Music Therapy, Play Therapy, and Virtual Reality as Nursing Led Anxiolytic Interventions During Pediatric Anesthesia Induction: A Systematic Review of Clinical Evidence

Introduction: Preoperative anxiety in children can disrupt physiological stability, hinder anesthesia induction, and affect recovery. Nursing-led, non-pharmacological interventions such as music therapy, play therapy, and virtual reality are increasingly recognized as safe and effective strategies to improve comfort and cooperation. Despite growing evidence, an updated synthesis of studies from ۲۰۲۰-۲۰۲۵ is needed to guide perioperative nursing practice. This review critically appraises and synthesizes clinical research on the anxiolytic effectiveness of these interventions during pediatric anesthesia induction, highlighting nursing roles, implementation strategies, and patient-centered outcomes. Methods: In accordance with PRISMA ۲۰۲۰ guidelines, PubMed, CINAHL, Embase, PsycINFO, and Scopus were searched (January ۲۰۲۰-May ۲۰۲۵) for studies involving children aged ۲-۱۲ undergoing general anesthesia, in which nurses delivered or coordinated music therapy, play therapy, or virtual reality during induction. Eligible designs included randomized controlled trials (RCTs), quasi-experimental studies, and observational studies reporting quantitative or qualitative anxiety outcomes. Two reviewers independently screened studies, extracted data, and assessed quality using Joanna Briggs Institute tools. Findings were narratively synthesized, considering heterogeneity in interventions and outcome measures. Results: Fourteen studies (n = ۱,۲۴۸ children) met the inclusion criteria: six examined music therapy, five investigated virtual reality, and three evaluated structured play therapy. Anxiety reduction was consistently reported across all interventions, with music therapy showing mean reductions of ۲۵-۴۰% on validated scales, typically via live or recorded sessions adapted to the child's age and preferences. Virtual reality interventions demonstrated high engagement rates (۸۵%) and rapid immersion, resulting in pre-induction anxiety reductions comparable to or greater than those achieved with midazolam in some cases. Play therapy often utilizing interactive medical play kits reduced anxiety by enhancing procedural understanding and fostering trust with perioperative nursing staff. Across all modalities, active nurse facilitation, thorough parental briefing, and integration into pre-induction workflows were critical to success. All studies reported high acceptability, minimal adverse effects, and improved cooperation during mask placement and induction. Quality appraisal indicated moderate to high methodological rigor in ۷۲% of studies. Conclusion: Music therapy, play therapy, and virtual reality when delivered or coordinated by perioperative nursing staff are effective, safe, and well-tolerated strategies for reducing preoperative anxiety in children. These approaches support child- and family-centered care, improve induction compliance, and may reduce reliance on pharmacological anxiolytics. Future research should focus on protocol standardization, long-term emotional outcomes, and integration into diverse perioperative settings to expand accessibility and ensure evidence-based nursing practice.

کلیدواژه ها:

Pediatric anesthesia ، Nursing interventions ، Music therapy ، Play therapy ، Preoperative anxiety