title: Evaluating the effectiveness of preoperative interventions: the appropriateness of using the Children's Emotional Manifestation Scale.
abstract: OBJECTIVE
  This study aimed to compare the effectiveness of two preoperative nursing interventions and examining the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative interventions.
  
  
  BACKGROUND
  There is some evidence that the Children's Emotional Manifestation Scale can be used as an objective assessment tool in documenting children's emotional responses. However, it is uncertain from previous study that whether the scale can be used in evaluating the effectiveness of preoperative interventions.
  
  
  METHODS
  A randomized controlled trial, between subjects design was carried out in a well-established day surgery unit.
  
  
  METHODS
  Children (7-12 years of age; n = 203) admitted for elective day surgery during a 13-month period, were recruited. By using a simple randomization method, 97 of children were assigned to the experimental group receiving therapeutic play intervention and 106 children were assigned to the control group receiving routine information preparation.
  
  
  RESULTS
  Children receiving therapeutic play preparation reported statistically significant lower anxiety levels, fewer negative emotions and lower heart rates and mean arterial blood pressures than children receiving information preparation. Children with high preoperative anxiety levels manifested more negative emotional behaviour during anaesthesia induction and were associated with faster heart rates and higher mean blood pressures.
  
  
  CONCLUSIONS
  The study demonstrates the appropriateness of using the Children's Emotional Manifestation Scale in evaluating the effectiveness of preoperative nursing interventions and presents clear evidence to support the effectiveness of therapeutic play intervention in preparing children for surgery when compared with the information preparation approach.
  
  
  CONCLUSIONS
  This study contributes towards enriching the experience of using child-sensitive research tools in evaluating the effectiveness of preoperative nursing interventions. The findings heighten the awareness of the importance of integrating therapeutic play as an essential component of holistic and quality nursing care to prepare children for surgery.
authors.affiliation: Nurse Instructor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. williamli@cuhk.edu.hk
authors.forename: Ho Cheung William
authors.initials: HC
authors.lastname: Li
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000451:nursing / Q000523:psychology; D000704:Analysis of Variance; D001007:Anxiety / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D001294:Attitude to Health; D001794:Blood Pressure; D016009:Chi-Square Distribution; D002648:Child; D002673:Child, Hospitalized / Q000523:psychology*; D004644:Emotions; D005260:Female; D006339:Heart Rate; D006723:Hong Kong; D006801:Humans; D008297:Male; D009730:Nursing Assessment / Q000379:methods*; D015403:Nursing Evaluation Research / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods*; D010989:Play Therapy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods* / Q000451:nursing / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index