Does Child-Friendly Design Reduce Preoperative Anxiety in Pediatric Surgery Patients?

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Abstract
Background: Hospital environments can be distressing for pediatric patients, particularly before surgery. Preoperative anxiety is a common issue among children, potentially leading to adverse psychological and physiological effects. Child-friendly environmental modifications, such as incorporating cartoon characters and natural scenery in hospital design, may help reduce anxiety and improve patient experience. Objective: This study aimed to evaluate the effect of child-friendly environmental design interventions—specifically, painting pediatric surgery ward walls with universal cartoon images and natural scenes—on preoperative anxiety levels in children. Methods: A mixed-methods design (comparative and descriptive) was employed. The study included 80 children aged 4 to 10 years, divided into two groups (n = 42 in the first group, n = 38 in the second group). Preoperative anxiety levels were assessed using The Children's Anxiety Meter-State and Trait scales. Additionally, children in the second group were asked, “ What is your opinion about painting the walls?” to collect qualitative feedback. Results: The mean preoperative state anxiety score was 5.40 ± 3.46 in the first group and 3.52 ± 3.50 in the second group ( p < .05), indicating a significant reduction in anxiety after the environmental intervention. In group 2 (after painting), 78.5% (n = 30) of children responded to the open-ended question, with 90% expressing satisfaction with the newly designed environment. Conclusion: Painting pediatric surgery ward walls with child-friendly imagery and natural scenes was found to be an effective nonpharmacological intervention in reducing preoperative anxiety in children. These findings support the integration of child-friendly environmental designs in pediatric healthcare settings to enhance patient wellbeing.

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