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Introduction
The distress that many children witness during the induction of anaesthesia has been identified as the major factor leading to the parent anxiety. Minimising the parent anxiety has been great challenges for clinicians. Typically, excessive parental anxiety may have risky implication during the induction of anesthesia (DAI) of children. Parents who vividly show sign of anxiety in the presence of their children during anaesthesia induction may perceive their children being equally upset. (Rice, Glasper, Keeton, et al 2008).
McEwen et al (2007) revealed that there are correlation between preoperative parental anxiety and childrens preoperative anxiety. Parents, who show high level of anxiety in the presence of their children may provocate increase in their children level of anxiety, and this may have affect the outcome during the time of operation.
Typically, few instruments have been validated to reduce the parents anxiety. Among the instruments identified to reduce parent anxiety during anaesthesia induction, the educational videotape has been identified as effective tool to minimise parent anxiety. Typically, the objective of using videotape before anaesthesia is to increase the parents anaesthesia knowledge in order to reduce parent anxiety. By providing information to parents about anaesthesia, and surgery, the method has been identified as a potent tool to minimise anxiety. Thus, the use of preoperative videotape will prepare the mind of parents about anaesthesia, and this will reduce the concerns of parents when bringing their children into surgical theatre. (Kelly, Adkins, 2003).
Despite the importance of videotape in the reduction of parents anxiety on their paediatric surgery, few studies have attempted to validate the use of videotape in the reduction of parents anxiety. For example, Karl and Pauza (1990) argued that educating parents on the information about surgery, and anaesthesia has been identified as the potent tool to manage anxiety among parents. The use of preoperative videotape, which demonstrates the induction of anaesthesia, has been found to reduce the parent anxiety. ( Kain et al, 1999). However, the authors did not use validated method to measure the level of parent anxiety with the use of videotape.
The purpose of this study is to demonstrate the effect of preadmission videotaped preoperative information on parental anxiety and satisfaction with care.
Statement of problem
Educating the parents about the outcome of anaesthesia has been identified as potent tool to reduce the level of parents anxiety of their preoperative children. The combination of information from videotape and printed preoperative information on anaesthesia has been identified to improve the satisfaction with care and lower parental anxiety. Apart from the benefits of the information from printed document and videotape in increasing the knowledge of parents on anaesthesia and surgery, the information will also decrease the parents anxiety, and the effect will reduce the anxiety that could be manifested from children during induction of anaesthesia. (Lee, 2003)
Despite the advantages the videotape and printed preoperative information offer in reducing parents anxiety, and satisfaction with care, few studies have been able to use validate measure to demonstrate the use of videotape in minimising the parents anxiety, and increase the parent satisfaction with care. The study conducted by Karl and Pauza (1990) demonstrated the effect of preoperative videotape on anaesthesia induction and the authors have been able to demonstrate the reduction of the parents anxiety on their preoperative children. Despite the contribution of the author, they have not been able to use validated measures on demonstrate anaesthesia knowledge.
Other research articles have focused on the parental presence during anaesthesia and how preoperative education influences their anxiety and satisfaction with care. Few of them have discussed about education of parent on anaesthesia through preoperative educational videotape, and printed preoperative information. The paucity of research papers on the effects of preoperative educational videotape and printed preoperative information about anaesthesia prompt this proposed study.
This study attempts to fill the gap that has created due to lack of research papers on the effectiveness of combination of videotape and printed preoperative information in lowering parental anxiety, and improvement of parent satisfaction with care prior to childs admission into anaesthesia room.
Research aims and objectives
To demonstrate parents anxiety prior to their childrens admission into anaesthesia room.
To demonstrate the importance of preoperative videotape and importance printed preoperative information in minimising the parental anxiety on preoperative children.
To achieve the research aims and objectives, the study will attempt to answer the following research questions.
Research Questions
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To what extent the use of video tape and printed preoperative information increase the knowledge of parents on anaesthesia?
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To what extent the use of videotape and printed preoperative information decrease the parent anxiety?
To answer the research questions, the paper will review the previous studies on the effect of preoperative videotape and printed information on parental anxiety and satisfaction with care.
Literature Review
The section reviews the literatures on the extent by which parent anxiety can lead to children anxiety.
In addition, the literatures explore the effect videotape in minimising parent anxiety during induction of anaesthesia on preoperative children.
Finally, the literatures explore whether the use of video tape increase the parents knowledge on anaesthesia.
Extent of Parent Anxiety
Franck, Cox, Winter (2004) demonstrated that operative experience is not only frightening to children but to parents as well. Although, many hospitals have adopted the system of allowing the parents to be present during the paediatric preoperative anaesthesia induction in order to reduce children agitation and screaming. Despite the parents presence during paediatric anaesthesia, however, this measure has not significantly reduced the level of parent anxiety. The worry of the parents is the fear that their children may experience pain during anaesthesia, and this has been found to contribute to the stress of the parents.
The parents fear sometimes increases because of the feeling that they are helpless to help their children from pain. Typically, many parents who show concern about their children pain have no knowledge of pain management. (Cassady et al,1999).
Zuwala, Barber (2001) argued that many parents are anxious whether they will be separated from their children during anaesthesia induction. Typically, parent anxiety may have correlative relation on children anxiety, and this may affect the anaesthesia induction and postoperative outcome. Miller (1999) also supported the argument of previous author by pointing out that parents anxiety can adversely affect the outcome of paediatric anaesthesia, and parents anxiety can have correlation effect with the level of children anxiety. The author argued that there is need to develop more validated strategy to manage parent anxiety on their children.
For example, the Mcewen, et al (2007) pointed out that the use of Amsterdam Preoperative Anxiety and Information Scale (APAIS) has been validated for patients of older age. In addition, the State-Trait Anxiety Inventory (STAI) has been validated to measure the parent anxiety. However, there are no known validated measures to manage parent anxiety about preoperative children. Thus, the authors argued that decreasing the parent anxiety would benefit positively child preoperative experience.
Romino et al (2005) also argued that preoperative children tend to demonstrate fear and anxiety before or during anaesthesia. Thus, parents presence is essential to alleviate the fear during anaesthesia induction. The author defined fear as an emotional reaction to threat and danger, which is out of ones control, while anxiety is defined as apprehension, uneasiness, and fear. Meanwhile, parents presence will make the children to understand that he or she is not alone and the outcome will be beneficial during paediatric anaesthesia.
However, when parents themselves develop anxiety during anaesthesia, and surgery, the purpose of their presence in the paediatric operating theatre may be eroded. It should be noted that adults especially the parents serve as role model to children, and the behaviour of the parents during the anaesthesia induction may serve as essential tool to the outcome of anaesthesia of their children and postoperative children behaviours. (Birkenstock, 2005).
Typically, the enhancement of parents knowledge about anaesthesia will have effect on the way parents will prepare their mind for the experience. Thus, if the parents are informed about the anaesthesia experience, the effect will reduce their level of anxiety, and their calm behaviour will be beneficial to children during anaesthesia induction. However, anxious parents who are not adequately informed about the anaesthesia will increase the level of their children anxiety. Thus, the parents who manifest high level of anxiety many increase the children level of fear, and this may affect the preoperative outcome. (Romino et al 2005).
Thus, to manage the level of parent anxiety, parents need to prepare their mind on paediatric anaesthesia in order to decrease children fear and anxiety. Francka, Spencer (2005) have demonstrated that the use of printed information and videotape on anaesthesia to increase the parental knowledge may reduce parent anxiety and increase satisfaction with care. However, there is need to validate the argument of the study by using the standardised instruments in order to measure the degree of reliability, and validity on the use of videotape and printed information to measure the level of parent anxiety and parent satisfaction on the pre-surgical paediatric anaesthesia.
The use of Video Tape in Improving the Parents Knowledge on Anaesthesia
Patients satisfaction is overall determinant of the quality of care. Measurement of quality of healthcare in the health field is the extent the parents are satisfied during the admission of their children in the hospital. The level of parent anxiety on preoperative children has been argued as one of the factor that can affect paediatric anaesthesia outcome. (Yellen, Richard, 2005).
Typically, parent anxiety has been demonstrated to increase the anxiety on children, and the increase in the anxiety on children can lead to postoperative maladaptive behavioural signs such as separation anxiety, nightmares, and eating disturbances. (Himes, Munyer, Henly, 2003).
Thus, with strong correlation between parent anxiety and preoperative child anxiety, the preoperative preparation educational program has been argued as the potent tool to reduce parents anxiety. Typically, the alternative treatment modalities such as videotape have been useful to provide information to parents in order to increase parents knowledge on anaesthesia. (Kain, 1999).
Kain (1999) argued that many parents have been dissatisfied with lack of preoperative information about paediatric anaesthesia. Many parents from Canada, USA, Australia, and Scotland have revealed strong desire for more knowledge about paediatric anaesthesia information. Studies conducted by Miller and Mangan (1983) revealed that parents who received extensive information about the anaesthesia induction of their children were more tense and revealed sign of satisfaction than the parents who did not have any knowledge about anaesthesia.
The investigation carried out by Franck et al (2004) has also revealed that parent having knowledge about pre-surgery and anaesthesia tend to exhibit lesser fear than the parent having no knowledge of anaesthesia. The authors pointed out that some parents interviewed confirmed that they are satisfied with the printed information received about paediatric anaesthesia. The information has built their knowledge about the paediatric anaesthesia, and has helped them to be able to manage their anxiety during the induction of anaesthesia of their children. (Himes, Munyer, Henly, 2003).
The study conducted by Wisselo et al (2004) showed that parents are interested to know about preoperative information through videotape in order to prepare their mind about paediatric anaesthesia. Typically, by presenting information to parents about paediatric anaesthesia through videotape has enhanced the knowledge of parents on what they actually wish to know on anaesthesia. Many parents sought for information such as side-anaesthesia side effects, postoperative pain management, and induction of anaesthesia. Thus, the information from printed preoperative material and videotape serve as effective tool to prepare the mind of parents. (Krupat, Fancey,Cleary 2000,Gaskey, 1987).
However, Greenberg et al (1999) argued that parents misconception about anaesthesia might affect the satisfaction of parents of their children during postoperative. The author argued educational videotape could serve as a useful tool in providing the parents with instructive information, which would correct the misconception that some parents hold about anaesthesia induction of their children. Meanwhile, Cassady et al (1999) pointed out that the effects of videotape have been helpful to improve the knowledge of parents on paediatric anaesthesia. Typically, the videotape is very essential to illustrate the induction of anaesthesia, and the information in the videotape can prepare the mind of parents on anaesthesia.
Karl et al (1990) also supported the argument of Cassady on the effect of videotape in improving the knowledge of parents on anaesthesia. The author pointed out that some parents find information from the videotape helpful because the information has helped some parents to demonstrate the reduction in anxiety when bringing their children into operation theatre for the first time.
For example, Bagshaw pointed out that
The preoperative psychological preparation of the family and child is important.
Preoperative information in the form of booklets, videotapes, educational
Programmes, or through telephone consultation or pre-admission clinics, has been
shown to reduce anxiety, answer questions, raise issues for discussion and avoid
unnecessary investigations or cancellation. (nd, p 178).
Despite the contribution of the literatures reviewed, they failed validate the anxiety and anaesthesia knowledge. Thus, the recommendation is that there is need for further research to determine preoperative educational videotape in order to improve the parental anaesthesia knowledge. This study intends to investigate the use of preadmission videotaped preoperative information on parental anxiety and satisfaction with care. Essentially, information provided from the videotape on induction of anaesthesia may serve as a useful tool to manage parent anxiety.
Summary of Literature Review
The literature review examines the extent of parent anxiety, and the use of video tape in improving the parents knowledge on anaesthesia. Typically, the literature reveals that many parents are dissatisfied with the paucity of information about their children preoperative, and lack of knowledge about anaesthesia has led to parent anxiety. Thus, providing printed preoperative information and video tape about the paediatric anaesthesia has been identified to improve the knowledge of the parent and this measure can manage the parent anxiety, and increase the parents satisfaction with care.
This study will collect data through methodology to validate the use of videotaped preoperative information on parent anxiety, and satisfaction with care.
Research Methodology
This section provides the research methodology for the propose study. The study further provides restatement of the research questions, and overview of research design. The section presents sample population of the study which consists of sample size, and strategy of sampling the target population. For data reliability, the section describes the method the proposal will carry out the data analysis. To carry out the data collection procedure, the paper will employ both qualitative and quantitative techniques. The qualitative technique will use interview to evaluate the parent satisfaction of the preoperative anaesthesia. The quantitative method of data collection will involve questionnaires.
Restatement of Research Questions
The study will employ both qualitative and quantitative methods for data collection. The study will use data collection to answer the following research questions in order to measure the parent anxiety and evaluate the parent satisfaction with care on the preoperative anaesthesia.
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To what extent the use of video tape and printed preoperative information increase the knowledge of parents on anaesthesia?
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To what extent the use of video tape and printed preoperative information decrease the parent anxiety?
Research Design
The paper will employ experimental method for research design. In the experimental method, the researcher intends to evaluate the parent anxiety and the level of parent satisfaction after watching videotape and reading printed preoperative information. The researcher will identify the target population that is needed to be investigated. In addition, the researcher will study the characteristics of target population before carrying out his investigation.
The researcher intends to obtain information about the paediatric day and surgery procedure, from the nursing staff of the hospital. This information will help the researcher to develop understanding about the running of the clinic, record of the children presently attending the hospital for paediatric anaesthesia. Typically, the researcher will estimate the relation between variable in order to draw conclusion on validity of the study.
For effective research design, the study will use probability-sampling technique to select the sample population. To select the sample population, the study will use non-bias technique to choose the sample population that will be used for the study. The ethical consideration is used in order to ensure compliance from the subject. To ensure that the study confound with ethical regulation, the study will be in line with ethical issue since the research is in medical field. The researcher will seek permission from the hospital authority, and parents before carrying out investigation on children. (Birkenstock, 2005).
Since this study intends to establish the parental anxiety and satisfaction with care and their need of knowledge about anaesthesia. The study will employ validated State-Trait Anxiety Inventory (STAI) to measure the parent anxiety after watching the video and read printed information on the paediatric anaesthesia. There is also going to be data analysis in order to ensure validity of the study. After the analysis of data, the paper will present the findings of the whole research. (Peat, 2002, Hopkins, 2000). To collect data from sample population, the researcher intends to use qualitative and quantitative techniques. The researcher intends to use suitable methods to collect data through semi-structured interview, observation, and questionnaires.
Method
The researcher will conform to ethical consideration before data collection. To conform to ethical issues, the researcher will seek for the approval from the parents, from the hospital and the institutional ethics committee before carrying out the investigation. To evaluate the parent anxiety and parent satisfaction on the pre-surgical paediatric anaesthesia. The researcher will develop structured multichotomous questionnaires to be distributed to the sample population.
The questions will be used to access the parents satisfaction with care on their children. In addition, with consents of the parents, the researcher will allow the parents to watch 20-minute documentary video. The information in the video is based on the information about the paediatric anaesthesia. The researcher will also employ a printed information material to educate the parent about the pre-surgical paediatric anaesthesia. The information in the document is a 20-page booklet to build the knowledge of the parents on anaesthesia. Moreover, the information in the printed booklet will be written with simple straightforward English, and the use of the medical technical jargons will be minimised.
The information in the videotape will be about the preoperative information about anaesthesia. The information will also consist of the visit of anaesthesiologist, premedication, transport of children to the operating theatre, the use of oxygen mask, maintenance of anaesthesia, recovery room, and the way to monitor nausea and vomiting. The video will also reveal information on postoperative pain therapy, and management of extubation, application of anaesthetic cream and induction of anaesthesia. The information in the video also includes stimulation of children and other activities of anaesthesia staff. (Snyder-Ramos et al, 2005, MceWen et al 2007)
After the parents have watched the video and read the printed information anaesthesia, the researcher will use questionnaires to evaluate the parents satisfaction with care of their children. The researcher will develop multichotomous structured questionnaires to evaluate the parent satisfaction. The questionnaires will be distributed to the parents before anaesthesia. The questionnaires will be designed to evaluate the degree of satisfaction of parents about the induction of anaesthesia. Typically, the questionnaire will pilot the degree of satisfaction in fivepoint scale. The questionnaire will provide five answers in which the parent will be allowed to choose one answer from the questionnaire.
An example of a question in the questionnaire will be as follows:
Q: Anaesthesia can improve the state of health of my child.
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Strongly Agree
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Agree
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Neutral
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Not Agree
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Strongly not agree
The total questions in the questionnaires will be 20 questions.
As discussed in the previous section, the researcher will also employ qualitative technique for data collection. The qualitative technique will involve employing interviewing to measure the level of parent satisfaction. Typically, after allowing the patients to watch the video, and read the printed preoperative information about paediatric anaesthesia. The researcher will use interview technique to sample the opinion of the parent about their satisfaction on the induction of anaesthesia on their children.
Sampling Strategy & Sample Sizes
The sample population involves appropriate size of the people that will be used for the research. The study population will be approximately 100 parents. The parents will be divided into two groups. Each group will consist of 50 parents. The first group will be distributed the questionnaires and the researcher use interview technique to evaluate the parent satisfaction of the second group. The sample population will involve parents who brought their children for anaesthesia. The parent could be male or female, and could be from any ethic group. Essentially, the cooperation of the parents will be sought for data collection on the investigation induction of anaesthesia of their children.
Typically, the researcher will use probability sampling for the sampling strategy. In the probability sampling, the Stratified Random Sampling will be used to select the sample population. The use of Stratified Random Sampling will be used because this will allow the researcher to cover the key group for the sample population. For example, the research intends to use approximately 50% male parents and 50% of female parents as sample population. Since the research will use interview and questionnaires to evaluate the parent satisfaction. The researcher will ensure that all the parents who will participate for the interview should be educated. (Trochim and Donnelly, 2007 Watson, et al 2008)
Measures of Parent Anxiety
The paper will employ validated State-Trait Anxiety Inventory (STAI) to measure the parent anxiety after watching the video and read the printed information on the paediatric anaesthesia. The STAI is a standard validated instrument to measure the level of anxiety and the traits level. (MceWen et al, 2007).
Spielberger, Gorusch, and Lushene pointed out that STAI has been validated as a research instrument to measure anxiety in adults. The STAI has been used for self-assessment device to measure the trait anxiety and state in adult. The author pointed out that state anxiety reflects, conceptualised transitory emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity. State anxiety may fluctuate over time and can vary in intensity . (Spielberger, Gorush, Lushene, nd).
To measure the level of parent anxiety, the study will use STAI to interpret the parental anxiety level. Typically, the high score on the state of parent anxiety will reflect more traits in the state of anxiety. In addition, low scores on the parent anxiety trait will mean low level of anxiety. (Spielberger, Gorush, Lushene, nd).
Data Collection Method
The researcher will sought for the written permission from the hospital authority, all the questionnaires and filled interview papers will be collected from the sample population, who enrol in the study. To enhance effective data collection, the researcher will collect all the data from interview and questionnaires by hand. Typically, the researcher will use two people to assist in the data collection. The data collected from the questionnaires will be grouped apart, and all data colleted from interview will be grouped apart. (Sprintall, 2003, Miles, Hubermann, 1994).
Data Analysis
The section provides method of data analysis in order to ensure the reliability and validity of the data.. Typically, data analysis is to ensure that the overall data establish reliability, validity, and credibility. ( Cohen & Crabtree, 2008, Cohen, Kahn, Steeves,2000).
Obtain high level of accuracy is essential in the data analysis, and to ensure high level of accuracy of the data collected, the researcher will check all the data collected for error and accuracy. The researcher will correct all the spelling errors in order to ensure data accuracy. Moreover, the paper will ensure that all the data conform with Trochim and Donnelly (2007) criteria. The criteria is to ensure that the data are legible, as well as ensuring that all the respondents answer all the important questions Typically, to ensure that the data is free of suspected bias, some questions will be asked twice. By using this strategy, the researcher will be able to remove all the suspected bias in the data. (Denzin, Lincoln 2007, Creswell, 2007, Denzin, Lincoln 2000).
Display the Findings
This result of the study is very important in order to demonstrate the effect of preadmission-videotaped preoperative information on parental anxiety and satisfaction with care. The result of the findings will be displayed through report, graphs, tables and charts.
Conclusion
The section provides summary of the proposal. The study will explore the effect of preadmission-videotaped preoperative information on parental anxiety and satisfaction with care. The paper review previous literature to answer the following research questions:
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To what extent the use of video tape and printed preoperative information increase the knowledge of parents on anaesthesia?
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To what extent the use of video tape and printed preoperative information decrease the parent anxiety?
The literatures are reviewed to explore the use of videotape and preoperative printed information on paediatric anaesthesia in order to improve the knowledge of the parent on paediatric anaesthesia. Typically, the literature demonstrated that parent anxiety could influence children anxiety during induction of anaesthesia. Thus, the use of video tape and printed preoperative information on anaesthesia can reduce the parent anxiety.
In addition, the proposal provides research methodology that provides method of data collection. The proposal will employ both quantitative and qualitative techniques to collect data. To measure the parent anxiety, the study will employ State-Trait Anxiety Inventory (STAI) that has been validated to measure level anxiety in adults.
To measure the level of parent satisfaction, the proposal will use interview method to determine the preoperative information on parental anxiety and satisfaction with care on their children.
The results of this paper will enhance the greater understanding of the nurses, medical profession, parents, hospital management, and government on the use of videotape and preoperative printed information on the management of parent anxiety and satisfaction with care.
Reference
The proposal will use Harvard style to display all the sources used to complete the proposal.
Appendices
The study will display tables, graphs, charts, and the questionnaires in the appendices.
List of References
Bagshaw, O. (nd).Preoperative parent and patient information, Paediatric services, The Royal College of Anaesthetists.
Birkenstock, D. (2005). A program to prepare children for Grommet insertion and adenoidectomy: A Gestalt Therapy Approach, Jeannette Dorothy Birkenstock, 2005. Master Dissertation, University of South Africa.
Cassady, J. F, Wysocki, T.T., Miller, K.M. et al (1999). Use of a Preanesthetic Video for Facilitation of Parental Education and Anxiolysis Before Pediatric Ambulatory Surgery, Anesth Analg. 88:246.
Cohen, D., & Crabtree, B. (2008). Evaluative criteria for qualitative research in health care: Controversies and recommendations. Annals of Family Medicine. 6(4), 331-339.
Cohen, M.Z., Kahn, D.L., Steeves, R.H. (2000) Hermeneutic Phenomenological Research: A Practical Guide for Nurse Researchers, Sage Publications, London.
Creswell, J.W. (2007). Qualitative Inquiry and Research Design: Choosing Among 5 Approaches, 2nd Edition. Sage Publications, Thousand Oaks, California.
Denzin, N. K., Y. S. Lincoln (Eds) (2007) The Landscape of Qualitative Research: Theories and Issues, 3rd Edition. Sage Publications, Thousand Oaks, California.
Denzin, N. K., Y. S. Lincoln (Eds) (2000). Handbook of Qualitative Research, 2nd Edition. Sage Publications, Thousand Oaks, California.
Franck, L.S.Cox, A.A. Winter, I. (2004). Parental concern and distress about infant pain, BMJ Journal,. 89(1) F71F75.
Francka, L. S. Spencer, C. (2005). Informing parents about anaesthesia for childrens surgery: a critical literature review, Patient Education Counselling, 59, (2). 117-125.
Gaskey,N. J. (1987). Evaluation of the effect of a pre-operative anesthesia videotape. AANA J; 55: 341345.
Glasper, A. Keeton, D. Spargo.P. (2008). The effect of a preoperative education programme on perioperative anxiety in children: an observational study, Pediatric Anesthesia, 18 ( 5). 426 430.
Greenberg, R.S. Billet, C. Zahurak.M. et al (1
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