Comparing Storybooks and Hand Puppets to Reduce Fear in Children Undergoing Day Surgery

The aim of this randomized controlled trial is to evaluate and compare the effectiveness of two different non-pharmacological distraction methods-educational storybooks and hand puppets-on preoperative fear and emotional manifestations in children undergoing day case surgery.

Methodology:

The study was conducted with 99 children, aged 4 to 7, who met the inclusion criteria. Participants were randomly assigned to one of three groups using a 1:1:1 allocation ratio:

Control Group (n=33): Received standard preoperative nursing care, including routine information provided by the hospital staff.

Storybook Group (n=33): In addition to standard care, children were read an educational storybook titled "Elif Ameliyat Oluyor" (Elif is Having Surgery). The book describes the surgical process through a child's perspective to familiarize them with the environment.

Hand Puppet Group (n=33): In addition to standard care, a researcher engaged the child in interactive play using a hand puppet. The puppet was used to simulate the medical procedures in a non-threatening and playful manner.

Data Collection and Outcome Measures:

Two primary tools were used to collect data:

Child Fear Scale (CFS): A self-report scale used to assess the child's level of fear.

Children's Emotional Manifestation Scale (CEMS): An observational scale used by researchers to record behaviors such as crying, facial expressions, and cooperation.

Data were collected at two specific time points:

T1 (Baseline): Approximately 1 hour before the surgical procedure (pre-intervention).

T2 (Final): Immediately before the child was transferred to the operating room (post-intervention).

The study seeks to determine whether these distraction techniques significantly lower fear scores compared to standard care and which method is more effective in a clinical setting.

Inclusion criteria

• Children aged between 4 and 7 years.
• Children hospitalized in the pediatric surgery ward.
• Scheduled for elective (planned) surgery.
• Ability to understand and speak Turkish.
• Willingness of both the child and a parent/legal guardian to participate in the study.

Exclusion criteria

• Children with long-term hospitalization history.
• Participants who received analgesic or sedative medication within the last 24 hours.
• Presence of major trauma, chronic disease, or chronic pain conditions requiring rapid assessment.
• Any physical or cognitive impairment that hinders effective communication (e.g., significant visual, hearing, or speech impairments).
• Presence of diagnosed mental or developmental disabilities.
• History of psychiatric disorders such as Attention Deficit Hyperactivity Disorder (ADHD).
• Participants or parents who wish to withdraw from the study at any stage.