Fun computer game

In many developed countries, computer games are a major part of the culture of children and teenagers. Members of the health care system and the general public often consider only the negative aspects of computer games, including the violence children are exposed to by some games and the passive element of this form of play, which can contribute to obesity, sluggishness, muscle atrophy, and other conditions. (1)

Despite these criticisms, research shows that children of the computer age prefer computer-assisted learning to any other teaching strategy. (1) Some educators' experiences show that students' cooperation increases in classes in which computers are used; thus, education using computers has become the preferred approach in some schools. (1) Computer games give children pleasure and expose them to experiential learning; therefore, they can be a good method for presenting health education, including preparing children to cope with disease and helping them through the preoperative process.

Traditionally, health care workers have used dolls, games, drawings, creative arts, and even videotapes to prepare children for surgery. Although several articles have described the use of computer games in advancing health in children, no studies have been conducted in Israel on using computers to help ailing children in general or to help children preparing for surgery in particular.

Tonsillectomy and adenoidectomy procedures are most common among children and adolescents, but little attention has been focused on constructing preparatory programs for children undergoing these procedures. (2) In light of the frequency of these surgeries and children's enjoyment of computer games, the authors, who are nurses at Assaf Harofe Medical Center, Bear Yaakov, Israel, decided to develop a computer game as a preparatory tool for tonsillectomy and adenoidectomy.

LITERATURE REVIEW

Most surgical procedures on children are performed on an outpatient basis. As a result, the time devoted to preparing the children is shortened, increasing the need to develop new, efficient ways to provide information. (3) Communication by computer offers the capability to meet this need and help children cope with important aspects of their illnesses. (4)

Personally focused, directed guidance at a level and in a manner children can understand is a factor shown to reduce stress in children who are waiting to undergo surgery. (3) Computer programs can meet these needs by offering a correlation between content and children's desires and capabilities. The program captures a child's imagination and allows for personal and significant familiarization with the information being presented. (1)

Health care-related literature mentions use or computer programs for guidance regarding prevention of sexually transmitted diseases, alcohol and drug abuse, and smoking among adolescents. (5-8) Although the long-term success of these programs was not determined, the programs delivered information to patients in a pleasant and interesting way and encouraged them to practice good health habits. One computer game was designed to simulate the negative consequences of drug abuse. The game called for participants to evaluate the risks of drug use and make decisions in hypothetical but realistic situations. (1)

Another learning game was developed to promote cardiac health. It helped children recognize the risks for heart disease and provided information on the importance of periodic medical examinations. (1) Computer games that promote health can take children beyond cognitive learning and into the realm of personal, experiential involvement.

A study of 66 teenagers ranging in age from 10 to 16 years and awaiting tonsillectomy or adenoidectomy compared the efficacy of traditional preoperative preparatory systems with the use of interactive, Internet preoperative preparatory software. No differences in levels of anxiety and pain were reported between the group prepared by traditional methods and the group prepared using the Internet software, but levels of knowledge and satisfaction were considerably higher in the group prepared using the Internet. (2)

Another study examined the influence of video game use in teaching children with Duchenne muscular dystrophy to train their respiratory muscles. The study concluded that the game improved the respiratory performance of these patients. (9)

A computerized guidance program for children with asthma was tested among 27 children ranging in age from nine to 13 years. After use of the guidance program, there was a considerable increase in levels of disease familiarity and behavioral changes, especially with regard to prevention and treatment strategies. (10) In contrast, in an experiment involving 101 children with asthma, no significant changes were found in quality of life, lung function, types of symptoms, or asthma severity between the group that used the learning game and the comparison group. (11)

Other computer programs mentioned in the literature were developed for diabetic children and as guidance for children with cancer who were awaiting radiation therapy. Their use was found to expand disease familiarity levels. (12,13)

INTERVIEWS

In the next stage of the process, interviews were conducted with 10 children awaiting surgery and 10 healthy children aged seven to 12 years to determine their favorite computer game types, characters, and scenarios. Findings from the interviews helped in developing the components of the game. Interviews with children awaiting surgery were conducted in the preoperative clinic several days before surgery.

A semi-structured questionnaire consisting of seven open-ended questions was used. Two questions were directed to the parents accompanying the child. Healthy children were asked only about their preferences regarding computer games. For the other children, the interview began with a general question to assess the children's fears and concerns about surgery and determine what kind of information they would like to receive. Similarly, parents were asked what the child was interested in at home and what kind of questions he or she asks. A multiple-choice question examined how the child would prefer to learn about the surgical procedure. Answer choices included personal guidance by a nurse or physician, a tour of the OR, a computer game, or a videotape. Next, participants were asked their preferences about specific computer game elements, including game type, characters, scenarios, levels of player's involvement, and contents.

QUESTIONNAIRE RESULTS

The main fears and concerns reported by the children referred to anesthetization and pain. Some feared waking up during the surgery and experiencing pain. Others feared not waking up from anesthesia after surgery.

One nine-year-old girl said, "I am afraid [of] feeling pain from the syringe and knife when they open you up and anesthetize you, and sometimes from the doctor hurting me." A 12-year-old boy said, "I am frightened by the chances of being paralyzed by the anesthetization, or not waking up from it at all."

Most of the children were not interested in information about the surgery and even indicated specifically that the information frightened them. An 11-year-old boy said, "I wouldn't want to know so I won't be afraid. Let them do it and that's it." Conversely, a 10-year-old girl said, "It's true that I'll be scared more if I would know, but this way I'll be more into it."

Some children asked about things related to the surgical setting, such as what the OR looks like, what is in it, and why the medical and nursing staff members wear green clothes and have masks on their faces. Some asked how they would be anesthetized and when they would wake up. The children defined the information they wished to know as nonintimidating and wanted to be assured that they would not feel pain A 10-year-old girl said, "I want more than anything that it ... would not hurt."

Some parents reported that their children feared the anesthesia and the pain. Aside from that, the parents thought the children were not interested in details about the procedures and preferred not to burden them with excessive information that might cause more anxiety than the children already had. The parents' answers validated the children's answers.

Regarding preoperative preparation, all of the children said they would prefer learning through a computer game. Comments included, "It's less scary, it's only a game;" "[because] in computer games nothing is real so it eases the fear;" and "[a] computer game is much more fun than going to the hospital and seeing it for real, because there are a lot of patients and scary doctors [in the hospital]."