Focus on Pediatrics: Divide lessons pre- and post-op for heart patients
Focus on Pediatrics: Divide lessons pre- and post-op for heart patients
Parents need to be included, too
Parents who will care for their child after open-heart surgery aren’t taught much about those duties before the operation. Most of the education comes after. Their anxiety level is too high, explains Beth Dullanty, RNC, BSN, staff development specialist for the pediatric service line at Sacred Heart Medical Center in Spokane, WA.
"We used to give more information up front, but parents are afraid their kids will die. Their stress level goes from about 100 down to 50 when their child comes out of surgery," she says. Pre-op teaching focuses on what the family needs to know to prepare for the day of surgery and what will happen on that day.
When the child comes in for pre-op lab work before surgery, staff on the pediatric intensive care unit (PICU) give parents and child a tour to familiarize themselves with the surroundings. "We try to have the nurse who will care for the patient the day of the surgery do this, but that doesn’t always work out," says Dullanty. Following the tour, the nurse discusses what will happen the day of surgery.
Children learn what they will hear, smell, and see and what types of tubes will be present. For example, if there will be a tube in the child’s nose following the surgery, they are told this and that it will itch.
Each child receives a teddy bear he or she can bring to surgery. The bear is given the same bandages and tubes as the child. "We put little pieces of the tubes on the bears. If the child will have a breathing tube, a little piece of the tube is placed in the bear’s mouth," explains Dullanty. As children’s bandages and tubes are removed following surgery, they remove them from the bear.
Parents learn that their child will be pale following surgery and won’t move a lot. They also are told about all the tubes that will be connected to their child. "How the parents react will greatly effect how the children will react so if we have our parents prepared then they don’t overreact," says Dullanty. Parents are told they will be allowed to briefly see their child following surgery, and then they must leave the room until the child is stabilized.
Show, don’t tell
Teaching begins about eight hours after surgery with nurses instructing parents during the routine care. Parents learn post-surgery medical care, how to move their child in bed or pick up their baby, how to get their child to eat, and pain management. The education is progressive; nurses first demonstrate a technique, they then help the parent with the procedure, and finally parents do it independently.
A piece of post-op education that was added following a survey of parents is the behavior changes they might expect when they first take their child home. In the survey, parents said that no one told them their child might wake up in the middle of the night for the next two weeks or want to sleep with a night light. "We added to our discharge teaching that parents could potentially see some short-term personality and behavior changes or sleep disorders in their children," says Dullanty.
While anxiety is the main learning barrier prior to surgery, several barriers can hinder teaching following surgery. One is that parents that can’t get off work to stay with their child at the hospital. When this occurs, nurses must schedule a time for teaching. Another barrier is language. If parents are non-English-speaking, teaching times must be set up when interpreters can be present. "Parents learn so much better when they see us caring for their child and they are part of the team," says Dullanty.
To make sure education is completed in a timely manner, nurses follow a flow sheet that charts what should be taught on day one, and day two for the length of the hospital stay. Parents also receive written, standardized discharge instructions. "Even though we go over everything with them, with the discharge instructions, they can look back at every single piece," says Dullanty.
For more information about pre- and post-op heart surgery education, contact:
- Beth Dullanty, RNC, BSN, Staff Development Specialist for Pediatric Service Line, Sacred Heart Medical Center, P.O. Box 255, Spokane, WA 99220. Telephone: (509) 474-5312. E-mail: [email protected].
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