When a child is referred to the sedation team, it is often for a procedure that would be stressful or traumatizing for the child to complete while awake. Even though sedation is used to decrease stress and anxiety in children, the sedation itself can be perceived or experienced as stressful.
In order to decrease this pre-procedure stress, child life specialists often utilize procedural preparation to educate the child regarding the procedure. Providing the child, as well as the family, appropriate information about the procedure has been shown to positively impact stress and coping in many studies (e.g. Fernandes, Arriaga, & Esteves, 2014; Perry, Hooper, & Massiongale, 2012). It is important to note that because every child and family is different, there are many aspects to consider when preparing a family for a medical procedure.
Going into the finer details of delivering individualized preparation education is beyond the length of this essay, therefore the focus will be on how the child life specialist chooses to prepare the child and family. Factors that impact how a child life specialist chooses preparation techniques include developmental level, current anxiety level, past medical experiences, available educational tools, attention span, and time.
As developmental experts, child life specialists are trained on how to communicate with patients of all developmental levels. This includes educating patients and their families at the developmentally appropriate level. A child who is at the developmental level of an infant requires limited preparation, due to both limited language and cognitive abilities. For example, an infant who is getting nitrous oxide might be given a mask to explore with adult supervision. A child who is developmentally a toddler would benefit from exploring the medical supplies, accompanied by simple words. Preschool level children could benefit from practicing the procedure on a doll, using either real or pretend medical tools with adult supervision.
While more spoken language is used to teach, it is important to limit explanations to concrete ideas backed by visuals. School-agers find it helpful to understand the steps in more detail, such as expected sensations and duration of procedure and may also like to watch videos of others completing the procedure. They are also able to understand more complex steps, but can become confused with words that have double meanings, such as “I.V.” and “Ivy”. Adolescents sometimes want to see the actual medical supplies, watch a video, or just hear a verbal explanation. If the child is able to communicate, the child life specialist may ask the child what she or he already knows or understands about the procedure in question. Not only does this tell the child life specialist what information needs to be covered, but it also helps the CLS correct misconceptions that the child has.
While it’s important to know the developmental level, the anxiety level that the patient is experiencing does impact how information should be given. Usually a patient with higher anxiety does better with information limited to the five senses, or what the child’s job will be in the procedure. For the verbal child, the child life specialist may ask how much information the child wants and attempt to honor that wish.
The child life specialist also considers whether or not the patient has done the procedure before and what other medical experiences the patient has had. Perhaps the child has done this procedure before, but it went poorly. The child life specialist would be careful how to initiate the preparation, allowing the child to lead and watching for any increase in anxiety. If anxiety is noted, the child life specialist would attempt to find out what is the root of the cause and address it.
There are so many wonderful tools available now that can assist in prepping a child for a procedure, such as books, cards, pictures, videos, electronic apps, medical supplies, and even seemingly random items. Preparation books date back to the beginning of child life programs and they come in all shapes and sizes, including home-made books or photo albums that might include pictures of the hospital and staff as well as mass-produced, copy-righted books using either real photos or cartoons.
Most child life specialists have “prep kits” that are boxes that hold the medical supplies used in various procedures. These prep kits are used to show patients and their families the actual medical supplies that will be used and the steps that the procedure takes. Usually there is a doll that comes with the kit that allows the child to practice the procedure. Older children and teens often find the videos very helpful in seeing the procedure play out in a more realistic and less threatening way.
Both younger and older children also enjoy playing preparation games on tablets that demonstrate the steps of the procedure in an animated, fun way. And when necessary, random items can become preparation materials. A pencil is a similar width to the syringes used to give nasal versed, and a paperclip with a binder clip attached can mimic the shape of a port needle. By pairing the appropriate preparation materials with the developmental and anxiety level of the child, the child is able to better understand the procedure and hopefully assess the procedure as less threatening, therefore decreasing the stress response (Lazarus & Folkman, 1984).
Finally, considerations of attention span and the amount of time before a procedure also impacts how a child is prepared. If the child can’t seem to concentrate through all the steps of a VCUG, the preparation should be shortened to accommodate the need. Additionally, a child might benefit from watching the video of a child having a port accessed and also practicing all the steps on the preparation doll multiple times, but if there is only 5 minutes before the procedure needs to take place, then the child life specialist must decide what will be the quickest and most efficient way to proceed.
In conclusion, there are many different aspects to consider when preparing a child for a procedure. It is important to gather as much information as possible in order to provide the material in the most effective way to decrease stress and anxiety. When a child is provided with a preparation that is tailored to her or his needs, that child has an increased chance of coping more effectively with the procedure. This in turn leads to a child that is more relaxed and compliant in the procedure room, creating an improved experience for everyone.
References
- Fernandes, S. C., Arriaga, P, & Esteves, F. (2014). Providing preoperative information for children undergoing surgery: A randomized study testing different types of educational material to reduce children’s preoperative worries. Health Education Research, 29(6), 1058-1076
- Lazarus, R. S., & Folkman, S. F (1984). Stress, appraisal, and coping. New York: Springer.
- Perry, J. N., Hooper, V. D., & Masiongale, J. (2012). Reduction of preoperative anxiety in pediatric surgery patient using age-appropriate teaching interventions. Journal of Perianesthesia Nursing, 27(2), 69-81.
