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Effect of Puppet Show on Children's anxiety and pain levels during the circumcision operation: A randomized
Özge Karakaya Suzan1, Özlem Öztürk Şahin2, Özer Baran3
1Department of Pediatric Nursing, Faculty of Health Sciences, University of Sakarya, Esentepe Campus, 54187, Turkey.
Insights
A puppet show during pediatric circumcision significantly reduced children's anxiety and pain. This non-pharmacological intervention offers a novel approach to managing procedural distress in young patients.
Area of Science:
- Pediatric Surgery
- Child Psychology
- Nursing Interventions
Background:
- Surgical procedures, particularly circumcision, are significant sources of anxiety and pain in hospitalized children.
- Therapeutic play, a non-pharmacological method, is increasingly used to manage pediatric procedural pain and anxiety.
- While therapeutic play has been used before and after surgeries, its application during procedures, specifically puppet shows, remains underexplored.
Purpose of the Study:
- To evaluate the effectiveness of a puppet show intervention on anxiety and pain levels in children aged 7-11 undergoing circumcision.
- To address the gap in research regarding therapeutic play implemented during surgical procedures.
Main Methods:
- A randomized controlled trial was conducted with 81 children aged 7-11 undergoing circumcision.
- Participants were divided into an experimental group (receiving a puppet show) and a control group.
- Pain and anxiety levels were assessed using the Wong Baker Faces Pain Rating Scale and the State-Trait Anxiety Inventory for Children.
Main Results:
- The experimental group demonstrated statistically significant lower median pain scores during and after circumcision compared to the control group.
- Children in the experimental group showed significant reductions in anxiety levels during and after the procedure compared to pre-treatment levels.
- The control group experienced increased anxiety during the procedure, with a subsequent decrease post-procedure.
Conclusions:
- The puppet show intervention effectively reduced pain and anxiety in children during and after circumcision.
- This study highlights the potential of puppet shows as a valuable therapeutic play method during pediatric surgical procedures.
- The findings support the integration of such non-pharmacological interventions in pediatric care to mitigate procedural distress.
Introduction:
Surgical procedures are the most common causes of anxiety and pain in hospitalized children. One of the most common surgical procedures for children is circumcision. Surgical procedures such as circumcision in hospitals are the most common causes of pain, fear, and anxiety in children. Therapeutic play methods as non-pharmacological applications are being developed recently for children who use analgesics in the treatment of pain and anxiety. Nurses can use the game in three areas such as a care strategy for hospitalized children during daily routine practices, surgery, and invasive or painful treatment procedures. An extensive literature review revealed that there were therapeutic game plays performed before and after the surgical procedure. Nonetheless, no therapeutic game play performed during the surgical procedure were reported. In addition, no reported study of puppet show which is one of the therapeutic game methods were found.
Objective:
The aim of this study was to investigate the effect of the puppet show demonstrated to 7-11 years old children during circumcision on the anxiety and pain level of children.
Design:
The study was designed as a randomized controlled experiment.
Materials And Methods:
The population of the study was the children between 7 and 11 years of old and being circumcised in the urology clinic at Research and Training Hospital in Karabük Turkey between 1 May and 1 September 2017. A total of 81 (experimental group: 40, control group: 41) children were included in the study. "Participant Information Form", "Wong Baker Faces Pain Rating Scale" and "State-Trait Anxiety Inventory for Children" were used as implemented in the literature.
Results:
The median pain score of the experimental group during and after the procedure was statistically lower than the control group. The level of anxiety during and after the procedure in the experimental group showed a statistically significant decrease compared to the pre-treatment level and the level of anxiety after the procedure showed a statistically significant decrease compared to the procedure. In the control group, while the level of anxiety during the procedure showed a statistically significant increase compared to the pre-treatment level, the level of anxiety after the procedure showed a statistically significant decrease compared to the one during the procedure.
Conclusion:
It was concluded that the puppet show performed during the circumcision procedure was effective in reducing the pain and anxiety that developed during the circumcision and continued after the procedure.
