Essay: Guided Imagination benefits for children with cancer

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Essay: Guided Imagination benefits for children with cancerEssay: Guided Imagination benefits for children with cancerORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERSThe purpose of the Critique assignment is to apply content discussed for the week.Read the attached article.Apply the identified Guidelines for Critiquing to develop a systematic description of the manuscript.The Critique is to answer the question as briefly and concisely as possible. Moving in to Evidence Based Practice, this is content that could be placed in a review or synthesis table.12 pt font, 1 page, use Box 9.1. Guided Imagination benefits for children with cancer. Essay: Guided Imagination benefits for children with cancer kodchakon__phumdoung_A Randomized Control Trial of Guided-Imagination and Drawing-Storytelling in Children with Cancer. A Randomized Control Trial of Guided-Imagination and Drawing-Storytelling in Children with Cancer. Kodchakon Piasai, Sasitorn Phumdoung*, Wantanee Wiroonpanich , Thirachit Chotsampancharoen Abstract:Hospitalized school-age children with cancer are confronted with stressful and life-threatening situations which can cause them unhappiness, tension, and stress. This randomized control trial investigated the effects of guided-imagination and drawingstorytelling on the happiness, relaxation, and salivary cortisol levels among hospitalized school-age children with cancer. Participants were randomly assigned to the experimental group (n=20) or the control group (n=20). The participants in the experimental group received guided-imagination for 30 minutes, followed by 30 minutes of drawing-storytelling, while the participants in the control group received only usual care. The Happiness Face Scale was used for measuring happiness and the Relaxation Scale was used for measuring relaxation. Saliva was also collected for testing cortisol levels. Descriptive and inferential statistics were used to analyze the data. The results showed that the experimental group receiving guided-imagination and drawing-storytelling had statistically significant increased happiness and relaxation scores over time, compared to the control group. Even though cortisol levels decreased throughout the study, there were no significant differences between the two groups. These results demonstrate that guided-imagination and drawing-storytelling can enhance happiness and relaxation levels but may not decrease salivary cortisol levels. Thus, it is recommended that nurses provide the guided-imagination and drawing-storytelling to pediatric patients to increase their happiness and relaxation. Pacific Rim Int J Nurs Res 2018; 22(4) 386-400 Keywords: Cancer, Children, Cortisol, Drawing-storytelling, Guided imagination, Happiness, Relaxation Received 15 May 2017; Accepted 6 March 2018 Introduction Cancer affects both the physical and emotional aspects of children, including procedures and treatments which cause stressful, life-threatening1 and long-term hospitalization.2 Children with cancer also may experience severe suffering from the lifelong damage from cancer and treatments compared to children with other chronic diseases.3 The existing interventions that have attempted to help hospitalized children with psychological distresses 386 Kodchakon Piasai, RN, PhD Candidate, Faculty of Graduate School, Prince of Songkla University, and Instructor, Institute of Nursing, Suranaree University of Technology, Thailand. E-mail: Correspondence to: Sasitorn Phumdoung*, RN, PhD, Professor, ObstetricsGynecology and Midwifery Department, Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand. E-mail: Wantanee Wiroonpanich, RN, PhD, Assistant Professor Pediatric Department, Faculty of Nursing, Prince of Songkla University, Thailand. E-mail: Thirachit Chotsampancharoen, MD, Assistant Professor Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand. E-mail Pacific Rim Int J Nurs Res • Guided Imagination benefits for children with cancer. Essay: Guided Imagination benefits for children with cancerOctober – December 2018 Kodchakon Piasai et al. (anxiety, depression, stress, negative emotions)4-5 are play activities or therapeutic play,6 and/or psychological preparation.5 Music intervention has been used for improving psychological distress (stress, distress, depression, anxiety),7 negative emotions as moods,8 and physical signs and status (pain, heart rate, respiratory rate).9 In addition, play activities can decrease the stress of children aged 7-11 years, but cannot decrease stress in younger children (age < 7 years).10 Moreover, playing computer games can reduce the distress behavior in children who receive an injection.11 Such studies show some or no benefits10 from the interventions on psychological and physical status. This reflects that only one intervention might have little effect on psychological and physical status of people. There are many activities to help children experience good feelings and emotions no matter if those children are healthy or sick. The activities that are most appropriate for children include play, such as playing with play-dough, doing art (painting) and crafts, playground activities, reading stories or tales, playing computer games12 and listening to music.13 Another way that makes children happy is imagining a previous fun experience as the imagination can help a person to recall a memory of happiness.14 Although there are many negative effects of cancer on children, there are rarely recent published studies identifying methods to help children with cancer to feel happy, relaxed, or at least provide the activities that help children with cancer to recover a sense of normalcy in experiencing some happiness, relaxation and relief from stress. From those interventions that have inconsistencies in the results;12-14 only providing one intervention may result in limited effects on psychological and physical status. Therefore, a combination of interventions may produce more benefit. Thus, this study attempted to test the effects of guided-imagination and computer drawing-storytelling on happiness, relaxation, and cortisol levels to help school-age children with cancer to experience happiness, relaxation and a reduction in cortisol levels. Vol. 22 No. 4 Conceptual framework and related literature Music therapy and therapeutic play were used to guide this study, which was supported by a holistic philosophy (body-mind interaction).15 The bodymind interaction was used to explain the effects of the interventions (GIM followed by computer drawingstorytelling) on happiness, relaxation, and cortisol levels. When people encounter a deleterious situation, the reactions include stress responses in the brain (hypothalamus and pituitary) and body reactions which involve the hypothalamic-pituitary-adrenal axis (HPA-axis).16 Stress reaction involves the hypothalamus secreting corticotropin-releasing hormone (CRH), which stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH). This in turn stimulates the adrenal cortex to release the cortisol hormone.16 The interventions of this study involved using imagination to help children recall a situation that impressed them. Guided-imagination aims to promote a child’s ability to use their imagination.17 Moreover, imagination empowers children to engender the events that have happened in the past as happiness.18 Furthermore, the imagination stimulates positive moods, for example, happiness and relaxation.19 Another intervention that is a component of GIM is classical music without lyrics. There are limited reports of music acting to lower stress, but only one study showed that music could reduce stress regarding decreasing cortisol levels.20Guided Imagination benefits for children with cancer. Essay: Guided Imagination benefits for children with cancerThe energy of sound goes to the primary auditory cortex and is processed in the amygdala21 that causes the pituitary gland to secrete the endorphin hormone which results in signals of positive feelings as/ m happiness and relaxation.22 Music also activates the interaction of the thalamus with the HPA-axis, and can induce children to relax;21 especially classical music without lyrics and with a beat of 64-70 beatin in the levels of sound of 45-50 decibels can cause persons to become more relaxed.23 Previous studies showed that music can reduce stress,24 which is reflected by decreasing cortisol levels.7 Furthermore, music has an effect on the hippocampus which is related 387 A Randomized Control Trial of Guided-Imagination and Drawing-Storytelling in Children with Cancer. to long-term memories and positive emotions, such as, pleasure and happiness.25 Feelings and physical signs are peoples’ responses to relaxation. The physical signs are heart rate, respiratory rate, and blood pressure26 and the physiologic measurement of relaxation includes heart rate, respiratory rate, blood pressure, and oxygen saturation. For oxygen saturation, relaxation through using yoga can help people to reduce their metabolism27 and reduce oxygen use as well, thus, children who feel relaxed will use less oxygen so more oxygen will be in their blood circulation compared to those who are not feeling relaxed.27 Computer drawing-storytelling as therapeutic play has effects on happiness, relaxation, and cortisol levels by distracting children from situations of suffering in a hospital, and provides the experience of enjoyable events, as well as helping children to focus on play activities and feel relaxed.28 Playing with storytelling stimulates creativity and imagination and is a tool for improving happy memories, and helps children to cope with stress or difficult situations, which is reflected by lowering cortisol hormone levels.29 Furthermore, these processes demonstrate that happiness, relaxation, and lower stress can have positive effects on each other. The conceptual framework of this study, the effects of GIM followed by computer drawing-storytelling, is presented in Figure 1. The hypothesis of this study was that school-age children with cancer who received guided-imagination and computer drawing-storytelling would have significantly higher happiness and relaxation scores, and lower cortisol levels than those who received usual care. Figure 1 Conceptual framework of the study. 388 Pacific Rim Int J Nurs Res • October – December 2018 Kodchakon Piasai et al. Methods Design: A randomized control trial RCT. Sampling: Purposive sampling was used to select the participants. According to the meta-analysis of therapeutic play in children, the effect size for therapeutic play on psychological and physical aspects is 0.80.30 Therefore, this study used the effect size of 0.80 and power of 0.80 for calculating the sample size by using the Cohen sample size table for the mean comparison.31 Finally, the sample size was 20 participants for each group, thus the total of both groups were 40 participants. The inclusion criteria were: school-age children aged 6-12 years with cancer, undergoing a supportive or curative treatment course, had been treated with radiotherapy or chemotherapy at least once, and had normal sight, hearing, and speaking. Exclusion criteria were: children with brain cancer as this impacts on the hypothalamus and pituitary gland, and children who received steroid drugs, children with cancer who also had an endocrine disorder, such as Addison’s disease which causes decreased levels of cortisol or Cushing’s syndrome which causes increased levels of cortisol.Guided Imagination benefits for children with cancer. Essay: Guided Imagination benefits for children with cancer32 After the parents signed the consent form and the children had signed the assent form, the participants were randomly assigned into either the experimental or control groups. Simple randomization was employed in this study until 20 participants had been obtained in each group. The study was conducted from May to July 2017 in the pediatric ward at a university hospital in the south of Thailand, which is the cancer center for children. Ethical considerations This study was approved by the Institutional Review Board, Faculty of Nursing (Code: NREC 0521.1.05/543) and Faculty of Medicine (Code: REC 60-106-19-6), Prince of Songkla University, Thailand. The nurses checked for eligible samples before allowing the primary investigator (PI) to approach them. The PI asked for permission from the Vol. 22 No. 4 participants and their guardians before conducting the study. The decision to participate or not in this study depended on the willingness of participants and their guardians. They could withdraw from this study at any time without any effect on the level of care and treatment that they would normally receive from the hospital. Instruments: Demographic characteristics and the illness history of the participants contained age, gender, religion, education, diagnosis, treatment, side effects of treatment, and comorbidity. The Happiness Face Scale was used to measure the level of happiness which the PI modified from the Faces Scale.33 The PI asked for permission from the owner of this scale before modifying it. The seven faces on the original Face Scale for measuring happiness have the same eyes, different levels of smile, with no explanations for the emotion of each face (distinguished by using the alphabet from A to G). Thus, the PI modified this Scale by adding details of emotion to the face pictures, such as, adding extra characteristics to the eyes, and to the mouth or smile. Moreover, the PI added an explanation for each face to help children understand the meaning of each face and to make it easier to decide which face picture was close to or similar to their feeling of happiness. The Happiness Face Scale had a single item question: “What is your feeling of your level of happiness (which means favorite, satisfied, or joyful or comfortable)?.” The participants could answer by selecting a face picture that was close to their feeling of happiness from the Happiness Face Scale (Figure 2). The rating of happiness scores consists of: most unhappy is 0, very unhappy is 1, a little unhappy is 2, indifferent is 3, a little happy is 4, very happy is 5, and most happy is 6. The lower the scores reflect the lower the happiness while the higher the score the higher the levels of happiness. 389 A Randomized Control Trial of Guided-Imagination and Drawing-Storytelling in Children with Cancer. Figure 2 Happiness Face Scale. Relaxation Scale and vital signs representing anger while the lower score represents deeply relaxation relaxation (heart rate, respiratory rate, blood pressure, which it might not suitable, and the reliability of the and oxygen saturation) could be used to measure the instrument was not reported. Therefore, the PI modified 25 levels of relaxation. This study used both vital signs the scores by switching and changing the face pictures representing relaxation and a self-report of relaxation that represent the feelings of relaxation. using a Relaxation Scale modified by the PI from the The feeling of relaxation could be measured Emotional Literacy Support Assistant (ELSA) using one questionnaire by asking the question “What relaxation thermometer scale,34 with permission. is your feeling of your level of relaxation (which The original relaxation scale does not fully means independence from pressure or stress)?.” explain the face pictures that represent the feelings of Participants could select the answer from the picture relaxation; in addition, it is difficult to identify the faces which was similar to their feeling of relaxation that and the thermometer scale that represent the feelings demonstrated their overall feeling of relaxation from of relaxation. Moreover, the higher score represents the Relaxation Scale (Figure 3). Figure 3 Relaxation Scale. 390 Pacific Rim Int J Nurs Res • October – December 2018 Kodchakon Piasai et al. Guided Imagination benefits for children with cancer.Essay: Guided Imagination benefits for children with cancerThe equipment for the assessment of vital signs representing relaxation was the same equipment used on the ward: a sphygmomanometer for measuring blood pressure, a pulse oximeter for measuring pulse rate and oxygen saturation, and a watch for counting respiratory rates. These instruments had been calibrated yearly using a standard and the certificates were still current. The salivary cortisol levels were measured by Electrochemiluminescent immunoassay (ECLIA). The steps of salivary cortisol assay were: (1) saliva was collected no earlier than 30 minutes after eating or drinking, (2) a synthetic swab was chewed for 2 minutes then it was spat out and put into a saliva tube, (3) specimens were kept in a refrigerator (2-8oC) until 3 specimens per participant had been collected, and (4) specimens were sent to the laboratory for assay. Salivary cortisol is reported in nmol/L. The content validity of both the Happiness Face Scale and Relaxation Scale had been verified by three experts and the Content Validity Index (CVI) were 0.98 and 0.99 respectively. Moreover, one hour test-retest reliability of the Happiness Face Scale (Cronbach’s Alpha = 0.86) and Relaxation Scale (Cronbach’s Alpha = 0.82) had been tested in 20 hospitalized school-age children with cancer at a central hospital in southern Thailand by the PI. For the measurement of cortisol levels, the standard test control of the laboratory technique consisted of four tests for calibration and two tests for the control test per 100 tests undertaken by a medical laboratory scientist. In this study a calibration test and control was performed 2 times per 120 tests. Instrument for Interventions: The instruments for the interventions were a compact disc (CD) for guided-imagination with classical music (GIM) and a computer tablet with a sketch application for drawing. The CD for guided-imagination contained classical music without lyrics (a soft soothing music with 6470 beats/min) mixed with a guided imagination story.The three stories used were stories that had made children feel happy in the past. The three stories were: Vol. 22 No. 4 “go to the sea,” “go to the zoo,” and “a walk in the park” in which participants could select one of the three stories to guide their imagination. The GIM and the computer tablet with a sketch application were approved by the three experts. Intervention procedure In the experimental group, the participants received GIM for 30 minutes followed by computer drawing-storytelling for 30 minutes by the researcher as well as receiving usual care from the ward. The GIM CD consisted of classical music in conjunction with the woman’s voice as suggestion for participants to use their imagination and it was used for 30 minutes with a volume of 45-50 decibels and earphones were used for listening. For the participants in the control group, they received the usual care (the standard care for pediatric patients on the ward consisted of providing any treatments, procedures, and nursing care to children with cancer normally given during hospitalization). The data collection for the experimental group were: pretest (time 1), before starting the intervention at 09.00 a.m.; time 2, immediately after finishing the intervention (GIM and computer drawing-storytelling) at 10.00 a.m.; and time 3, 1 hour after finishing the intervention at 11.00 a.m.. For the control group, data collection was conducted at the same three time points as in the experimental group without any intervention. The recruitment and flow of participants through the study is shown in Figure 4. Data analysis Information about demographic characteristics and the illness history of the participants were analyzed by using means, standard deviations (SD), frequencies, percentages, chi-squares and t-tests. The hypothesis was tested using repeated measures ANOVA (RMANOVA). Moreover, as the salivary cortisol levels were not normally distributed, the Friedman test was used to determine the differences at each time point within the group and Wilcoxon Signed-Rank test 391 A Randomized Control Trial of Guided-Imagination and Drawing-Storytelling in Children with Cancer. Figure 4 The recruitment and flow of participants through the study. was used for testing the difference in each data point between the two groups. Results Demographic data and the illness history of participants The mean ages of participants in the experimental and control groups were 9.6 years (SD=2.04) and 8.95 years (SD=2.31) respectively. Both groups 392 consisted of boys and girls. The religion of the participants were Buddhist and Islamic. Moreover, the education of the participants in both groups was similarly distributed from kindergarten to grade 7. Likewise, in regards to diagnosis and treatment, most participants in both groups had been diagnosed with leukemia and were undergoing chemotherapy. Ov … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10 Order NowjQuery(document).ready(function($) { $.post(‘’, {action: ‘wpt_view_count’, id: ‘9235’});});jQuery(document).ready(function($) { $.post(‘’, {action: ‘mts_view_count’, id: ‘9235’});});

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