International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 11, June, 2013

Pages: 111-117

Date of Publication: 18-Jun-2013


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EFFECT OF PLAY INTERVENTION IN THE REDUCTION OF ANXIETY AMONG PREOPERATIVE CHILDREN

Author: Nisha K., Umarani J.

Category: Healthcare

Abstract:An important index used to estimate the Nation's health is, the health status of children in the country. Children are more vulnerable due to their lack of knowledge of procedures, a lack of control, a lack of explanation in child-appropriate terms, and a lack of pain management. Hospitalized children may experience high level of anxiety due to many different factors both physical and psychological factors. The present study aimed to determine the effectiveness of play intervention on anxiety among children admitted in preoperative wards of selected hospitals at Mangalore. The objectives of the study were to determine the effectiveness of play intervention among experimental group. The study design was two group pre-test post- test design. The sample comprised of 60 preoperative school age children in the age of 6-12 years who were selected by Purposive sampling technique and divided into experimental and control group. Pretest anxiety was assessed and play intervention(video game) was given to the experimental group along with the routine care and only routine care to the control group. The data was collected by using demographic proforma and numerical state anxiety scale. The study result showed that the calculated 't' value ( t= 4.225) was greater than the table value (t58 = 1.671) at 0.05 level of significance. The pre-test anxiety score was independent of all the demographic variables such as age, gender, religion, type of family, residence, care giver present during hospital stay, past child reactions to any procedures. The finding of the study shows that the play intervention was effective in reducing the anxiety among preoperative children.

Keywords: Effectiveness, school age children, anxiety, play intervention.

Full Text:

INTRODUCTION
An important index used to estimate the Nation’s health is the health status of children in the country1 . Unfortunately, even the healthiest baby can get sick2 . Surgery can be a threatening experience for everyone, especially for children. Hospitalized children may experience high level of anxiety due to many different factors both physical and psychological factors1 . It is not surprising therefore that up to 65% of children experience significant anxiety associated with the preoperative period2 . A child’s surgery is often a very significant and memorable event in the life of the entire family and especially the child’s personal history3 . Preoperative anxiety is an extremely unpleasant sensation for children4 . Preoperative anxiety refers to anxiety regarding the events that take place prior to surgery5 . In India approximately 3 million of children undergo surgery, among them boys are more than girls and the ratio is 7:46 . Up to 25% of children have been noted to require physical restraint7 . Loss of freedom can produce stress and anxiety in children8 . Play therapy in a hospitalized setting is innovative and concisely accomplishes the task of supporting children emotionally in their time of chaos, fear, and pain9 . The nurses play an important role in helping the parent and child cope with their anxiety and stress7 . The anxiety caused by the hospital environment and surgical procedure may be harmful during the preoperative period because it might affect cognitive, social, and affective development, in addition to increasing negative behaviours during the child’s postoperative period10. The pharmacological and non pharmacological therapy is used to reduce the anxiety of the child11. Play is an important part of child life and it is an important aspect to foster the growth and development of a child12. Play comes naturally to children and is often their favourite activity. Providing an environment conducive to play activities like giving a toys or using of handheld game technology to make the environment less threatening, has been shown to reduce anxiety and this also help in getting child cooperation with medical procedures and anaesthesia induction13 . A study was conducted to identify the effect of play on pre-operational anxiety among children. There was a significant reduction in the trend of anxiety increment after surgery in the intervention group in comparison to the control group. Attending in playrooms and using play activities might have reduced the trend of increment in the anxiety level induced by surgical procedures6 . The influence of play activity among children between 5 and 12 years of age undergoing medical procedures at the outpatient surgical centre revealed that during the preoperative period, children who participated in playful activities in the recreation room had their anxiety reduced in comparison with those that only stayed in the preoperative holding area14 . The child copes up with the anxiety in different ways. So the investigator felt the need of using a distracter as diversion therapy. A conceptual framework is an interrelated concepts or abstractions assembled together in a rational scheme by virtue of their relevance to a common theme. The conceptual framework used in the present study was adapted from the General Systems Theory introduced by Ludwig Van Bertalanffy (1968)15,16 .

MATERIAL AND METHODS
The study design chosen was two group pre-test post- test design. The population of the study was school age children at selected private hospitals at Mangalore. Permission from the institution ethics committee was obtained prior to the study. The parents of the children gave written consent for the study. Purposive sampling technique was used for selecting the study subjects. The sample comprised of 60 school age children of 6-12 years who got admitted in the preoperative ward subjected to surgery within 24 hours and divided into 30 for experimental and 30 for control group. The tool used for the study was demographic proforma and Numerical State Anxiety Scale. After a brief self introduction, the investigator explained the purpose of the study and obtained informed consent from the parents. On the first day the investigator observed the setting, structure, and the appliances for use. The investigator obtained consent from the parents to participate in the study. The parents were interviewed on the basis of baseline proforma. The investigator made the children comfortable on the bed comfortably. Pretest was assessed for both experimental and control group using numerical state anxiety scale. Then the experimental group children were provided with standard care and play intervention [video game] half an hour in the morning and half an hour in the evening for one day prior to surgery and the children in the control group was given only standardized care. Post test was assessed to both groups using Numerical State Anxiety Scale. The data was analyzed by descriptive and inferential statistics.

RESULT
In experimental group highest percentage (43.3%) of children were in the age group 8- 10yrs, where as in control group majority (36.3%) of children were in the age group 10- 12yrs. Highest percentages of children were females (53.3%) in the experimental group and in the control group (50%). Majority of the children were in joint family the experimental group (50%) and the control group majority (43.3%). Most of the children in experimental group were from rural area (53.3%) and in the control group children were (50%) from both rural and urban area. Highest percentages of care giver present in the experimental group were (33.3%) both mother’s and father’s whereas in control groups (36.3%) were mothers. With regard to past reaction to any other procedure is minimal with the percentage of (56.3%) in the experimental group and (50%) control group. The experimental and control group (100%) has not under gone any distraction technique during hospital stay. Figure.1. depicts that all the children in the experimental group and control group were having a lot anxious. In the post-test of experimental group 80% of them had medium anxious level and 20% were having little anxious. In the post test score of control group 87% were having a lot anxious, 13% had medium anxious and pre-test remained the same even in the experimental group. The post-test level of anxiety in the experimental group was found to be lower than the control group. Computed paired ‘t’ test showed the effectiveness of play intervention in reducing the anxiety in the experimental group. Table.1and 2 showed that the mean post-test anxiety score (3.43±1) was lower than mean pre-test score (6.4± 0.5). The calculated ‘t’ value ( t= 4.225) was greater than the table value (t29 = 1.699) at 0.05 level of significance. To test the effectiveness of play intervention, statistical significance between the post- test anxiety scores in the experimental and control group, unpaired ‘t’ test was computed. The mean score of experimental group (3.43±1) was lower than mean of control group (4.43 ± 0.83). The calculated ‘t’ value (t= 4.225) was greater than the table value (t58 = 1.671) at 0.05 level of significance. Hence the research hypothesis was accepted. Hence there is a significant difference in the anxiety score of children between experimental and control group. The associations of the pre-test anxiety score with selected demographic variables were found out by using Chi-square test. The data presented in experimental group shows there was a no significant association of the pre-test anxiety score with selected demographic variable as the calculated value is less than the table value at 0.05 level of significance, but for the gender, table value is lower than the calculated value. Hence the hypothesis was accepted as there was a significant association between gender and anxiety. The data presented in the control group shows there was a no significant association of the pre-test anxiety score as calculated value is less than the table value at 0.05 level of significance. Hence the hypothesis is rejected as, there is no significant association between anxiety level and selected demographic variables.

DISCUSSION
The pre-test anxiety scores in both control and experimental group showed that the entire sample had alot anxious. But in the post-test, anxiety level in the experimental group showed that majority (80%) of the sample experienced medium anxious and 20% little. In the control group majority (90%) was found to have medium anxious and 10% experienced alot anxious. A study was done to evaluate the level and prevalence of anxiety at the preoperative period using the YPAS-m in preschool children. The study result showed that their is significant difference in the level of anxiety in experimental and control group17 . Effectiveness of play intervention is calculated using unpaired t test. The mean score of experimental group (3.43±1) was lower than mean of control group (4.43±0.83). The calculated ‘t’ value ( t= 4.225) was greater than the table value (t58 = 1.671) at 0.05 level of significance. This study is supported by another study done among children between ages of 3–6 yr who were randomized into two equal groups. The anxiety of each child was assessed using the Modified Yale Preoperative Anxiety Scale. The experimental group was provided with a toy and standard care and control group by only standard care. The results showed significantly less anxiety in children who received a toy than the other group who did not18 . A study was done with a total of 150 children aged 2-16 yrs, the sample was divided into two groups; experimental group were provided with standard care and play room activity and control group with standard care. The State-Trait Anxiety Inventory was used to assess anxiety. The analysis showed that 51.1% of children in experimental group were having reduced anxiety19 . For determine the association between level of anxiety among children in preoperative wards with selected demographic was done there were no significant association between anxiety level and selected demographic variables in control groups. But in experimental group the gender of children shows significant association. This study was supported by a study in which the children of age group 3-7 yrs showed a significant association between anxiety level and age and gender20 . The present study was confined to a specific geographical area which obviously imposes limits to any larger generalization. The study was confined to a small number of subjects. However it could be done on more samples for larger generalization. Anxiety was assessed using only Numerical State Anxiety Scale. Play intervention was given just, a day prior to surgery.

CONCLUSION
The present study highlighted the effectiveness of play intervention on anxiety as a nonpharmacological and cost effective intervention for children. Anxiety is a situation where all children will face in all age group. Diversion therapy is chosen as the primary intervention for decreasing the anxiety level of children in preoperative ward because it provides a simple approach in reducing anxiety. A better understanding of health issues associated with the anxiety among school children has constituted a challenge for clinician and researchers. So there is a great lot scope for exploring this area. Research should be conducted to identify the scope of play intervention to alleviate anxiety among children

References:

1. Marlow DR, Redding BA. Text book of Pediatric Nursing. 6th ed. Pennsylvania: WB Saunders Publication; 2008.p. 386-8.

2. Wilson D andHockenberry MJ. Nursing Care of Infants and Children. 8th ed. New Delhi: Elsevier Pvt Limited; 2007.p. 456-9.

3. Kain, Z. N., and Caldwell-Andrews, A. (2005). Preoperative psychological preparation of the child for surgery: An update. Anesthesiology Clinics of North America, 23, 597-614.

4. Cooke M, Chaboyer W, Hiratos M, Schluter P. The effect of music on pre-operative anxiety in day surgery. Journal of Advanced Nursing. 2005;52(1):47-55.

5. Peter J. D, Franklyn P. and Etsuro K. Smith’s Anesthesia for Infants and Children, 8th ed. Elsevier Pvt Limited;philadelfia;2007.457-8

6. Wright k.d , Sherry H. S, Allen F G etl.( 2007) Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children. A critical review. Behavior Modification; 2007, 31:52-79.

7. Lumley MA, Melamed BG, Abeles LA. Predicting children's presurgical anxiety and subsequent behavior changes.Source;jpj, 1993 Aug;18(4):481-97.

8. Julie L. Lerwick. The Impact of ChildCentered Play Therapy on Anxiety Levels in Pre Neurosurgical Pediatric Patients; Anesthesiology Clinics of North America, 23, 58-7.

9. Li, H. C., Lopez, V., and Lee, T. L. (2007). Effects of preopertive therapeutic play on outcomes of school-age children undergoing day surgery. Research in Nursing and Health, 30, 320-332.

10. Susan C. Reinhard. Barbara G. Nirvana Huhtala P. Ann B. Supporting Family Caregivers in Providing Care. Bookshelf ID: NBK2665PMID: 21328765.

11. Browne NT, Flanigan LM, McComiskey CA, Pieper P. Nursing Care of the Pediatric Surgical Patient. Boston, Mass: Jones and Bartlett Publishers; 2007:3-16.

12. Golden L, Pagala M, Sukhavasi S, Nagpal D, Ahmad A, Mahanta. Giving toys to children reduces their anxiety about receiving premedication for surgery. AnesthAnalg. 2006;102:1070-2.

13. Ammed M.J, Farrell M.A, Karala A etl, preoperative anxiety in children risk factors and nonpharmacolcogical management. M.E.J. ANESTH .2011, 21 (2).

14. Weber Fernanda Seganfredo. The influence of playful activities on children's anxiety during the preoperative period at the outpatient surgical center. J. Pediatr. (Rio J.) [serial on the Internet]. 2010 June [cited 2013 May 18] ; 86(3): 209-214. Available from:http://www.scielo.br/scielo.php?script =sci_arttextandpid=S0021755720100003000 08andlng=en. http://dx.doi. org/10.1590/ S0021-75572010000300008.

15. Polit DF, Hungler BP. Nursing research principles and methods. 6th ed. Philadelphia: Lippincott; 1999. 16. Talbot LA. Principles and practice of nursing research. St. Louis: Mosby; 1995

17. Talbot LA. Principles and practice of nursing research. St. Louis: Mosby; 1995 Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, HofstadterMB. The Yale Preoperative Anxiety Scale: how does it comparewith a ”gold standard”AnesthAnalg. 1997;85:783-8.

18. Clatworthy, S. (1981). Therapeutic play: Effects on hospitalized children. Journal of the Association for the Care of Children’s Health, 9(4), 108-114.

19. Caprilli, S., Anastasi, F., Grotto, R., Abeti, M. S., andMesseri, A. (2007). Interactive music as a treatment for anxiety and stress in children during preoperative period: A randomized prospective study. Journal of Developmental and Behavioral Pediatrics, 28(5), 399-403

20. Li, H. C., and Lopez, V. (2008). Effectiveness and appropriateness of therapeutic play intervention in preparing children for surgery: A randomized controlled trial study. Journal forSpecialists in Pediatric Nursing, 13(2), 63-73.

Data in table 2 shows that, the mean anxiety score of experimental group (3.43±1) was lower than mean of control group (4.43±0.83). The calculated ‘t’ value ( t= 4.225) was greater than the table value (t58 = 1.671) at 0.05 level of significance. Hence the hypotheses was accepted as there was a significant difference in the anxiety score of children between experimental and control group


Figures 1 show that in experimental group and control group were having 100% of a lot anxious. The post-test of experimental group were 80% of them had medium anxious level and 20% were has little anxious. In post test score control group 87% of sample were a lot anxious, 13% had of sample had medium anxious and pre-test remained same even in the experimental group.

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Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
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List of Awardees

Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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