The effects of goldfish on anxiety, fear, psychological and emotional well-being of hospitalized children: A randomized controlled study

Published:November 18, 2022DOI:


      • The use of non-pharmacological methods is very important in the management of anxiety and fear in children.
      • The animal assisted practice can help reduce the anxiety and fear levels of hospitalized children and increase psychological and emotional well-being.
      • These interventions can be used in normal pediatric clinic nursing care in hospital.



      This study aimed to determine the effect of goldfish intervention on anxiety, fear, psychological and emotional well-being of hospitalized children.

      Materials and methods

      Between November 2020 and August 2021, an open-label, single-center randomized controlled experimental study was conducted in Türkiye's Eastern Anatolia region. The study included 112 children aged 8 to 10 years old (56 in the study group and 56 in the control group). The study and control groups were randomly assigned to strata using a table of random numbers. The children in the study group observed after goldfish intervention for three days. As data collection tools, the State-Trait Anxiety Inventory for Children, Child Fear Scale, and the Stirling Children's Well-being Scale were used.


      The mean state anxiety scores of the children in the study group who looked after goldfish intervention decreased significantly compared to the control group. When the two groups were compared, the difference between the post-test measurements were significant (p < 0.05). The mean score of the fear scale in the post-test measurements of the study group children was significantly lower than the control group (p < 0.05). Finally, the emotional, and psychological well-being post-test scale mean scores of the study group children were higher than the control group (p < 0.01).


      Goldfish intervention was found to be effective in decreasing the state anxiety and fear levels and increasing the psychological and emotional well-being levels of the children in the study group.


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        • Akın A.
        • Yılmaz S.
        • Özen Y.
        • Raba S.
        • ve Özhan Y.
        Stirling Çocuklar İçin Duygusal ve Psikolojik İyi Oluş Ölçeği'nin Türkçe formunun geçerlik ve güvenirliği.
        in: Sakarya’da Eğitim V. Araştırmaları Kongresi. Sakarya University Institute of Educational Sciences Publications, Sakarya2016: 74-79
        • Akşit S.
        • Cimete G.
        The effect of nursing interventions on the anxiety level of mothers after admission of their children to the intensive care unit.
        C. Ü. Hemşirelik Yüksekokulu Dergisi. 2015; 5: 25-36
        • Aydın B.
        Knowledge and attitudes of college students about buying aquarium fish.
        Ege Journal of Fisheries and Aquatic Sciences. 2018; 35: 447-454
        • Aydın B.
        Students' opinions and attitudes about retail aquarium stores.
        Journal of Anatolian Environmental and Animal Sciences. 2019; 4: 465-472
        • Barker S.B.
        • Knisely J.S.
        • Schubert C.M.
        • Green J.D.
        • Ameringer S.
        The effect of an animal-assisted intervention on anxiety and pain in hospitalized children.
        Anthrozoos. 2015; 28: 101-112
        • Barkey M.E.
        • Stephens B.
        Comfort measures during invasive procedures: The role of the child life specialists.
        Child Life Focus. 2000; 2: 1-4
        • Bouchard F.
        • Landry M.
        • Belles-Isles M.
        • Gagnon J.
        A magical dream: A pilot project in animal-assisted therapy in pediatric oncology.
        Canadian Oncology Nursing Journal. 2004; 14: 14-17
        • Braun C.
        • Stangler T.
        • Narveson J.
        • Pettingell S.
        Animal-assisted therapy as a pain relief intervention for children.
        Complementary Therapies in Clinical Practice. 2009; 15: 105-109
        • Brown S.
        • Snelders J.
        • Godbold J.
        • Moran-Peters J.
        • Driscoll D.
        • Donoghue D.
        • Mathew L.
        • Eckardt S.
        Effects of animal-assisted activity on mood states and feelings in a psychiatric setting.
        American Psychiatric Nurses Association. 2019; 26: 555-567
        • Cardinal F.G.
        • Arroyo G.M.
        • Magbanua S.
        • Sajnani A.K.
        Measurement of anxiety in 3-9-year-old children receiving nursing intervention.
        Journal of Caring Sciences. 2017; 6: 293-302
        • Çelebi A.
        • Aytekin A.
        • Küçükoğlu S.
        • Çelebioğlu A.
        Hospitalized children and play.
        İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi. 2015; 5: 156-160
        • Christian B.J.
        Translational research – The stress and uncertainty of hospitalization and strategies for pediatric nurses to improve the quality of care for children and families.
        Journal of Pediatric Nursing. 2018; 41: 140-145
        • Chubak J.
        • Hawkes R.
        • Dudzik C.
        • Foose-Foster J.M.
        • Eaton L.
        • Johnson R.H.
        • Macpherson C.F.
        Pilot study of therapy dog visits for inpatient youth with cancer.
        Journal of Pediatric Oncology Nursing. 2017; 34: 331-341
        • Clements H.
        • Valentin S.
        • Jenkins N.
        • Rankin J.
        • Baker J.S.
        • Gee N.
        • Snellgrove D.
        • Sloman K.
        The effects of interacting with fish in aquariums on human health and well-being: A systematic review.
        PLoS One. 2019; 14: 1-36
        • Cowell D.R.
        A clinical practice change initiative to incorporate animal assisted therapy in advanced practice registered Nurses’ clinical practice for children and adolescents.
        University of Southern Mississippi, 2017
        • Delta Society
        Standards of practice for animal-assisted activities and therapy.
        • Delvecchio E.
        • Salcuni S.
        • Lis A.
        • Germani A.
        • Di Riso D.
        Hospitalized children: Anxiety, coping strategies, and pretend play.
        Frontiers in Public Health. 2019; 7: 250
        • Favara-Scacco C.
        • Smirne G.
        • Schilirò G.
        • Di Cataldo A.
        Art therapy as support for children with leukemia during painful procedures.
        Medical and Pediatric Oncology. 2001; 36: 474-480
        • Foster R.L.
        • Park J.
        An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children.
        Pain Management Nursing. 2012; 13: 94-106
        • Friedmann E.
        The role of pets in enhancing human well-being: Physiological effects.
        in: Robinson I. The Waltham book of human-animal interaction: Benefits and responsibilities of pet Wwnership. Pergamon Press, 1995: 33-53
        • Gee N.R.
        • Harris S.L.
        • Johnson K.L.
        The role of therapy dogs in speed and accuracy to complete motor skills tasks for preschool children.
        Anthrozoös. 2007; 20: 375-386
        • Gerçeker G.Ö.
        • Ayar D.
        • Özdemir Z.
        • Bektaş M.
        Gaining of Children’s state anxiety and Children’s fear scale to Turkish language.
        E-Journal of Dokuz Eylul University Nursing Faculty. 2018; 11: 9-13
        • Goddard A.T.
        • Gilmer M.J.
        The role and impact of animals with pediatric patients.
        Pediatric Nursing. 2015; 41: 65-71
        • Günay U.
        Aile merkezli bakımın kanserli çocuk ve ebeveynlerinin kaygı düzeyine etkisi.
        in: Institute of Health Sciences. Doctorate thesis. Erciyes Üniversitesi, 2014
        • Gündüz S.
        • Yüksel S.
        • Aydeniz G.
        • Aydoğan R.
        • Türksoy H.
        • Dikme İ.
        • Efendiler İ.
        Çocuklarda hastane korkusunu etkileyen faktörler.
        Çocuk Sağlığı ve Hastalıkları Dergisi. 2016; 59: 161-168
        • Hägglöf B.
        Psychological reaction by children of various ages to hospital care and invasive procedures.
        Acta Paediatrica. 1999; 88: 72-78
        • Havener L.
        • Gentes L.
        • Thaler B.
        • Megel M.
        • Baun M.
        • Driscoll F.
        • Beiraghi S.
        • Agrawal N.
        The effects of a companion animal on distress in children undergoing dental procedures.
        Issues in Comprehensive Pediatric Nursing. 2001; 24: 137-152
        • Hinic K.
        • Kowalski M.O.
        • Holtzman K.
        • Mobus K.
        The effect of a pet therapy and comparison intervention on anxiety in hospitalized children.
        Journal of Pediatric Nursing. 2019; 46: 55-61
        • Hsieh Y.-C.
        • Liu H.-T.
        • Cho Y.-H.
        Reducing fear in preschool children receiving intravenous injections.
        Hu Li Za Zhi the Journal of Nursıng. 2012; 59: 79-86
        • İnal S.
        • Akgün M.
        Terapotik Communjcation of hospitalization child.
        Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi. 2003; 6: 67-76
        • Jorgenson J.
        Therapeutic use of companion animals in health care.
        Image – the Journal of Nursing Scholarship. 1997; 29: 249-254
        • Kahan B.C.
        • Rehal S.
        • Cro S.
        Risk of selection bias in randomised trials.
        Trials. 2015; 16: 405
        • Kaminski M.
        • Pellino T.
        • Wish J.
        Play and pets: The physical and emotional impact of child-life and pet therapy on hospitalized children.
        Children’s Health Care. 2002; 31: 321-335
        • Kanık E.
        • Taşdelen B.
        • Erdoğan S.
        Randomization in clinical trials.
        Marmara Medical Journal. 2011; 24: 149-155
        • Kaya Memiş A.
        Okul nezaket algısının ilkokul öğrencilerinin psikolojik ve duygusal iyi oluşları ile ilişkisinin incelenmesi.
        Uludağ Üniversitesi. 2018;
        • Kruger K.A.
        • Serpell J.A.
        Animal-assisted interventions in mental health: Definitions and theoretical foundations.
        in: Fine A.H. Handbook on animal-assisted therapy. 3rd ed. Academic Press, 2010: 33-48
        • Lan Y.-P.
        • Huang Z.-H.
        • Finley G.A.
        • Zuo Y.-X.
        Effects of the combination of mask preconditioning with midazolam pretreatment on anxiety and mask acceptance during pediatric inhalational induction and postoperative mask fear in children.
        Chinese Medical Journal. 2012; 125: 1908-1914
        • Liddle I.
        • Carter G.F.A.
        Emotional and psychological well-being in children: The development and validation of the Stirling Children’s well-being scale.
        Educational Psychology in Practice. 2015; 31: 174-185
        • Mazurek Melnyk B.
        Intervention studies involving parents of hospitalized young children: An analysis of the past and future recommendations.
        Journal of Pediatric Nursing. 2000; 15: 4-13
        • McKinley S.
        • Coote K.
        • Stein-Parbury J.
        Development and testing of a faces scale for the assessment of anxiety in critically ill patients.
        Journal of Advanced Nursing. 2003; 41: 73-79
        • McMurtry C.M.
        • Noel M.
        • Chambers C.T.
        • McGrath P.J.
        Children’s fear during procedural pain: Preliminary investigation of the Children’s fear scale.
        Health Psychology. 2011; 30: 780-788
        • Meers L.
        • Stefanini C.
        • Sofie D.
        • Normando S.
        • Samuels W.E.
        • Kalmar I.
        • Ödberg F.
        Is it wise to involve animals in prisons and rehabilitation programs? A study conducted in Flanders (Belgium).
        Journal of Veterinary Behavior. 2010; 5: 50
        • Möller E.L.
        • Nikolić M.
        • Majdandžić M.
        • Bögels S.M.
        Associations between maternal and paternal parenting behaviors, anxiety and its precursors in early childhood: A meta-analysis.
        Clinical Psychology Review. 2016; 45: 17-33
        • Moreira R.L.
        • do Gubert F.A.
        • de Sabino L.M.M.
        • Benevides J.L.
        • Tomé M.A.
        • Martins M.C.
        • de Brito M.A.
        Assisted therapy with dogs in pediatric oncology: Relatives’ and nurses’ perceptions.
        Revista Brasileira de Enfermagem. 2016; 69: 1188-1194
        • Nathanson D.E.
        • de Faria S.
        Cognitive improvement of children in water with and without dolphins.
        Anthrozoös. 1993; 6: 17-29
        • O’Haire M.
        Companion animals and human health: Benefits, challenges, and the road ahead.
        Journal of Veterinary Behavior. 2010; 5: 226-234
        • Özusta H.Ş.
        Çocuklar için durumluk-sürekli kaygı envanteri uyarlama, geçerlik ve güvenirlik çalışması.
        Türk Psikoloji Dergisi. 1995; 10: 32-44
        • Petronio-Coia B.J.
        • Schwartz-Barcott D.
        A description of approachable nurses: An exploratory study, the voice of the hospitalized child.
        Journal of Pediatric Nursing. 2020; 54: 18-23
        • Rodriguez C.M.
        • Clough V.
        • Gowda A.S.
        • Tucker M.C.
        Multimethod assessment of children’s distress during noninvasive outpatient medical procedures: Child and parent attitudes and factors.
        Journal of Pediatric Psychology. 2012; 37: 557-566
        • Rokach A.
        Psychological, emotional and physical experiences of hospitalized children.
        Clinical Case Reports and Reviews. 2016; 2: 399-401
        • Rozanski A.
        • Kubzansky L.D.
        Psychologic functioning and physical health: A paradigm of flexibility.
        Psychosomatic Medicine. 2005; 67: S47-S53
        • Saraç T.
        Ahi Evran Üniversitesi son sınıf ögrencilerinin gelecek kaygısı ve umutsuzluklarının incelenmesi.
        Ahi Evran University, Graduate School of Natural and Applied Sciences2015
        • Sarman A.
        • Günay U.
        The effect of calligraphy/calligraphy practice on the anxiety and depression of children who treated in child and adolescent psychiatry clinic.
        Inönü University, Institute of Health Sciences. Master's Thesis2018
        • Sarman A.
        • Sarman E.
        An overlooked ıssue: Negative effects of child's hospital treatment on family and preventive nursing approaches.
        University of Health Sciences Journal of Nursing. 2020; 2: 113-120
        • Savaş E.
        • Şener E.
        • Yıldız M.
        Japon balıklarında (carassius sp.) embriyolojik ve larval gelişimin incelenmesi.
        İstanbul Üniversitesi Veteriner Fakültesi Dergisi. 2006; 32: 7-19
        • da Silva S.G.T.
        • Santos M.A.
        • de Floriano C.M.F.
        • DamiÃpoundso E.B.C.
        • de Campos F.V.
        • Rossato L.M.
        Influence of therapeutic play on the anxiety of hospitalized school-age children: Clinical trial.
        Revista Brasileira de Enfermagem. 2017; 70: 1244-1249
        • Snipelisky D.
        • Burton M.C.
        Canine-assisted therapy in the inpatient setting.
        Southern Medical Journal. 2014; 107: 265-273
        • Spielberger C.D.
        Manual for the state-trait anxiety inventory for children.
        Consulting Psychologists Press, 1973
        • Theofanidis D.
        Chronic illness in childhood: Psychosocial adaptation and nursing support for the child and family.
        Health Science Journal. 2007; 1: 1-9
        • Üstün G.
        • Erşan E.E.
        • Kelleci M.
        • Turgut H.
        Evaluation of the psychosocial symptoms by several variables in the hospitalized children.
        Cumhuriyet Medical Journal. 2014; 36: 25-33
        • Vagnoli L.
        • Caprilli S.
        • Vernucci C.
        • Zagni S.
        • Mugnai F.
        • Messeri A.
        Can presence of a dog reduce pain and distress in children during venipuncture?.
        Pain Management Nursing. 2015; 16: 89-95
        • Vos T.
        • Barber R.M.
        • Bell B.
        • Bertozzi-Villa A.
        • Biryukov S.
        • Bolliger I.
        • Charlson F.
        • Davis A.
        • Degenhardt L.
        • Dicker D.
        • Duan L.
        • Erskine H.
        • Feigin V.L.
        • Ferrari A.J.
        • Ferrari A.J.
        • Fitzmaurice C.
        • Fleming T.
        • Graetz N.
        • Guinovart C.
        • Fleming T.
        • Haagsma J.
        • Murray C.J.L.
        Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the global burden of disease study 2013.
        Lancet. 2015; 386: 743-800
        • Waite T.C.
        • Hamilton L.
        • O’Brien W.
        A meta-analysis of animal assisted interventions targeting pain, anxiety and distress in medical settings.
        Complementary Therapies in Clinical Practice. 2018; 33: 49-55
        • Walden M.
        • Lovenstein A.
        • Randag A.
        • Pye S.
        • Shannon B.
        • Pipkin E.
        • Ramick A.
        • Helmick K.
        • Strickland M.
        Methodological challenges encountered in a study of the impact of animal-assisted intervention in pediatric heart transplant patients.
        Journal of Pediatric Nursing. 2020; 53: 67-73
        • Wu A.S.
        • Niedra R.
        • Pendergast L.
        • McCrindle B.W.
        Acceptability and impact of pet visitation on a pediatric cardiology inpatient unit.
        Journal of Pediatric Nursing. 2002; 17: 354-362
        • Yayan E.H.
        • Zengin M.
        Therapeutic play in child clinics.
        Gümüşhane University Journal Of Health Sciences. 2018; 7: 226-233
        • Yılmaz U.
        • Oltuoğlu H.
        • Hanazay B.
        • Aylaz R.
        Uğraş terapisinin kronik hastalıklı çocukların durumluk kaygı düzeylerine etkisi. Uluslararası Katılımlı 3. Ulusal Pediatri Hemşireliği Kongresi.
        Kongre Özet Kitabı, Sözel Bildiri, 2011
        • Zarei N.
        • Negarandeh R.
        The relationship between unmet needs of parents with hospitalized children and the level of parental anxiety in Iran.
        Journal of Pediatric Nursing. 2021; 57: e74-e78