Parental presence in OR means happy customers
Assign staff person to accompany parent
Do parents alleviate a child’s anxiety in the operating room (OR)? Or do they just add to the confusion and fear a child may have? Should a same-day surgery program allow a parent in the OR? If so, how long and who is responsible for the parent? While parents believe their children are less anxious when they are present during anesthesia induction, studies show that parental presence alone does not reduce a child’s anxiety.1
There is, however, a Yale University School of Medicine Study that shows that while only 12% of the anesthesiologists involved in the study believed that parental presence does have a significant calming effect on the child, 98% of the parents reported significantly higher satisfaction with their children’s medical care when they are allowed to accompany their premedicated child to the OR.2
You definitely should consider parental satisfaction, says Ellen Kavee, MD, assistant clinical professor, Department of Anesthesiology and Pediatrics at Mount Sinai School of Medicine in New York City. "We have to remember that although the child is our patient, it is the parent who is the consumer," she says.
Because parents often have a choice of locations for same-day surgery, this small difference may mean a parent choosing your program over another, says Sharon L. Tolhurst, RN, CNOR, MBA, executive director of ambulatory services for the Sarasota (FL) Memorial Healthcare System.
Have a protocol in place
Before you allow parents in the OR, have a well-defined protocol or policy that spells out who can come into the OR, how long a parent can stay, and which staff members are responsible for the parent , suggests Dona Martin Laing, RN, MSN, CNOR, CEN, clinical nurse specialist for perioperative services at MetroHealth Medi-cal Center in Cleveland. (See "Parental presence in the operating room during anesthesia induction" in this issue.) "Spend time developing the policy so all staff members, surgeons, and anesthesiologists are on board before you bring in the first parent," says Laing. It is far more comforting to the parent if there is no confusion among staff members regarding the parent’s presence, she explains.
Most programs that allow parents in the OR allow only one parent, and only during the initial induction of anesthesia, says Kavee. Some places have the parents leave before any intravenous lines or intubation are started, she adds. In all cases, a staff member, or in Kavee’s case, a surgical resident, is assigned to accompany the parent into and out of the OR at the appropriate times.
Parent’s presence must be approved
In Laing’s program, parents are not offered the option of accompanying the child until the surgeon and anesthesiologist have approved their presence, she says. "This may occur as the child is being prepared to go to the operating room," she adds. At that point, parents are told they can go into the OR for induction of anesthesia, if they want to, she explains. "We suggest that they hold the child’s hand, sing a favorite song, tell a story, or just talk quietly to reassure the child," Laing says. At the same time, the circulating nurse or a child life specialist is standing with the parent, she adds. "Once the child is asleep, the staff member places a hand on the parent’s arm and says it is time to leave," she explains. If a parent is hesitant, the nurse takes the parent’s hand and walks him or her out of the OR, she adds.
"We tell parents that they may be able to accompany the child during the pre-test telephone call and on the morning of surgery," says Tolhurst. "We explain that the final decision is made by the surgeon and the anesthesiologist, but we want them to consider whether or not they want to go in during induction," she says. During these conversations, the nurse explains what will happen and how long the parent may stay. "Setting expectations up front makes it easier for everyone," Tolhurst adds.
Kavee tells parents accompanying their child in the OR that if the child cries during a mask induction, it actually is helpful because the child breathes the anesthesia more deeply, which makes him or her fall asleep more quickly. "It’s important to let parents know that their child’s reaction to the mask or an unusual circumstance is normal," she adds.
Parents going into the OR generally wear a gown, hat, and shoe covers, says Laing. If the room is sterile, they wear masks as well, she adds.
Could be difficult for some parents
Even if your facility allows parents in the OR, be aware that sometimes it is better if they don’t accompany the child, says Kavee. "I’ve seen some children who are more mature than the parent; in fact, the children sometimes are telling the parents not to worry," she says. If one parent or another cannot stay calm and console the child, they should not accompany the child into surgery, she adds.
It’s also important to let parents know that they don’t have to go to the OR if they are not sure they want to go, says Laing. No parents should feel that their child will be all alone and traumatized if they don’t accompany them, she explains.
Some patients may have difficult airways, so the anesthesiologist may ask that the parents not watch induction, says Kavee. "It would be more traumatic for the parent to observe the anesthesiologist having a difficult time, and it would be more difficult for the OR staff to do their jobs," she explains. Children under a year old also do not need parents in the OR, says Kavee. "Children this young typically have difficult airways, and they usually are not calmed by a parent," she says.
References
1. Kain ZN, Mayes LC, Caramico LA, et al. Parental presence during induction of anesthesia. A randomized controlled trial. Anesthesiology 1996; 84:1,060-1,067.
2. Kain ZN, Mayes LC, Wang SM, et al. Parental presence and a sedative premedicant for children undergoing surgery: A hierarchical study. Anesthesiology 2000; 92:939-946.
Sources
For more information about parents in the operating room, contact:
• Ellen Kavee, MD, Assistant Clinical Professor, Department of Anesthesiology and Pediatrics, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1010, New York, NY 10029. Telephone: (212) 241-7467.
• Sharon L. Tolhurst, RN, CNOR, MBA, Executive Director of Ambulatory Services, Sarasota Memorial Healthcare System, 1941 Waldemere St., Sarasota, FL 34239. Telephone: (941) 917-1900. E-mail: [email protected].
• Dona Martin Laing, RN, MSN, CNOR, CEN, Clinical Nurse Specialist for Perioperative Services, 2500 MetroHealth Drive, Cleveland, OH 44109. Telephone: (216) 778-3084. Fax: (216) 778-3239. E-mail: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content