CTRI

Hospitalization can be a threatening and stressful experience for children [1]. Because of unfamiliar with the environment and medical procedures and unaware of the reasons for hospitalization, it can result in children’s anger, uncertainty, anxiety, and feelings of helplessness [2, 3]. Anxiety is the most commonly reported of these negative responses, and high levels of anxiety can be harmful to children’s physiological and psychological health. Excessive anxiety also impedes children’s efficacy in coping with medical treatment, and increases their uncooperative behaviour and negative emotions towards healthcare professionals [1, 3, 4].

Play has long been regarded as a vital element in the normal growth and development of children [5, 6], and is widely used in many Western countries to alleviate the stress experienced by paediatric patients and their families during hospitalization [7]. Through play, children are given the opportunity to develop mastery of self and the environment and to enhance their understanding of the world [8].

Previous studies have reported that play is an effective method of reducing anxiety, fear, and negative emotions among hospitalized children, contributing to their recovery through physical and emotional comforting, and enabling children to express their feelings and knowledge about their illness while facilitating communication between children and health workers, which is considered important for holistic and high-quality care (9)

Play activities are used in routine care for hospitalized children as a form of preparation for surgical or invasive procedures and also during painful or unpleasant procedures. Play is an effective way of making hospitalization less difficult for children, reducing their pain and anxiety. Play also facilitates harmony and communication between children and health workers. The play has an important role in reducing the negative effects of children’s hospitalization (9).

Wolfer and Visintainer [10] conducted an influential study to examine the stress responses and adjustment to hospitalization of paediatric surgical patients. The result showed that children who received psychological preparation, including hospital play interventions, in contrast to those who did not, reported fewer upset behaviour and post-hospital adjustment problems, but more co-operation with the hospital.

Hospitalized children experience more anxiety and fear due less communication with medical teams, medical equipment, visiting restrictions, not being able to leave their rooms or go to the playroom. Children may also wonder as to the reason for experiencing these conditions and possibly conclude that they are undergoing punishment. Therefore, play is important for reducing anxiety and fear in children. Hence this stud aimed to understand the effect of therapeutic play on fear and anxiety levels in children post-surgery.

It is well known that hospitalization is highly stressful for children and can have adverse effects on their health. Previous studies have indicated that a lack of control over the hospital setting and medical procedures is a major source of stress, which may cause substantial fear and anxiety for hospitalized children. There is evidence that individuals with adequate self-control over a potential threat would encourage a positive coping strategy, consequently improve their psychological health. A hospital play intervention is necessary to help children maintain control through familiarization and rehearsal over the hospital setting and medical procedures.

We also believe that through participating in hospital play activities children would enhance their interpersonal skills and social and creative abilities. Children will not only have fun, but will also be encouraged to desensitize fearful and anxious situations and to instil greater self-control over the new situation that they are involved in. It will also help to improve the interaction of children with healthcare workers.

What is the effect of therapeutic play on fear and anxiety levels in children post-surgery?

To investigate the effect of therapeutic play on fear and anxiety levels in children post-surgery.

2. To find out the anxiety levels of the children with the help of screen for child anxiety related disorders (SACRED).

3. To assess the change in the fear and anxiety levels of children when engaging in therapeutic play with various medical equipment’s, plushies and toys.

Therapeutic play has no effect on fear and anxiety levels in children post-surgery.

Study Setting: Pediatric Physiotherapy IPD, Dr. A.P.J Abdul Kalam college of physiotherapy, Loni.

Informed consent will be obtained from the caregivers of the participants and demographic data will be recorded.

Participants will be administered with the Play therapy intervention for 30 mins per session for 7 days (a week).

The fear levels will be measured using the hospital fears rating scale (HFRS), while the anxiety levels will be measured using the Screen for child anxiety related disorders (SACRED).

Day 1: Initial Play - Going through every step of the medical procedure using different toys and equipment.

Day 2: Medical Play - Various real and/or toy medical equipment like stethoscope, syringe without needles, bandages, medical cup, gloves, mask, and nurse’s cap during children’s hospitalization will be used.

Day 3: Medical Play - Getting children involved in different kinds of expressive play activities like painting, singing, sand play, puppets and encourage them to share or express their feelings.

Day 4: Distraction Play - Interesting sensory toys to distract children’s attention from medical procedure done.

Day 5: Distraction Play - Interesting games like blowing bubbles, music, relaxation techniques will be given to the children.

Day 6: Developmental Play - Involving children in appropriate play activities like board games.

Day 7: Developmental Play - Involving children in appropriate play activities like story books, arts and crafts.

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2. Fernandes SC, Arriaga P. The effects of clown intervention on worries and emotional responses in children undergoing surgery. J Health Psychol. 2010;15:405–15.

3. Li HCW, Lopez V, Lee TLI. Effects of preoperative therapeutic play onmoutcomes of school-age children undergoing day surgery. Res Nurs Health. 2007;30:320–32.

4. Lohaus A, Klein-Hessling J, Ball J, Wild M. The prediction of health-related in behavior in elementary school. J Health Psychol. 2004;9:375–9

5. Erikson E. Childhood and society. 2nd ed. New York: W. W. Norton & Company; 1963.

7. LeVieux-Anglin L, Sawyer EH. Incorporating play interventions into nursing care. Pediatr Nurs. 1993;19:459–63.

8. Norris AE, Aroian KJ, Warren S, Wirth J. Interactive performance and focus groups with adolescents: The power of play. Res Nurs Health. 2012;35:671–9.

9. Buyuk ET, Erdeniz EH, Uzsen H, Odabasoglu E, Koyun M. The Effect of Play Activities for COVID-19 Positive and MIS-C Pediatric Patients on the Anxiety and Fear of Children and Their Parents. Paediatria Croatica. 2021 Oct 1;65(4).