A review of current approaches used to help children and parents cope with health care procedures.
There has been a long-standing belief that children and parents require preparation and support in the event of hospitalization. Programs that prepare children for hospitalization are designed to inform the child about what will happen and to familiarize the child with his environment. Although these programs provide only general information, they do impact upon the way a child can cope with specific procedures. Even though it is unclear why information is beneficial, there are reported studies that demonstrate its effectiveness. Information about health care procedures is provided through modelling, procedural, and sensory information, and stress-point nursing. While some of these techniques, as described in the literature, may be too extensive for every nurse to fully carry out with every child, the principles can be incorporated by all nurses. The studies cited give some indication that early preparation is beneficial for older children (7 years old and older), but that younger children benefit from preparation immediately prior to the procedure. Children with a previous hospital experience are thought to respond to information on rehospitalization in a unique way. Furthermore, while children may demonstrate anxiety initially when given certain kinds of information, stress-point nursing (repeated information and support) has been reported to be particularly beneficial. The research findings tend to oppose the notions that young children should not receive information, that all children benefit equally from the same type and timing of preparation, that a child who has had a previous experience requires less preparation, and that a one-time pre-admission program provides adequate preparation. The provision of emotional support and the use of play as a means of helping children cope with procedures is strongly supported in the anecdotal and theoretical literature. However, there are few controlled studies that have specifically analyzed the effects of play programs in pediatric settings. Studies done examining techniques that assist the child in gaining a sense of control suggest that a child can benefit from being helped to gain a sense of mastery over a stressful event. Progressive muscle relaxation and desensitization have been shown to reduce anxiety and discomfort during health care procedures. The effectiveness of these techniques, who can best use them, and when they should be used are questions still to be answered. The varying degrees of methodological rigor in present studies point to a need for further research. One cannot definitively state how closely nursing practice reflects available research findings as outlined in this article.(ABSTRACT TRUNCATED AT 400 WORDS)