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- Wennström, Berith, et al.
(författare)
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Child drawings and salivary cortisol in children undergoing preoperative procedures associated with day surgery
- 2013
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 28:6, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPerioperative procedures in children can impair their emotional status negatively with stress and/or anxiety. Cortisol concentrations and drawings could be helpful in gaining information about a child's levels of stress and/or anxiety when attending the hospital for surgery.PurposeThe purpose of this study was to determine the degree of anxiety and stress as well as to explore the association between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children's drawings) as interpreted by the Swedish version of the Child Drawing: Hospital manual.MethodsA total of 93 children scheduled for day surgery were included. Salivary cortisol was sampled preoperatively on the day of surgery at which time the children were also requested to make a drawing of a person at the hospital.ResultsResults showed no association between salivary cortisol concentration and the CD:H score.ConclusionThe drawings and salivary cortisol concentration preoperatively on the day of surgery reflect different components of the conditions of fear, anxiety, or stress emerging in the situation.
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| 2. |
- Wennström, Berith, et al.
(författare)
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Evaluation of the Swedish version of the Child Drawing : Hospital Manual
- 2011
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Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 67:5, s. 1118-1128
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper is a report of psychometric testing of the Swedish version of the Child Drawing: Hospital Manual.Background. Drawings have shown to be useful in assessing emotional status and anxiety in children because they generally speak to us more clearly and openly through their drawings than they are willing or able to verbally.Method. The Child Drawing: Hospital Manual was translated into Swedish according to World Health Organization guidelines (a routine procedure for translation of English instruments) in order to assess anxiety by analysing the drawings of 59 children (5–11 years), of whom nine were girls and 50 boys undergoing day surgery during 2007–2009.Results. Inter-rater reliability (five independent scorers) was high and internal consistency reliability was good (coefficient alpha = 0.77). Parts A and C, as well as the total scale score of the Child Drawing: Hospital Manual, discriminated anxiety significantly between the group of children undergoing day surgery and a comparison group of school children, indicating adequate construct validity.Conclusion. For the Swedish version of the Child Drawing: Hospital Manual, our study demonstrates evidence for adequate construct validity in Parts A and C (and total scale score), high inter-rater reliability and acceptable internal consistency reliability. However, some improvements are needed before the instrument will be a clinically useful assessment of anxiety in children undergoing day surgery.
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| 3. |
- Wennström, Berith
(författare)
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Experiences, symptoms and signs in 3-11 year old children undergoing day surgery within the context of the perioperative dialogue
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surgical interventions create real, imagined, or potential fear or anxiety in many children, thus highlighting a need for the health professionals who work with them to increasingly act as facilitators. The overall aim of the present thesis was to gain a deeper understanding of 3-11 year-old children’s perioperative symptoms, signs, experiences and main concerns when attending hospital for day surgery and of how they manage this situation. Paper I explores bodily and verbal expressions of postoperative symptoms using a qualitative and descriptive methodology. Fourteen boys between 3-6 years of age were interviewed and observed. The participant observation method was the primary source of data and the domains and subdomains together showed how bodily and verbal expressions could be intertwined. For boys of this age, distinguishing pain, nausea and distress is diffi cult, and they also have different ways of communicating the ‘correct’ words in clarifying a symptom. For paper II, a grounded theory (GT) study was carried out based on data from 15 boys and 5 girls (aged 6-9 years) scheduled for day surgery. The aim was to explore what it means for children to attend hospital for day surgery. Data were collected using tape-recorded interviews, participant observations and pre- and postoperative drawings. The analysis showed that the main concern for children undergoing day surgery was that they were forced into an unpredictable and distressful situation.They perceived a “breaking away from daily routines” and were “facing an unknown reality”. A conceptual model was generated, including a core category, “enduring infl icted hospital stress”, which explains how the situation was handled. Initially, the children tried to “gain control” over the situation. However, during the perioperative period they experienced a “loss of control” and “cooperated despite fear and pain”. Post-operatively they “breathed a sigh of relief” and tried to “regain normality in life” again. Paper III presents a psychometric test of the Swedish version of the Child Drawing: Hospital Manual (CD:H), which intends to assess hospital anxiety in children. Drawings from 59 children (aged 5-11) undergoing day surgery were analyzed and compared to drawings from 71 school children (aged 5–11) in a comparison group. The results showed that the Swedish version of the CD:H has adequate construct validity (Parts A, C and total scale score), high inter-rater reliability and acceptable internal consistency reliability. In paper IV, the effi cacy of the perioperative dialogue was investigated by analysing salivary cortisol in 5-11 year old children undergoing day surgery. Seventy-nine boys and 14 girls (n=93) scheduled for day surgery were randomly recruited into three groups with different types of perioperative care: Standard perioperative care (control group) (n=31), Standard perioperative care including preoperative information (n=31), and the Perioperative Dialogue (PD) (n=31). Postoperatively, the PD group had signifi cantly lower saliva cortisol concentrations than the other two groups and these levels continuously decreased during the day of surgery. Among the children who received analgesics, the PD group received signifi cantly less morphine related to bodyweight. Irrespective of group, there was a positive correlation between morphine consumption and salivary cortisol concentration. In paper V, associations between objective measures of stress (cortisol concentration in saliva) and subjective assessment of hospital anxiety (children’s drawings) are investigated. The sample included 93 children (79 boys and 14 girls) scheduled for elective day surgery requiring general anaesthesia. The results showed no signifi cant associations between children’s saliva cortisol concentration (stress) and their drawings (anxiety) in any of the parts of the CD:H or individual items. In conclusion, the studies contribute to a deeper understanding of how 3-11 year-old children undergoing day surgery experience and express their situation, symptoms and physiological stress in the context of the PD. Keywords; anxiety, children, cortisol, day surgery, drawings, nursing, perioperative dialogue, stress, symptoms
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| 4. |
- Wennström, Berith, et al.
(författare)
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Patient symptoms after colonic surgery in the era of enhanced recovery--a long-term follow-up.
- 2010
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Ingår i: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 19:5-6, s. 666-672
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The main purpose of this study was to analyse, prospectively, patient symptoms during the first four weeks following elective colon surgery. A secondary aim was to find areas to improve inpatient information and postoperative care. BACKGROUND: Fast-track recovery following colon surgery has been proven beneficial to patients in the early postoperative phase. Less is known about the continuous recovery at home. DESIGN: A prospective follow-up survey. METHODS: Consecutive patients (n = 32) planned for elective colon surgery were evaluated. Both open and laparoscopic operations were included. All followed a fast-track protocol in hospital. Patient symptoms were recorded by validated quality of life questionnaires (EORTC QLQ-C 30, EORTC QLQ-CR 38 and Brief Pain Inventory). An interview was conducted five weeks and one year after surgery. RESULTS: The hospital stay was six days, and 10% of patients were readmitted. The fast-track concept worked well. The main problems after discharge were fatigue, nausea and bowel disturbances. Pain was not a significant issue. Most symptoms had disappeared after four weeks. CONCLUSIONS: The first period at home is troublesome, and better information about common symptoms is needed. A direct telephone line has been set up to answer questions and to lower patient anxiety. RELEVANCE TO CLINICAL PRACTICE: Clinical guidelines for patient's discharge planning can be performed based on the results from this study. Further improvement regarding the epidural anaesthesia is needed to reduce minor side effects.
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| 5. |
- Wennström, Berith, et al.
(författare)
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The perioperative dialogue reduces postoperative stress in children undergoing day surgery as confirmed by salivary cortisol
- 2011
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Ingår i: Pediatric Anaesthesia. - : Wiley-Blackwell. - 1155-5645 .- 1460-9592. ; 21:10, s. 1058-1065
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the efficacy of 'the perioperative dialogue (PD)' by analyzing salivary cortisol, in 5- to 11-year-old children undergoing day surgery. Background: To deal with anxiety prior to investigations and/or procedures, children need to be confident and informed about what is going to happen. Therefore, intervention strategies should be initiated before admission to hospital. Methods and materials: Children (n = 93), 79 boys and 14 girls, scheduled for elective day surgery requiring general anesthesia were randomly recruited into three groups: (i) standard perioperative care (n = 31), (ii) standard perioperative care including preoperative information (n = 31), and (iii) the PD (n = 31). Saliva was sampled for cortisol analysis at specific time points during the pre- and perioperative procedures. Results: The children who received the PD had significantly lower (P = 0.003) salivary cortisol concentrations postoperatively. Moreover, it continuously decreased during the day of surgery compared with the other two groups (P < 0.01). Among the children who received analgesics, the PD group received significantly less morphine (P = 0.014) related to body-weight: the mean dose was 0.1 mg.kg(-1) (n = 9) in the control group vs 0.04 mg.kg(-1) (n = 6) in the PD group. Irrespective of group, there was a positive correlation between the children's morphine consumption and salivary cortisol concentration (r = 0.56; P = 0.038). The W-B scale score was higher in the group that received morphine (median = 3 vs median = 1; P = 0.001). Conclusions: The PD's caring, continuity, and on-going dialogues were associated with low concentrations of salivary cortisol postoperatively and reduced morphine consumption and thus appears to be a valuable complement to standard perioperative care in children undergoing day surgery.
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