Ginny Curtin, RN, MS, PNP, recently saw a 10-year-old boy who was terrified of having tonsil and adenoid surgery. He was afraid of getting an IV, that he would never return home, and that his mother would not be able to find her way to the hospital on the day of the surgery.
Curtin, a nurse at Lucile Packard Children’s Hospital in Palo Alto, Calif., tried to calm the boy by explaining the sequence of events on the day of surgery, but she knew he needed more time than she could give during a pre-op appointment. Luckily she had a new resource ready for him: an interactive website that would allow him to learn how to prepare for his surgery, aspects of his treatment, and how to get around once he was at the hospital.
The Packard Kids Connection website, which launched in June 2007, is the hospital’s newest strategy in the effort to prepare children for their stays at Packard. According to nurses like Curtin, a member of the team that created the site, this high-tech tool is invaluable when it comes to giving kids a sense of control and allaying their fears about the mysteries of surgery.
What to expect
Although tonsil, adenoid, and ear tube procedures are among the most common surgeries at Packard, children also come for everything from cardiac repairs to bronchoscopies to gastrointestinal procedures.
To prepare the children for their surgeries, first they see a nurse practitioner for a pre-op appointment about a month before the procedure. During this appointment, the nurse performs a physical exam and explains the sequence of events for the day of the surgery. Curtin also mentions the website if the patients are interested in learning more.
For example, in the get treated link on the site, children can click on icons to learn about anesthesia, getting an IV, getting an X-ray, having an MRI, going for a CT scan, or having blood drawn. Having a needle inserted for an IV is one of the most common fears among kids, Curtin says. The website explains the entire process, such as the numbing cream the nurse may use, and the fact that children can use relaxation techniques to stay calm.
The website is ideal for school-age kids who have a need for lots of information, Curtin says. It allows the child to tailor their experience to what they want to know.
Curtin has also seen the benefits of the website among her teen patients, who seem more prone to worry and fearing worst-case scenarios.
In addition to using the website to prepare for surgery, many patients will have an appointment with a child life specialist either a couple days before their procedure or the day of the surgery. For preschool-age children, the specialists use medical play with a doll to teach children about the anesthesia mask, and how monitors and leads will be attached to their bodies. In this age group, IVs are usually inserted after children are asleep, so child life specialists do not need to spend extensive time preparing them for this.
School-age patients, however, are awake for the IV insertion. The child life specialists teach them how to prepare a plan for positioning themselves for the needle insertion, says Shannon Gullion, BS, CTRS (certified therapeutic recreation specialist). Children can hold their parents in a belly-to-belly position with their arm out, or sit next to a parent who is holding the arm. Children can also decide whether they prefer to watch the needle insertion or distract themselves by looking the other way to read a book.
Behind the scenes
Although one strategy for preparing kids for surgery is to arm them with information before the surgery, one of the challenges is avoiding too much detail.
For example, the content team for the website originally planned to have a section that walked the children through the OR, but Curtin and the child life specialist reminded the team that the children are sedated during the surgery and that knowing the details of the OR might frighten some kids.
One of the best things Ginny contributed was helping us know the level of understanding kids can process, says Marisa Desai, MPH, manager of the website project. By default, we always tried to develop content talking to parents, but we really wanted this to be something for the kids.
Curtin also had a role in verifying the site was medically accurate. For example, she made sure devices such as the blood pressure cuff were shown on the correct part of the arm and the child character on the site was wearing the surgical gown at the proper time.
Although Curtin acknowledges the project was time consuming, she hears from parents and pediatric patients that the website is invaluable for kids when it comes to reducing anxiety about coming to the hospital.
We ended up with such a wonderful product, Curtin says. I use it every day, and I enjoyed helping create something you actually use rather than something that simply sits on a shelf.