Medical Play Intervention as an Atraumatic Care Approach for Hospitalized Preschool Children: A Systematic Literature Review

Authors

  • Titik Anggraeni School of Health Estu Utomo Boyolali, Central Java, Indonesia
  • Sarwoko School of Health Estu Utomo Boyolali, Central Java, Indonesia
  • Herbasuki Academy of Nursing Patria Husada Surakarta
  • Sri Sayekti Heni Sunaryanti School of Health Estu Utomo Boyolali, Central Java, Indonesia

DOI:

https://doi.org/10.30994/jqph.v9i2.618

Keywords:

Anxiety, Atraumatic Care, Medical Play, Hospitalization, Preschool Chldren

Abstract

Hospitalization in preschool children can cause anxiety, fear, psychological stress, and uncooperative behavior during hospital treatment. Medical play is one of the atraumatic care approaches used to reduce the negative impacts of hospitalization on children. This study aimed to analyze the effectiveness of medical play interventions as an atraumatic care approach for hospitalized preschool children. The research method used was a Systematic Literature Review following the PRISMA guidelines. Articles were searched through the PubMed, Scopus, and ScienceDirect databases using keywords related to medical play, atraumatic care, preschool children, and hospitalization. The articles included were primary studies published between 2020–2025 that met the inclusion and exclusion criteria. A total of 9 primary articles were analyzed in this study. The synthesis results showed that medical play interventions were effective in reducing anxiety, fear, hospitalization stress, and psychological trauma in preschool children. In addition, medical play also improved children’s cooperative behavior during medical and nursing procedures. The forms of intervention included therapeutic play, storytelling, pretend play, and the use of toy medical equipment. The study concludes that medical play is an effective non-pharmacological intervention in the implementation of atraumatic care for hospitalized children. These findings can serve as a basis for the development of evidence-based nursing in pediatric nursing services and support the optimal implementation of atraumatic care in pediatric wards.

References

Abdi, F., Karamoozian, A., Lotfilou, M., Gholami, F., Shaterian, N., Niasar, A. A., Aghapour, E., & Jandaghian-Bidgoli, M. (2025). Effect of play therapy and storytelling on the anxiety level of hospitalized children: A randomized controlled trial. BMC Complementary Medicine and Therapies, 25(1), 1–12. https://doi.org/10.1186/s12906-025-04767-4

Aryani, R., & Zaly, N. W. (2021). Pengaruh terapi bermain mewarnai terhadap kecemasan hospitalisasi pada anak prasekolah. Jurnal Keperawatan Klinis Indonesia, 5(2), 85–92.

Ayaz, R., & Doğmuş, Y. U. (2025). The effectiveness of child-centered play therapy on anxiety: A systematic literature review. Sosyal Politika Çalışmaları Dergisi, 25(1), 55–68.

Benazeera, B., & Aranha, P. R. (2025). Effectiveness of nurse-led play intervention on anxiety and distress among hospitalized children. Journal of Pediatric Nursing Care, 18(2), 77–85.

Çelik, G., & Şahiner, N. C. (2024). The effect of therapeutic play on preoperative anxiety and fear in preschool children. Journal of Pediatric Nursing, 76, 112–118. https://doi.org/10.1016/j.pedn.2024.05.021

Dalei, S. R., & Nayak, G. (2020). Effect of art therapy and play therapy on anxiety among hospitalized preschool children. Journal of Biomedical Sciences, 7(2), 55–61.

Delvecchio, E., Salcuni, S., Lis, A., Germani, A., & Di Riso, D. (2019). Hospitalized children: Anxiety, coping strategies, and pretend play. Frontiers in Public Health, 7, 250. https://doi.org/10.3389/fpubh.2019.00250

Díaz-Rodríguez, M., Alcántara-Rubio, L., Aguilar-García, D., Pérez-Muñoz, C., Carretero-Bravo, J., & Puertas-Cristóbal, E. (2021). The effect of play on pain and anxiety in children in the field of nursing: A systematic review. Journal of Pediatric Nursing, 61, 15–22. https://doi.org/10.1016/j.pedn.2021.02.012

Godino-Iáñez, M. J., Martos-Cabrera, M. B., Suleiman-Martos, N., Gómez-Urquiza, J. L., Vargas-Román, K., Membrive-Jiménez, M. J., & Albendín-García, L. (2020). Play therapy as an intervention in hospitalized children: A systematic review. Healthcare, 8(3), 239. https://doi.org/10.3390/healthcare8030239

He, H. G., Zhu, L., Chan, S. W. C., Liam, J. L. W., Li, H. C. W., Ko, S. S., Wang, W., & Chan, M. F. (2021). Therapeutic play intervention on preoperative anxiety among hospitalized children: A randomized controlled trial. Journal of Advanced Nursing, 77(2), 641–652. https://doi.org/10.1111/jan.14628

Ilmiasih, R., & Ningsih, N. S. (2022). Application of atraumatic care philosophy to children in hospitals: A literature review. Jurnal Keperawatan Anak, 10(2), 112–120.

Kiliç Çetin, K. D., & Coşkun Şimşek, D. (2025). The effect of therapeutic play on fear and behavioral distress in children receiving high-flow nasal cannula oxygen therapy. Journal of Pediatric Nursing, 82, 45–52. https://doi.org/10.1016/j.pedn.2025.02.014

Kırkan, T. S., & Kahraman, A. (2023). The effect of toy nebulizer and toy mask on fear and anxiety in children undergoing nebulization therapy. Journal of Pediatric Nursing, 71, e45--e51. https://doi.org/10.1016/j.pedn.2023.04.011

Koukourikos, K., Tzeha, L., Pantelidou, P., & Tsaloglidou, A. (2015). The importance of play during hospitalization of children. Materia Socio-Medica, 27(6), 438–441. https://doi.org/10.5455/msm.2015.27.438-441

Li, W. H. C., Chung, J. O. K., Ho, K. Y., Kwok, B. M. C., & Team, P. I. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatrics, 16(1), 36. https://doi.org/10.1186/s12887-016-0570-5

Lopes-Júnior, L. C., Bomfim, E., Olson, K., Neves, E. T., Silveira, D. S., Nunes, M. D. R., Nascimento, L. C., Pereira-da-Silva, G., & Lima, R. A. G. (2020). Effectiveness of hospital clowns for symptom management in paediatrics: Systematic review of randomised and non-randomised controlled trials. The BMJ, 371, m4290. https://doi.org/10.1136/bmj.m4290

Moola, S., Munn, Z., Tufanaru, C., Aromataris, E., Sears, K., Sfetc, R., Currie, M., Lisy, K., Qureshi, R., Mattis, P., & Mu, P. F. (2020). Chapter 7: Systematic reviews of etiology and risk. In E. Aromataris & Z. Munn (Eds.), JBI Manual for Evidence Synthesis. Joanna Briggs Institute. https://doi.org/10.46658/JBIMES-20-08

Musviro, M., Handayani, S., & Nurhayati, E. (2023). The effectiveness of storytelling therapy on emotional comfort among hospitalized preschool children. Jurnal Keperawatan Pediatrik, 6(1), 22–30.

Nazari, A., Sarmadi, S., Ghazanfari, M. J., Gholami, M., Zeydi, A. E., & Zare-Kaseb, A. (2025). The effectiveness of play therapy on depression and anxiety in hospitalized children with cancer: A systematic review. Supportive Care in Cancer, 33(1), 1–14. https://doi.org/10.1007/s00520-024-08912-7

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

Putri, D. A., Handayani, L., & Fitriani, R. (2023). The effectiveness of play therapy on cooperative behavior among hospitalized preschool children. Jurnal Keperawatan Anak, 11(2), 101–109.

Rashid, A., Cheong, A., Hisham, R., Shamsuddin, N. H., & Roslan, D. (2021). Effectiveness of pretend medical play in improving children’s health outcomes and well-being: A systematic review. BMJ Open, 11(3), e041506. https://doi.org/10.1136/bmjopen-2020-041506

Rodrigues, C. C. F. M., Santos, V. E. P., & Sousa, P. (2017). Patient safety and nursing: interface with stress and Burnout Syndrome. Revista Brasileira de Enfermagem, 70(5), 1083–1088. https://doi.org/10.1590/0034-7167-2016-0194

Sari, A. S. P., Lestari, N. E., & Istiani, H. G. (2021). Storytelling using picture books reduces anxiety in hospitalized preschool children. Jurnal Ilmiah Ilmu Keperawatan Indonesia, 11(1), 35–42.

Topal, S., Demir, Y., & Aydin, B. (2025). Therapeutic play-based intervention and psychosocial well-being among preschool children after traumatic hospitalization experiences. Children and Youth Services Review, 165, 107812. https://doi.org/10.1016/j.childyouth.2025.107812

Veraksa, A., Plotnikova, V. A., Sukhikh, V., Kornienko, D. S., & Rudnova, N. (2025). Non-therapeutic play to overcome negative emotional symptoms and improve emotional intelligence in children aged 3--7: A systematic review. Frontiers in Psychology, 16, 1456854. https://doi.org/10.3389/fpsyg.2025.1456854

Yildirim, M., Sevinç Akin, H. Y., & Akin, B. (2024). The effect of medical material toys on anxiety and trauma during medical procedures in hospitalized children. Journal of Pediatric Nursing, 79, 90–97. https://doi.org/10.1016/j.pedn.2024.08.012

Zengin, M., Yayan, E. H., & Düken, M. E. (2020). The effect of therapeutic play on fear and anxiety in children after liver transplantation. Pediatric Transplantation, 24(8), e13812. https://doi.org/10.1111/petr.13812

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Published

2026-05-30

How to Cite

Anggraeni, T., Sarwoko, Herbasuki, & Sri Sayekti Heni Sunaryanti. (2026). Medical Play Intervention as an Atraumatic Care Approach for Hospitalized Preschool Children: A Systematic Literature Review. Journal for Quality in Public Health, 9(2), 181–191. https://doi.org/10.30994/jqph.v9i2.618