Reduction of preoperative anxiety in pediatric surgery patients using age-appropriate teaching interventions

Evaluation of the Effect of Individual and Group Tour on the Anxiety Scores of 4-7-year-old Hospitalized Children and their Mothers

Background:

Anxiety is a human response to any unknown situation. Hospitalization and encountering an unfamiliar environment could lead to anxiety and its complications. Therefore, the aim of the present study was to evaluate the effect of individual and group tours on anxiety in children and their mothers.

Materials and Methods:

This quasi-experimental study was conducted on the three groups of individual tour, group tour, and control in two stages. The study was performed on 84 children. The self-report image anxiety scale and State-Trait Anxiety Inventory (STAI) (Spielberger et al.) were used for the assessment of anxiety among children and their mothers, respectively. Data were analyzed using Statistical Package for the Social Sciences software.

Results:

The results showed that the mean score of children's anxiety differed significantly between the three groups after the intervention (F = 40.58, p < 0.001). In addition, the three groups were significantly different in terms of the mothers' anxiety after the intervention (F = 4.12, p < 0.02). No significant difference was observed between the group tour and individual tour groups regarding the children's anxiety score (F = 0.02, p = 0.980) and mothers' state anxiety scores (F = 0.054, p = 0.950).

Conclusions:

The hospital visiting tours decreased the hospitalized children's anxiety and their mother's anxiety. This might be due to their greater familiarity with the ward's nurses, hospital environment, and facilities, familiarization with the unfamiliar new places and the location of different places, and speaking to and finding a sense of empathy and sympathy with their peers.

Influence of preoperative information support on anxiety, pain and satisfaction with postoperative analgesia in children and adolescents after thoracic surgery: A randomized double blind study

AIMS/BACKGROUND

The proportion of patients who experience anxiety prior to planned surgery, even a minimally invasive one, is estimated at 50-70%. Thoracic surgery, causes significant preoperative anxiety, especially in children. The aim of this study was to determine the effect of an important component of psychological preparation for a surgery as information support on levels of anxiety, pain and satisfaction with postoperative analgesia.

METHODS

The randomized double blind study including patients aged 9-18 years qualified for lateral thoracotomy or Ravitch procedure. The subjects were randomized to the control group (n=56) provided with a routine preoperative information by a nurse, and the experimental group (n=56) offered additional psychological consultation. Data were collected via the State-Trait Anxiety Inventory.

RESULTS

In the experimental group, the level of state anxiety at 48 h post-surgery was significantly lower than prior to the procedure, but only in subjects with preoperative trait anxiety Conclusion: Information support from a psychologist offered prior to a thoracic surgery decrease the level of postoperative state anxiety solely in children with lower levels of trait anxiety. Higher level of postoperative state anxiety negatively affect patients' satisfaction with post-surgical analgesia.

TRIAL REGISTRATION

ClinicalTrials.gov; Influence of Preoperative Support on Anxiety, Pain and Satisfaction With Postoperative Analgesia; NCT03488459, https://clinicaltrials.gov/ct2/show/record/NCT03488459?cntry=PL&city=Rabka-Zdr%C3%B3j&rank=1.

A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures

OBJECTIVES

Insufficient preparation for children who are undergoing bone marrow aspiration can cause anxiety and negative outcomes. Nonpharmacological therapies have been proven to reduce fear in children who are undergoing painful procedures. We have therefore developed a mobile application to help reduce these patients' anxiety by providing them with procedural information and coping skills.

METHODS

This single-blinded, randomized controlled trial included 60 patients age 5 to 12 years old who were undergoing bone marrow aspiration procedures in Thailand that were conducted between May 2015 and May 2016. Sixty participants were randomly assigned to the intervention group (mobile application added to usual care) or the control group (usual care only). Preprocedural anxiety levels were evaluated by visual analog scales (child anxiety visual analog scale); this was repeated in the intervention group immediately after patients used the mobile application. On the day of the procedure, the patients' cooperation levels were assessed by using the modified Yale Preoperative Anxiety Scale. The total amount of sedative drugs that were used was also recorded. The paired t test and the Wilcoxon signed rank test were used to analyze within-person change, whereas the t test and the Wilcoxon rank sum test were used for group comparisons.

RESULTS

The child anxiety visual analog scale score of patients in the intervention group decreased significantly after they used the mobile application (P < .0012). The modified Yale Preoperative Anxiety Scale score of patients in the intervention group was significantly lower than that in the control group (P < .01). There was no difference in sedative use between the 2 groups.

CONCLUSIONS

This mobile application possibly had effectiveness in routine use for reducing anxiety and increasing patients' cooperation in bone marrow aspiration procedures.

An evaluation of preoperative anxiety in Spanish-speaking and Latino children in the United States

BACKGROUND

There is a large body of literature examining factors associated with children's preoperative anxiety; however, cultural variables such as ethnicity and language have not been included.

AIMS

The purpose of this investigation was to examine the role of Latino ethnicity and Spanish-speaking families in pediatric preoperative anxiety.

METHODS

Participants were 294 children aged 2-15 years of age undergoing outpatient, elective tonsillectomy and/or adenoidectomy surgery and general anesthesia. Participants were recruited and categorized into 3 groups: English-speaking non-Latino White (n = 139), English-speaking Latino (n = 88), and Spanish-speaking Latino (n = 67). Children's anxiety was rated at 2 time points before surgery: the time the child entered the threshold of the operating room (Induction 1) and the time when the anesthesia mask was placed (Induction 2).

RESULTS

Results from separate linear regression models at Induction 1 and Induction 2, respectively, showed that being from a Spanish-speaking Latino family was associated with higher levels of preoperative anxiety compared with being from an English-speaking family. In addition, young age and low sociability was associated with higher preoperative anxiety in children.

CONCLUSION

Clinicians should be aware that younger, less sociable children of Spanish-speaking Latino parents are at higher risk of developing preoperative anxiety and manage these children based on this increased risk.

Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer

Cancer poses substantial challenges to both physical and mental health of patients. On the other hand, breast cancer is one of the most common cancers among Iranian women. Therefore, the present study was conducted to investigate the effect of mindfulness-based training on psychological status and quality of life (QoL) of patients with breast cancer living in Ilam, Iran. This quasi-experimental study was performed on 66 patients diagnosed with breast cancer. The patients assigned into two groups of experimental and control. Experimental group received mindfulness-based group training through eight 90-min sessions. Sessions were conducted twice a week and were completed within 1 month. The research tools included a QoL questionnaire (WHOQOL-BREF), Schneider’s life expectancy questionnaire, and the depression anxiety stress scale (DASS-21). The questionnaires were completed before and during the interviews with the patients 2 months after intervention. Data were analyzed using SPSS (version 16) and running descriptive and analytical statistics. Before the intervention, there was no significant difference between he experimental and control groups considering QoL, life expectancy, depression, anxiety, and stress (p>0.05). However, after the intervention, the patients in the experimental group reported higher QoL and life expectancy and less severe depression, anxiety, and stress (p < 0.05). Considering the positive effect of mindfulness-based training on the psychological status and QoL of patients with breast cancer, we recommend health nurses conduct mindfulness-based training for patients receiving clinical care services.

Tablet-Based Intervention for Reducing Children's Preoperative Anxiety: A Pilot Study

OBJECTIVES

To examine the feasibility, acceptability, and effects of a novel tablet-based application, Story-Telling Medicine (STM), in reducing children's preoperative anxiety.

METHODS

Children (N = 100) aged 7 to 13 years who were undergoing outpatient surgery were recruited from a local children's hospital. This study comprised 3 waves: Waves 1 (n = 30) and 2 (n = 30) examined feasibility, and Wave 3 (n = 40) examined the acceptability of STM and compared its effect on preoperative anxiety to Usual Care (UC). In Wave 3, children were randomly allocated to receive STM+UC or UC. A change in preoperative anxiety was measured using the Children's Perioperative Multidimensional Anxiety Scale (CPMAS) 7 to 14 days before surgery (T1), on the day of surgery (T2), and 1 month postoperatively (T3).

RESULTS

Wave 1 demonstrated the feasibility of participant recruitment and data collection procedures but identified challenges with attrition at T2 and T3. Wave 2 piloted a modified protocol that addressed attrition and increased the feasibility of follow-up. In Wave 3, children in the STM+UC demonstrated greater reductions in CPMAS compared with the UC group (ΔM = 119.90, SE = 46.36, t(27) = 2.59, p = .015; 95% confidence interval = 24.78-215.02).

CONCLUSION

This pilot study provides preliminary evidence that STM is a feasible and acceptable intervention for reducing children's preoperative anxiety in a busy pediatric operative setting and supports the investigation of a full-scale randomized controlled trial.

THE EFFECT OF A HYPNOTIC-BASED ANIMATED VIDEO ON STRESS AND PAIN REDUCTION IN PEDIATRIC SURGERY

Presurgical stress and its negative influences on postsurgical recovery and pain are well documented in the medical literature. Hence, the reduction of stress is advisable. The present study aimed to reduce stress using a hypnotic-based animated video. Thirty children aged 3 to 16 years hospitalized for ambulatory surgery for undescended testes or umbilical/inguinal hernia were recruited for the study. They watched the video 1 time prior to surgery in the presence of their parents and reported their anxiety and pain pre- and postvideo watching on a visual analogue scale. The results show a statistically significant reduction in both anxiety and pain. The article describes the structuring of the animated video and includes links to English, Hebrew, and Arabic versions of it.

Unstructured play for anxiety in pediatric inpatient care

PURPOSE

The purpose of this study was to examine the effects of unstructured play activities on the anxiety levels of hospitalized children.

METHODS

A nonequivalent control group pretest posttest design was employed for this study. The sample included children (N = 165) ages 4-7 years admitted to a large pediatric referral center in the United Arab Emirates. The control group (n = 84) received usual care, while the experimental group (n = 81) engaged in age-appropriate unstructured play activities using disposable games and toys. Parents and siblings, if present, were encouraged to participate. Research assistants conducted the play activities twice a day, with 30-min morning and evening sessions. Anxiety was measured at baseline and at the end of days 2 and 3 with a translated form of the Short-State-Trait Anxiety Inventory for Children.

RESULTS

Anxiety scores in both groups were similar at baseline and decreased significantly over the 3 days. Compared with the control group, anxiety scores in the intervention group were significantly lower on day 2 (12.7 ± 2.3 vs. 10.7 ± 2.5, p = .003) and day 3 (10.6 ± 2.2 vs. 9.47 ± 2.4, p < .001). The greatest decrease occurred in the percentage of children in the experimental group with medium-level anxiety scores: baseline (n = 61, 75%), day 2 (n = 24, 30%), and day 3 (n = 0, 0%).

CONCLUSIONS

This simple, low-cost play intervention implemented by nurses resulted in statistically and clinically significant decreases in the anxiety levels of children in an acute inpatient setting.

Minimizing pediatric healthcare-induced anxiety and trauma

Frequently, episodes of care such as preventive clinic visits, acute care, medical procedures, and hospitalization can be emotionally threatening and psychologically traumatizing for pediatric patients. Children are often subject to psychological trauma, demonstrated by anxiety, aggression, anger, and similar expressions of emotion, because they lack control of their environment. This sense of helplessness, coupled with fear and pain can cause children to feel powerless in healthcare settings. These emotional responses can delay important medical treatment, take more time to complete and can reduce patient satisfaction. Healthcare professionals are uniquely positioned to prevent healthcare-induced trauma and reduce healthcare-induced anxiety. This article introduces a new way to choice, agenda, resilience and emotion (CARE) for pediatric patients in the healthcare setting by implementing the four following treatment principles called the care process: (1) Choices: Offer power in a powerless environment; (2) Agenda: Let patients and families know what to expect and what is expected of them; (3) Resilience: Highlight strengths and reframe negatives; and (4) Emotional support: Recognize and normalize common fears and responses. Engaging the CARE principles helps patients and families feel empowered and mitigates, reduces, and may even ameliorate risk of anxiety and trauma responses.

Interactions Between Children and Pediatric Nurses at the Emergency Department: A Swedish Interview Study

Admission to an emergency department can be considered a stressful event for both the child and the family. Due to the nature of traumas, illnesses and fatalities it is a chaotic forum in which good communication between child and staff can be difficult to establish.

PURPOSE

The purpose of the study was to describe nurses' methods when interacting with children aged three to six at a pediatric emergency department and to identify aspects in need of further investigation.

METHODS

The study included seven nurses who work with children. The data were collected through semi-structured interviews and analyzed using qualitative content analysis.

RESULTS

The analysis resulted in three main themes; fundamentals for being able to create a good encounter, nurse's adaptations when encountering children and limitations associated with providing child and family-centered care in the pediatric emergency department.

CONCLUSIONS

Healthcare organizations must create time to allow important communication to take place between staff and pediatric patients so that children and families feel safe when being treated. The implementation of effective measures to train staff in communication with pediatric patients is important.

PRACTICE IMPLICATIONS

The child should participate in his/her care and in procedures as much as possible. By listening to children and their parents proposals, especially before invasive procedures, effective ways to handle pain and discomfort may be developed.

A comparison of the effect of two doses of oral melatonin with oral midazolam and placebo on pre-operative anxiety, cognition and psychomotor function in children: A randomised double-blind study

Background and Aims:

Melatonin (MT), a naturally occurring pituitary hormone has a sleep promoting effect. There are very few studies on pre-operative oral MT (0.2–0.5 mg/kg) in children. We planned a study to assess the efficacy of oral MT in two doses and compare it with oral midazolam and placebo for pre-operative anxiolysis, sedation, maintenance of cognition and psychomotor skills, parental separation behaviour and venepuncture compliance.

Methods:

This prospective double-blind randomised study was conducted after ethical committee approval on 100 children aged 5–15 years, American Society of Anaesthesiologists physical status I and II undergoing elective surgery at our hospital from January 1, 2014, to December 31, 2014. Mentally disordered children were excluded from the study. They were randomised into four groups of 25 each (A, B, C, D) to receive either oral MT 0.5 mg/kg or 0.75 mg/kg or oral midazolam 0.5 mg/kg or placebo 45–60 min, respectively, before induction. The child's anxiety, cognition and psychomotor function before and after pre-medication, behaviour during the parental separation and venepuncture were appropriately scored. Kruskal–Wallis analysis of variance for intergroup and Wilcoxon matched pairs tests for intragroup comparisons of data were applied.

Results:

The four groups were comparable regarding mean age, weight and sex. The anxiety score reductions in the three groups when compared to placebo were statistically significant. Children receiving MT 0.75 mg/kg had maximum anxiolysis and venepuncture compliance (P < 0.05). Cognition was decreased with maximum sedation, successful parental separation and psychomotor impairment in the midazolam group (P < 0.05).

Conclusion:

Oral MT (0.5 mg/kg and 0.75 mg/kg) in children decreases pre-operative anxiety without impairing cognitive and psychomotor functions, the 0.75 mg/kg dose being most effective.

Play-based procedural preparation and support intervention for cranial radiation

PURPOSE

The primary objective of this study was to examine the relationship between play-based procedural preparation and support intervention and use of sedation in children with central nervous system (CNS) tumors during radiation therapy. The secondary objective was to analyze the cost-effectiveness of the intervention compared to costs associated with daily sedation.

METHODS

A retrospective chart review was conducted, and 116 children aged 5-12 years met criteria for inclusion. Outcome measures included the total number of radiation treatments received, the number of treatments received with and without sedation, and the type and duration of interventions, which consisted of developmentally appropriate play, education, preparation, and distraction provided by a certified child life specialist.

RESULTS

The results of univariate analyses showed that age, tumor location, and total number and duration of interventions were significantly associated with sedation use during radiation therapy. Multivariate analyses showed that, after adjustment for age, tumor location, and craniospinal radiation, a significant relationship was found between the total number and duration of the interventions and sedation use. The implementation of a play-based procedural preparation and support intervention provided by a certified child life specialist significantly reduced health-care costs by decreasing the necessity of daily sedation.

CONCLUSIONS

Support interventions provided by child life specialists significantly decreased both sedation use and the cost associated with daily sedation during cranial radiation therapy in children with CNS tumors. This study supports the value of the child life professional as a play-based developmental specialist and a crucial component of cost-effective healthcare.

Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery

OBJECTIVE

To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery.

METHODS

A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children's preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed.

RESULTS

In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies.

CONCLUSIONS

This systematic review suggests that AV interventions can be effective in reducing children's preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice.

Preoperative Education and Decreasing Preoperative Anxiety Among Children Aged 8 - 10 Years Old and Their Mothers

BACKGROUND

Preoperative anxiety is associated with adverse clinical, behavioral, and psychological outcomes. Various effective interventions targeting preoperative anxiety in children exist.

OBJECTIVES

The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management.

PATIENTS AND METHODS

After obtaining the institutional ethics committee approval and written informed parental consent, 36 ASA-I, II children (age range, 8 - 10 years) underwent small operations were included in this prospective randomized study. The participants were allocated into the intervention (n =18) and control (n =18) groups. Children in the first group were prepared routinely. In the second group children and their mothers received data about anesthesia and operation by the booklet. Children-maternal anxiety was assessed using the anxiety level form, at the night and in the morning before surgery. Few days after surgery mothers, residents, and children experiences and satisfaction from anxiety management were assessed in the focus group discussion.

RESULTS

Mean scores and standard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6, respectively (P = 0.06). In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery (P = 0.00). Comparison between groups was not significant (P = 0.6) and (P = 0.1). The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 (P = 0.00), respectively. In the intervention group, mothers' anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 (P = 0.04). Comparison between groups was not significant (P = 0.7) and (P = 0.1). According to the focus group discussions, booklet study, provided education, sympathy of medical team, spiritual issues and beliefs reduced anxiety and fear of surgery. Anesthesia and lack of knowledge of what will happen, crying and restlessness of children increased preoperative anxiety.

CONCLUSIONS

In this study, the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children (in mothers it was significant P < 0.05). Since there is a direct relation between mothers' and their children's anxiety, using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers.

Pediatric perioperative education current practices: a national survey of children's hospitals in the United States

Identifying existing practices is a first step in the creation of developmentally and culturally effective teaching materials for children and families. This national survey queried two groups to explore current pediatric perioperative education practices: 81 nurses from a perioperative pediatric specialty association and 30 administrators representing leading children's hospitals within the United States. The aim was to improve perioperative care through the design of educational materials from the child's perspective.