About preparation
To relieve stress on children’s medical procedures
Although the speed of growth and development of young children varies from person to person, in Europe and the United States, psychological preparation is defined as providing an environment and opportunities to bring out the coping ability of children and parents by explaining illness, hospitalization, surgery, examinations, etc. in a way that suits each cognitive development. (Platt，1959；American Academy of Pediatrics，1971；American Academy of Pediatrics，1978)
It is said that three factors are important in preparing. (1) Communicate information without lies to the child, (2) Support the emotional expression of the child (interactivity), (3) Build a relationship of trust between the child and his / her family and hospital staff.（Vernon et al，1965)
Elements for performing preparations and things to be aware of when performing
In the West, preparation is unavoidable for preschool children, and it is common to work with Child Life Specialists, Hospital Play Specialists, doctors and nurses to provide preparations to children and parents who are hospitalized and undergo surgery.(Crocker，1974；Azarnoff & Flegal，1975； American Academy of Pediatrics，2000)
Preoperative orientation has been attempted as a preparation for surgery. For example, visual information provision tools such as books, pamphlets, picture-story shows, puppet shows, VTRs, play programs using realistic tools such as toys and actual medical equipment, and operating room experience tours.（Johnson，1974；Wolfer & Visintainer，1975；Pinto & Hollandsworth，1989；Manworren & Woodring，1998）Seeing, hearing, touching, feeling, smelling, checking each memory you have experienced, and giving a reassuring, simple and concrete explanation of the upcoming surgery. It is considered important to encourage children’s coping ability and emotional response.(Fassler，1980；Petrillo & Sanger，1980；Thompson & Stanford，1981；Kain et al., 1998)
It is said that props that can be played directly in the hand, tools such as visually appealing models and pictures should be used for preparation, and that preparation should be performed “individually” according to the cognitive development of each child.
By “contagion hypothesis” regarding anxiety between children and parents, the psychological confusion and negative behavioral changes of children can be further reduced by having parents participate in the preparation, not just the children. It has also been reported to reduce parental anxiety. (Skipper & Leonard，1968；Wolfer & Visintainer，1975；Kain et al，2002)
Application of preparation and distraction
The American Academy of Pediatrics (1971) cites early childhood (3 years and older) as an application of preparation. The reason is
- Has the concept of object permanence
- Can be symbolized
- Increases ability to retain and recall concepts of objects and events（Piaget，1964/1968）
- Perception of time → I can put up with the satisfaction of the present for the future
- Emotional expression and conversation ability → Understand explanations and express emotions（Erickson，1958）
Even if you are 3 years old, the speed of growth and development varies from person to person, so it is important to explain illness, hospitalization, surgery, examinations, etc. in a way that suits each cognitive development. It is also important to provide an environment and opportunities that bring out the coping abilities of children and parents. Distraction is effective from infants to early early childhood,because unable to carry out preparation.
Preparation guidelines
- Both children and parents should participate in the preparation process.
- Information should be provided in line with the cognitive abilities of the child.
- Emphasis should be placed on the sensations that the child is likely to experience.
- Children and parents should be encouraged to express their emotions throughout the preparation process.
- This process should lead to the development of a relationship of trust between the person doing the preparation and the family.
- Children and parents should be assisted by those who have such trust during hospitalization at any time of tension.
(Thompson, Richard H. Stanford, Gene. supervised by Noboru Kobayashi. Child life in hospitals : theory and practice.p157. Chuohoki Publishing.2000.).
To supplement No.2 and 3, preparations need to provide children with “two pieces of information”. First, it is important for the child to know the “procedural information” as a child. For example, in the case of surgery, the order in which things proceed based on oneself (I enter the operating room ⇒ lie down on the bed ⇒ wear an anesthesia mask ⇒ repeat deep breathing ⇒ sleep ⇒ ICU when I wake up. The second is “sensory information”, and it is important for children to know in advance information such as tingling, getting hot, and smelling together with “procedural information”. Helps to promote psychological preparation. Please also read the reference article below.
