The effect of pre-operative therapeutic play on post-operative outcomes of Hong Kong Chinese children and their parents having surgery in a day surgery unit

Background. Surgery causes considerable stress and anxiety that can have a profound effect on both children and their parents. Therefore, they need to be well prepared before surgery to minimize their anxiety, enhance their feeling of control, and promote positive post-operative outcomes. With the increasing number and complexity of paediatric surgery being performed in day surgery units, there is a compelling need for nurses to develop and evaluate appropriate interventions tailored to the needs of children and parents so as to enhance their ability to cope with surgery.;Therapeutic play has been used as a psychological preparation for helping children cope with the stress of hospitalisation. However, the majority of previous studies into the effect of therapeutic play were based only on theories and clinical observations. The lack of empirical evidence makes it difficult to determine precisely the effectiveness of therapeutic play. Therefore, there is vital need for more rigorous empirical scrutiny.;Aim. The aim of this study was to examine the effects of preoperative therapeutic play on the immediate preoperative and postoperative outcomes of Hong Kong Chinese children undergoing surgery, and their parents in a day surgery unit.;Methods. The study was conducted in two phases. The first phase consisted of developing and testing the psychometric properties of three instruments that were used in the second phase of the study. These instruments included the Chinese version of the State Anxiety Scale for Children, the Chinese version of the Trait Anxiety Scale for Children, and the Children's Emotional Manifestation Scale.;An intervention study was conducted in the second phase of the study. A randomized controlled trial, two-group pretest and repeated posttest, between subjects design was employed. Hong Kong Chinese children (7-12 years of age; N = 203) admitted for elective surgery in a day surgery unit during a 13-month period, were invited to participate in the study along with their parents. By using a simple complete randomisation method, 97 children with their parents were assigned to the experimental group receiving therapeutic play intervention, and 106 children with their parents were assigned to the control group receiving routine information preparation.;Results. The results showed that both children and parents in the experimental group reported statistically significant lower state anxiety scores than the control group in both pre- and post-operative periods. Children in the experimental group also exhibited statistically significant fewer instances of negative emotional behaviours, displayed lower heart rates and mean arterial blood pressures. Additionally, parents in the experimental group reported significantly higher level of satisfaction with the preoperative nursing preparation given. The results, however, did not find statistically significant differences in children's postoperative pain scores and post-hospital adjustment between the two groups.;Conclusion. The first phase of this study confirmed the psychometric properties of the Chinese version of the State and Trait Anxiety Scales for Children, and the Children's Emotional Manifestation Scale. The results also support the appropriateness of these instruments as clinical research tools in evaluating the effectiveness of preoperative nursing interventions.;The second phase of this study had addressed a gap in the literature by empirically testing the effectiveness of the therapeutic play intervention in preparing children for surgery, and their parents, which had been under-researched. It also provides empirical evidence that therapeutic play, using preoperative tour visit to the operating theatre, doll demonstration and return demonstration on the procedure of anaesthesia, is more effective in improving immediately pre- and post-operative outcomes of children and their parents than information-based preparation alone.;Significance of the study. It is anticipated that this study could increase nurses' understanding of the emotional responses of children undergoing surgery and enrich their experience in using child-sensitive research tools in evaluating the effectiveness of preoperative nursing interventions. Most importantly, this research provides empirical evidence of the benefits of incorporating therapeutic play in the preoperative preparation of children and parents thus charting a path towards promoting holistic and quality care.*.;*This dissertation is a compound document (contains both a paper copy and a CD as part of the dissertation). The CD requires the following system requirements: Windows MediaPlayer or RealPlayer.