Young patients require special considerations when preparing to have a surgical procedure, however medically routine it may be. Nurses who work in pediatric surgery know it's the little things that make all the difference when it comes to a stress-free surgical experience for children and their families.

Thinking Ahead

At Children's Healthcare of Atlanta, the preparation begins in the physician's office when a surgical procedure is scheduled. The surgical department developed a handout that is provided to affiliated physician's offices that explains where the hospital is located and what the parents can expect prior to surgery, including how parents can prepare their little one at home. Parents also may visit www.choa.org/surgerysafety before their child's surgery.

"This helps the parents and cuts down a little bit of their stress," said Margaret Lambert, BSN, RN, resource nurse at Children's Healthcare of Atlanta. "We also make phone calls a week prior to the surgery when we go over all the preoperative instructions, such as what time they have to arrive [at the hospital], and the eating and drinking instructions for the children."

The hospital offers preoperative and preanesthesia clinics families may choose to attend.

The Pediatric Surgery Center, Plano, TX, also offers a preoperative tour and encourages parents to visit their Web site, www.pediatricsurgerycenter.com, which Becky Serna-Autrey, RN, described as "fantastic."

"[The Web site] teaches parents a lot, and all of our surgeons have pamphlets that explain everything we're going to do," Serna-Autrey added.

Above All, Honesty

Lambert noted before age 5, lengthy, detailed descriptions aren't necessary.

"You really can't 'prepare' a toddler," Lambert said. "The main thing is to be truthful about where they are going and what's happening to them. That establishes trust with a child. If you tell them they're going to McDonald's and you take them to the hospital, that doesn't establish a lot of trust."

Serna-Autrey couldn't agree more. "Sometimes parents will say, 'Oh, you're going to get a hair cut," and ask us to please not mention their child is going into an operating room," Serna-Autrey said. "[I think] that's a horrible way to treat a child, but we cannot say anything if that is the parents' wish. But, that's about one in every 1,000 cases."

Waiting Game

The day of the surgery, parents arrive with their child a couple hours before the procedure is scheduled to begin. "We let the parents be with them and hold them as much as possible," Lambert said. "We have toys in the lobby they can play with, and then they are taken back to a private room and the parents stay with them."

When Lambert meets the family in their private room, she lets the child sit on mom's or dad's lap, and gets down to the patient's level whenever possible. "I'll talk to them and then assess them from head to toe and listen to their heartbeat," she said. "I put the pulse ox on their finger and it lights up; so we'll turn the light on and they like that. Then I'll try to get their blood pressure. Being cheerful puts the parents at ease and also most children."

A child life specialist is available to assist the perioperative nurses with preparing a child for a procedure through play and explanation, if necessary.

At Pediatric Surgery Center, Serna-Autrey said the staff tries to deinstitutionalize the experience. "We try to keep the children in their own clothing as much as possible, and they can bring their favorite toy, blanket or baby [doll], whatever works for them," she said.

Both nurses noted distraction is the best tool. The waiting areas are equipped with the televisions and DVD players with current kid favorites.

Time Apart

About 20-30 minutes prior to the procedure, a preanesthesia medication, typically midazolam, is administered.

"It sedates the patients a little bit and they don't remember leaving mom and dad, which helps greatly," Lambert said. "When we take them back to the operating room, they are usually put to sleep with the mask and then the IVs are started, so none of the 'owies' are done when they are awake."

All the education in the world may not put a parent's mind at ease when it comes time for their child to be taken back to the OR. Although the parents have an opportunity to talk with the anesthesiologist, the thought of their child under general anesthesia can be difficult.

"While I may think this is a simple ear tube or hernia repair, to this parent and child it is major," Lambert noted.

Serna-Autrey agreed, and said assessing the parents and meeting their needs is also part of her job. "Taking care of the parents is as important [as caring for the patient], Serna-Autrey said. "I may have a minute or so to talk to parents [before the procedure], and you can learn a lot about what they are concerned about in that time."

She asks parents to be strong for their child, because the child will react to how they react, and she also reassures the parents their little treasure will be in good hands. "While I'm in the room with their child, I am the child's 'parent' - it is my job to take care of that child as if they were my own and make sure nothing goes wrong," Serna-Autry explained.

All Done

Following surgery, the child is taken into the PACU for recovery. When children aren't able to articulate their pain management needs, nurses observe each child's behavior and use a pain scale to determine any level of discomfort. After pain medicine is administered, if necessary, and the child becomes alert, he is reunited with his parents.

The final part of Lambert and Serna-Autrey's role is a follow-up phone call to the family to make sure the child is recovering well. While complications can occur with any procedure, kids generally recuperate quickly from routine surgeries. "Toddlers bounce back really fast," Lambert noted. "Faster than adults, I can assure you." n

Barbara Mercer is senior associate editor at ADVANCE.