Preparing children for surgery

Abstract

12 Paediatric Nursing vol 17 no 3 April 2005 When I started to teach nursing it was difficult to find an evidence base for children’s nursing but there was one topic that could be used as an example of how research can guide practice. This was pre-operative preparation of children. Psychological research had described the distress and problems experienced by children who had been through surgery without adequate psychosocial preparation. Researchers went on to test various interventions, including written materials, videos, play sessions and preparation visits to hospital (Visintainer 1977). The research was based on theories of child development and children’s responses to stressful events. Pre-operative preparation served as an early example for nurses about how theory could be used to develop and test practice and lead to recommendations for change. Much of this research was published in the 1970s and 1980s and a review summarised the state of evidence about the benefits and drawbacks of various approaches and implications for practice (Eiser 1990). However, there is always more to be learned. It’s an important principle in research never to take anything for granted. When people ask me what is the difference between undergraduate and postgraduate study I repeat something I heard in a conversation years ago that has stuck with me, that the higher the academic level the greater the need to question certainty. So in the first year of a nursing diploma or degree it’s usually enough to be able to describe the knowledge that has been presented to you. With each increase in academic level it is necessary to become increasingly challenging and to recognise that knowledge is constantly changing. Studying a higher degree such as a PhD can be a lonely experience. It requires concentration on a particular topic that can appear obsessive. You can have to live with uncertainty because you must question the knowledge that has already been published and the new knowledge that you hope to create. It is necessary to be both very sceptical, so as to avoid making assumptions, but to be confident enough not to give up in the face of all this uncertainty. Doing research is as much about personality as it is about brain power. My student Lucy Smith showed me the importance of looking anew at the issue of preparing children for hospital. As part of her Master’s degree she designed a project to find out from children what they were told before admission to hospital for surgery, how they found it out and whether they could tell us what they wanted to know before admission. Demonstrating other important features of researchers, persistence and determination, she then went on to do the study. She found that there were problems with the practice in pre-operative preparation: an audit showed that very few children attended the pre-admission clinic where they could have been prepared for admission through play and other guidance. When she interviewed a small group of children she found that some got most of their information from a leaflet designed for parents. She also found that they could describe what they wanted to know in some detail and had suggestions for how the information should be communicated to children (Smith and Callery 2005). Lucy’s sample was very small and there is a need for further research about children’s information needs and the most effective ways to meet them. There are opportunities for children to explain their experiences with a variety of health conditions, such as the Children First web site (see references). Pre-operative preparation of children used to be a good example of the evidence base for practice but it’s time that researchers returned to the topic PN Preparing children for surgery