The preparation of children for day surgery from the parent's viewpoint: A mixed methods study

Abstract

Aim

The purpose of the study was to describe the preparation of children for day surgery from the parent's viewpoint.

Design

Empirical Research Mixed Method.

Methods

The research applied a mixed-methods study design. The study was conducted at the Paediatric Day Surgical Department of one REDACTED between 2018 and 2020 at the same time as an associated randomised controlled conduct trial. Parents of 41 children (ages 2–6 years) completed measures assessing their preparation for day surgery and satisfaction with the procedure. Semi-structured interviews were conducted with 15 parents to better understand their experiences.

Results

According to the results, most of the parents (95%) told their children about the upcoming day surgery procedure. The child was prepared for the surgery with cognitive and sensory information, and the preparation usually started at home well before the surgery. The parents' experiences with the most critical aspects of preparing their child included three main categories: (1) usability of the preparation method; (2) content and timing of the preparation method and (3) consideration of the family perspective.

INTRODUCTION

The number of day surgical procedures for children has increased significantly on a global scale (Erhaze et al., 2016; Pomicino et al., 2018; Quemby & Stocker, 2014) for practical reasons, namely, day surgery is cost-effective, reasonable, safe and meaningful for the family (Boles, 2016). In addition, this type of surgery affords the family an opportunity for a quick return home and to everyday life, usually within 1 day (Wright et al., 2010), decreases hospital infections (Fortier et al., 2015) and cuts surgery queues (de Luca et al., 2018). Each year, more than five million paediatric patients in the United States are registered for a day surgery while approximately 60%–80% (de Luca et al., 2018) of all surgeries performed on children around the world are day surgeries. In the next few years, the share of planned day surgery procedures among paediatric patients is expected to grow to 75% (Bailey et al., 2019).

Background

Parental participation in the day surgery of a preschool child is essential because it increases the child's and parent's sense of security, allows family togetherness, and decreases the child's fear, postoperative pain and side effects caused by anaesthesia (Chartrand et al., 2017; Copanitsanou & Valkeapaa, 2014; Wright et al., 2010). During day surgery, a child needs help, information and supervision from both the parent and the healthcare provider, like nurses, along with their parent's presence. The parent's presence evokes security and confidence and decreases unnecessary hospital fear (Salmela et al., 2011). In addition, parents need to bear responsibility and make essential decisions. Therefore, it is necessary to prepare parents for the child's surgery (Chang et al., 2020; Healy, 2013).

Parents are responsible for preparing their child, making decisions and providing support throughout the day surgery service chain (Chang et al., 2020; Healy, 2013). The child's family must understand what will happen during day surgery (Cutillo et al., 2020; Healy, 2013). Therefore, the starting point for preparing for day surgery should be increasing the child's and parents' knowledge, smooth cooperation, and social support (Chang et al., 2020; Selimen & Andsoy, 2011). Preparation methods affect both the parents' satisfaction and involvement in the procedure (Chartrand et al., 2017). Nevertheless, it is still often the case that each parent receives the same routine information about their child's procedure, with this information expected to meet everyone's needs and expectations (Lööf & Lönnqvist, 2022). The prevalence of the routine approach is surprising, as taking individual needs into account strengthens the parent's ability to cope (Eldridge & Kennedy, 2010; Lerret, 2009) and reduces cancellations of procedures (Turunen et al., 2018).

The rapid development of information and communication technologies (ICT) and the ubiquitous nature of smartphones have opened new possibilities for web-based or digital preparation programmes for day surgery (Agbayani et al., 2020; Fortier et al., 2015). Both the Internet and mobile technologies represent highly effective tools for sharing relevant information about perioperative procedures (Kim et al., 2019). Nevertheless, there is limited empirical evidence about the effectiveness of using mobile applications in preparing for surgery during the perioperative period, with only a few relevant studies available (Liu et al., 2018). According to Rantala et al. (2020), more research concerning how digital solutions support families and children must be conducted.

To the best of our knowledge, only a few studies have described how children younger than 7 years of age, and their parents, are prepared for day surgery (Birnie et al., 2019; Kleye et al., 2021). Previous studies have focused on either the preparation of older children (Rantala et al., 2020), paediatric patients with a wide age range (0–18 years) (Chow et al., 2016; Kim et al., 2019), or young people with long-term illnesses (Majeed-Ariss et al., 2015). Furthermore, the descriptions of interventions have significantly varied and often describe the effectiveness of individual interventions, that is audio-visual (Chow et al., 2016), web-based mobile (Rantala et al., 2020) or technology-based approaches (Kim et al., 2019), on anxiety among children (Chow et al., 2016; Rantala et al., 2020). According to Chang et al. (2020), there is a sizeable knowledge gap about the extent to which paediatric patients are prepared for day surgery.

Aim

The study aimed to describe the preparation of preschool children for day surgery from the parent's viewpoint. The objective of the research was to generate new information and develop customer-oriented preparation for parents of young children undergoing day surgery. The research questions of the quantitative phase of the study were: (1) What preparation methods do preschool parents use to prepare their children for day surgery and when?, along with (2) How satisfied were the parents with the preparation methods for their child's day surgery? The research question of the qualitative phase of the study was: (1) What were the parents' experiences with the most critical aspects of preparing their child for day surgery?

METHODS Study design

The research applied a mixed methods approach to describe children's preparation for day surgery from the parent's viewpoint. The combination of quantitative and qualitative research components was expected to strengthen the understanding of a specific context, in this case, parent's views on the preparation of their children for day surgery (Fetters, 2019; Flick, 2018; Granikov et al., 2020; Schoonenboom & Johnson, 2017). All data were prioritised equally during data collection and analysis (Flick, 2018). We used a quantitative approach to explore parents' preparation processes and satisfaction while a qualitative approach was used to describe preschool children's preparation for day surgery from the parent's point of view (Figure 1). The research applied The Good Reporting of a Mixed Methods Study (GRAMMS) checklist (O'cathain et al., 2008) (Appendix S1).

FIGURE 1. Study design.

Quantitative phase Participants

The quantitative phase of the research involved parents (n = 41) and their preschool children (2–6 years of age) who were eligible for elective day surgery. Participation in the study was voluntary. All children were classified as ASA 1–2 (American Society of Anaesthesiologists), that is healthy (1) or having a mild general illness that was in balance with treatment (2) and entered the surgery with their parents without having eaten or drank in the period prior to the surgery. Inclusion criteria were (1) that the child's day surgery was performed under general anaesthesia and (2) no laparoscopic technique was used. The elective day surgeries included testicular repairs, repairs of foreskin stenosis, hernias, and surgeries related to skin and subcutaneous tissues (excluding laser surgery) and orthopaedics (e.g. ganglia, yet excluding the removal of fixation material).

Design and procedure

The parents were recruited in connection with an RCT study (the randomised controlled trial REDACTED), which aimed to evaluate the effectiveness of a mobile application intervention in preparing preschool children and their parents for paediatric day surgery. Clinical secretaries at the participating hospital went through the surgery schedules each month and then informed the researcher of any people who fit the selection criteria. After calling the families and receiving oral consent, the families were sent written informed consent forms related to the study which included instructions and questionnaires. Families in the intervention group were also provided a guide for downloading and using the free BuddyCare (Android or iOS) mobile intervention application, including instructions for preparing for surgery 3–4 weeks before their child's surgery. The application provided a timeline that illustrates the phases of the surgical process and promptly delivered information. Families of the control group received instructions in line with the conventional form of preparation. These instructions, which were mailed to each family's home address, included information about the time of the surgery and recovery following surgery. In addition to the written guidelines, each child had an opportunity to watch a video called ‘Juuso and unikorkki’ (meaning ‘a boy named Juuso with an intravenous cannula (“sleep cap”) in his hand’). The parents could contact the hospital if they had any additional queries. The parents brought a form of written consent when arriving at the hospital.

The quantitative data reported in this study were collected using a questionnaire that the parents completed at home after discharge from the hospital. The questionnaire included questions about which preparation methods the parents had used and how satisfied they were with them. The questionnaires included clear instructions for how to complete the forms measuring children's preparation for day surgery.

Outcome measures Preparation methods used by parents

In the quantitative research, parents were asked which non-pharmacological methods they had used to prepare for their child's day surgery. The questions prompted parents to describe what kind of information they had given their children, what kinds of feelings they had discussed with their children while covering different phases of the procedure and what feelings were discussed when the parent told the child that the surgery would be the next day. The parents answered the questions using ‘yes’ or ‘no’ alternatives. The same background information as was collected in the RCT study was collected in this study; more specifically, the parent's gender, marital status, education and previous hospital experience, along with any pain medication the child may have received.

The questionnaire, which was originally designed by Pölkki (2002), includes “the preparation methods used by the parents for the child's procedure” and was psychometrically tested for reliability in an earlier study. The original questionnaire for parents, originally developed by Pölkki (2002), consists of four sections, but only a part of section two was used in the presented research.

Parents' satisfaction

Parents' satisfaction with the preparation, including various methods, was measured using a 100-mm horizontal line, which had the value 0 (‘I wasn't satisfied’) on one side and the value 10 (‘I was delighted’) on the other side. This is an example of a Visual Analogue Scale (VAS), which is a continuous, self-reported scale that measures a characteristic or attitude believed to vary over a given continuum (0–10). In the employed measure, we provided the parents with the following instruction: ‘There is a scale with ‘I wasn't satisfied’ at one end and ‘I was delighted’ at the other. Could you answer the question: How satisfied were you with the preparation instructions for your child's day surgery?’. The scale is considered reliable and valid (Williamson & Hoggart, 2005).

Data analysis

Parents' background information and the preparation methods for day surgery were described using frequencies and proportions. The statistics were calculated using IBM SPSS software for Windows (version 28; SPSS Inc., Chicago, IL). Parents' satisfaction with the preparation they received was described using the mean value (with standard deviation (SD)).

Qualitative phase Participants and procedure

The participants of the qualitative phase were parents (n = 15) with a child scheduled for day surgery. Participants for the qualitative phase were selected based on the time of their procedure, with sampling continuing until data saturation was achieved (Gray et al., 2020). Data saturation was achieved after 15 participants took part in the research. The data were saturated when new interviews started repeating the same information instead of providing new insights (Gray et al., 2020). None of the patients who were approached to take part in the research refused to participate in the interview.

The qualitative data were collected between January 2018 and May 2020 at the Paediatric Day Surgical Department of one REDACTED while the primary study was conducted. The participating parents brought a written consent form when arriving at the hospital. Next, the researcher arranged an interview with the child's parents. The semi-structured face-to-face interviews were conducted in the hospital environment, either in the patient's room or playroom, with no other families present. The interviews took place before the child's surgery. The interview question was: How did parents experience the most critical aspects of preparing their child for day surgery? The interviews lasted from 5 to 10 min. The interview framework was intentionally left rather loose so that parents would provide honest descriptions of their experiences. The face-to-face interviews consisted of open-ended questions in which the participants were asked to comment on both the method they used to prepare a preschool child for day surgery and their satisfaction with it. The research design, which included the employed methodologies, is shown in Figure 1. Repeat interviews were not needed.

Analysis

The study material was analysed using inductive content analysis because this method is suitable for qualitative data (Renz et al., 2018). In the first step, the researcher familiarised themselves with the material by reading through the written text several times (Elo & Kyngäs, 2008). In the preparation phase, a sentence or phrase in a sentence (these represent the possible analytical units) that was related to the research question was chosen from the data. Only the content that corresponded to the research question was marked in the text, with analytical units with different contents delineated with different colours. Meaningful units were then summarised, with similar codes then grouped into subcategories, categories and main categories (Elo et al., 2014; Kyngäs et al., 2020).

Ethical considerations

This study received Research Ethics Committee approval from REDACTED in June 2017. The study was conducted in agreement with the Helsinki declaration (World Medical Association, 2021). Written consent was obtained from all of the participants. Ethical considerations were respected at all stages of the study, and peoples' privacy and data protection were ensured throughout the data collection process (Gray et al., 2020). Participation did not affect the child's day surgical procedure. The researcher followed ethical principles to guarantee ethical quality. No public metadata exists for the research data.

RESULTS Quantitative phase Participants

A total of 41 children and their parents were recruited for the quantitative phase of the research; of these parent–child pairs, two did provide information about demographic characteristics. Most of the respondents were women (90%) and were married (74%) or cohabiting (21%). Most respondents had a vocational education (44%) or a college or polytechnic education (33%). Half (49%) of the families had no previous hospital experience. Of those who had visited the hospital before, 17 (85%) reported good experiences while one shared a bad experience (5%). None of the children used regular pain medication (Table 1).

TABLE 1 Demographic characteristics of the participants (n = 41) in the quantitative phase.

Demographic variable	n	%
Total	39	95.1
Missing	2	4.9
Gender
Male	4	10.0
Female	35	90.0
Marital status
Married	29	74.0
Cohabitation	8	21.0
Other	2	5
Educational level
Vocational education	17	44.0
College or polytechnic education	13	33.0
University education	9	23.0
Previous hospital experience
No	19	48.7
Yes, once	12	30.8
Yes, multiple times	8	20.5
Previous hospital experience
Good	17	85.0
Quite good	2	10.0
Poor	1	5.0
Child taking regular pain medication
No	39	100.0
Yes	–	–

Preparation methods used by parents Cognitive and sensory information

Regarding cognitive information, 39 (95%) parents reported that they had told their children about the upcoming day surgery procedure while two (5%) parents did not provide this information. Parents mostly told their children where the procedure would be performed (95%), what kind of procedure would be performed, who would perform it, and when the child could go home from the hospital (93%).

Most of the parents told their children about the anaesthesia that would be used during the procedure, the preparations related to the procedure (83%), and why it was essential (81%). A slightly lower share of parents told their children about the waking room/bed ward (73%) and the duration of the procedure (63%). In addition, parents told their children about wound care, the possibility for parents to be present at the hospital, and that toys would be available in the hospital (Figure 2).

FIGURE 2. Cognitive information provided to the children by their parents (n = 41).

Most of the parents discussed various emotions and feelings with their child, for example fear/anxiety (88%) during the procedure, pain (76%) after the procedure and pain/nausea (83%) at different parts of the hospital visit (Figure 3).

FIGURE 3. Sensory information provided to the children by their parents (n = 41).

Time of preparation

Of the parents, 38 (95%) told their child about the procedure for the first time at home while one parent (2.5%) told their child about the procedure at the hospital. Moreover, one parent talked about the procedure before an operation was cancelled/postponed (Figure 4).

FIGURE 4. The time of the surgical process during which parents prepared their child (n = 41) for day surgery.

Parental satisfaction

The parents were generally satisfied with the preparation they received, with a mean VAS of 8.7 (SD = 1.5). Of the parents who participated in the research, 10 (24%) gave the maximum score of 10 when asked about preparation, 11 (27%) scored the preparation as 9–9.9 and 11 (27%) scored their satisfaction with the preparation as 8–8.9. The results revealed that 20% of parents were not completely satisfied and would have desired further preparation.

Qualitative phase Participants

A total of 15 children and their parents were recruited for the qualitative phase of the research. Most of the respondents were women (87%) and were married (73%) or cohabiting (20%). Most respondents had a college or polytechnic education (80%); none of the parents had a vocational education. Over half of the families had either one (13%) or multiple (47%) previous experiences at the hospital, and everyone who had visited the hospital before had good experiences. None of the children used regular pain medication (Table 2).

TABLE 2 Demographic characteristics of the interviewed participants (n = 15) in the qualitative phase.

Demographic variable	n	%
Gender
Male	2	13.3
Female	13	86.7
Marital status
Married	11	73.3
Cohabitation	3	20.0
Other	1	6.7
Educational level
Vocational education	–	–
College or polytechnic education	12	80.0
University education	3	20.0
Previous hospital experience
No	6	40.0
Yes, once	2	13.3
Yes, multiple times	7	46.7
Previous hospital experience
Good	9	100
Quite good	–	–
Poor	–	–
Child taking regular pain medication
No	15	100
Yes	–	–

Parents' experiences with the most critical aspects of preparing their child

The inductive content analysis returned three main categories related to the preparation of children for day surgery: 1. usability of the preparation method; 2. content and timing of the preparation method and 3. consideration of the family perspective (Table 3).

TABLE 3 Parents' experiences of preparing their preschool child for day surgery.

Results of the inductive content analysis'
Subcategory (19)	Category (9)	Main category (3)
The functionality of the preparation method The additional load of the preparation method The quality of the preparation method Possibility to contact the staff Contact information for the hospital	Operating characteristics Possibility to contact the hospital	The usability of the preparation method
Adequacy of information Amount of information Quality of information Up-to-date information Detailed instructions for different procedures Scheduling information Getting to know the environment virtually Presentation of the procedure	Sufficient information High-quality information Timing at which the information was provided Getting to know the hospital environment	The content and timing of the preparation method
Taking diversity into account Family needs Trusting parents as experts in the care of their child The child has the opportunity to get to know what is done in the hospital Playground and meeting new friends Material aimed at children	Considering the individuality of the family Valuing the expertise of parents Considering the child's developmental level	Consideration of the family perspective

Usability of the preparation method

The parents said that the usability of the preparation method was influenced by the technique's functionality and the fact that it did not burden the parents. One parent mentioned: ‘…the programme seemed to slow down, and you had to provide confirmation several times before it was successful…’ (Parent P11). In addition, the parents said that it was essential for them to be able to contact the hospital if necessary.

Content and timing of the preparation method

The parents said that the preparation methods provided sufficient content about day surgery. One of the parents stated: ‘…if you want information much in advance, the mobile application made it possible…’ (Parent 12). In addition, the parents said that the information had to be high-quality, which meant that it could be efficiently accessed and included specific instructions for various procedures. One of the parents mentioned: ‘…the presentations were a bit old-fashioned, but there was enough information…’ (Parent 2). The parents also shared that it was important for the timing of the information to be correct. The parents said that getting to know the hospital environment was necessary, either through virtual or live means.

Consideration of the family perspective

Parents who were preparing their child for day surgery also said that the information they received should consider the family perspective. For instance, they shared that the preparation should consider the individual characteristics of different families, such as diversity and the family's specific needs. One of the parents mentioned: ‘…we went through all of the pictures and videos with the child, and we also read a fairy tale…’ (Parent 12) with another parent stating that they did not look at any videos or pictures. In addition, the parents said that the hospital staff should value parents' expertise, as the parents know their children the best. One of the parents described the situation as follows: ‘…I looked through all of the pictures and the video myself. Still, I didn't show it to the child because I judged it was better for the child that way…’ (Parent 3). The parents also said that it was essential to consider the child's developmental level when preparing them for day surgery; in other words, the preparation materials should be available in various forms that are relevant to different levels of development. One of the parents said: ‘…in a video aimed at children, it would be nice to include either a child or a character familiar to the child…’ (Parent 7). Furthermore, the interviews revealed that parents would like their children to play and get to know new playmates at the hospital. As an example, one parent stated: ‘…we would have liked to show the child a picture of the hospital's playroom…’ (Parent 8).

DISCUSSION

This mixed-methods study aimed to describe the preparation of children for day surgery from the parent's perspective. The study produced new information on how parents prepare their children and their experiences with the most critical aspects of preparing children for day surgery. According to the results, parents of preschool children consider the usability of the preparation method, the content and timing of the preparation method, and the consideration of the family perspective as necessary features of preparing a child for day surgery. Parents prepared their children for surgery with the help of cognitive and sensory information, and the preparation usually started at home well before the surgery. This study also demonstrated that a clear majority of parents told their children about the upcoming day surgery procedure.

According to the results, most parents gave their children detailed information about the upcoming surgery, including what will happen at each stage of surgery. Based on what has been reported in previous studies, the starting point for preparing for day surgery should be increasing the knowledge of both the child and parent, smooth cooperation, social support (Chang et al., 2020; Selimen & Andsoy, 2011) and understanding of what will happen in day surgery, and the opportunity to ask questions and receive instructions for appropriate care (Cutillo et al., 2020; Tam et al., 2020); these actions are critical to ensuring that the child and parents arrive at the hospital prior to day surgery in a calm state without pain, fear, anxiety or stress (Chang et al., 2020; Selimen & Andsoy, 2011). The parents want to participate and receive information about their child's day surgery (Aranha & Dsouza, 2019); according to our research, the parents told the child about the different stages of the procedure. Preparing the parents for a child's surgery is one of the most critical steps of day surgery. It helps parents and children to adapt to the situation (Anderson et al., 2020; Rice et al., 2008; Spencer & Franck, 2005; Yang et al., 2016) even if the situation often involves conflicting feelings and responsibility (Spencer & Franck, 2005). In addition, it is essential to prepare the parents because they are the child's psychosocial growth environment, experts in their feelings and a source of security. As has been stated in previous research, the parents and child cannot be separated, as the family as an entity has clear needs during medical procedures (Justus et al., 2006; Kain & Wang, 2007).

The parents who participated in this study provided their children information about anaesthesia, the duration of the procedure and what would happen after the procedure. It has previously been reported that children experience the induction phase as the scariest phase of the day surgery process (Eijlers et al., 2017); as such, more information about this phase should be provided to parents and children in the future. Parents should be given information about what happens after the procedure, such as assessing pain, pain medication and non-pharmacological methods (Anderson et al., 2020). In addition, parents often find managing recovery after day surgery challenging (Romaniuk et al., 2014), which could be explained by the amount of information given today regarding the intraoperative and postoperative phases needing to be more extensive.

According to this study, it was also crucial for parents that the family perspective was taken into account during preparation. Parents' involvement is essential because it increases parents' satisfaction with health care, reduces anxiety in both parents and children (Çamur & Sarıkaya Karabudak, 2021) and promotes a child's feeling of security (Dadlez et al., 2018; Romaniuk et al., 2014). Parents want to give their children versatile, clearly structured, relevant and up-to-date information, such as when and what kind of procedure will be performed on the child, who will perform the surgery, and when the child will be able to return home. In addition, parents want to offer children the opportunity to get to know the hospital environment so that it will feel safe when they arrive for day surgery. In this study, the parents hoped that the preparation would take into account the child's level of development, and that the preparation approach – which could be either traditional or rely on digital methods – would allow them to become familiarised with the hospital environment and receive timely information about the upcoming surgery.

Although the families participating in this study were generally satisfied with the preparation they received, it is important to note that day surgery is a significant event in the life of the child's family and can potentially frighten the child and cause anxiety and stress among parents (Gordon et al., 2011; Jaaniste et al., 2007; Lööf & Lönnqvist, 2022). As such, preparation for day surgery must support the needs of the family. In the future, the family perspective must be brought to the centre of preparation. Hospitals should focus on creating family-oriented tools for preparation that are flexible and supportive of the family's needs. Considering the individual needs of families can strengthen parents' coping (Eldridge & Kennedy, 2010; Kain & Wang, 2007; Lerret, 2009). According to Lööf and Lönnqvist (2022), the so-called routine provision of information is ineffective because the content and way in which information is presented do not correspond to the way children of various ages process information and understand content.

Digitalisation could be one solution to this dilemma. Digitalisation and digital health technologies are being increasingly used in healthcare to provide better services and offer new care paths (Hamilton et al., 2018; WHO, 2018; Yin et al., 2019). Digital tools include smartphones, tablets, various online platforms and wearable devices that are relevant to people's health and offer efficient modes for providing information (Booth et al., 2021; Yin et al., 2019). The scarcity of healthcare resources and the patient-oriented and -centred form of treatment make digital solutions especially relevant (Waller et al., 2015). It is already known that well-designed IT solutions can improve communication, improve the results for families and caregivers and accelerate the work of hospital staff (Kennedy & Howlin, 2021; Newnham et al., 2017). Digital solutions can offer children and families relevant, high-quality information at the right time of the care process (Adler et al., 2018; Suleiman-Martos et al., 2022) while the use of mobile applications during preparation for day surgery would effectively remove any distance or time limitations for access (McCloskey et al., 2018; Nytun et al., 2022).

The presented results once again highlight the importance of customer-oriented service design. The day surgery service chain should include clear policies and a shared understanding of the roles and responsibilities of parents and nurses in the hospital. Furthermore, transparent practices and participation can support the well-being of children and parents by decreasing uncertainty, which can be expected to alleviate both children's pain and fear and parents' anxiety and stress (Kain & Wang, 2007). In the future, the focus of preparation for day surgery should shift from the provision of information to materials that fit the child's level of development and the parent's needs (Lööf & Lönnqvist, 2022).

Strengths and limitations

In this study, the criteria often set for mixed methods research were taken into account, that is three key factors were taken into account when reporting the study results. The study included two methodological components, quantitative and qualitative phases. Both involved specific research questions, data collection approaches and analytical methods, which were defined by the methodology (Pluye & Hong, 2014). The presented research employed a contemporary design (“QUAN+QUAL”), the purpose of which was to improve the understanding of the phenomenon; more specifically, data collection and analysis were performed simultaneously, yet the qualitative and quantitative materials remained independent of each other until the results were combined to describe the studied phenomenon (Granikov et al., 2020).

Quantitative data were collected as a part of a questionnaire, which had been judged to demonstrate sufficient reliability and validity. Regarding the quantitative data, the sample size remained small, which could affect the generalisability of results. In addition, the generalisability of the presented results is affected by the fact that data were only collected from one hospital. However, the results can be regarded as a basis for the fact that it is essential to study a topic of interest regardless of certain limitations.

The same researcher conducted all of the interviews, and the parents were notified that participation was completely voluntary. To improve the reliability and transferability of qualitative research results, the study aimed for openness; for this reason, the selection of participants, their background information, and the data collection and analytical process were described in sufficient detail. The reliability of the research was improved by describing the contents of various categories and explaining how they were formed during inductive content analysis; this also improved the credibility of the research. The reporting of the collected data was complemented with the provision of several figures. The decision to include verbatim statements from study participants increased the reliability of the study. The necessary actions were taken to ensure that the interviewees' privacy was preserved. Qualitative analyses included certain challenges, one of which is that the analysis of material always involves the researcher's point of view. In this study, the risk of subjective opinions was reduced by the fact that another researcher was involved in the analytical process (Elo et al., 2014; Kyngäs et al., 2020). Similarities were found between parents' statements in the interviews and the quantitative results; this increases the reliability of the qualitative data (Lim et al., 2015). The interviews with parents were conducted in the hospital environment, which could vary from a patient room to another quiet space. During the interviews, parents' answers were written verbatim directly on paper; this deviated from the common practice of recording interviews. This solution was reached because it would have been unethical for the children's families to take them to a separate room before the child's procedure. At worst, it could have increased parents' anxiety and stress and children's fear. Most parents were mothers, which limits the generalisability of the results. It is possible that the negative experiences of the parents could also affect the outcomes.

CONCLUSIONS

Parents of preschool children prepared their children for day surgery in good time and were satisfied with the preparation materials they received. When discussing the critical aspects of preparation for day surgery, the parents mentioned the availability of high-quality materials, solutions with good usability and the consideration of the family perspective. As such, the results revealed a clear need for sufficiently versatile materials that support the different needs of families. At present, the available preparation methods focus primarily on the preoperative phase rather than on what happens in the operating room. As a result, parents require more materials that can help prepare them, along with their child, for what happens in the operating and recovery rooms and the timeline for recovery at home. However, new technological solutions can only partially replace face-to-face contact with nurses, so purely focusing on digital solutions may not meet the expectations of every family. Digitalisation can offer suitable solutions for preparation prior to surgery, but any new form of technology must be functional. Therefore, hospitals need to consider that all the materials they provide must be family-friendly to be effective. Mixed-method research is a valuable approach as it allows for the collection of diverse and trustworthy data sets through surveys while also providing a deeper insight into the experiences and emotions of families.

AUTHOR CONTRIBUTIONS

Heli Kerimaa: Conceptualisation, methodology, validation, formal analysis, investigation, resources, writing. Mervi Hakala: Writing – review & editing, supervision. Marianne Haapea: Formal analysis, writing – review & editing. Willy Serlo: Writing - review & editing, supervision. Tarja Pölkki: Conceptualisation, methodology, writing – review & editing, supervision.

ACKNOWLEDGEMENTS

The authors would like to thank all of the preschool children and parents who participated in this study. The authors also acknowledge all of the healthcare personnel who were involved in the research.

FUNDING INFORMATION

This research received grants from the Research Foundation of the Mannerheim Child Protection Union and the Society for Research in Nursing Sciences (HTTS).

CONFLICT OF INTEREST STATEMENT

The authors have declared no conflict of interest.

DATA AVAILABILITY STATEMENT

Available upon reasonable request.