Abstract
Objectives: Anxiety and anticipatory stressors are commonly experienced by children visiting the Pediatric Emergency Department (PED), but little research exists that addresses the efficacy of interventions to decrease this stress. This one-sample pretest-postest pilot study gathered preliminary data on the feasibility and effectiveness of utilizing audiobooks to reduce fear and state anxiety in children in the PED.Methods: Participants were 131 children in kindergarten through 8th grade (M = 9.4 years, 54% female), triaged urgent or emergent, presenting to the PED. Participants self-reported fear (Children's Fear Scale) and state anxiety (modified State-Trait Anxiety Inventory for Children; mSTAIC) before and after listening to an age-appropriate audiobook (two options). Data regarding patient experience were also collected. Paired samples t-test was used to examine pre–post intervention changes in fear and state anxiety.Results: Significant, albeit small, improvements in fear and the mSTAIC states of nervous, calm, happy, and relaxed were found after use of the audiobook (Cohen's dz = 0.22–0.35). Small, yet significant correlations were found between child age/grade level and improvements in fear and in the mSTAIC states of scared and relaxed, suggesting that the audiobook was more beneficial for older participants. Over 60% of participants liked the audiobook content “a lot” as well as enjoyed listening to the audiobook “a lot.” Without prompting, 15% of participants requested to listen to an additional audiobook.Conclusions: Listening to an audiobook is feasible and could be effective in decreasing fear and state anxiety for children during a waiting period in the PED. The technology is low-cost, simple, and portable. The results of this study should be interpreted with prudence due to the lack of a control group and results that, although significant, were modest based on effect size conventions; future studies should explore the impact of audiobooks on patient stress with an expanded sample size and control group.
Highlights
Feelings of anxiety, stress, and fear before healthcare procedures can have psychological and physiological effects, adversely interfering with optimal patient outcomes [1]
Ancillary Results Child age and school grade level were significantly correlated with pre–post differences in fear [rs = 0.18, p’s = 0.04] and in the modified STAIC states of scared [r = −0.21, p = 0.02; r = −0.19, p = 0.03] and relaxed [r = 0.18, p = 0.05; r = 0.18, p = 0.04]. These results suggest that the audiobook was more beneficial for older participants; with greater age, participants experienced a larger reduction in fear and feeling scared alongside a greater increase in feelings of relaxation
ED triage level, and final diagnosis were all non-significant as between-subjects variables, indicating that pre–post differences in fear and state anxiety were not differentially affected by any of these factors
Summary
Stress, and fear before healthcare procedures can have psychological and physiological effects, adversely interfering with optimal patient outcomes [1]. Anxiety and anticipatory stressors are commonly experienced by children during visits to the Emergency Department, which may engender uncooperative behaviors and difficulty tolerating medical procedures. Research in the ED has focused primarily on pharmacological and non-pharmacological methods to minimize procedural pain, often during venipuncture or laceration repairs [3,4,5,6,7,8,9,10,11]. Research suggests that between 36 and 50% of children may experience heightened state anxiety from being present in the Pediatric ED (PED), without even undergoing a procedure [2, 12]. Minimal research has investigated the efficacy of interventions to decrease anticipatory anxiety, stress, and fear in the PED. Research has examined the use of ambient lighting, music, and aromatherapy in the waiting room, as well as the utilization of Child Life and hospital clowning with varying success [12,13,14]
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