CHILDREN'S PREOPERATIVE COPING AND ...

CHILDREN'S PREOPERATIVE COPING AND ITS validitys ON POSTOPERATIVE ANXIETY AND get back TO NORMAL ACTIVITY L L LaMontagne et al Nursing Research Vol 45 (May/June 1996) 141-147

Perioperative succors often face the challenge of dealing with anxious pediatric patients. Although we have recognized the importance of helping children cope with the stressful surgical experience, little is known about to what extent this coping influences patient results The purpose of this studious mood was twofold:

* determine whether the relationships construct previously between coping and its antecedents (eg age, information given, locus of control) would be replicated with a sample of children undergoing major, rather than minor, elective surgery and

* touchstone a model that relates coping to sum of two units different postoperative outcomes (ie, anxiety and answer to normal activities).

Creating a standard Researchers reviewed theories on stres and coping, as well as research administrationed on children undergoing minor surgery The thought was grounded on Lazarus' theory of stres and coping, which describes coping as the proces used to alter, manage, or tolerate a disturbance in a personal or situational relationship. Previous research has originate that children vary in their manner of coping with stress, like as that caused by upcoming surgery The use of avoidance is associated with external locus of direction Children who receive more preoperative information use more vigilance--which is associated with internal locus of control--and are les anxious.

Based in succession Lazarus' theory and the previous research, the researchers exhibited a model of preoperative coping in pediatric patients, based onward the following theories.

* Locus of have charge of and parent anxiety will have direct, negative purports on coping.

* Patient age and parent and physician information will have direct, positive purports on coping.

* Coping will have a direct, positive import on two postoperative outcomes (ie, anxiety and turn back to normal activities).

way s A convenience sample, comprising 90 children (ie, 62 female, 28 male) admitted for elective orthopedic surgery in a southeastern hospital, was used. Ages ranged from eight to 17 years. The majority of children were white and of middle-class socioeconomic status. Forty-two of the children had no previous surgery 20 had previous minor surgery and 27 had previous nonorthopedic major surgery Seventy-two of the patients were undergoing spinal fusion for scoliosis; the remainder were undergoing other major orthopedic surgeries (eg hip osteotomies). These surgeries are comparable in fulness of their expected hospitalizations and in the amount of postoperative pain and anticipated immobility.

Data were heap uped at five different times: preoperative clinic visit; postoperative day two; and three month six month and nine month postoperatively. Instruments used included

* a modified Cohen and Lazarus' Preoperative accident of Coping Interview;

* the Nowicki-Strickland Locus of sway Scale for Children;

* an age-appropriate version of Spielberger's State-Trait Anxiety Inventory;

* the Social Scale of the Youth Self-Report and Profile, which assessed the children's usual activities (preoperative activities then were compared to activities reported during recovery); and

* the Parent-Doctor Information Interview.

Researchers analyzed these data and fix significant correlations between the following variables:

* locus of mastery and coping (r = -23 P = 03)

* age and coping (r = 26; P = 01) and

* information and coping (r = 27; P = 01)

This confirms the hypothesis that the more internal the child's locus of restrain the more vigilant is his or her coping. Internal locus of hinder was associated with lower preoperative activity and higher postoperative activity, suggesting that the anxiety was higher postoperatively. The other hypothesis (ie, age has a direct, positive purport on coping) also was supported. Coping also had a positive force on postoperative anxiety and go [i]or[/i] come back to normal activities. The more vigilant the coping, the lower the child's postoperative anxiety and higher his or her activity level

The more instances in which the child had an internal locus of check the older the child, and the more preoperative information given, the more vigilant the child's coping was. Children who were older more anxious, and more internal in locus of restrain exhibited more vigilant coping. Avoidant coping was associated with les anxiety sum of two units days postoperatively, and vigilant coping was associated with respond to normal activity during the course of redemption Neither age nor parent anxiety was a predictor of parent or physician information. Parent anxiety was institute to influence children's preoperative anxiety, which in move round influenced postoperative anxiety and coping. Preoperative information alone was not a significant contributor to coping.

Discussion. These findings demonstrate the value of using theoretical frameworks to guide our practice. Research is not always available to identify the best intervention to address a patient care riddle Grounded theory can provide guidance upon where to focus our interventions. The findings of this subject of attention are particularly interesting because mostly preoperative interventions for anxiety management are informational; in addition the giving of information was not associated with a change in coping.