Evaluation of paper filigree and aquarium fish activities in reducing stress among children admitted to the pediatric emergency department a randomized controlled trial

Objective: This study aimed to evaluate the effectiveness of two distraction-based methods -paper quilling and aquarium fish observation- in reducing the negative psychological effects of the emergency department environment on children and their parents. Materials and Methods: This single-center, randomized controlled experimental study was conducted between 2023 and 2024 in the Pediatric Emergency Department of Pamukkale University. The study included a total of 90 randomly selected children aged 6–12 years and their parents. Participants were divided into three groups: the paper quilling group (n=30), the aquarium fish observation group (n=30), and the control group (n=30). Pre- and post-intervention measurements were administered to both the experimental and control groups. Data were collected using the State-Trait Anxiety Inventory for Children, the Children's Fear Scale, and the Stirling Children's Well-being Scale. Results: Both methods significantly reduced children's fear levels and improved their psychological well-being (p<0.001). The paper quilling activity enhanced children's sense of control and self-regulation skills through active participation, whereas aquarium fish observation was particularly effective in reducing state anxiety (p=0.007). However, no significant difference was found among the groups regarding trait anxiety levels (p>0.05). Conclusion: These two distraction-based interventions applied in the emergency department positively influenced children's emotional states by increasing psychological well-being and reducing fear levels. The paper quilling method provides an innovative contribution to the literature, while aquarium fish observation stands out as an easily applicable and effective strategy. Keywords: Anxiety; Distraction methods; Fear; Pediatric Emergency Department; Psychological well-being