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Original Research
Reducing preoperative anxiety in paediatric patients undergoing tonsillectomy and adenoidectomy: An exploratory study on the use of a pictorial schedule
Submitted: 05 September 2025 | Published: 24 April 2026
About the author(s)
Alida J. Roos, Centre for Augmentative & Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South AfricaStefan R. Nilsson, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Gunilla M. Thunberg, University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Speech and Language Pathology Unit, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; and DART-Centre for AAC and Assistive Technology, Sahlgrenska University Hospital, Gothenburg, Sweden
Emma M.C. Forsgren, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Juan Bornman, Centre for Augmentative & Alternative Communication, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
Abstract
Background: Tonsillectomy and adenoidectomy (T&A) are among the most frequently performed paediatric surgeries, typically preceded by significant preoperative anxiety. Effective nurse–patient communication can alleviate this anxiety and improve emotional well-being. Pictorial schedules have been proposed as a supportive communication tool to familiarise children with procedural steps, thereby promoting orientation, predictability and a sense of control.
Aim: This study aimed to determine whether a pictorial schedule could reduce preoperative anxiety in paediatric patients undergoing T&A surgery.
Setting: This research was conducted in a paediatric ward in a day care hospital in Gauteng, South Africa.
Methods: A quasi-experimental time series design with a delayed comparison group was used. Eight participants were equally divided between an intervention group (receiving the pictorial schedule) and a comparison group. Anxiety was assessed using two validated self-report measures – the Children’s Anxiety Scale and the Facial Affective Scale – and one validated observational tool, the Faces, Legs, Activity, Cry and Consolability (FLACC) scale. Data were analysed descriptively, with each procedural step examined to compare self-reported and observed anxiety levels.
Results: Findings from the self-report measures indicated that the pictorial schedule contributed to reduced anxiety levels in the intervention group. However, the reduction in anxiety was step-specific, with anxiety increasing as the surgery approached for both groups. Observational data from the FLACC scale did not consistently align with self-report measures, suggesting the need for multiple, complementary methods of assessment.
Contribution: The study supports integrating multimodal anxiety assessment, combining self-report and observational measures, in pediatric surgical care.
Conclusion: Pictorial schedules may reduce preoperative anxiety by enhancing predictability and understanding of routine.
Keywords
Sustainable Development Goal
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