Preparing parents for their child's surgery: preoperative parental information and education

Parental Experiences While Waiting For Children Undergoing Surgery in Singapore

PURPOSE

To explore the experiences and needs of parents while waiting for their children undergoing surgery.

DESIGNS AND METHODS

A descriptive qualitative study was conducted. A purposive sample of 11 parents who went through their first waiting experiences during their children's surgeries in a Singapore public hospital was recruited. Children younger than or equal to 16 years of age were included. A semi-structured interview guide facilitated the individual face-to-face interviews. Thematic analysis was used.

RESULTS

Four themes were identified: "Care and care provision affecting waiting experiences", "Parental concerns and surgery affecting waiting experiences", "Coping strategies used during waiting periods" and "Recommendations to improve waiting experiences". Pre-operative instructions, the professionalism of medical teams, and a lack of timely updates affected parental experiences. Parents expressed their worries. The complexities and types of surgery influenced how they felt. Their concerns included potential complications, surgical outcomes, anesthesia-related side effects, and post-operative care including pain. They spent their waiting times eating, resting, using their smart devices, and coping with a support system. Environmental improvements, more updates, and mobile applications were recommended by the participants.

CONCLUSION

For a parent, the wait during his/her child's surgery can be unsettling. Our results give insights into parental waiting experiences and needs during their children's surgeries.

PRACTICE IMPLICATIONS

These findings can guide the improvement of the current practise based on our evidence or the implementation of newer technology to provide better waiting experiences for parents during their children's surgeries and to enhance the quality of clients' experiences in the hospital.

Preoperative information needs of parents: a descriptive survey

Background

Receiving preoperative information is a right of all parents whose children are admitted for surgery. Information for parents can help to prepare children and lessen anxiety for both parent and child.

Aim

This study aims to assess the preoperative information needs of parents.

Methods

This was a cross-sectional descriptive study. A non-probability convenience sampling technique was used to select 100 parents whose children, aged between 0 and 18 years, were admitted for surgery. The Parents Desire for Information scale was used to collect the data, which were then analysed using descriptive statistics.

Results

The majority of the sample indicated that it is essential to receive preoperative information. The aspects of preoperative information rated as essential were as follows: need for the surgery; duration of hospitalisation; informed consent; fasting time; investigations; medications; physical preparations; dress code for the child; waiting time and place; parental involvement in the operating theatre/recovery/ward; pain management; post-operative care including eating, drinking, ambulation, wound care, discharge instructions and follow up. The majority (60%) of the parents said that they prefer to receive verbal instructions. The majority (63%) of the study participants said that it was the doctors who provided the information, and of these, 70% rated the information received as good.

Conclusions

The present study concludes that parents of children undergoing surgery welcome comprehensive preoperative information.

Evaluation of anesthesia informed consent in pediatric practice - An observation cohort study

Background and Aims

An informed consent requires active participation by both physicians and patients. It is the responsibility of the physician to give the complete disclosure of information in easy language for the parent to understand. An informed consent process can be a challenge especially for the anesthetists when time is a limiting factor for patient-anesthetist interaction especially in same day admission and day surgery. The aim of this study was to subjectively evaluate the understanding and recall of the informed consent by the parents.

Material and Methods

The validated survey was conducted over 10 weeks and was limited to one parent per child and to the parent who was directly involved in the consent process.

Results

Majority of parents rated positively for adequate disclosure of all items of information. Consent process done on day of surgery was found to be associated with lower parental rating in adequacy of disclosure of pain relief options. Seniority of anesthetists was associated with higher parental rating of adequacy of information regarding post operative plan, specific risk of child and overall consent process. Consent for minor surgeries, on day of surgery, did not significantly affect the parental performance in their recall of disclosed information but was associated with significant lower rating of adequacy of postoperative plan. Postoperative pain is among the areas for improvement especially in day surgery cases.

Conclusion

Consent taken on day of surgery was found to be associated with lower parental rating. Postoperative plan for pain required improvement especially in day surgery cases.

There's an App for That; Improving Communication during Pediatric Cardiothoracic Surgery

Supplemental Digital Content is available in the text.

Introduction:

Waiting while a loved one is in surgery can be a very stressful time. Current processes for updating families vary from institution to institution. Providing timely and relevant updates, while important to the family, may strain a surgical team’s operational system. In our initial experience with the Electronic Access for Surgical Events (EASE) application (app), we tested the extent to which its implementation improved communication with patient families.

Methods:

We compared compliance data collected pre-EASE (December 2013 through September 2014) and post-EASE implementation (October 2014 until December 2015).

Results:

Although the pre-EASE compliance rate for bi-hourly updates was 46% (118/255) of cases, post-EASE implementation achieved a compliance rate of 97% (171/176). A 2-sample test of proportions confirmed a significant improvement in compliance after the introduction of EASE technology (P < 0.001). Analysis of the 177 noncompliant cases in the pre-EASE period indicated that noncompliance occurred most frequently at the end of the case (97/177, 55%) when the patient remained in the operating room > 2 hours after the last update to the family. We also observed noncompliance at the beginning of the case (46/177, 26%), when the patient arrived in the operating room > 2 hours before the time of the first update. Family satisfaction scores that rated their experience during surgery as “Very Good” improved from 80% pre-EASE implementation to 97% postimplementation. We sustained this improvement for 1 year.

Conclusions:

A mobile technology app (EASE) improved both frequency and compliance with surgical updates to families, which resulted in a statistically significant increase in family satisfaction scores.

Treating perioperative anxiety and pain in children: a tailored and innovative approach

Millions of children undergo outpatient surgery in the United States each year; the overwhelming majority will experience significant perioperative anxiety and pain. Behavioral preparation programs focused on skills acquisition and modeling, considered essential for effective preparation, are no longer offered to most children and families in the outpatient surgery setting. Moreover, what little preparation does occur is typically generic in nature, rather than tailored to unique characteristics of the child and family. Untreated anxiety and pain have significant implications for children's short- and long-term recovery and future interactions in the medical environment. The rapid growth of the World Wide Web and increasing access to Internet by families across the country provide an opportunity to develop tailored, Web-based behavioral preparation programs that can be accessed repeatedly at times convenient to the child and family, that include coping skills training and modeling, and that can provide unique output based upon child and parent characteristics known to impact perioperative pain and anxiety. In this review article, we present a conceptual framework for a computer-based intervention that may transform the way we manage children and parents before and after surgery.

Lived experiences relating to pediatric surgery: the case of Mexican American mothers in a southern US border city

PURPOSE

This study examined the lived experiences of Mexican American mothers residing near a US/Mexico border town whose children underwent a surgical procedure requiring general anesthesia.

DESIGN

Phenomenology was used to examine the lived experiences of the participants.

METHOD

Twelve Mexican American mothers were interviewed in the preoperative phase; 9 from the 12 participants were interviewed in the post-surgery phase. Giorgi's method of phenomenological analysis was used to identify the common themes.

FINDINGS

Thematic differences and commonalities were found in the lived experiences between bilingual and monolingual Spanish-speaking Mexican American mothers in the preoperative and post-surgery phase.

CONCLUSION

The lived experiences of Mexican American mothers regarding their children's surgery are shaped by language barriers and sociocultural factors. The findings of this study could inform health care providers on how to prepare Mexican American mothers about their children's surgery requiring general anesthesia.

Pediatric perioperative education current practices: a national survey of children's hospitals in the United States

Identifying existing practices is a first step in the creation of developmentally and culturally effective teaching materials for children and families. This national survey queried two groups to explore current pediatric perioperative education practices: 81 nurses from a perioperative pediatric specialty association and 30 administrators representing leading children's hospitals within the United States. The aim was to improve perioperative care through the design of educational materials from the child's perspective.

A descriptive survey of the information needs of parents of children admitted for same day surgery

Going to the hospital for surgery is an event that most people may find daunting. Anticipation of the unknown, lack of control over events and unfamiliarity with the environment may result in feelings of anxiety and stress. This research paper used a quantitative descriptive survey to establish the information needs of parents of children admitted for same day surgery. The main aims of this study were to establish what information parents had received prior to their child's admission for same day surgery, and how they perceived this information. It also determined what other information they required. The findings demonstrated that the majority of parents in this study were satisfied with the information they had received. However they wanted further advice on the waiting times involved, the equipment used in the operating room department, pain relief and the procedures in the recovery room.

Parental anxiety associated with Kawasaki disease in previously healthy children

OBJECTIVE

The objective of this study was to explore the lived experience of parents of children diagnosed with Kawasaki disease (KD) and to identify factors associated with increased levels of parental anxiety.

STUDY DESIGN

Three focus groups were conducted including 25 parents of 17 patients with KD, seven (41%) of whom had coronary artery complications. A conceptual model was developed to depict parental experiences and illustrate the key issues related to heightened anxiety.

RESULTS

Themes identified included anxiety related to the child's sudden illness and delay in obtaining a correct diagnosis because of the lack of health care providers' awareness and knowledge regarding KD. Parents were frustrated by the lack of information available in lay language and the limited scientific knowledge regarding the long-term consequences of the disease. Parents also reported positive transformations and different perspective toward challenges in life. However, the parents of children with coronary artery complications expressed persistent anxiety even years after the acute phase of the illness due to the uncertainty of the long-term prognosis.

CONCLUSIONS

There remains a critical need for richly textured research data on the perspective and experience of families of children with KD.

Association between parental anxiety and compliance with preoperative requirements for pediatric outpatient surgery

PURPOSE

The purpose of this study was to determine if parental anxiety interferes with the ability to follow preoperative requirements.

METHOD

In a single center observational study of parents of children admitted to a same-day surgical unit at a tertiary pediatric hospital, parental preoperative anxiety was measured by the State-Trait Anxiety Inventory (STAI) questionnaire. Anxiety was correlated to a four points assessment of adherence with the following preoperative requirements: dietary restrictions, timely arrival at the hospital, arrival at the assigned room, and completion of required medical forms, because those requirements are the greatest external contributors to surgical cancellation according to hospital statistics.

RESULTS

A total of 203 families completed the study. The average STAI score on the day of surgery was 38+/-12 (population average, 36+/-11). Only 130 families (66%) complied with all four preoperative requirements. A higher level of anxiety was significantly associated with lower probability of compliance (odds ratio, 0.88; 95% confidence interval, 0.78-1.00, P=05). In univariate models, factors associated with higher STAI scores included younger parent age, younger children, only child, child's first surgery, and no medical consultation between surgical assessment and surgery.

DISCUSSION

Parental anxiety could be associated with a lower likelihood of parents following preoperative requirements and could contribute to increased likelihood of surgical cancellation.

Management of preoperative anxiety in children

Although anesthesia during surgery prevents children from recalling actual surgical events, they are subjected to stressful events while preparing for surgery. One estimate suggests that 60% of children experience significant anxiety before anesthesia induction and surgery, and literature from around the world indicates that preoperative anxiety is a global concern for health care providers. The challenge that nurses face is to better manage children's anxiety in today's fast paced ORs. This article uses case studies to show nursing strategies that can be used to help allay the fears of children at different psychosocial stages of development.

Particularités pédiatriques de l'information préopératoire. Le point de vue de l'anesthésiste–réanimateur

Medical information is mandatory before any medical procedure, including pediatric anesthesia. Preoperative information covers many aspects, including medico-psychologic and judicial aspects. When the patient is a child, information must be delivered to the parents in priority. However, the French law has given a particular attention to the opinion of the child. In 70% of the cases, preoperative anxiety of the parents is more related to anesthesia than to the surgical procedure itself. We have to explain the most frequent adverse effects, as well as the more severe and well known complications to the parents, even though they are very infrequent. The only cases where preoperative information is not required are: emergency cases and refusal of the patient or the parents to be informed. While information is necessarily oral, it may be completed using a written document. The quality of the preoperative information directly influences the quality of the psychological preoperative preparation of the parents, and thereafter of the child. Preoperative preparation programs have been developed, but controversial results have been observed. The great majority of the studies on preoperative programs were performed in the USA, where the demand for preoperative information is very important. It is far from sure that the results of all these studies may be extrapolated to French parents, and French studies are needed.