Reducing preoperative anxiety in paediatric patients undergoing tonsillectomy and adenoidectomy: An exploratory study on the use of a pictorial schedule

Background: Tonsillectomy and adenoidectomy (TA) are among the most frequently performed paediatric surgeries, typically preceded by significant preoperative anxiety. Effective nurse–patient communication can alleviate this anxiety and improve emotional well-being. Pictorial schedules have been proposed as a supportive communication tool to familiarise children with procedural steps, thereby promoting orientation, predictability and a sense of control. Aim: This study aimed to determine whether a pictorial schedule could reduce preoperative anxiety in paediatric patients undergoing TA surgery. Setting: This research was conducted in a paediatric ward in a day care hospital in Gauteng, South Africa. Methods: A quasi-experimental time series design with a delayed comparison group was used. Eight participants were equally divided between an intervention group (receiving the pictorial schedule) and a comparison group. Anxiety was assessed using two validated self-report measures – the Children’s Anxiety Scale and the Facial Affective Scale – and one validated observational tool, the Faces, Legs, Activity, Cry and Consolability (FLACC) scale. Data were analysed descriptively, with each procedural step examined to compare self-reported and observed anxiety levels. Results: Findings from the self-report measures indicated that the pictorial schedule contributed to reduced anxiety levels in the intervention group. However, the reduction in anxiety was step-specific, with anxiety increasing as the surgery approached for both groups. Observational data from the FLACC scale did not consistently align with self-report measures, suggesting the need for multiple, complementary methods of assessment. Contribution: The study supports integrating multimodal anxiety assessment, combining self-report and observational measures, in pediatric surgical care. Conclusion: Pictorial schedules may reduce preoperative anxiety by enhancing predictability and understanding of routine.