Effect of Video Games Compared to Storytelling on Preoperative Anxiety and Fear among Children undergoing Surgery

Background: Hospitalization and surgery are traumatic experiences for children. Children might lessen their preoperative anxiety and worry through play activities. The aim of the study: is to evaluate the effect of video games compared to storytelling on preoperative anxiety and fear among children undergoing surgery. Design: a quasi-experimental research design was used. Sample: 150 preschool-age children (3-6years) were equally and randomly divided into three groups: two study groups (video games and storytelling group) and control group (fifty children in each group), Setting: The current research was applied to the inpatient Ear, Nose and Throat (ENT) department at Minia University Hospital, and the Pediatric surgical hospital which is affiliated with Minia University Hospital. Tools: Three tools were utilized in the current study; a structured interview questionnaire, the State-Trait Anxiety Inventory for Children (STAIC), and the Glasses Fear Scale (GFS). Results: Preoperative fear and anxiety were lower among studied groups after video games and storytelling than before. The lowest scores of STAIC and GFS were in the video games group, followed by the storytelling group, and finally the control group . A highly statistically significant difference (P=0.000) was detected between the total mean score of STAIC and GFS before and after the test . Conclusion: Compared to children in the control group who just received regular medical care, playing video games and using storytelling as a distraction tactic for children facing surgery is an excellent method for easing their preoperative anxiety and worry. Recommendations: nurses should work together with medical staff to routinely utilize non-pharmacological methods such as video games and storytelling techniques to reduce the fear of surgery and anxiety among children undergoing surgery


Introduction
Children who undergoing surgery may experience physiological and psychological reaction as a result of the stressful event and potential damage to their overall health.
Preoperative anxiety, which has a prevalence of 40-65percent and may occur at any time before a surgery, is the most prevalent psychological issue among children in surgical units.

Aim of the study:
To evaluate effect of video games compared to storytelling on preoperative anxiety and fear among children undergoing surgery.

Hypothesis of the research:
 Children undergoing surgery who will received either video games or storytelling are expected to have lower level of anxiety and fear than control group.
 Anxiety level and fear are expected to be lessening posttest as compared to pretest in both study groups.

Design of the research
The current research used a quasiexperimental research design

Setting
The research was applied at the inpatient

Research tools for data collection
The following tools were used to gather the necessary data.

Tool 3: The glasses fear scale
It is a variation of the visual analog scale, which was developed by Aiken (1959) and modified by Gift (1989), and adopted by the researcher in the current study. This scale is designed to gauge children's self-reported levels of fear. Six cylinders or glasses make up the child's version. The first cylinder, which is empty, symbolizes "no fear or not scared at all," while the following 5 cylinders, which range from "low fear to very fearful," are filled with varying degrees of "fear," and the last cylinder, which is fully filled, symbolizes "extreme fear and most scared." Each glass is given a number value from zero to five for statistical purposes.

Validity and reliability
Nine nursing professionals with expertise in pediatric as well as psychiatric mental health nursing were provided with the study's data collection instruments to assess translation and to test the content validity. Reliability was conducted to evidence the consistency of the tool.
The reliability coefficients between items of STAIC were 0.86, and for glasses fear scale was 0.76.

Pilot study
The fifteen children, who represented 10% of the sample, were used to test the tools' usability and clarity, as well as gauge how long data collecting would take. The children from the pilot research were included in the whole sample; no tool modifications were made in light of the pilot study's findings.

Field of work
Before applying of the study, official Then all children were exposed to the pretest sheet (tools 2 and 3). Assessment of children level of anxiety and fear was done before the surgery within the preoperative days as scheduled by the pediatric surgeon (pre-test). The preoperative level of anxiety and fear was evaluated on an individual basis STAIC (tool 2) and GFS (tool 3).

Control group:
The day before surgery, children got the usual instruction and care. It covered before and after care of the operation as well as information about fasting periods, personal hygiene, vital signs, and dressing, care of the wound, and the utilization of analgesic medications to ease discomfort after surgery.

Video games group:
In order to choose the proper games for the If the child had never played a video game before, it was taught to them.

Storytelling group
Storytelling for the intervention group was divided into two phases. The first phase involved telling a story that lasted for about thirty minutes using an entertaining and educational booklet format. This format consisted of pages with attractive and colorful graphics as well as one story or sentence per page while the child was being made to repeat the story. In the second stage, the child and the researcher talk about the story. Preoperative evaluation and postintervention pre-operation (the day before the surgery) are two phases of data collection.

Ethical considerations
The         Group of Control n=50 before After before After before After

Discussion
Preoperative anxiety is a worried or anxious mood that develops before surgical intervention.
In could be used as a method to take the child's concern away from his own pain, fear, and anxiety to focus on games and enjoying them.   (2020) who found that total mean score of fear lower after using therapeutic play with statistical significance differences between intervention and control group.

Conclusion
The current research's results concluded that video games and storytelling are effective in alleviating preoperative anxiety and fear.
Children in intervention groups had lower preoperative anxiety score on STAIC than before and lower preoperative fear scores on GFS than before. Also, the lowest preoperative totals mean scores of STAIC and GFS were in the video games group, followed by the storytelling group, and finally the control group who took only the routine care. So, video games and storytelling among children undergoing surgery are appropriate, easy, effective, and economical methods for minimizing preoperative anxiety and fear without any side effects for pediatric patients. Also, the nurses can utilize them as a part of the care they give to children, and these results support the proposed current study hypotheses.

Recommendations
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