J Korean Acad Nurs.  2012 Jun;42(3):333-341. 10.4040/jkan.2012.42.3.333.

The Effects of Pre-operative Visual Information and Parental Presence Intervention on Anxiety, Delirium, and Pain of Post-Operative Pediatric Patients in PACU

• Yoo JB
• Kim MJ
• Cho SH
• Shin YJ
• Kim NC

• KMID: 1785217
• DOI: http://doi.org/10.4040/jkan.2012.42.3.333

Abstract

PURPOSE
The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage.
METHODS
This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain.
RESULTS
Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group.
CONCLUSION
The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU.

Keyword

Recovery room; Child; Anxiety; Delirium; Pain

MeSH Terms

Adolescent
Anesthesia Recovery Period
Anesthesia, General
*Anxiety
Child
*Delirium
Female
Humans
Male
*Pain
*Pain Measurement
Parents
Patient Education as Topic
Postanesthesia Nursing
Preoperative Care
Recovery Room

Figure

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  Figure 1 Research design.

Reference

1. Bae JY, Song E, Kim JT, Kim HS, Kim JS, Kim SD. Comparison of emergence agitation between sevoflurane, desflurane, and propofol with bispectral index monitoring in pediatric anesthesia. Korean Journal of Anesthesiology. 2008. 55:161–165.

2. Broadman LM, Rice LJ, Hannallah RS. Testing the validity of an objective pain scale for infants and children. Anesthesiology. 1988. 69(3A):A770.

3. Caumo W, Broenstrub JC, Fialho L, Petry SM, Brathwait O, Bandeira D, et al. Risk factors for postoperative anxiety in children. Acta Anaesthesiologica Scandinavica. 2000. 44:782–789. http://dx.doi.org/10.1034/j.1399-6576.2000.440703.x.

4. Cho SC, Choi JS. Development of the Korean form of the state-trait anxiety inventory for children. Seoul Journal of Psychiatry. 1989. 14(3):150–157.

5. Cole JW, Murray DJ, McAllister JD, Hirshberg GE. Emergence behaviour in children: Defining the incidence of excitement and agitation following anaesthesia. Paediatric Anaesthesia. 2002. 12:442–447. http://dx.doi.org/10.1046/j.1460-9592.2002.00868.x.

6. Deleskey K. Family visitation in the PACU: The current state of practice in the United States. Journal of PeriAnesthesia Nursing. 2009. 24:81–85. http://dx.doi.org/10.1016/j.jopan.2009.01.002.

7. Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit; An under-recognized syndrome of organ dysfunction. Seminars in Respiratory and Critical Care Medicine. 2001. 22:115–126. http://dx.doi.org/10.1055/s-2001-13826.

8. Francis J. Prevention and treatment of delirium and confusional state. 2011. Retrieved August 30, 2011. from http://www.uptodate.com/contents/prevention-and-treatement-of-delirium-and-confusional-states.

9. Hong JY. Effects of sensory information on preoperative anxiety of day-case surgery patients. Korean Journal of Anesthesiology. 2001. 40:435–442.

10. Im JH. Effect of ketorolac and fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing tonsillectomy and adenoidectomy. 2003. Seoul: Ewha Womans University;Unpublished master's thesis.

11. Ji HS. Effects of visual information program on the easing of anxiety of pediatric patients and their parents. 2004. Gongju: Kongju National University;Unpublished master's thesis.

12. Kamerling SN, Lawler LC, Lynch M, Schwartz AJ. Family-centered care in the pediatric post anesthesia care unit: Changing practice to promote parental visitation. Journal of PeriAnesthesia Nursing. 2008. 23:5–16. http://dx.doi.org/10.1016/j.jopan.2007.09.011.

13. Kennedy CM, Riddle II. The influence of the timing of preparation on the anxiety of preschool children experiencing surgery. Maternal-Child Nursing Journal. 1989. 18:117–132.

14. Kim YH, Lee HZ. The effects of informational intervention on postoperative pain following tonsillectomy in children. Journal of Korean Academy of Child Health Nursing. 2002. 8:400–413.

15. Koo HY, Cho YJ, Kim OH, Park HR. The effects of information using photographs on preoperative anxiety in children and their parents. Journal of Korean Academy of Child Health Nursing. 2007. 13:273–281.

16. Lee SC, Chung CJ, Chin YJ, Lee SI, Lee JH. The effects of anesthetic agents on emergence delirium in pediatrics strabismus surgery. Korean Journal of Anesthesiology. 2007. 52:138–142. http://dx.doi.org/10.4097/kjae.2007.52.2.138.

17. Lee SH, Chung KW, Park IO. Effects of preoperative nursing information on anxiety and stress in patients undergoing surgery. Journal of the Korean Association of Operating Room Nurses. 2001. 9(1):99–111.

18. Lee MH. The effects of visual information program on anxiety and role behaviour of pediatric tonsillectomy patients and their mothers. 2008. Seoul: Kyung Hee University;Unpublished master's thesis.

19. McCaffery M. Nursing management of patient with pain. 1979. Philadelphia: Lippincott.

20. O'Kelly SW, Voepel-Lewis T, Tait AR. Postoperative behavior and emergence delirium in pediatric patients: A prospective study. Anesthesiology. 1997. 87:A1060.

21. Paik HJ, Ahn YM. Measurement of pain following strabismus surgery in children. Journal of the Korean Ophthalmological Society. 2000. 41:985–992.

22. Potts NL, Mandleco BL. Pediatric nursing: Caring for children and their families. 2002. New York: Delmar.

23. Roberts BL. Managing delirium in adult intensive care patient. Critical Care Nurse. 2001. 21:48–55.

24. Sikich N, Lerman J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology. 2004. 100:1138–1145.

25. Suh HJ, Yoo YS. Intensive care unit nurse's knowledge, nursing performance and stress about delirium. Korean Journal of Adult Nursing. 2007. 19:55–65.

26. Vlajkovic GP, Sindjelic RP. Emergence delirium in children: Many questions, few answers. Anesthesia and Analgesia. 2007. 104:84–91. http://dx.doi.org/10.1213/01.ane.0000250914.91881.a8.

27. Yoon HB, Cho KJ. A survey on the nonpharmacologic nursing intervention for children in pain. Journal of Korean Academy of Child Health Nursing. 2000. 6:144–157.

28. Yoon JR, Kim TK, Yoon SJ, Kim YS, Kim SH, Kim MG, et al. Severe postoperative delirium lasting for three weeks. Korean Journal of Critical Care Medicine. 2004. 19:42–46.

29. Yu MY, Park JW, Hyun MS, Lee YJ. Factors related to delirium occurrence among the patients in the intensive care units. Journal of Korean Clinical Nursing Research. 2008. 14:151–160.