Bruce et al. (1983) USA |
45 children aged 3-4 years, submitted to dental extraction and restoration |
Experimental |
• Hospital objects. Parents and children acted as patient and professional and simulated the procedure • A 20-25 min session on the day before the procedure |
• Cooperation, negative behavior and heart rate • Manifest Upset Scale • Cooperation Scale Monitoring of heart rate for 2 min |
The EG related to the procedure was more cooperative than the other two groups |
Li et al. (2007a) China |
203 children aged 7-12 years undergoing elective surgery and their parents |
Experimental |
• Visits the reception, anesthetic induction, operation and recovery rooms • Representative doll with a size similar to the child's • Representation of the obtaining of vital signs, anesthetic induction and venipuncture • A one-hour session a week before the procedure |
• Child and parents' anxiety, emotional behavior during anesthesia, postoperative pain and parents' satisfaction • Chinese version of the State Anxiety Scale for Children (CSAS-C) • Chinese version of the State Anxiety Scale for Adults • Children's Emotional Manifestation Scale (CEMS) Visual analog scale (VAS) |
Anxiety scores were lower, negative behavior was less frequent, and there was a higher degree of satisfaction among parents from the EG |
Vaezzadeh et al. (2011) Iran |
122 children aged between 7 and 12 years submitted to elective surgery. |
Experimental |
• Visits the reception, operation and recovery rooms • Demonstration in a pediatric manikin similar in size to a child aged 6-8 years • Children handled the equipment and then demonstrated the procedures on the doll • A one-hour session, one day before surgery |
• Anxiety • Spielberger State Anxiety Scale for children (SSAS-c) |
There was a higher reduction in mean anxiety scores in the EG preoperatively (31.44 ± 5.87) than in the CG (38.31 ± 7.44) |
Yu-Li et al. (2013) Taiwan |
19 children aged 3-15 years submitted to radiotherapy |
Experimental |
• Storytelling, role-playing game, coloring books with every step of the treatment process. Child-like doll, clay molding, painting, video games and cartoons projected on the ceiling of the treatment room during radiotherapy. One 15-20 min session a day, every afternoon, from Monday through Friday |
• Anxiety • The Faces Anxiety Scale (FAS) • Beck Youth Anxiety Inventory (BAI-Y) • Heart rate • Differences in cortisol levels |
The EG showed a significantly lower score/level of anxiety (1.89 ± 0.93) when compared to the CG (3.00 ± 1.33) before radiotherapy |
Ruschel (1995) Brazil |
60 children aged 3-10 years submitted to congenital heart defect surgery
|
Quasi-experimental |
• Materials related to pre and postoperative care. Doll, suture threads, needles, tweezers and scissors • Simulation surgery with doll |
• Child's attitude in relation to several procedures • Form |
There was statistical significance (p < 0.05) at the moments: quiet wakening, cooperation during procedures, accepting the absence of the mother, and fluid restriction |
He et al. (2015) China |
95 children aged 6-14 years submitted to elective surgery |
Experimental |
• Video about the surgery with pictures of the operating room environment. Demonstration with doll of the preoperative procedures. Demonstration by the child • Manual with medical objects and equipment used during surgery. A one-hour session three to seven days before the procedure |
• Perioperative anxiety, negative emotional expression and post-operative pain • State Anxiety Scale for Children (SAS-C) • Children's Emotional Manifestation Scale (CEMS) • The Numeric Rating Scale (NRS) Medical record |
The EG showed less negative emotional behavior before anesthesia induction, low levels of anxiety, and less postoperative pain
|
Kiche and Almeida (2009) Brazil |
34 children aged 3-10 years submitted to minor and medium surgeries |
Quasi-experimental |
• Doll, saline solution, gauze, adhesive tape, masks, scissors, dressing forceps, gloves, splints and other specific items according to the child's dressing • Two sessions, one after the dressing and the second session on the following day, before changing dressing |
• Behaviors that showed acceptance and adaptation to the procedure • Form • Wong and Baker scale |
The behaviors that show lower acceptance and adaptation to the procedure decreased, and those showing greater acceptance and adaptation increased after the therapeutic play session |
Ribeiro et al. (2001) Brazil |
42 children aged 3-6 years submitted to blood collection |
Quasi-experimental |
• Doll, syringe, test tube, cotton, adhesive tape. Scalpel with one catheter and bottle with red liquid • One session before the procedure. |
• Behavior during blood collection • Form |
The EG showed a reduction in the behaviors of "aggression, verbal expression, body movement, expression of emotion, and dependence" and showed an increase in the behaviors of "being quiet"
|
Pontes et al. (2015) Brazil |
60 children aged 3-6 years submitted to vaccination procedure |
Quasi-experimental |
• Doll, disposable syringes, needles, cotton and stickers for venipuncture • One 20-minute session before the vaccination |
• Child's reactions • Observation during vaccination • Interview with parent/guardian |
The EG had more reactions of "being quiet" and "collaborating spontaneously"; behaviors such as "pushing," "clinging to parents," "asking to be picked up," and "stiffness" were less present. Behaviors of "crying," "clinging to parents," "flushing," and "moving/agitating" were more present in the CG |
Li et al. (2014) China |
108 children aged 7-12 years admitted to undergo elective surgery |
Experimental |
• Visits to the operating room and presentation of equipment • Demonstration in the operating room with a doll on the following procedures. The post-anesthetic recovery period is explained • Demonstration by the child of the procedures on the doll • A 1-hour session |
• Anxiety, emotional responses during anesthesia induction and satisfaction of parents • State Anxiety Scale for children and adults • Children's Emotional Manifestation Scale • Questionnaire and semi-structured interview |
The EG showed a lower level of anxiety, demonstrated fewer emotions during the anesthetic induction, and the parents of the children from the group reported more satisfaction after surgery |
Weber (2010) Brazil |
50 children aged 5-12 years submitted to surgery |
Experimental |
• Recreational activities with the use of games, toys, books, comic books, movies, TV and materials for drawing • One session 15 min after entering the Ambulatory Surgical Center, lasting 15 min |
• Anxiety level • Observation when entering the operating room and 15 min after entering the room • Modified Yale Preoperative Anxiety Scale |
92% of the children in EG did not have anxiety, while in the CG, 84% were still anxious
|
Zahr (1998) Lebanon |
100 children aged 3-6 years submitted to elective surgery |
Experimental |
• Materials for painting, dolls, puzzles and bicycles • Demonstration using puppets of the sequence of events from admission, surgery to discharge • The child was encouraged to play, handle the equipment and re-present the play • One session carried out the day before the procedure |
• Behavior, blood pressure and pulse • Manifest Upset Scale • Cooperation Scale • Post-Hospital Behavior Questionnaire (PHBQ) |
Children from the EG were calmer than those from the CG (2.52 ± 1.28 vs. 3.76 ± 1.16, t = -5.08; p = 0.001) |
Li and Lopez (2008) China |
203 children aged 7-12 years submitted to surgery |
Experimental |
• Visits to the reception, anesthetic induction, surgery and recovery rooms • Demonstration of procedures on a doll with size similar to that of a child • A one-hour session carried out one week before the procedure |
• Anxiety of the children and their parents and parental satisfaction • Chinese version of the State Anxiety Scale for Children (CSAS-C) • Chinese version of the State Anxiety Scale for Adults • The Postoperative Parents' Satisfaction Questionnaire (PPSQ) |
The EG showed statistically lower anxiety scores in the pre- and postoperative periods (F [1,201] ¼ 5:36, p < 0.02) and less frequent negative behavior than the CG and their parents showed a greater degree of satisfaction |
Li et al. (2007b) China |
203 children aged 7-12 years submitted to elective surgery |
Experimental |
• Visits to the reception, anesthetic induction, surgery and recovery rooms • Demonstration of procedures on a doll with size similar to that of a child |
• Child's anxiety, behavior and level of postoperative pain • Chinese version of the State Anxiety Scale for Children (CSAS-C) • Children's Emotional Manifestation Scale (CEMS) • Visual analog scale (VAS) |
Children from the EG and their parents showed lower anxiety scores in the pre- and postoperative periods (F [1,201] ¼ 5.36, p < 0.02); less frequent negative behavior (t [201] ¼ _5.4, i < .0001) and their parents showed a greater degree of satisfaction |