NURSING STRATEGIES TO REDUCE ANXIETY IN HOSPITALIZED CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS
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Keywords
pediatric anxiety; hospitalized children; nursing interventions; non-pharmacological; distraction; play therapy; music therapy
Abstract
Hospitalisation and hospital-based procedures can provoke significant anxiety in children, influencing distress and cooperation with care. Nurses are well positioned to deliver non-pharmacological interventions to reduce anxiety. To quantify the pooled effect of nursing-implemented or nursing-facilitated non-pharmacological interventions on anxiety in hospitalized children compared with usual/standard care, and to explore differences by intervention category and clinical setting. A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. Comparative studies involving children (18 years) in inpatient or peri-procedural/perioperative hospital settings were included. Data were synthesised using standardized mean differences (Hedges g; negative values indicate lower anxiety) with a random-effects (DerSimonian–Laird) model. Heterogeneity was assessed using I², and small-study effects were examined using funnel plot inspection and Egger’s test. Fifteen studies (N=1517) were included. The pooled random-effects estimate showed a significant reduction in anxiety favouring intervention groups (g = -1.10, 95% CI -1.56 to -0.65; p0.001), with substantial heterogeneity (I² = 93.9%). Sensitivity analysis excluding extreme effects (|g|>3) remained significant (g = -0.70, 95% CI -0.99 to -0.42; p0.001). Subgroup analyses suggested variability by intervention type, and Egger’s test indicated potential small-study effects (p=0.024). Nursing-implemented non-pharmacological interventions reduce anxiety in hospitalized children, but effect sizes vary widely across interventions and contexts. Standardised outcome measurement and well-powered trials are needed to strengthen guidance for practice.