The effect of mandala coloring on pain, stress, and sleep quality in children hospitalized in a burn unit: A randomized controlled trial.

PURPOSE: This study evaluated the effects of mandala coloring on pain, perceived stress, and sleep quality in children hospitalized in a pediatric burn unit.

DESIGN AND

METHODS

A pretest-posttest parallel randomized controlled trial was conducted at the Burn Center of University of Health Sciences Van Training and Research Hospital between July 2025 and February 2026. Forty children aged 7-12 years were randomly assigned to an intervention (n = 20) or control (n = 20) group. The intervention group received 30-min mandala coloring sessions daily for seven days, controls received routine nursing care. Pain, perceived stress, and sleep quality were assessed using the Wong-Baker Faces Pain Rating Scale, Perceived Stress Scale for Children, and Children's Sleep Habits Questionnaire, respectively. Data were analyzed using two-way mixed ANOVA (Group × Time).

RESULTS

Groups were comparable (p > .05). Significant Group × Time interactions were found for pain (F(1,38) = 38.329, p < .001, ηp2 = 0.508), perceived stress (F(1,38) = 65.595, p < .001, ηp2 = 0.639), and sleep quality (F(1,38) = 9.100, p = .005, ηp2 = 0.197). The mandala coloring group showed greater reductions in pain and perceived stress and greater improvement in sleep quality than controls. Effect sizes were large to very large.

CONCLUSIONS

Mandala coloring is an effective, low-cost, non-invasive intervention for reducing pain and perceived stress and improving sleep quality in hospitalized pediatric burn patients.

IMPLICATIONS FOR PRACTICE: Mandala coloring may be integrated into routine pediatric burn nursing care as a nurse-led intervention to support pain relief, stress reduction, and sleep improvement.