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The experience of surgery can be extremely stressful for children and their family members. Many children's hospitals offer a formal surgical preparation program to patients and their families, usually led by a child life specialist. However, smaller hospitals or ambulatory surgery centers may not be able to use this approach to preparing children for surgery. In this scenario, the perioperative nurse is in the ideal position to provide developmentally appropriate surgical preparation and education at the bedside. Knowledge of normal child development and age-appropriate diversional activities are necessary to implement an effective surgical preparation program. This age-appropriate preparation can help facilitate a positive medical experience that can reduce anxiety and affect the child's and his or her family's view of future medical encounters.
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Preoperative Care of Children: Strategies From a Child Life Perspective 1.7 https://www.aorn.org/Member_Apps/Product/Detail?productID=9643
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JUDY J. PANELLA, BS, CCLS
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Purpose/Goal
To provide the learner with knowledge specic to developmentally appropriate preoperative care of children.
Objectives
1. Explain the role of the child life specialist.2. Discuss the role of the perioperative nurse in decreasing preoperative parental and child anxiety.
3. Describe strategies for providing developmentally appropriate care to infants, children, and adolescents.
4. Describe strategies for providing care to children with developmental delays.
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AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centers Commission on Accreditation.
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This program meets criteria for CNOR and CRNFA recerti-cation, as well as other CE requirements.
AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.
Conict-of-Interest Disclosures
Judy J. Panella, BS, CCLS, has no declared afliation that could be perceived as posing a potential conict of interest in the publication of this article.
The behavioral objectives for this program were created by Kristi Van Anderson, BSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC, director, Perioperative Education. Ms Van Anderson and Ms Bakewell have no declared afliations that could be perceived as posing potential conicts of interest in the publication of this article.
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AORN recognizes these activities as CE for RNs. This recognition does notimply that AORN or the American Nurses Credentialing Center approves or endorses products mentioned in the activity.
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Preoperative Care of Children: Strategies From a Child Life Perspective 1.7 https://www.aorn.org/Member_Apps/Product/Detail?productID=9643
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JUDY J. PANELLA, BS, CCLS
ABSTRACT
The experience of surgery can be extremely stressful for children and their family members. Many childrens hospitals offer a formal surgical preparation program to patients and their families, usually led by a child life specialist. However, smaller hospitals or ambulatory surgery centers may not be able to use this approach to preparing children for surgery. In this scenario, the perioperative nurse is in the ideal position to provide developmentally appropriate surgical preparation and education at the bedside. Knowledge of normal child development and age-appropriate diversional activities are necessary to implement an effective surgical preparation program. This age-appropriate preparation can help facilitate a positive medical experience that can reduce anxiety and affect the childs and his or her familys view of future medical encounters. AORN J 104 (July 2016) 12-19. AORN, Inc, 2016. http://dx.doi.org/10.1016/j.aorn.2016.05.004
Key words: pediatric, preoperative, age-appropriate preparation, child life, coping.
The experience of surgery, including its unfamiliar routines, clothing, sights, sounds, and smells, can be extremely stressful for children and their family members. Nurses caring for children preoperatively must be prepared to provide developmentally appropriate care to help relieve the anxiety of children and the childrens family members.1 Allowing time for age-appropriate preoperative preparation activities and involving the childs parents or caregivers in the process may benet the child by reducing anxiety.2 Fortier et al3 found that preventing preoperative anxiety in children may help prevent negative outcomes after surgery, such as negative behavioral changes and postoperative pain. Because anxiety may have a substantial effect on a patients well-being, it is important to understand that a single experience can drastically shape how a child views future medical visits and encounters with health care professionals.
Perioperative anxiety in both children and their family members is a normal aspect of the surgical experience.4 High
parental anxiety may perpetuate high anxiety in the child, so it is important to address the fears and concerns of the childs family members and involve them in the childs care.2,3,5 If a patient or family member is made to feel that his or her reactions are abnormal or that the surgical experience should be easy, medical personnel can be perceived as demeaning and unsupportive.
Most major medical centers and childrens hospitals have child life departments that provide formal surgical preparation programs, generally led by child life specialists. A child life specialist is a trained professional who has experience helping children and family members cope with health care experiences. Child life specialists often meet children and adolescents during preoperative testing appointments to help explain anesthesia and surgery in developmentally appropriate terms. This may include providing preoperative tours and facilitating medical play to promote familiarization and mastery of unfamiliar and often scary equipment. Ideally, children should
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meet the child life specialist for age-appropriate preparation anywhere from 24 hours to several days before a planned surgical event. Although younger children may benet from preparation closer to the date of surgery to avoid building anxiety, adolescents may benet from preparation at least 7 to 10 days in advance.4
A small hospital or ambulatory surgery center may not employ a child life specialist, and children may arrive with little to no formal preparation for a surgical or anesthetic event. The surgical and anesthesia team explains the surgical process and anesthesia sequence to children and family members in this situation. However, the perioperative nurse remains a consistent and trusted presence throughout the preoperative period and should understand how to help children and their family members cope with preoperative anxiety. When preoperative preparation by a child life specialist cannot be provided, perioperative nurses are in the best position to assist children and family members in coping with the surgical environment and its routines. Depending on the information that has been provided by the surgeon at a clinic visit and the independent research family members or patients may have performed on their own, children can arrive with varying levels of understanding and misconceptions about surgery. An in-depth knowledge of development can guide nurses and other providers to deliver age-appropriate care that can enhance childrens ability to cope effectively with a stressful situation and create an atmosphere that promotes positive coping for future medical experiences. A summary of the developmental norms and implications to consider for the preparation of children and adolescents undergoing a surgical or anesthetic event is provided in Table 1.
When preparing the child for surgery, the role of the parent or caregiver cannot be overstated. Nurses must be aware that preoperative preparation relies on developing a collaborative relationship with the caregiver. The presence and involvement of a parent or caregiver can help normalize the hospital environment for the child, provide support, and reduce stress.6 Nurses can use their knowledge of development to teach parents or caregivers coping strategies to use with the child during the preoperative and postoperative periods. This article provides developmentally appropriate interventions nurses can use to improve the surgical experience for children and their family members.
DEVELOPMENTALLY APPROPRIATE SURGICAL PREPARATION
By taking into consideration the childs developmental level and the associated parental concerns, nurses can make
alterations in their care to provide adequate preparation while performing preoperative assessments and tasks. However, some planning is required to institute effective diversional and educational interventions that can improve the surgical experience for children and their family members. Gathering appropriate medical equipment such as an IV catheter with extension tubing, blood pressure cuff, stethoscope, anesthesia mask, or electrocardiogram (ECG) leads that are clearly labeled for teaching purposes can serve as excellent show and tell items for what children may see or experience during their visit (Figure 1). Books, bubbles, handheld games or tablets, and light-up or musical toys can also be kept in a box on the unit and used as diversional activities for children of different developmental ages. These materials must be thoroughly cleaned according to the facilitys infection control policy between uses. Suggested interventions that the perioperative nurse can implement to support children and their family members throughout their surgical experience are described by age group in the following sections.
Preparing Infants and Toddlers
Preparing the parents of neonates (birth to 27 days old), infants (28 days to one year old), and toddlers (one year to two years old)7 for what to expect before a procedure and how they can help care for their children may lead to lower stress levels for both the parents and the children.8 Validating a parents fears and concerns and providing supportive listening can be helpful in reducing parent stress, thus reducing patient stress. If the situation seems appropriate, using humor can sometimes be a starting point to build rapport with parents.
If there is communication with caregivers before the day of surgery, the nurse should remind parents to bring comfort items (eg, a blanket that smells like home, pacier, favorite stuffed animal, familiar bottle and nipple for use in recovery) that can aid in coping and help address issues related to a change in environment and routine.1 Because separation from caregivers is the primary source of stress for this age group, parents should be encouraged to remain with their children whenever feasible.4 Parents should be at their childrens bedside in the postanesthesia care unit (PACU) as quickly as medically possible to decrease separation anxiety.4 Informing parents of the anesthesia and surgical sequence, postoperative dressings, and monitoring equipment may help decrease some of their anxiety, thus creating a calmer environment for their children.
Infants and toddlers likely do not benet from a direct explanation of a surgical procedure. Infants rely on their parents to meet their needs and may be soothed preoperatively
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Table 1. Developmental Considerations When Caring for Children Undergoing Surgery1-5
Age Developmental Considerations Implications of Medical Experiences Neonatal/infancy: birth to 1 year [notdef] Learn through senses and motor
movements[notdef] Reliant on caregivers for basic needs,
building trust with caregivers
[notdef] Separation anxiety
[notdef] Lack of stimulation
[notdef] Disruption of sleeping and feeding routine
Toddlerhood: 1-2 years [notdef] Interact with environment through senses
[notdef] Begin seeking autonomy
[notdef] Developing free will
[notdef] Separation anxiety
[notdef] Fear forced dependence
[notdef] Distractions during medical care may
reduce anxiety (songs, toys)
[notdef] Fear of mutilation and pain
[notdef] Misconceptions regarding surgery
[notdef] Separation anxiety
[notdef] May view surgery as punishment for some
wrongdoing[notdef] Do not have an understanding of the
bodys organs
Middle childhood (school-aged
children): 6-11 years [notdef]
Acquire capacity for rational, logical
thought and abstract thinking[notdef] Gain the capacity for hypothetical and
deductive reasoning[notdef] Gain the ability to understand rules, the
concept of fairness, and cooperation with
others[notdef] Gain mastery and sense of competence by
demonstrating knowledge and skills (like to
be involved in care)
[notdef] Fear the unknown, loss of control
[notdef] Fear of bodily injury and pain, especially
intrusive procedures in the genital area [notdef] Fear of illness and disability
[notdef] Better tolerance for separation anxiety, but
still present[notdef] Misconceptions about surgery may still be
present, may still see surgery as
punishment
Early childhood (preschoolers):
2-5 years [notdef]
Language and social skills are developing [notdef] Developing symbolic thought
[notdef] Seeking initiative; want to assert control
over their world[notdef] Primarily perceptive thinkers; reasoning
may be distorted[notdef] Feel remorse for inappropriate actions
Early adolescence: 12-18 years [notdef] Rapidly maturing physically and
emotionally[notdef] Developing ones own identity
[notdef] Progressing toward mature thinking and
abstract thought[notdef] Better able to understand causation of
disease[notdef] Value privacy, independence
[notdef] Peer relationships are of supreme
importance
[notdef] Fear of bodily injury, death, and pain
[notdef] Fear of loss of identity and control
[notdef] Concerned about body image, may worry
about cosmetic implications of surgery [notdef] Concern about peer group status after
surgery or hospitalization
References1. Difusco LA. Pediatric surgery. In: Rothrock JC, ed. Alexanders Care of the Patient in Surgery. 15th ed. St Louis, MO: Mosby; 2015:1008-1080.2. McLeod S. Erik Erikson. Simply Psychology. http://www.simplypsychology.org/Erik-Erikson.html
Web End =http://www.simplypsychology.org/Erik-Erikson.html . Published 2008. Updated 2013. Accessed April 7, 2016.
3. Harris TB, Sibley A, Rodriguez C, Brandt ML. Teaching the psychosocial aspects of pediatric surgery. Semin Pediatr Surg. 2013;22(3):161-166.4. McLeod S. Jean Piaget. Simply Psychology. http://www.simplypsychology.org/piaget.html
Web End =http://www.simplypsychology.org/piaget.html . Published 2009. Updated 2015. Accessed April 7, 2016.
5. Leack KM. Perioperative preparation of the child and family. In: Tkacz Browne N, Flanigan LM, McComiskey CA, Pieper P, eds. Nursing Care of the Pediatric Surgical Patient. 3rd ed. Burlington, MA: Jones & Bartlett Learning; 2013:3-16.
with gentle rocking, paciers, and warm blankets. Infants and toddlers interact with their environment through their senses and therefore may benet from music or toys for distraction.1 Toddlers may also benet from hands-on manipulation of appropriate medical equipment (eg, blood pressure cuff, anesthesia mask).1,9 Using simple words and allowing the toddler to hold and explore equipment used during
assessments can be helpful in gaining trust and cooperation. For example, stating I need to check your blood pressure; this is the cuff, and allowing the toddler to hold and play with the cuff before placing it on the arm or leg may be benecial. Hearing the words and modeling can help gain cooperation during an examination: I need to listen to your heart; how about I listen to Moms heart rst? Infants and
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Figure 1. A box of medical supplies clearly labeled for teaching purposes only that is easily accessible in the preoperative space can hold show and tell items.
toddlers may use their parents as barometers for how they should feel about a situation.10 If a parent appears calm and compliant with a nurse, the child may demonstrate the same behavior.
Preparing Preschoolers
Children in early childhood (ie, preschool children ages two to ve years)7 have verbal abilities, and it is important to understand the tendency of the child to misinterpret words and concepts that require abstract thinking.4 For example, using terms such as gas anesthesia or saying we are going to put you to sleep can often be misunderstood. Instead try language and explanation, such as medicine air or hospital medicine sleep that is different from sleep you have at home. Preschoolers may believe they did something wrong to deserve what is happening to them. Explaining to children that they had no role in causing their illness will decrease guilt and worry about punishment.4
When assessing a patient in this age group, the nurse should preferably sit at the childs eye level. Children may be more cooperative when remaining close to a parent and may be most
comfortable sitting on his or her lap. The nurse should try to elicit from the parent the understanding of the child regarding the reason he or she is at the hospital. Determining the childs point of reference can be helpful in proceeding with additional explanation. For example: I understand you are here today because you have been getting a lot of sore throats and your tonsils are causing some trouble. It is important to use the correct anatomic term for body parts and medical equipment in addition to child-friendly descriptors to help provide extra explanation. For example: This is the pulse oximeter; it checks your oxygen and how your heart is beating. It is a sticker that wraps around your nger or toe and has a red light inside.
Preschool children may be frightened by surgical attire and experience distress related to separation from caregivers.4 The nurse should encourage parents to be present and involved in as much of the preoperative and postoperative process as medically possible. It may be appropriate to give the parent and the child a surgical hat and mask to wear and play with to help normalize the environment. Remind the child that when the doctor works on his or her body, he or she will be asleep with anesthesia (ie, hospital sleeping medicine) and will not feel anything the doctor is doing until it is time to wake up.
Allowing preschoolers to explore and manipulate appropriate medical equipment can lead to familiarization and may decrease stress.1 Modeling by performing a blood pressure or temperature check on a parent can be helpful in gaining cooperation from the child. If the child brings a stuffed animal, always ask permission rst before listening to Fluffys heart. Reminders about postoperative dressings and the surgery spot (ie, incision) can be helpful. The preschooler should be prepared for a sore spot but should be reminded that it will get better. Reinforce the times and places that parents or caregivers will be present with the child.
Preparing Children in Middle Childhood
Children in middle childhood (school-aged children between 6 and 11 years old)7 should have a greater capacity than toddlers or preschoolers to tolerate separation from caregivers and are increasingly able to understand the concepts of illness.4 A school-aged child should have some degree of understanding about the surgical procedure on arrival at the hospital or surgical center. Children in this age group gain a sense of competence by demonstrating their knowledge and skills. An effective way to elicit information is simply to ask. For example: Tell me what you know about why you are here today can be a great starting point. It is important to
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direct this question to the child rather than the parent. Children in this age group have had more exposure to media and peer inuence,6 which can lead to misconceptions or worries of not waking up from anesthesia or awakening during surgery. Using clear language and explaining the differences between sleep at home and hospital sleeping medicine can be quite helpful.
Because children in this age group fear the unknown, illness, and bodily harm,1,6 a concern that sometimes arises with school-aged children related to anesthesia is what they will or will not remember. When the patient hears you wont remember anything, particularly when describing a preoperative medication, patients may fear they will wake up not remembering their name, family members, or fundamental traits about themselves.
Pictures and other visual aids are particularly effective in explaining surgery to this age group. A simple childrens anatomy book can be useful for visual learners and help reinforce medical explanations. At this age, some children may just be beginning to understand that organs and body systems are complex entities, but unseen body functions may need to be explained by the nurse.1 Younger children in this age range may still think their heart is similar to what they see on Valentines Day cards and may generalize the term stomach to their entire abdomen (tummy or belly). Using an anatomy book can help children gain a more accurate understanding of their body, the size and location of the surgical site, where to look for the incision after the surgery, or why they will not be able to see the surgical site after surgery. Creating a ip book of pictures containing common surgical sites, such as the tonsils, adenoids, and ear canal, can be helpful for both children and parents. If a facility has a high rate of orthopedic procedures and casting, having a doll that is casted can be a great visual for what to anticipate (Figure 2).
Allowing the child appropriate choices and opportunities to be involved in his or her care can often lead to better cooperation.1 Telling the child, I have to check your temperature and blood pressure and listen to your heart and lungs and then asking, Which would you like me to do rst? is an example of how to offer an appropriate limited choice. Asking yes or no questions such as Can I check your temperature? allows the child to say no, placing the nurse in a difcult situation. The temperature must be obtained regardless, violating the trust the nurse is building with the child. Consider allowing the child to perform simple tasks, such as removing his or her own ECG leads in the PACU, to help the child feel more involved in his or her care. Also,
asking school-aged children to help develop their own coping strategies can be helpful in supporting their independence. Help them choose from several options; for example: Some kids like to watch me start the IV, others like to look away or listen to music on their phones, and others like to hold their moms or dads hand. Which do you think would help you most?
Preparing Adolescents
The nurse may encounter a wide range of emotions and behaviors from early adolescents (12 to 18 years).7 Adolescents fear a loss of self-control and autonomy11 and therefore may react negatively to being told what to wear (ie, hospital gown), how to behave (ie, answering questions related to their medical history, discussing uncomfortable or private topics), or to maintain NPO status by withdrawing or not cooperating with the health care team. Many of the strategies used for younger children also work for adolescents, with a few modications and additions. Address the adolescent patient, rather than the parents, from the beginning of the check-in process to support their desire for independence.4 Many adolescents
Figure 2. A doll with a cast or bandage may show children how their surgery spot may appear after surgery.
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should be able to answer most, if not all, of the interview questions related to allergies, NPO status, and pain scores. It can be easy for a parent to take over the conversation, which may cause the adolescent patient to withdraw.
Peer relationships are of supreme importance to adolescents. Allowing the adolescent access to their phone to text friends can help them feel connected to their peer group. Setting ground rules from the beginning, reminding the adolescent that he or she may keep the phone in the preoperative or postoperative area but must still attend to the discussion and answer questions when asked by the health care team, is essential. Playing a favorite game or phone application can help distract adolescents and normalize the situation, which can lower anxiety and help reduce the need for preoperative anxiolytic medication.11
The adolescent should have had a role in the surgical decision-making process and have an understanding of the need and indications for surgery. Even so, teens can still benet from more detailed explanations and visual aids. Many adolescents are interested in science and the human body. Using anatomy books or diagrams can be useful in helping the teen become more comfortable and provides an opportunity to ask questions. Common concerns for this age group may include an altered body image, peer rejection, disability, loss of control, and fear of death.1 When addressing these concerns, the nurse should not dismiss the teens worries because a question may be difcult to answer. This does not allow the adolescent to feel as if his or her concerns are heard and validated. When answering questions, an honest approach can be helpful in building rapport.
Because of heightened concerns about body image, adolescents are often extremely worried about the resulting cosmetic effects of an operation.4 They may seem more concerned about what their scar will look like than the actual surgical and anesthesia process. Validating these concerns without judgment or minimizing them can lead to more effective cooperation and conversation. Adolescents also value their privacy, and the nurse should be especially mindful of this.1 For example, if the adolescent needs to use the restroom, offer an additional gown to wear around the back to help him or her feel more covered. Inform teens about who will need to examine them and why.
Children With Developmental Delays
Medical experiences can be stressful for many children who fall within developmental norms, but can be much more
challenging for those with developmental delays or a sensory processing disorder (eg, autism spectrum disorder). As with any disorder, the patients impairments may fall at different points on a spectrum. A child or teen could have minimal impairment in only one or two domains of development, such as social interactions and language, or have signicant decits across multiple domains that greatly affect their cognitive understanding.12 For this reason, the nurse should not make assumptions about the patients abilities based on the diagnosis listed in the chart. Another factor to consider, especially in children with autism spectrum disorder, is that many are concrete thinkers and may not understand abstract thoughts or common idioms such as frog in your throat. A child may literally picture themself swallowing a frog. Sensory integration is also an important consideration. Sometimes, the noise level or brightness of the lights may be a negative trigger. Emotional regulation can be extremely challenging for this group of patients.13
A hospitalization or surgical procedure may provoke challenging behaviors in children with autism spectrum disorder. These behaviors can include aggression, tantrums, hitting, kicking, biting, and scratching.13 The challenge is delivering care in an effective, safe manner. Family-centered care principles, such as acknowledging parents and caregivers as the experts about their children and involving them in the development of an optimal care plan, are crucial when planning interventions for any child, but they are especially important when caring for children with special needs or developmental delays. It is advisable to try to speak privately with a parent rst to determine the most effective approach for the child. Parents know their childs likes and dislikes, trigger words and behaviors, and communication preferences and interventions that have helped redirect challenging behaviors in the past and can lead to more compliance from the patient. Some questions to consider when talking with parents include the following:
[notdef] What is the childs level of understanding regarding the
procedure?
[notdef] What interventions have worked well during past medical
encounters?
[notdef] How does the child communicate (verbally or nonverbally)?
Does he or she use any communication devices (eg, picture cards)?
[notdef] Is the child sensitive to touch or noise? [notdef] Are there any items of
xation or self-stimulating behaviors that the child uses?
[notdef] What strategies work best for transitions such as moving
rooms or separation from a caregiver?12
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Resources for Pediatric Surgical Patients and Their Family Members
Bhatia S. The Surgery Book: For Kids. Bloomington, IN: AuthorHouse; 2010.
Colombo L. Uncover the Human Body: An Uncover It Book. San Diego, CA: Silver Dolphin Press; 2003.
Duncan D. When Molly Was in the Hospital: A Book for Brothers and Sisters of Hospitalized Children. Windsor, CA: Rayve Productions, Inc; 1994.
Kids worry too: a guide for adults helping children understand hospitalization. Nebraska Medicine. http://www.nebraskamed.com/app_files/pdf/childlife/kids-worry.pdf
Web End =http:// http://www.nebraskamed.com/app_files/pdf/childlife/kids-worry.pdf
Web End =www.nebraskamed.com/app_les/pdf/childlife/kids-worry http://www.nebraskamed.com/app_files/pdf/childlife/kids-worry.pdf
Web End =.pdf . Accessed April 7, 2016.
Matt M, Ziemian J. Human Anatomy Coloring Book. Mineola, NY: Dover Publications, Inc; 1982.
[notdef]
When the child arrives, if more than one caregiver is present, it may be possible to complete many of the admission questions with one parent or caregiver while the child remains in a space where he or she may be more comfortable, such as in the waiting room, with another caregiver. For children who have had multiple medical encounters, being in a preoperative holding room may produce anxiety. Although there is clearly an indication for the child to know or have some understanding of what is happening during the surgical encounter, what is often most helpful with this population is to simply manage the environment. Upon meeting the child, speak softly and slowly and allow time for the patient to process information and respond. Depending on a patients developmental level, it may not be sensible to engage in a detailed preparation discussion, but simple pictures of spaces or reminders about a sore surgery spot or place the doctor is going to x may be sufcient.13
For some children, saying the word no can provoke a tantrum. Remove unnecessary equipment from the patients room if possible and keep supplies and materials out of view until just before use to avoid triggering tantrums or other challenging behaviors.13 For example, if the nurse is setting up supplies to start an IV, it may be helpful to collect the tourniquet, alcohol swabs, IV catheter, and tape on a treatment tray outside the room and roll it in just before the procedure. If noises or lights trigger difcult behaviors in a patient, keep environmental stimuli to a minimum and offer to turn down lights or reduce volume on alarms, but ensure
alarms are still audible for the nurse.13 The best strategy to keep in mind is individualized care. Every child is different, and strategies that worked for one patient with a developmental challenge may not work for the next.
CONCLUSION
Understanding the interaction of development and the potential psychosocial effect of surgery helps providers address the common concerns and fears experienced by children and their family members. Optimal care is provided when the medical team understands and respects the childs developmental level, includes family members and caregivers in decision making, and works to create a positive medical experience. The strategies presented in this article are not intended to increase the nurses workload in an already busy and fast-paced perioperative work environment. Rather, they are meant to provide the reader with effective interventions that can be practically implemented by nurses and positively affect children and their family members. In the future, more research on outcomes associated with quality preoperative preparation, such as improved pain management and decreased anxiety, is necessary to gain a better understanding of the benets associated with these strategies.
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Judy J. Panella, BS, CCLS, is a child life specialist at Duke Childrens Hospital and Health Center, Durham, NC. Ms Panella has no declared afliation that could be perceived as posing a potential conict of interest in the publication of this article.
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EXAMINATION
Continuing Education:
Preoperative Care of Children: Strategies from a Child Life Perspective 1.7 https://www.aorn.org/Member_Apps/Product/Detail?productID=9643
Web End =www.aornjournal.org/content/cme
PURPOSE/GOAL
To provide the learner with knowledge specic to developmentally appropriate preoperative care of children.
OBJECTIVES
1. Explain the role of the child life specialist.2. Discuss the role of the perioperative nurse in decreasing preoperative parental and child anxiety.3. Describe strategies for providing developmentally appropriate care to infants, children, and adolescents.4. Describe strategies for providing care to children with developmental delays.
The Examination and Learner Evaluation are printed here for your convenience. To receive continuing education credit, you must complete the online Examination and Learner Evaluation at https://www.aorn.org/Member_Apps/Product/Detail?productID=9643
Web End =http://www.aornjournal.org/content/cme .
QUESTIONS1. A child life specialist is a trained professional who has experience helping children and their family members cope with health care experiences.a. true b. false
2. Child life specialists often meet children and adolescents during preoperative testing appointments, which may involve1. explaining anesthesia and surgery in developmentally appropriate terms.
2. providing a preoperative tour.3. facilitating medical play.4. admitting the child to the hospital.a. 1 and 3 b. 2 and 4c. 1, 2, and 3 d. 1, 2, 3, and 4
3. When preoperative preparation by a child life specialist cannot be provided, anesthesiologists are in the best
position to assist children and family members in coping with the surgical environment.a. true b. false
4. To institute effective educational and diversional interventions for children undergoing surgery, perioperative nurses may consider gathering appropriate medical supplies for show and tell, such as1. medications.2. stethoscopes.3. anesthesia masks.4. glass ampules.5. blood pressure cuffs.6. electrocardiogram (ECG) leads.a. 1, 3, and 5 b. 2, 4, and 6c. 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6
5. The primary source of stress for infants and toddlers isa. altered body image.b. fear of death.
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c. loss of control.d. separation from caregivers.
6. When interacting with preschoolers, it is important for the perioperative nurse to understand that children in this age group may1. misinterpret words that require abstract thinking.2. believe they did something wrong to deserve what is happening to them.
3. be concerned about the cosmetic implications of undergoing surgery.
4. be more cooperative when remaining close to a parent.a. 1 and 3 b. 1, 2, and 4c. 2, 3, and 4 d. 1, 2, 3, and 4
7. To help the school-aged child feel more involved in his or her care, the perioperative nurse should consider allowing the child to perform simple tasks when appropriate, such asa. removing his or her own ECG leads.b. scheduling a postoperative appointment.c. changing his or her own surgical dressing.d. choosing when to be discharged.
8. Common concerns of adolescent patients include1. altered body image.2. peer rejection.3. disability.
4. caregiver separation.5. loss of control.6. fear of death.a. 1, 3, and 5 b. 2, 4, and 6c. 1, 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6
9. When caring for children with autism spectrum disorder, the perioperative nurse should use family-centered care principles, including1. acknowledging parents and caregivers as experts regarding their children.
2. involving parents and caregivers in the development of an optimal care plan.
3. speaking privately with a parent rst to determine the most effective approach for the child.a. 1 and 2 b. 1 and 3c. 2 and 3 d. 1, 2, and 3
10. When managing the environment for a child with autism spectrum disorder, the perioperative nurse should1. speak softly and slowly.2. avoid using the word no.3. remove unnecessary equipment from the patients room.
4. keep supplies out of view until just before use.5. turn down lights and volume of alarms.a. 4 and 5 b. 1, 2, and 3c. 1, 2, 3, and 4 d. 1, 2, 3, 4, and 5
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LEARNER EVALUATION
Continuing Education: Preoperative Care of Children: Strategies From a Child Life Perspective 1.7 https://www.aorn.org/Member_Apps/Product/Detail?productID=9643
Web End =www.aornjournal.org/content/cme
This evaluation is used to determine the extent to which this continuing education program met your learning needs. The evaluation is printed here for your convenience. To receive continuing education credit, you must complete the online Examination and Learner Evaluation at https://www.aorn.org/Member_Apps/Product/Detail?productID=9643
Web End =http://www.aornjournal.org/content/cme . Rate the items as described below.
OBJECTIVES
To what extent were the following objectives of this continuing education program achieved?1. Explain the role of the child life specialist. Low 1. 2. 3. 4. 5. High
2. Discuss the role of the perioperative nurse in decreasing preoperative parental and child anxiety.
Low 1. 2. 3. 4. 5. High
3. Describe strategies for providing developmentally appropriate care to infants, children, and adolescents. Low 1. 2. 3. 4. 5. High
4. Describe strategies for providing care to children with developmental delays.
Low 1. 2. 3. 4. 5. High
CONTENT
5. To what extent did this article increase your knowledge of the subject matter?
Low 1. 2. 3. 4. 5. High
6. To what extent were your individual objectives met? Low 1. 2. 3. 4. 5. High
7. Will you be able to use the information from this article in your work setting?1. Yes 2. No
8. Will you change your practice as a result of reading this article? (If yes, answer question #8A. If no, answer question #8B.)
8A. How will you change your practice? (Select all that apply)1. I will provide education to my team regarding why change is needed.
2. I will work with management to change/implement a policy and procedure.
3. I will plan an informational meeting with physicians to seek their input and acceptance of the need for change.
4. I will implement change and evaluate the effect of the change at regular intervals until the change is incorporated as best practice.
5. Other: __________________________________
8B. If you will not change your practice as a result of reading this article, why? (Select all that apply)1. The content of the article is not relevant to my practice.
2. I do not have enough time to teach others about the purpose of the needed change.
3. I do not have management support to make a change.
4. Other: __________________________________
9. Our accrediting body requires that we verify the time you needed to complete the 1.7 continuing education contact hour (102-minute) program: _____________
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