{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T05:54:46Z","timestamp":1785045286956,"version":"3.55.0"},"reference-count":47,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T00:00:00Z","timestamp":1763251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","pediatricnursing.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pediatric Nursing"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1016\/j.pedn.2025.11.026","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:08:20Z","timestamp":1763701700000},"page":"268-275","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"special_numbering":"C","title":["Assessing clown therapy to reduce preoperative anxiety in hospitalized children: A quasi-experimental design"],"prefix":"10.1016","volume":"86","author":[{"given":"L.","family":"Ruiz-Azcona","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Lechosa-Mu\u00f1iz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.R.","family":"Ardila-Valle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"G\u00f3mez-G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.O.","family":"G\u00f3mez-Paz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"G\u00f3mez-S\u00e1nchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Pardo-Vitorero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Paz-Zulueta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.J.","family":"Cabero-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"5","key":"10.1016\/j.pedn.2025.11.026_bb0005","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1177\/1359105313475900","article-title":"Parental anxiety and stress before pediatric anesthesia: A pilot study on the effectiveness of preoperative clown intervention","volume":"19","author":"Agostini","year":"2014","journal-title":"Journal of Health Psychology"},{"key":"10.1016\/j.pedn.2025.11.026_bb0010","doi-asserted-by":"crossref","DOI":"10.1016\/j.ctcp.2019.101077","article-title":"The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis","volume":"38","author":"\u00c1lvarez-Garc\u00eda","year":"2020","journal-title":"Complementary Therapies in Clinical Practice"},{"key":"10.1016\/j.pedn.2025.11.026_bb0015","series-title":"Diagnostic and Statistical Manual of Mental Disorders","first-page":"129","author":"American Psychiatric Association","year":"2013"},{"key":"10.1016\/j.pedn.2025.11.026_bb0020","series-title":"M\u00e9todos de Investigaci\u00f3n Cl\u00ednica y Epidemiol\u00f3gica","author":"Argimon","year":"2013"},{"issue":"4","key":"10.1016\/j.pedn.2025.11.026_bb0025","doi-asserted-by":"crossref","first-page":"431.e1","DOI":"10.1016\/j.jpurol.2023.04.032","article-title":"Effect of therapeutic play based training program on pre- and post-operative anxiety and fear: A study on circumcision surgery in Turkish Muslim children","volume":"19","author":"Ayan","year":"2023","journal-title":"Journal of Pediatric Urology"},{"key":"10.1016\/j.pedn.2025.11.026_bb0030","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.ijso.2020.03.004","article-title":"Prevalence and factors associated with preoperative parental anxiety among parents of children undergoing anesthesia and surgery: A cross-sectional study","volume":"24","author":"Ayenew","year":"2020","journal-title":"International Journal of Surgery Open"},{"key":"10.1016\/j.pedn.2025.11.026_bb0035","doi-asserted-by":"crossref","first-page":"e434","DOI":"10.1016\/j.pedn.2024.05.007","article-title":"The efficacy of finger puppets, distraction cards and kaleidoscope for reducing anxiety in children undergoing day surgery","volume":"77","author":"Bayar","year":"2024","journal-title":"Journal of Pediatric Nursing"},{"issue":"9","key":"10.1016\/j.pedn.2025.11.026_bb0040","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1111\/pan.13206","article-title":"A visual analog scale to assess anxiety in children during anesthesia induction (VAS-I): Results supporting its validity in a sample of day care surgery patients","volume":"27","author":"Berghmans","year":"2017","journal-title":"Paediatric Anaesthesia"},{"key":"10.1016\/j.pedn.2025.11.026_bb0045","series-title":"STAI. Manual for the State-Trait Anxiety Inventory (Self Evaluation Questionnaire). Versi\u00f3n Espa\u00f1ola","author":"Buela-Casal","year":"2015"},{"issue":"2","key":"10.1016\/j.pedn.2025.11.026_bb0050","article-title":"Contribution of the therapeutic toy structured in a model of nursing care for hospitalized children","volume":"37","author":"Caleffi","year":"2016","journal-title":"Revista Ga\u00facha de Enfermagem"},{"key":"10.1016\/j.pedn.2025.11.026_bb0055","doi-asserted-by":"crossref","first-page":"e244","DOI":"10.1016\/j.pedn.2024.07.012","article-title":"The effects of preoperative therapeutic play on anxiety and fear levels in preschool children","volume":"78","author":"Celik","year":"2024","journal-title":"Journal of Pediatric Nursing"},{"issue":"4","key":"10.1016\/j.pedn.2025.11.026_bb0060","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1111\/jocn.17582","article-title":"Non-pharmacological interventions for preoperative anxiety in children: A systematic review and network meta-analysis","volume":"34","author":"Chen","year":"2025","journal-title":"Journal of Clinical Nursing"},{"issue":"7","key":"10.1016\/j.pedn.2025.11.026_bb0065","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0305101","article-title":"Family participatory clown therapy in venipuncture in hospitalized children: A non-randomized controlled trial","volume":"19","author":"Chen","year":"2024","journal-title":"PLoS ONE"},{"issue":"2","key":"10.1016\/j.pedn.2025.11.026_bb0070","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1111\/jan.12205","article-title":"Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: A quantitative systematic review","volume":"70","author":"Chieng","year":"2014","journal-title":"Journal of Advanced Nursing"},{"issue":"6","key":"10.1016\/j.pedn.2025.11.026_bb0075","first-page":"1504","article-title":"Hospital clowning: A cost-effective intervention for reducing preoperative anxiety in children","volume":"27","author":"Chiesa","year":"2022","journal-title":"Journal of Health Psychology"},{"key":"10.1016\/j.pedn.2025.11.026_bb0080","article-title":"A mixed-method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery","volume":"13","author":"Dai","year":"2018","journal-title":"Journal of Advanced Nursing"},{"key":"10.1016\/j.pedn.2025.11.026_bb0085","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.pedn.2021.02.022","article-title":"The effect of play on pain and anxiety in children in the field of nursing: A systematic review","volume":"61","author":"D\u00edaz-Rodr\u00edguez","year":"2021","journal-title":"Journal of Pediatric Nursing"},{"issue":"1","key":"10.1016\/j.pedn.2025.11.026_bb0090","doi-asserted-by":"crossref","DOI":"10.1111\/jspn.12272","article-title":"Video game distraction and anesthesia mask practice reduces children\u2019s preoperative anxiety: A randomized clinical trial","volume":"25","author":"Dwairej","year":"2020","journal-title":"Journal for Specialists in Pediatric Nursing"},{"key":"10.1016\/j.pedn.2025.11.026_bb0095","doi-asserted-by":"crossref","first-page":"e54","DOI":"10.1016\/j.pedn.2021.01.001","article-title":"The effect of three different methods on venipuncture pain and anxiety in children: Distraction cards, virtual reality, and buzzy\u00ae (randomized controlled trial)","volume":"58","author":"Erdogan","year":"2021","journal-title":"Journal of Pediatric Nursing"},{"issue":"3","key":"10.1016\/j.pedn.2025.11.026_bb0100","doi-asserted-by":"crossref","first-page":"340.e1","DOI":"10.1016\/j.jpurol.2022.03.008","article-title":"The effect of using tablet computer on surgical stress: A single-blinded randomized controlled trial","volume":"18","author":"Evren Sahin","year":"2022","journal-title":"Journal of Pediatric Urology"},{"key":"10.1016\/j.pedn.2025.11.026_bb0105","article-title":"A child-centred research checklist to improve the design and reporting of paediatric research studies: A descriptive mixed methods study","volume":"162","author":"Foster","year":"2024","journal-title":"International Journal of Nursing Studies"},{"issue":"6","key":"10.1016\/j.pedn.2025.11.026_bb0110","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1007\/s00431-022-04440-9","article-title":"Clown therapy for procedural pain in children: A systematic review and meta-analysis","volume":"181","author":"Fusetti","year":"2022","journal-title":"European Journal of Pediatrics"},{"issue":"1","key":"10.1016\/j.pedn.2025.11.026_bb0115","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1553-2712.2009.00620.x","article-title":"Validation of the Wong-Baker FACES pain rating scale in pediatric emergency department patients","volume":"17","author":"Garra","year":"2010","journal-title":"Academic Emergency Medicine"},{"issue":"1","key":"10.1016\/j.pedn.2025.11.026_bb0125","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jopan.2024.03.009","article-title":"Effect of short-term deep breathing exercises on perioperative anxiety and pain in pediatric orthopedic patients: A randomized controlled trial","volume":"40","author":"Hu","year":"2025","journal-title":"Journal of Perianesthesia Nursing"},{"issue":"6","key":"10.1016\/j.pedn.2025.11.026_bb0130","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.redar.2015.09.006","article-title":"Reliability and validity of the Spanish version of the modified Yale preoperative anxiety scale","volume":"63","author":"Jerez","year":"2016","journal-title":"Revista Espa\u00f1ola de Anestesiolog\u00eda y Reanimaci\u00f3n"},{"issue":"3","key":"10.1016\/j.pedn.2025.11.026_bb0135","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1097\/00000539-200003000-00036","article-title":"The visual analog scale allows effective measurement of preoperative anxiety and detection of patients\u2019 anesthetic concerns","volume":"90","author":"Kindler","year":"2000","journal-title":"Anesthesia & Analgesia"},{"issue":"9","key":"10.1016\/j.pedn.2025.11.026_bb0140","doi-asserted-by":"crossref","first-page":"809","DOI":"10.4103\/ija.ija_1269_23","article-title":"Prediction of correlation between preoperative parents\u2019 anxiety and their child\u2019s anxiety before elective surgery under anaesthesia: An observational study","volume":"68","author":"Kumari","year":"2024","journal-title":"Indian Journal of Anaesthesia"},{"issue":"16","key":"10.1016\/j.pedn.2025.11.026_bb0145","doi-asserted-by":"crossref","first-page":"9828","DOI":"10.3390\/ijerph19169828","article-title":"Research progress on risk factors of preoperative anxiety in children: A scoping review","volume":"19","author":"Liu","year":"2022","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"10.1016\/j.pedn.2025.11.026_bb0150","article-title":"Effectiveness of hospital clowns for symptom management in paediatrics: Systematic review of randomised and non-randomised controlled trials","volume":"371","author":"Lopes-J\u00fanior","year":"2020","journal-title":"BMJ"},{"issue":"3","key":"10.1016\/j.pedn.2025.11.026_bb0155","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1177\/13674935211062336","article-title":"Non-pharmacological interventions to reduce anxiety among children undergoing surgery: A systematic review","volume":"27","author":"Mathias","year":"2023","journal-title":"Journal of Child Health Care"},{"issue":"3699","key":"10.1016\/j.pedn.2025.11.026_bb0160","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1126\/science.150.3699.971","article-title":"Pain mechanisms: A new theory","volume":"150","author":"Melzack","year":"1965","journal-title":"Science"},{"issue":"3","key":"10.1016\/j.pedn.2025.11.026_bb0165","doi-asserted-by":"crossref","first-page":"8165","DOI":"10.4081\/pr.2019.8165","article-title":"The impact of medical clowns exposure over postoperative pain and anxiety in children and caregivers: An Israeli experience","volume":"11","author":"Newman","year":"2019","journal-title":"Pediatric Reports"},{"issue":"4","key":"10.1016\/j.pedn.2025.11.026_bb0170","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1177\/1750458918782878","article-title":"Psychometric evaluation of the post hospitalization behavior questionnaire for ambulatory surgery and postoperative behavior and recovery in children undergoing tonsil surgery","volume":"29","author":"Nilsson","year":"2019","journal-title":"Journal of Perioperative Practice"},{"key":"10.1016\/j.pedn.2025.11.026_bb0175","series-title":"El Ni\u00f1o Hospitalizado: Caracter\u00edsticas, Evaluaci\u00f3n y Tratamiento","author":"Palomo","year":"1999"},{"issue":"6","key":"10.1016\/j.pedn.2025.11.026_bb0180","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1109\/JBHI.2019.2892485","article-title":"The effect of mirroring display of virtual reality tour of the operating theatre on preoperative anxiety: A randomized controlled trial","volume":"23","author":"Park","year":"2019","journal-title":"IEEE Journal of Biomedical and Health Informatics"},{"issue":"2","key":"10.1016\/j.pedn.2025.11.026_bb0185","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1055\/s-0030-1267932","article-title":"Do clown visits improve psychological and sense of physical well-being of hospitalized pediatric patients? A randomized-controlled trial","volume":"223","author":"Pinquart","year":"2011","journal-title":"Klinische P\u00e4diatrie"},{"issue":"2","key":"10.1016\/j.pedn.2025.11.026_bb0190","first-page":"e50","article-title":"Effectiveness of clown therapy for children in the perioperative period: Systematic review with meta-analysis","volume":"61","author":"Re","year":"2024","journal-title":"L\u2019Infermiere"},{"issue":"6","key":"10.1016\/j.pedn.2025.11.026_bb0195","doi-asserted-by":"crossref","first-page":"313.e9","DOI":"10.1542\/hpeds.2016-0166","article-title":"Factors predicting parent anxiety around infant and toddler post-operative pain","volume":"7","author":"Rosenberg","year":"2017","journal-title":"Hospital Pediatrics"},{"issue":"1","key":"10.1016\/j.pedn.2025.11.026_bb0200","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1186\/s12887-024-05211-1","article-title":"Effects of clowning on anxiety, stress, pain, and hormonal markers in paediatric patients","volume":"24","author":"S\u00e1nchez","year":"2024","journal-title":"BMC Pediatrics"},{"key":"10.1016\/j.pedn.2025.11.026_bb0205","article-title":"Clown intervention to reduce anxiety and pain in pediatric patients undergoing minor procedures: A systematic review and meta-analysis","volume":"13","author":"S\u00e1nchez-P\u00e9rez","year":"2022","journal-title":"Frontiers in Psychology"},{"issue":"5","key":"10.1016\/j.pedn.2025.11.026_bb0210","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1055\/s-0043-106854","article-title":"Clowns in paediatric surgery: Less anxiety and more oxytocin? A pilot study","volume":"229","author":"Scheel","year":"2017","journal-title":"Klinische P\u00e4diatrie"},{"issue":"2","key":"10.1016\/j.pedn.2025.11.026_bb0215","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/jnu.12277","article-title":"Use of play therapy in nursing process: A prospective randomized controlled study","volume":"49","author":"Sezici","year":"2017","journal-title":"Journal of Nursing Scholarship"},{"key":"10.1016\/j.pedn.2025.11.026_bb0120","first-page":"635","article-title":"Medical clowning in hospitalized children: A meta-analysis","volume":"19","author":"Sliman","year":"2023","journal-title":"World Journal of Pediatrics"},{"issue":"3","key":"10.1016\/j.pedn.2025.11.026_bb0220","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.jopan.2020.08.015","article-title":"Parental and child anxiety perioperatively: Relationship, repercussions, and recommendations","volume":"36","author":"Sullivan","year":"2021","journal-title":"Journal of Perianesthesia Nursing"},{"key":"10.1016\/j.pedn.2025.11.026_bb0225","article-title":"Clown care in the clinical nursing of children: A meta-analysis and systematic review","volume":"12","author":"Wang","year":"2024","journal-title":"Frontiers in Pediatrics"},{"issue":"1","key":"10.1016\/j.pedn.2025.11.026_bb0230","first-page":"9","article-title":"Pain in children: Comparison of assessment scales","volume":"14","author":"Wong","year":"1988","journal-title":"Pediatric Nursing"},{"issue":"12","key":"10.1016\/j.pedn.2025.11.026_bb0235","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0313841","article-title":"Application of clown care in hospitalized children: A scoping review","volume":"19","author":"Xin","year":"2024","journal-title":"PLoS ONE"}],"container-title":["Journal of Pediatric Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0882596325004130?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0882596325004130?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T23:08:13Z","timestamp":1775516893000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0882596325004130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":47,"alternative-id":["S0882596325004130"],"URL":"https:\/\/doi.org\/10.1016\/j.pedn.2025.11.026","relation":{},"ISSN":["0882-5963"],"issn-type":[{"value":"0882-5963","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Assessing clown therapy to reduce preoperative anxiety in hospitalized children: A quasi-experimental design","name":"articletitle","label":"Article Title"},{"value":"Journal of Pediatric Nursing","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pedn.2025.11.026","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}