Nurse-Led Card Game Eases Kids' Pre-Surgery Anxiety

A nurse-led card game may help ease children's anxiety at a particularly stressful point in surgery—entry to the operating room—and may improve cooperation during anesthesia induction and early postoperative behavior, according to a single-center trial. The findings offer preliminary support for structured, low-cost, non-digital therapeutic play as a practical addition to pediatric preoperative preparation. The trial, conducted at Children's Hospital, Zhejiang University School of Medicine in China, was reported (DOI: 10.1007/s12519-026-01097-4) online on 19 September 2026 in World Journal of Pediatrics. Preoperative anxiety affects about 60% of children and is linked with poorer cooperation at anesthesia induction, greater postoperative pain, and maladaptive behavioral changes. While many proven approaches rely on costly digital platforms or virtual reality, this intervention uses simple materials: a trained nurse led a 40-minute session the evening before surgery, using two modules—'Time-limited Treasure Hunting' and 'Surgical Adventure'—to familiarize children with medical equipment and perioperative procedures.

Of 164 children randomized, 162 were analyzed. Children in the card-game group appeared less anxious at operating-room entry, were more likely to cooperate during anesthesia induction, and showed fewer post-discharge behavioral problems, particularly generalized anxiety, per caregiver reports. Heart rate and blood pressure changed over time but did not differ between groups, and caregiver anxiety scores were similar, though they rose in both groups when children separated from caregivers. The authors suggest the benefit may reflect distraction, greater familiarity with procedures, improved predictability, and a stronger sense of control. They cautioned that the trial was single-center, restricted to otolaryngology inpatients, unable to blind children and providers, used weekly randomization, and lacked long-term follow-up.

The nurse-led Medical Vanguard card game may be a practical, low-cost, non-pharmacological adjunct to standard preoperative care, especially for children facing separation and direct exposure to the operating room. Because it uses simple materials and can be delivered by trained nurses in small groups, it could be easier to incorporate into busy pediatric surgical pathways than digital or virtual-reality programs. The trial did not reduce caregiver anxiety, suggesting that future preparation should pair child-focused play with support for parents and caregivers. Multicenter studies with longer follow-up are needed to test generalizability, examine whether behavioral benefits persist, and evaluate integrated child–caregiver models. If replicated, the approach could be considered for routine preoperative preparation and future quality-improvement programs.