Ventriloquist intervention prepared with drama technique in reducing pain, anxiety and fear in children during invasive procedures

INTRODUCTION

This study aimed to investigate the effects of a ventriloquist nursing intervention, incorporating drama techniques, on pain, anxiety, and fear experienced by children aged 5 to 10 years undergoing painful medical procedures.

METHODS

This study was designed as a time-series randomized controlled trial. Data were collected from the outpatient units of a Pediatric Hospital in a province in eastern Turkey between 24 May 2023 and 28 October 2023. This study involving a total of 72 children. Pain, anxiety, and fear levels were assessed before, during, and after intravenous cannula insertion.

RESULTS

Randomization ensured that both groups had similar demographics, with an average age of 7.50 ± 1.73 years and an equal distribution of gender. During the painful procedure, it was observed that both groups experienced an increase in pain, anxiety, and fear, though this increase was statistically less significant in the ventriloquist group. Ultimately, in the post-procedure period, children in the ventriloquist group exhibited lower levels of pain, anxiety, and fear compared to the control group (p < 0.05).

CONCLUSION

The findings of this study suggest that ventriloquist nursing interventions, utilizing drama techniques, can effectively reduce pain, anxiety, and fear in children undergoing painful medical procedures.

Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery

Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.

Innovative Program to Prevent Pediatric Chronic Postsurgical Pain: Patient Partner Feedback on Intervention Development

BACKGROUND

The risk of developing chronic postsurgical pain (CPSP) in youth is related to psychological factors, including preoperative anxiety, depression, patient/caregiver pain catastrophizing, and poor self-efficacy in managing pain. While interventions exist to address these factors, they are generally brief and educational in nature. The current paper details patient partner feedback on the development of a psychologist-delivered perioperative psychological program (PPP) designed to identify and target psychological risk factors for CPSP and improve self-efficacy in managing pain.

METHODS

Qualitative interviews were conducted with two patients and their caregivers to discuss their surgical and pain management experience and to advise on components of the PPP.

RESULTS

Reflexive thematic analysis of interviews generated the following themes, which were incorporated into the content and implementation of the PPP: caregiver involvement, psychological and physical strategies for pain management, biopsychosocial pain education, intervention structure, and supporting materials.

CONCLUSIONS

The development of a novel psychologist-led PPP is a promising approach to mitigate mental health risks associated with pediatric CPSP and potentially boost postoperative outcomes and family wellbeing. Integrating patient partner feedback ensures that the PPP is relevant, acceptable, and aligned with the needs and preferences of the patients it is designed to serve.

Effect of preoperative cluster care nursing on patient compliance during preoperative isolation of pediatric patients before cochlear implant surgery

OBJECTIVE

This study investigates the effect of pre-operative cluster care nursing on patient compliance during preoperative isolation of pediatric patients from their family members before cochlear implant surgery.

STUDY METHODS

A total of 350 pediatric patients who underwent cochlear implant surgery at Sichuan Rehabilitation Hospital from January 2021 to December 2022 were enrolled. The children were divided into two groups:Experimental group (group E) consisted of 182 children who received pre-operative cluster care nursing, and control group (group C) consisted of 168 children who received pre-operative routine nursing. The compliance scores of the two groups of patients when separated from their families before entering the operating room and the number of patients requiring intravenous injection of midazolam were recorded.

RESULTS

The compliance scores of group E were significantly lower than those of group C (t = 4.141, P < 0.001). The percentage of patients requiring intravenous injection of midazolam was recorded: it was 21.98% (40/182) in group E and 42.26% (71/168) in group C. Notably, the injection rate of midazolam in group E was significantly lower than that in group C (χ2 = 16.597, P < 0.001).

CONCLUSION

Pre-operative cluster care nursing can improve patient compliance and reduce the use of sedative drugs during preoperative isolation of pediatric patients from their family members for cochlear implant surgery.

The Effect of Hand Massage on Preoperative Anxiety Level and Hemodynamic Variables in Children: A Randomized Controlled Trial

PURPOSE

The study was conducted to determine the effect of hand massage applied to preoperative children on anxiety level and hemodynamic variables.

DESIGN

This research study is a randomized controlled trial with control and study groups, pre- and post-tests.

METHODS

This study was conducted between April and September 2017 with 84 children who were planned to receive an operation by applying general/local anesthesia in a province in the south of Turkey. The population of the research was composed of children between the ages 9 and 12 (study group = 42 and control group = 42). The data were collected through "Child and Parent Information Form," "State-Trait Anxiety Inventory for Children," "Physical Symptoms Follow-up Form for Anxiety," and "Satisfaction Evaluation Scale."

FINDINGS

The state-trait anxiety mean after hand massage was found to be 25.78 ± 5.90 in the study group, and 31.80 ± 6.51 in the control group (P < .05). There was a statistically significant difference (P < .05) between the systolic blood pressures and heart rate averages of the children in the study group after hand massage. There was a negative correlation between the satisfaction hand massage and state-trait anxiety means of the study group children (P < .05).

CONCLUSIONS

Hand massage was found to have a positive effect on reducing anxiety, systolic blood pressure and heart rate. No effect was found on diastolic blood pressure, respiratory rate and SpO2. We recommend that more extensive studies on hand massage are performed.

Age-specific and family-centered information modalities to prepare children at home for day-care surgery

BACKGROUND

Surgery induced stress and anxiety in children and parents can be reduced by providing preoperative information adapted to their needs. Aim of this study was to evaluate the effects of three different information modalities (coloring page, mobile application and videos) to prepare children and their parents for day-care surgery on preoperative anxiety and postoperative pain experienced by the child, and preoperative anxiety and satisfaction of parents.

METHODS

Prospective observational study including children and their parents that were offered specifically developed information modalities to prepare for day-care surgery. Results were compared between children and their parents that used none (i.e., control group) versus one or more information modalities (i.e., intervention group). Primary outcomes were preoperative anxiety measured using PROMIS v2.0 Anxiety and postoperative pain in children. Secondary outcomes were preoperative parental anxiety (STAI questionnaire) and family satisfaction with information and communication (modified PedsQL Healthcare Satisfaction questionnaire). Subgroup analyses were performed between preschoolers (0-5 years) and school-aged (≥5) children.

RESULTS

93 patients (male 53%) were included in the intervention (n=56) and control group (n=37). Levels of children's preoperative anxiety and postoperative pain, and parental anxiety did not differ between both groups. Families of prepared children were more satisfied with information and communication about preoperative surgical information (8 vs. 6.6, p=0.004) and satisfaction with how parents (7 vs 8, p=0.019) and children (8 vs 6, p=0.018) were prepared for surgery.

CONCLUSIONS

Preoperative anxiety did not differ between prepared and unprepared children. The use of specifically developed family-centered and age-appropriate information modalities to prepare children for day-care surgery at home results in superior family satisfaction.

LEVEL OF EVIDENCE

III.

Developmentally Appropriate Care of Pediatric Patients in the Perioperative Setting

Pediatric patients do not undergo procedures exclusively at pediatric specialty facilities. Many perioperative nurses will care for a pediatric patient at some point in their career. Children and their caregivers often experience elevated levels of anxiety during the perioperative experience. Possessing knowledge of the child's age and developmental stage and using effective communication techniques can decrease this anxiety. This article presents insights into the stages of pediatric cognitive and psychosocial development and special pediatric health care considerations. Approaching and interacting with a child in a manner appropriate for their age and developmental stage can foster a more trusting nurse-child-caregiver relationship and reassure the caregiver that the perioperative team is providing their child with safe, high-quality care. Also included are five hypothetical case studies that illustrate effective communication styles and developmentally appropriate techniques that personnel can apply during the pediatric patient's perioperative experience.

[The relation between preoperative anxiety and awareness during anesthesia: an observational study]

BACKGROUND

Anxiety is a state of worry caused by the anticipation of external or internal danger. Awareness During Anesthesia (ADA) is an unexpected memory recall during anesthesia. In this study, we aimed to determine the factors that affect preoperative anxiety and observe the incidence of ADA, as well as to determine the anxiety levels of these patients with a history of ADA.

METHODS

This study was planned to be prospective, observational, and cross-sectional. Patients in whom septoplasty was planned, who was admitted to the anesthesiology outpatients between March 2018 and September 2018, were ASA I-II, and aged 18-70 years were included in the study. The demographic characteristics of patients were recorded. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety during a preoperative evaluation. The modified Brice awareness score was used simultaneously to determine previous ADA.

RESULTS

The anxiety scores of patients who were conscious during anesthesia were higher than other patients. The mean STAI score was 40.85±14.8 in the 799 patients who met the inclusion criteria of this study. When the anxiety scores were compared, the scores were higher in females than in males (p < 0.05). The mean STAI score was found as 40.3±13.8 in patients who dreamed during anesthesia.

CONCLUSION

It is important to determine the anxiety levels of patients in the preoperative period to prevent the associated complications. Preoperative anxiety, besides preventing ADA, should be dealt with in a multidisciplinary manner. ADA should be carefully questioned while evaluating previous anesthesia experiences.

Evaluation of Preoperative Information Needs in Pediatric Anesthesiology

Background

Adequate preoperative information for pediatric patients and their families can prevent preoperative anxiety and improve postoperative outcome. The aim of this study was to conduct a survey to determine the preoperative information needs of children and their parents before anesthesia for elective surgery.

Material/Methods

Two healthcare centers enrolled children from 10 to 17 years of age who had planned elective surgery under general or regional anesthesia, and their parents and anesthesiologists. A questionnaire was designed for the study. Participants were asked to complete the questionnaire on the day of the preoperative visit of the pediatric anesthesiologist.

Results

There were 158 respondents, including 43 children (27.2%) undergoing elective surgery, 92 parents (58.2%), and 23 pediatric anesthesiologists (14.6%). The most helpful way of providing information, according to 12 children (41.4%), 53 parents (67.1%), and 17 pediatric anesthesiologists (77.3%), was in written form as a leaflet. The most common requests for information included: the postoperative regimen, 78 parents (96.3%) and 28 children (90.3%); recovery from anesthesia, 77 parents (95.1%) and 29 children (93.5%); postoperative pain management, 78 parents (96.3%) and 26 children (83.9%); and duration of anesthesia, 78 parents (96.3%) and 23 children (74.2%).

Conclusions

A preoperative survey of children and their parents showed that the most requested information was about the postoperative regimen, recovery from anesthesia, postoperative pain management, and duration of anesthesia. Both children and parents preferred to have preoperative information provided in written form, and the best time to provide information was on the day before surgery.