Stress-Relieving Effects of Colour-by-Number Mandalas in Children Hospitalised due to a Chronic Disease

Abstract views: 274 / PDF downloads: 130


  • Didem COŞKUN ŞİMŞEK no
  • Mustafa ŞAHİNOĞLU



Child, Nurse, Chronic Disease, Colour by Number Mandala, Stress


This randomised controlled study aimed to evaluate the stress-relieving effects of colour-by-number mandalas in children hospitalised due to a chronic disease. This study involved 120 children aged 8 to 11 years. The participants were randomly assigned either to the experimental group or to the control group, with each group consisting of 60 children. The Descriptive Information Form and the Perceived Stress Scale were used in data collection. The experimental group had a lower total mean Perceived Stress Scale score than the control group, and the scores of these two groups significantly differed. Thus, the colour-by-number mandalas could effectively decrease the stress levels of children hospitalised due to a chronic disease.


Altay, N., Kilicarslan-Toruner, E., Sarı, Ç. (2017). The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment. European Journal of Oncology Nursing, 28, 1-6.

Arnett, M. C., Malchiodi, C. A. (2013). Understanding children’s drawings in medical settings. Art therapy and health care, 33-47.

Artilheiro, A. P. S., Almeida, F. d. A., Chacon, J. M. F. (2011). Use of therapeutic play in preparing preschool children for outpatient chemotherapy. Acta Paulista de Enfermagem, 24, 611-616.

Aydın, G. B., Yüksel, S., Ergil, J., Polat, R., Akelma, F. K., Ekici, M., . . . Odabaş, Ö. (2017). The effect of play distraction on anxiety before premedication administration: a randomized trial. Journal of Clinical Anesthesia, 36, 27-31.

Ball, J. W., Bindler, R. M., Cowen, K. J., Shaw, M. R. (2012). Principles of pediatric nursing: Caring for children: Pearson Upper Saddle River, NJ.

Barlow, J. H., Ellard, D. R. (2006). The psychosocial well‐being of children with chronic disease, their parents and siblings: An overview of the research evidence base. Child: care, health and development, 32(1), 19-31.

Büyük, E. T., Bolışık, B. (2015). The effect of preoperative training and therapeutic play on children’s anxiety, fear, and pain. Journal of Pediatric Surgical Nursing, 4(2), 78-85.

Canbulat, N., Inal, S., Sönmezer, H. (2014). Efficacy of distraction methods on procedural pain and anxiety by applying distraction cards and kaleidoscope in children. Asian Nursing Research, 8(1), 23-28.

Costa Fernandes, S., Arriaga, P. (2010). The effects of clown intervention on worries and emotional responses in children undergoing surgery. Journal of health psychology, 15(3), 405-415.

Crnković, M., Divčić, B., Rotim, Ž., Čorić, J. (2009). Emotions and experiences of hospitalized school age patients. Acta Clinica Croatica, 48(2), 125-134.

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.

Durualp, E., Altay, N. (2012). A comparison of emotional indicators and depressive symptom levels of school-age children with and without cancer. Journal of Pediatric Oncology Nursing, 29(4), 232-239.

Francischinelli, A. G. B., Almeida, F. d. A., Fernandes, D. M. S. O. (2012). Routine use of therapeutic play in the care of hospitalized children: nurses' perceptions. Acta Paulista de Enfermagem, 25, 18-23.

Hall, C., Reet, M. (2000). Enhancing the state of play in children's nursing. Journal of Child Health Care, 4(2), 49-54.

Hatzmann, J., Peek, N., Heymans, H., Maurice-Stam, H., Grootenhuis, M. (2014). Consequences of caring for a child with a chronic disease: Employment and leisure time of parents. Journal of Child Health Care, 18(4), 346-357.

He, H.-G., Zhu, L., Chan, S. W. C., Klainin-Yobas, P., Wang, W. (2015). The effectiveness of therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and postoperative pain in children undergoing elective surgery: a systematic review. Pain Management Nursing, 16(3), 425-439.

He, H. G., Zhu, L., Li, H. C. W., Wang, W., Vehviläinen‐Julkunen, K., & Chan, S. W. C. (2014). A randomized controlled trial of the effectiveness of a therapeutic play intervention on outcomes of children undergoing inpatient elective surgery: study protocol. Journal of advanced nursing, 70(2), 431-442.

Knoll, A. T., Carlezon Jr, W. A. (2010). Dynorphin, stress, and depression. Brain research, 1314, 56-73.

Kyle, T. (2008). Essentials of pediatric nursing: Lippincott Williams & Wilkins.

Latal, B., Sennhauser, F. (2012). The child with a chronic disease at school-age. Therapeutische Umschau. Revue therapeutique, 69(8), 453-458.

Lemos, I. C. S., Silva, L. d., Delmondes, G. d. A., Brasil, A. X., Santos, P. L. F., Gomes, E., Kerntop, M. (2016). Therapeutic play use in children under the venipucture: a strategy for pain reduction. American Journal of Nursing Research, 4(1), 1-5.

Lerwick, J. L. (2013). Psychosocial implications of pediatric surgical hospitalization. Paper presented at the Seminars in pediatric surgery.

Li, W., Chan, S., Wong, E., Kwok, M., Lee, I. (2014). Effect of therapeutic play on pre-and post-operative anxiety and emotional responses in Hong Kong Chinese children: a randomised controlled trial. Hong Kong Medical Journal.

Li, W. H., Chung, J. O., Ho, E. K., Chiu, S. Y. (2011). Effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of Hong Kong Chinese children hospitalized with cancer. Journal for Specialists in Pediatric Nursing, 16(3), 190-198.

Li, W. H., Chung, J. O. K., Ho, K. Y., Kwok, B. M. C. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC pediatrics, 16(1), 1-9.

Lima, K. Y. N. d., Santos, V. E. P. (2015). Play as a care strategy for children with cancer. Revista gaúcha de Enfermagem, 36, 76-81.

Manyande, A., Cyna, A. M., Yip, P., Chooi, C., Middleton, P. (2015). Non‐pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database of Systematic Reviews(7).

Masarik, A. S., Conger, R. D. (2017). Stress and child development: A review of the Family Stress Model. Current opinion in psychology, 13, 85-90.

Mohammadi, A., Mehraban, A. H., Damavandi, S. A. (2017). Effect of play-based occupational therapy on symptoms of hospitalized children with cancer: A single-subject study. Asia-Pacific journal of oncology nursing, 4(2), 168.

Moore, E. R., Bennett, K. L., Dietrich, M. S., Wells, N. (2015). The effect of directed medical play on young children's pain and distress during burn wound care. Journal of Pediatric Health Care, 29(3), 265-273.

Norris, A. E., Aroian, K. J., Warren, S., Wirth, J. (2012). Interactive performance and focus groups with adolescents: The power of play. Research in nursing & health, 35(6), 671-679.

O'Conner-Van, S. (2000). Preparing children for surgery—an integrative research review. AORN journal, 71(2), 334-343.

Obaid, K. B. (2015). Psychosocial impact of hospitalization on ill children in pediatric oncology wards. J Nurs Health Scien.[on-line], 4(3), 72-78.

Oral, T., Ersan, C. (2017). Adaptation of the perceived stress scale in children (8-11 years) into Turkish. SEFAD (37), 419-428.

Özkan, T. K., Polat, F. (2020). The effect of virtual reality and kaleidoscope on pain and anxiety levels during venipuncture in children. Journal of PeriAnesthesia Nursing, 35(2), 206-211.

Potasz, C., Varela, M. J. V. D., Carvalho, L. C. D., Prado, L. F. D., Prado, G. F. D. (2013). Effect of play activities on hospitalized children's stress: a randomized clinical trial. Scandinavian journal of occupational therapy, 20(1), 71-79.

Prentice, A., Williams, A. (2011). The influence of maternal, fetal and child nutrition on the development of chronic disease in later life: The Stationery Office.

Sanchez-Garcia, M., Segura-Flores, M., León-Garrido, M., Rodríguez-Rosado, A., Pena-Andreu, J., Fontalba-Navas, A. (2015). Reduction of preoperative anxiety in children using non-pharmacological measures. J Nurs Care, 2167-1168.

Seaward, B. L. (2017). Managing stress: Jones & Bartlett Learning.

Sen, S. (2020).Psychosocial impact of hospitalization on ill children in pediatric oncology wards. International Research Journal of Human Resource and Social Sciences, 7(4).

Snoeren, F., Hoefnagels, C. (2014). Measuring perceived social support and perceived stress among primary school children in the Netherlands. Child indicators research, 7(3), 473-486.

Spielberger, C. D., Sarason, I. G., Strelau, J., Brebner, J. M. (2014). Stress and anxiety: Taylor & Francis.

Stulmaker, H. L., Ray, D. C. (2015). Child-centered play therapy with young children who are anxious: A controlled trial. Children and Youth Services Review, 57, 127-133.

Thompson, R. A. (2014). Stress and child development. The Future of Children, 41-59.

Ullan, A., Belver, M. (2019). Integrative pediatrics and child care play as a source of psychological well-being for hospitalized children: study review. Integrative Pediatrics and Child Care, 2(1), 92-98.

Ullán, A. M., Belver, M. H., Fernández, E., Lorente, F., Badía, M., Fernández, B. (2014). The effect of a program to promote play to reduce children's post-surgical pain: with plush toys, it hurts less. Pain Management Nursing, 15(1), 273-282.

Uman, L. S., Chambers, C. T., McGrath, P. J., Kisely, S. R. (2006). Psychological interventions for needle‐related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews(4).




How to Cite

COŞKUN ŞİMŞEK , D., & ŞAHİNOĞLU , M. (2023). Stress-Relieving Effects of Colour-by-Number Mandalas in Children Hospitalised due to a Chronic Disease. GEVHER NESIBE JOURNAL OF MEDICAL AND HEALTH SCIENCES, 8(1), 220–227.