Commentary on Smith L and Callery P (2005) Children's accounts of their preoperative information needs. <i>Journal of Clinical Nursing</i> 14, 230–238

In this study conducted at the Royal Liverpool Children's Hospital, the authors assessed the information needs of children through direct interviews with children aged 7–11 years. Although limited by sample size, self-selection, timing and assumed homogeneous background, it is an important view from the perspective of the children. It is universally accepted that children should participate in their care and be informed of procedures in an age-appropriate manner. However, in a review of the literature, there is limited information regarding the specific information children need to allay their anxiety. In this study, children were able to identify their learning needs for preoperative information. The study is an important step in understanding approaches to make the surgical experience more comfortable for children. The children in the survey reported that they did not receive direct information from the hospital or from a healthcare professional. The information from this sample came from printed information for parents, television and experiences of others. This is an important issue as information from other sources may be misinterpreted, or misunderstood. Experiences of parents and others have an emotional impact and may have little relationship to the child's experience. The methodology enabled the children to identify their needs through writing, drawing and discussing their information needs. This enabled the children to communicate in an age-appropriate format. Categories of information desired by the children included information about the procedure, anaesthesia, the hospital environment and pain management. In an online search* * The search of the websites and online information in the UK, US and Canada is Barbara Sheers’ contribution and was not included in the original article by Lucy Smith and her colleagues. most children's hospitals in the US, Canada and the UK offer a wide spectrum of services for children and their families to receive preoperative information. Services range from limited information about the facility, focusing on essential information relating to hospital policy, to age-appropriate information about the expectations of hospitalizations. Most of the information was directed at the parents. Only a few of the hospital websites had information directed towards the children or implied that such information was available. Many of children's hospitals engage the services of child life specialists to ease the hospital experience and answer questions about the hospital experience. Some facilities offer preoperative tours designed for the children. During the tours children spend time in the environment and play with equipment. During the prehospitalization visit there is an opportunity to have their questions answered. Although these services are available, families may elect not to use them for a variety of reasons. In a few of the hospitals preoperative information sessions and tours are mandatory. This study adds to our body of knowledge of the needs of children and how their needs can be expressed. Clinicians can use this knowledge to prepare children better for their surgical procedures and alleviate anxiety thereby improving outcomes in care. Considerations for preoperative teaching include issues of age-appropriate information, the timing and delivery of the information and the opportunity to meet the specific information needs of the individual child. The information needs can be met in a variety of formats including booklets, printed materials, games and visits. The delivery and timing of the information needs to be geared to the child's age, experience and developmental level. Too much information or graphic descriptions can create additional anxiety. The timing needs to be close enough to procedure to allow for information synthesis with a contact to ask additional questions as they arise. Additional research is needed to explore the best methods to deliver the preoperative teaching and measure the effectiveness of the teaching in postoperative outcomes. The findings suggest that administrators and clinicians need to work together to afford flexibility in hospital policy to offer informational services that are age appropriate to the children. Some facilities have model programmes in place. These programmes view the child as the patient and focus on meeting their learning needs. Portions of the model programmes can be expanded into all settings offering surgical procedures to children. This study is an initial step, as clinicians begin to understand what children want and need to know about their procedures. In meeting the learning needs of the children we can reduce anxiety and teach them to be better consumers of health care.

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