Perceptions of parents' participation in the care of their child undergoing day surgery: pilot-study.

In Canada, more than 100,000 children have procedures in day surgery units. In spite of certain programs designed to prepare those children and their parents for the procedures and events that take place in a hospital, the parents' role during the day stay is not openly and directly approached. Although many pediatric centers recognize the importance of the role of the family in the life of children with health problems, the perceptions of parents with children undergoing day surgery and their role in the hospital have not yet been studied. Therefore, the objective of our study was to describe parents' perceptions regarding their participation in the care of their children in a day surgery. Godin and Kok's (1996) integrated behavior prediction model related to health, which was drawn from Ajzen's theory of planned behavior (1991), was chosen for this research. An interview questionnaire was developed as the measurement instrument. Content analysis was the basis for the analysis of the data gathered through the interview questionnaire. Our article presents the results of this pilot study.

[A new instrument to measure distress in the operated child]. / Un nouvel instrument pour mesurer la détresse d'un enfant opéré.

Having noted the lack of a French language tool to evaluate distress behaviours of children in a day care surgery situation, and after an exhaustive review of the literature on the subject, the author developed a measuring instrument for distress levels in such children. The 1999 version of the Echelle descriptive des comportements de l'enfant opéré (EDCEO) is a chart of observations used to measure anxiety, fear and pain in children aged 3 to 10 during the day when surgery is performed. The author describes the instrument, its components and the steps leading to its validation. Suggestions as to its uses in clinical and research situations are also presented.

[Measure of parental behavior during children's ambulatory surgery]. / Mesure des conduites parentales lors d'une chirurgie de l'enfant en court séjour.

A new instrument, l'Inventaire des conduites parentales, was validated by the main author during her doctoral studies. The purpose of her research was to measure the effect of an educational intervention on parent's behaviors. This instrument, based on an educational theoretical framework, was composed of 16 behaviors divided into 3 categories: verbal information, cognitive strategies and attitudes. The reliability of the initial version of the instrument was measured with a sample of 142 parents. The interrater agreement was of 94.3%. The factor analysis showed that 14 of the 16 items were closely related to 4 clusters of variables. Following the factor analysis results, and the utilization of this instrument by research assistants, it was revised and is now described in this article.

[Effects of a preoperative educational intervention on the behavior of parents of three to six-year old children having day surgery]. / Les effets d'une intervention éducative préopératoire sur la conduite de parents d'enfants de trois à six ans opérés dans le cadre d'une chirurgie d'un jour.

This quasi-experimental study assessed the effects of an intervention with the parents of children aged 3-6 at 2 weeks before the child's admission for day surgery. It entailed providing the parents with an educational booklet embodying the learning theories of Gagné and of Bandura. The 150-parent sampling was randomized into 2 experimental groups (receiving the educational booklet) and 1 control group (receiving only an information leaflet). Their behaviour was observed by means of video camera at various times on the day of surgery. In addition, the subjects themselves (usually the mother) assessed their level of anxiety. The parents in the experimental groups displayed greater competence on the day of surgery, and reported less anxiety, than did the control subjects. The study underscores the effectiveness of an educational approach favouring the use of family-targeted instructional material. It also shows that parents are able to use the information they receive to effectively prepare their tots for day surgery. The implications for research and clinical practice are examined from the vantage points of benefits to parents, child, and nursing staff and implementation of new ambulatory-care strategies.

Assessment and management of children's pain in community hospitals.

Registered nurses (n = 72) working in 10 paediatric units in community hospitals in north-eastern Ontario, Canada, participated in a descriptive study investigating how nurses assess and manage pain in children. A four-part questionnaire was used to collect the self-reported data. Twenty-five (36%) of the respondents defined pain as an individual and personal experience and another 25 (36%) respondents defined pain as a more or less localized sensation or discomfort resulting from the stimulation of specialized nerve endings. In response to three different clinical situations, the subjects' mean pain ratings were: 5.72 for an infant; 7.34 for a 3-year-old; and 7.29 for a 12-year-old child. The criterion 'nurses' judgment' was cited as being used frequently in both the assessment and decision making process; however, there was indication that some of the current knowledge in the assessment and management of pain in children was not known or being used.

[Emotional states of mothers and behavior of the child during minor surgery]. / Etat emotionnel des meres et comportement de l'enfant lors d'une chirurgie mineure.

The objectives of this descriptive correlational study were to measure the degree of fear-anxiety in mothers and in their children who were having minor surgery, and then to verify if there was a relationship between these two variables. Other variables examined were: child's age, rooming-in, premedication and child's experience with surgery. Fifty (50) mothers described their emotional states both on the day before and during the surgery. Fifty (50) children between the ages of two (2) and ten (10) years old were observed at five different times (one hour preoperatively, leaving for the OR, pre-induction, coming back to the room and one hour post-operatively). Their behaviours were noted on a new scale, the ECEO: Echelle des comportement de l'enfant opéré. This scale was developed to describe the behaviour of children experiencing fear, anxiety and pain. Results show that the mother's fear-anxiety score was significantly higher during the surgery than before it (t df.49 = 3.77, p < 0.001). Rooming-in significantly affected mothers' emotional states (F = 4.07, p < 0.05). Younger children were more affected than older ones; they also showed more distress when the mother was present (t df.49 = 5.31, p < 0.001). Rooming-in contributed significantly to the child's stress score; children whose mother roomed-in at least one night showed more distress behaviours than children whose mothers did not room-in (t df.48 = 2.03, p < 0.05). A correlation was found between the degree of mothers' fear-anxiety and the children's fear-anxiety-pain score or distress behaviours (r = .28, p < 0.05). A strong relationship was established between the total distress score of the child and his or her score when the mother was present (r = .81, p < 0.01). These results support the theory of social referencing: the child is influenced greatly by the mother's emotional state and he refers to her for the interpretation of events provoking anxiety. Therefore, nurses should inform and support mothers, especially those who are rooming-in; they should also make more use of parents in the preparation and the management of the child for surgery. The development and validation of an instrument measuring fear-anxiety-pain in younger children will facilitate evaluation of the effect of surgery or other procedures on the child, and the planning adequate interventions.

[Preparation for surgery]. / Préparation à la chirurgie.

Pediatric surgery can be a traumatic experience for both parents and children. That's why many children are now released the day of their operation. However, the need for preoperative counselling, reassurance and information is still there. The author explains why and shares the results of a preoperative questionnaire that she developed and implemented in a pediatric unit. The resulting improvement in the quality of care is documented.