Why is hospital preparation important?
James, aged 9, comes into hospital to have open heart surgery for a hole in his heart. He is admitted to the ward in the evening and enjoys meeting the play specialists as they have model aeroplanes for him to build. His parents have not told him that he is having an operation and feeling that they are doing the best by their child they have asked that no one else tell him either.
After his surgery James is unconscious for a day at the doctors’ wishes and his parents are at his bedside in intensive care. But, then comes the time to wake him up. At first he still has the ventilator attached and he his disoriented, but as he wakes up his breathing tube is removed and he should be able to begin to drink and sleep more naturally. But, James is panicked. He doesn’t understand where he is and why he is uncomfortable. He begins to scream and cry uncontrollably. His parents, who have just had the worst 2 days of their life watching their son helplessly become helpless again as he angrily turns his back on them.
The nurses have no choice but to give him more strong painkillers and sedation to calm him down and to bring his blood pressure down to stop it hurting his healing heart. His parents try to point out the plaster on his chest, as this was the only thing they said he would have, as part of a trip to a play centre. James is so angry with his parents that on leaving the intensive care he is still hardly talking to them.
As a nurse in intensive care I was part of the team of nurses who looked after James. This is an unusual situation as usually the play specialist and nursing team on the ward, where I have also worked, are able to convince parents that children recover quicker and are happier if they have been prepared for what is going to happen. The staff knows that parents know more about each individual child, but they have years of experience and research available to them in this specific area. It is for this reason that we should all strive more and more to work in equal partnership for the best interests of our children. (1)
Preparing children for procedures in hospital decreases their anxiety, helps them chose to be more cooperative and supports their coping skills. It may even teach them new ones! (2) As a parent I know hospital can be a place that makes you feel completely out of control. So why not take back the control and start by preparing your child yourself?
When can this preparation start?
- If you have a baby or toddler up to two years old.
The focus should be on preparing yourself. If you are relaxed then your baby will feel the same (3). Just like before your child was born when you were able to look round the birthing suite, or meet the midwife that was coming to your home, so now can you phone the hospital to arrange a visit to the ward that you and your baby will be staying on before the event. Senior nurses are even more than happy to show you round the intensive care unit if there is a chance that you may have to pay that a visit too. Having shown many anxious and at times tearful parents round I have not known one who does not leave happier and more relaxed.
- If your child is 2-4 years old
Then you should explain to them the day before (3) in language of your choosing. They need to know that they are going into hospital and what will happen when they get there. Giving them more than a day or two notice is not a very good idea as at this age children have a limited concept of time. We have all told our little ones to wait ten minutes only to be approached seconds later and asked ‘is it time yet!’Try to assure you relay the plan in a positive light, so that they realize the hospital visit is not a punishment for anything.
- At approx age five to six
When you notice that your little one is starting to understand the concept of time and is perhaps even learning the days of the week then you can be reassured in telling them three to five days (3)before. This ensures they have time to process the information, ask any questions and relay any anxiety to you. As in the previous age group it is important to reassure them that the visit is about fixing something and never a punishment.
- When your child is around seven to eleven years old
You can tell them a week before the visit and at this time there is no need to hide any information. They are old enough to understand the reason for the hospital stay (3)and that certain procedures may hurt, but that it will lead to less pain in the long run. Even though I will never advice lying to your child as it always seems to create more problems in the long run. It is still important to approach the subject in a positive manner and not dwell on the negatives.
- If your child is twelve years or older
At this age children can sign the consent alongside you for any procedures and even in later years sign it for themselves if deemed capable by the medical professionals.
It is important to include them in the planning from the very beginning. This can be a difficult stage for parents who are coping with an individual who is striving for independence, but it is important to remember they still need your support. It is recommended to ask them at intervals what you can do to help them and in that way you can find your place as parents without frustrating your child in a stressful situation (3).
For ways on how to prepare your child with useful books to read, games to play and what preparation you can expect from the play therapist at the hospital please see my next parental advice article (16th March 2013). In the mean time the slidehow will give you an idea of what is to come. happy parenting!
3. Hospital, Boston Childrens. For parents and families: age related guidelines. childrenshospital.org. [Online] 2013. [Cited: March 12, 2013.]