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Reduce anxiety in children, parents for better outcomes
Tours, explanations are good preparation
No one likes to undergo surgery, and children are especially vulnerable to anxiety prior to surgery. A recent study demonstrates that pre-surgical intervention designed to reduce the fears of children and parents does have a positive impact on the child's surgical experience and recovery.1
Researchers at Yale-New Haven (CT) Children's Hospital placed 408 children and their parents in four groups. The control group received the standard of care, a second group allowed parental presence during induction of anesthesia, a third group received family-centered behavioral preparation, and the fourth group received oral midazolam. The group receiving family-center preparation showed significantly lower anxiety in the holding area and during anesthesia induction, exhibited less emergence delirium after surgery, required significantly less analgesia in the recovery room, and was discharged from recovery earlier than the other groups.
Although staff members at Children's Surgery Center in Columbus, OH, was not part of the research study, they understand the importance of preparing patients and their families for the day of surgery early, says Sandy Hagood, RN, nurse manager of perianesthesia at Children's Surgery Center. "We start explaining what to expect in our pre-op phone call prior to the day of surgery," she says. "We explain how much time they can expect to spend in the waiting room and the pre-op area, and we talk about where they will wait for their child during surgery."
Because anxiety increases the longer a person waits, the staff at Children's tracks how long someone has been waiting and checks with them every 30 minutes to let them know what is happening and to reassure them that they haven't been forgotten, she adds.
The "Surgical Safari" is one way that the staff at the Ghesquiere Family Center for Children's Surgery at Royal Oak, MI-based Beaumont Hospital address fears and concerns of patients and their parents. The educational class is held on Saturdays. "We have a video for parents and children to view, then we conduct tours of all the areas they will see on their surgery day, including the operating rooms," Hagood reports.
To reinforce the point at which parents and children are separated on the day of surgery, staff members take the parents into one operating room to talk with them, and other staff members take the children into another operating room. "We don't want to confuse the children by letting them think their parents will come into the operating room with them," explains Amanda Nash, RN, nurse manager of the center.
In the operating room with the parents, staff members explain that their children will never be alone and that the anesthesiologists for the center are specially trained to work with children, says Nancy Strzyzewski, RN, CPAN, nurse clinician and educator for the center. The children are reassured that they will not hurt because the "medicine the doctors give them will make them sleep and feel no pain," she says. "We also let them try on the oxygen masks and explain that they can take their mask home to show their friends."
On the day of surgery, different activities are planned to distract children and reduce their anxiety, says Allynn Petersen, RN, CNOR, administrator of the center. "We only have one television in the waiting area to control some of the noise and confusion, but we have portable DVD players for the children and a selection of movies that are appropriate for all ages," she says.
In the few months since the center's opening in January 2007, staff members have found some changes that were needed. "I didn't think about this before our opening, but we perform a lot of retinal surgical procedures for children who were premature, so they are blind," says Nash. "All of our diversions relied on sight initially, but we are adding storybook CDs and music, as well as portable CD players," she explains. The hospital's recreational therapy department also has helped the surgery center staff find tactile toys that are interesting to the children with no or low vision, she adds.