Background. Preoperative anxiety complicates treatment and requires assessment by nurses in children. Children, with or without disability, are helped when pictures are used to support communication. The purpose of this pilot study was to test the reliability and validity of the modified short State-Trait Anxiety Inventory (STAI) using a modified Talking Mats method in children undergoing day surgeries. Method. A modified short STAI with pictorial support along the lines of the Talking Mats method was pre- and postoperatively administered to 42 typically developing children aged three to nine years. The parents assessed the children’s anxiety, simultaneously and independently, by scoring the short STAI by proxy. Results. The modified short STAI showed moderate internal consistency and good construct validity in the age group seven to nine years. Conclusions. The results of this study support the use of the instrument for self-reports in children aged seven to nine years. Future research will explore the possibilities of also using this instrument for children with cognitive and communicative difficulties. 1. Introduction It is a main concern to reduce preoperative anxiety in children, because it is associated with painful effects on postoperative recovery [1, 2]. Preoperative anxiety is also correlated with adverse postoperative behavioral abnormalities [3]. It is important for nurses to measure children’s emotional responses to surgery when planning appropriate nursing interventions [4]. It is also important for nurses to assess children’s anxiety with a validated instrument. Children’s emotions and anxiety behavior can sometimes be measured on an observational scale [5]. However, as children grow up, their behavioral expressions will be partially under voluntary control, and self-reports and behavioral measurements are only modestly correlated in research. Behavioral assessments, as well as self-reports, have several validity problems [6]. It is a challenge to use self-reports to assess children’s anxiety. Children’s levels of distress and their cognitive and communicative competence are essential concerns when nurses need valid self-reports [7]. It is also a challenge to obtain the child’s perspective and use a self-report if the child has a cognitive or communicative disability [8]. Despite the methodological challenges of administering self-reports, it is still considered the golden standard [9]. Parents’ and nurses’ perceptions of children’s emotions should only be considered an estimate of the emotions experienced by children, as they are not the
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