Various Ways To Minimize Hospital Fear Among Children

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Children have always found going through an operation as a frightening experience. They tend to cry a lot and become uncooperative. All these stresses and fears, even the use of pain relief after the procedure, can be diminished through application of simple interventions like drawings, continuity, and dialogue. A study in the Sahlgrenska Academy at the University of Gothenburg, Sweden revealed this. The children’s descriptions of their hospital and surgical experience were noted by Berith Wennstrom in her thesis interviews. The analysis of saliva samples from 93 children from 5 to 11 years old was also performed, as part of the thesis, so that the concentration of the stress hormone cortisol would be measured.

The researchers utilized a special model where children have been assigned to one of three groups: (a) in the first group, children were taken care in the usual manner prior to surgery; (b) in the second group, children received additional information of what was to be expected on the day of the surgery; and (c) in the third group, children received care based from a special model, called perioperative dialogue (PD).

According to Berith Wennstrom, the study illustrated that there had been reduced levels of stress after surgery among those who were taken care of following the PD model. Moreover, they required less pain-relieving morphine, compared to children taken care of with the conventional approach. The basis of PD model is allowing time for the child to reflect on the upcoming operation by continuity and dialogue, as well as giving the nurse-anesthetist enough time and resources in lending support to the child and the family. Preparative visits to the clinic, where the child will be familiarized with the faces he might encounter on the surgery day, are good examples.

The thesis also included a unique experiment which made us of drawings to analyze children’s fear of hospital. It was shown in the comparison between the drawing of children in school and those in the hospital that the latter exhibited weak pen pressure, utilization of few colors and poor use of the page area. All these observations can be attributed to an elevated anxiety level of children who were to be operated. Moreover, drawings can aid in facilitating dialogue with children undergoing an operation, and a means for them to communicate their concerns.

Children 6-9 years old were also interviews before and after day surgery. The interviews demonstrated that the children feel forced into a volatile situation most of the time, which demands them to face an unusual world and to overcome the obligatory hospital stress.   What can be deduced would be that children would try to cope with the situation, but they lose this sense of control, for example, when they become lightheaded from sedatives.

Furthermore, engaging in a continuous dialogue with children, with the use of the children’s own language, is very necessary in preventing fear and anxiety about the surgery from setting in.  Administration of sedatives should not be routinely, instead careful and thorough assessment should be done.

Berith Wennstrom articulated the thesis conclusion—“the Swedish perioperative healthcare functions relatively well and supports children and their parents.” He added that in order to succeed, it is necessary to see the hospital experience from the child’s perception, and to reduce the hospital stress and fear of children pre-operatively. Additionally, the thesis entitled “Experiences, symptoms and signs in 3-11 year-old children undergoing day surgery in the context of the perioperative dialogue” was defended successfully last November 11, 2011.




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