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Spaggiari S, Calignano G, Montanaro M, Zaffani S, Cecinati V, Maffeis C, Di Riso D. Examining Coping Strategies and Their Relation with Anxiety: Implications for Children Diagnosed with Cancer or Type 1 Diabetes and Their Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:77. [PMID: 38248541 PMCID: PMC10815397 DOI: 10.3390/ijerph21010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
The onset of chronic diseases in childhood represents a stressful event for both young patients and their caregivers. In this context, coping strategies play a fundamental role in dealing with illness-related challenges. Although numerous studies have explored coping strategies employed by parents of children with chronic diseases, there remains a gap in the understanding of children's coping strategies and their correlation with their and their parents' anxiety. This study aims to investigate coping strategies and their interaction with anxiety in groups of young patients with cancer, type 1 diabetes (T1D), and their respective caregivers, in comparison to healthy children and caregivers. We recruited a total of 61 control children, 33 with cancer, and 56 with T1D, 7 to 15 years old, along with their mothers. Each participant completed a customized survey and standardized questionnaires. No significant differences emerged in coping strategies used by children among the different groups. However, when examining the association between coping strategy and anxiety, we found specific patterns of interaction between children's use of coping strategies and their and their mothers' anxiety levels. This study underscores the importance of an illness-specific approach to gain deeper insights into this topic and develop targeted interventions aimed at enhancing the psychological well-being of these vulnerable populations.
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Affiliation(s)
- Silvia Spaggiari
- Department of Developmental Psychology and Socialization (DPSS), University of Padua, 35131 Padova, Italy; (G.C.); (D.D.R.)
| | - Giulia Calignano
- Department of Developmental Psychology and Socialization (DPSS), University of Padua, 35131 Padova, Italy; (G.C.); (D.D.R.)
| | - Maria Montanaro
- Complex Structure of Pediatrics and Pediatric Oncohematology “Nadia Toffa”, Central Hospital Santissima Annunziata, 74121 Taranto, Italy; (M.M.); (V.C.)
| | - Silvana Zaffani
- Pediatric Diabetes and Metabolic Disorders, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University of Verona, 37134 Verona, Italy; (S.Z.); (C.M.)
| | - Valerio Cecinati
- Complex Structure of Pediatrics and Pediatric Oncohematology “Nadia Toffa”, Central Hospital Santissima Annunziata, 74121 Taranto, Italy; (M.M.); (V.C.)
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University of Verona, 37134 Verona, Italy; (S.Z.); (C.M.)
| | - Daniela Di Riso
- Department of Developmental Psychology and Socialization (DPSS), University of Padua, 35131 Padova, Italy; (G.C.); (D.D.R.)
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LiaBraaten BM, Linneman N, Czarnecki M, Davies WH, Zhang L, Simpson PM, Jastrowski Mano KE, Weisman SJ, Hainsworth KR. Stress Numerical Rating Scale-11: Validation in Pediatric Inpatient and Outpatient Pain Settings. Pain Manag Nurs 2023:S1524-9042(23)00076-0. [PMID: 37059666 DOI: 10.1016/j.pmn.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 04/16/2023]
Abstract
Stress is a commonly reported issue in pediatric populations of chronic and acute pain. Both outpatient and inpatient settings impose time constraints, which decreases opportunities to measure and address patient stress. The aim of these studies was to evaluate the validity of the Stress Numeric Rating Scale-11 (SNRS-11) in both inpatient and outpatient settings. The SNRS-11 is a single item stress measure ranging from 0 to 10 with endpoint anchors: 0 = "No stress" and 10 = "Highest stress possible". Results showed discriminative validity in the inpatient sample and convergent and discriminant validity in both outpatient and inpatient samples. Additionally, approximately 40% to 50% of the sample reported moderate-severe stress on all post-operative days. The SNRS-11 shows promise as a quick, easy, and free stress measure to be used in both inpatient and outpatient settings.
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Affiliation(s)
- Brynn M LiaBraaten
- Department of Anesthesiology, Medical College of Wisconsin, and Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Milwaukee, Wisconsin.
| | - Nina Linneman
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - W Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa M Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Steven J Weisman
- Department of Anesthesiology, Medical College of Wisconsin, and Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Milwaukee, Wisconsin; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Keri R Hainsworth
- Department of Anesthesiology, Medical College of Wisconsin, and Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Milwaukee, Wisconsin
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Zamani M, Sigaroudi AE, Pouralizadeh M, Kazemnejad-Leili E. Effect of the Digital Education Package (DEP) on prevention of anxiety in hospitalized children: a quasi-experimental study. BMC Nurs 2022; 21:324. [PMID: 36434594 PMCID: PMC9700912 DOI: 10.1186/s12912-022-01113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Masoumeh Zamani
- grid.411874.f0000 0004 0571 1549Department of Nursing, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, 4146939841 Iran
| | - Abdolhosein Emami Sigaroudi
- grid.411874.f0000 0004 0571 1549Department of Nursing, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, 4146939841 Iran ,grid.411874.f0000 0004 0571 1549Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Moluk Pouralizadeh
- grid.411874.f0000 0004 0571 1549Department of Nursing, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, 4146939841 Iran
| | - Ehsan Kazemnejad-Leili
- grid.411874.f0000 0004 0571 1549Department of Biostatistics, Shahid Beheshti School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Fronk E, Billick SB. Pre-operative Anxiety in Pediatric Surgery Patients: Multiple Case Study Analysis with Literature Review. Psychiatr Q 2020; 91:1439-1451. [PMID: 32424544 DOI: 10.1007/s11126-020-09780-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pre-operative anxiety affects millions of pediatric surgery patients each year and can have both short and long-term adverse effects in the post-operative period. As a result, it is particularly important for healthcare providers and others involved in the child's care, such as the parents, to be aware of interventions that can be used to reduce the onset of pre-operative anxiety and, thus, the likelihood of negative post-operative changes. The purpose of this paper is to familiarize the reader with the issue of pre-operative anxiety through a review of the literature and analysis of case studies. First, the paper looks at the causes of pre-operative anxiety and its effect on the development of maladaptive behavioral, emotional, and physiological changes. It then discusses the ways pre-operative anxiety can be measured and current methods for reducing the post-operative adverse outcomes associated with it. After doing so, it proposes the need for additional research and the use of precision medicine by physicians.
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Affiliation(s)
- Emily Fronk
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Stephen Bates Billick
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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Back pain in adolescents with idiopathic scoliosis: the contribution of morphological and psychological factors. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1959-1971. [DOI: 10.1007/s00586-020-06489-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/25/2020] [Accepted: 05/31/2020] [Indexed: 01/13/2023]
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Eijlers R, Staals LM, Legerstee JS, Berghmans JM, Strabbing EM, van der Schroeff MP, Wijnen RMH, Kind LS, Hillegers MHJ, Dierckx B, Utens EMWJ. Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival. J Clin Psychol Med Settings 2020; 28:313-322. [PMID: 32306238 PMCID: PMC8192387 DOI: 10.1007/s10880-020-09716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children.
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Affiliation(s)
- Robin Eijlers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Johan M Berghmans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
- Department of Anaesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Elske M Strabbing
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc P van der Schroeff
- Dutch Craniofacial Centre, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - René M H Wijnen
- Intensive Care and Department of Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Laura S Kind
- Centre for Special Care Dentistry, CBT Rijnmond, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Wytemaweg 8, Rotterdam, 3015 CN, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Centre for Child Psychiatry De Bascule, Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
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Stein Duker LI, Schmidt AR, Pham PK, Ringold SM, Nager AL. Use of Audiobooks as an Environmental Distractor to Decrease State Anxiety in Children Waiting in the Pediatric Emergency Department: A Pilot and Feasibility Study. Front Pediatr 2020; 8:556805. [PMID: 33585358 PMCID: PMC7874121 DOI: 10.3389/fped.2020.556805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Anxiety and anticipatory stressors are commonly experienced by children visiting the Pediatric Emergency Department (PED), but little research exists that addresses the efficacy of interventions to decrease this stress. This one-sample pretest-postest pilot study gathered preliminary data on the feasibility and effectiveness of utilizing audiobooks to reduce fear and state anxiety in children in the PED. Methods: Participants were 131 children in kindergarten through 8th grade (M = 9.4 years, 54% female), triaged urgent or emergent, presenting to the PED. Participants self-reported fear (Children's Fear Scale) and state anxiety (modified State-Trait Anxiety Inventory for Children; mSTAIC) before and after listening to an age-appropriate audiobook (two options). Data regarding patient experience were also collected. Paired samples t-test was used to examine pre-post intervention changes in fear and state anxiety. Results: Significant, albeit small, improvements in fear and the mSTAIC states of nervous, calm, happy, and relaxed were found after use of the audiobook (Cohen's d z = 0.22-0.35). Small, yet significant correlations were found between child age/grade level and improvements in fear and in the mSTAIC states of scared and relaxed, suggesting that the audiobook was more beneficial for older participants. Over 60% of participants liked the audiobook content "a lot" as well as enjoyed listening to the audiobook "a lot." Without prompting, 15% of participants requested to listen to an additional audiobook. Conclusions: Listening to an audiobook is feasible and could be effective in decreasing fear and state anxiety for children during a waiting period in the PED. The technology is low-cost, simple, and portable. The results of this study should be interpreted with prudence due to the lack of a control group and results that, although significant, were modest based on effect size conventions; future studies should explore the impact of audiobooks on patient stress with an expanded sample size and control group.
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Affiliation(s)
- Leah I Stein Duker
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - Anita R Schmidt
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Phung K Pham
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sofronia M Ringold
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Alan L Nager
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Keck School of Medicine at the University of Southern California, Los Angeles, CA, United States
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Shain LM, Pao M, Tipton MV, Bedoya SZ, Kang SJ, Horowitz LM, Wiener L. Comparing Parent and Child Self-report Measures of the State-Trait Anxiety Inventory in Children and Adolescents with a Chronic Health Condition. J Clin Psychol Med Settings 2019; 27:173-181. [PMID: 31127422 DOI: 10.1007/s10880-019-09631-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety symptoms in children and adolescents with a chronic health condition have been estimated as high as 40% lifetime prevalence. Clinicians often rely on parent/caregiver information to supplement or substitute child self-report related to pediatric physical and mental health. We developed a caregiver proxy version (STAI-P) for the State-Trait Anxiety Inventory (STAI) State Anxiety Scale that was compared with a child self-report version in 201 parent-child dyads to evaluate its utility in measuring state anxiety in chronically ill youth. For patients aged 7-12, self-reports of state anxiety were moderately associated with parent distress and health provider-reported functional status, but negatively associated with parent STAI-P scores. For patients aged 13-17, self-reports of state anxiety were significantly associated with STAI-P scores, parent distress, and health provider-reported functional status. The STAI-P parent version may be a useful tool in identifying and addressing anxiety symptoms in youth living with a chronic health condition.
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Affiliation(s)
- Lindsey M Shain
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Mary V Tipton
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Sima Zadeh Bedoya
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Sun J Kang
- Genetic Epidemiology Branch, National Institute of Mental Health, NIH, Bethesda, MD, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
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Al-Yateem N, Rossiter RC. Unstructured play for anxiety in pediatric inpatient care. J SPEC PEDIATR NURS 2017; 22. [PMID: 27966275 DOI: 10.1111/jspn.12166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/30/2016] [Accepted: 11/11/2016] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Emirate of Sharjah, United Arab Emirates.,Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Emirate of Sharjah, United Arab Emirates.,School of Nursing, Midwifery and Indigenous Health, Faculty of Science, Charles Sturt University, Orange Campus, New South Wales, Australia
| | - Rachel C Rossiter
- School of Nursing, Midwifery and Indigenous Health, Faculty of Science, Charles Sturt University, Orange Campus, New South Wales, Australia
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Kim JS, Park JH, Foster RL, Tavakoli A. Psychometric validation of Emotional Reaction Instrument-English to measure American children's emotional responses to hospitalisation. J Clin Nurs 2012; 23:1541-51. [PMID: 23043670 DOI: 10.1111/j.1365-2702.2012.04274.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to test the initial psychometric properties of the Emotional Reactions Instrument-English with hospitalised American children, ages 7-12 years, in the USA. BACKGROUND Children's negative emotional responses have been a subject of concern for paediatric clinicians and researchers, especially because negative emotional responses following or during hospitalisation are associated with adverse patient outcomes. Existing self-report paediatric instruments have a number of limitations including lack of clinical feasibility and psychometric evidence. DESIGN A survey and psychometric approach was used to test initial reliability and validity of the Emotional Reactions Instrument-ENGLISH. METHODS Two hundred hospitalised American children, 7-12 years of age, who were admitted to a Children's Hospital in the USA were recruited for this study. The children were administered the Emotional Reactions Instrument-English, the Facial Affective Scale, and a demographic form. RESULTS Internal consistency was supported by a Cronbach's alpha of 0·83 for the total scale. Alpha coefficients for subscales ranged from 0·59-0·82. Construct validity was tested with exploratory factor analysis. Through principal component analysis, four factors were identified that explained 64% of the variance. Concurrent validity was supported by most items in the Emotional Reactions Instrument-English being significantly correlated with the Facial Affective Scale (r = 0·18-0·59). The instrument can be administered to hospitalised children in 5-10 minutes. CONCLUSIONS The results of this exploratory study provide initial support for the psychometric adequacy of the Emotional Reactions Instrument-English with hospitalised American children ages 7-12 years. Further testing of the Emotional Reactions Instrument-English is required to validate the subscales and evaluate the instrument's use with children of different ages, race and ethnicity. RELEVANCE TO CLINICAL PRACTICE This study introduces a new, clinically feasible instrument to measure children's diverse emotional responses to hospitalisation.
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Affiliation(s)
- Jin-Sun Kim
- Authors: Jin-Sun Kim, PhD, RN, Professor, Department of Nursing, Chosun University; Jeong-hwan Park, PhD. RN, Associate Professor, Department of Nursing, Chosun University, Gwangju, South Korea; Roxie L Foster, PhD, RN, FAAN, Professor, College of Nursing, University of Colorado Denver, Aurora, CO; Abbas Tavakoli, DrPH. MPH, ME, Statistician and Director of Statistical Laboratory, College of Nursing, University of South Carolina, Columbia, SC, USA
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Assessing Children's Anxiety Using the Modified Short State-Trait Anxiety Inventory and Talking Mats: A Pilot Study. Nurs Res Pract 2012; 2012:932570. [PMID: 22991660 PMCID: PMC3444045 DOI: 10.1155/2012/932570] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 07/29/2012] [Accepted: 08/03/2012] [Indexed: 02/07/2023] Open
Abstract
Background. Preoperative anxiety complicates treatment and requires assessment by nurses in children. Children, with or without disability, are helped when pictures are used to support communication. The purpose of this pilot study was to test the reliability and validity of the modified short State-Trait Anxiety Inventory (STAI) using a modified Talking Mats method in children undergoing day surgeries. Method. A modified short STAI with pictorial support along the lines of the Talking Mats method was pre- and postoperatively administered to 42 typically developing children aged three to nine years. The parents assessed the children's anxiety, simultaneously and independently, by scoring the short STAI by proxy. Results. The modified short STAI showed moderate internal consistency and good construct validity in the age group seven to nine years. Conclusions. The results of this study support the use of the instrument for self-reports in children aged seven to nine years. Future research will explore the possibilities of also using this instrument for children with cognitive and communicative difficulties.
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Foster RL, Park JH. An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children. Pain Manag Nurs 2011; 13:94-106. [PMID: 22652282 DOI: 10.1016/j.pmn.2011.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 06/22/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022]
Abstract
Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.
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Affiliation(s)
- Roxie L Foster
- University of Colorado Denver College of Nursing, Aurora, Colorado, USA
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Apell J, Paradi R, Kokinsky E, Nilsson S. Mätning av barns oro vid undersökning eller behandling på sjukhus — en studie som utvärderar short STAI. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/010740831103100110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kim JS, Park JH, Foster RL, Cheng S. Psychometric assessment of the Emotional Reactions Instrument-Korean (ERI-K) to measure Korean children's emotional reaction to hospitalization. J Transcult Nurs 2010; 22:31-9. [PMID: 21191034 DOI: 10.1177/1043659610387150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to test psychometric properties of the Emotional Reactions Instrument-Korean (ERI-K). A convenience sample of 170 hospitalized Korean children was recruited. Each child was asked to describe how she or he felt during hospitalization, through the ERI-K and the Facial Affective Scale. Surprisingly, children reported lower levels of negative emotions and physical discomfort and a moderate level of positive emotion (Happy, Good). Internal consistency reliability of .88 for the 14-item scale provides strong support for reliability. Construct validity was supported by item-to-total correlations ranging between .42 and .65. Exploratory factor analysis identified two factors that explained 54% of the variance. Further testing of the ERI-K is recommended to provide additional evidence of psychometric adequacy across Korean populations.
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Affiliation(s)
- Jin-Sun Kim
- Department of Nursing, Chosun University, 375 Seosuk-dong, Dong-Ku, Gwangju, South Korea
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Bringuier S, Dadure C, Raux O, Dubois A, Picot MC, Capdevila X. The Perioperative Validity of the Visual Analog Anxiety Scale in Children: A Discriminant and Useful Instrument in Routine Clinical Practice to Optimize Postoperative Pain Management. Anesth Analg 2009; 109:737-44. [DOI: 10.1213/ane.0b013e3181af00e4] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Crandall M, Lammers C, Senders C, Savedra M, Braun JV. Initial Validation of a Numeric Zero to Ten Scale to Measure Children's State Anxiety. Anesth Analg 2007; 105:1250-3, table of contents. [DOI: 10.1213/01.ane.0000284700.59088.8b] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kleiber C, McCarthy AM. Evaluating instruments for a study on children's responses to a painful procedure when parents are distraction coaches. J Pediatr Nurs 2006; 21:99-107. [PMID: 16545670 DOI: 10.1016/j.pedn.2005.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Existing research identifies numerous variables that may influence children's distress responses during medical procedures. In preparation for a large multisite study to test relationships among these numerous variables and parent distraction coaching, a pilot study of instruments was performed that measured the more complex constructs, namely anxiety, coping, temperament, attention, and parenting style. This article describes the benefits, process, and results of evaluating research instruments before initiating a large study on children's distress during ;medical procedures. A convenience sample of 68 children (4-12 years old) and their parents participated in this study. Children completed state and trait anxiety measures and a coping style scale. Parents completed questionnaires about their child's temperament, attention behavior, anxiety, and coping during a recent medical procedure, and about their own anxiety and parenting style. Coefficients of reliability of the measures were examined and understandability of the instruments was assessed. A forward regression showed that nurturing parenting style, parent's state anxiety, and child's state anxiety accounted for 32% of the variance in child distress during a recent medical procedure.
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Brooks SJ, Kutcher S. Diagnosis and measurement of anxiety disorder in adolescents: a review of commonly used instruments. J Child Adolesc Psychopharmacol 2003; 13:351-400. [PMID: 14642023 DOI: 10.1089/104454603322572688] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As part of a comprehensive review of clinical research tools used in adolescent psychiatric disorders, a survey of 200 recent studies of adolescent anxiety (publication dates of December 1994 to May 2001) identified 70 different diagnostic and symptom measurement instruments. The design features and psychometric properties of the 15 most commonly used instruments were reviewed, and their strengths and weaknesses were evaluated. The conclusions arising from this review are: (1) too many different instruments are being used by investigators; (2) more than 20% of studies did not report the use of developmentally appropriate (i.e., child/adolescent-specific) diagnostic instruments; (3) another 15% of these studies relied on diagnostic instruments that demonstrate substantial weaknesses in reliability and validity; (4) the concordance between anxiety disorder diagnoses from different interview schedules is unknown; (5) the relative validity of diagnoses and ratings of anxiety severity based on information yielded by parents versus information yielded by adolescents is unclear; (6) clinician-rated symptom severity scales specific to anxiety disorder are rarely utilized; (7) the most commonly used self-report measures discriminate poorly between anxiety and depression, and their items are not indexed to specific anxiety disorders; and (8) some newer self-report anxiety instruments discriminate well between anxiety and depression and have diagnostic validity for specific anxiety disorders.
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Affiliation(s)
- Sarah J Brooks
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Kleiber C, Sorenson M, Whiteside K, Gronstal BA, Tannous R. Topical anesthetics for intravenous insertion in children: a randomized equivalency study. Pediatrics 2002; 110:758-61. [PMID: 12359791 DOI: 10.1542/peds.110.4.758] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Children view needle sticks as the worst source of pain and fear in the hospital setting. In an effort to minimize the pain of needle sticks, the use of eutectic mixture of lidocaine and prilocaine (EMLA) has become standard practice in many children's hospitals. Unfortunately, EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction, leading to difficult vein cannulation. A newly available local anesthetic (ELA-Max) may require less time and cause less vasoconstriction. The purpose of this randomized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max. METHODS Thirty well children (14 girls and 16 boys) who were between the ages of 7 and 13 years volunteered to have EMLA applied to the dorsal aspect of 1 hand for 60 minutes and ELA-Max applied to the other hand for 30 minutes. Right and left hands were randomized to treatment type and order of intravenous (IV) insertion. Clinical Research Center nurses, blind to the anesthetic randomization, attempted to insert a 22-gauge Teflon IV catheter into a vein in each hand. The children rated pain during IV insertion on the Oucher scale, and the nurse rated the difficulty of the insertion. RESULTS There was no significant difference in pain ratings for hands that were treated with EMLA (mean: 20.5) or with ELA-Max (mean: 24), and there was no difference for the difficulty of vein cannulation. Children's preprocedure state anxiety was positively associated with pain ratings. CONCLUSIONS ELA-Max, applied for 30 minutes before IV cannulation, has an anesthetic effectiveness similar to EMLA applied for 60 minutes. Some children rated IV insertion pain fairly high for both hands (eg, 60 on a 0- to 100-point scale) despite anesthetic treatment. Preprocedural anxiety may affect the perception and/or rating of pain. There were no differences between hands that were treated with EMLA or with ELA-Max for success of IV insertion.
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Affiliation(s)
- Charmaine Kleiber
- Department of Nursing, Children's Hospital of Iowa with University of Iowa Health Care, Iowa City, Iowa 52242-1083, USA.
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