In addition, the children took a subjective test to evaluate the level of pain they were feeling before and after participating in the activities. They also performed a free word association task by relating their impressions about 7 cards illustrated with elements from the hospital context (Nurse, Doctor, Hospital, Medicine, Patient, Pain, and Book).
The outcomes were positive for all groups, as both interventions reduced the level of cortisol and increased the production of oxytocin in all the children analyzed, while the sensation of pain and discomfort was also mitigated, according to the evaluation of the children themselves.
However, a significant difference was that the positive results of the children in the storytelling group were twice as good as those in the riddles group. These findings led the researchers to conclude that the narrative activity was substantially more effective.
"Another highlight of this study is that it was not performed in an artificial environment, but rather within the routine of the pediatric ICU. The storytelling was done individually; the child chose which story would be told. Among the books offered, we chose titles available in ordinary bookstores and without a pre-defined emotional bias, so that the story would not influence the child's reaction so much after the activity," highlighted Dr Brockington.
Even though storytelling was already being adopted in many children's hospitals, this is the first time we are presented with robust evidence of its physiological and psychological impacts. This contributes to seeing the activity as an effective and low-cost therapeutic method, which can make a great difference in the quality of life for children in intensive care units.
"I consider this study to be one of the most important I have participated in, due to its simplicity, rigor, and potential direct impact on practices in the hospital environment, aiming at the relief of human suffering. As it is a low-cost and highly safe intervention, it can potentially be implemented in the entire public system, once larger-scale studies verify its reproducibility and effectiveness. We intend to extend and replicate it in other settings and patient groups and to support volunteering dedicated to the noble activity of storytelling, now with more solid scientific evidence," pointed out Dr Moll.
The emotional impacts of storytelling were also revealed in the results of the free word association test, done at the end of each intervention. Children in the storytelling group reported more positive emotions than in the control group, when exposed to the Hospital, Nurse, and Doctor words.
For example, the children in the control group responded to the card with the drawing of a Hospital saying, "This is the place that people go when they are sick". Children in the storytelling group reported for the same card as: "this is the place that people go to get better."
For the illustrations of a nurse and a doctor, the same pattern was observed. Children in the control group remarked "This is the bad woman who comes to give me an injection", while those who were told the stories said phrases such as: "This is the woman who comes to heal me."
Although the research had the support of trained volunteer storytellers from the Brazilian non-profit association "Viva e Deixe Viver", the authors state that storytelling is an activity that can be equally practiced by parents and educators, thus providing space for children to participate in the choice of the book and to interact with the story.
In addition to reducing anxiety and stress, the activity enables the strengthening of bonds between the child, the narrator, and the other people present in the environment.
The authors also remarked that the findings of this research on storytelling point to additional potential applications for children experiencing environmental stress, such as the disruption caused by the pandemic.
Storytelling by parents, relatives and friends may be a simple and effective way to improve the wellbeing of a child and is accessible to all families.
In addition, the children took a subjective test to evaluate the level of pain they were feeling before and after participating in the activities. They also performed a free word association task by relating their impressions about 7 cards illustrated with elements from the hospital context (Nurse, Doctor, Hospital, Medicine, Patient, Pain, and Book).
The outcomes were positive for all groups, as both interventions reduced the level of cortisol and increased the production of oxytocin in all the children analyzed, while the sensation of pain and discomfort was also mitigated, according to the evaluation of the children themselves.
However, a significant difference was that the positive results of the children in the storytelling group were twice as good as those in the riddles group. These findings led the researchers to conclude that the narrative activity was substantially more effective.
"Another highlight of this study is that it was not performed in an artificial environment, but rather within the routine of the pediatric ICU. The storytelling was done individually; the child chose which story would be told. Among the books offered, we chose titles available in ordinary bookstores and without a pre-defined emotional bias, so that the story would not influence the child's reaction so much after the activity," highlighted Dr Brockington.
Even though storytelling was already being adopted in many children's hospitals, this is the first time we are presented with robust evidence of its physiological and psychological impacts. This contributes to seeing the activity as an effective and low-cost therapeutic method, which can make a great difference in the quality of life for children in intensive care units.
"I consider this study to be one of the most important I have participated in, due to its simplicity, rigor, and potential direct impact on practices in the hospital environment, aiming at the relief of human suffering. As it is a low-cost and highly safe intervention, it can potentially be implemented in the entire public system, once larger-scale studies verify its reproducibility and effectiveness. We intend to extend and replicate it in other settings and patient groups and to support volunteering dedicated to the noble activity of storytelling, now with more solid scientific evidence," pointed out Dr Moll.
The emotional impacts of storytelling were also revealed in the results of the free word association test, done at the end of each intervention. Children in the storytelling group reported more positive emotions than in the control group, when exposed to the Hospital, Nurse, and Doctor words.
For example, the children in the control group responded to the card with the drawing of a Hospital saying, "This is the place that people go when they are sick". Children in the storytelling group reported for the same card as: "this is the place that people go to get better."
For the illustrations of a nurse and a doctor, the same pattern was observed. Children in the control group remarked "This is the bad woman who comes to give me an injection", while those who were told the stories said phrases such as: "This is the woman who comes to heal me."
Although the research had the support of trained volunteer storytellers from the Brazilian non-profit association "Viva e Deixe Viver", the authors state that storytelling is an activity that can be equally practiced by parents and educators, thus providing space for children to participate in the choice of the book and to interact with the story.
In addition to reducing anxiety and stress, the activity enables the strengthening of bonds between the child, the narrator, and the other people present in the environment.
The authors also remarked that the findings of this research on storytelling point to additional potential applications for children experiencing environmental stress, such as the disruption caused by the pandemic.
Storytelling by parents, relatives and friends may be a simple and effective way to improve the wellbeing of a child and is accessible to all families.
