The effect of storytelling on anxiety and behavioral disorders in children undergoing surgery: a randomized controlled trial

Play-based training program for overcoming hospital fear in children

PURPOSE

Whether or not they have had medical procedures in hospitals before, children experience fear of medical procedures performed in hospitals or in general. These children need to be given information about the medical procedures or general procedures performed in the hospital in an effective way through different methods. One of these methods is play. This study aims to determine the effect of play-based training program on the fear of medical procedures in healthy children aged 7-12 years.

DESIGN AND METHODS

The research was conducted in an intervention with the control group. The study was conducted with 120 children who met the inclusion criteria in two different primary and secondary schools in Türkiye. Training was given to 60 children in the intervention group for four weeks. Data were collected from both groups using the Medical Procedures Fear Scale at three different stages: pre-training, post-training, and follow-up. Analyses were performed using the SPSS 25 program.

RESULTS

It was observed that the control group's post-test and follow-up test medical procedure fear score was greater than that of the intervention group (p < 0.05). Intervention group's post-test and follow-up test medical procedure fear score was more significant than the pre-test (p < 0.05).

CONCLUSION

Play-based hospital fear overcoming training is a method that reduces the fear of medical procedures in healthy children aged 7-12 years. It may benefit children if these training practices are carried out in schools with the co-operation of healthcare professionals.

PRACTICAL IMPLICATIONS

Play-based training programs can be implemented in various healthcare settings to reduce children's fear of medical procedures and improve their overall well-being through collaboration among healthcare professionals and community organizations.

Effect of play therapy and storytelling on the anxiety level of hospitalized children: a randomized controlled trial

BACKGROUND

Children are anxious when hospitalized due to being away from home and undergoing treatment.This anxiety has an effect on their disease process, treatment, growth and development.Children's anxiety has an effect on parents' anxiety and can lead to lower level of cooperation among the children and their parents with the treatment team.the present study aimed to compare the effect of play therapy and storytelling on the anxiety of hospitalized children.

METHODS

A randomized controlled trial study with a three-group design (play therapy, storytelling and control) was conducted in 75 children aged 3 to 10 years admitted to Imam Ali Alborz Hospital of Karaj, Iran between 2022-2023.The data before and after the intervention were collected by the Spence children's anxiety scale and the face tool for anxiety assessment and analyzed by the Mixed effect model statistical method.

RESULTS

There is a statistically significant difference between the anxiety score of the children for whom storytelling was used and control group. Also, among the two therapies of storytelling and play therapy, only storytelling therapy has a significant effect on reducing children's anxiety.Regarding the time of measuring the anxiety score(the first, second, third day after the intervention), it was found that as this time increases, the children's anxiety decreases significantly.morever, the children's gender, age, and history of hospitalization are influencing factors.

CONCLUSION

Play therapy and storytelling play an effective role in controlling the anxiety of hospitalized children, although storytelling had a greater role in reducing the anxiety of hospitalized children than play therapy. It is suggested to provide the necessary conditions and facilities for the implementation of these methods in children's inpatient departments.

TRIAL REGISTRATION

https://irct.behdasht.gov.ir/ ,IRCT20220704055367N1,13/7 /2022.

Effect of storytelling on anxiety and fear in children during hospitalization: A systematic review and meta-analysis

BACKGROUND

Hospitalization often induces anxiety and fear in children, which may lead to maladaptive behaviours. Prior research has found that storytelling can help improve children's communication and reduce their stress. Not only does it enhance children's ability to express their emotions more effectively and comfortably, it also assists them in releasing negative emotions like anxiousness and fear.

OBJECTIVES

To evaluate the effectiveness of storytelling in reducing children's anxiety and/or fear during hospitalization.

METHODS

A systematic review and meta-analysis were conducted. The search spanned across eight online databases from their inception dates to January 2024. The Cochrane Risk of Bias Tool was utilized to perform quality appraisals. Effects model was utilized to conduct the meta-analysis. Subgroup analyses were conducted for age of participants, geographical location and measurement used.

FINDINGS

A total of eight studies were included in this review. Compared to standard care, storytelling was found to be effective in reducing anxiety and/or fear in children during hospitalization. Anxiety scores were not affected by the participants' age, but the geographical location and type of measurement scales used showed significant subgroup differences.

CONCLUSION

Storytelling interventions help to reduce anxiety and fear levels in hospitalized children. It was suggested that hospitals could provide the necessary training to healthcare workers to perform storytelling more effectively. Additionally, involvement of parents in storytelling could be encouraged, ensuring continuity even after discharge. Further research can be conducted in more diverse geographical regions and explore how storytelling content can vary across different ages.

Impact of dentistry modeling story on dental anxiety in 6-8-year-old children of industrial workers: A randomized controlled trial

AIMS

This study aimed to evaluate the impact of a specially designed dentistry modelling story on dental anxiety and managing behavior among children of industrial workers.

MATERIALS AND METHODS

Two hundred and ten children of age 6-8 years, at their first dental visit, were randomly assigned to one of the two groups: Intervention group - Group A (n = 105) who received a specially designed dentistry modeling story followed by Tell, Show, Do (TSD) technique of behavior guidance; and control group - Group B (n = 105) who received a folk story, not related to dentistry and TSD. Situational anxiety for the children was assessed using the Modified Child Dental Anxiety Scale-face version (MCDAS-f) before and after storytelling. Single session of identical dental treatment was provided to the two groups, which included dental and radiographic examination followed by restorative treatment in any one tooth. Child's behavior during the dental procedure was assessed using Frankl Behavior Rating Scale. After completion of treatment, parents were asked for their preference of the behavior management method used.

RESULTS

Children in both the groups showed a significant reduction in anxiety after storytelling (P < 0.001). No significant difference was found in the anxiety and behavior of the children between the two groups (P > 0.05). Dentistry modeling story received significantly higher preference as compared to folk story by the parents (P < 0.05).

CONCLUSIONS

Both dentistry modeling story and folk story can be effective, inexpensive methods, to reduce short-term dental anxiety.

A randomised controlled study on efficacy of midazolam and cartoon for decreasing preoperative anxiety in preschool children undergoing strabismus surgery

BACKGROUND

This study aimed to evaluate the effect and influence of midazolam and cartoon on postoperative behaviour in reducing preoperative anxiety in preschool children.

METHODS

Three hundred children undergoing monocular strabismus correction were divided into three groups: midazolam (M), cartoon (C), and CM. Preoperative anxiety scores, cooperation scores during anaesthesia induction, awakening time, emergence agitation, and postoperative adverse behaviours were recorded.

RESULT

The preoperative anxiety scores of group CM in the preoperative area and before anaesthesia induction were lower than those of group C and M. Compared with Group C, the cooperation scores of Group M and Group CM decreased significantly. And group M's awakening time was prolonged. The incidence of agitation during awakening and adverse behaviour 1 week after surgery and the cooperation scores in group CM was lower than in groups M and C. The anxiety levels were positively correlated with the agitation and behavioural changes.

CONCLUSION

Watching cartoon videos combined with a low-dose midazolam shows efficacy in reducing preoperative anxiety in children.

The impact of storytelling on building resilience in children: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Storytelling is an effective tool for communication, is universally comprehensible and transcends linguistic barriers, adapting to cultures easily. Storytelling has a strong influence on children and has been used for knowledge retention and for developing imagination, creativity and prosocial behaviours. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The systematic review offers essential insights into the effects of storytelling interventions on the development of resilience in children. It indicates the various forms of storytelling interventions implemented and also the specific measures of resilience employed in the studies. The review has demonstrated that storytelling plays a crucial role in the development of protective factors in children including resilience. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric and mental health nurses working in community, hospital or mental health units play an important role in mental health interventions, particularly when it comes to children and young adults. Employing storytelling techniques can help psychiatric and mental health nurses provide timely and consistent support to children while helping them explore support systems, mechanisms and coping strategies helping build resilience. This holds particular importance for low- and middle-income countries where limited resources pose challenges in providing adequate support for mental health programmes for children. Methods such as storytelling are simple and adaptable to the specific challenges faced in the mental health setting.

ABSTRACT

INTRODUCTION: Resilience is a crucial aspect of mental health and coping that enables individuals to effectively recover from challenges. Fostering resilience in children becomes a significant objective. Storytelling is known to positively affect resilience, providing opportunities to share and develop narratives that help make sense of difficult experiences, find meaning in them, and building beliefs around our capacity to adapt well to challenging experiences.

AIM

The aim of this review is to synthesize peer-reviewed studies on the impact of storytelling interventions in developing resilience in children.

METHOD

The review adhered to the updated PRISMA 2020 guidelines and was registered with PROSPERO (CRD42022365474). We conducted searches in 12 databases with search strings comprising of concepts regarding storytelling, resilience and children.

RESULTS

The review included 11 studies published between 2012 and 2022. The narrative synthesis of the studies indicates that storytelling interventions enhanced psychological resilience in children.

DISCUSSION

Storytelling-based interventions in school settings with participatory approaches using cultural stories, and positive psychology-based interventions were effective and feasible.

IMPLICATIONS FOR PRACTICE

This review has scope for informing future interventions with children, especially those who live in marginalized communities in low- and middle-income countries (LMICs).

The effect of watching videos using virtual reality during operating room transfer on the fear andanxiety of children aged 6-12 undergoing inguinal hernia surgery: A randomized controlled trial

BACKGROUND

Being in a hospital and undergoing a surgical intervention are very stressful for the children and their parents. It is critical to keep the pain, fear and anxiety of children at a minimum level during this period in order to have a better process.

PURPOSE

The aim of this study was to evaluate the effect of watching videos using virtual reality on fear and anxiety of children aged 6-12 years old during operating room transfer for inguinal hernia surgery.

METHODS

This prospective and randomized controlled study used parallel trial design guided by the CONSORT checklist. The study was conducted with two groups: the group that watch videos using virtual reality group and the control group. Data were collected using follow-up forms; the Children's State Anxiety Scale and the Children's Fear Scale.

RESULTS

Children in the virtual realty group had lower anxiety and fear scores than the children in the control group (p < 0.05). Evaluation of the in-group measurements demonstrated that the fear and anxiety scores of the children in the virtual reality group decreased after the transfer compared to that of the pre-transfer, while the children in the control group experienced higher fear and anxiety scores (p < 0.05).

CONCLUSION

Virtual reality is an effective method to reduce fear and anxiety in children aged 6-12 years old during their transfer to the operating room.

IMPLICATIONS FOR PRACTICE

Evidence-based protocol and guidelines should be developed for nonpharmacological methods such as virtual reality for procedural fear and anxiety in children.

Effectiveness of motion graphic-based narrative therapy with a cognitive-behavioral approach in reducing fluoride varnish therapy anxiety for six-year-old children

BACKGROUND

Fluoride varnish therapy (FVT) is a dental caries preventive service that its effectiveness has been well documented. A lot of children, especially the five-year-old and six-year-old ones, are suffering with anxiety during this service and do not readily allow it. The present study aimed to cast light on the effect of motion graphic-based narrative story with a cognitive-behavioral approach in reducing FVT anxiety among six-year-old children.

MATERIALS AND METHODS

This study was an intervention trial type that was conducted in Ardabil city and among school students. Five children suffering from FVT anxiety were randomly selected for the intervention. First, Venham and Gaulin-Kremer's anxiety scale was completed for them. The motion graphic-based narrative therapy was implemented for six weeks. Session 1 was assigned to filling the questionnaire and collecting data. The motion graphic-based narrative therapy started from the second session. The anxiety scale was filled for the children every ten days for a total of four times. The results were analyzed by Blanchard and Schwarz's progress formula and control charts. The intervention sessions included gathering information, watching motion graphics, relaxation skills, watching the process of performing fluoride varnish therapy, teaching the advantages of fluoride varnish therapy, and in the last session performing fluoride varnish therapy with the technique of attention diversion while watching motion graphics.

RESULTS

The motion graphic-based narrative therapy by the cognitive-behavioral approach proved effective in reducing anxiety. At the end of the intervention sessions, the level of anxiety decreased from 8 to 2.2 and the statistical control chart of the process shows that the intervention process is stable and the stability in order to reduce anxiety and the results are within the control limits.

CONCLUSION

The results show that motion graphic-based narrative therapy can be a psychotherapy method for reducing the symptoms of dental anxiety among children.

The effect of storybook reading on children's preoperative fear and anxiety levels: A randomized controlled study

BACKGROUND

The aim of this study was to evaluate the effect of reading a preoperative preparation-themed storybook on children's preoperative fear and anxiety levels.

METHODS

The research design was a randomized controlled experiment. The research sample included 80 children (40 in the story group and 40 in the control group) who met the inclusion criteria. Data collection tools were collected through face-to-face interviews with the 'Survey Form', 'Child Fear Scale (CFS)' and 'Modified Yale Preoperative Anxiety Scale (mYPAS)'. In the research, the book named Elif Has Surgery was used as an intervention tool. In the story group, the preoperative preparation-themed storybook was read to the child in their room at the clinic by their mother within 10 min. The control group received only clinical routine. The study was approved by the ethics committee.

RESULTS

There was a statistically significant difference between the groups in the mean scores of the CFS and mYPAS scales in the control and story groups (p < 0.05).

CONCLUSIONS

This study found that reading a preoperative preparation-themed storybook reduced children's fear and anxiety before surgery. It may be recommended to expand the use of preoperative preparation-themed storybooks in order to prevent fear and anxiety experienced before surgery in paediatric surgery clinics. Story reading is an effective, cheap, non-pharmacological intervention. The clinical trial registration number is NCT05478369.

Development and learning efficacy of a simulation rubric in childhood pneumonia for nursing students: A mixed methods study

BACKGROUND

Nursing students often lack knowledge, skills, and appropriate attitudes toward chest physiotherapy, which affects the quality of care provided to children with pneumonia in clinical practice. Helping students learn about the effectiveness of simulations can improve their nursing ability.

OBJECTIVES

To develop a rubric associated with the simulation of childhood pneumonia and to examine the learning efficacy of students using the rubric to assess the knowledge, skills, and attitudes in the simulation.

DESIGN

A mixed methods study using a post-test survey and a descriptive qualitative analysis of students' reflective journals.

SETTINGS

A paediatric simulation classroom at the University Clinical Skills Centre in Northern Taiwan.

PARTICIPANTS

214 third-year students enrolled in a four-year nursing programme.

METHODS

Quantitative and qualitative data were collected after the course to obtain a comprehensive understanding of its effects. Quantitative data from the questionnaire were analysed using descriptive statistics. Qualitative data were analysed using content analysis.

RESULTS

The quantitative results showed that mean knowledge and nursing students' attitudes were moderate. Of the six sub-indices, chest percussion technique and communication with family and children had the highest mean with 3.32 ± 0.67 and 3.01 ± 0.68, respectively. The students discovered that they often focused on performing technical steps without pre-analysing patient information. Most students also indicated difficulty showing emotional caring behaviours toward patients. The qualitative results revealed that students reflected on their learning post-self-evaluation of the rubric, particularly regarding knowledge of systemic assessments, patient-centred nursing skills, and caring attitudes.

CONCLUSIONS

The knowledge, skills, and attitude rubric can help students develop their learning process in a more organised manner, promote the development of their caring performances toward children, and assist them in their future clinical care practices.

Audio-visual storytelling for reducing dental anxiety in Iranian children: a randomized controlled trial

Purpose

The aim of the study was to compare the effectiveness of the audio–visual storytelling method and the "tell–show–do" (TSD) technique on reducing children's dental anxiety.

Methods

A controlled clinical trial study was performed with two experimental groups and a control group. Forty-five 6-to-9 years old children were randomly divided into the groups. Venham Picture Test and Facial Image scale were used as measurement tools. Repeated measures analysis of variance and Bonferroni post hoc test were used to evaluate the interventions.

Results

The results of the post hoc test showed that there was a significant difference between the mean scores of the control group and storytelling group according to both anxiety scales (p = 0.001). Also, there was a significant difference between the mean scores of the control group and TSD group according to both anxiety scales (p = 0.01).

Conclusion

The audio–visual storytelling appears an effective, applicable method for reducing children's dental anxiety. However, it is significant to select an appropriate story and also to consider the dentist–patient relationship.

The Use of a Dental Storybook as a Dental Anxiety Reduction Medium among Pediatric Patients: A Randomized Controlled Clinical Trial

This randomized clinical trial aimed to evaluate the effectiveness of a specially designed dental storybook in reducing dental anxiety among children. Eighty-eight children (6−8 years old) were randomly divided into two groups: the intervention group (received the storybook) and the control group (did not receive the storybook). Three dental visits (screening, examination and cleaning, and treatment) were provided for each child. Anxiety was assessed following each visit using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Venham clinical anxiety scale (VCAS). The behavior was assessed using the Frankl’s Behavior Rating Scale (FBRS). The intervention group showed significantly lower anxiety and more cooperative behavior during treatment than the control group (p < 0.0001). The intervention group showed a significant decrease in anxiety scores and more cooperative behavior across time according to the CFSS-DS (p = 0.001) and Frankl behavior scale OR = 3.22, 95% CI 1.18−8.76. Multivariate models found that using the storybook was a significant independent factor in reducing anxiety and improving behavior after controlling for sex, previous visits, family income, and mother’s education. In conclusion, the dental storybook can decrease children’s dental anxiety and improve their behavior during dental treatment.

Health Care Providers' Experiences of the Non-Pharmacological Pain and Anxiety Management and Its Barriers in the Pediatric Intensive Care Units

OBJECTIVES

Children in the intensive care unit experience a high level of pain and anxiety. This study aimed to reveal the health care providers experience of non-pharmacological pain and anxiety management and its barriers in the pediatric intensive care unit.

METHODS

This qualitative-descriptive study was conducted with thirteen nurses and five physicians in the pediatric intensive care unit in Iran. Individual, in-depth and semi-structured interviews were conducted, which were analyzed by conventional content analysis.

RESULTS

Five main categories were identified from data analysis: 1) The importance of parents' presence, 2) Disturbance in the presence of parents and communication during the COVID-19 pandemic, 3) Choosing non-pharmacological approaches according to the child's interests and conditions, 4) Building trust in the child through non-pharmacological interventions 5) Barriers to non-pharmacological pain and anxiety management in the pediatric intensive care unit.

CONCLUSION

Health care providers implement some non-pharmacological methods to manage pain and anxiety in the pediatric intensive care unit. Facilitating the open presence of parents, using innovative methods to communicate with children, and training and psychological support for nurses and parents, especially during the COVID-19 pandemic are recommended.

Mothers Level of Education and Preoperative Informative Story Book Reading Helps Reduce Preoperative Anxiety in Children in Turkey

PURPOSE

This study aimed to evaluate the use of a standard story book, compared to an informative story book, as preoperative preparation to relieve anxiety.

DESIGN AND METHODS

A total of 120 children with ASA I-II, aged 6-8 years, scheduled to undergo elective adenoidectomy, tonsillectomy, and adenotonsillectomy were enrolled in this randomized controlled study. The control group received a non-medical, colorful story book, while the intervention group received an informative story book appropriate for their age. The book was either read by literate children or the mothers of illiterate children. The book was read aloud at least once before the surgery while they were together. The patients' baseline anxiety level was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) immediately after entering the preoperative holding area (T0). Mothers' anxiety level was assessed using the State and Trait Anxiety Inventory (STAI). Information about the reader, how many times the book was read, the age and education level of the mother, and the presence of a surgical history in the patients' siblings was obtained from the mother through a questionnaire. After premedication with oral midazolam, patients' anxiety level was assessed while entering the operation room (T1).

RESULTS

The intervention group had significantly lower mYPAS scores at T0 and T1 than the control group. Those who read the intervention book ≥3 times had significantly lower mYPAS values than those who read 2 times or less. Mothers with a low education level had higher anxiety levels in both groups.

CONCLUSIONS

Repeatedly informing children by reading an informative story book and higher education level of mothers are the most important factors for relieving preoperative anxiety in children.

PRACTICE IMPLICATIONS

Reducing preoperative anxiety is an important factor for children and their families.

Construction and validation of a Brazilian educational comic book for pediatric perioperative care

PURPOSE

Educational material can facilitate familiarization with the hospital and surgical contexts for children and guardians and minimize potential difficulties experienced during hospitalization. This study aimed to construct and validate a comic book for guiding children in perioperative care.

DESIGN AND METHODS

A descriptive study was conducted at a pediatric ward in a university hospital in Brazil. A content validity index with a concordance of 0.8 was used for validation.

RESULTS

The content was validated with the participation of 19 content judges (nurses, anesthesiologists, and surgeons); face validity was achieved with the participation of 22 parents and their respective children aged 7-12 years old. The contents of the comic book included perioperative care (hospitalization, fasting, surgical team, operating room, and anesthesia). Universal content validity indices of 0.89 and 0.99 were obtained for content and face validity, respectively. Free Portuguese educational material titled "Getting to know the Surgery Center" was created in the form of a 19-page comic book in print and digital formats. The comic book was face and content validated and considered relevant for children in perioperative care. The suggestions of the healthcare professional and families who participated contributed toward the final version of this educational comic book.

PRACTICE IMPLICATIONS

This study aimed to further the development of educational materials that help alleviate stress, fear, and anxiety among children awaiting surgery, as well as their parents/guardians. As such, it offers a positive and appropriate contribution to perioperative nursing. The study further contributes to a discussion on pediatric nursing, which goes beyond clinical care and procedure. In the context of pediatric surgery and the children themselves, the results indicate that the family must be included in the surgical process and that the language employed must be appropriate to the target audience. Our comic book can be used by nurses to develop similar resources for diverse needs.

The effect of storytelling on fear in school-age children during hospitalization

Hospitalization places children in conditions that may nurture fears of new surroundings, strangers, and unknown actions. Storytelling can be administered as a distraction from the fears that a child experiences during treatment. This study aims to determine the effectiveness of storytelling against fear due to hospitalization in school-age children admitted to the hospital. This study used a quantitative approach with a pre-experimental design and the method used was nonequivalent control group pretest-posttest design. Subjects in this study consisted of two groups namely the intervention and the control groups. The total number of respondents was n=32 and located at the Maternity and Children Hospital in Indonesia. Bivariate analysis showed that storytelling intervention had a significant relationship with the fear of hospitalization among the hospitalized school-age children (p-value=0.001< 0.05). Also, there was a significant difference between the fear score in the intervention and the control groups (p-value=0.001<). Therefore, applying storytelling in the nursing intervention of pediatric patients in hospitals can be recommended to minimize the fear in children.