The Effects of Pre-Intervention Training Provided through Therapeutic Play on the Anxiety of Pediatric Oncology Patients during Peripheral Catheterization

Research Article

Austin J Nurs Health Care. 2017; 4(1): 1037.

The Effects of Pre-Intervention Training Provided through Therapeutic Play on the Anxiety of Pediatric Oncology Patients during Peripheral Catheterization

Orhan E1* and Yildiz S2

1Department of Nursing Education, Koc University Hospital, Turkey

2Department of Pediatric Nursing, Istanbul University,Turkey

*Corresponding author: Eda Orhan, Department of Nursing Education, Koc University Hospital, Istanbul, Turkey

Received: March 27, 2017; Accepted: May 02, 2017; Published: May 11, 2017

Abstract

Aim: The study aims to determine the effect of pre-intervention training provided through therapeutic play on reducing the anxiety of pediatric oncology patients during peripheral catheterization.

Materials and Methods: This experimental study was conducted between September 2012 and March 2013. The study included 40 children (20 in the control group and 20 in the experimental group) who were receiving treatment for hematological-oncological diseases in the Pediatric Hematology and Oncology Units of Istanbul University, Istanbul Faculty of Medicine and Cerrahpasa Faculty of Medicine, and in the Department of Pediatrics of the American Hospital. The children were randomly allocated into the experiment and control groups. The children were asked to complete an information form before the peripheral catheterization. The intervention was explained to the experimental group through therapeutic play. The data obtained through the State-Trait Anxiety Inventory for Children (STAIC) after the peripheral catheterization were analyzed using the Statistical Package for Social Science (SPSS) 21 package for Windows.

Findings: It was found that the mean trait anxiety scores were similar and remained moderate in the experimental and control groups; that there wasn’t any statistically difference between the groups (p<0.05); and that the mean state anxiety score of the experimental group was lower than that of the control group (Control: 43.40 ± 5.42, Experimental: 31.50 ± 4.73) and this difference was statistically significant (p<0.001). The state anxiety level was found to be reduced in all children - regardless of the variables - with the training provided through therapeutic play.

Conclusion: Children provided training with therapeutic play before the intervention can reduce their anxiety during procedures, such as peripheral catheterization. The use of therapeutic play made widespread in health institutions will decrease both pain and suffering in children.

Keywords: Therapeutic play; Education; Anxiety; Peripheral catheterization; Cancer; Child

Introduction

Pediatric cancer is a life-threatening chronic disease. Despite significant progress with medical treatment and in the rates of survival in the last 30 years, progress in terms of the children’s psychosocial problems remains inadequate. Therefore, the number of studies on the psychosocial status of children with cancer has increased in the last 15 years [1-3].

The worst aspect of cancer for children diagnosed with the disease is the repetitive and painful treatment procedures to which they are exposed. The frequent intravenous, subcutaneous or intramuscular interventions and insertion of port-catheters cause stress and fear in hospitalized children [4,5].

Nurses should be aware of the fact that any medical practice can be traumatic for children. In particular, school-age children may want to learn the reasons for the medical practices and tests and can ask questions about their disease, as they have an idea of body parts, organs and their functions. Nurses should inform the children about the treatment procedures, making sure that they understand them, and in doing so, choose the appropriate technique for the children’s developmental age, competence for coping with the disease and previous experience [3,6-8].

Nurses also should reduce the children’s anxiety or stress due to the experience they have in the hospital and prepare them for the next treatment procedures they will undergo [9]. One of the most appropriate methods for this is therapeutic play. Therapeutic play is a play technique which reduces the trauma due to the disease or being hospitalized, evaluates the children’s feelings and misunderstandings about the treatment or procedures, and is used for the children to develop positive coping methods before, during and after the events that cause stress [10,11].

Many case studies indicate the benefits of therapeutic play for hospitalized pediatric patients: Therapeutic play was emphasized to be important in meeting the psychosocial needs of pediatric oncology patients by O’Connor and Drennan in 2003, in developing a trust relationship between pediatric patients and healthcare personnel by Pan, Chiu, Shen and Chen in 2004, and in reducing the children’s negative feelings during bloodletting by Riberio and Sabates in 2001 [12].

Children can better understand the reasons for being hospitalized, having surgery or invasive procedures and learn to cope with the stress caused by these factors more effectively. Bandages, injectors without needles, gloves, masks or uniforms to be worn, or dolls on which children can practice, are among appropriate materials that can be used in dramatic play. Medical toys are useful to show medical and surgical operations to children and help them express their feelings [3,4].

Even in a hospital, a child’s world is a world of playing. Enabling hospitalized children to play has become one of the necessities of nursing. In particular, pediatric nurses should know the importance of playing, research this subject and be able to use play while they are giving care to hospitalized children [2,8].

This study aims to determine the effect of pre-intervention training provided through therapeutic play on reducing the anxiety of pediatric oncology patients during peripheral catheterization.

The hypotheses of this study

H0: There is no difference between the postprocedural state anxiety levels of children who receive, or do not receive training through therapeutic play.

H1: The postprocedural state anxiety level is lower in the children who receive training through therapeutic play.

H2: The postprocedural state anxiety level is higher in the children who do not receive training through therapeutic play.

The independent variables of this study were the training provided to the children through therapeutic play and the introductory information on the children (age, gender, education, etc.), and the dependent variable was the score on the State-Trait Anxiety Inventory for Children.

Materials and Methods

The permissions were obtained from the Clinical Research Ethics Committee of Istanbul University, Cerrahpasa Faculty of Medicine Dean’s Office (No: B.30.2.ÎST.0.30.90.00/26699, Date: 9.10.2012), the Pediatric Hematology and Oncology Unit of Cerrahpasa Faculty of Medicine, Department of Pediatrics (No: 31553, Date: 1.11.2012), Istanbul Faculty of Medicine, Oncology Institute (No: B.30.2.IST.0.53.00.00/2901, Date: 10.17.2012), and the American Hospital, Directorate of Nursing Services (No: 13092012-35, Date: 13.09.2012) before the study. The parents and children were informed about the aim, plan and duration of the study using the Informed Consent Form before the study, and then included in the study if they volunteered to participate.

This experimental study was conducted with pediatric oncology patients in the Pediatric Hematology and Oncology Units of Istanbul University, Istanbul Faculty of Medicine and the Cerrahpasa Faculty of Medicine, and in the Department of Pediatrics of American Hospital to analyze the effect of the training provided through therapeutic play before peripheral catheterization on the anxiety level of children aged between 8 and 12 who receive treatment in pediatric hematology-oncology units. The study population consisted of 40 pediatric patients receiving treatment in these units for hematologicaloncological diseases. The sample size was calculated through power analysis at 95% confidence interval and with ± 5% margin of error in line with the literature [1,12], and determined to be 34 patients: 17 in the control group and 17 in the experimental group. All were children (n=40) who were receiving treatment in these units during the dates of this study and met the inclusion criteria, considering the possible participant losses. The children were randomly allocated into the experimental and control groups.

Inclusion criteria

The participants must have been;

Data Collection Tools

The data were collected using the information form for Children prepared by the researcher to obtain introductory information on the children and the State-Trait Anxiety Inventory for Children to assess the children’s anxiety level. During the intervention, the children were provided training using the Chemo Duck toy and a training booklet.

Information form for children

The form includes 18 questions on the children’s age, gender, literacy, number of siblings, health coverage, diagnosis, duration of the diagnosis, knowing the diagnosis, having surgery and the type of the surgery, existence of physical disability and its type, having chemotherapy and number of cycles, having radiotherapy and the number of sessions, and the number of monthly laboratory tests and hospitalizations. The form was administered as a pilot study to the first 10 cases.

The training booklet

The Vascular Access Training and Coloring Book prepared by the researcher provides information about the definition, intended use and benefits of peripheral vascular access through caricaturized drawings and gives the children a chance to color them while reading the information. The drawings have caricaturized by the researcher and the information has referenced and translated in Turkish from The Chemo Duck website [13] (Figure 1).