How can health care teams help kids prepare for heart surgery?University of Michigan Health System U-M pediatric heart specialist leads preparation of new guide published today by American Heart Association team A pediatric heart specialist from the University of Michigan's renowned Congenital Heart Center is the lead author of a new guide published today by the American Heart Association, on ways to help children prepare for heart surgery. The new recommendations say timing and technique are everything when educating very young children about procedures. For older children, learning relaxation techniques and exposure to others who demonstrate positive coping during similar situations are very effective methods to prepare for procedures.  The AHA scientific statement, published in today's Circulation: Journal of the American Heart Association, indicate that older children may benefit from having information about a week before their procedure, while younger children may be less anxious if information is withheld until the day before surgery. The expert panel suggests that pre-procedural education be individualized, since abundant information actually might increase the anxiety of some children who are undergoing invasive cardiac procedures. "Our responsibility as health care providers is to help prepare children and adolescents in a way that these invasive procedures result in as little stress, anxiety and psychological trauma to young patients as possible," said Sarah LeRoy, R.N., M.S.N., the U-M pediatric nurse practitioner who led the writing group. She continues, "There is a large body of research that supports simple, low-tech interventions that can be done by a variety of healthcare practitioners, but utilization of these interventions has not been widespread. Our goal was to create a document that would pull together available research in a document that would facilitate program-wide, systematic implementation of these interventions." Preparation needs to be based on both age and previous experiences, LeRoy adds. "Children who have been through surgery will often react differently than those who have not," she said. Recommendations discussed in the guidelines include coping skills training such as relaxation techniques and guided imagery in which the child learns to focus on a positive, relaxing scene during times of stress. Another idea is relaxation supported by biofeedback. Most children seem interested in the equipment used for biofeedback and lack the skepticism that some adult patients may have. Refocusing techniques include using video games to distract children during procedures and having child-friendly waiting and procedure areas. Play therapy is a recommended form of communication for younger patients to present medical concepts. Using "props" such as syringes, masks, and dolls with incisions can help prepare children for their hospital experience. For pre-teens and teenagers, child-to-child and parent-to-parent peer counseling has been shown to help patients cope with a cardiac procedure. Typically, children who need invasive cardiac procedures have congenital heart disease, which affects 8 out of every 1,000 live births. Two or three of those children will require cardiac catheterization or surgical repair. The U-M Congenital Heart Center is one of the world's most experienced and most comprehensive programs for this kind of care, with an international patient base that comes to the U-M's C.S. Mott Children's Hospital for more than 850 heart operations and 600 heart catheterizations each year. "For many patients, these procedures occur over a spectrum of developmental stages. They might need a procedure as an infant; another as a toddler; another as a 10 year old; and still another at age 18. They often have unresolved fears and gaps in information from hospital experiences that occured at very young ages," LeRoy says. The new guidelines offer the following age-appropriate interventions before cardiac procedures to help ease these tensions.
The guidelines also suggest the timing of these interventions. For children age 2 years and younger, interventions should be the day of, or during the procedure. For those age 2 to 7 years, a 15-minute session the day before the procedure usually suffices. Some 6- to 7-year olds may benefit from information as early as a week in advance. For children age 7 to 11, information should begin one to two weeks before the procedure. For highly anxious or experienced children in this age group, coping skills training or biofeedback could begin as early as six weeks before the procedure. For children age 12 to 15 years, information may begin when the decision for surgery/catheterization is made; peer counseling can be at any time; coping skills training and biofeedback may begin six weeks before the procedure. "The bottom line is that not all interventions are for all people. There are factors that need to be assessed and then the intervention tailored accordingly," LeRoy says. The report explains that everyone on the healthcare team who cares for the child, from physicians to nurses, social workers and pediatric psychiatrists, plays a role in educating children and their families about the interventions, LeRoy says.
For more information, or to contact University of Michigan Health System, see their website at: www.med.umich.edu |
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