Journal of Pediatric Nursing
Volume 21, Issue 6 , Pages 397-399, December 2006

Surgical Preoperative Preparation for Children: The Need for More Evidence From Nurse Scientists

  • Cecily L. Betz, PhD, RN, FAAN (Editor-in-Chief, Journal of Pediatric Nursing)

USC Center for Excellence in Developmental Disabilities, Childrens Hospital Los Angeles, Los Angeles, CA

Article Outline

 

Each year, millions are hospitalized for a myriad of reasons. In 2002, 3.7 million children and youth from 1 to 21 years of age were discharged from a hospital, amounting to 4.4 hospital discharges per 100 children. Among children between the ages of 1 and 14 years, the discharge rates were particularly high among those with respiratory (asthma, pneumonia, and acute and chronic bronchitis) and gastrointestinal diagnoses (appendicitis, noninfectious enteritis, and colitis), with those having respiratory conditions accounting for the highest rates (U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 2004). Those with respiratory problems accounted for 29% of hospital discharges, and 26% of hospital discharges were attributable to those with injuries, victims of poisonings, and those with gastrointestinal, endocrine, immune, nutritional, and metabolic problems. The proportion of children discharged in this group who underwent surgical procedures was 45% (Kozak, Lees, & DeFrances, 2006).1 In 2001, 645,000 children under the age of 15 years were discharged from short-stay hospitals' ambulatory surgery centers (National Center for Health Statistics, 2001).

As these statistics indicate, the number of children who undergo some type of surgical procedure is considerable. Additionally, there has been a significant shift in the delivery of care used to surgically treat children such as the short/day surgical program and the use of improved surgical techniques and anesthetic agents (Percelay and the Committee on Hospital Care, 2003). Yet, during the past several years, there has been a dearth of nursing literature and research addressing the psychosocial and comfort needs (excluding pain management) of hospitalized children and children who undergo painful intrusive and surgical procedures.

In the past, nurses were in the forefront in terms of contributing to the science, that is, in widening our understanding of the type of surgical preoperative preparation needed to alleviate the anxiety of children and to promote their sense of mastery in dealing with this stressful experience. Beginning with the classic studies conducted by Visintainer and Wolfer, which examine the effects of systematic preoperative preparation and supportive care on the stress responses of children and their parents as well hospital and posthospitalization adjustment of children (Visintainer & Wolfer, 1975, Wolfer & Visintainer, 1975), other nurse scientists followed suit, contributing to the understanding of children's responses to hospitalization and, in particular, to the stress accompanying painful and intrusive procedures and surgeries.

Tiedeman and Clatworthy (1990) enhanced our ability to understand the anxieties children experience during hospitalization with the development of the Child Drawing: Hospital tool (Clatworthy, Simon, & Tiedeman, 1999). Dr. Sandee McClowry's work with hospitalized children demonstrated the importance of considering the child's behavioral style and temperament for individualizing care in the application of nursing interventions (McClowry, 1991, McClowry & McLeod, 1990, McLeod & McClowry, 1990). Dr. Linda LaMontagne's research, spanning more than two decades, has increased our understanding of how children and youth cope with upcoming surgeries. Using Lazarus' framework (Folkamn & Lazarus, 1984, Lazarus, 1966, Lazarus, 1997), Dr. LaMontagne's body of work has broadened our knowledge concerning the children's and youth's appraisal of stress and coping in response to surgery (for a more comprehensive listing of Dr. LaMontagne's work, refer to the Bibliographic and Further Reading sections at the end of this editorial [the former includes Dr. LaMontagne's studies that were cited in this editorial, whereas the latter includes those that were not cited]; LaMontagne, 1984, LaMontagne, 2000, LaMontagne et al., 2003, LaMontagne et al., 2004a, LaMontagne et al., 2004b).

As a result of the research conducted by these nurse and interdisciplinary scientists, we have acquired evidence that can be applied to the development and implementation of preparation programs to assist hospitalized children and youth. We have learned that the child's response to surgical procedures is influenced by several factors characterized as related to the child, to the child's family, and to the child's condition and hospital environment (Bar-Mor, 1997). We now know that effective preoperative preparation programs need to be based on the provision of developmentally appropriate information that include both the sequence and sensations associated with the surgical experience. Other child-related variables that have been found to be associated with the effectiveness of preoperative preparation are the timing of the intervention to account for the child's developmental needs, previous surgical experiences, the level of severity of the child's condition, and developmental age. Parental factors identified include the level of family support and parent–child relationships. The characteristics of the hospital environment also influence the child's response in terms of the extent to which preparation programs and hospital staff are responsive to the child and family, that is, the extent to which the environment is child centered and family centered (Bar-Mor, 1997, Kain et al., 1996, Melamed & Siegel, 1980, Moushey et al., 1988).

Now, it appears that researchers from disciplines other than nursing are also contributing to the increasing body of knowledge and evidence for the practice application of preoperative preparation programs. Our interdisciplinary colleagues in child life, medicine, child psychology, and music therapy have directed more current research efforts in examining the effectiveness of preoperative preparation on children's stress reactions associated with the surgical experience, including instrument development and alternative intervention models (Barrera et al., 2002, Kennelly, 2000, Méndez et al., 2001, Walworth, 2005). Although these colleagues have contributed to our understanding of this phenomenon, nurses have a unique role and perspective in not only contributing to the science but also in employing clinical interventions to support children and youth in dealing with this stressful experience (Bar-Mor, 1997, Justus et al., 2006, Keller, 1995, LaMontagne, 2000). There is so much more to be learned with regard to preparing children and youth for surgery in this ever-evolving health care environment and in the ever-changing American society. Nurse scientists can again be instrumental in contributing to this body of knowledge.

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References 

  1. Bar-Mor G. Preparation of children for surgery and invasive procedures: Milestones on the way to success. Journal of Pediatric Nursing. 1997;12:252–255
  2. Barrera ME, Rykov MH, Doyle SL. The effects of interactive music therapy on hospitalized children with cancer: A pilot study. Psychooncology. 2002;11:379–388
  3. Clatworthy S, Simon K, Tiedeman ME. Child drawing: Hospital—An instrument designed to measure the emotional status of hospitalized school-aged children. Journal of Pediatric Nursing. 1999;14:2–9
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  10. LaMontagne, L. L. (1984). Children's locus of control beliefs as predictors of preoperative coping behavior. Nursing Research, 33, 76–79, 85.
  11. LaMontagne LL. Children's coping with surgery: A process-oriented perspective. Journal of Pediatric Nursing: Nursing Care of Children and Families. 2000;15:307–312
  12. LaMontagne LL, Hepworth JT, Cohen F, Salisbury MH. Cognitive–behavioral intervention effects on adolescents' anxiety and pain following spinal fusion surgery. Nursing Research. 2003;52:183–190
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Further reading 

  1. LaMontagne L, Hepworth JT, Salisbury MH, Cohen F. Effects of coping instruction in reducing young adolescents' pain after major spinal surgery. Orthopaedic Nursing. 2003;22:398–403
  2. LaMontagne, L. L. (1985). Facilitating children's coping: Preoperative assessment interviews. AORN Journal, 42, 718, 720, 722–713.
  3. LaMontagne LL. Children's preoperative coping: Replication and extension. Nursing Research. 1987;36:163–167
  4. LaMontagne LL, Hepworth JT, Byington KC, Chang CY. Child and parent emotional responses during hospitalization for orthopaedic surgery. MCN: The American Journal of Maternal/Child Nursing. 1997;22:299–303
  5. LaMontagne LL, Hepworth JT, Cohen F. Effects of surgery type and attention focus on children's coping. Nursing Research. 2000;49:245–252
  6. LaMontagne LL, Hepworth JT, Johnson BD, Cohen F. Children's preoperative coping and its effects on postoperative anxiety and return to normal activity. Nursing Research. 1996;45:141–147
  7. LaMontagne LL, Hepworth JT, Salisbury MH. Anxiety and postoperative pain in children who undergo major orthopedic surgery. Applied Nursing Research. 2001;14:119–124
  8. LaMontagne LL, Hepworth JT, Salisbury MH, Riley LP. Optimism, anxiety, and coping in parents of children hospitalized for spinal surgery. Applied Nursing Research. 2003;16:228–235
  9. LaMontagne LL, Johnson JE, Hepworth JT, Johnson BD. Attention, coping, and activity in children undergoing orthopaedic surgery. Research in Nursing and Health. 1997;20:487–494
  10. LaMontagne LL, Wells N, Hepworth JT, Johnson BD, Manes R. Parent coping and child distress behaviors during invasive procedures for childhood cancer. Journal of Pediatric Oncology Nursing. 1999;16:3–12
  • 1 For the purposes of this survey, surgical procedures were operationalized as surgeries, invasive diagnostic procedures such as spinal taps, and therapeutic treatments such as the intravenous administration of chemotherapy.

PII: S0882-5963(06)00325-3

doi:10.1016/j.pedn.2006.07.005

Journal of Pediatric Nursing
Volume 21, Issue 6 , Pages 397-399, December 2006

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