Effectiveness of Picture Book on Preoperative Anxiety among Children (6-12 Years) in Selected Hospitals at Mangalore

 

Jenifa Rohila Noronha1*,  Shanthi S2

1II year M.Sc. Nursing, Laxmi Memorial College of Nursing, Mangalore, Karnataka,

2Assistant professor, Laxmi Memorial College of Nursing, Mangalore, Karnataka,

*Corresponding Author Email: jenifanoronha@gmail.com, shantjoe82@gmail.com

 

ABSTRACT:

Surgery can be a threatening experience for everyone, especially for children. Children are more vulnerable for anxiety due to their lack of knowledge of procedures, a lack of perceived control, a lack of explanation in child-appropriate terms, and a lack of pain management. The aim of the study was to assess the effectiveness of picture book on preoperative anxiety among children (6-12 years). A Quasi experimental pre-test post-test control group design was used and purposive sampling technique was adopted to select the total 30 preoperative children. Hamilton anxiety rating scale was used to assess the preoperative anxiety in children. The results shown that, experimental group (80%) had severe anxiety and control group (60%) had moderate to severe anxiety in pre test  and during post test highest percentage of subjects in the experimental group (53.33%) had mild to moderate anxiety while comparing to control group. The mean post-test anxiety level (24.8±2.98) was lowered than the pre-test anxiety level (32.86±3.29), t(14)=2.15, p<0.05. The mean post-test level of anxiety in experimental group (24.8±2.98) was significantly lower than the mean post-test anxiety level of the control group (30.07±2.96), t(28)=2.05, p<0.05.  Hence it is revealed  that picture book found effective in reducing the preoperative anxiety among children.

 

KEYWORDS: Effectiveness; Picture book; Pre-operative anxiety; Preoperative children

 

 

INTRODUCTION:

Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomena that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been associated with display a number of maladaptive behaviors, in post-surgery, including post-operative pain, sleeping disturbances, parent-child conflict and separation anxiety.1 It is estimated that 50% to 75% of children undergoing surgery will develop extreme anxiety and distress during the preoperative period.2

Children have some developmental limitations in cognitive capacities, self-control and greater dependency to the caregivers, so they are more vulnerable to the operational stress and anxiety than adults.3 The provision of pre-operative information on pre and postoperative care is the most common method of preparing children for surgery. However, this approach is mostly focused on providing procedural information, the psychological needs of children also increases knowledge, enhances coping strategies, decreases anxiety, lessens fears and better trust between families and health care providers.4

 

A  study conducted on effect of performing preoperative preparation programme on school age children’s anxiety. A randomized controlled trail was performed on 122 children age of 7-12years of age (experimental group-61 and control group-61) in Aminkola pediatric hospital, Mazandaran.. The experimental group received a therapeutic play therapy and the study was concluded that therapeutic play intervention is an appropriate method for preparing children before surgery decreases their anxiety.5 Another study which was conducted to evaluate the effects of surgery preparation using children’s book to prepare children and parents for elective ENT surgery. The sample consisted of 160 mother/child (2-10 years) in the experimental group and 240 samples in control group. The preoperational book were given to experimental group, Results showed that mothers and children who received the book exhibited less self-reported state anxiety prior to the operation compared control group. Pre –operative preparation book can provide educational and anxiety reducing benefits.6

 

MATERIALS AND METHODS:

A quasi experimental study design was used. The population of the study was preoperative children (6-12 years) at selected hospitals, Mangalore. Approval of the study was obtained from institution’s ethics committee. Purposive sampling technique was utilized to select the 30 subjects based on their inclusion criteria. The samples were randomly assigned into experimental group (n=15) and control group (n=15). The consent was taken from the parents prior to the data collections. The data was collected by demographic proforma and Hamilton Anxiety Rating scale. Pre test was assessed for both experimental and control group 24 hours before the surgery. The experimental group were provided with picture book along with standard care, whereas control group received only a standard care. The picture book consisted of preoperative, intraoperative and postoperative interventions. The post test was assessed on the day of surgery for both the group by using Hamilton Anxiety Rating scale.

 

 

RESULTS:

Demographic Variables:

The highest percentage of subjects in the control group (53.33%) was in the age group of 8-10 years, where as in the experimental group (60%) was in the age group of 6-8 years. The highest percentage of the subjects in the experimental group and control group (66.66%) were males and the least percentage (33.33%) were females. Majority of the sample in the control group (53.33%) belonged to 3rd to 5th standard and in experimental group (60%) belonged to 1st to 3rd standard. The highest percentage of subjects in the experimental group (60%) and in the control group (80%) was belonged to nuclear family. With regard to the parents educational status majority (86.66%) in control group and experimental group (80%) were educated.

 

Level of Preoperative Anxiety:

The data in  table 1 shows  that, highest percentage of subjects in the experimental group (80%) had severe anxiety and control group (60%) had moderate to severe anxiety in pre test  and during post test highest percentage of subjects in the experimental group (53.33%) had mild to moderate anxiety and control group (73.33%) had moderate to severe anxiety.

 

Effectiveness of picture book in reducing preoperative anxiety of children (6-12 years of age)

To find out the significant difference between the mean pre-test and post –test anxiety levels, paired ‘t’ test was used.

 

The data in table 2 depict that, the mean post-test anxiety level (24.8±2.98) was lowered than the pre-test anxiety level (32.86±3.29). The calculated ‘t’ value (t=6.92) was greater than the table value (t(14)=2.15), p<0.05.  To test the significant difference between the mean post-test anxiety levels of the experimental and control group, unpaired ‘t’ test was used.

 

Table 1: Grading of pre and post test preoperative anxiety score of children (6-12 years of age) in experimental and control group.                      N=15+15

Interpretation

Experimental group

Control Group

Pre test

Post test

Pre test

Post test

(f)

(%)

(f)

(%)

(f)

(%)

(f)

(%)

Mild severity (<17)

-

-

-

-

-

-

-

-

Mild to Moderate (18-24)

-

-

8

53.33

1

6.66

-

-

Moderate to severe (25-30)

3

20

6

40

9

60

11

73.33

Severe (>30 )

12

80

1

6.66

5

33

4

26.66

 

Table 2: Mean, mean difference, standard deviation and ‘t’ values of pre-test and post-test anxiety levels.                              N=15

 

Mean

SD

Mean difference

t value

Pre test

32.87

3.29

8.06

6.92*

Post test

24.8

2.98

df=14, p<0.05

 

 

Table 3: Mean, mean difference, standard deviation and ‘t’ values of the post-test anxiety levels of control group and experimental group.                                                                                                     N=15+15

 

 

Mean

SD

Mean difference

t value

 

Experimental group

24.80

2.98

5.27

4.85*

Control group

30.07

2.96

t(28)=2.05, p<0.05    * Significant.

 

The data in Table 3 shows that the mean post-test anxiety level of experimental group (24.8±2.98) was significantly lower than the mean post-test anxiety level of the control group (30.07±2.96),  the calculated t value (t= 4.85) was greater than the table value (t(28)=2.05), p<0.05.  Hence it is conclude that children in the experimental group had reduction in preoperative anxiety when comparing to control group and also picture book found effective in reducing the preoperative anxiety among children.

 

Association between Post-Test Preoperative Anxiety Scores with Selected Demographic Variables:

There was no significant association between the post-test preoperative anxiety scores with demographic variables in the experimental group and control group.

 

DISCUSSION:

In the present study, the highest number of subjects in control group belonged to the  age group of 8-10 years and  3rd to 5th standard similarly in the experimental group belonged to the  age group of 6-8 year and 1st to 3rd standard.. The majority of subjects in the experimental group and control group were males. The pre-test preoperative anxiety of subjects in the experimental group had severe anxiety and control group had moderate to severe anxiety where during Post-test, preoperative anxiety of subjects in the experimental group had mild to moderate anxiety while comparing to control group.  The findings were supported by a study conducted in Manipal to determine the Effectiveness of picture book on children’s worries about surgery among 60 preoperative children, who were assigned into experimental (30) and control group (30). Majority of the children in the experimental group 20 (66.7%) and in control group 15 (50%) were in the age group of 5-9 years. The number of males were more both in experimental 21(70%) and in control group 25 (83.3%). The majority of the children in control group (56.7%) and experimental group (66.7%) were in lower primary education. The study results also showed that the majority (56.7%) of children in the control and 50% of children in experimental group had moderate worry related to surgery during pre-test and post-test was found that 66.7% of children had moderate worry in control group where as 66.7% children in experimental group had mild to moderate worries.7 Statistically  significant difference  was found between the mean post-test anxiety level and pre-test anxiety level in the experimental group also the mean post-test anxiety level of experimental group was significantly lower than control group . The similar study conducted in Mangalore on the effectiveness of play intervention on 60 preoperative children in the age group of 6-12 years showed that 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 (t(58)=1.671) at 0.05 level of significance.8

 

CONCLUSION:

The findings of the present study indicated that picture book was effective in reducing the preoperative anxiety in children.

 

REFERENCES:

1.       Wright KD, Sherry HS, Allen FG. Prevention and Intervention strategies to alleviate Preoperative anxiety in children. A critical review. Behaviour Modification 2007; 31(1):52-79.

2.       Jones E, Landreth G. The efficacy of intensive individual play therapy for chronically ill children. International Journal of Play Therapy 2006 Aug;1: 117-40

3.       Morrow V, Richards M. The ethics of social research with children: an overview. Children & Society 2008 Jun;10(2):90-105.

4.       Zahr LK. Therapeutic play for hospitalised preschool in Lebanon. Paediatric Nursing 2004;23(5):449-54.

5.       Nazamin V. The effect of performing preoperative preparation programme on school age children’s anxiety. Iran journal of paediatrics. 2011 Dec; 21(4):461-466

6.       Felder PR, Maksys A, Noestlinger C, Gadner H, Stark H, Pfluegler A, et al. Using a children's book to prepare children and parents for elective ENT surgery: results of a randomised clinical trial. International Journal of Paediatric Otorhinolaryngology. 2003 Jan;67(1):35-41.

7.       Babitha M, Mamatha S, Anjaline. Effectiveness of picture book on children’s worries about surgery. International Journal of Nursing Education 2011 Jul-Dec;3(2):8-11

8.       Nisha K, Umarani J. Effect of play intervention in reduction of anxiety among preoperative children. International Journal of Current Research and Review 2013 Jun;5(11):104-8.

 

 

 

 

Received on 18.05.2015                                                 Modified on 20.06.2015

Accepted on 26.06.2015                                      © A&V Publication all right reserved

Asian J. Nur. Edu. and Research 5(4): Oct.- Dec.2015; Page 523-525

DOI: 10.5958/2349-2996.2015.00107.X