Systematic Reviews and Meta Analysis
The Effect of Hospital Clown Intervention on Children on Anxiety in the Preoperative Period: A Systematic Review
Abstract
Objective: In the preoperative period, children experience anxiety. Anxiety in the preoperative period should be reduced in order to increase the compatibility of children with the applied procedures. This review was carried out to examine randomized controlled studies to determine the effect of the hospital clown intervention on children level of anxiety in the preoperative period.
Method: This research is a systematic review. In this respect, "preoperative, non-pharmacological methods, child, anxiety and clown" keywords were matched and five databases, including PubMed, MEDLINE, Google Scholar, Science Direct and Cochrane, were searched for the years 2005-2021.
Results: A total of 1207 publications were reached as a result of the search of databases in this research. A total of 10 (N=1506) publications that met the inclusion criteria were included in the research and evaluated in terms of results. Within the scope of the study, interventions were made with children aged between 2 and 16 years in the pediatric service, during the transfer to the operating room, during the anesthesia induction and in the post-operative period, with medical clown, art therapy, midazolam, hydroxyzine and parental presence. Children's anxiety levels were evaluated with the "State-Trait Anxiety Inventory" or "Modified Yale Preoperative Anxiety Scale".
Conclusion: It was concluded that the hospital clown intervention applied to children was effective in reducing anxiety in the preoperative period.
Keywords
References
- Aleo E, Picado AL, Abancens BJ, Soto Beauregard C, Tur Salamanca N, Esteban Polonios C, Torrejon MJ, Perrino CG, Rivas A, Arias E, Rodriguez D, Rivas MA, Rojo MLR, Garcia PF, Alarcon JR, Urguiza BSP. (2021). Evaluation of the effect of hydroxyzine on preoperative anxiety and anesthetic adequacy in children: double blind randomized clinical trial. BioMed Research İnternational, 7394042.
- Charana A, Tripsianis G, Matziou V, Vaos G, Latrou C, Chloropoulou P. (2018). Preoperative anxiety in greek children and their parents when presenting for routine surgery. Anesthesiology Research and Practice, 2, 1-6.
- Dionigi A ve Gremigni P. (2017). A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children. Journal of Clinical Nursing, 26 (5-6), 632-640.
- Dionigi A, Sangiorgi D, Flangini R. (2014). Clown intervention to reduce preoperative anxiety in children and parents: a randomized controlled trial. Journal of Health Psychology, 19(3), 369-80.
- Dur Ş, Gözen D, Bilgin M. (2016). Attitudes and behavior of nurses in state and private hospitals with respect to family-centered care. The Journal of Current Pediatrics, 14, 1-9.
- Efrat-Triester D, Altman D, Friedmann E, Margalit DL, Teodorescu K. (2021). Exploring the usefulness of medical clowns in elevating satisfaction and reducing aggressive tendencies in pediatric and adult hospital wards. BMC Health Services Research, 21 (1), 15.
- Eijlers R, Dierckx B, Staals LM, Berghmans JM, van der Schroeff MP, Strabbing EM, Utens EM. (2019). Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: a randomised controlled trial. European Journal of Anaesthesiology, 36 (10), 728-737.
- Golan G, Tighe P, Dobija N, Perel A, Keidan I. (2009). Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial. Paediatric Anaesthesia, 19 (3), 262-266.
- Hansen LK, Kibaek M, Martinussen T, Kragh L, Hejl M. (2011). Effect of a clown's presence at botulinum toxin injections in children: a randomized, prospective study. Journal of Pain Research, 4, 297-300.
- He HG, Zhu L, Chan SWC, Liam JLW, Li HCW, Ko SS, Wang W. (2015). Therapeutic play intervention on children's perioperative anxiety, negative emotional manifestation and postoperative pain: a randomized controlled trial. Journal of Advanced Nursing, 71(5), 1032-1043.
- Hür G, Zengin H, Suzan ÖK, Kolukısa T, Eroğlu A, Çınar N. (2022). Joanna Brıggs Enstitüsü (JBE) randomize kontrollü çalışmalar için kalite değerlendirme aracı’nın Türkçe’ye uyarlaması. Sağlık Bilimlerinde İleri Araştırmalar Dergisi, 5 (2), 112-117.
- Javed T, Khan AS, Jarral NA, Taqi Z, Raza M, Shahid Z. (2021). Medical clowning: a cost-effective way to reduce stress among children undergoing invasive procedures. Cureus, 13 (10), e18886.
- Joanna Briggs Institute. Critical Appraisal Tools. (2018). Erişim Tarihi: 17.05.2022. https://jbi.global/critical-appraisal-tools
- Kocherov S, Hen Y, Jaworowski S, Ostrovsky I, Eidelman AI, Gozal Y, Chertin B. (2016). Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: a randomised controlled trial. Journal of Paediatrics and Child Health, 52(9), 877-881.
- Kristensen HN, Lundbye-Christensen S, Haslund-Thomsen H, Graven-Nielsen T, Elgaard Sørensen E. (2018). Acute procedural pain in children: intervention with the hospital clown. The Clinical Journal of Pain, 34(11),1032-1038.
- Kristensen HN, Sørensen EE, Stinson J, Thomsen HH. (2019). “We do it together!” An ethnographic study of the alliance between child and hospital clown during venipunctures. Journal of Pediatric Nursing, 46:e77-e85.
- Leguizamon CR, Castano BO, Morales CG, Cifuentes NL. (2017). Humour therapy intervention to reduce stress and anxiety in paediatric anaesthetic induction, a pilot study. British Journal of Anaesthesia, 119(4), 847-848.
- Lopes-Júnior LC, Bomfim E, Olson K, Neves ET, Silveira DSC, Nunes MDR, Nascimento LC, Pereira-da-Silva G, Lima RAG. (2020). Effectiveness of hospital clowns for symptom management in paediatrics: Systematic review of randomised and non-randomised controlled trials. British Medical Journal, 16, 371.
- Meiri N, Schnapp Z, Ankri A, Nahmias I, Raviv A, Sagi O, Saied MH, Konopnicki M, Pillar G. (2017). Fear of clowns in hospitalized children: prospective experience. European Journal of Pediatrics, 176(2), 269-272.
- Messina M, Molinaro F, Meucci D, Angotti R, Giuntini L, Cerchia E, Brandigi E. (2014). Preoperative distraction in children: hand-held videogames vs clown therapy. La Pediatria Medica e Chirurgica, 36, 5-6.
- Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLOS Medicine, 6, 1-5.
- Mortamet G, Merckx A, Roumeliotis N, Simonds C, Renolleau S, Hubert P. (2017). Parental perceptions of clown care in paediatric intensive care units. Journal of Paediatrics and Child Health, 53(5), 485-487.
- Perktaş E, Özmert E. (2017). Çocukların hastane kaygılarının azaltılması üzerine bir değerlendirme: hastane palyaço projesi. Çocuk Sağlığı ve Hastalıkları Dergisi, 60, 83-87.
- Scheel T, Hoeppner D, Grotevendt A, Barthlen W. (2017). Clowns in paediatric surgery: Less anxiety and more oxytocin? A pilot study. Klinische Padiatrie, 229 (5), 274-280.
- Tener D, Ofir S, Lev-Wiesel R, Franco NL, On A. (2016). Seriously clowning: medical clowning interaction with children undergoing invasive examinations in hospitals. Social Work in Health Care, 55(4), 296-313.
- The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials (2017). Erişim Tarihi: 28.06.2022 https://jbi.global/sites/default/ files/2019-05/JBI_RCTs_Appraisal_tool2017_0.pdf
- Ucun Y, Küçük L. (2020). The effect of therapeutic clown intervention on mental health of children: Systematic review. Journal of Academic Research in Nursing, 6 (3), 598-609.
- Vagnoli L, Caprilli S, Messeri A. (2010). Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option? Paediatric Anaesthesia, 20(10), 937-943.
- Vagnoli L, Caprilli S, Robiglio A, Messeri A. (2005). Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. The Journal of Pediatrics, 116(4), e563-7.
- van Venrooij LT, Barnhoorn PC. (2017). Hospital clowning: a paediatrician's view. European Journal of Pediatrics, 176(2), 191-197.
- Yıldırım M, Köroğlu E, Yücel C, Kırlak Ş, Şen S. (2019). The effect of hospital clown nurse on children's compliance to burn dressing change. Burns, 45(1), 190-198.
Çocuklara Uygulanan Tıbbi Palyaço Girişiminin Preoperatif Dönemdeki Anksiyeteye Etkisi: Sistematik Derleme
Abstract
Amaç: Preoperatif dönemde çocuklar kaygı yaşarlar. Çocukların uygulanan prosedürlere uyumunun artırılabilmesi için preoperatif dönemdeki kaygının azaltılması gerekmektedir. Bu sistematik derleme, çocuklara uygulanan tıbbi palyaço girişiminin preoperatif dönemdeki kaygı düzeyine etkisini belirlemek amacıyla gerçekleştirilmiştir.
Yöntem: Bu araştırma sistematik derleme niteliğindedir. Bu amaçla “preoperative, non-pharmacological methods, child, anxiety ve clown” anahtar kelimeleri eşleştirilerek PubMed, MEDLINE, Google Scholar, Science Direct ve Cochrane olmak üzere beş veri tabanı 2005-2021 yıllarını kapsayacak şekilde taranmıştır.
Bulgular: Bu araştırmada veri tabanlarının taraması sonucunda toplam 1207 yayına ulaşılmıştır. Araştırmaya dâhil edilme kriterlerine uygun olan toplam 10 (N=1506) yayın araştırma kapsamına alınmış ve sonuçlar açısından değerlendirilmiştir. Araştırma kapsamında 2-16 yaş arasında olan çocuklara pediatri servisi, ameliyathaneye transfer süreci, anestezi indüksiyonu sırasında ve ameliyattan sonraki dönemde tıbbi palyaço, sanat terapi, midazolam, hidroksizin ve ebeveyn varlığı ile müdahaleler yapılmıştır. Çocukların kaygı düzeyleri “Durumluk-Süreklik Kaygı Envanteri” veya “Modifiye Yale Preoperatif Kaygı Skalası” ile değerlendirilmiştir.
Sonuç: Çocuklara uygulanan tıbbi palyaço müdahalesinin preoperatif dönemdeki kaygıyı azaltmada etkili olduğu sonucuna ulaşılmıştır.
Keywords
References
- Aleo E, Picado AL, Abancens BJ, Soto Beauregard C, Tur Salamanca N, Esteban Polonios C, Torrejon MJ, Perrino CG, Rivas A, Arias E, Rodriguez D, Rivas MA, Rojo MLR, Garcia PF, Alarcon JR, Urguiza BSP. (2021). Evaluation of the effect of hydroxyzine on preoperative anxiety and anesthetic adequacy in children: double blind randomized clinical trial. BioMed Research İnternational, 7394042.
- Charana A, Tripsianis G, Matziou V, Vaos G, Latrou C, Chloropoulou P. (2018). Preoperative anxiety in greek children and their parents when presenting for routine surgery. Anesthesiology Research and Practice, 2, 1-6.
- Dionigi A ve Gremigni P. (2017). A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children. Journal of Clinical Nursing, 26 (5-6), 632-640.
- Dionigi A, Sangiorgi D, Flangini R. (2014). Clown intervention to reduce preoperative anxiety in children and parents: a randomized controlled trial. Journal of Health Psychology, 19(3), 369-80.
- Dur Ş, Gözen D, Bilgin M. (2016). Attitudes and behavior of nurses in state and private hospitals with respect to family-centered care. The Journal of Current Pediatrics, 14, 1-9.
- Efrat-Triester D, Altman D, Friedmann E, Margalit DL, Teodorescu K. (2021). Exploring the usefulness of medical clowns in elevating satisfaction and reducing aggressive tendencies in pediatric and adult hospital wards. BMC Health Services Research, 21 (1), 15.
- Eijlers R, Dierckx B, Staals LM, Berghmans JM, van der Schroeff MP, Strabbing EM, Utens EM. (2019). Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: a randomised controlled trial. European Journal of Anaesthesiology, 36 (10), 728-737.
- Golan G, Tighe P, Dobija N, Perel A, Keidan I. (2009). Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial. Paediatric Anaesthesia, 19 (3), 262-266.
- Hansen LK, Kibaek M, Martinussen T, Kragh L, Hejl M. (2011). Effect of a clown's presence at botulinum toxin injections in children: a randomized, prospective study. Journal of Pain Research, 4, 297-300.
- He HG, Zhu L, Chan SWC, Liam JLW, Li HCW, Ko SS, Wang W. (2015). Therapeutic play intervention on children's perioperative anxiety, negative emotional manifestation and postoperative pain: a randomized controlled trial. Journal of Advanced Nursing, 71(5), 1032-1043.
- Hür G, Zengin H, Suzan ÖK, Kolukısa T, Eroğlu A, Çınar N. (2022). Joanna Brıggs Enstitüsü (JBE) randomize kontrollü çalışmalar için kalite değerlendirme aracı’nın Türkçe’ye uyarlaması. Sağlık Bilimlerinde İleri Araştırmalar Dergisi, 5 (2), 112-117.
- Javed T, Khan AS, Jarral NA, Taqi Z, Raza M, Shahid Z. (2021). Medical clowning: a cost-effective way to reduce stress among children undergoing invasive procedures. Cureus, 13 (10), e18886.
- Joanna Briggs Institute. Critical Appraisal Tools. (2018). Erişim Tarihi: 17.05.2022. https://jbi.global/critical-appraisal-tools
- Kocherov S, Hen Y, Jaworowski S, Ostrovsky I, Eidelman AI, Gozal Y, Chertin B. (2016). Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: a randomised controlled trial. Journal of Paediatrics and Child Health, 52(9), 877-881.
- Kristensen HN, Lundbye-Christensen S, Haslund-Thomsen H, Graven-Nielsen T, Elgaard Sørensen E. (2018). Acute procedural pain in children: intervention with the hospital clown. The Clinical Journal of Pain, 34(11),1032-1038.
- Kristensen HN, Sørensen EE, Stinson J, Thomsen HH. (2019). “We do it together!” An ethnographic study of the alliance between child and hospital clown during venipunctures. Journal of Pediatric Nursing, 46:e77-e85.
- Leguizamon CR, Castano BO, Morales CG, Cifuentes NL. (2017). Humour therapy intervention to reduce stress and anxiety in paediatric anaesthetic induction, a pilot study. British Journal of Anaesthesia, 119(4), 847-848.
- Lopes-Júnior LC, Bomfim E, Olson K, Neves ET, Silveira DSC, Nunes MDR, Nascimento LC, Pereira-da-Silva G, Lima RAG. (2020). Effectiveness of hospital clowns for symptom management in paediatrics: Systematic review of randomised and non-randomised controlled trials. British Medical Journal, 16, 371.
- Meiri N, Schnapp Z, Ankri A, Nahmias I, Raviv A, Sagi O, Saied MH, Konopnicki M, Pillar G. (2017). Fear of clowns in hospitalized children: prospective experience. European Journal of Pediatrics, 176(2), 269-272.
- Messina M, Molinaro F, Meucci D, Angotti R, Giuntini L, Cerchia E, Brandigi E. (2014). Preoperative distraction in children: hand-held videogames vs clown therapy. La Pediatria Medica e Chirurgica, 36, 5-6.
- Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLOS Medicine, 6, 1-5.
- Mortamet G, Merckx A, Roumeliotis N, Simonds C, Renolleau S, Hubert P. (2017). Parental perceptions of clown care in paediatric intensive care units. Journal of Paediatrics and Child Health, 53(5), 485-487.
- Perktaş E, Özmert E. (2017). Çocukların hastane kaygılarının azaltılması üzerine bir değerlendirme: hastane palyaço projesi. Çocuk Sağlığı ve Hastalıkları Dergisi, 60, 83-87.
- Scheel T, Hoeppner D, Grotevendt A, Barthlen W. (2017). Clowns in paediatric surgery: Less anxiety and more oxytocin? A pilot study. Klinische Padiatrie, 229 (5), 274-280.
- Tener D, Ofir S, Lev-Wiesel R, Franco NL, On A. (2016). Seriously clowning: medical clowning interaction with children undergoing invasive examinations in hospitals. Social Work in Health Care, 55(4), 296-313.
- The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials (2017). Erişim Tarihi: 28.06.2022 https://jbi.global/sites/default/ files/2019-05/JBI_RCTs_Appraisal_tool2017_0.pdf
- Ucun Y, Küçük L. (2020). The effect of therapeutic clown intervention on mental health of children: Systematic review. Journal of Academic Research in Nursing, 6 (3), 598-609.
- Vagnoli L, Caprilli S, Messeri A. (2010). Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: what could be the most promising option? Paediatric Anaesthesia, 20(10), 937-943.
- Vagnoli L, Caprilli S, Robiglio A, Messeri A. (2005). Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. The Journal of Pediatrics, 116(4), e563-7.
- van Venrooij LT, Barnhoorn PC. (2017). Hospital clowning: a paediatrician's view. European Journal of Pediatrics, 176(2), 191-197.
- Yıldırım M, Köroğlu E, Yücel C, Kırlak Ş, Şen S. (2019). The effect of hospital clown nurse on children's compliance to burn dressing change. Burns, 45(1), 190-198.
There are 31 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Nursing |
| Journal Section | Systematic Review |
| Authors | |
| Early Pub Date | October 15, 2023 |
| Publication Date | October 15, 2023 |
| Submission Date | July 11, 2022 |
| Published in Issue | Year 2023 Volume: 6 Issue: 3 |
