Warm welcome for pre-op kids

Warm welcome for pre-op kids

beingwell magazine Winter 2007
By: Tina Rogers

Take me home, I’m scared,” nags the inner voice of many adults in hospital facing surgery, however minor.

When fear is amplified by the strange sights, sounds and smells of hospital life, you could be forgiven for wanting to run and hide.

Consider a child less than four feet tall, weighing in at 45 pounds and only six years’ life experience to fall back on. The fear can be much worse: Everything seems huge and imposing. Imagine being a small person in a hospital, surrounded by strangers in unusual garb, with unfamiliar machinery and devices — this adds to the anxiety. When these strangers then take a child into the operating room, leaving the parents behind, anxiety can easily turn to terror — for the whole family.

Not so at Southlake Regional Health Centre. Six-year old Emma Jackson, recently admitted to have her tonsils removed, went through the surgical pre-admission program, called You’re The Star, a week before her tonsil surgery. On operation day her experience was a good one, devoid of anxiety from start to finish, according to her mom.

“Emma knew exactly what was going to happen,” said Mrs. Jackson. “She was the one telling us where she should be going, and what was going to be happening at each step. She was not anxious at all.”

The unknown is scary. For children it can be terrifying, and reduce their trust in unknown adults. This program helps children ready themselves and their parents for surgery by removing the unknown.

Just describing something cannot set the scene in the same way a demonstration can, especially for a child.

The program is really a dress rehearsal in which each child is made the star of his or her own operation. Designed for children between the ages of four and 10, the program provides explanations in simple terms, at their own level, which helps them understand the process surrounding the surgery and to address their fears.

The initial version of the program was rolled out in the mid-90s. The program was recently revived and revamped following a three-year hiatus after the SARS epidemic, so Southlake could continue to provide benefits to families and healthcare providers alike.  

“Studies have shown that children who are prepared in advance through programs such as ours are less anxious about coming to the hospital for surgery than those kids who aren’t sure of what to expect,” said Dr. David Finkelstein, ear, nose and throat (ENT) specialist. “In our experience, the parents gain as much, if not more, from the program (as) their kids do.”

Through this program, Southlake demonstrates to their young patients that the hospital is a friendly place and reassures parents their children are in good hands. This results in less stress for everyone involved and makes hospitalization more bearable all-round.

About a week before the day of surgery, the children have a one-hour rehearsal for their surgery. The children, accompanied by one or both parents, are taken step-by-step through the sequence of events that will happen before and after the operation.

It’s a team effort. Two warm, friendly clinical nursing staff present the program to a small group of four children. The entire evening is prepared and presented in a way that young people can relate to, using language that is non-threatening and lacking in mystery and is directed to the children, with parents as onlookers.

The presenters, pediatric nurse, Debi Welling and surgical day care nurse, Debbie Thomas, give the children the chance to see, touch and feel the medical equipment and instruments that will be used to do their pre-operative assessments.

A blood pressure cuff is called a muscle tester, the anaesthesia mask is described as the jet pilot mask, while the oximeter is called a clothes pin or little duckie. The two nurses answer all the children’s questions and make an effort to bond with them.

A tour of the waiting room, operating room and recovery room follows, with the chance to see and touch equipment so that it becomes familiar. The children become involved in the process, there’s plenty of fun to be had during the hour and a caring hospital volunteer attends in a supportive role.

On the day of Emma’s surgery, “She was looking forward to seeing her friends Debbie, Debi and Marjorie,” said Mrs. Jackson, referring to the two nurses and volunteer who befriended her daughter a week before.

The tour ends with Rusty the puppet reinforcing what the children learned during the rehearsal. Puppeteers Ms Welling or Ms Thomas give hilarious performances through Rusty and engage the children in fun and laughter while testing the learning experience and warming the children to the friendly atmosphere.

York Region Emergency Medical Services (EMS) sponsors the program through the purchase of many stuffed owls, one for each child that goes through the program. The children are encouraged to name their own owl and bring it with them on the day of surgery.   

This program is offered to every child scheduled for surgery, most of whom are ENT. There were more than 475 ENT surgeries in 2005 and most of those were for five- or six-year-olds.

With the objective of having all surgical children go through the program, an information package is provided through ENT doctors’ offices and the program is promoted to parents at their child’s surgery consultation appointment.

The pre-operative assessment clinic is an adult version of the childrens’ program. It provides the opportunity to talk surgical patients through what will happen on the day of surgery in full detail. It does not include a tour or, not surprisingly, a stuffed owl.

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