Going to the hospital for surgery can be an unfamiliar and daunting experience for most people and can evoke feelings of anxiety and stress. In particular, it can be a potentially threatening experience for children and their parents. However, having access to relevant information in advance of admission in order to assist in preparing for this event can be of benefit and have positive results in terms of reducing anxiety for both children and parents. Taking this into consideration, a research study was undertaken to explore the information needs of parents of children admitted for day surgery.
The literature reviewed explored the historical experiences of children in hospital and the involvement, or lack thereof, of parents in caring for their children during a hospital admission. The benefits of same-day surgery were considered, in particular the shorter period of separation between parent and child, resulting in less behavioural changes in children.
Interventions used to prepare children and their parents for the hospital and surgical experience were discussed and these included use of a child-orientated book,1 a Saturday Morning Club2 a child life specialist,3 and therapeutic play.4 Preparation of parents was recognised as a fundamental ingredient in ensuring more positive outcomes for the child.
Survey
A cross-sectional, descriptive, correlation survey design was used to establish what the information needs of parents were in terms of the procedures which occurred in the operating room, and how this information may best be provided.
A sample of convenience and non- probability (n = 120) were given a self-administered, structured questionnaire developed specifically for this study. Internal consistency and reliability were established and predictive analytics software was implemented in analysis of the data.
Survey findings
In the return rate of 70.8% (n = 85), a large number of parents (90.6%) indicated they had received information, with the majority receiving this on the day of surgery. Parents perceived that this information benefited them in preparing themselves and their child for the impending surgery.
Interestingly, only 32.9% of parents indicated they would like to receive more information on the procedures that occurred in the operating room. More than 96% of the parents who responded to the questionnaire received verbal information, with only 9.4% receiving written material. This information was provided by nurses on the ward and in the department, anaesthetists and surgeons.
Parents were asked to rate the information they received using a Likert scale relating to 12 specific items pertaining to operating room procedures (see Table 1). The mean values indicated that this information was rated very good and a high level of importance was attached to each statement.
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Parents indicated a statistically significant difference (p < 0.05%) in the level of importance on receiving information on five of these items: fasting time, dress codes for staff, the child and for parents in the operating room, and the journey to the operating room department.
Other results identified pamphlets (65.9%) and a visit from healthcare staff (50.6%) as the most desired type of information format, with the most popular time to receive this information as one week before the child’s surgery (44.7%).
As previously stated, the majority of parents who responded to the questionnaire were satisfied with the information they received on the procedures relating to the operating room department. They indicated that all 12 items posed in the questionnaire were either important or very important and rated the information they received as mostly very good and excellent.
Most of the respondents received this information on the day of surgery. Yet previous studies have shown that giving information at least one week in advance of surgery is the optimal time for parents to receive it, as they have time to assimilate it and use it more effectively in preparing themselves and their child for the admission to hospital.2,5,6
Previous research has identified that nurses, doctors and parents were the main communicators to children during an admission to hospital7 and the results in this study indicated a similar trend.
Research studies have shown that parents and their children can benefit from receiving information on the process and procedures involved in an admission to hospital. It can assist them to prepare for the new and unfamiliar experiences they may encounter.1,2,3,4
Nurses and other healthcare personnel must endeavour to provide the best possible information to parents.8,9 It has been established that receiving both written and verbal information may improve parents’ knowledge and ensure satisfaction.5,10
In this study, mostly verbal methods were used to convey information. Clear communication can be effective and nurses can be central in this process.11
Interventions favoured by the respondents included a written information booklet or pamphlet, or a visit from healthcare staff working in the operating room department. This supports previous research highlighting written information booklets/pamphlets as a popular choice.1,6,10,11
Respondents also commented that they would like information to be more child-friendly. This would facilitate children to understand its content and become more actively involved in preparation for their own admission.
Nurses can be central in facilitating improved outcomes for children undergoing surgery and for their parents who support them.8 They can become key figures in developing strategic systems of communication between healthcare staff in the children’s day unit, the operating room department and healthcare users.
Nurses have the skills to facilitate and deliver on clinical practice initiatives such as the creation of information booklets or co-ordinating pre-operative visits to the children’s day unit.1
Furthermore, nurses have the capacity to undertake research investigations in the clinical field, both individually and within an interdisciplinary team approach. It is with these skills and competencies that nurses can go forward and create information systems to meet patients’ information needs.
A child orientated information booklet on a trip to the operating theatre is available on the Cork University Hospital website at www.cuh.hse.ie under the children’s services section. This is in addition to a suite of information available to both parents and children about preparing for the child’s stay in hospital.
A previous version of this article was published in the Journal of Pediatric Nursing 2013; 28: 179-185
References
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Rice, M, Glasper, A, Keeton, D & Spargo, P. The effect of a preoperative education programme on perioperative anxiety in children: an observational study. Pediatric Anesthesia. 2008; 18: 426-430
Brewer, S, Gleditsch, SL, Syblik, D, Tietjens, ME & Vacik, HW. Pediatric Anxiety: Child Life Intervention in Day Surgery. Journal of Pediatric Surgery. 2006; 21(1): 13-22
Li, HCW, Lopez, V & Lee, TL. Effects of Preoperative Therapeutic Play on Outcomes of School-Age Children Undergoing Surgery. Research in Nursing & Health. 2007; 30: 320-321
Spencer, C & Franck, LS. Giving parents written information about children’s anaesthesia: Are setting and timing important?. Pediatric Anesthesia. 2005; 15: 547 – 553
Wisselo, TL, Stuart, C & Muris, P. Providing parents with information before anaesthesia: what do they really want to know? Pediatric Anesthesia. 2004; 14: 299– 307
Dreger, VA & Tremback, TF. Management of Preoperative Anxiety in Children, AORN. 2006; 84(5): 801-804
O’Neill, C. Preparing children for hospital: what does the evidence say?. Journal of Children and Young People’s Nursing. 2007; 1(5): 242 – 247
Department of Health and Children (DoHC). Quality and Fairness – A health system for you. Dublin: Hawkins House, 2001
Bellew, M, Atkinson, KR & Dixon, G. The introduction of a pediatric anaesthesia leaflet: An audit of its impact on parental anxiety and satisfaction. Pediatric Anaesthesia. 2002; 12: 124-130
Stone, KJ & Glasper, EA. Can leaflets assist parents in preparing children for hospital? British Journal of Nursing. 1997; 6(8): 1054 – 1058
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