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International Journal of Pediatric Nursing Effectiveness of Origami on
Hospitalized Anxiety among Children Admitted in Paediatric Units of a
Selected Tertiary Care Hospital Ludhian...
Article · January 2021
DOI: 10.37628/IJPN
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Manisha Thakur Navjot Kaur
BEE ENN COLLEGE OF NURSING, CHAK BHALWAL All India Institute of Medical Sciences Bathinda College of Nursing
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Puneet Aulakh Pooni
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ISSN: 2455-6343
International Journal of
Volume 7, Issue 2, 2021
Pediatric Nursing DOI (Journal): 10.37628/IJPN
http://nursing.journalspub.info/index.php?journal=IJPN&page=index
Research IJPN
Effectiveness of Origami on Hospitalized Anxiety among
Children Admitted in Paediatric Units of a Selected
Tertiary Care Hospital Ludhiana, Punjab
Manisha Thakur1,*, Navjot Kaur2, Puneet A. Pooni3
Abstract
Hospital can be a difficult place for young children and their families. In hospitals, children may find
strange faces, different routines, strange equipment’s and limited family contact leads to development
of anxiety in children. Anxiety can hamper there early recovery and leads to psychological effect on
the child. Play provisions like origami can help children to overcome the anxiety and work as outlets
for hostilities. The present study was conducted with an objective to assess the effectiveness of
origami on hospitalized anxiety among children admitted in paediatric units. A pre-experimental
design was preferred to assess the effectiveness of origami on hospitalized anxiety among 40 children
of age group 4–10 years selected by convenience sampling in paediatric units of DMC and Hospital,
Ludhiana. The intervention was given to children for minimum 15–20 minutes for three consecutive
days. Structured likert scale to assess anxiety and bio-physiological measures was used to collect the
data using observation technique and self-report method. The mean anxiety score before intervention
was higher (33.10±10.61, 37.61%) than after intervention (28.85±9.37, 32.78%). The difference of
mean pre-test and post-test hospitalized anxiety was found to be statistically significant (p<0.05). The
study findings revealed that origami was effective in reducing the level of hospitalized anxiety among
children.
Keywords: Anxiety, children, equipment, hospitalized anxiety, origami
INTRODUCTION
Hospitalization is a process of admitting children in hospital for reasons of planning or emergency
that requires the child to stay in the hospital in order to undergo treatment and medication. It plays an
important role in the care of children’s health and recovery [1]. Each year, a significant number of
children incur physical injuries requiring medical
*Author for Correspondence attention. More than 225,000 of these children are
Manisha Thakur hospitalized yearly (Center for Disease Control,
E-mail: manishathakur605@gmail.com
2009). Hospitalization has many unfavorable
1
Post Graduate M.Sc. Nursing Student, Department of effects on children which need to be prevented.
Nursing, Dayanand Medical College and Hospital, Ludhiana, Different age group perceive their view about the
Punjab, India
2
Assistant Professor, Department of Child Health Nursing, hospitalization according to their physical and
Dayanand Medical College and Hospital, Ludhiana, Punjab, mental maturity [2]. In a sense, for children the
India hospital is like a foreign country to whose customs,
3
Professor and HOD, Department of Paediatrics, Dayanand
Medical College and Hospital, Ludhiana, Punjab, India language and schedules they must learn to adapt.
Hospitalization can have positive as well as
Received Date: January 07, 2021 negative effect on child. The factors causing the
Accepted Date: April 26, 2021
Published Date: June 17, 2021 negative outcome of hospitalization are isolation
from the family, fantasies, anxiety and fears from
Citation: Manisha Thakur, Navjot Kaur, Puneet A. Pooni. the new environment, social deprivation (nowadays
Effectiveness of Origami on Hospitalized Anxiety among
Children Admitted in Paediatric Units of a Selected Tertiary no longer a reality), pain and other complications
Care Hospital Ludhiana, Punjab. International Journal of of illness, surgery and stressful medical procedures,
Pediatric Nursing. 2021; 7(2): 1–9p. fears of disablement and death [3].
© JournalsPub 2021. All Rights Reserved 1
Effectiveness of Origami on Hospitalized Anxiety among Children Thakur et al.
According to Hockenberry, Wilson and Winkelstein, the main factor that can lead to strain on the
activity of hospitalization is the separation of parents, loss of control, and fear of bodily injury and
pain. In addition to stress, hospitalization also causes fear and anxiety in children aged 4–6 years [4].
Regardless of age, experience, other socio-demographic variable or the degree of illness or injury,
the hospitalization constitutes a major crisis in the life of a child. The emotional trauma may elicit
various behavioral reactions. Excessive anxiety also hinder children efficacy in adjusting with medical
treatment, and increase their uncooperative behavior. The experience of being hospitalized is usually
an anxiety-provoking and even traumatic experience, especially for children. Children are more prone
to adverse results of being sick, and their hospitalization is a traumatic event with potential
consequences for children and their loved ones. Due to cognitive, emotional limitations and
dependence on others, they are particularly vulnerable to stresses involved in adapting to their
condition of illness and hospitalization. Hospitalization brings lot of stress in the life of a child leading
to hinder their cognitive growth and development [5]. Coyne's research (2006) concluded that
hospitalized children undergo a lot of stress and experience various fears and anxieties, especially,
separation from parents, etc. [6].
The children irrespective of their ages are more sensitive to the hospital environment. The
surroundings prevailing is totally new to them like IV cannula, white coat health personnel’s,
procedures are more frustrating. This leads to increase in anxiety among them hence leading to their
uncooperative behavior and negative emotions towards health care staff. The value of play to a
hospitalized child has been recognized to meet the physical, mental and emotional needs of child. Play
provision should be provided to enhance their coping abilities, communication and bring change in
their behavior towards health care staff [7].
A study conducted in Chennai revealed that administering play therapy for 2 consecutive days with
4 hours interval had led to significant reduction in anxiety in experimental group. The mean anxiety
score before and after the intervention was found to be 49 and 42.7 in experimental group whereas in
control group it was found to be 49.5 and 48.4, respectively [8].
There are wide ranges of recreational activities which have been used in hospital settings to distract
hospitalized children. There are certain play activities, art therapy which includes drawing, painting,
sketching. Out of which origami is also one of them which is getting popularized nowadays [9].
Provisions like origami in hospital can lead to the conducive environment for proper growth and
development physiologically and psychologically. Origami acts as diversional activity for children
engaging themselves in molding waste paper, color paper into meaningful shapes and sizes. Activities
like this can motivate them to socialize and verbalize their feeling regarding the surroundings [5].
Origami can be used as one of the strategies to reduce or alleviate hospitalization anxiety to gain
cooperation of the child by diverting their mind from various stressful activities of hospital. Various
studies are conducted to assess the effect of origami on hospitalized anxiety among children of
different age group in different settings. The findings of various studies show that origami is helpful
techniques in reducing level of hospitalized anxiety among children [10]. In a hospital environment, a
supervised and guided diversional program provides warmth, friendly and happy atmosphere which
will help the child continue to grow and develop. In most of the super-specialty and multispecialty
hospitals, there is a specialist who coordinates the play as well as the diversional programs.
Origami is a promising, cost effective, nonpharmacological technique to reduce hospitalized
anxiety and can be used to enhance intellectual and cognitive process while being admitted in the
hospital. So, the researcher planned to use origami as a technique among children to reduce
hospitalized anxiety.
© JournalsPub 2021. All Rights Reserved 2
International Journal of Pediatric Nursing
Volume 7, Issue 2
ISSN: 2455-6343
MATERIALS AND METHODS
A pre-experimental (one group pre-test and post-test) research design was used to assess the
effectiveness of origami on hospitalized anxiety among 40 children who were admitted in paediatric
units (paediatric medicine ward and paediatric surgery ward) of a selected tertiary care hospital,
Ludhiana, Punjab.
E → O1 → X → O2 → O3 → X → O4 → O5 → X → O6
E: Experimental group
X: Intervention
O1: Observation I
O2: Observation II
O3: Observation III
O4: Observation IV
O5: Observation V
O6: Observation VI
Schematic representation of Methodology Flowchart is shown in Figure 1.
RESULTS AND DISCUSSION
The specific objectives of the study were:
1. To assess the pre-test and post-test level of hospitalized anxiety among children.
2. To compare the pre-test and post-test level of hospitalized anxiety among children.
Organization of the Data for Analysis
The analysis of the data from the study was presented under the following headings:
• Section I: Socio-demographic and clinical profile of the children.
• Section II: Assessment and comparison of pre-test and post-test hospitalized anxiety among
children.
• Section III: Bio-physiological data of children.
• Section IV: Association of post-test level of hospitalized anxiety with socio- demographic and
clinical profile.
Section I: (Socio-demographic and Clinical Profile of the Children)
Table 1 reveals the socio-demographic characteristics of children. Less than half, i.e., 18(45.0%) of
children were in the age group of 4–6 years. More than half of the children 23(57.5%) were males.
Maximum no. of children, i.e., 25(62.5%) were first born child in the family. Out of 40 children,
24(60.0%) children belonged to rural area. Majority of children, i.e., 26(65.0%) belonged to the joint
family. Out of 40 children, 29(72.5%) children belonged to Hindu religion. Maximum number of
parents, i.e., 39(97.5%) were married and living together. Out of 40, 17(42.5%) parents were from
Upper Middle Class (II). Out of 40 children, half of the children’s mother and father, i.e., 20(50%)
have done graduation and above.
Table 2 reveals the clinical profile of children admitted in paediatric units, only 06(15.0%) children
were diagnosed with liver disease and dengue disease. Majority of the children, i.e., 39(97.5%) were
admitted in paediatric medicine ward. Out of 40 children, 15(37.5%) children had history of elective
hospitalization. Maximum number of children, i.e., 36(90.0%) had history of acute illness. More than
half of the children, i.e., 30(75.0%) had history of duration of hospitalization between 01 and 05 days.
Out of 40 children 29(72.5%) had no previous exposure to hospitalization. Majority of the children,
i.e., 35(87.5%) had mother as primary care giver. Majority of the children, i.e., 32(80) had both (oral
and intravenous) route of medication.
© JournalsPub 2021. All Rights Reserved 3
Effectiveness of Origami on Hospitalized Anxiety among Children Thakur et al.
RESEARCH DESIGN
Pre-experimental
RESEARCH SETTING
Paediatric Units (paediatric medicine and paediatric surgery)
TARGET POPULATION
Hospitalized children in the age group 04–10 years
SAMPLING TECHNIQUE
Convenience
SAMPLE SIZE
N=40
Intervention
Origami for consecutive 3 days for minimum 15–20 minutes
TOOLS METHODS
PART A(I)-Socio Demographic profile of children
PART A(II)-Clinical profile of children • Parent report (pen & paper)
PART B–Structured likert scale to assess anxiety
• Observation
among children during hospitalization.
PART C–Bio-physiological Measures
ANALYSIS AND INTERPRETATION OF DATA
Descriptive and inferential statistics
Figure 1. Methodology chart.
© JournalsPub 2021. All Rights Reserved 4
International Journal of Pediatric Nursing
Volume 7, Issue 2
ISSN: 2455-6343
Table 1. Distribution of children as per their socio-demographic profile.
Socio-demographic characteristics f(%)
Age (in years)
4–6 18(45.0)
7–8 16(40.0)
9–10 06(15.0)
Gender
Male 23(57.5)
Female 17(42.5)
Birth order
First 25(62.5)
Second 14(35.0)
Third or more 01(02.5)
Habitat
Rural 24(60.0)
Urban 16(40.0)
Type of family
Joint 26(65.0)
Nuclear 12(30.0)
Extended 02(05.0)
Religion
Hindu 29(72.5)
Muslim 01(02.5)
Sikh 10(25.0)
Marital status of parents
Live together 39(97.5)
Widow/widower 01(02.5)
Socio-economic status ( as per Kuppuswamy scale 2019)
Upper class (I) 06(15.0)
Upper middle class (II) 17(42.5)
Lower middle class (III) 15(37.5)
Upper lower class (IV) 02(05.0)
Educational status of mother
Graduate and above 20(50)
Secondary 17(42.5)
Elementary 03(7.5)
Educational status of father
Graduate and above 20(50)
Secondary 14(35)
Elementary 06(15)
Mean age of children = 6.80 ± 1.62
Section II: Assessment and Comparison of Pre-test and Post-test Hospitalized Anxiety among
Children
Table 3 reveals the level of anxiety among hospitalized children before and after intervention shows
that, before intervention 18(45%) children had experienced mild anxiety, while moderate anxiety was
experienced by 22(55%) children and after intervention 25(62.5%) had experienced mild anxiety,
while moderate anxiety was experienced by 15(37.5%) children.
© JournalsPub 2021. All Rights Reserved 5
Effectiveness of Origami on Hospitalized Anxiety among Children Thakur et al.
Table 2. Distribution of children as per their clinical profile.
Clinical profile f(%)
Diagnosis
Liver disease 06(15.0)
Dengue 06(15.0)
Acute febrile illness 11(27.5)
Pain abdomen 05(12.5)
Kidney disease 04(10.0)
Postoperative 02(05.0)
Others 06(15.0)
Admission ward
Paediatric medicine 39(97.5)
Paediatric surgery 01(02.5)
Type of hospitalization
Elective 15(37.5)
Emergency 25(62.5)
Type of illness
Acute 36(90.0)
Chronic 04(10.0)
Duration of hospitalization (in days)
01–05 30(75.0)
06–10 07(17.5)
11–15 02(05.0)
16–20 01(02.5)
Previous admission to hospital
Yes 11(27.5)
No 29(72.5)
No. of hospitalization in last year (n=11)
One time 11(100)
Primary Care giver of the child during present hospitalization
Father 05(12.5)
Mother 35(87.5)
Route of Medication
Intravenous 08(20)
Both (oral and intravenous) 32(80)
Table 3. Distribution of children as per the level of hospitalized
anxiety before and after intervention (origami).
Level of Pre-test Post-test
Score
Anxiety f(%) f(%)
No anxiety 00–29 -- --
Mild 1–30 18(45%) 25(62.5%)
Moderate 31–60 22(55%) 15(37.5%)
Severe 61–88 -- --
Comparison of Level of Hospitalized Anxiety among Children before and after the Intervention
(Origami)
The mean anxiety score and mean% before intervention in children was more (33.10±10.61,
37.61%) than after intervention. After intervention mean anxiety score and mean % was found to be
© JournalsPub 2021. All Rights Reserved 6
International Journal of Pediatric Nursing
Volume 7, Issue 2
ISSN: 2455-6343
(28.85±9.37, 32.78%). This difference was found to be statistically significant (p=0.005) with t value
2.99 and hence, it was inferred that origami was effective in reducing the level of hospitalized anxiety
among children.
Section III: Biophysiological Data of Children
Respiration rate
The comparison of pre-test and post-test level of respiration rate revealed that, on day 1, 37(92.5%)
children had desirable range of respiration rate before intervention and 38(95%) children had
desirable range of respiration rate after the intervention. However, the difference was found to be
statistically nonsignificant (p=1). On day 2, all 40(100%) children had desirable range of respiration
before and after the intervention. On day 3, before intervention, 38(95%) children had desirable range
of respiration, whereas all 40(100%) children had desirable range of respiration rate after intervention.
However, the difference was found to be statistically nonsignificant (p=0.15).
Table 4. Association of post-test level of hospitalized anxiety with socio-demographic profile.
Socio-demographic Variables N Mean ± SD F/t value p value
Age (in years)
4–6 18 31.27 ± 10.09
7–8 16 27.87 ± 07.53 1.47 0.24NS
9–10 06 24.16 ± 10.88
Gender
Male 23 27.87 ± 7.78
0.76 0.44NS
Female 17 30.17 ± 11.30
Birth order
First 25 27.80 ± 9.71
Second 14 30.71 ± 10.13 0.42 0.66NS
Third or more 01 29.00
Habitat
Rural 24 28.20 ± 9.64
0.52 0.60NS
Urban 16 29.81 ± 9.19
Type of family
Joint 26 30.07 ± 9.60
Nuclear 12 26.58 ± 9.53 0.62 0.54NS
Extended 02 26.50 ± 3.53
Religion
Hindu 29 29.24 ± 9.67
Muslim 01 27.00 0.09 0.91NS
Sikh 10 27.90 ± 9.37
Marital status of parents
Live together 39 28.92 ± 9.49
0.30 0.76NS
Widow/widower 01 26.00
Socio-economic status (as per Kuppuswamy scale 2019)
Upper class (I) 06 30.00 ± 13.43
Upper middle class (II) 17 28.41 ± 9.38
0.14 0.93NS
Lower middle class (III) 15 28.40 ± 8.52
Upper lower class (IV) 02 32.50 ± 7.77
Minimum score: 00, NS= Nonsignificant (p>0.05); df=F (df=39); t (df=38) Maximum score: 88
Blood pressure
The comparison of pre-test and post-test level of blood pressure revealed that, on day 1, 28(70%)
children had desirable range of blood pressure, before and after the intervention. However, the
© JournalsPub 2021. All Rights Reserved 7
Effectiveness of Origami on Hospitalized Anxiety among Children Thakur et al.
difference was found to be statistically nonsignificant (p=01). On day 2, 28(70%) children had
desirable range of blood pressure before intervention, whereas 32(80%) children had desirable range
of blood pressure after intervention. However, the difference was found to be statistically
nonsignificant (p=0.30). On day 3, before intervention 25(95%) children had desirable range of blood
pressure and after intervention 32(100%) children had desirable range of blood pressure. However,
the difference was found to be statistically nonsignificant (p=0.08).
Heart rate
The result concluded that all 40(100%) children had desirable range of heart rate before and after
intervention on all three days.
Table 5. Association of post-test level of hospitalized anxiety with clinical profile.
Clinical profile n Mean ± SD F/t value p value
Diagnosis
Liver disease 06 29.83 ± 9.06
Dengue 06 27.00 ± 11.57
Acute febrile illness 11 27.90 ± 08.83
Pain abdomen 05 32.60 ± 14.36 0.37 0.88NS
Kidney disease 04 30.50 ± 8.06
Postoperative 02 33.50 ± 9.19
Others 06 25.66 ± 6.97
Admission ward
Paediatric medicine 39 28.56 ± 9.32
1.21 0.23NS
Paediatric surgery 01 40.00
Type of hospitalization
Elective 15 27.53 ± 10.40
0.68 0.49NS
Emergency 25 29.64 ± 8.83
Type of illness
Acute 36 28.61 ± 9.54
0.47 0.63NS
Chronic 04 31.00 ± 8.60
Duration of hospitalization (in days)
01–05 30 28.46 ± 9.74
06–10 07 28.42 ± 8.24
1.01 0.39 NS
11–15 02 28.00 ± 1.41
16–20 01 45.00
Previous admission to hospital
Yes 11 23.72 ± 6.21
2.23 0.03*
No 29 30.79 ± 9.72
Primary Care giver of the child during present hospitalization
Father 05 25.60 ± 7.79
0.82 0.41NS
Mother 35 29.31 ± 9.59
Route of medication
Parenteral 08 35.12 ± 13.62
2.22 0.03 *
Both 32 27.28 ± 7.48
Minimum score: 00, NS= Nonsignificant (p>0.05); df=F (df=39); t (df=38) Maximum score: 88
Oxygenation Saturation
The results concluded that all 40(100%) children had desirable range of oxygenation saturation
before and after the intervention on all three days.
© JournalsPub 2021. All Rights Reserved 8
International Journal of Pediatric Nursing
Volume 7, Issue 2
ISSN: 2455-6343
Section IV: Association of Post-test Level of Hospitalized Anxiety with Socio-demographic and
Clinical Profile
Table 4 reveals the association of post-test level of hospitalized anxiety with socio-demographic
profile of children. The table showed that, socio-demographic profile like age, gender, birth order,
habitat, type of family, religion, marital status of parents and socio-economic status of family was
found to be statistical nonsignificant at p>0.05. Hence, it can be concluded that all above factors were
not associated with post-test level of hospitalized anxiety.
Table 5 reveals the association of post-test level of hospitalized anxiety with clinical profile of
children. The table showed that clinical profile like previous history of admission and route of
medication were found to be statistical significant at p<0.05. Hence, it can be concluded that previous
history of admission and route of medication were associated with post-test level of hospitalized
anxiety.
CONCLUSION
Hence, it was concluded that 40 children admitted in paediatric units were studied to assess the
effectiveness of origami on hospitalized anxiety. The difference of mean pre-test and post-test
hospitalized anxiety was found to be statistically significant (p<0.05). Therefore, the findings
concluded that origami was effective in reducing the level of hospitalized anxiety among children.
CONFLICT OF INTEREST
There is no conflict of interest.
ACKNOWLEDGEMENT
The author would like to thank her parents, teachers and friends for their continuous support and all
the health care professionals who sincerely assisted the researcher throughout the study.
FUNDING INFORMATION
Self by the corresponding author
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