Stuffed animals, cruises’ alleviate surgical anxiety

Orientations produce calmer children and parents

One same-day surgery program offers a "cruise." Another program offers one-on-one tours and talks. Although the approach is different, the goal is the same: Prepare children for their same-day surgery experience by explaining the unknown and making the whole experience less scary.

Offering an orientation for children is important because parents don’t always know how to explain surgery to their children, even if they know what to expect, says Emily Fazio, CCLS, a child life specialist in day surgery at Children’s Healthcare of Atlanta at Egleston. Fazio even has had parents mislead their children by telling them they are going to get ice cream as they head to the hospital.

Fazio’s orientation program usually is a meeting between Fazio, the patient, and the patient’s parents. "I like to talk with patients one-on-one rather than large groups because each patient is undergoing a different procedure, and a difference in age of patients also means different concerns," she points out.

If there are two children of similar age and maturity level undergoing the same procedure and she can make the parents’ wait a little shorter by combining the orientation meetings, she does talk with more than one family at a time. "I conduct the orientation at the same time the patients and parents come into our preoperative clinic," explains Fazio. "This is usually a few days to no more than a week before their surgery."

Timing is important because younger children, such as 3- or 4-year-olds, don’t retain the information any longer than a week, she says.

"I walk them around the area, let them see where they will come on the day of surgery, and show them all of the areas they will see, except the operating room," Fazio continues.

She explains to the children that the operating room is a sterile area to make sure no germs are in the room during surgery. She subsequently shows them pictures of the operating room and the equipment that they will see.

The children at Children’s Surgery Center in Columbus, OH, also are not allowed in the operating room during their tour, but they take a virtual tour of the operating room on-line at a computer in the surgery center, says Annette R. Svagerko, RN, CNOR, OR, clinical coordinator at the center.

"Because our center has a nautical theme with a reception desk designed as a boat and fish and other aquatic designs throughout the center, we call our orientation tour a cruise," she explains. "Each child on the cruise receives a stuffed animal that they can bring back on the day of the surgery as a comfort item."

It is important to show children some of the unfamiliar things that they will see on the day of surgery and let them touch them and get accustomed to them, says Svagerko. "We let them put the anesthesia mask on their face so they won’t be frightened by it, and we let them choose how the mask will smell," she explains.

Same-day surgery nurses put a small amount of scented oil on the inside of the mask so that the smell is more pleasant, she says. "The children can pick from a variety of scents such as peppermint, evergreen, bubble gum, or strawberry," she adds. (Editor’s note: The manufacturer is LorAnn Oils, Lansing, MI. Web: www.lorannoils.com.)

Telling the children what will happen doesn’t mean just talking about clinical issues, points out Svagerko. "Not only do they try on the anesthesia mask, but we also let them experience the pulse oximeter, the blood pressure cuff, the stethoscope, and the otoscope." While giving the children an opportunity to see and touch these clinical items ahead of time is important, you have to remember that they are children, she says.

"We also show them a Mylar balloon and explain to them that their name will be on one of the balloons and it will be attached to their bed," she says. "They know that, along with the stuffed animal we give them, they will have their own balloon and their own place on the day of surgery, and this also reassures them."

Children ask different questions based upon their ages, with younger children wanting to know if it will hurt and older children more interested in when they can return to normal activities, Fazio adds.

"The most important thing to remember is to be honest," she says.

Make sure, also, that the nurses calling the day before surgery do a good job of preparing the parents, Fazio suggests. In addition to giving instructions on what the child can and cannot drink or eat prior to surgery, be sure to remind parents of the process, she says. Tell them what to expect in the waiting room, in recovery, and at discharge, she explains. Let them know how long they can expect to be at the facility and how their child will feel at discharge, she adds.

"If the parents are comfortable that they know what will happen, they are calmer and can reassure the child," she adds.

Sources

For more information, contact:

  • Emily Fazio, CCLS, Child Life Specialist, Patient and Family Support Services, Children’s Healthcare of Atlanta at Egleston, 1405 Clifton Road, Atlanta, GA 30322. Phone: (404) 315-3771. E-mail: Emily.fazio@choa.org.
  • Annette R. Svagerko, RN, CNOR, OR Clinical Services Coordinator, Children’s Surgery Center, 660 Children’s Drive, Columbus, OH 43205. Phone: (614) 722-2920. E-mail: svagerka@chi.osu.edu.