Hospitalization often induces profound stress in children, disrupting their sense of safety and familiarity. Hospital stays and medical treatments can create considerable emotional distress and trauma for children and their families. Such experiences may result in adverse outcomes like discomfort, anxiety, and psychological trauma for children (Coşkun et al., 2024; Özdemir & Elmaoğlu, 2023). During this phase, children are unable to endure separation from their parents. A sudden alteration in a child's surroundings may result in diminished appetite and induce anxiety, particularly in hospital settings characterized by elevated noise levels in the ward. Certain children exhibited defense mechanisms like sadness, regression, negativism, separation anxiety, and phobia (Patel et al., 2024). White collar syndrome, also referred to as white uniform phobia, is characterized by a child's dread of healthcare professionals. Additionally, many children experience anxiety related to medical procedures, such as injections or vaccinations, which can further exacerbate their distress (Orenius et al., 2018). Beyond the decline in physical health and disruptions to daily routines, children may also experience shifts in their emotional well-being due to psychological, physiological, and social factors. This condition, referred to as anxiety, can impact individuals at any developmental stage and is considered pathological when it becomes disproportionately intense in relation to the triggering stimulus. Early detection and intervention for anxiety are crucial, especially in hospitalized children (Mofatteh, 2021).

Pediatric nurses aim to deliver atraumatic care with three key objectives: helping children and families adjust more quickly to the hospital environment, actively engaging families in the care process, and reducing the harmful psychological and physical effects of medical treatments on children. Central to this approach are several core principles: pain prevention and management, maintaining family presence, adopting a family-centered care model, encouraging emotional expression, fostering the child's sense of autonomy, implementing primary nursing for continuity of care, empowering families in decision-making, and creating opportunities for family participation in caregiving. To achieve these goals, nurses employ evidence-based, non-pharmacological comfort measures including breastfeeding support, distraction techniques, maternal voice therapy, kangaroo mother care, therapeutic touch, play therapy, and other individualized strategies designed to alleviate distress and promote the child's overall well-being during hospitalization (Coşkun et al., 2024; Akarsu & Balci, 2022).

Pain is now defined as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (Raja et al., 2020). It is a universal human experience and a prevalent reason for individuals to seek medical assistance. Pain can be categorized based on degree, duration, and etiology, or according to gender or condition. Poor pain management can heighten sensitivity and amplify responses to subsequent instances of procedural pain, such as vaccinations (Craig & MacKenzie, 2021). Pain presents itself in different forms, including acute and chronic pain. Acute pain encompasses sudden and intense discomfort localized in a specific area, often resulting from injuries or post-operative conditions. Procedural pain, a subset of acute pain, occurs due to medical interventions like needle insertions or injections. Typically, acute pain is managed using non-pharmacological approaches, such as distraction techniques and physical interventions (Olaizola et al., 2024). Administering pain management for pediatric patients in a hospital setting can be challenging. The pain experienced by these people is frequently intense and is insufficiently assessed or managed. The discomfort linked to operations for children who receive regular therapy and require diagnostic testing and medical care for their ailments is sometimes inadequately addressed (Kasahun et al., 2023). The various phases of cognitive and physical development will influence how children perceive and react to unpleasant experiences. Effectively addressing potentially traumatic situations is crucial, as it may represent the child's initial interaction with health professionals. A favorable childhood experience may mitigate fear and anxiety related to pain that persists into adulthood (Downey & Crummy, 2022).

Research indicates that distraction can effectively alleviate acute pain in pediatric patients. A meta-analysis investigating the use of digital technologies as a distraction tool for children undergoing painful procedures revealed notable decreases in both self-reported and observer-reported pain levels (Gates et al., 2020). This study aims to provide valuable insights into pediatric pain treatment and psychological support in hospital settings by examining the distinct advantages and results of play and art healings during venipuncture. The research findings may guide clinical practices, promote patient-centered care strategies, and eventually improve the quality of care for hospitalized children undergoing medical operations. Prior studies have demonstrated the effectiveness of distraction methods, such as play and painting, in alleviating pain and anxiety in pediatric patients during medical procedures. Koller and Goldman (2012) highlighted the significance of diversion treatments in alleviating distress during venipuncture in pediatric patients. Scientists discovered that interactive distractions, including play activities, markedly reduced pain perception and anxiety levels in juvenile patients. Elevated anxiety levels can negatively impact patient care, especially for children. Play is a crucial part of care plans for hospitalized children, providing creative expression, recreation, and coping mechanisms. A supervised play program in hospitals fosters a warm environment for growth and development. In larger hospitals, a child life specialist may oversee the program. A designated play area, appropriate materials, and peer companionship are essential. Toys, materials, and equipment serve as educational instruments, allowing children to reconstruct a world tailored to their scale. This includes individuals, cherished possessions, and emotions (Rajasthan, Sikar, & Goutham, 2014).

Play is an essential aspect of children's lives and plays a vital role in fostering their growth and development. Toys act as tools that provide a natural setting for children to explore and engage. They can acquire knowledge, articulate their thoughts, explore their environment, and engage with their family and healthcare staff to manage anxiety and the stress associated with hospitalization. (Koukourikos et al., 2021). Play can be defined as an activity in which a youngster naturally engages and derives enjoyment. Play has a significant part in the development of emotional, cognitive, affective, physical, and social skills (Elbeltagi et al., 2023).

Art healing helps alleviate negative sensations associated with hospitalized children and enhance their comfort and psychological well-being (Shella, 2018). It emphasizes the utilization of art materials for self-expression and comprises three components: art materials, the therapist, and the kid. Art healing is described as the utilization of various art media for the personal expression of emotions related to the concerns that prompt individuals to seek treatment, with an emphasis on conveying sentiments rather than achieving aesthetic appeal. It facilitates non-verbal communication, enhancing awareness of concealed emotions, fostering enjoyment, and potentially encouraging the sharing of challenges. Art healing can be employed in various manners contingent upon the group, objective, and context (Czamanski-Cohen & Weihs, 2023). Creative art healing offers a non-pharmacological method for managing pain, incorporating both physical and psychological strategies. Literature frequently highlights interventions that combine various forms of creative art healing, such as dance and music integration. “Art Healing” is a distinct modality within the broader realm of creative art healing and has become increasingly popular among pediatric populations. This therapeutic approach combines psychotherapy with the creative process, facilitated by a licensed art healing who guides patients in creating art, fostering understanding, and promoting self-exploration. In medical settings, art healing aims to provide emotional support during patients' medical experiences and to help them cope with physical pain and psychosocial issues, including anxiety and fear. It extends beyond visual art activities, such as drawing or coloring, as mere distraction techniques during painful procedures. For instance, an art healing intervention may involve having a patient create a self-portrait, enabling the patient, the therapist, and the medical team to gain insights into how the patient's self-image has been affected by their medical experiences (Regev, 2023; The Canadian Art Therapy Association, 2025).

Additionally, a systematic study conducted by Suleman et al. (2023) assessed the effects of distraction strategies on pain and distress in pediatric healthcare environments. The evaluation recognized play and artistic distractions as efficacious non-pharmacological therapies for mitigating pain and anxiety in children during medical procedures. The authors underscored the necessity for additional study to investigate the distinct advantages of various distraction techniques across different therapeutic settings. A recent study by Suleman et al. (2024) examined the comparative efficacy of play and art healings in managing pain in young patients. The researchers performed a randomized controlled experiment with hospitalized children undergoing venipuncture, discovering that both play and art healings markedly decreased pain and anxiety levels relative to usual care. The art healing group exhibited a more significant decrease in pain intensity, underscoring the efficacy of creative interventions in pediatric healthcare. Therefore, the current study aims to compare the effects of art healing, play intervention, and standard treatment in alleviating pain and anxiety among hospitalized children undergoing venipuncture.

The current study is grounded in Melzack and Wall's (1965) Gate Control Theory of Pain, which posits that cognitive and affective processes influence nociceptive inputs through descending neural pathways. It is supposed that engaging children in activities like art or play is an effective method of “closing the gate” on pain perception by steering attention to non-threatening stimuli (Koller & Goldman, 2012). Additionally, the Biopsychosocial Model ((Engel, 1977)) conceptualizes pediatric procedural pain because of the interaction between biological mechanisms (e.g., nociception), psychological states (e.g., anxiety), and social-environmental factors (e.g., caregiver presence). Overall, theoretical frameworks emphasize the use of multisensory, child-focused distractions to mitigate pain perception and anticipatory anxiety (Benchimol-Elkaim et al., 2024).

This study addresses a critical gap in pediatric pain literature by empirically investigating the comparative efficacy of non-pharmacological interventions, specifically Art Healing and Play Distraction, for mitigating venipuncture-related pain and anxiety in children. While pharmacological approaches are well-established, evidence remains limited regarding structured, creative and play-based distraction techniques during acute medical procedures. Our research advances this underexplored domain through three key contributions. First, it captures immediate physiological and psychological responses (measured within 60 s post-procedure) to evaluate the direct impact of interventions before cortical regulation occurs, a methodological refinement over prior studies that often delay assessment. Second, employing a standardized venipuncture protocol with validated tools (Wong-Baker FACES Pain Rating Scale; Facial Affective Scale) ensures replicability and addresses inconsistent methodologies in existing literature. Third, child-centric design prioritizes autonomy through self-directed creative/play engagement, offering novel insights into how participatory experiences modulate distress. By directly comparing Art Healing, Play Distraction, and standard care, this work bridges an empirical gap in understanding their relative therapeutic value. Ultimately, these findings provide actionable clinical guidance for integrating evidence-based, developmentally appropriate non-pharmacological strategies into routine pediatric practice to improve procedural experiences.