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UBC Theses and Dissertations

A comparison of preadmission preparation programmes for children undergoing Day Care Surgery Harper, Jeanine M.


This study was an outcome oriented experiment considering the effects of Preadmission Preparation on 110 children between the ages of 5 and 12 years entering B.C.'s Children's Hospital for Day Care Surgery. Preadmission Preparation has been shown to reduce negative reactions to hospitalization on children having inpatient surgery. To date, no one has found Preadmission Preparation to be of benefit to children having Day Care Surgery. The study considered effects of attention only; general Preparation; Hospital Tours; Instructional Approaches (Modeling and Rehearsal-Instruction); and Modes of Preparation (Print and Audio-Visual). Additionally, the interaction of experimental factors of preparation programmes with individual characteristics of the children (age, gender, position in sibling structure, socio-economic status, verbal ability, health locus of control, trait anxiety, previous hospitalizations, chronic conditions, and stressful life events) were examined. Measures used as outcomes were: Hospital Behaviour Questionnaire, Observation Rating Scale, and Children's State Anxiety Inventory (Spielberger, et al., 1973). These instruments gave 8 different variables. For the repeated measures aspect of the design, data were collected one week and immediately prior to preparation and immediately prior to and six weeks following surgery. Children who received attention only (the experimental control group) were found to react differently than children who received no attention on only one variable. Although Tours alone were found to reduce negative reactions to day care surgery, Preparation in general (regardless of Approach or Mode) was not found to be effective, and in some cases increased negative reactions. Children receiving Rehearsal-Instruction approach programmes had lower verbal and overall observed anxiety prior to surgery than those receiving Modeling programmes. However, they also had higher dependent anxiety following discharge. The Audio-Visual programme reduced negative behaviours on more dependent variables than the Print programme. Rehearsal-Instruclion/Print and Rehearsal-Instruction/Audio-Visual each reduced different negative reactions. Of the 10 individual characteristics of children considered in this study, 5 did not interact with the Programme variables on more than 2 dependent variables or had insufficient cell sizes and were not interpreted. Girls appeared to both benefit from and be more negatively affected by preparation than boys, whose reactions to day care surgery were less affected by preparation. Preparation programmes were particularly effective in reducing negative reactions in children from lower socio-economic families and tours were particularly effective for children with chronic conditions. Children with more external health locus of control benefited most from Modeling or Rehearsal-Instruction programmes with no Tour. Children with high and low trait anxiety reacted differently to preparation, with different effects observed on different measures and for different programme conditions. It was noted that dependent measures did not react in similar ways, nor consistently throughout the study. Limitations of a clinical study with extensive analyses is discussed. Further investigations of measures used to evaluate reactions to day care surgery is warranted. Clinical discussion and further research of programme facets and individual characteristics of children is recommended.

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