Azam Shirinabadi Farahani1 
, Ali Omidi2 , Reihane Moghimian Shahrbabaki 3, Fatemeh Akbari Arjestan4 , Mohammadamin Jandaghian-Bidgoli5 , Zohreh Makarem6
, Ali Omidi2 , Reihane Moghimian Shahrbabaki 3, Fatemeh Akbari Arjestan4 , Mohammadamin Jandaghian-Bidgoli5 , Zohreh Makarem6
1- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran ,moghimianreihane1@gmail.com
4- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
6- School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
2- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Reproductive and Family Health Research Center, Kerman University of Medical Sciences, Kerman, Iran ,
4- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
6- School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
Abstract: (134 Views)
Background: Mandala Coloring and Playing are distraction strategies to reduce the anxiety level in children. However, their effects are inconsistent and have received little attention for the management and prevention of anxiety in hospitalized children. The main objective of this study was to compare the effect of distraction strategies of Mandala coloring and playing with Lego on reducing preoperative anxiety in pediatric patients undergoing surgeries.
Methods: The study was designed as a randomized, single-blind, tree-arm, parallel-group controlled trial. There were 96 children aged 6 to 18 years who were admitted to the pediatric surgery ward in Mofid Children's Hospital in Tehran-Iran. Simple randomization was used for choosing the participants for dividing them into two intervention groups and one control group. The interventions (Mandala Coloring and Playing with Lego) lasted 15-20 minutes in Mandala and Lego groups. In the control group, they received care according to the ward’s routine procedure. Anxiety as the main outcome variable was measured using the State-Trait Anxiety Inventory in two stages (before the intervention and immediately after the intervention) for children. Analysis of variance was used to compare the means in the three groups, and Tukey’s post-hoc test was used to assess the significance of differences between pairs of group means.
Results: Less state anxiety was observed after the intervention in the Lego group compared to the Mandala group (-4.69 ± 7.58, P =0.094). The data also revealed significant differences before and after the intervention in the Lego group in terms of preoperative trait anxiety (35.84 ±10.25 and 34.38 ± 8.89, respectively, P = 0.038).
Conclusion: The results demonstrated that playing with Lego and Mandala coloring, compared to the control group that received care, according to the ward routine procedure, had an effective role in reducing preoperative anxiety in children; however, playing with Lego had the most effect on decreasing anxiety state in children.
Methods: The study was designed as a randomized, single-blind, tree-arm, parallel-group controlled trial. There were 96 children aged 6 to 18 years who were admitted to the pediatric surgery ward in Mofid Children's Hospital in Tehran-Iran. Simple randomization was used for choosing the participants for dividing them into two intervention groups and one control group. The interventions (Mandala Coloring and Playing with Lego) lasted 15-20 minutes in Mandala and Lego groups. In the control group, they received care according to the ward’s routine procedure. Anxiety as the main outcome variable was measured using the State-Trait Anxiety Inventory in two stages (before the intervention and immediately after the intervention) for children. Analysis of variance was used to compare the means in the three groups, and Tukey’s post-hoc test was used to assess the significance of differences between pairs of group means.
Results: Less state anxiety was observed after the intervention in the Lego group compared to the Mandala group (-4.69 ± 7.58, P =0.094). The data also revealed significant differences before and after the intervention in the Lego group in terms of preoperative trait anxiety (35.84 ±10.25 and 34.38 ± 8.89, respectively, P = 0.038).
Conclusion: The results demonstrated that playing with Lego and Mandala coloring, compared to the control group that received care, according to the ward routine procedure, had an effective role in reducing preoperative anxiety in children; however, playing with Lego had the most effect on decreasing anxiety state in children.
perspective: Original Article |
Subject:
Nursing
References
1. Gholami S, Mojen LK, Rassouli M, Pahlavanzade B, Farahani AS. The predictors of postoperative pain among children based on the theory of unpleasant symptoms: a descriptive-correlational study. J Pediatr Nurs. 2020;55:141-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Dei‐Asamoa R, Fiagbe D, Dellor D, Osafo J. Predictors of preoperative anxiety in pediatric surgical patients in Ghana: A bi‐center study. Mental Health Science. 2024;2(3):e76. [View at Publisher] [DOI] [Google Scholar]
3. Ünver S, Güray Ö, Aral S. Effectiveness of a group game intervention in reducing preoperative anxiety levels of children and parents: A randomized controlled trial. AORN J. 2020;111(4):403-12. [View at Publisher] [DOI] [Google Scholar]
4. Mathias EG, Pai MS, Bramhagen A-C. Effect of distraction interventions on anxiety in children undergoing surgery: A meta-analysis. Journal of Health and Allied Sciences NU. 2023;13(03):323-31. [View at Publisher] [DOI] [Google Scholar]
5. Alvarez-Garcia C, Yaban ZŞ. The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis. Complementary therapies in clinical practice. 2020;38:101077. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Meletti DP, Meletti JFA, Camargo RPS, Silva LM, Módolo NSP. Psychological preparation reduces preoperative anxiety in children. Randomized and double-blind trial. J Pediatr (Rio J). 2019;95(5):545-51. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Turgut A, İlçe AÖ, Öztürk H. The Effect of Immersive Virtual Reality Application on Anxiety, Pain, and Parental Satisfaction in the Perioperative Process of Children: A Randomized Controlled Trial. Pain Manag Nurs. 2024. [In Press] [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Fronk E, Billick SB. Pre-operative anxiety in pediatric surgery patients: multiple case study analysis with literature review. Psychiatr Q. 2020;91(4):1439-51. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Moghimian R, Babaie M, Amiri S, Moharamkhani M, Dalvand S, Shirinabadi Farahani A. Spiritual Health and COVID-Related Anxiety Among Adolescents with and Without Chronic Disease. Jundishapur J Chronic Dis Care. 2024;13(3):e139448. [View at Publisher] [DOI] [Google Scholar]
10. Robinson EM, Baker R, Hossain MM. Randomized Trial Evaluating the Effectiveness of Coloring on Decreasing Anxiety Among Parents in a Pediatric Surgical Waiting Area. J Pediatr Nurs. 2018;41:80-3. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Gürcan M, Atay Turan S. The effectiveness of mandala drawing in reducing psychological symptoms, anxiety and depression in hospitalised adolescents with cancer: A randomised controlled trial. Eur J Cancer Care (Engl). 2021;30(6):e13491. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Zengin M, Yayan EH, Düken ME. The effects of a therapeutic play/play therapy program on the fear and anxiety levels of hospitalized children after liver transplantation. J Perianesth Nurs. 2021;36(1):81-5. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Purrezaian H, Besharat MA, Koochakzadeh L, Farahani H. Development and effect-evaluation of a new family-based art therapy on depression and pain anxiety of the hospitalized children with cancer. Quarterly of Clinical Psychology Studies. 2020;10(37):21-42. [View at Publisher] [DOI] [Google Scholar]
14. Bosman J, Bood Z, Scherer-Rath M, Dörr H, Christophe N, Sprangers M, et al. The effects of art therapy on anxiety, depression, and quality of life in adults with cancer: a systematic literature review. Support Care Cancer. 2021;29(5):2289-98. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Wong W, Zhang D, Hu J, U C. Improving Emotional and Social Development in Preschool Children: Exploring the Effects of Mindfulness‐Based Mandala Intervention in Social Work Practice in Macao. Child Fam Soc Work. 2024. [View at Publisher] [DOI] [Google Scholar]
16. Khademi F, Rassouli M, Rafiei F, Moayedi S, Torres M, Marzban N, et al. The effect of mandala colouring on anxiety in hospitalized COVID‐19 patients: A randomized controlled clinical trial. Int J Ment Health Nurs. 2021;30(Suppl. 1):1437-44. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Mungalim SM, Rismawati RR. The Effect of Lego Play Activity Therapy on Anxiety Levels of Preschool Children (3-6 years) due to Hospitalisation. Jurnal Ilmiah Keperawatan Indonesia (JIKI). 2020;3(1):57-66. [View at Publisher] [DOI] [Google Scholar]
18. Moghimian Shahrbabaki R, Nourian M, Farahani AS, Nasiri M, Heidari A. Effectiveness of listening to music and playing with Lego on children's postoperative pain. J Pediatr Nurs. 2023;69:e7-12. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Jin Y, Wang C, Zhang X, Deng S. The effective effect of lego toy production on improving the negative emotion of autistic children from the perspective of design psychology. Psychiatr Danub. 2022;34(suppl 4):S44-5. [View at Publisher] [Google Scholar]
20. Deshpande R, Shah MR. Effectiveness of Play Therapy on Pain and Anxiety in Children Post Surgery. International Journal of Health Sciences and Research. 2019;9(4):84-9. [View at Publisher] [Google Scholar]
21. Moll-Bertó A, López-Rodrigo N, Montoro-Pérez N, Mármol-López MI, Montejano-Lozoya R. A Systematic review of the effectiveness of non-pharmacological therapies used by nurses in children undergoing surgery. Pain Manag Nurs. 2024;25(2):195-203. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Spielberger CD, Gorsuch R, Lushene R, Vagg P, Jacobs G. State-trait anxiety inventory. Palo Alto, CA: Mind Garden. 1983. [View at Publisher] [DOI] [Google Scholar]
23. Jodaki K, Abdi K, Mousavi MS, Mokhtari R, Asayesh H, Vandali V, et al. Effect of rosa damascene aromatherapy on anxiety and sleep quality in cardiac patients: A randomized controlled trial. Complement Ther Clin Pract. 2021;42:101299. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Roohy G, Rahmany A, Abdollahy A, Mahmoody GhR. The effect of music on anxiety level of patients and some of physiological responses before abdominal surgery. J Gorgan Univ Med Sci. 2005;7(1):75-8. [View at Publisher] [Google Scholar]
25. Rajeswari SR, Chandrasekhar R, Vinay C, Uloopi K, RojaRamya KS, Ramesh MV. Effectiveness of cognitive behavioral play therapy and audiovisual distraction for management of preoperative anxiety in children. Int J Clin Pediatr Dent. 2019;12(5):419-22. [View at Publisher] [DOI] [PMID] [Google Scholar]
26. Forouzandeh N, Drees F, Forouzandeh M, Darakhshandeh S. The effect of interactive games compared to painting on preoperative anxiety in Iranian children: A randomized clinical trial. Complement Ther Clin Pract. 2020;40:101211. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Vagnoli L, Bettini A, Amore E, De Masi S, Messeri A. Relaxation-guided imagery reduces perioperative anxiety and pain in children: a randomized study. Eur J Pediatr. 2019;178(6):913-21. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. Shaheen A, Nassar O, Khalaf I, Kridli SAO, Jarrah S, Halasa S. The effectiveness of age‐appropriate pre‐operative information session on the anxiety level of school‐age children undergoing elective surgery in Jordan. Int J Nurs Pract. 2018;24(3):e12634. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Al‐Yateem N, Brenner M, Shorrab A, Docherty C. Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non‐inferiority trial. Child Care Health Dev. 2016;42(4):572-81. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Babaei S, Fatahi Babani S, Fakhri M, Shahsavari S, Parviz A, Karbasfrushan A, et al. Painting therapy versus anxiolytic premedication to reduce preoperative anxiety levels in children undergoing tonsillectomy: a randomized controlled trial. Indian J Pediatr. 2021;88(2):190-1. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Lee SL. Why color mandalas? A study of anxiety-reducing mechanisms. Art Ther (Alex). 2018;35(1):35-41. [View at Publisher] [DOI] [Google Scholar]
32. Abbing A, Ponstein A, van Hooren S, de Sonneville L, Swaab H, Baars E. The effectiveness of art therapy for anxiety in adults: A systematic review of randomised and non-randomised controlled trials. PloS one. 2018;13(12):e0208716. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. Chow CH, Van Lieshout RJ, Schmidt LA, Dobson KG, Buckley N. Systematic review: audiovisual interventions for reducing preoperative anxiety in children undergoing elective surgery. J Pediatr Psychol. 2016;41(2):182-203. [View at Publisher] [DOI] [PMID] [Google Scholar]
34. Malik R, Yaddanpudi S, Panda NB, Kohli A, Mathew PJ. Predictors of pre-operative anxiety in Indian children. The Indian Journal of Pediatrics. 2018;85(7):504-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
35. Zamanifard M, Soltanian M, Edraki M, Moravej H, Sharifi N. The Effects of Virtual Directed Painting Therapy on Anxiety, Depression, and Self-efficacy of Children with Type 1 Diabetes: A Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery. 2022;10(3):210-22. [View at Publisher] [DOI] [PMID] [Google Scholar]
36. Härter V, Barkmann C, Wiessner C, Rupprecht M, Reinshagen K, Trah J. Effects of Educational Video on Pre-operative Anxiety in Children-A Randomized Controlled Trial. Front Pediatr. 2021;9:640236. [View at Publisher] [DOI] [PMID] [Google Scholar]
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