Research Final Defense

Communication and Anxiety| 1
Chapter I
THE PROBLEM AND ITS SETTING
Anxiety is very common to those patients, especially pediatric, who are afraid of
medical procedures and the possible results afterwards. Children commonly report feeling
afraid or anxious as they anticipate and engage in health care settings with medical
professionals and possibly become aggressive towards the health care provider (Smith,
2013). Published case reports have focused on the vasovagal response to procedures
involving needles. A vasovagal response includes a drop in blood pressure which leads to
dizziness, fainting and shock. Patients who experience a vasovagal response to needles
are more likely to have an intense fear response the next time they seek treatment (Wright,
Yelland, Heathcote, Ng and Wright, 2009). These children can also be passive
participants in sometimes-stressful conversations with administrative professionals. Most
concerning, up to 20% of the population reports feeling “white coat syndrome”—in which
children become anxious and alarmed when coming into contact with medical doctors or
any health care providers (Sine, 2008).
According to a study conducted in Griffith University in Australia, 170
participants in Ormeau Medical Center responded to their questionnaires and over 60% of
the patients undergoing blood extraction procedure, getting a flu shot, and etc., showed
physical symptoms; shortness of breath, dry mouth, nausea, dizziness. Over 20% passed
out or fainted upon insertion of the needle. Based on the data, 46.2% responded that they
fear it will be the same traumatic experience they had and 48.7% responded that they are
simply afraid (Wright et. al., 2009).

The primary objective of this study is to know the impact of an effective health
care communication between a Medical Technologist and a patient preceding the
procedure. The researchers would like to determine if the methods of social interaction of
a Medical Technologist are effective in gaining the trust and reducing the anxiety of the
patient before the procedure.
Statement of the Problem
This study aims to seek answers to the following questions:
1. What is the demographic profile of the participants in terms of:
a. Age
b. Sex
2. What is the level of pre-school children’s anxiety undergoing blood extraction
before and after health care communication?
3. Is there a significant difference in the level of anxiety of pre-school children before
and after health care communication?
4. Is there a significant relationship between health care communication and anxiety
among pre-school children undergoing blood extraction?
There was no statistically significant relationship between the difference in the
level of anxiety of pre-school children before and after health care communication.
Similarly, the variable health care communication and anxiety had no significant
relationship also.
Significance of the Study
Blood extraction or collection and processing techniques must be carefully
standardized in order to make valid measurements commencing the required blood tests.
This study will be valuable to the following:
Pre-school Children. This study will help the patients to understand the control.
The result of this study may improve communication to lower down the level of patient
anxiety before the procedure.
Pre-school Legal Guardians. This study will provide information to the legal
guardians as to the different techniques of blood extraction and can serve as a learning
experience to calming down their children.
Registered Medical Technologists. This study will provide the Medical
Technologists different ideal techniques on approaching pre-school children undergoing
blood extraction.
Academe. This study will help the institution of higher education to recognize
what important factors are to be indicated in procedures and a more effective approach of
communication.
Future Researchers. This will serve as an example for the future researchers to
learn the possible use and benefits. This study will also explain the rules that must be
followed to protect the being of the patient.

Department of Health. This study will be beneficial to the Libarary and Resource
Centers of the Department of Health as it would provide information concerning
approaches on health care communication.
Scope and Delimitation
This study focused on the effect of health care communication towards the pre-
school patients in Out-Patient Department undergoing blood extraction in Puericulture
Center, General Santos City. This study is aimed to know the effective ways to
communicate the patient to lessen their anxiety during blood extraction. A checklist was
utilized to take note of the observation among the pre-school patients and the Medical
Technologist. The outcome of this study is limited to the data gathered from journal about
health care communication, anxiety and pre-school patient.
The researchers conducted this study on July 23 to July 27 at 8 o’clock in the
morning to 4 o’clock in the afternoon. The result obtained in 5 days verified the number
of respondents.
Theoretical Framework
The inputs of this study are the medical technologists, health care communication
skill and level of anxiety. The output of this study is health care communication skills for
an improved management of patient. Peplau’s interpersonal relations theory focuses on
the nurse-client relationship and therapeutic process that takes place. Communication that
occurs in this context involves complex factors such as environment, in addition to
attitudes, practice and belief in the dominant culture. Pelau’s interpersonal relation theory
defines four stages of the relationship that achieve a common goal. Orientation phase were
the health care provider engages the patients in treatment, and the patient is able to ask a
question and receive explanations and information. This stage helps the patient develop
trust and is where first impression about the healthcare system begin to evolve.
Identification phase were the patient and health care provider begin to work together. His
interaction provides the basis for understanding, trust and acceptance as the patient
becomes an active participants. Exploitation phase were the patient takes advantage of all
services offered, exploiting the healthcare provider-patient relationship to address the
procedure. Resolution phase were a result of effective communication, the patients’ needs
are met (Neese 2015).
According to Gamble (2013), “Communication is our link to humanity.”
Communication is needed not only for transmission of information and knowledge to one
another, but more significantly to inter-relate as human beings everywhere in the world.
The actions we make define and give an additional meaning to what we actually mean.
Communication does not limit to what our mouth speaks, however, it includes the body
language and the way our faces express deeper emotions. Interaction with the patients
requires being cautious especially in term of cultural differences (Brinckert, 2010).
Conceptual Framework
The conceptual framework is a particular variable in the study connect with each
other. Thus, it identifies the variables required in the research investigation and provides
an outline of how you plan to conduct your study. (Regoniel Patrick 2015).
The health care provider will give an instruction to the patient or guardian before
and after the procedure that might test if the level of patients’ anxiety would change. The
Figure 1 shows the relationship between the health care communication and the patients’
level of anxiety. The connection between the communication of health care provider and
the patient anxiety would be the variable if the anxiety will lessen or remain. The
independent variable of this framework is healthcare communication and the dependent
variable is patient anxiety
HEALTH CARE PATIENTS ANXIETY

COMMUNICATION
Figure 1 Conceptual Framework
Definition of Terms
The accompanying terms used in conducting the research are characterized
thoughtfully and operationally to encourage better comprehension of the study.

Anxiety. Refers to the fear or nervousness manifested by crying, sweating,
paleness, trembling, aggression, avoidance, and lack of cooperation of the child to the
blood extraction procedure.
Blood Extraction. A process of getting blood sample using a syringe or lancet.
Health Care Communication. A tool used to ease the participants from their
anxiety and an aid to provide a great patient care and an instrument in providing patient's
satisfaction.
Pre-school Children. Participants age 3 to 6 years whose psychological
development in early childhood or pre-primary school level.

Chapter II
REVIEW OF RELATED LITERATURE AND STUDIES
In this chapter, the review of related literatures and studies that had been discussed
in the previous chapters will focus the; anxiety, communication skills, and phlebotomy.
Anxiety
Everyone may feel anxious from time to time. Worries, fear and anxieties are
common to us all. They are not physically or mentally damaging and, on most occasions,
these responses are reasonable or even vital to survival. They are the normal reactions to
stress or danger and only become a problem when they are exaggerated or experienced
out of context (Kennerly, 2009). Everyday anxiety can be mild or occasional and this can
be considered to be justified and normal. However, mostly in children, they experience
tension more frequently and more intensely. This fear can be abnormally excessive and
beyond that which is justified by external threat and markedly interferes with the
individual’s ability to function optimally. Anxiety are mostly triggered by a combination
of biological factors, psychological factors such as; stressful or traumatic life events, a
family history of anxiety problems, childhood development issues, alcohol, medications
or illicit substances and other medical or psychiatric problems (Rector, Bourdeau, Kitchen
and Joseph-Massiah., 2016). A study was conducted in the Philippine Children’s Medical
Centre entitled “Measurement of Anxiety in Acutely and Chronically Ill Patient of
Philippine Children’s Medical Center,” examined 323 pediatric patients, ages 8 to 19 years
and attends school, seen at OPD (Out-Patient Department) or in patients of the Philippine
Children’s Medical Centre, who are acutely and chronically ill. A score of 33 to 36 of the
male and female pediatric patients, showed anxiety level and suggests that there is no
significant difference. Acutely and chronically ill patients presented the same anxiety
levels.
The patient-clinician interaction has been consistently reported as a critical aspect
affecting patient satisfaction with health care (Oliveira et. al., 2012). A study conducted
by Nacionales (2008), in Davao Medical Center (DMC), showed that pediatric patients
that had been confined in the hospital for a week had assessed the quality care of the health
care providers as insufficient, lacking and need an improvement It was highly
recommended that health care providers to introduce themselves, greet their patients,
discuss about clinical concerns and toward the health care solutions (Asnani, 2009).
During communication, it is preferable to avoid any medical jargon and use simple and
clear terms to be able to send the appropriate message (Schillinger, 2010).
Anxiety are thought to be one of the most common psychiatric diagnoses in
children or adolescents (Baesdo et. al., 2009). Anxiety and pain are intricately interrelated.
The approach to pain must include an appreciation of anxiety, and vice versa (Merritt,
2014). A fear of needle, being injured and fainting can be a huge barrier for people to
acquire good health care. This fear is one of the major factors on the patient’s anxiety in
blood extraction. Commonly among adults, a verbal warning of refuse is usually given if
the patient cannot handle the procedure, however, in children, due to their developmental
level and limited cognitive development, children use behaviour, instead of words, to
communicate the emotions they feel. Common behavioural demonstrations of fear,
anxiety, and helplessness include aggression, withdrawal, lack of cooperation, and

regression (Rodriguez, Clough, Gowda & Tucker, 2012). Children commonly think the
possibility of an extremely painful procedure. Children fear mutilation, and suffer from
guilt, pain, rage, and similar manifestations specific to their developmental level. Anxiety-
provoking experiences such as hospitalizations and medical care can affect a child’s
physical growth, personality, or emotional development. In some cases, anxiety-based
trauma may prejudice the development of behavioral, emotional, or cognitive disorders
(Lerwick, 2015). While preschool and young school-age children are not likely to respond
to reasoning or detailed explanation, emotional support at an age-appropriate level reduces
pain and anxiety. Older children can be comforted by a reassuring explanation of
anticipated procedures (Merritt, 2014). It is important for medical providers to learn to
mitigate psychological trauma in pediatric care. If left untreated, childhood trauma caused
by health care -induced anxiety can cause significant mental health issues in a child’s life
(Lerwick, 2015).
Compared to other fears (e.g., fear of heights), being afraid of needles are usually
associated with psychological effect of the mere thinking of faintness upon exposure to
stimulant (i.e., ‘‘vasovagal reactions’’). Some individuals exhibits “diphasic” response in
the presence of needles. This response is characterized by a sudden increase in arousal and
also, an abrupt decrease below the normal levels that may leave the individual fainting
unless the patient can be assisted to leave the position. Published case reports have focused
on the vasovagal response to procedures involving needles. A vasovagal response includes
a drop in blood pressure which leads to dizziness, fainting and shock. Patients who
experience a vasovagal response to needles are more likely to have a difficult time or even
avoided seeking medical treatment the next time (Wright et. al., 2009).
Study also shows that aside from fear of needles, the feeling of disgust plays
important roles towards the fear of injections among specific individual. The threat that
the patient perceives is based on the specific dangers associated with phobic stimuli (e.g.,
contamination of the needle) or disgust. The feeling of disgust is experienced with regard
to certain stimuli that serve as reminders of the animal origin and mortality of the humans
(i.e., the sight of blood, wounds, or needle penetrating the skin). Disgust reactions are
associated with the parasympathetic activity of the brain; therefore, it is more likely that
the individual will be at risk of experiencing vasovagal reaction (Starcevic and Castle,
2016).
Communication Skills
Interpersonal communication is described as a tool for improving the quality
health care that are being provided by the health care professionals (USAID, 2012).
Effective interpersonal communication between health care provider and client is one of
the most important elements for improving client satisfaction, compliance and health
results. Better communication leads to extended dialogue which enables patients to
disclose critical information about their health problems and providers to make more
accurate diagnoses. Good communication enhances health care education and counselling,
resulting in more appropriate treatment regimens and better patient compliance. Effective
interpersonal communication benefits the health system as a whole by making it more
efficient and cost effective.
Communication is a two-way process which has both verbal as well as nonverbal
components, in which a professional must also be aware, that not only verbal interaction
is important, but also to one’s body language. Patient-professional interaction is an

essential skill in medical practice. It is the primary foundation on which a therapeutic
relationship with the patient is created (Rajashree, 2011). A good communication skill
constitutes having a comprehensible pronunciation, active listening skills, non-verbal
communication and the ability to bridge professional and lay language. In addition,
cultural awareness, which is also linked with language, verbally and non-verbally, plays
an important role to create a full understanding with the patient (Wright, 2012).
The Office of the Health Ombudsman of Australia states that; “Effective
communication between a health practitioner and their patient can improve overall
satisfaction and contribute towards better long-term health outcomes.” The said skill and
knowledge is the subject of most medical educational program, however, in the real
hospital setting, it might not get the attention that it needs. These skills are taught in the
programs, but only in the form of data gathering, diagnosis, and treatment (Van
Swervellen, 2009). Health care communication skills help to identify the problems of a
patient more accurately, and helps them to adjust to the psychological stress they are under
from their illness, or just the idea of undergoing a medical procedure. Communication
factors used during patient centered care and shared decision-making approaches are more
dynamic in nature, with clinicians and patients expressing their needs, concerns, and
preferences. Every contact that is made with a patient must require courteous, respectful,
considerate, and informative communication. This way, the patient feels that they get the
responses they want, leaving it to as a positive encounter with a health care professional
(Van Swervellen, 2009). Negri’s study (USAID, 2012) states that patients who understand
the nature of their illness and its treatment, and who believe the provider is concerned
about their well-being, show greater satisfaction with the care received and are more likely
to comply with treatment regimes. The patient-clinician interaction has been consistently
reported as a critical aspect affecting patient satisfaction with health care (Oliveira et. al.,
2012). A study conducted by Nacionales (2008), in Davao Medical Center (DMC),
showed that pediatric patients that had been confined in the hospital for a week had
assessed the quality care of the health care providers as insufficient, lacking and need an
improvement It was highly recommended that health care providers to introduce
themselves, greet their patients, discuss about clinical concerns and toward the health care
solutions (Asnani, 2009). During communication, it is preferable to avoid any medical
jargon and use simple and clear terms to be able to send the appropriate message
(Schillinger, 2010).
Developing partnership conversations about medical procedures, such as,
acknowledging that they arrived despite of being anxious towards needles, asking how
their day went, and let them identify uncomfortable feelings will increase the possibility
of their friendly participation (Mackereth & Tomlinson, 2014). Communication begins
not with the intention to communicate but with the act of paying attention. To show
attention to their medical needs and hear what they want to say, gives them the thought
that a health care provider genuinely cares for their necessities (Barker, 2016). In addition,
emphasizing their right to say stop whenever they are not feeling it, but also the benefits
of enduring the quick procedure, displays their control to the possibility of the proceedings
(Mackereth & Tomlinson, 2014).
The phrases are not the only subject to an effective interaction, but also
management of the voice. Voice management refers not only to the accurate pronunciation
of words, but also to the pitch or intonation. It is very important to keep a respectful and
considerate intonation when communicating to patients. The tone will help in establishing
what you really mean, and keep an understanding with the patient. In addition, the volume
of one’s voice must be appropriate wherein the patient will have no problem hearing, may
it be louder when dealing with patients who are having problems with their hearing (e.g.
older patients) (Wright, 2012).
In recognizing pediatric patient’s unique emotional and relational needs, CARE
was developed for health care providers in interacting with them. CARE stands for
choices, agenda, resilience, and emotional support respectively.
Choices. Children, when brought to a health care setting, they often feel afraid.
The provider must take time to explain to the child about a situation in which they need
control and choice. If this is not accomplished, anxiety may arise. The objective of this is
for the empowerment and safety of children.
Agenda. Fear and anxiety also resulted from being unsure or unprepared of what
will happen. The provider must set an agenda of what to expect in a situation. With this,
anxiety, fear, or maybe trauma can be avoided. With more communication, children may
build rapport with the provider.
Resilience. With communication of identifying the child’s strengths, the provider
makes an action in reducing the child’s anxiety plus identifying with the child and their
parent present, this makes a strong parent-child relationship.
Emotions. Hearing the child’s emotion is valuable and creates opportunity to build
patient-provider relationship. When they feel understood, they feel safe and it decreases
the possibility of having anxiety (Studer, as cited in Lerwick, 2015).

Blood Extraction
Blood extraction has been practised for centuries and is still one of the most
common invasive procedures in health care. The primary role of phlebotomy is the
collection of blood samples for laboratory analysis in aid to the physician to diagnose and
monitor medical conditions of the patients (Strasinger & Di Lorenzo, 2011). Phlebotomy
involves the use of large, hollow needles that have been in a blood vessel. The needles can
carry a specific volume of blood that, in the event of an accidental puncture, may be more
likely to transmit disease, such as Human Immunodeficiency Disorder and Hepatitis B
(Dhingra et. al., 2010).
Blood extraction can be very sensitive and crucial in terms of preserving the
sample obtained. The manner of collection has an overall effect of the quality of sample
being produced for laboratory testing. It is vital that blood collectors (phlebotomists) are
well versed of the fundamentals of phlebotomy to avoid leading to inaccurate test results,
leading to misdiagnosis and mistreatment of the patient and the inconvenience to repeat
the test (Nayal et. al., 2011). Furthermore, if not performed correctly, errors resulting from
phlebotomy may cause serious harm to patients be it death or a major disability.
Establishing and implementing quality-control mechanisms in the process which are
composed of materials and methods to promote better outcomes (Tadiosa, 2017).
Blood extraction might sometimes be erroneously considered as a relatively easy
task to perform, and it may bridge the gap between the patient and the laboratory. In order
to attain a good grasp of the phlebotomy practice, a year of training may be necessary as
this amount of training corresponds to an equivalent of close to 99% accuracy during the
first attempt of blood collection. However, a phlebotomist’s success is not only depicted
by the number of actual performance of the procedure (Vuk, Cipek, & Jukic, 2015). The
rapid innovation of the technology in the field of blood extraction made useful devices
such as evacuated tubes and vein x-rays that will reflect better quality of the specimens,
and to improve the welfare of the patients. Efforts must be made in terms prioritizing the
safety of the patients in order to create the primary instrument of a good quality service
(Ialongo & Bernardini, 2015).
Related Studies
Kennedy, Luhmann & Zempsky (2008), in a journal entitled “Clinical
Implications of Unmanaged Needle-Insertion Pain and Distress to Children,” showed
increasing evidence has demonstrated that pain from venipuncture and intravenous
cannulation is an important source of pediatric pain and has a lasting impact. Ascending
sensory neural pain pathways are functioning in preterm and term infants, yet descending
inhibitory pathways seem to mature postnatal. Consequently, infants may experience pain
from the same stimulus more intensely than older children. In addition, painful perinatal
procedures such as heel lancing or circumcision have been found to correlate with stronger
negative responses to venipuncture and intramuscular vaccinations weeks to months later.
Similarly, older children have reported greater pain during follow-up cancer-related
procedures if the pain of the initial procedure was poorly controlled, despite improved
analgesia during the subsequent procedures. Fortunately, both pharmacologic and
nonpharmacologic techniques have been found to reduce children's acute pain and distress
and subsequent negative behaviors during venipuncture and intravenous catheter
insertion. This review summarizes the evidence for the importance of managing pediatric
procedural pain and methods for reducing venous access pain.

According to Sahiner & Bal, (2015), in an article entitled “The Effects of Three
Different Distraction Methods on Pain and Anxiety in Children,” there are three different
distraction methods (distraction cards, listening to the music of cartoon and balloon
inflation) on pain and anxiety relief of children during phlebotomy. The respondents
(children ages 6 to 12 who are sent for blood tests) were randomized into four groups as
the distraction cards, the music, the balloon inflation, and the control. The researchers
conducted interviews with children and their parents or the observer before and after the
procedure. Data were obtained by conducting interviews with the children, their parents,
and the observer before and after the procedure. The pain levels and the anxiety levels of
children were assessed by parent and observer. The procedural child anxiety levels
reported by the observer showed a significant difference among the study groups. All the
forms of distraction significantly reduced pain and anxiety perception.
The study of Frost, Metcalf, Brooks, Kinnersley, Greenwood & Powell (2015)
entitled “Teaching Pediatric Communication Skills to Medical Students,” stated that it is
well recognized that communicating with children and their families can be challenging
for health professionals. A survey of young patients by the Health Commission suggested
that many children are unhappy with the way in which health workers relate to them whilst
they are in hospital. Equipping undergraduate students with the tools for effective
communication via specific teaching whilst on clinical placement should therefore be part
of the curriculum at all universities. Good clinical communication skills correlate with
improved health care outcomes. The recognition that communication skills are a basic
clinical skill and the development of practical teaching tools have led to an improvement
in communication skills teaching. This study has been centered on consultations with an
adult patient. Although several projects have addressed pediatric trainees’ communication
skills, there is limited work exploring undergraduate level teaching that is focused on the
distinct complexities of communicating with children and their families, particularly the
challenges of a three-way consultation between a child, their parent, and the doctor.
Synthesis
Failure to communicate effectively is a common mistake among health care
providers. This research study, entitled “Influence of health care Communication and
Anxiety among Pre-school Children Undergoing Blood Extraction,” was conducted to
know the relationship of the variables “health care communication” and “anxiety.”
Children usually use their behavior as their way of expressing what they feel, instead of
words due to their developmental level and limited cognitive development (Rodriguez et.
al., 2012). Health care communication is taught in the medical programs, within the books,
in the form of data gathering, diagnosis, and treatment. However, interacting with people
does not need the step-by-step communication that the books taught them (Van
Swervellen, 2009), it actually begins, not only with the intention to communicate but with
the act of paying attention. This research study is aimed to be an aid to the health care
providers to have the concept that refers to the strategies on how to communicate,
effectively and respectfully, to the pediatric patient that has been exposed to possible
factors that may trigger anxiety. In addition, this study attains to be of help in the field of
Medical Technology, specifically blood extraction, in terms of awareness of the presence
of anxiety among pre-school children and the impact of health care communication
towards their anxieties.

Chapter III
METHODOLOGY
This chapter presents the research. The planned research design, methods of
sample selection, study locale, selection of data collection instruments including its
procedure, bioethical consideration, and the statistical treatment. This chosen
methodology gives the general pattern for gathering and processing of research data.
Research Design
Descriptive Design utilized in gathering the data using experiment and correlation
methods were used. Its main aim is to describe the relationship among variables rather
than to infer cause-and-effect relationships (Polit & Beck, 2010). The design was helpful
in obtaining a picture of pre-school children undergoing blood extraction and in
establishing the relationship between healthcare communication and anxiety of pre-school
children.
Population and Sampling Design
In this study, the population were all the children who was confined and be tested
(JULY 2018) in the Medical Laboratory of the Jose C. Catolico Sr. Purieculture Center
located at Pres. Sergio Osmeña Avenue, within Government Hall Compound, General
Santos City. Every day this population encapsulate more or less 5 to 10 children. These
children range from ages 3 to 6-year-old to fit the description of a pre-school patient. The
exclusion for the pre-school patients were; incubated patients, in cardio respiratory
distress, with development and learning disabilities, and anyone with major psychiatric
disorders.
INFLUENCE OF HEALTH CARE COMMUNICATION AND ANXIETY

AMONG PRE-SCHOOL CHILDREN UNDERGOING BLOOD
EXTRACTIION
Methodology
1. The level of patients’
anxiety that will undergo
blood extraction before Research Design:
communicating to the
health worker. Descriptive Correlational
Locale of the Study:

Jose C. Catolico Sr.
Puericulture Family
2. The level of anxiety of Planning and Maternity
pre-school patients after Center
healthcare
communication.
Respondents of the Study:
Pre-school Patients;
Medical Technologists
3. There is a significant Research Instrumentation:

difference in the level of
anxiety of pre-school Checklist
patient before and after
healthcare
communication. Statistical Treatment:
T-test;
Pearson’s r Correlation
Reduction of anxiety of patients undergoing blood

extraction.
Figure 2. Research Design

The inclusion for the Medical Technologist is that, as long as currently employed
in Puericulture Center as a Medical Technologist and performing blood extraction,
regardless of their years of experiences, they are more than qualified to be a respondent.
The participants were based on those pre-school patients who undergone blood extraction,
together with the consent of their Legal Guardian. Convenience Sampling Technique was
utilized to gather and determine the level of anxiety among pre-school patients toward
Blood Extraction.
Study Locale
The study was conducted at Jose C. Catolico Sr. Puericulture Family Planning and
Maternity Center located at Pres. Sergio Osmeña Avenue, South Cotabato, General Santos
City. The center is a non-government organization that offers Post and Prenatal Care,
Family Planning, Immunization, Laboratory Tests Particularly Complete Blood Count and
Newborn Screening test and etc. The center is a two story building that provides 1 ward
room which contains 7 beds, 2 semi-private room wsith 3 beds, 2 private rooms with 1
bed each room, a treatment room, a laboratory, a nurse’s station, and a doctor’s room. The
medical laboratory has 2 Medical Technologists performing the Pre-Analytical,
Analytical, and Post-Analytical phases. Every day, they cater more or less 2 confined
paediatric patients and 5 to 10 paediatric outpatients.
Research Instrument
The researchers developed a checklist for the; Level of Anxiety of the Pre-school
Patients; and Communication Level of the Medical Technologist. The checklist was
examined by an expert to confirm the correspondence of the developed checklist with the
present study. Thus, the researchers were able to determine the level of patients’ anxiety
and the skills of Medical Technologist in communication.
There were two (2) sets of checklist; one for the Medical Technologist and one for
the patient. The patient’s checklist is composed seven (7) symptoms of anxiety. These
symptoms was graded as; not seen, a little, moderate, and to great extent. The Medical
Technologist’s checklist are composed of eight (8) situations that the healthcare worker
will or will not perform. These situations were graded as; not seen, poor, fair, and
satisfactory.
The checklist for the pre-school patient was validated by; (1) Pediatrician, (1)
Medical Technologist, (1) Psychometrician. As for the checklist for the medical
Technologist, it will be validated by; (2) Medical Technologists, (1) Psychometrician.
Data Gathering Procedure
To gather the data for the research:
Phase I: Permission
1.1 The researchers asked for the approval of the dean to conduct a study outside the
school campus.
1.2 The researchers asked for permission to the Jose C. Catolico Sr. Puericulture
Center, to conduct the study inside their institution, in the blood extraction room.
1.3 A letter was formulated addressed to the Legal Guardians respondents to ask their
consent to participate in the said study.

Phase II: Preparation
2.1 The researchers developed a checklist as the instrument.
2.2 The researcher prepared a checklist which covered the entire variable included in
their statement of the problem. These checklists have undergone validation by the
experts.
2.3 After validation, checklists were subjected to pilot testing followed by reliability
testing with a statistician. If not, the checklists were revalidated once more until it
was ready to utilized
2.4 After the final approval of the checklists, the researchers were able to reproduce
enough copies of the checklist intended for the number of participants that will be
catered.
Phase III: Data Collection
3.1 The researchers conducted the study on July 23 to July 27 (Monday to Saturday)
8 o’clock in the morning and 4 o’clock in the afternoon.
3.2 Only 2 representatives from the group were enabled to conduct the study in order
to avoid any biases and to have more consistent results.
3.3 The researchers were observing and note-taking from afar, wherein observation is
still obtainable and the capability to hear the communication is adequate.
Consequently, the presence of the representatives was certainly not affected by
any of the variables present during the process.

3.4 Consent was asked from the pre-school patient’s guardian. The guardian was
related to the patient. If the guardian is a minor, the consent is invalid for the
individual to sign. A guardian, in legal of age, and related to the patient is the only
eligible to sign the consent.
3.5 There were 2 checklists that will be utilized before healthcare communication, one
for the Medical Technologist and one for the patient. After the blood extraction,
the same set of checklist for the patient was utilized.
Bioethical Consideration
In gathering the data, the researchers provided the respondents the accurate
information and the reason why they were conducting the study. Consent was given to the
guardian of the patients. They were allowed to reject in participating to what the
researchers were doing. They were not be forced to answer the questionnaires as they have
the right to decide whether to get involved or not in the study. The assurance was given to
the participants that every precaution was taken to protect their privacy and the
confidentiality of the information gathered. WMA Declaration of Helsinki Ethical
Principles for Medical Research Involving Human Subjects, 2017.
Statistical Treatment
After data collection, the researchers computed the answers provided from the
questionnaires given to the participants. The statistical treatments that were used to
interpret the results are the following:

Frequency and Percentage. Specifies the portion of the respondents in
percentage based on their demographic profile.
Mean. Used to interpret the data given by the participants to describe the level of
the state.
T test. Used to compare the average score before and after communication
between the pre-school patient and the healthcare provider and answers if the healthcare
communication causes significant change in the pre-school patients’ anxiety.
Pearson’s r Correlation. Used to determine if there is a significant relationship
between the pre-school patients’ anxiety and healthcare communication.

CHAPTER IV
PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA
This chapter presented analyzed and interpreted the data gathered in this study.
The various results were presented in the succeeding tables and figures with corresponding
discussion and explanation.
3 4 5 6
28%
40%
20%
12%
Figure 3. Percentage and Age of the Participants
Table 3 shows the different percentages of the participants according to age.
Children ages 3 have a result of 28%, ages 4 years old yield a percentage of 20%, ages 5
ended up 12%, and lastly ages 6 years old got 40% with a total of 100%. Ages 3 to 5 years
old are more subjected to screening test due to its developing immunity. Ages 6 years old
have a large percentage because it is noted that most participants are age 6, which obtained
40% of the total sample population. At this age, they are being exposed to several factors
such as contact with other children especially in school, environmental changes and
exposure which may lead to illness because they are more active compared to ages 3 to 5
years old. Based on the Finland’s Physical Activity for Children research, the proportion
of 3–15-year-old children engaging in at least 60 minutes of moderate-to-vigorous
physical activity a day varies between 16% and 59%. The specific percentages are 29%
of three-year-old children, 49% of children in primary school (40% of girls and 59% of
boys) and 18% of adolescents in lower secondary school (16% of girls and 22% of
boys).11 Similar results have been observed in another study among primary school
children (35%) (Katariina, 2016.)
Female Male
32%
68%
Figure 4. Percentage and Sex of the Participants
Figure 4 shows that 32% of the respondents are females and 68% of the
respondents are males. This implies that there were more male pre-school patients that
underwent blood extraction in Jose C. Catolico Sr., Puericulture Center. In a population
of children of mid-range socioeconomic status in, lower physical activity among girls in
comparison to boys can be explained, in part, by weaker influences on physical activity at
school, through parent’s support and through lower participation in community sport.
Because these influences are potentially modifiable, future intervention strategies to

increase physical activity should focus on each of these areas simultaneously, and pay
particular attention to equality of support and opportunities for girls and boys (Telford et.
al., 2016.)
Before After Difference

Age
0.71 0.57 -0.14

3
0.40 0.60 0.20

4
1.00 0.67 -0.33

5
0.10 0.10 0.00

6
Table 1. Level of Pre-School Children’s Anxiety Undergoing Blood Extraction
Before and After Health Care Communication (In Terms of Age)
Table 1 shows the result of children ages 3 to 6 undergoing blood extraction before
and after heath care communication. The children ages 3 shows 0.71 before the procedure
and 0.57 after the procedure. The children ages 4 gives a result of 0.40 before the
procedure and 0.60 after the procedure. The children ages 5 have ended a result of 1.00
before the procedure starts and a result of 0.67 after the procedure was ended. The children
ages 6 have a result of 0.10 before and after the procedure. Interestingly, the results of the
children ages 3 to 4 have an increase result before the procedure starts and a low result
after. But in patients in age of 5, the results show the highest peak of experiencing anxiety
level during the said procedure. In contrast to the result of age 6 which gives the lowest
peak of anxiety. According to the BabyCenter Medical Advisory Board that 3 to 5 years
old has the higher level of anxiety because for all children it’s a normal part of their
emotional development. as children imaginations grows, they suddenly think about all
kind of real or imagined threats they also becoming more aware of what goes on around
them. Children with those ages are more anxious about things in their daily life and their
fears are the product of their developing imagination, and their ability to predict what
could happen in the future. Preschoolers or even kindergarten are no exception to feel
anxiety especially as there is still a lot that they don’t understand about the world. There
is a lot of childhood anxiety problems surface around age 5 according to Layne wood,
because this is a time of major transition for most children as they learn to cope with new
social situations and academic pressure. Some degree of anxiety is normal with those ages,
but prolonged or intense anxiety can indicate underlying problem (Layne Wood, 2017).
According to Febby G. Cardinal et. al., (2015), anxiety is considered a normal
aspect of children’s behavioral and emotional development. Children aged 3 to 4 years
old demonstrated a significantly higher level of anxiety than children aged 6 to 9 years
old. Furthermore, children aged 9 years old exhibited a “very low” level of anxiety
compared to children of all other age groups. These findings are concurrent with the results
of previous studies that indicated that the level of anxiety is inversely proportional to the
age of the child. Many important cognitive shifts occur between 3 to 4 years old. 3 years
old are considered pre-operational thinkers and very solely only on the concrete
appearance of the objects rather than ideas. Hence, objects like face masks, gloves,
thermometer, and particularly needles would induce the anxiety. They tend to catalogue
information into concepts based on attributes that define the idea or the object. Different
theories have been proposed to explain why females are more likely to develop anxiety
disorder than males. Environmental upbringing of the child and hormonal differences
between males and females has been suggested as differentiating factors. However, the
child’s age and developmental level are considered important factors that influence the
anxiety levels between sexes.
Sex Before After
Female Mean .3750 .3750
N 8 8
Male Mean .4706 .4118
N 17 17
Total Mean .4400 .4000
N 25 25
Table 2. Level of Pre-School Children’s Anxiety Undergoing Blood Extraction
Before And After Health Care Communication (In Terms of Sex)

Sum of Mean
Squares df Square F Sig.
Before Between (Combined) .575 1 .575 .972 .338
* sex Groups
Within Groups 10.057 17 .592
Total 10.632 18
After Between (Combined) .278 1 .278 .399 .539
* sex Groups
Total 9.333 14
Table 3. Significance Value of the Level Of Anxiety Before And After
Communication (In Terms of Sex)
Table 3 shows that there is a difference between the levels of anxiety before and
after communication in terms of sex. The female has the same level of anxiety before
(.3750) the communication and after (.3750) the communication. The male is more
anxious before (.4706) the communication than after (.4118) they experienced
communication. Although, the results from the respondents before they experienced
communication and after are not significant, as well as their differences which are
presented in Table 3. This indicates that the anxiety level of a child is impossible to predict
with their gender. Wick-Nelson & Israel (2011) mentioned that communication
apprehension can happen to anyone regardless of the gender. Thus, it is important to note
that female and male process their feelings and experiences differently. According to
Borfman (2016), based on the purported greater sensitivity to risk in females than males
and propensity for risk aversion in anxiety, clinical anxiety and female gender were
hypothesized to act synergistically in reducing reward sensitivity.
Age Before After Difference
3.00 Mean 0.71 0.57 -0.14
N 7 7
4.00 Mean 0.40 0.60 0.20
N 5 5
5.00 Mean 1.00 0.67 -0.33
N 3 3
6.00 Mean 0.10 0.10 0.00
N 10 10
Total Mean 0.44 0.40 -0.04
N 25 25
Table 4. Difference, Mean, Standard Deviation of the Level of Anxiety Before and
After Health Care Communication
Gender plays a minimal role in overall emotion recognition accuracy in children
with anxiety problems. The gender difference suggests that school-age girls may not be
more proficient than boys in emotion recognition when a combination of various dynamic,
non-verbal cues for emotion are available as in our study. Non-anxious boys may make
effective use of contextual cues to compensate for their difficulty with facial emotion
recognition compared with girls. If so, the present results may be generalizable to real
world social settings where various non-verbal channels of expression and contextual cues
are available to children. Women recognize only subtle emotions better than men, but the
female advantage disappears when recognizing highly expressive cues. Because animated
characters tend to be more expressive than facial pictures, gender differences may
diminish when using animated instruments (Lee, 2014.)
4 Age
Before
3
After
2
-
1 2 3 4
Figure 5. Level Of Pre-School Children’s Anxiety Before and After (In terms of
Age)
Table 4 shows that there is a difference between the levels of anxiety before and
after communication in terms of age. The respondents with age of 3, had a high anxiety
before (0.71) the communication than the after (0.57), same goes with other ages.
Although with the respondents with age of 4, they seemed to be more anxious after the
communication than before as seen in Figure 5. Nonetheless, the results from the
respondents before and after they experienced communication are not significant which is
presented in Table 6, as well as their differences which are presented in Table 5.
Age Before After Difference
3.00 Mean 0.71 0.57 -0.14
N 7 7
4.00 Mean 0.40 0.60 0.20
N 5 5
5.00 Mean 1.00 0.67 -0.33
N 3 3
6.00 Mean 0.10 0.10 0.00
N 10 10
Total Mean 0.44 0.40 -0.04
N 25 25
Table 4. Difference, Mean, Standard Deviation of the Level of Anxiety Before and
After Health Care Communication

This implies that the communication may be ineffective or the distraction
technique, which was only through verbal approach, is not enough. According to Canbulat
et. al. (2013), to create an impact to the child’s attention, strategic methods, procedural
duration, and other factors in communication are to be considered. Strategic methods are
widely used to reduce procedural pain and anxiety, such as; visual distraction methods.
The approaches performed in various ways during medical procedures are done to attempt
to divert the attention, instead of being too focused thinking about the procedure.
Sum of Mean
Squares df Square F Sig.
before Between (Combined) 2.774 3 .925 1.766 .197
* age Groups
Total 10.632 18
after Between (Combined) 1.783 3 .594 .866 .488
* age Groups
Total 9.333 14
Table 5. Significance of Before and After Communication In Terms Of Age.
According to Miguez-Navarro et. al. (2016), timing is also an important factor in
the efficacy of distraction. In order to minimize anticipatory anxiety and to accelerate
emotional recovery after the event, distraction should begin as soon as the child goes into
the treatment room and should continue for several minutes after the procedure. Miguez-
Navarro mentioned that distraction can be started when the decision to perform
venipuncture was taken, and just before the preparation of material commenced. The
visual distraction would reduce suffering and, at the same time, allow venipuncture to be
performed in an emergency. The distraction diverts the stressful stimulus, and centering
the patient on a pleasant stimulus.
Paired Differences
95% Confidence
Variables Interval of the

Sig.
Difference
Std. Std. Error (2-
Mean Deviation Mean Lower Upper t df tailed)
before – after .04000 .45461 .09092 -.14765 .22765 .440 24 .664
Table 6. Significance Value of the Relationship of Before and After Communication
According to Rezai et. al. (2016), to reduce the pain of venipuncture in children
more effectively, it is better to employ these techniques according to age as well as mental
and physical conditions of children; video games in the age range of 3 - 6 years; animation
in 3 - 7 years; making bubbles in 3 - 12 years; music and squeezing the plastic ball in 4 -
12 years; distraction cards, touching, and breathing exercise in 6 - 12 years; TV movies in
7 - 12 years; and virtual reality in the age range of 8 - 12 years can reduce the pain of
venipuncture in children more effectively. It should be noted that playing bubbles should
not be done insensitively, especially if the patient is known to be diagnosed with cancer,
for it may increase the risk of infection.

Variable R (Pearson) Sig Remarks
Age and Anxiety Before -0.32 0.119 Not significant
Sex and Anxiety Before 0.064 0.761 Not significant
Age and Anxiety After -0.293 0.155 Not significant
Sex and Anxiety After 0.025 0.907 Not significant
Before and After 0.795 0.000 Significant
Communication and Anxiety -0.242 0.244 Not significant
Table 7. Significnce Value of all the Variables
The Table 7 shows that there is no significant relationship between communication
and the level of anxiety among participants which indicates that the communication is not
a determinant to predict the level of anxiety. Therefore, the anxiety level of the children
is impossible to be determined by an effective ineffective communication of the Medical
Technologist. Previous literature provided several factors that cause fear in the pediatric
patient. According to Salmela et. al. (2010), painful shots done by the nurses are the great
fears identified by children. While the unknown and unfamiliar people were not the largest
reported reason of children. Crying is a symptom of stress according to health care
professionals, while it is an effective coping strategy according to a child life specialist.
Dealing with a child that is coping under stress needs to be a collaborative group effort.
All health care professionals reported that meeting a child's psychosocial needs leads to
better outcomes, and caring for the whole family helps reach the child's psychosocial
goals. Most of the medical workers reported that children read their parents' expressions
and act accordingly. One child life specialist stated, "Children at times worry more about
their parents than themselves." Many of the subjects stated that genuine care and service
to the parents creates a healthier environment for the patient. It was reported that sibling
support groups are available at the hospital because when a child is chronically-ill, it
affects the whole family. There is a need for siblings of patients to be cared for during
hospitalization, and they need to be trained in how to support their stressed brothers or
sisters. It was found that family-centered care helps improves the wellbeing of the patient.
Research has proven that the level of parental anxiety affects the psychosocial outcomes
of the pediatric patient and family members (Kaddoura, 2013). Regardless of the medical
technologist’s communication sufficiency, which is supposed to help the children cope
with their anxiety, the children’s anxiety still cannot be determined by its effectivity.
Children’s initial experience of pain intensity during venipuncture seems to be related to
their previous memories of the procedure. In other words, children acquire fear through
direct conditioning such that a single exposure to a painful stimulus can cause an
individual to remain fearful of that stimulus. Studies have shown that adults have an
influential role in the development of children's autobiographical memories and the way
that parents talked to their children about the procedure after the fact may have been
related to their recall. In addition to pain intensity, there may be individual cognitive and
personality factors (e.g., pain catastrophizing and anxiety sensitivity) that also play a role
in determining whether or not children develop negatively exaggerated memories. The
present findings reinforce the need for effective pain management by showing that higher
levels of pain during a commonly experienced medical procedure are related to
exaggerated memories of anxiety over time (Noel, et. al., 2009).
QUESTIONS BEFORE AFTER VARIANCE
Crying or whining 0.92* 0.72* 0.20
Sweating seen on child’s face 0.20* 0.20* 0.00
Paleness of the child’s lips 0.28 0.36 -0.08
Trembling of hands 0.48 0.44 0.04
Withdrawal or avoidance o the procedure 0.76 0.60 0.16
Lacks cooperation with the health care provider 0.76 0.36 0.20
Aggressive behavior 0.40 0.36 0.04
Total 3.80 3.24 0.56
Mean 0.54 0.46 0.08
Verbal description Low Very low Low
Table 8. Level of Patient Anxiety Before and After Communication
SCALE VERBAL DESCRIPTION
0.00-0.50 VERY LOW
0.60-1.50 LOW
1.60-1.70 MODERATE
1.76-2.30 HIGH
2.40-3.00 VERY HIGH
Table 9. Scale and Verbal Description

The Table 8 showed that the highest weighted mean is 0.92 which indicate that the
children-patients were commonly seen crying or whining. Children state that among their
worst fears during hospitalization are those related to various nursing interventions, such
as being exposed to injections and needles, and the needle thus symbolizes a strong
negative feeling (Salmela et al., 2010). In other words, most children find having a needle
stressful (Karlsson et. al., 2014). While the lowest weighted mean was 0.20 which
indicated that the children-patients were not very anxious which may be manifested with
sweating on child’s face. According to Miguez-Navarro et. al. (2016), 38% of children
ages 3 to 10 had to be physically restrained during a venipuncture reported that the pain
intensity and behavioral responses of 3- to 10-year-old children were moderate.
In the same table that referred to the after communication of the health care
provider to the child-patient the highest weighted mean was 0.72 which indicated that the
child was still seen crying or whining but to a lesser degree. According to Melanie Noel
(2010), there may be individual cognitive and personality factors that also play a role in
stimulating the child to cry. It showed communication somehow helped the children cope
up with their anxiety, while the lowest weighted mean is 0.20 which still indicate that the
children-patients still were not very anxious.
Table 10 shows that the indicator with the highest weighted mean is the
“Identification of the Patient” with a mean of 2.84. This indicates that the Medical
Technologists executed proper identification of the patient. According to Strasinger
(2012), there are two forms of proper identification of the patient; first, verbally asking
the patient to state his/her name; and lastly, checking the information in the requisition
form of the patient including the patients name, hospital number, date of birth and
physician.
HEALTH CARE COMMUNICATION INDICATORS RESULTS
1. Identification of the patient 2.84
2. Use of permissive approach 2.76
3. Answers question politely 2.32
4. Talks to patient calmly 2.68
5. Emotional support 2.64
6. Use of distraction techniques 1.56
7. Enlists patient help 2.08
Table 10. Level of Health Care Communication
According to the World Health Organization, failure to correctly identify patients
continues to result in medication errors, transfusion errors, testing errors, wrong person
procedures, and the discharge of infants to the wrong families. patient misidentification is
identified as a root cause of many errors, the Joint Commission listed improving patient
identification accuracy as the first of its National Patient Safety Goals and this continues
to be an accreditation requirement.
Table 10 also shows that the indicator with the lowest weighted mean is the “Use
of distraction techniques.” This indicated the Medical Technologist poorly demonstrated

using any means of distraction towards the patient. The health care providers used
distraction technique, however, it was only through verbal approach, which is not enough.
According to Canbulat et. al. (2013), strategic methods are widely used to reduce
procedural pain and anxiety. Audiovisual distraction methods are very strong tool, in
terms of diverting the attention of the patient. The approaches performed in various ways
during medical procedures to try to divert the attention instead of being too focused
thinking about the procedures. Canbulat’s study used kaleidoscope and distraction cards
as distraction approaches as they might be useful for reducing pain and anxiety during
medical procedures. Pain levels were investigated during venipuncture in children and the
effects of using kaleidoscope as a distraction method to control procedural pain and
anxiety. Their results indicated that pain and anxiety during the procedure was effectively
controlled with the kaleidoscope. This strongly implies that the use of visual distraction
approach can effectively divert the anxiety of the pediatric patient.

Chapter V
SUMMARY OF FINDING, CONCLUSION AND RECOMMENDATIONS
This chapter presents the summary of findings, conclusion and recommendations
on the findings which answers to the problem at the beginning of the influence of health
care communication and anxiety among pre-school children undergoing blood extraction.
Summary of Findings
The study was designed to find out the level of anxiety experienced by the patient
before and after the communication given by health care providers. The level patient’s
anxiety was assessed through several questions.
The study used descriptive –Quantitative method. Respondent were from Jose C.
Catolico Sr. Peuriculture who had undergone blood extraction. The questionnaires were
utilized to gather data in response to the specific level of anxiety. Frequency, mean and
percentage were used as the statistical data.
After the analysis and interpretation of the data the researcher found out that the
total weight mean level of anxiety before in term of age was 0.44
The total weighted mean of anxiety after communication in term of age was 0.40;
it means that communication helped the patient case the anxiousness they felt.
The relationship of anxiety before and after are significant based on the data
gathered. However, there is no significant relationship between communication and the
level of anxiety among participants which indicates that communication is not a

determinant to predict the level of anxiety. The anxiety level of children cannot be
determined by an effective ineffective communication of the Medical technologist.
Conclusion
After the analysis and interpretation of data gathered, it brought the following
results. There was a difference between the level of anxiety of the pre-school children
before and after the communication, however, this was not significant. The relationship
of health care communication and anxiety was not significant. Therefore, health care
communication did not play a role in the anxiety of the patient. Interestingly, the anxiety
levels before and after communication has a significant relationship. This implies that
anxiety levels before communication is a determinant of the anxiety levels after.
Recommendations
Based on the findings, the researchers recommended the following: first, the
Medical Technologists must utilize more effective distraction techniques such as; videos,
colorful toys, balloons, television, and even bubble making, in order to divert the attention
of the child undergoing blood extraction, with this, it can somehow help the child cope up
with their anxiety. Second, for the child’s parent(s) or guardian(s), they must avoid
showing or making the child feel their anxiety for it can be manifested to the child, making
him/her also anxious. Lastly, for the future researchers, this research would serve as a
starting point to search more about the relationship between the children’s anxiety and
communication during medical-related procedures and that they should accommodate a
larger group or number of respondents.

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in Patient Undergoing Ultrasound and Ct-scan Guided-Biopsy

APPENDIX A
Letter of Permission to the Dean
General Santos Doctors’ Medical School Foundation Inc.

North Osmeña, Bulaong, General Santos City
Tel. No.: (083) 302-3507
GRACE JOY NIETES
College Dean
GSDMSFI
Dear Ms. Nietes:
In behalf of my research members, I am asking under the supervision of Ms. Charity E.
Panerio to please allow us to conduct our research study entitled “INFLUENCE OF
HEALTH CARE COMMUNICATION AND ANXIETY AMONG PRE-SCHOOL
CHILDREN UNDERGOING BLOOD EXTRACTION” at Jose C. Catolico Sr.
Puericulture Center, Pres. Sergio Osmeña, General Santos City, South Cotabato.
We would like to ask for your permission in regards with the data gathering procedures
that will be conducted on July 23 to July 27, 2018.
Thank you for your cooperation.
Respectfully yours,
NELLY M . WATA
Group Representative
Noted by:
CHARITY E. PANERIO, MATCC

Research Adviser
APPENDIX B
Letter of Permission to the Center

Tel. No.: (083) 302-3507
ADORA D. AUGUIS, M.D., MHCA
Hospital Administrator
General Santos City
Thru: Human Resource
Dear Ma’am/Sir:
We, the 4th Year BS Medical Technology students of General Santos Doctors’ Medical
School Foundation Inc., is undertaking a research entitled “INFLUENCE OF HEALTH
CARE COMMUNICATION AND ANXIETY AMONG PRE-SCHOOL
CHILDREN UNDERGOING BLOOD EXTRACTION.”
In connection with this, we would like to request from your good office to allow us to
conduct a pilot testing for our research in Auguis Clinic and Hospital. We wish to utilize
the Clinical Laboratory (Blood Extraction Room) on July 17, 2018.
Rest assured that all data gathered and activity will be strictly for research purposes only.
We are looking forward for your favorable action on this regard.
Respectfully yours,
NELLY M. WATA
YASMINE O. DALIG, RMT, MPH

Research Adviser
APPENDIX C
Letter of Permission to the Respondents

Tel. No.: (083) 302-3507
Dear Respondents:
In behalf of my research members from General Santos Doctors’ Medical School
Foundation Inc. taking up Bachelor of Science in Medical Technology, to please allow us
to conduct our research study “INFLUENCE OF HEALTH CARE
COMMUNICATION AND ANXIETY AMONG PRE-SCHOOL CHILDREN
UNDERGOING BLOOD EXTRACTION” at Jose C. Catolico Sr. Puericulture Center,
Pres. Sergio Osmeña, General Santos City, South Cotabato.
We would like to ask for your consent to be one of the participants in our study. The data
gathering procedures will be conducted on April 2 to April 6 (Monday to Friday).
Thank you for your cooperation.
Respectfully yours,
NELLY M. WATA
Noted by:

Research Adviser
APPENDIX D
Letter of Permission to the Validators

Tel. No.: (083) 302-3507
MARIA CHRISTINA B. DOMINGO M.D.
PEDIATRICIAN
Dear Ma’am:
The undersigned is a Third-year BS Medical Technology student of General Santos
Doctors’ Medical School Foundation Inc. undertaking a research “INFLUENCE OF
HEALTH CARE COMMUNICATION AND ANXIETY AMONG PRE-SCHOOL
CHILDREN UNDERGOING BLOOD EXTRACTION.”
With your expertise, I am humbly asking your permission to re-validate the attached
revised self-made checklist, for the study using the attached rating tool. Attached to this
are; Statement of the Problem and Checklist for the Patient.
I am looking forward that my request would merit your positive response.
Respectfully yours,
NELLY M. WATA
Noted by:
CHARITY PANERIO, MATCC
Research Adviser

Tel. No.: (083) 302-3507
CARLO HERECO MARI H. DEMANARIG
REGISTERED MEDICAL TECHNOLOGIST
Dear Sir:
Doctors’ Medical School Foundation Inc. undertaking a research entitled “INFLUENCE
OF HEALTH CARE COMMUNICATION AND ANXIETY AMONG PRE-
SCHOOL CHILDREN UNDERGOING BLOOD EXTRACTION.”
Respectfully yours,
NELLY M. WATA
Noted by:

Research Adviser

Tel. No.: (083) 302-3507
VANESSA FERNANDEZ
REGISTERED PSYCHOMETRICIAN
Dear Ma’am:
Respectfully yours,
NELLY M. WATA
Noted by:

Research Adviser

Tel. No.: (083) 302-3507
MARY MAE CHEUNG, RMT, PhD
Department Head – Medical Technology
Notre Dame Dadiangas University
Dear Ma’am:
With your expertise, I am humbly asking your permission to re-validate the revised self-
made checklist, for the study using the attached rating tool. Attached to this are; Statement
of the Problem and Checklist for the Patient.
Respectfully yours,
NELLY M. WATA
Noted by:

Research Adviser
APPENDIX E
CHECKLIST FOR PATIENTS
Name (optional): _______________________
Age: ______ Gender: ________
HEALTH CARE COMMUNICATION AND ANXIETY
Instruction: Kindly put a checkmark (/) the best represents your response to each
statement.
Level of Anxiety Indicators Not seen A little Moderate To Great

Extent
(0) (1) (2)
(3)
1. Crying or whining
2. Sweating seen on child’s

face
3. Paleness of the child’s lips
4. Trembling of hands
5. Withdrawal or avoidance of
the procedure
6. Lacks cooperation with the

health care provider
7. Aggressive behavior
APPENDIX F
CHECKLIST FOR MEDICAL TECHNOLOGISTS
HEALTH CARE COMMUNICATION AND ANXIETY
Instruction: Kindly put a checkmark (/) that best represents your response to each
statement.
Health care Communication Not seen Poor Fair Satisfactory

Indicators
(0) (1) (2) (3)
1. Identification of the patient
2. Use of permissive approach
3. Answers question politely
4. Talks to patient calmly
5. Emotional support
6. Use of distraction
techniques
7. Enlists patient help

APPENDIX G
DOCUMENTATION
Plate 1. Jose C. Catolico Sr. Puericlture Family Planning & Maternity Center Inc.
Plate 2. Clinical Laboratory

Plate 3. Blood Extraction Chair

APPENDIX H
Certificate to the Statistician
Tel. No.: (083) 302-3507
Dear Ma’am:
This is to certify that the undersigned has reviewed and validated the results from the
checklists conducted by the proposed research entitled INFLUENCE OF HEALTHARE
COMMUNICATION AND ANXIETY AMONG PRE-SCHOOL CHILDREN
UNDERGOING BLOOD EXTRACTION.”” of the Fourth Year students of Medical
Technology Department of Genral Santos Doctors’ Medical School Foundation, Inc.
___________________________________
MARY GLENDA LUGTU, RPSY, PH.D.
Statistician
CURRICULUM VITAE
Name: Donabelle A. Cantoneros
Age: 19
Address: Zone 4 Block 9, Uhaw Fatima, General Santos City
Birth Date: June 19, 1999
Birth Place: General Santos City
Civil Status: Single
Religion: Roman Catholic
Father’s Name: Nicolas D. Cantoneros
Mother’s Name: Zandra A. Cantoneros
Educational Background:
Preparatory Level: Upper Tambler Elementary School
Primary Level: Upper Tambler Elemantary School
Secondary Level: General Santos City National High School
Tertiary Level: General Santos Doctors’ Medical School Foundation Inc.

Name: Cheryll Claire C. Cerenio
Age: 19
Address: San Jose, Norala, South Cotabato
Birthdate: December 29, 1998
Birthplace: Balauro Kadingilan, Bukidnon
Father’s Name: Alex E. Cerenio
Mothers Name: Carmelita C. Cerenio
Primary Level: San Jose Elementary School
Secondary: Notre Dame of Norala
Tertiary: General Santos Doctors’ Medical School Foundation Inc.

Name: Bai Norhaina W. Maulana
Age: 25
Address: #026 Sousa Extension Brgy. Rh 12, Cotabato City
Birth Date: July 29, 1993
Birth Place: Cotabato City
Religion: Islam
Father’s Name: Zaidona M. Maulana
Mother Name: Peya W. Maulana
Preparatory Level: Rojas Elem School
Primary Level: Rojas Elem School
Secondary Level: Notre Dame of Religious Virgin Mary College of Cotabato
Tertiary Level: Notre Dame Hospital and School Of Midwifery

Name: Harold O. Sauro
Age: 20
Address: Prk. Pagkakaisa Zone 24 Brgy. City Heights,
General Santos City
Birthdate: March 29, 1998
Birth Place: General Santos City
Father’s Name: Galileo L. Sauro
Mother’s Name: Ginna O. Sauro
Preparatory Level: Dadiangas Heights Elementary School
Primary Level: Dadiangas West Central Elementary School
Secondary Level: Holy Trinity Colleges of General Santos City

Name: Nelly M. Wata
Age: 19
Address: 47 Block 8, Dadiangas City Heights, General
Santos City
Birthdate: May 20, 1999
Birth Place: Apopong, General Santos City
Religion: Islam
Father’s Name: Amelito A. Wata
Mother’s Name: Imelda M. Wata
Preparatory Level: Dadiangas Waest Central Elementary School
Primary Level: Dadiangas West Central Elementary School
Secondary Level: Mindanao State University - College of Education Training
Department

Name: Trisha L. Linao
Age: 19
Address: Muñez Subdivision, Valencia Site, Polomolok,
South Cotabato
Birthdate: May 18, 1999
Birthplace: General Santos City
Father’s Name: Ricardo C. Linao
Mother’s Name: Marivic L. Linao
Preparatory Level: Southern Baptist School of Polomolok
Primary Level: Polomolok Central Elementary School
Secondary Level: Saint Lorenzo School of Polomolok Inc.

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Communication and Anxiety| 1

THE PROBLEM AND ITS SETTING

participants in sometimes-stressful conversations with administrative professionals. Most

any health care providers (Sine, 2008).

According to a study conducted in Griffith University in Australia, 170

simply afraid (Wright et. al., 2009).

care communication between a Medical Technologist and a patient preceding the

patient before the procedure.

Statement of the Problem

This study aims to seek answers to the following questions:

1. What is the demographic profile of the participants in terms of:

2. What is the level of pre-school children’s anxiety undergoing blood extraction

before and after health care communication?

3. Is there a significant difference in the level of anxiety of pre-school children before

and after health care communication?

4. Is there a significant relationship between health care communication and anxiety

among pre-school children undergoing blood extraction?

There was no statistically significant relationship between the difference in the

Significance of the Study

Blood extraction or collection and processing techniques must be carefully

This study will be valuable to the following:

anxiety before the procedure.

experience to calming down their children.

Registered Medical Technologists. This study will provide the Medical

Technologists different ideal techniques on approaching pre-school children undergoing

followed to protect the being of the patient.

Centers of the Department of Health as it would provide information concerning

approaches on health care communication.

Scope and Delimitation

school patients in Out-Patient Department undergoing blood extraction in Puericulture

health care communication, anxiety and pre-school patient.

The researchers conducted this study on July 23 to July 27 at 8 o’clock in the

an improved management of patient. Peplau’s interpersonal relations theory focuses on

occurs in this context involves complex factors such as environment, in addition to

services offered, exploiting the healthcare provider-patient relationship to address the

are met (Neese 2015).

According to Gamble (2013), “Communication is our link to humanity.”

requires being cautious especially in term of cultural differences (Brinckert, 2010).

independent variable of this framework is healthcare communication and the dependent

variable is patient anxiety

HEALTH CARE PATIENTS ANXIETY

Figure 1 Conceptual Framework

The accompanying terms used in conducting the research are characterized

thoughtfully and operationally to encourage better comprehension of the study.

Anxiety. Refers to the fear or nervousness manifested by crying, sweating,

blood extraction procedure.

Blood Extraction. A process of getting blood sample using a syringe or lancet.

Pre-school Children. Participants age 3 to 6 years whose psychological

development in early childhood or pre-primary school level.

REVIEW OF RELATED LITERATURE AND STUDIES

be considered to be justified and normal. However, mostly in children, they experience

individual’s ability to function optimally. Anxiety are mostly triggered by a combination

family history of anxiety problems, childhood development issues, alcohol, medications

Centre entitled “Measurement of Anxiety in Acutely and Chronically Ill Patient of

The patient-clinician interaction has been consistently reported as a critical aspect

care providers as insufficient, lacking and need an improvement It was highly

clear terms to be able to send the appropriate message (Schillinger, 2010).

Anxiety are thought to be one of the most common psychiatric diagnoses in

communicate the emotions they feel. Common behavioural demonstrations of fear,

anxiety, and helplessness include aggression, withdrawal, lack of cooperation, and

physical growth, personality, or emotional development. In some cases, anxiety-based

trauma may prejudice the development of behavioral, emotional, or cognitive disorders

to reasoning or detailed explanation, emotional support at an age-appropriate level reduces

pain and anxiety. Older children can be comforted by a reassuring explanation of