Academic journal article International Journal of Emotional Education

Effects of Clown Doctors on Child and Caregiver Anxiety at the Entrance to the Surgery Care Unit and Separation from Caregivers

Academic journal article International Journal of Emotional Education

Effects of Clown Doctors on Child and Caregiver Anxiety at the Entrance to the Surgery Care Unit and Separation from Caregivers

Article excerpt

Introduction

The hospitalization of children and adolescents due to surgery can be a very stressful event for children (e.g., Fortier & Kain, 2015; Fortier, Martin, Chorney, Mayes, & Kain, 2011) and their parents (Bevan et al., 1990; MacLaren & Kain, 2008a; Shirley, Thompson, Kenward, & Johnston, 1998). Pediatric patients often experience high levels of preoperative state anxiety, consisting of feelings of increased fear, tension, nervousness, and worry. These concerns are mostly related to fear of the unknown, specifically the hospital setting, fear of complications from the medical intervention, the loss of autonomy and separation from caregivers (Fernandes & Arriaga, 2010; Fernandes, Arriaga, & Esteves, 2015; LeRoy et al., 2003; Quiles, Ortigosa, Méndez, & Pedroche, 2000). These negative effects can be externalized through several emotional and behavioral responses, which can have negative impacts in the short, medium and long-term (Caldas, Pais-Ribeiro, & Carneiro, 2004). These impacts can vary in how and when they are manifested, including resistance to treatment, reduced cooperation and avoidance of interactions with the healthcare professionals (Li & Lam, 2003), more difficulties in post-surgical recovery, delirium, and other postoperative symptoms (e.g., enuresis, apathy, sleep disturbances, pain) that may occur during hospitalization or after discharge (Chieng, Chan, Klainin-Yobas, & He, 2014; Kain, Caldwell-Andrews, Maranets, et al., 2004; Kain, Mayes, Caldwell-Andrews, Karas, & McClain, 2006). The result is that these problems can create a chronic habit of poor response to medical care or extend the need for treatment through longer hospital stays or more outpatient treatment.

One of the most common procedures used to prevent or manage children's preoperative anxiety and ease anesthesia induction is the administration of sedative premedication (e.g., midazolam, melatonin, droperidol), which has been found to be effective in decreasing the level of anxiety in pediatric patients who undergo general surgery (Gitto et al., 2015; O'Sullivan & Wong, 2013). However, because the use of sedation may provoke a plethora of side effects (e.g., ataxia, drowsiness, confusion) (LeRoy et al., 2003) including child apprehension and rejection (Golden et al., 2006), several non-pharmacological interventions have been tested to relieve preoperative anxiety. Among these, we highlight the importance of psycho-educational preparation of children and parents for surgery (Fernandes et al., 2015; Fernandes, Arriaga, & Esteves, 2014; Fortier et al., 2015), and specific cognitive and behavioral interventions, such as the use of shaping (MacLaren & Kain, 2008b), suggestion methods (Fortier et al., 2010), and distraction or refocusing techniques. Distraction, for instance, can be facilitated by playing with toys (Golden et al., 2006), video games (Patel et al., 2006), watching videos (Kerimoglu, Neuman, Paul, Stefanov, & Twersky, 2013; Kim, Jung, Yu, & Park, 2015), or through the use of humor (Berger, Wilson, Potts, & Polivka, 2014). Therapeutic play intervention (Chetta, 1981; William Li, Lopez, & Lee, 2007), biofeedback techniques (Campbell, Clark, & Kirkpatrick, 1986), music-assisted relaxation (Robb, Nichols, Rutan, Bishop, & Parker, 1995) and interactive music therapy (Kain, Caldwell-Andrews, Krivutza, et al., 2004) have also been used to reduce child preoperative anxiety. However, not all seem to have the same effectiveness, and many are influenced by various factors, including the person doing the intervention, the timing and setting in which the intervention takes place. For example, Kain and colleagues (2004) have found that interactive music therapy did not reduce child anxiety during the induction of anesthesia, compared to premedication sedation. However, upon separation and admission to the operating room, children's anxiety was dependent on the therapist. …

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