Anxiety and postoperative pain in children who undergo major orthopedic surgery.

Anxiety and pain are major concerns not only for children who undergo surgery, but also for their parents and health care professionals. A convenience sample of 74 adolescents who underwent major orthopedic surgery for repair of idiopathic scoliosis and their parents was used to investigate the relationships among children's and parents' preoperative and postoperative anxiety and children's postoperative pain. Age-appropriate versions of Spielberger's State-Anxiety scales measured children's and parents' anxiety, and a visual analog scale assessed children's pain intensities. Children's state anxiety increased from preoperative to postoperative levels, and their postoperative anxiety levels positively related to their pain intensities on days 2 and 4 following the operation. Parents' anxiety decreased from preoperative to postoperative levels, and their postoperative anxiety positively related to their children's postoperative anxiety. Studying both parents and children helped to explain the variance in children's self-reported anxiety. Parents' emotional states are important indicators of children's emotional states and, subsequently, their pain experience. The results of this study suggest that allowing children to assist in the assessment of their postoperative pain may help health care professionals better understand the subjective component of pain. The findings also emphasize the importance of including parents in future studies in which the aim is to understand children's behavioral responses and recovery outcomes.     

Paediatric day surgery: impact on Hong Kong Chinese children and their parents

Paediatric day surgery is a potentially stressful and threatening experience for children and parents. The purposes of this study were to investigate the effects of paediatric day surgery on anxiety level of Hong Kong Chinese children and their parents, and to examine the relationship between children's preoperative anxiety and their level of cooperation during induction and postoperative periods. A total of 112 children admitted for circumcision with their parents in a day surgery unit were recruited. The state anxiety level for both children and parents was assessed at the time of admission and again at 4 hours after operation. Children's level of cooperation during the induction and the postoperative periods were also assessed. The results showed that the preoperative anxiety level for both children and their parents was relatively high. Children with high preoperative anxiety levels were associated with lower levels of cooperation during induction and postoperative periods. The results also indicated that parents' high state anxiety was associated with their children's high state anxiety. This study designated that preoperative intervention to minimize children and parents' anxiety is crucial and that there is still room for improvement.     

The Relationship Between Children's Locus of Control and Their Anticipatory Anxiety

ABSTRACT Objectives: This study investigated the relationship between children's locus of control and their state anxiety scores, and determined whether children's locus of control could predict their state anxiety scores before academic examinations.
Design: A test-retest within subjects design was used.
Sample: 519 school children were invited to participate in the study.
Measurements: Participants were asked to respond to the Chinese version of the Nowicki-Strickland locus of control scale and state anxiety scale for children in stressful and nonstressful situations. The data were collected in 2005.
Results: There were significant strong positive correlations between the state anxiety and locus of control scores in the period before academic examinations. Multiple regression analysis showed that the Nowicki-Strickland locus of control score was a good predictor of children's state anxiety in a stressful situation.
Conclusions: This study supports the use of the Nowicki-Strickland locus of control scale as a screening tool to identify school children who are most likely to exhibit high levels of anxiety before academic examinations. Understanding children's locus of control in advance is a necessary step toward designing appropriate interventions to reduce their stress and bolster their coping mechanisms.     

Mediating functions of maternal anxiety and participation in care on young children's posthospital adjustment

The purpose of this study was to determine whether maternal anxiety and mothers' participation in their children's care during hospitalization mediated the effects of a child behavior informational intervention for mothers on their children's posthospital negative behavioral change. Participants were 49 mothers and their young children, ages 24-68 months, who were unexpectedly hospitalized with unplanned medical or surgical conditions. These participants were drawn from a larger study of the separate and combined effects of child behavior information and parent role information on the process and outcomes of maternal and child coping with unplanned hospitalization. Findings indicated that the effects of child behavior information on children's posthospital negative behavioral change were mediated by maternal anxiety and participation in their children's care during hospitalization. Results of this study provide support for targeting mothers with informational interventions in order to enhance outcomes in hospitalized children.     

孤独症儿童父母焦虑情绪分析

目的 探讨孤独症儿童父母焦虑情绪与性别及文化程度的关系.方法 对140例确诊的孤独症儿童的父亲或母亲采用焦虑自评量表调查.结果 患者母亲的焦虑程度[(54.20±6.19)分]高于父亲[(42.73±8.25)分],差异有统计学意义(t=6.783,P＜0.05),男童父母的焦虑程度[(51.38±11.24)分]高于女童父母的焦虑程度[(43.23±6.12)分],差异有统计学意义(t=4.894,P＜0.05).孤独症儿童父母的焦虑程度与其文化程度呈负相关(F值为10.788,P＜0.05).结论 孤独症患者的父母存在焦虑情绪,且此种情绪受文化差异和儿童性别的影响.有必要重视并关注孤独症父母的不良情绪,减少其心理问题,以利对息儿的治疗.

Abstract：

Objective To evaluate the relationship between the anxiety condition and educational background of the autistic children's parents. Methods Questionnaires for the self-evaluation of anxiety were collected from the parents of 140 children with autism. Results The autistic children's mothers had significantly higher score of anxiety than the fathers (42. 73 ±8. 25) (t =6. 783,P ＜0. 05). The autistic boy's parents had significantly higher anxiety pressure than autistic girl's parents ( 51.38 ± 11.24 vs. 43.23 ± 6. 12) ( t = 4. 894,P ＜0. 05). The anxiety intensity of the autistic children's parents was negatively correlated with the parents'educational background ( F = 10. 788, P ＜ 0. 05 ). Conclusion The autistic children' s parents had certain anxiety,which is correlated with the their educational background and genders of the autistic children. It is necessary to interfere the negative mood to facilitate the treatment of the autistic children.     

Anxiety responses of 5- to 11-year-old children during and after hospitalization

The purpose of this study was to examine the anxiety responses of 5- to 11-year-old children (N = 52) during and after hospitalization from their perspective. Change in anxiety over time was examined, as was the relationship between children's anxiety and age, sex, length of hospitalization, previous admission, and parental anxiety. Children demonstrated a decrease in anxiety from admission to discharge, whereas anxiety remained fairly constant from discharge to posthospitalization. Younger children (5 to 7 years), boys, and children not previously admitted were more anxious and did not show a decrease in anxiety over time. Findings of this study have implications for practice and further research.     

小丑照护对患儿焦虑疼痛干预效果的Meta分析

目的 通过Meta分析评价小丑照护缓解患儿焦虑、疼痛程度的影响.方法 计算机检索PubMed、Cochrane Library、EMbase、CINAHL、Web of Science、知网、维普和万方数据库,获取小丑照护对患儿焦虑、疼痛程度效果的随机对照研究和类实验性研究,检索时限为建库至2021年2月.2名研究者依...     

肿瘤患儿父母的压力及焦虑状况调查分析

[目的]探讨肿瘤患儿父母的压力及焦虑情况,探索解决问题的护理依据.[方法]应用状态-特质焦虑量表,通过问卷调查的方法对34例肿瘤患儿父母的压力感受及情绪状态进行评估.[结果]母亲所感受的压力程度大于父亲,父母的状态焦虑均高于常模.[结论]肿瘤患儿父母的压力焦虑状况应引起护理人员的重视,护理人员有必要为患儿父母提供心理支持及健康教育,缓解其焦虑程度有利于患儿的治疗及护理.     

儿童焦虑性情绪障碍筛查表的中国城市常模

背景目前国内尚无有关儿童焦虑障碍评估量表的中国常模.制定儿童焦虑障碍筛查表的中国城市常模对于评估中国城市儿童焦虑性障碍,辅助临床诊断、科研及流行病学调查提供筛查工具具有实用意义. 目的建立儿童焦虑性情绪障碍筛查表 (SCARED)的中国城市常模并检验其信度和效度. 设计 2001- 10/2002- 04以全国 14个城市的小学 2年级至初中年级的学生以及长沙市、济南市、深圳市儿童心理门诊的焦虑障碍儿童为研究对象的抽样调查. 单位一所省级精神专科医院的精神科. 对象 2001- 10/2002- 04在全国 14个大中城市抽样,样本来自北京市、天津市二个直辖市及华北(太原市)、东北(四平市),华中(武汉市、长沙市),西北(西安市),华南(深圳市),西南(绵阳市),华东(济南市、福州市、宜春市) 6个行政区采样 2 019名(男 1 012名,女 1 007名),平均年龄( 11 ± 2)岁,由学生及其父母分别填写 SCARED,组成常模组.同期在长沙、济南、深圳儿童心理门诊收集焦虑障碍儿童 90名,组成焦虑组. 方法在课堂上由主试者宣读指导语,学生填好后当堂回收,并带一份儿童焦虑性情绪障碍筛查表父母问卷请家长填写.同时在长沙市请家长填写 CBCL,儿童填写 PHCSS.检验 SCARED的信度和效度. 主要观察指标 SCARED的信度和效度. 结果 SCARED的重测信度为 0.567～ 0.608,半分信度为 0.88, Crobach a系数为 0.43～ 0.89,项目与总分的一致性在 0.43～ 0.74.量表的效度较好,与 Achenbach 儿童行为量表( CBCL)、 Piers Harris儿童自我意识量表( PHCSS)的相应分量表相关( r=0.564,0.603;P均 < 0.05).焦虑组儿童 SCARED得分高于常模组( t=8.06～ 12.89,P=0.000),对焦虑症性障碍诊断的灵敏度为 0.74,特异度为 0.79. 结论儿童焦虑性情绪障碍筛查表信度和效度符合计量学要求,可用于中国儿童焦虑症状的评估.     

Trait anxiety and children's state anxiety,cognitive behaviors,and performance under stress

Sixty-seven fourth-grade children anticipated and then performed a mathematics task in either a high or a low stress condition. While the children anticipated performing the task, measures of seven cognitive behaviors were obtained by means of both a Think Aloud procedure and a questionnaire. Measures of trait and state anxiety and task performance were also obtained. Trait anxiety was found to be related to state anxiety and the cognitive behaviors of preoccupation, and for females, justification of positive attitude. The performance of high but not low trait-anxious children was found to be affected by levels of stress. This finding aids in reconciling discrepancies in previous research concerning children's trait anxiety and performance.The authors wish to thank Verlin Gilbert, principal of Deerfield School, and John Lowther, principal of Broken Arrow School, Lawrence, Kansas, for their generous assistance with this project.     

Construct validity of the parents' postoperative pain measure

OBJECTIVES: Pain assessment can be a challenging task for parents, who increasingly provide the care for their children after surgery. This research provides evidence of the construct validity of the Parents' Postoperative Pain Measure (PPPM), a 15-item behavioral scale. METHODS: Study 1 examined the ability of scores on the PPPM to discriminate between pain and anxiety in a sample of 75 children (30 girls) between the ages of 7 and 12 years undergoing day surgery. Study 2 examined the sensitivity of scores on the PPPM to analgesic intervention among a sample of 28 children (7 girls) between the ages of 7 and 12 years undergoing day surgery. RESULTS: In Study 1, scores on the PPPM closely followed the pattern of children's self-reported pain intensity and not state-related anxiety. Results from Study 2 showed that scores on the PPPM, like children's self-reported pain intensity ratings, were sensitive to analgesic intervention. DISCUSSION: The results of these studies provide further support for the construct validity of the PPPM and confirm that the measure is a valid pain assessment tool for use by parents at home following children's surgeries.     

Evaluating instruments for a study on children's responses to a painful procedure when parents are distraction coaches

Existing research identifies numerous variables that may influence children's distress responses during medical procedures. In preparation for a large multisite study to test relationships among these numerous variables and parent distraction coaching, a pilot study of instruments was performed that measured the more complex constructs, namely anxiety, coping, temperament, attention, and parenting style. This article describes the benefits, process, and results of evaluating research instruments before initiating a large study on children's distress during ;medical procedures. A convenience sample of 68 children (4-12 years old) and their parents participated in this study. Children completed state and trait anxiety measures and a coping style scale. Parents completed questionnaires about their child's temperament, attention behavior, anxiety, and coping during a recent medical procedure, and about their own anxiety and parenting style. Coefficients of reliability of the measures were examined and understandability of the instruments was assessed. A forward regression showed that nurturing parenting style, parent's state anxiety, and child's state anxiety accounted for 32% of the variance in child distress during a recent medical procedure.     

Children's venipuncture pain: influence of technical factors.

Several aspects of venipuncture technique were evaluated to assess their relationship to reported pain. Subjects were 514 children aged 5-17 who had venipuncture performed by a technician in a hospital outpatient laboratory. A research assistant timed the duration of venipuncture and then obtained visual analogue pain scores from the children following venipuncture. Blood volume obtained from venipuncture was also measured. The technician who performed the procedure, amount of blood drawn, and time required to complete the venipuncture did not contribute to the prediction of children's pain. Age and anxiety, which were treated as covariates, were significant predictors of pain. The distribution of pain experienced by children was positively skewed and about one-third of children were above the mean pain score. From the results of this study, venipuncture pain can be recommended for the study of issues in children's pain. Further, the findings recommend the development and utilization of interventions to reduce children's venipuncture pain.     

脑瘫患儿父母焦虑情绪与应对方式的调查

目的 :调查脑瘫患儿父母焦虑情绪与应对方式的相关性。方法 :通过问卷调查 178例患儿父母焦虑情绪与应对方式 ,并采用直线相关分析应对方式与焦虑情绪的关系 ,比较脑瘫患儿父母与一般患儿父母的差异。结果 :脑瘫患儿父母的焦虑水平显著高于一般患儿父母 (P <0 .0 5 ) ,其焦虑水平与消极应对方式呈显著正相关 (P <0 .0 1)。结论 :应该提高脑瘫患儿父母的应对能力 ,降低焦虑水平。     

Children's views of their adaptation to type 1 diabetes mellitus

When a family learns their child has insulin-dependent type 1 diabetes mellitus, or type 1 diabetes, shock and anxiety are quickly followed by the reality of the demands of managing the condition. Demands include injections or continuous insulin infusion, blood glucose monitoring 2 to 4 times a day, regimented meal planning, and intensive planning of daily activities. Like many chronic illnesses, type 1 diabetes can have long-term effects on the child and family. Health providers must offer support in a number of ways. To determine the best way to approach children with diabetes mellitus, this study examined children's perceptions of their adaptation to type 1 diabetes. Recognizing children's own perceptions is critical for long-term understanding and management. The children in this study had overall positive self-perceptions and good attitudes toward illness. Even though many adults perceive diabetes mellitus in children as an overwhelming experience, the children's attitudes in this study were very positive.     

A Longitudinal Investigation of Maternal and Child ‘Anxious Cognitions’

Overestimation of threat and underestimation of coping have been frequently reported amongst anxious adults and children. The current study examines the longitudinal relationship between mothers’ anxious cognitions and expectations about their child, and children's anxious cognitions. 54 children (aged 10–11 years) and their mothers reported on their interpretation of ambiguous scenarios at two time points. Mothers also reported on their expectations about their child's reaction to ambiguous situations. Significant cross-sectional associations were found between mother and child anticipation of distress. Associations were most consistent between mothers’ expectations and children's cognitions. Furthermore, based on regression analyses, mothers’ expectations predicted change in children's anxious cognitions over time. Evidence for a reciprocal relationship, that child cognitions predict change in mothers’ expectations, was found for girls. The results provide empirical support for potential influences on the development of children's ‘anxious cognitive style,’ and suggest targets for preventing and reducing maladaptive cognitions in children.     

Pediatric anxiety: child life intervention in day surgery

Although many hospitals offer a surgical preparation program to children and families, minimal research has been conducted specifically on preparation by child life specialists. The purpose of this double-blind intervention study was to determine if children prepared for day surgery by a child life specialist exhibited less anxiety than those who received routine standard of care. One hundred forty-two children, aged between 5 and 11 years old, undergoing elective otolaryngology surgery completed the study. The "Child Drawing: Hospital" instrument developed by Clatworthy, Simon, and Tiedeman [Clatworthy, S., Simon, K., & Tiedeman, M. E. (1999). Child Drawing: Hospital - An instrument designed to measure the emotional status of hospitalized school-aged children. Journal of Pediatric Nursing, 14, 2-9] was used to determine children's anxiety levels preintervention and postintervention. Eighty children received formal preparation for their surgeries by a child life specialist and 62 received no intervention. The data were analyzed using a repeated-measures model with intervention, age, sex, and level of surgery for main effects. The anxiety score change was significantly better for the patients in the child life intervention group than for those in the nonintervention group, F(1,135) = 4.24, p = .04. The increase in anxiety scores in the nonintervention group suggests that children could benefit from preoperative preparation. Health professionals, including nurses, may impact children's abilities to cope with a surgical process. The information in this study will be useful in deciding whether all children, not just those with a perceived need, should be prepared prior to an elective day surgery.     

Adjustment to diabetes mellitus in preschoolers and their mothers

Although preschool-aged children with diabetes might be at increased risk for both general and disease-specific psychological adjustment difficulties, this issue has not been investigated. We evaluated both general and diabetes-related adjustment of 20 preschool-aged children and their mothers. The mothers completed the Child Behavior Checklist, Parenting Stress Index, Parents' Diabetes Opinion Survey, and the Preschool Diabetes Behavior Checklist. The latter measure was constructed specifically for this study to measure the frequency of oppositional and avoidance behaviors of children regarding diabetes management tasks. Mothers reported that their children displayed significantly more internalizing behavior problems (anxiety, depression, withdrawal) and were a significantly greater source of parental stress compared with corresponding nondiabetic normative group samples. Also, certain maternal attitudes about diabetes and its treatment were correlated with the children's disease-specific behavior problems. The children's general psychological adjustment, however, was not predictive of these diabetes-specific behavior problems.     

Exploration of variables related to children's behavioral distress during electrodiagnosis.

To investigate variables potentially related to children's distress during electromyography/nerve conduction studies (EMG/NCS), mothers of 39 children ages two to 17 years reported the child's gender, experience with EMG/NCS, previous negative medical/dental experiences, general response to painful procedures, information-seeking style prior to procedures, health care fears, and information about the mothers' own health care fears and their anxiety regarding EMG/NCS. Physicians who performed the studies completed a behavioral distress checklist for each child. Results indicated that children exhibiting more behavioral distress were younger, had been uncooperative with previous painful procedures, were more likely to have had more negative medical/dental experiences, and had mothers who themselves reported greater fear and anxiety about undergoing EMG/NCS. Regression analyses indicated that previous negative medical/dental experiences accounted for additional variance in distress beyond that attributed to the child's age. Significant positive correlations between children's distress and specific previous negative medical/dental experiences were found.