Encounters with healthcare services during childhood, particularly surgical evaluation processes, are a significant source of stress for both children and their parents. The initial evaluation, physical examination, and the prospect of a possible procedure conducted in pediatric surgery outpatient clinics can lead to increased levels of anxiety and fear in children. This situation not only affects the child's current psychological state but also reduces their cooperation during the examination, makes collaboration with healthcare professionals more difficult, and can negatively impact the overall healthcare experience. Increased levels of anxiety and fear in children are not limited to emotional reactions alone; they also affect physiological and behavioral responses, thereby shaping the entire healthcare process. Similarly, parents may also experience significant situational anxiety due to uncertainty about their child's health status, the possibility of surgical intervention, and the responsibility for care. Parental anxiety is a significant factor that can influence children's levels of anxiety and fear and can indirectly shape the child's healthcare experience through parent-child interaction.
Are aged between 5 and 10 years,
Are undergoing their first outpatient pediatric surgery evaluation,
Have no prior history of surgery, and Agree (along with their parents) to voluntarily participate in the study.
Are in unstable general condition or require emergency medical intervention,
Have intellectual disabilities, or Have visual or hearing impairments.
Single group
Multisensory Stimulation
Other interventionMultisensory Stimulation
Children's Pre-procedural Anxiety Level
Children's Anxiety Scale - State Scale The CAS-S resembles a thermometer featuring a bulb at the bottom and horizontal lines spaced at intervals as they rise upwards. Designed for children aged four to ten, this scale instructs children to "Imagine that all your anxious or nervous feelings are in the bulb or lower part of the thermometer." "If you feel a little anxious or tense, your feelings may rise a little higher on the thermometer. "Put a line on the thermometer to show how anxious or nervous you are." It was discovered during the researchers' data collection process that some children were familiar with the typical mercury thermometer represented on the scale, and when children did not understand this analogy, they used an alternative scenario that did not explicitly describe a thermometer. Children are told, "Think of all the anxious or nervous feelings as being at the bottom here (point with your finger on the scale).
Children's Fear Level
The Child Fear Scale (CFS), validated and proven reliable by Gerçeker et al. (2018), is used to measure a child's anxiety level. The CFS is a scale that evaluates children's anxiety levels using a 0-4 rating system, consisting of five drawn facial expressions ranging from a neutral expression (0=no anxiety) to a frightened face (4=severe anxiety). It can be used by families and researchers to assess pre-procedural and intra-procedural pain and anxiety in children and is aimed at children aged 5-10 years. The CFS is based on the Faces Anxiety Scale developed by McKinley et al. (2003) to measure the fear or anxiety of adults in the intensive care unit. It is a scale consisting of one item and five gender-neutral faces. The facial muscle changes in the fearful expressions were drawn by a graphic artist based on photographs of frightened faces. The scale will be administered to children as a pre-test and post-test.
Parental State Anxiety Level
State-Trait Anxiety Inventory A 10-item short version of the 40-item State-Trait Anxiety Inventory (STAI) was developed by Zsido et al. In the process of shortening the STAI, Zsido et al. (2020) first removed the reverse-scored items from the scale and then reduced these inventories to their short 5-item forms (STAIS-5 and STAIT-5) by performing confirmatory factor analysis (CFA), item response theory analysis, and ROC analysis to preserve the best discriminating items. The 4-point Likert-type scales consist of 5 items. The emotions and behaviors indicated in STAIS-5 are marked according to their degree of severity as 1 = None, 2 = Somewhat, 3 = Moderately, 4 = Very much; and the STAIT-5 items are marked as 1 = None, 2 = Sometimes, 3 = Moderately, 4 = Very much. Individuals scoring 10 or higher on STAIS-5 and 14 or higher on STAIT-5 are considered clinically anxious. The Cronbach's alpha values for STAIS-5 and STAIT-5 were calculated as 0.86 and 0.91.
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