The Effect of Expressive Writing Therapy on Fear Scores in Hospitalized Children Aged 10-12 Years

Authors

  • Susi Roida Simanjuntak Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Universitas Sam Ratulangi, Indonesia
  • Selvin Tody Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Universitas Sam Ratulangi, Indonesia
  • Milkha Pangalila Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Universitas Sam Ratulangi, Indonesia
  • Khairun Nisa Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Universitas Sam Ratulangi, Indonesia

DOI:

https://doi.org/10.54832/phj.v7i2.1469

Keywords:

children, expressive writing, fear, hospitalization

Abstract

Introduction:   Fear is one of the impacts of hospitalization commonly experienced by children. The fear experienced by children during hospitalization can contribute to the development of other psychological problems, therefore, nurses are expected to implement interventions to address children’s fear during hospitalization.  This study aimed to analyze the effect of expressive writing on the level of fear among school-aged children undergoing hospitalization.

Methods:  The research design used in this study was a pre-experimental one-group pretest–posttest design involving 25 hospitalized children aged 10–12 years. The sampling technique used was purposive sampling. The instrument employed to measure children’s fear levels was the Children’s Fear Measurement Scale (CFS). The intervention implemented in this study was expressive writing administered over three days. Fear scores were measured on the first day prior to the intervention and re-measured on the third day after the intervention was completed. Data were analyzed using the Wilcoxon test.

Results:  The results showed that expressive writing therapy was significantly associated with fear scores (p < 0.05). This indicates that expressive writing therapy can help reduce fear scores in children after a three-day intervention.

Conclusions:  Based on these findings, expressive writing therapy can be considered as one of the nursing interventions to address fear in children during hospitalization. Nurses are expected to facilitate hospitalized children in engaging in expressive writing therapy.

Downloads

Download data is not yet available.

References

Altay, N., Kilicarslan-Toruner, E., & Sari, Ç. (2017). The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment. European Journal of Oncology Nursing, 28, 1–6. https://doi.org/10.1016/j.ejon.2017.02.007

Dewi, M. M., Nurhaeni, N., & Hayati, H. (2021). The effect of storytelling on fear in school-age children during hospitalization. Pediatria Medica e Chirurgica, 43(s1). https://doi.org/10.4081/pmc.2021.269

Gökoğlu, A., & Sukut, Ö. (2025). Should I play or should I watch: the effects of active and passive distraction methods on children’s pain, fear and anxiety during invasive procedures: a randomized controlled clinical trial. BMC Pediatrics, 25(1). https://doi.org/10.1186/s12887-025-06188-1

Greenbaum, C. A., & Javdani, S. (2017). Expressive writing intervention promotes resilience among juvenile justice-involved youth. Children and Youth Services Review, 73, 220–229. https://doi.org/10.1016/j.childyouth.2016.11.034

Gülduran, E., & Özalp Gerçeker, G. (2026). Effect of Distracting Methods on Procedure-Related Fear, Anxiety, and Pain During Intramuscular Injection: A Randomized Controlled Trial. Journal of Emergency Nursing, 52(1), 127–142. https://doi.org/10.1016/j.jen.2025.08.003

Hafizah, N., & Sulistyarini, I. (2024). Treatment of Depression in Children Through Expressive Writing Therapy Penanganan Depresi Pada Anak Melalui Terapi Menulis Ekspresif. Desember, 13(4), 625–631. https://doi.org/10.30872/psikostudia.v13i4

Hedén, L., von Essen, L., & Ljungman, G. (2020). Children’s self-reports of fear and pain levels during needle procedures. Nursing Open, 7(1), 376–382. https://doi.org/10.1002/nop2.399

Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2019). Wong’s Nursing Care of Infants and Children. In Elsevier (Eleventh). Elsevier.

KAHRIMAN, I., AKSOY, B., KANDAZ, U., BORAN, S., GÖGER, B., & KIRBAŞ, Z. Ö. (2026). Effects of a puppet-assisted house-tree-person test on fear and anxiety in children receiving chemotherapy and associated influencing factors: A projective, quasi-experimental study. Journal of Pediatric Nursing, 88, 34–43. https://doi.org/10.1016/j.pedn.2026.02.007

Karataş, N., Gürcan, M., Kaya, A., Altinişik, Z. I., & Işler, A. (2025). Quality of pediatric nursing care is effective in reducing fears of nursing interventions and materials used in hospitalized children: Results of a clinic-based study. Journal of Pediatric Nursing, 84, 8–14. https://doi.org/10.1016/j.pedn.2025.05.007

Köle, G. S., & Yildiz, İ. (2025). The relationship between fear of medical procedures and psychosocial symptoms in hospitalized children: A cross-sectional study. Journal of Pediatric Nursing, 84, 149–155. https://doi.org/10.1016/j.pedn.2025.05.025

McLenon, J., & Rogers, M. A. M. (2019). The fear of needles: A systematic review and meta-analysis. In Journal of Advanced Nursing (Vol. 75, Number 1, pp. 30–42). Blackwell Publishing Ltd. https://doi.org/10.1111/jan.13818

McMurtry, C. M., Noel, M., Chambers, C. T., & McGrath, P. J. (2011). Children’s Fear During Procedural Pain: Preliminary Investigation of the Children’s Fear Scale. Health Psychology, 30(6), 780–788. https://doi.org/10.1037/a0024817

Mortari, L., Valbusa, F., & Bombieri, R. (2024). “The Nous Project”: A SEL program to promote emotional self-understanding in elementary school children. Social and Emotional Learning: Research, Practice, and Policy, 4. https://doi.org/10.1016/j.sel.2024.100060

Özsavran, M., Baz, A., & Karakaya, C. (2025). Play-based training program for overcoming hospital fear in children. Journal of Pediatric Nursing, 82, 21–30. https://doi.org/10.1016/j.pedn.2025.02.016

Öztürk Şahin, Ö., & Topan, A. (2019). Investigation of the Fear of 7–18-Year-Old Hospitalized Children for Illness and Hospital. Journal of Religion and Health, 58(3), 1011–1023. https://doi.org/10.1007/s10943-018-0688-x

Pennebaker, J. W., & Chung, C. K. (2011). Expressive Writing: Connections to Physical and Mental Health. In Oxford handbook of health psychology (In H. S. Friedman). Oxford University Press.

Rapoport, C. S., Choi, A. K., Radovsky, S., Chen, M. A., Devereaux, M., Korhummel, M., O’Donnell, S., Malcarne, V. L., & Kuo, D. J. (2025). A mixed methods pilot study of a virtual therapeutic writing intervention for adolescent/young adults with cancer. Journal of Psychosocial Oncology, 43(5), 664–681. https://doi.org/10.1080/07347332.2025.2454497

Ren, H., Meng, S., Yin, X., Li, P., Xue, Y., Xin, W., & Li, H. (2025). Effects of expressive writing of positive emotions on mental health among patients with ovarian cancer undergoing postoperative chemotherapy. European Journal of Oncology Nursing, 74. https://doi.org/10.1016/j.ejon.2024.102756

Roswita, O., Roku, V. R., Nugroho, F. C., Kementerian, P. K., & Kupang, K. (2024). PENGALAMAN HOSPITALISASI PADA ANAK YANG DIRAWAT DI RSB DRS. TITUS ULLY KOTA KUPANG. Journal of Innovation Research and Knowledge, 4(5).

Suminar, I. T., Gamayanti, I. L., & Lusmilasari, L. (n.d.). RELATIONSHIP BETWEEN NURSE SUPPORTS AND FEARS OF HOSPITALIZED SCHOOL AGE CHILDREN IN PKU MUHAMMADIYAH HOSPITAL, YOGYAKARTA, INDONESIA. Belitung Nursing Journal, 3(4), 376–382. Retrieved http://belitungraya.org/BRP/index.php/bnj/

Zhang, W., Jhang, J. C., & Greenwell, M. R. (2023). Effects of replay and rehearsal expressive writing on mental health: a randomized controlled trial. Journal of Mental Health, 32(3), 582–591. https://doi.org/10.1080/09638237.2022.2140783

Zhu, J., Hussain, M., Joshi, A., Truica, C. I., Nesterova, D., Collins, J., Saunders, E. F. H., Hayes, M., Drabick, J. J., & Joshi, M. (2020). Effect of creative writing on mood in patients with cancer. BMJ Supportive and Palliative Care, 10(1), 64–67. https://doi.org/10.1136/bmjspcare-2018-001710

Downloads

Published

2026-04-23

How to Cite

Simanjuntak, S. R., Tody, S., Pangalila, M., & Khairun Nisa. (2026). The Effect of Expressive Writing Therapy on Fear Scores in Hospitalized Children Aged 10-12 Years. PROFESSIONAL HEALTH JOURNAL, 7(2), 861–868. https://doi.org/10.54832/phj.v7i2.1469

Issue

Section

Articles

Citation Check