CRNAs prepare family for child’s surgery
Little else grips a family with greater trepidation than the experience of sending a child to the operating room for surgery. The fear is often compounded with the confusing combination of emotions of sadness, anger and in some cases guilt. Families, who are preparing for this experience, do not have to go through it alone. In many cases, a Certified Registered Nurse Anesthetist (CRNA), the advanced practice nurse responsible for administering anesthesia serves many roles to families throughout the surgical process.
He or she will care for the child preoperatively, in the holding area where the parents release the care of the child to the anesthesia team. The CRNA then cares for the child intraoperatively, during the administration of anesthesia and the conclusion of the anesthetic. The child remains with the CRNA postoperatively until the care of the child is placed in the hands of the postoperative care unit nurses, (PACU formerly known as the “recovery room” team.
CRNAs do far more than care for the patient’s physical comfort during the surgical process. They are often involved during the intake stage and are available to families throughout the patient’s recovery.
To help families prepare for a child’s surgery, the Pennsylvania Association of Nurse Anesthetists (PANA) has prepared the following tips:
Preparing Your Child
– Some hospitals offer a pre-admission program for children and families. Check to see if yours does. If so, take advantage of this opportunity. Becoming familiar with the hospital will relieve stress for both you and your child.
– Make sure you communicate with your child. Learn his or her fears and concerns. Answer the child’s questions honestly. Let the child know that there may be some discomfort when he or she wakes up, but that many other children have had this experience and recovered quickly and happily. Try to be calm when giving your child facts. You need to be honest about what is going to happen, but not overly detailed. Keep the information you are providing both age and developmentally appropriate for your child.
– One mistake parents sometimes make is telling their child that he or she is going to take a nap. Though the intentions are good, this attempt at protecting your child from fear could cause anxiety for real naptime in the future. Instead, be up front, but be gentle. Tell your child, “The doctor or nurse anesthetist will give you medicine to make you sleep so that it won’t hurt when the doctor fixes your -.”
– Always be positive. Do not inadvertently threaten with comments such as “If you’re bad, they are going to stick you with a needle.”
– Also note dietary restrictions are crucial and you need to help your child with this tough preparation. It is very important to discuss the “nothing by mouth” or, NPO guidelines used by your anesthesia provider as there is variation in the interpretation of these guidelines. The guidelines differ from newborn to adolescents.
– If the guidelines are not accurately followed, a delay or rescheduling of surgery could result.
Preparing the Parents Further Prepares the Child
– Surgery is a frightening experience for everyone, and particularly terrifying when your child is involved. Nurse anesthetists understand this and are dedicated to help parents throughout the process. Feel free to discuss the separation procedure with your CRNA. Ask questions – At what point will you need to release your child to the care of the anesthesia team? Can you hold your infant until the sedative takes place? If there will be liquid sedation given by mouth in order to smooth the separation process from the parent, will the parent be involved in having the child drink the small amount of medication? Sedative medication is usually mixed in a small amount of cherry or grape flavored acetaminophen and taken by children without issue, but find out if you can be involved in this process. The acetaminophen is important as it also acts as a pain reliever, which can last until well after surgery is completed. If the procedure is minor in nature, this may be all the pain reliever that is needed.
– Please be aware that each surgical facility will have its own policies regarding the parent’s participation in the care of a child going for surgery. Also, the needs and wants of children will differ based on the age and developmental stage of the child.
The Day of Surgery
– Some specialized children’s facilities allow the parent(s) to be present to hold or comfort the child at the beginning of the anesthetic phase of the procedure. The parents are then escorted out of the operating room after the child drifts off to sleep at the hands of the nurse anesthetist.
– A key point made by Danielle Mullen, CRNA at Children’s Hospital in Philadelphia and active member of the Pennsylvania Association of Nurse Anesthetists (PANA), is that many CRNAs are parents.
– In most cases a calm and cooperative parent is a valuable asset to the anesthesia team. They are appreciative of strong family unit that is supportive.
– Now is the time to let our your tears, hug your significant others and gather the strength and composure your child needs from you when you rejoin him or her in the post surgical area. Each hospital will have its own unique area for parents to reunite with the child freshly emerged from anesthesia. Sit at the child’s bedside and if appropriate, hold and touch your child.
– Many parents who take steps to prepare both themselves and their child find that they are strong and composed on the day of surgery. Nonetheless, both parents and children will need support throughout the process.
Have Others Comfort You During Surgery
– Build your support network for the day of the operation. Have close relatives and/or friends join you in your wait for the surgery to be completed. Their support will give you strength and comfort. If no one is able to join you at the hospital, bring your cell phone and have several people ready to take your call throughout the procedure. Prior to the day of surgery, make sure your cell phone gets a signal at the hospital.
– Duration of surgery varies widely. Ask for an estimate ahead of time from the surgeon so that you can be there for you child as the postoperative phase begins.
– In conclusion, be aware that the recovery period has its challenges. Like adults, children will feel weak for a while and their activities will need to be monitored. Talk to your child about his or her experience and feelings after the child returns home. Strong, open communication is a key component to the healing process.
– Remember that Certified Registered Nurse Anesthetists are highly trained advanced practice registered nurses and in many cases, parents. They are there for you and your child from the beginning to recovery, ready to assist your family with advice and comfort.
More than 2,300 CRNAs practice in the state of Pennsylvania, consistently administering safe, high-quality anesthesia care. For more information on PANA and issues related to anesthesia, visit the association’s Web site at www.pana.org.