Preparing children for same day surgery: Innovative approaches

p SYCHOLOGICALLY preparing children for medical events to avoid subsequent emotional trauma has been stressed since the 1940's (Plank, 1976). A child having surgery often experiences many fears and concerns related to their surgery which warrants such preparation. Fears about pain, separation from family, and fears of the unknown are some common concerns children express before surgery. At Texas Children's Hospital, our staff of Nurses, a Pediatric Nurse Practitioner, and Child Life Specialists, try to alleviate these fears with a psychological preparation program for surgical patients and their families. These professionals help the child adjust to the hospital atmosphere by helping him/her understand what will happen and how to find resources to cope with the new experience. Because children often fear the worst if they are not told what is going to happen, honest, age-appropriate explanations are used, and much time is given to the child to process the information and formulate any questions the he/she may have. In a same day surgery or same day admission scenario, adequate preparation is particularly challenging. At our hospital, those patients constitute 75% of our total surgical volume. Adding to the challenge are the logistics of being located in one of the world's largest medical centers. The majority of our parents were either unwilling or unable to make an additional trip to the hospital for the traditional preoperative program and tour. As a result, over the past few years we have focused our efforts on providing our patients and families what they need by video tape and telephone contact all in the comfort of their own home! Through these measures we have increased clinical preadmission by approximately 60%. Our customized videotape of the perioperative process addresses concerns of the parent and those of the child. Included in the video is a complete tour of the admitting, preoperative holding, operating room, and postanesthesia care unit. We filmed the video from the perspective of a former parent and child. The premise is that they have returned to the hospital to show other children what to expect when they come for their visit. The narrator acts as our representative taking them around the hospital to various perioperative areas. In the last section, the narrator explains additional information the parent will need such as where to park, what supplies to have at home for their child, etc. We supply the surgeons' office staff with the videos, requesting that they give it to the parent after the office visit. The parents are asked to return it to us on the day of surgery. As a follow-up and to collect clinical information on the patient, our staff nurse calls the parent at home or work up to 2 weeks before the day of surgery. Despite our success with these changes, we realized that it was still essential to have an effective in-person preadmission program. Parents are always given the option of bringing their child to the hospital for in-person preadmission and are encouraged to do so if their child has an extensive medical history. During this process, the Child Life Specialist plays a key role in the psychological preparation of our patients. She uses information gathered from the admitting nurse and nurse practitioner to begin an assessment of the child's preparation needs. During this assessment, the Child Life Specialist discusses with the family and patient any previous