الفهرس 
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Abstract
Hospitalization and surgery are stressful events children face especially during the early
years. Anxiety and fear are the most common phenomena reported during the preoperative
period. Effective anxiety and fear management require number of interventions to achieve
optimal results. The most commonly used interventions to reduce or prevent preoperative
anxiety are play activities and passive distraction technique. These techniques are helpful to
capture the children’s interest and divert their attention away from noxious and fearful stimuli.
The current study aimed to determine the effect of play activities versus passive
distraction technique on preoperative anxiety and fear levels among children undergoing
surgeries. A quasi experimental design was used in this study.
The present study was conducted in the general pediatric surgical units at Alexandria
University Children at El-Shatby and Smouha Specialty Hospitals. A convenient sample of 90
hospitalized school-age children undergoing general surgeries were included. Their ages
ranged from 7-11 years and stayed in the hospital for more than 24 hours preoperatively.
Children were randomly assigned to three equal groups: two study groups and one control
(every group consisted of 30 school-age children). Study group (I): Thirty hospitalized
children who received the play activities. Study group (II): Thirty hospitalized children who
received passive distraction technique. Control Group: Thirty hospitalized children who
received the routine care of surgical unit only.
Three tools were used to collect data of the present study. The first tool was developed
by the researcher namely Socio-demographic and Medical Data of Children Structured
Interview Schedule. Tool two: State Trait Anxiety Inventory for Children (STAIC) was
adopted form charles D. Spielberger, (1964). Tool three: The Children’s Fear Scale (CFS)
was adopted form McMurtry et al. (2011) to measure fear among children.
The results of the present study were as follows:
Socio-demographic characteristics and medical data for school- age children undergoing
surgeries.
- The highest percentage of the school-age children who received play activities,
passive distraction and control group were in the age group from 9 to 11 years (40%,
36.7%, and 53.3% respectively).
- The highest percentage of school-age children who received play activities, passive
distraction technique and those of control group were males (66.7%, 63.3% and 60%
respectively).
- It was clear that 23.3%, 20% of school-age children in play activities group and
passive distraction group were diagnosed with inguinal hernia where as 20% of
school-age children in control group were diagnosed also with hydrocele.
Effect of play activities on preoperative anxiety among school-age children undergoing
surgeries (puzzle, colored cards, art materials, craft materials, playing games (snake&
ladders)
* Puzzle
-In first session, it was demonstrated that 11.1% of children mentioned that they often feel
fine before intervention compared to 88.9% of them after intervention.
-While in second session, 10% of children stated always that they feel fine before
intervention compared to more than two-thirds of them after intervention (70%).
-None of children mentioned always that they feel fine before intervention (0.0%) compared
to all children after intervention (100%) through third session.
* Colored cards
- In second session, none of children mentioned always that they feel fine before
intervention (0,0%) compared to 80 % of them after intervention. In addition, all
children reported that they often become upset and tense when they think about their
current concerns before intervention (100%) compared to 20% of them after
intervention.
* Art materials (painting)
- In first session, the majority of children reported always that they feel that difficulties
were piling up in such a way that they cannot overcome difficulties before
intervention (83.3 %) compared to none of them after intervention (0.0%).
- In second session, 80% of children reported that they often feel that difficulties were
piling up in such a way that they cannot overcome difficulties before intervention
compared to 20% of them after intervention.
- While in third session, 42.9% of children reported always that they feel that
difficulties were piling up in such a way that they cannot overcome difficulties before
intervention compared to none of them after intervention (0.0%).
* Craft materials (clay)
- In first session, 62.5% of children cited always that they become upset and tense when
they think about their current concerns before intervention compared to none of them
after intervention (0.0%).
- While in second session, 66.7% of children stated that they often become upset and
tense when they think about their current concerns before intervention compared to
none of them after intervention (0.0%).
- The majority of children mentioned that they often become upset and tense when they
think about their current concerns before intervention (92.9%) compared to 21.4% of
them after intervention through third session.
* Games (snake and ladders)
- In first session, the majority of children mentioned always that they feel that
difficulties were piling up in such a way that they cannot overcome difficulties before
intervention (71.4%) compared to none after intervention (0.0%).
While in second session, 85.7% of children mentioned that they often feel that
difficulties were piling up in such a way that they cannot overcome difficulties before
intervention compared to 14.3% of them after intervention.
- Regarding third session, 80% of children mentioned that they often feel that
difficulties were piling up in such a way that they can’t overcome difficulties before
intervention compared to none after intervention (0.0%).
Effect of play activities on preoperative fear among school-age children undergoing
surgeries (puzzle, colored cards, art materials, craft materials, playing games (snake&
ladders).
* Puzzle
- In first session, it was noticed that none of the children mentioned that they
complained of medium fear before intervention (0.0%) compared to 88.9% of them
after intervention.
- Through second session, 70% of children had medium fear before intervention
compared to 40% of them after intervention.
- Regarding third session, it was clear that all children reported that they had simple fear
after intervention (100%) compared to none of them before intervention (0.0%).
* Colored cards (play activity)
- In second session, it was clear that 80% of the children suffered from simple fear after
intervention compared to 20% of them before intervention.
*Art materials (painting)
- In first session, half of the children mentioned that they had intense fear before
intervention (50%) compared to 16.7% of them after intervention.
- While in second session, 80% of the children stated that they had medium fear before
intervention compared to 40% of them after intervention.
- Regarding third session, 57.1% of the children cited that they had medium fear before
intervention compared to 28.6% of them after intervention.
* Craft materials (clay)
- In first session, it was clear that 87.5 % of children cited that they had medium fear
after intervention compared to 12.5% of them before intervention.
- It was shown that in second session, all of children stated that they had medium fear
before intervention (100%) compared to 33.3% of them after intervention.
- Regarding the third session, 85.7% of children mentioned that they had simple fear
after intervention compared to none of them before intervention (0.0%).
* Games (snake and ladders)
- In first session, it was found that 71.4 % of children cited that they had simple fear
after intervention compared to none of them before intervention (0.0%).
- While in second session, 71.4 of the children stated that they had medium fear before
intervention compared to 28.6% of them after intervention.
- Regarding third session, 80% of the children mentioned that they had medium fear
before intervention compared to 20% of them after intervention.
Effect of passive distraction technique on preoperative anxiety among school-age
children undergoing surgeries.
*Tom and Jerry video
- In first session. It was noticed that 44.4% of the children cited that they often feel fine
before intervention compared to 88.9 % of them after intervention.
- While in second session, it was reported that 20 % of the children stated always that they
feel fine before intervention compared to 50% of them after intervention.
- Regarding third session, it was shown that half of the children reported always that they
feel fine before intervention (50.0%) compared to 75% of them after intervention.
* Toy story video
- In first session, all children stated that they become always upset and tense when they
think about their current concerns before intervention (100%) compared to 14.3 % of
them after intervention.
- While in second session, the highest percentage of children reported that they often
become upset and tense when they think about their current concerns before
intervention (88.9%) compared to 11.1 % of them after intervention.
- All children reported that they were often become upset and tense when they think about
their current concerns before intervention (100%) compared to 16.7 % of them after
intervention through third session.
* Sponge bob video
- In first session, all children become always upset and tense when they think about
their current concerns before intervention (100 %) compared to none after intervention
(0.0%).
- All children were often become upset and tense when they think about their current
concerns before intervention (100 %) compared to none after intervention (0.0%)
through second session.
- None of children stated that they were hardly ever become upset and tense when they
think about their current concerns before intervention (0.0%) compared to 75% of
them after intervention through third session.
* Masha’s tales video
- In first session, all of children stated that they were always tired quickly before
intervention (100%) compared to none of them after intervention (0.0%).
- While in second session, one third of children cited that they were always tired
quickly before intervention (33.3%) compared to none of them after intervention
(0.0%).
- Regarding third session, Small percent of children stated always that they were tired
quickly before intervention (14.3%) compared to none of them after intervention (0.0%).
* Princess stories video
- In first session, all children mentioned that they were always become upset and tense
when they think about their current concerns before intervention (100 %) compared to
none of them after intervention (0.0%).
- While in second session, all children mentioned that they were often become upset and
tense when they think about their current concerns before intervention (100 %)
compared to 25% of them after intervention.
- The majority of children mentioned that they were often become upset and tense when
they think about their current concerns before intervention (80%) compared to 40% of
them after intervention through third session.
Effect of passive distraction technique on preoperative fear among school-age children
undergoing surgeries.
*Tom & Jerry video
- In first session, it was noticed that 88.9 % of children reported that they had medium
fear after intervention compared to none before intervention (0.0%).
- In second session, 80% of children stated that they suffered from simple fear after
intervention compared to 20% of them before intervention.
- Regarding third session, 75% of children mentioned that they had medium fear before
intervention compared to 25% of them after intervention.
* Toy story video
- In first session, almost three quarters of children mentioned that they had intense fear
before intervention (71.4%) compared to none after intervention (0.0%).
- While in second session, 88.9% of children stated that they suffered from medium fear
before intervention compared to 44.4% of them after intervention.
- Regarding third session, 66.7% of children mentioned that they had intense fear before
intervention compared to none after intervention (0.0%).
* Sponge bob video
- In first session, it was clear that 70 % of children stated that they complained of
intense fear before intervention compared to 20% of them after intervention.
- In second session, all of children stated that they suffered from medium fear before
intervention (100%) compared to 50% of them after intervention.
- Regarding third session, none of children mentioned that they had intense fear after
intervention (0.0%) compared to 62.5% of them before intervention.
* Masha’s tales video
- In the first session, none of children reported that they complained of medium fear
after intervention compared to all of them before intervention (100%).
- In second session, 33% of children stated that they suffered from intense fear before
intervention compared to none of them after intervention (0.0%).
- Regarding third session, 85.7% of children stated that they had medium fear before
intervention compared to 14.3% of them after intervention.
* Princess stories video
- In first session, it was clear that none of the children complained of intense fear after
intervention compared to all of them before intervention (100%).
- While in second session, 75% of children stated that they suffered from simple fear
after intervention compared to none of them after intervention (0.0%).
- Regarding third session, it could be seen that 40% of children mentioned that they had
simple fear after intervention compared to none before intervention (0.0%).
Preoperative level of anxiety and fear between the school-age children in study groups
(group I and II) and control group through one hour before surgery.
- It revealed that 66.7% of school- age children in play activities group and 30% of
children in passive distraction group had low level of anxiety compared to none in
control group (0.0%).
- At the same time, there was 33% of school-age children in play activities group had
average level of anxiety, compared to 50%and 36.7% of those children in passive
distraction group and control group respectively.
- It revealed that 20% of the children in passive distraction group had above average level
of anxiety compared to 16.7% of those in control group. In addition, 46.7% of school -
age children in control group had very high level of anxiety compared to none in both
play activities and passive distraction groups.
- A statistically significant difference was found between preoperative level of anxiety
in play activities group and control group (P <0.001).
- A statistically significant difference was found between preoperative level of anxiety in
passive distraction group and control group (P<0.001).
- A statistically significant difference was found between the preoperative level of
anxiety between play activities group and passive distraction group (p= 0.004).
- In relation to fear, it was found that none of children in play activities group and
control group had no fear compared to only 3.3% of passive distraction group.
- There was 83.3% of children in play activities group, 50% in passive distraction group
had simple fear compared to none in control group.
- It was obvious that 16.7% of children in play activities group, 46.7% in passive
distraction group had medium fear compared to 6.7% in control group.
- It revealed that 26.7% of children in control group had intense fear compared to none
of those children in both play activities group and passive distraction group. In
addition, 66, 7% of school - age children in control group had extreme fear compared
to none in both play activities group and passive distraction group.
- A statistical significant difference was found between the preoperative level of fear in
play activities group and control group (P <0.001)
- A statistical significant difference was found between passive distraction group and
control group (P<0.001)
- A statistical significant difference was found between the preoperative level of fear in
play activities group and passive distraction group in this study (p= 0.014).