Comparing Three Nurse-Led Non-Pharmacological Interventions for Reducing Fear and Improving Cooperation in Children Undergoing Minor Surgical Procedures Nurse-Led Interventions for Fear and Cooperation in Children Undergoing Minor Surgery

Abstract

Background: Children’s fear of procedures and lack of cooperation with behavioral management are some of the major issues when conducting minor surgeries on children in emergency cases. In order to overcome the problems, various nurse-led non-pharmacological interventions have been recommended. However, direct comparison data between several types of these interventions within one clinical environment is rather scarce.
Methods: A quasi-experimental comparative study was performed at the emergency departments of three governmental hospitals subordinated to Salah Al-Din Health Directorate, Iraq. Altogether 140 children between ages of 5 and 12 years who had undergone minor surgical interventions were assigned to four intervention groups: clay play (n=31), distraction cards (n=33), recreational activities (n=36) and a control group of routine care (n=40). Fear of procedures was measured with the help of Child Medical Fear Scale (CMFS) and behavioral cooperation was estimated by means of Frankl Behavior Rating Scale (FBRS). Statistical analysis included Mann-Whitney U and Kruskal-Wallis tests for between-group comparison of nonparametric measurements.
Results: All three interventions led to significant decrease in fear and significant increase in behavioral cooperation compared to the control group (p<0.001). Recreational activities proved to be more efficient than the other two interventions for all items of the CMFS scale. Significant between-group difference for both dependent variables was found. Pair-wise analysis showed superiority of recreational activities in reducing children’s fear (p=0.009) and increasing cooperation (p=0.009) over clay play. There were no significant differences between distraction cards and recreation activities in enhancing behavioral cooperation (p=0.212). Pre-existing emotional condition was a moderating factor for cooperation.
Conclusions: All three interventions surpassed routine care significantly. Recreational activities provided for a wider range of improvement while distraction cards proved to be an effective and feasible method. The results suggest incorporation of brief pre-procedure preparation into routine pediatric emergency nursing practice.