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Lecture
for medical students at the Faculty of Medicine King Fahad Medical City on 19th
May 2014 by Professor Omar Hasan Kasule Sr.
·
Impact
of anxiety: the length and difficulty of the procedure may be increased,
inaccurate data may be obtained from the procedure, and physical harm may occur
as a result.
·
Psychological
preparation for invasive procedures prevents anxiety
·
Intrusive
healthcare experiences can have a profound negative impact on a child's
psychological well-being for months to years after the experience.
·
We
need techniques and strategies to enable the child cope
·
Techniques
for preparation
·
Techniques
for procedural support
·
Techniques
for follow-up,
PSYCHOLOGICAL
PREPARATION OF CHILDREN FOR SURGERY[3]
·
Puppet play
·
Mother counseling
·
Preoperative anxiety is
associated with a number of poor postoperative outcomes and with significant
parental and child distress before surgery.
·
Preparing children for surgery
can prevent many behavioral and physiologic manifestations of anxiety.
·
Psychologic and behavioral
interventions and pharmacologic interventions are available to treat
preoperative anxiety in children.
·
This article discusses the
psychologic preparation of children for surgery.
·
The
cost of a preparation program is relatively low, but its value for the subject
undergoing treatment is very high.
·
Feelings
of satisfaction and contentment usually accompany the preparation process, and
are mutual.
·
Preparation
programs must be implemented regularly and systematically.
·
The
preparation program must allow for the special characteristics of each child
and family
·
Demonstration
aids are used to stresses love for children
·
Counseling
·
Cooperation
between all the agents involved
·
Research
in this area there are methodological weaknesses in previous research, and make
suggestions for improving future research.
·
In
general, preparation interventions have been shown to be effective across a
range of health outcomes. However, the relative efficacy of different
strategies has been difficult to assess, as has the contribution of several
patient variables to outcome.
·
Considering
interventions used prior to surgery, there is not a clear demonstration of
effectiveness, in part because large numbers of outcome variables have been
used.
·
In
contrast, the preparation intervention literature using adult patients facing
invasive medical procedures has shown the relative superiority of modeling
procedures and coping strategies.
·
Psychological
preparation for invasive medical and dental procedures has been based on the
rationale that high levels of pre-procedural fear are detrimental to patients'
subsequent adaptation.
·
Outcome
studies that have employed informative, psychotherapeutic, modeling,
behavioral, cognitive-behavioral, and/or hypnotic techniques are summarized and
evaluated.
·
Although
the research suggests that each of these approaches can be effective, such serious
methodological problems as heterogeneity of sample characteristics, limited
range of outcome measures, and lack of manipulation checks prevent definitive
conclusions.
·
Legal-ethical
concerns and the issue of cost effectiveness are also considered. Suggestions
are made for future research and theory development.
·
Previous studies offer
contradictory evidence regarding the effects of cortisol changes on health
outcomes for surgical heart patients. Increased cortisol and inflammation have
been related to psychological stress while separate studies have found an inverse
relation between cortisol and inflammation.
·
Psychological preparations for
surgery can reduce stress and improve outcomes and may interact with cortisol
changes. Following from these relationships, we hypothesised that a preparation
for surgery will interact with changes in cortisol to affect outcomes.
·
Measures were the SF 36 General
Health and Activities, medical visits and satisfaction.
CORTISOL
CHANGES INTERACT WITH THE EFFECTS OF A COGNITIVE BEHAVIOURAL PSYCHOLOGICAL
PREPARATION FOR SURGERY ON 12-MONTH OUTCOMES FOR SURGICAL HEART PATIENTS…2
·
Eighty-five patients were
randomly assigned to standard care plus a psychological preparation or standard
care alone using a single-blind methodology.
·
Data on psychological and
biological functioning were collected at admission, 1 day prior and 5 days
post-surgery, and 12-months after hospital discharge.
·
General health and activities,
and medical visits were related to the interaction of cortisol change and
psychological preparation in support of the hypothesis.
·
Patients were more satisfied in
the preparation group than controls.
·
Based on these findings, some
outcomes from psychological preparations may be affected by changes in levels
of cortisol. These results caution against a one-size-fits-all approach to
psychological preparations.
·
OBJECTIVE: To estimate the
effects of extensive psychic preparation for cardiac surgery and to see whether
personality characteristics modify these effects.
·
DESIGN: Randomized. SETTING: St.
Antonius Ziekenhuis, Nieuwegein and the center of the Dutch Heart Foundation
for patient projects 'Hartenark', Bilthoven, the Netherlands.
·
METHOD: Patients waiting for
cardiac surgery were randomly assigned to a preparatory programme: a 2-hour
information programme in the hospital or a 2-day programme in the Hartenark,
comprising medical information, relaxation exercises and group discussions.
Psychological assessments were made by questionnaires preoperatively and at
4-month follow-up.
[MORE
PSYCHOLOGICAL PREPARATION IN HEART SURGERY FOR CERTAIN PATIENTS IS BENEFICIAL]…RESULTS
·
Of 223 patients, II were lost, 94
joined the informative programme and II8 the more extensive preparation. There
were 174 men and 38 women, whose average ages were 58.6 and 60.3 years,
respectively.
·
The scores in the preoperative
preparatory programmes were the same.
·
After-surgery scores on
'subjective invalidity' and 'vital exhaustion' were improved, while those on
'somatic neurosis' and especially 'anxiety' were deteriorated, in both
programmes.
·
When taking in account the
preoperative psychic condition, it was shown that the more extensive programme
benefited patients who preoperatively had relatively few psychosomatic
complaints or relatively strong anxiety.
[MORE
PSYCHOLOGICAL PREPARATION IN HEART SURGERY FOR CERTAIN PATIENTS IS BENEFICIAL]…CONCLUSION:
·
Extensive preparation for cardiac
surgery had a positive effect on physical wellbeing and anxiety in patients who
before the operation had relatively few complaints or indicated that they were
anxious.
·
Patients who reported less anxiety
and patients who felt less well physically before the operation benefited more
from a information programme.
·
The effects of pre-surgery
intervention messages on postsurgical pain and recovery in 42 female patients
were compared.
·
Each participant was scheduled
for at least two periodontal surgeries and exposed to one of four messages
before each surgery.
·
Auditory and visual messages
classified as "control enhancement" were associated with reduction of
pain after the second surgery with no effect after the first surgery.
·
Hospitalization and surgery are
generally accepted as stressful situations for children.
·
A review of the literature
indicates therapeutic play is effective in helping children cope with stressful
situations.
·
This article further illustrates
the benefits of using therapeutic play in the psychological preparation of
preschool children undergoing cardiac surgery.
·
Play as a useful assessment and
intervention tool for the nurse is examined.
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