The effects of storytelling on anxiety and sleep in hospitalized children with fracture: A randomized clinical trial


1 Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Nursing, Maragheh University of Medical Sciences, Maragheh, Iran

3 Cabrini Research, Cabrini Health, VIC 3144; School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC 3800, Australia; Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran


Background: Hospitalization induces anxiety and causes sleep disorders in children. Objective: This study aimed to examine the effects of listening and reading a tale on anxiety and sleeping onset time (SOT) among hospitalized children with fracture. Methods: This randomized clinical trial was conducted on 102 children with extremity fracture in Shohada Hospital of Tabriz in 2018–2019. Subjects were recruited consecutively and randomly allocated into three groups: control, storytelling, and simultaneous listening to and reading a tale. The data were collected using a demographic information questionnaire: questions on SOT, heart rate, and the Reynolds and Richmond Children's Anxiety Questionnaire. One-way analysis of variance, paired t-test, Chi-square and Fisher's exact test, and analysis of covariance were used to analyze the data. Results: Mean SOT, mean anxiety, and mean pulse rate did not significantly differ between the three groups at baseline. After the intervention, the mean SOT and mean pulse rate decreased significantly in all three groups (P < 0.001); however, the between-group differences were not statistically significant (P > 0.50). The mean manifest anxiety did not change significantly in any of the groups (P > 0.05). Conclusion: Storytelling had no effect on anxiety, heart rate, and SOT of children with fractures. Further studies can help determine the best method of storytelling for children with fractures.


1. Hockenberry M, Wilson D, Rodgers C. Wong’s Essentials of
Pediatric Nursing‑eBook. Vol. 10. Canada: Elsevier Health
Sciences; 2016.
2. Karami J, Momeni KH, Mohammadi F, Shahbazirad A. The
effectiveness of narrative therapy for reducing symptoms of
separation anxiety in children. Iran J Pediatr Nurs 2015;1:48‑56.
3. Bekmaz K, Hojjati H, Akhoundzadeh G. Relationship between
mothers’ concerns and nursing support of children admitted to
Baqiyatallah Al‑Azam Hospital of Ali Abad Katoul, Golestan
Province, Iran, in 2018. Mod Care J 2019;16:e92471.
4. Lerwick JL. Minimizing pediatric healthcare‑induced anxiety and
trauma. World J Clin Pediatr 2016;5:143‑50.
5. Li WH, Chung JO, Ho KY, Kwok BM. Play interventions to
reduce anxiety and negative emotions in hospitalized children.
BMC Pediatr 2016;16:36.
6. Kanchan L, Sharma CH, Aarti S. Randomized clinical trial to
evaluate the effectiveness of storytelling by researcher on the
hospitalization anxiety of children admitted in pediatric ward
of selected hospitals of District Patiala, Punjab. Int J Sci Res
7. Batuman A, Gulec E, Turktan M, Gunes Y, Ozcengiz D.
Preoperative informational video reduces preoperative anxiety
and postoperative negative behavioral changes in children.
Minerva Anestesiol 2016;82:534‑42.
8. Brown WJ, Wilkerson AK, Boyd SJ, Dewey D, Mesa F,
Bunnell BE. A review of sleep disturbance in children and
adolescents with anxiety. J Sleep Res 2018;27:e12635.
9. Sadat Hoseini A. A survey of the effect of non pharmacological
intervention to improve of sleep in pediatric, that suffering of
chronic illness. Iran J Nurs Res 2013;7:60‑72.
10. Ghaneian M, Kazemi‑Zahrani H. Prevalence of sleep disturbance
and neuropsychological learning disabilities in preschool
children in Isfahan City. J Shahid Sadoughi Univ Med Sci
11. Eugene AR, Masiak J. The neuroprotective aspects of sleep.
MEDtube Sci 2015;3:35‑40.
12. Mobasheri F, Azizi H, Rastbaf F. The epidemiological pattern of
injuries among children under 15 years of age in Fasa in 2013.
J Fasa Univ Med Sci 2016;6:69‑78.
13. Aghakhani K, Ameri E, Ameri M, Mohtarami S. Epidemiology
of orthopedic trauma in children and adolescent in a referral
center in Tehran: A prospective study. Tehran Univ Med J
14. Zhaleh M, Borji S, Sohrabi N, Abasifard Z. Upper and lower
extremities fractures in children under 12 years referred to
Taleghani Hospital in Kermanshah, 2003‑2014. J Clin Res
Paramed Sci 2016;5:86‑9.
15. Vahhab E, Gholamzadeh S, Zarenezhad M. Injury‑related
pediatric mortality in Shiraz, Iran: A community‑based survey.
Shiraz E Med J 2019;20:e69815.
16. Mirahmadizadeh A, Hemmati A, Zahmatkesh S, Saffari M,
Bagheri P. Incidence of accidents and injuries in children under
6 years old in southern Iran: A population‑based study. J Inj
Violence Res 2020;12: 135–144.
17. Merckaert S, Chaibi E, Meriem S, Kwiatkowski B, Divjak N,
Zambelli PY. Epidemiology of pediatric upper extremity
fractures in a tertiary care center in Switzerland. Pediatr Emerg
Care 2021;37:e825‑35.
18. Chaibi E, Zambelli PY, Merckaert S. Epidemiology of paediatric
lower extremity fractures in a tertiary care center in Switzerland.
Eur J Trauma Emerg Surg 2020; 1-11.
19. Zhaleh M, Borji S, Abasifard Z, Safi F, Shahsavari S. Assessment
of limb fractures in children below 12 years of age. Trauma Mon
20. Asadi P, Asadi K, Rimaz S, Monsef‑Kasmaie V, Zohrevandi B,
Mohtasham‑Amiri Z. Epidemiology of trauma in children
admitted to Poursina teaching hospital. J Guilan Univ Med Sci2015;23:9‑15.
21. Caruso G, Caldari E, Sturla FD, Caldaria A, Re DL, Pagetti P,
et al. Management of pediatric forearm fractures: What is the
best therapeutic choice? A narrative review of the literature.
Musculoskelet Surg 2021;105:225‑34.
22. Pace JL. Pediatric and adolescent forearm fractures: Current
controversies and treatment recommendations. J Am Acad
Orthop Surg 2016;24:780‑8.
23. Zarei K, Parandeh Z, Seyedfatemi N, Khoshbakht F, Haghani H,
Zarei M. Impact of storytelling on physiological, worry and
social anxieties in hospitalized school‑aged children. Med Surg
Nurs J 2013;2:115‑21.
24. Strøm‑Tejsen P, Zukowska D, Wargocki P, Wyon DP. The effects
of bedroom air quality on sleep and next‑day performance.
Indoor Air 2016;26:679‑86.
25. Sekhavatpour Z, Khanjani N, Reyhani T, Ghaffari S,
Dastoorpoor M. The effect of storytelling on anxiety and
behavioral disorders in children undergoing surgery: A randomized
controlled trial. Pediatric Health Med Ther 2019;10:61‑8.
26. Yuosef Pour N, Agha Yousefi A. The effect of atorytelling in
pain reduction of children with leukemai. Q J Health Psychol
27. Taghavi M, Alishahi M. Evaluation of validity and reliability
of revised children main fast anxiety scale. J Psycol
28. Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M,
Cortesi F, et al. The Sleep Disturbance Scale for
Children (SDSC). Construction and validation of an instrument
to evaluate sleep disturbances in childhood and adolescence.
J Sleep Res 1996;5:251‑61.
29. Ajorloo M, Irani Z, Aliakbari Dehkordi M. Story therapy effect
on reducing anxiety and improvement habits sleep in children
with cancer under chemotherapy. Health Psychol 2016;5:87‑107.
30. Ghorbani R, Raeisi Z. The effect of narrative therapy on school
anxiety in female primary students. J Child Ment Health
31. Hakim A, Shafiey M, Bassak Nedjad S,
Hossien Haghighizadeh MH. Impact of storytelling on anxiety
in 4‑7 year old children in hospital: A randomized clinical trial
study. Avicenna J Nurs Midwifery Care 2018;26:155‑64.
32. Shabib Asl N, Naderi F, Makvandi B. The effect of storytelling
on behavioral problems (aggression‑withdrawal) of preschoolers’
in Ahvaz. J Appl Environ Biol Sci 2015;5:353‑7.
33. Fazeli E. The effectiveness of storytelling on aggression
and anxiety in elementary school students. J Soc Sci
34. Yuniartini N. The effect of storytelling therapy before sleep in
sleep quality preschool age children undergoing hospitalization
in the child care room Sanglah hospital Denpasar. Community of
Publishing in Nursing 2013;1:1‑6.