A.

Environmental factors that influence anxiety levels

The relationship between the environment and anxiety has been a topic of interest in the
field of psychology and nursing. Numerous studies have suggested that environmental factors
play a significant role in the development and exacerbation of anxiety disorders. The hospital
setting has been found to be a major source of stress and anxiety for children [2]. Interventions in a
hospital setting, such as medical procedures, can cause fear and anxiety, especially in children.
The physical environment of a hospital, including factors such as noise, temperature, and lack of
privacy, can contribute to the overall anxiety experienced. Cold and often desolate surroundings
devoid of familiar objects can be intimidating for children. Moreover, the presence of medical
equipment and the constantly busy environment further contribute to their distress. Nurses often
encounter issues with lack of participation in medical procedures among pediatric patients due to
hospital anxiety. It is important for hospitals to recognize the impact of the environment on
pediatric patients' mental well-being. Although plain white walls have been used in clinical
settings for decades to ensure maximum contrast for best possible vision, the majority of research
suggests bright colored walls, child-friendly decorations and non-verbal music in pediatric clinical
settings help reduce the anxiety levels of school-age children, and thus increase the willingness of
the children to learn and participate in nursing interventions and medical procedures.

The researchers observed that most hospitals, especially in the Philippines, incorporate
monochromatic colors in almost all of their interior design. Clinical settings can be daunting and
stressful places for children and their families. The lack of color in pediatric clinical settings can
leave an intimidating impression to the children. The use of more colors in the interior design
of clinical settings created better environments for children and their families (Ghazali, R., &
Abbas, M. Y., 2017). The color yellow is associated with happiness, cheerfulness and a positive
emotional state. the color blue is associated with secure, calm, comforting; green with quietness;
red with anger, aggression, excitation; black with depression or anxiety (Ghazali, R., & Abbas, M.
Y., 2017). In a similar study, blue was selected by 31.2% (119) of the children for positive
emotion (happy), followed by pink by 29.3% (112). For negative feeling (sadness), 52.1% (199)
of children chose black, while 46.9% (179) chose red (Annamary K, Prathima, GS, et al., 2016).

Music and ambiance of the room significantly alleviate anxiety in hospitalized patients,
especially children . Stress and anxiety stimulate epinephrine secretion by stimulating sympathetic
nerves which lead to alteration of vital signs such as heart rate, blood pressure, respiratory rate,
and body temperature[5]. Music has an influence on the brain, stimulating alpha waves, producing
endorphins, and ultimately lowering anxiety and pain. Individuals' anxiety levels can be greatly
reduced by listening to music. In a study, the mean score of anxiety levels and vital signs of
hospitalized children were high, but after three days of listening to nonverbal music, the mean
vital signs decreased significantly to within the normal range. (Hakim A, Kaldozkhi S, et al.,
2023)

The quality of a child's relationship with their parents or caregivers plays a crucial role in
their anxiety levels. A supportive, nurturing, and secure attachment to parents can help reduce
anxiety, while inconsistent, neglectful, or abusive relationships can increase anxiety. There is
[1]
significant correlation between the learning environment and attitudes toward learning . An
environment that promotes emotional safety and inclusivity creates an environment where
patients feel comfortable expressing themselves without fear of ridicule or judgment. When
patients feel emotionally safe, they are more likely to engage actively in learning. School climate
had a strong significant relationship with both general family functioning (r = .53, p < 0.01) and
family process (r = .58, p < 0.01). General family functioning and school climate were uniquely
associated with stress, anxiety, and depression (Β = −.280 or higher), p < 0.05, controlling for
demographics. Room environment and intrapersonal relationships plays a major role in
developing a positive attitude toward learning (Hussain, MA. 2011).

The research highlights the significance of environmental factors in healthcare and

education. In healthcare, using colorful and child-friendly designs in hospitals can alleviate
anxiety in pediatric patients and their families. Additionally, music can significantly reduce
anxiety levels in patients, especially children, by stimulating positive brain responses. In
education, a positive classroom environment is crucial for fostering a favorable attitude toward
learning. This includes emotional safety, supportive teachers, engaging materials, and positive
peer interactions. Moreover, strong interpersonal relationships, whether in healthcare or
education, have a considerable impact on individuals' well-being. In summary, creating
supportive, inclusive, and emotionally safe environments in healthcare and education can reduce
anxiety and promote positive attitudes toward learning and overall well-being.

1.Hussain, MA. (2011). “Relationship of classroom environment with anxiety and attitude
of secondary school students towards the learning of English”.
https://prr.hec.gov.pk/jspui/bitstream/123456789/2006/1/999S.pdf
https://doi.org/10.1177/23779608221138432
2. Li, W., Chung, J. W. Y., Ho, K., & Kwok, B. M. C. (2016). Play interventions to
reduce anxiety and negative emotions in hospitalized children. BMC Pediatrics,
16(1). https://doi.org/10.1186/s12887-016-0570-5
3. Ghazali, R., & Abbas, M. Y. (2017). Paediatric Wards: Healing environment
assessment. Asian Journal of Environment-behaviour Studies, 2(3), 77–87.
https://doi.org/10.21834/aje-bs.v2i3.191
4. Annamary K, Prathima GS, Sajeev R, Kayalvizhi G, Ramesh V, Ezhumalai G. (2016
July 01). “Colour Preference to Emotions in Relation to the Anxiety Level among
School Children in Puducherry - A Cross-Sectional Study”.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020302/
5. Hakim A, Kaldozkhi S, Tashakori A, Ghanbari S. (2023 June 05). “The effect of non-
verbal music on anxiety in hospitalized children”. BMC Pediatric 23, p.279
https://doi.org/10.1186/s12887-023-04101-2