Nurse-led card game helps children face the operating theatre with less anxiety

A low-cost, nurse-led game reduced anxiety at operating-room entry, improved co-operation during anaesthesia and was linked to fewer behavioural problems after discharge in a trial in China.

A simple card game led by a trained nurse may help ease the anxiety many children feel before surgery, according to researchers at Children’s Hospital, Zhejiang University School of Medicine in China. Their trial, published online in the World Journal of Pediatrics in September 2026, suggests that a low-cost, non-digital play intervention can improve how children handle the most stressful part of the process: entering the operating room and beginning anaesthesia. The findings come as hospitals continue to look for ways to support children without relying on expensive technology.

Pre-operative anxiety is common in paediatric surgery and has been linked to poorer co-operation during anaesthesia, higher pain after the operation and behavioural changes after discharge. While earlier studies have shown benefits from structured play, hand-held games, tablets and virtual reality, those approaches can be difficult to scale in busy wards because they need equipment, time and staff. The new intervention was designed to avoid those barriers by using simple materials and a nurse-led format that could fit more easily into routine care.

In the study, a nurse trained in child-life principles spent about 40 minutes with each child, either individually or in groups of up to three, on the evening before surgery. The session used two modules: “Time-limited Treasure Hunting”, in which children matched tokens representing medical equipment while hearing short explanations, and “Surgical Adventure”, a board game that introduced the ward, operating theatre and perioperative steps. Of 164 children randomly assigned, 162 were included in the final analysis.

According to the trial results, children who took part in the game were less anxious when they reached the operating room, more likely to co-operate during anaesthesia induction and less likely to show behavioural problems after leaving hospital. Caregivers reported fewer generalised anxiety symptoms after discharge in the intervention group. By contrast, heart rate and blood pressure changed over time in both groups but did not differ meaningfully between them, and caregiver anxiety rose in both groups at the point of separation from the child.

The researchers said the strongest effect appeared at operating-room entry, when children are suddenly confronted with the clinical setting and separated from their caregivers. They suggested the benefit may come from distraction, greater familiarity with procedures, more predictable expectations and a stronger sense of control, while the group setting may also have allowed children to reassure one another. Still, the authors cautioned that the trial was single-centre, limited to ear, nose and throat inpatients, unblinded and short-term, so larger multicentre studies will be needed before the approach can be widely adopted. Similar play-based studies in earlier research have also found that games can reduce anxiety for children, and in some cases their parents, before surgery, reinforcing the idea that therapeutic play may have a useful place in pre-operative preparation.