Patients Confirmed with Salivary Cortisol Levels: A Systematic Review

For many children, hospitalization can lead to a state of increased anxiety. Being away from home, the invasive procedures undertaken, and the uncertainty of the outcome cause an uncomfortable situation in anticipation of real or imagined hazards. This systematic review aims to assess current evidence on the types of non-pharmacological interventions used and their impact on children's anxiety or distress levels when they visit the hospital for planned or unplanned admissions. The Databases PubMed, Psych INFO, and Google Scholar were queried for papers published from January 2000 to March 2023 reporting the use of non-pharmacological interventions interacting with children in hospital or clinical environments and confirmed with saliva cortisol levels. A total of nine studies were retrieved. Across these studies, four different strategies of non-pharmacological interventions were used. Anxiety and distress were found to be reduced in the majority of the studies as confirmed with salivary cortisol. Overall, there is evidence that non-pharmacological interventions hold a promising role in reducing levels of anxiety or distress in children as confirmed with saliva cortisol. However, research on saliva cortisol as a tool of anxiety measurement requires higher quality studies to strengthen the evidence base.

Effect of therapeutic play based training program on pre- and post-operative anxiety and fear: A study on circumcision surgery in Turkish Muslim children

INTRODUCTION

Developmentally appropriate pre-surgical educational programs can help alleviate the anxiety of both children and parents. As one of the most common pediatric surgical procedures is circumcision; and they may experience anxiety and fear before and after this surgical procedure, this study is considered to make an important contribution to the literature.

OBJECTIVE

This study aimed to examine the effect of therapeutic play based training program on pre- and post-operative anxiety and fear levels of children aged 8-11 years who would undergo circumcision.

STUDY DESIGN

This was a quasi-experimental study that consisted of a pre- and post-intervention and control groups; and concluded with 60 children aged 8-11 years (intervention group: 30 and no intervention/control group: 30). Child and Parent Information Form, Childhood Anxiety Sensitivity Index (CASI) and Fear for Medical Procedures Scale (FMPS) were used as data collection tools. Children in the intervention group applied a "therapeutic play-based training program" 2 h before they underwent circumcision surgery. Therapeutic toys used in the educational program has designed by researchers.

RESULTS

After the training program, children in the intervention group obtained lower CASI (preop t = 6.383, p < .001; postop t = 8.763, p < .001) and FMPS (preop t = 6.331, p < .001; postop t = 9.366, p < .001) total mean scores than those in the control group.

DISCUSSION

This study was concluded that the therapeutic play based training program used to prepare children for circumcision surgery was effective in reducing their pre- and post-operative anxiety and medical fears. Considering that male circumcision is a religious and cultural necessity in Turkey, further studies can also examine whether the anxiety and medical fear scores differ in study groups that include children who are not Muslim or live in a different country, and whether the training program will be effective in reducing their anxiety and medical fears.

CONCLUSIONS

A therapeutic play based training program can be used to prepare children for circumcision in the preoperative period.

The Influence of Patient-Centered Communication on Children's Anxiety and Use of Anesthesia for MR

Background: The aim of this study was to inspect the influence of patient-centered communication (PCC) with 4- to 10-year-old children on the use of anesthesia for magnetic resonance imaging exams (MRs). Methods: A total of thirty children received the PCC and pre-simulated the exam with an MR toy. Another 30 children received routine information about the MR and pre-simulated the exam with the toy. Anesthesia use in these two groups was additionally compared with a previously existing group of children (n = 30) who had received only routine information about the exam (CG). Children’s anxiety was assessed with a self-report question plus heartbeat frequency. Children’s satisfaction was assessed through several questions. The analyses were based on group comparisons and regression. Results: A total of two children (7%) in the PCC + simulation group used sedation compared with 14 (47%) in the simulation group and 21 (70%) in the CG. Differences between the PCC + simulation and the other two groups were significant (p < 0.001), although not between the simulation and the CG. The decrease in anxiety was significantly greater (self-reported p < 0.001; heart rate p < 0.05) and satisfaction was higher (p = 0.001) in the PCC + simulation, when compared with the simulation group. Reduced anxiety was associated with less anesthesia use (OR 1.39; CI 1.07−1.79; p = 0.013). Conclusions: PCC + simulation was more effective than simulation and routine practice in decreasing children’s anxiety, increasing satisfaction, and reducing the use of anesthesia for MRs.

Effect of the Digital Education Package (DEP) on prevention of anxiety in hospitalized children: a quasi-experimental study

BACKGROUND

Hospitalization of children is a stressful event. However, the child's education at the time of hospital admission can be effective for the prevention of their anxiety via the use of more attractive methods. The study's aim was to assess the effectiveness of the education using a digital education package on the level of anxiety of hospitalized children.

METHODS

This is a quasi-experimental study with the randomized block method. The sample size was calculated based on Shahrabadi et al.'s study and sixty eligible hospitalized children were allocated to the two study groups from June 2019 to December 2020, in Hefdah-e-Sahrivar hospital which is the central pediatric hospital in Rasht city. The intervention was education using a digital package that was done 15 min after the hospitalization of the children. Pediatrics' Spielberger's anxiety Inventory was used for measuring the participants' anxiety before and after the intervention. We used Chi square test, Fisher exact test and paired t-test to analyze data. A p-value < 0.05 was considered statistically significant.

RESULTS

In the post-intervention phase, total mean scores of anxiety were significantly lower in the experimental group (60.17 ± 6.46) rather than in the control group (72.6 ± 8.83) (P < 0.001). The mean anxiety scores before and after the intervention were 87.43 ± 11 vs. 60.17 ± 6.46 in the intervention group and 81.5 ± 11 vs. 72.6 ± 8.83 in the control group, respectively. There were significant differences in intergroup anxiety scores between the two study groups (P < 0.001).

CONCLUSIONS

The current study showed that the Digital Education Package (DEP) is an effective method for reducing children's anxiety during hospitalization. Therefore, we recommended it as a preferred and simple method rather than routine education for pediatric nurses.

The feasibility study of Internet-assisted play therapy to resolve psychological disorders in primary healthcare settings: A qualitative study

BACKGROUND

Play therapy is an intelligent tool in cognitive-behavioral therapies. In today's world, the Internet and technology play a key role in all aspects of people's life including mental health. The present study explores the feasibility of using Internet-assisted play therapy to solve children's psychological issues in primary healthcare systems.

MATERIALS AND METHODS

The present qualitative research was conducted by the content analysis approach on 20 experts working in the healthcare centers, who were selected purposefully. The sample was saturated with these 20 participants. Data were collected through semi-structured interviews and were coded manually. Then, they were analyzed in the Atlas.ti software package.

RESULTS

The results revealed 15 themes and 10 sub-themes. The themes included (1) safety, (2) efficiency, (3) client-orientedness, (4) organizational growth, (5) time, (6) effectiveness, (7) justice-orientedness, (8) access, (9) feedback, (10) analysis, (11) children's computer game room, (12) reward, (13) group game, and (14) capability to be integrated into other electronic programs.

CONCLUSION

It seems that Internet-based play therapy is plausible to be used as a service in primary healthcare to tackle the psychological problems of children in the target population if the challenges related to the exploratory themes are taken care of.

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.

The Relationship between the Unmet Needs of Chinese Family Caregivers and the Quality of Life of Childhood Cancer Patients Undergoing Inpatient Treatment: A Mediation Model through Caregiver Depression

A large proportion of the global burden of childhood cancer arises in China. These patients have a poor quality of life (QoL) and their family caregivers have high unmet needs. This paper examined the association between the unmet needs of family caregivers and the care recipient’s QoL. A total of 286 childhood cancer caregivers were included in this cross-sectional study. Unmet needs and depression among caregivers were assessed by the Comprehensive Needs Assessment Tool for Cancer Caregivers (CNAT-C) and the Patient Health Questionnaire (PHQ-9), respectively. The patient’s QoL was proxy-reported by the Pediatric Quality of Life Inventory Measurement Models (PedsQL 3.0 scale Cancer Module). Descriptive analyses, independent Student’s t-tests, one-way ANOVA, and mediation analyses were performed. The mean scores (standard deviations) for unmet needs, depression, and QoL were 65.47 (26.24), 9.87 (7.26), and 60.13 (22.12), respectively. A caregiver’s unmet needs (r = −0.272, p < 0.001) and depression (r = −0.279, p < 0.001) were negatively related to a care recipient’s QoL. Depression among caregivers played a mediating role in the relationship between a caregiver’s unmet needs and a care recipient’s QoL. As nursing interventions address depression among caregivers, it is important to standardize the programs that offer psychological support to caregivers.

"The effects of family therapeutic interventions on mental health and quality of life of children with cancer: A systematic review"

BACKGROUND

The diagnosis of a childhood malignancy and the following period are very stressful for the little patient and the whole family. Depression, anxiety, and poor quality of life (QoL) are some of the negative effects of pediatric cancer to the children and their parents. Family therapeutic interventions aim to improve mental health and QoL of these children.

METHODS

A systematic search of the electronic database PubMed was conducted for articles that studied the effect of family therapeutic interventions on mental health and QoL of children with cancer.

RESULTS

A total of 634 articles were evaluated, of which 10 articles met the inclusion criteria. A percentage of 70% of the studies, representing seven different types of interventions, seemed to be beneficial for the participant's mental health and QoL. The remaining three studies did not significantly improve mental health and QoL.

CONCLUSION

The results of our review indicate that family psychosocial interventions are beneficial for children with cancer. These children and their families are a growing population requiring more patient-centered, time flexible interventions which may enhance family bonding and patients' positive emotions.

Cross-Sectional Associations between Living and Built Environments and Depression Symptoms among Chinese Older Adults

In this study, we explored the cross-sectional associations between living and built environments and depression among older Chinese adults. Data from 5822 participants were obtained. Depression symptoms were evaluated through the use of the Patient Health Questionnaire (PHQ-9), with a score higher than 4 categorized as having depression symptoms. The living environment was assessed by asking about dust in the environment and barrier-free facilities. We considered the presence of amenities within a 10 min walking distance and the proportion of green space within an 800 m distance from participants’ dwellings to reflect the built environment. Data were analyzed by multilevel logistic regression. Participants living in a non-dusty environment with proximity to green space had a lower risk of depression (non-dusty environment: OR = 0.784, 95% CI = 0.642, 0.956; green space: OR = 0.834, 95% CI = 0.697, 0.998). However, having no access to barrier-free facilities and hospital proximity increased the depression risk (barrier-free facilities: OR = 1.253, 95% CI = 1.078, 1.457; hospital: OR = 1.318, 95% CI = 1.104, 1.574). Dusty environments, access to barrier-free facilities and proximity to hospitals and green spaces were associated with depression symptoms among older Chinese adults.

Improving the Emotional Distress and the Experience of Hospitalization in Children and Adolescent Patients Through Animal Assisted Interventions: A Systematic Review

Introduction

Animal Assisted Interventions (AAIs) are increasingly common in pediatric care settings as a means to promote the physical, mental, and emotional well-being of hospitalized children and adolescents.

Objectives

The aim of this work was to review published studies implementing AAIs in hospital settings and to assess the effects of AAIs on the biobehavioral response to stress and pain, social behavior, quality of life and level of satisfaction with hospitalization in children and adolescents. Stress and burden, quality of life, mood and level of satisfaction with hospitalization in parents/caregivers as well as stress and burden, perception of the work environment and job satisfaction in hospital staff were also reviewed.

Methods

All published studies reporting quantitative assessments were systematically searched using PubMed, Scopus, ProQuest and Web of Science databases in accordance with PRISMA guidelines. The aim was to identify studies examining the effects of AAIs on behavioral, psychological and physiological responses to stress in children and adolescents (0-18 years) formally admitted to a hospital for a stay, as well as in those undergoing a visit for treatments or medical examinations.

Results

Of the 350 studies screened, 21 were eligible for inclusion. Most of them focused on stress, pain, and anxiety reduction in pediatric patients, and used both physiological parameters and behavioral and psychological observations/scales. All studies employed dogs. Results show the potential of AAIs to reduce anxiety and behavioral distress in pediatric patients while acting on physiological measures associated with arousal.

Conclusion

Although further, more rigorous studies are still needed, the findings of this review may have implications for clinical practices suggesting appropriate planning of AAIs by pediatric healthcare professionals.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=178993], identifier [CRD42020178993].

The Effects of Designing an Educational Animation Movie in Virtual Reality on Preoperative Fear and Postoperative Pain in Pediatric Patients: A Randomized Controlled Trial

PURPOSE

The purpose of the study was to investigate the effects of watching an educational animated movie on fear and pain in children aged 6 to 12 years old.

DESIGN

A randomized controlled trial.

METHODS

In this study, the CONSORT checklist was used as a guide. The sample of participants (n = 132) was allocated to the Educational Animation Group (n = 44), Documentary Group (n = 44), and Control Group (n = 44) using block randomization. During the data collection, an information form, the Children's Fear Scale and Wong-Baker Faces Pain Rating Scale were used.

FINDINGS

Preoperative fear and postoperative pain scores were significantly lower in the Educational Animation group than in the other groups.

CONCLUSIONS

The educational animated movie was found to be an effective method in reducing preoperative fear and postoperative pain. Educational animated movies, which were effective in reducing the fear and pain of the child in the preparatory operations, increased the educational effectiveness and cooperation of the child.

Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review

BACKGROUND

The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting.

METHODS AND FINDINGS

The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning).

CONCLUSION

Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.

Neuroplasticity at Home: Improving Home-Based Motor Learning Through Technological Solutions. A Review

Background: Effective science-based motor rehabilitation requires high volume of individualized, intense physical training, which can be difficult to achieve exclusively through physical 1-on-1 sessions with a therapist. Home-based training, enhanced by technological solutions, could be a tool to help facilitate the important factors for neuroplastic motor improvements.

Objectives: This review aimed to discover how the inclusion of modern information and communications technology in home-based training programs can promote key neuroplastic factors associated with motor learning in neurological disabilities and identify which challenges are still needed to overcome.

Methods: We conducted a thorough literature search on technological home-based training solutions and categorized the different fundamental approaches that were used. We then analyzed how these approaches can be used to promote certain key factors of neuroplasticity and which challenges still need to be solved or require external personalized input from a therapist.

Conclusions: The technological approaches to home-based training were divided into three categories: sensory stimuli training, digital exchange of information training, and telerehabilitation. Generally, some technologies could be characterized as easily applicable, which gave the opportunity to promote flexible scheduling and a larger overall training volume, but limited options for individualized variation and progression. Other technologies included individualization options through personalized feedback that might increase the training effect, but also increases the workload of the therapist. Further development of easily applicable and intelligent solutions, which can return precise feedback and individualized training suggestions, is needed to fully realize the potential of home-based training in motor learning activities.

The Effect of Music-Moving Toys to Reduce Fear and Anxiety in Preschool Children Undergoing Intravenous Insertion in a Pediatric Emergency Department: A Randomized Clinical Trial

INTRODUCTION

Intravenous catheter insertion is a highly invasive medical procedure that causes fear and anxiety in children. This study aimed to analyze the effect of a toy (with music and movement) distraction method on fear and anxiety in children aged 4 to 6 years.

METHODS

This experimental, randomized clinical trial used parallel trial design guided by the Consolidated Standards of Reporting Trials checklist. Using simple randomization, eligible children (age 4-6; N = 60) were assigned to the intervention group (n = 30), who received the toy distraction method, or to the control group (n = 30), who received standard care. The Children's Fear Scale was used to evaluate the fear levels, and Children's State Anxiety Scale was used to evaluate anxiety levels. Physiological parameters (pulse, oxygen saturation) and crying time were monitored by the researcher as indicators of fear and anxiety. The chi-square test, repeated measures analysis of variance, Friedman test, t test, the Mann-Whitney U test, Wilcoxon test, and the intraclass correlation test were used for data analysis.

RESULTS

There was no statistically significant difference in terms of fear and anxiety scores, physiological parameters, and crying time during the procedure between the children in the intervention and control group.

DISCUSSION

We found that this method of toy distraction was not effective in reducing fear or anxiety during the intravenous catheter insertion procedure. Accordingly, we recommend that this distraction method be performed in different age groups and with larger samples in various painful and stressful practices in the future and that comparison be made with various distraction methods.

Play simulation for children in magnetic resonance imaging-a clinical perspective

INTRODUCTION

Magnetic Resonance Imaging (MRI) can be a challenging examination, particularly for children. The aim of this Clinical Perspective is to outline early experiences, based upon a service evaluation (defined as an assessment of how well the intended aims are achieved), of the Playful Magnetic Resonance Imaging Simulator (PMRIS) (Domed, Lyon, France) in reducing the number of children requiring general anaesthetic (GA) in order to undergo Magnetic Resonance Imaging (MRI).

METHODS

Baseline data from an audit of children undergoing MRI under GA in 2017 had previously been captured as part of the funding bid for the PMRIS. Estimation of costs associated with anaesthesia were made, then combined with the overall numbers of MRI under GA to estimate projected anaesthetic related cost-savings based on the reported effectiveness of the PMRIS. Once the PMRIS was in place, data were collected for children attending a Play Specialist supervised session. The number and age of children proceeding directly to MRI without requiring a GA was determined. The associated cost benefit was calculated and compared with the projections made in the initial funding bid.

RESULTS

Over a 7 month period 36 children, average age 6 years, age range 4 to 11 years, who had initially been triaged for MRI under GA, attended a Play Specialist led session on the PMRIS. Of these, 30, average age 6 years, age range 4 to 11 years proceeded directly to MRI without a GA. Based on the costings used for the initial funding bid, this equates to a gross cost-saving of £9,000 over 7 months.

DISCUSSION

This service evaluation shows a positive impact of Play Specialist sessions using the PMRIS with 30 out of 36 children having a successful awake MRI as a result. There are limitations to this evaluation, particularly that whilst all these children had been triaged for MRI under GA it cannot be known how many might have had an awake MRI with different preparation. Nevertheless, according to the local referral pathways these children would otherwise have had MRI under GA.

CONCLUSION

This service evaluation has shown that the number of GAs required for children having MRI has reduced for this particular service through the use of the PMRIS, with Play Specialist support, with associated reduction in risk and cost savings.

The Effect of Play on Pain and Anxiety in Children in the Field of Nursing: A Systematic Review

PROBLEM

The role of play in the reduction of anxiety and pain and in the improvement of behaviours and overall wellbeing in children in the field of nursing care in hospital settings.

ELIGIBILITY CRITERIA

Studies published during the period 2014-2019 including original articles in English, Spanish and Portuguese. Databases consulted: SCOPUS, MEDLINE/PubMed, WoS, and CUIDEN (Nursing database in Spanish).

SAMPLE

Seventeen relevant records were selected. After critical reading using the CASPe (Critical Appraisal Skills Programme in Spanish) instrument, 7 articles were rejected and 10 were finally selected.

RESULTS

Each of eight studies showed significant evidence for the role of therapeutic play in the reduction of anxiety and pain and in the overall wellbeing of paediatric patients.

IMPLICATIONS

This review aimed to critically assess and synthesize the existing empirical evidence on the contributions of therapeutic play interventions for reducing anxiety, pain and improving the overall wellbeing of paediatric patients.

CONCLUSIONS

Based on these findings, it may be safe to say that therapeutic play interventions are effective in reducing the negative emotional manifestations of children, decreasing preoperative anxiety and pain, improving compliance with the induction of anaesthesia and reducing anxiety and postoperative pain. There is also evidence that dramatic puppetry is an effective preoperative care and preparation strategy for reducing anxiety in children undergoing surgery.

Evaluation of an In-Hospital Recreation Room for Hospitalised Children and Their Families

OBJECTIVE

Many children's hospitals have established 'recreation rooms' to help reduce distress among hospitalised children and families. We investigated recreation rooms in two Australian children's hospitals to determine: 1) families' first use of the room (including discovery and delays); 2) characteristics of families accessing the room; 3) parents' positive and negative associations with the room; and 4) parents' most and least valued aspects of the room.

METHOD

Using a concurrent mixed methods design, parents completed questionnaires (Restorative Experiences Tool, Parenting Stress Index-Short Form, Paediatric Quality of Life Inventory) and an optional interview. We analysed data using t-tests and multiple regressions (questionnaires) and content analysis (interviews).

RESULTS

Parents (n = 123) commonly reported delays in accessing the recreation room (n = 74, 60.2%). Parents' distress was positively related to their frequency of room use (r = 0.28, p = .001). Families of hospitalised children with lower physical (r = -0.36, p < .001) and psychosocial (r = -0.31, p = .001) functioning used the room more frequently than families of children with higher functioning. Parents reported more positive than negative associations with the rooms for themselves (t(121) = 20.92, 95% CI = 4.34-5.25), their hospitalised child (t(117) = 23.91, 95% CI = 5.00-5.90), and any siblings (t(79) = 15.76, 95% CI = 4.28-5.52). Thirteen parents completed the interviews. We identified three themes: 1) respite; 2) social support and reduced isolation; and 3) need for greater accessibility (particularly for infants/toddlers).

CONCLUSIONS

Respite and social support provided within the recreation rooms may be particularly important for highly distressed parents and families of children with lower psychosocial and physical functioning. Dedicated areas for different age groups may help to improve accessibility of the recreation rooms.

Effectiveness of non-pharmacological interventions to manage anxiety in adolescents in the perioperative period: a systematic review protocol

OBJECTIVE

This review aims to evaluate the effectiveness of non-pharmacological interventions to manage anxiety in adolescents in the perioperative period.

INTRODUCTION

Adolescents undergoing surgery suffer considerable levels of anxiety and distress before surgery, which are maintained beyond the procedure. Although the benefit of non-pharmacological interventions in this area is significant, their efficacy is still under-studied.

INCLUSION CRITERIA

This review will consider studies that focus on adolescents aged 10 to 19 years, who have undergone a surgical procedure. All studies that focus on non-pharmacological interventions occurring in the perioperative period designed to reduce anxiety without restrictions on comparators, geography, or culture will be included.

METHODS

An initial limited search of PubMed and CINAHL has been undertaken and will be followed by a second search for published and unpublished studies, without limitations of publication date, in major health care-related electronic databases. Studies in English, Spanish, and Portuguese will be included. After full-text studies are retrieved, methodological quality assessment and data extraction will be performed independently by two reviewers. A narrative synthesis will accompany the results and, if possible, a meta-analysis will be performed and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020184386.

The setting up and running of a children's activity group and learning centre for children with haematological and oncology conditions

BACKGROUND

Children diagnosed with haematological and oncology conditions spend long periods of time undergoing treatments in hospital. Treatments are intensive and may include combinations of chemotherapy, radiation, surgery and bone marrow transplants. This often means that they have prolonged hospital stays away from family, friends and familiar environments.

AIM

We aimed at starting an activity group and learning centre based in the hospital setting for children undergoing treatment for haematological and oncology conditions.

METHODS

The activity group and learning centre was set up in a tertiary care hospital under the department of Paediatric Haematology, Oncology and Bone Marrow Transplantation with the support of a local NGO called 'Samiksha Foundation' in Bangalore, India. Children who participated in the programme engaged in learning through participation in the activity groups which engaged in academic and non-academic activities. The activity group and learning centre was piloted in April and May of 2019. During the pilot sessions, 156 children participated in the group. Children of all ages were welcome to attend and were given activities based on their age and learning levels. Until March 2020, the group has seen over 600 children in attendance.

RESULTS

This methods report examines various aspects of the activity group such as setting up of the activity groups, how they are run, the activities conducted in the groups and the effects the group has had on children and their families as reported by them while undergoing treatment.

CONCLUSION

The overall response to the activity groups was positive and widely accepted among our patient community. The intervention proved to be effective, easy to implement and relatively inexpensive. We hope that by sharing data from our centre, more paediatric units may be able to implement such groups for children.