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 Table of Contents  
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 30-34

Impact of preoperative education program on parental anxiety: A pilot project

1 Department of Child Health Nursing, Yenepoya University, Mangalore, Karnataka, India
2 Department of Medical Surgical Nursing, Laxmi Memorial College of Nursing, Mangalore, Karnataka, India
3 Department of Paediatrics, Yenepoya Medical College, Mangalore, Karnataka, India

Date of Web Publication2-Jun-2016

Correspondence Address:
Priya Reshma Aranha
PhD Scholar, Yenepoya University, Mangalore - 575 018, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2321-4848.183374

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Background: Hospitalization and surgery are stressful experiences for children and their parents. Parents are disturbed and anxious when their child is hospitalized and waiting for a surgery. Objective: To assess the impact of preoperative education program on parental anxiety. Materials and Methods: A quasi-experimental study with a time-series design was conducted in a selected hospital. Using purposive sampling technique, 12 parents of children undergoing surgery were selected as study participants and were segregated into two groups–experimental and control groups – with six participants in each group. The experimental group received preoperative education program, whereas the control group received routine care. Parental anxiety was measured using state trait anxiety inventory on admission, prior to shifting the child to the operation theatre (OT), 6 h, 24 h, and 48 h after the surgery, respectively. Results: The mean anxiety score of parents were less in the experimental group compared to the control group after the intervention. A significant change was observed in the mean score of parental anxiety over the period of time in the experimental group (F(4,20)= 58.628, P = 0.001). The calculated t-value was significant at the time points, that is, from admission to prior to shifting the child to the OT (P = 0.001), from admission to 6 h after the surgery (P = 0.000), from admission to 24 h after the surgery (P = 0.001), and from admission to 48 h after the surgery (P = 0.004) between the groups. Conclusion: The preoperative education program has shown to be effective in reducing parental anxiety and can be effectively used in pediatric surgical units to support the parents.

Keywords: Anxiety, parents, preoperative education program

How to cite this article:
Aranha PR, Sams LM, Saldanha P. Impact of preoperative education program on parental anxiety: A pilot project. Arch Med Health Sci 2016;4:30-4

How to cite this URL:
Aranha PR, Sams LM, Saldanha P. Impact of preoperative education program on parental anxiety: A pilot project. Arch Med Health Sci [serial online] 2016 [cited 2022 Jun 28];4:30-4. Available from: https://www.amhsjournal.org/text.asp?2016/4/1/30/183374

  Introduction Top

The advanced era of technological development in child healthcare has resulted in more pediatric procedures being performed in various settings. In the current scenario, the parents assume a greater role in the care of their child, especially during hospitalization, and while preparing for an upcoming surgery that is a stressful event for both.[1],[2],[3] The literature reveals that preoperative anxiety is common among parents [4] and they can be anxious regarding various events during their child's surgical experience such as anesthesia and associated risks, how the child would respond to the surgical experience and their own inadequacy in taking care of their child after the discharge from the hospital.[5]

Parental anxiety may be associated with various factors. A study identified specific factors such as age of the child, previous surgery, if other children in the family had surgery, gender of the parent, educational level of the parents, and whether or not parents had received preoperative information from an anesthesiologist prior to surgery that produced preoperative anxiety in the parents.[6] Children are influenced by parental advice and guidance in coping with new or stressful situations. Therefore, parents play a critical role in preparing and helping the children to cope with their surgery.[7]

Literature review

A literature review identified the effect of surgery on parents, reviewed various developmentally appropriate presurgical educational programs, and discussed the impact of these programs on the children and their parents.[4] Factors, such as humor and distraction [8] and preoperative visits,[9] have been proved to be effective in relieving preoperative anxiety in children and their parents. Studies have also shown that adequate parental preparation alone may be sufficient to minimize the anxiety in children.[5]

A literature shows that providing information to parents including verbal, video, or written modalities on the pre-, intra-, and postoperative events in a child's surgical journey could improve the knowledge and satisfaction among the parents and decrease their anxiety.[10] Another study proved that individualized education programs were effective in reducing parental anxiety during their child's surgery and improved their satisfaction regarding the preoperative preparation.[11]

A single blind randomized control trial tested the effectiveness of a standardized preoperative preparation in reducing the parental anxiety, and concluded that it is efficient in preparing parents for their child's surgery.[12] It was also proved that a preadmission program was effective in preparing families psychologically for day surgery.[13] A study has compared a tour of the OT (information-based), a commercially available videotape (modeling-based) and child life preparation (coping-based), to reduce preoperative anxiety among children and their parents. The group who received child life coping skills preparation exhibited less anxiety.[14] Various research studies indicated that the use of videotape has been an effective mode of preoperative education as it facilitates information provision that is less costly.[15],[16],[17] Minimization of preoperative stress in parents should be a priority for hospital personnel.[18] Thus, it is essential for the health professionals to provide specific and appropriate information to prepare the parents for their child's surgery. The present study evaluates the impact of a preoperative education program on the anxiety of parents whose children are undergoing surgery.

  Materials and Methods Top

A quasi-experimental study was conducted in a selected hospital in Mangaluru, Karnataka, India. Ethical approval was obtained from the Institutional Ethics Committee. The study population comprised of parents of children aged 8-12 years undergoing elective surgery. Using purposive sampling technique, a total of 12 parents, were assigned to control (N = 6) and experimental (N = 6) group, respectively. The intervention in the study was the preoperative education program. It consisted of a video on pre-, intra-, and postoperative events a child faced during a surgery, which the parent watched along with their child. As a part of the preoperative education program, an information pamphlet was provided to the parents during the interactive sessions.

The parents in the control group received the routine preoperative education, whereas those in the experimental group received preoperative education program within 1 h of the admission of their child. The parental anxiety was assessed on admission of the child, prior to shifting the child to the operation theater (OT), 6 h after surgery, 24 h after surgery, and 48 h after surgery using State-Trait Anxiety Inventory (Charles D. Spielberger 1977).

  Results Top

Study result showed that all the parents in the control group, and majority (83.3%) of the parents in the experimental group were in the age group of 30-39 years. All the study participants were females. Fifty percent of the control group and 66.7% of the experimental group had primary education. Majority of the parents, in both the groups, were homemakers. In the experimental group, majority (83.3%) belonged to nuclear family, whereas in the control group, majority (83.3%) belonged to joint family. The data also shows that 66.6% in the control group and 83.3% in the experimental group were from rural areas. In the experimental group (83.3%) and in the control group (50%) did not get exposed to surgical procedure in the family. Majority (66.7% in each group) of parents did not have any previous surgical experience. Majority (83.3% in each group) of parents did not prepare their child for surgery.
Figure 1: Line diagram showing the comparison of parental anxiety between the groups at different time intervals

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It was observed that on admission the mean parental anxiety scores were 115.00 ± 6.13 in the experimental group and 107.66 ± 7.60 in the control group, respectively. Prior to shifting the child to the OT, the scores were 96.67 ± 3.72 and 109.00 ± 6.32, respectively; at 6 h after the surgery, the scores were 92.00 ± 2.82 and 101.67 ± 3.61, respectively; at 24 h after the surgery, the scores were 86.50 ± 2.25 and 98.67 ± 5.39, respectively; and at 48 h after the surgery, the scores were 85.33 ± 3.32 and 94.50 ± 6.28, respectively, in the experimental and control groups.

The data in [Table 1] show that there is a significant change in the mean score of parental anxiety over the period of time within the experimental group (F (4,20)= 58.628, P = 0.001) and within the control group (F (4,20)= 8.062, P<0.001). Further, data in [Table 2], obtained from the post hoc analysis of parental anxiety, show that in the experimental group, reduction of parental anxiety score is significant prior to shifting the child to the OT (P = 0.01), and subsequently the score reduced significantly at 6 h, 24 h, and 48 h after the surgery (P<0.05), whereas in the control group, the reduction in parental anxiety score was not significant.
Table 1: Mean, SD, and F value in the experimental and control groups

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Table 2: Post hoc analysis of parental anxiety by Bonferroni test

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To compare the effectiveness of intervention between the two groups, t -test was computed. Data in [Table 3] show the mean ± SD for the parental anxiety and the t -test value at various time points. The calculated t -value was significant at different times points, that is, from admission to prior to shifting to the OT (P = 0.001), from admission to 6 h after the surgery (P = 0.000), from admission to 24 h after the surgery (P = 0.001), and from admission to 48 h after the surgery (P = 0.004).
Table 3: Mean, SD, mean difference, mean change, and t value for fear score at different time point between the groups (N = 12)

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  Discussion Top

It is essential to manage preoperative anxiety of the parents as it can affect the outcome in children as well. The current study evaluated that the preoperative education program is effective in reducing parental anxiety of those whose child is undergoing a surgery. Similar studies [19],[20] conducted previously also support the current study findings. The main component of preoperative education program was the video film. A study [21] has shown that a preoperative informational video was useful in reducing parental anxiety.

From the current study, it was observed that the parents experience anxiety during their child's perioperative period. These findings are consistent with a study conducted to assess the anxiety and stress of fathers and mothers in the 24 h after their child's surgery, which reported that there was a high level of stress and anxiety among the parents during this period.[22] The current study findings are also consistent with a study where the parents who received an educational pamphlet and viewed a video regarding the induction of anesthesia exhibited decreased anxiety.[23]

Moreover, another study [24] carried out to assess the effect of preoperative cognitive behavioral program on the parental anxiety during their children's surgery has concluded that the preoperative education program can significantly reduce the parental anxiety that supports the current study findings.

  Conclusion Top

Preparing parents for their child's surgery is an essential responsibility of healthcare professionals. Parental anxiety negatively affects the parents' coping with new or stressful situations while the children are undergoing surgery. It is a challenge for the nurses working in the pediatric surgery units to minimize parental anxiety. As the parents received the preoperative education program, the knowledge gained regarding the pre-, intra-, and postoperative events enabled them to prepare well for the child's upcoming surgery. Therefore, it is concluded that preoperative education program is effective and can be successively implemented in pediatric surgery units to minimize parental anxiety. Further studies can be done to develop and implement other interventions that can help parents to cope up with their child's surgery. Health-care facilities can develop this kind of preoperative education program within their policy and protocol. It is a onetime investment for the hospital, but all the parents and their children getting admitted to the hospital for surgery can be benefitted a lot. Nurses can use this as an effective tool to prepare the parents for their child's surgery as it is an audiovisual device that will enlighten them in a better manner.


The authors express sincere thanks to the administrators, doctors, nurses, and other hospital staff of Yenepoya Medical College Hospital, Mangaluru, Karnataka, India for all the support rendered during the study and the parents for being a part of the study.

Financial support and sponsorship

Yenepoya University, Mangaluru has funded the project.

Conflicts of interest

There are no conflicts of interest.

  References Top

Landolt MA, Boehler U, Schwager C, Schallberger U, Nuessli R. Post-traumatic stress disorder in paediatric patients and their parents: An exploratory study. J Paediatr Child Health 1998;34:539-43.  Back to cited text no. 1
Landolt MA, Vollrath M, Ribi K, Gnehm HE, Sennhauser FH. Incidence and associations of parental and child posttraumatic stress symptoms in pediatric patients. J Child Psychol Psychiatry 2003;44:1199-207.  Back to cited text no. 2
Hug M, Tönz M, Kaiser G. Parental stress in paediatric day-case surgery. Pediatr Surg Int 2005;21:94-9.  Back to cited text no. 3
Brewer S, Gleditsch SL, Syblik D, Tietjens ME, Vacik HW. Pediatric anxiety: Child life intervention in day surgery. J Pediatr Nurs 2006;21:13-22.  Back to cited text no. 4
Ibanga AJ, Ibanga HB. Psychological Issues in Paediatric Surgery. Paediatric Surgery: A Comprehensive Text for Africa. Global Help. 2011. Available from: . [Last accessed 2015 Mar 21].  Back to cited text no. 5
Litman RS, Berger AA, Chhibber A. An evaluation of preoperative anxiety in a population of parents and infants and children undergoing ambulatory surgery. Paediatr Anaesth 1996;6:443-7.  Back to cited text no. 6
Piira T, Sugiura T, Champion GD, Donnelly N, Cole AS. The role of parental presence in the context of children's medical procedures: A systematic review. Child Care Health Dev 2003;31:233-43.  Back to cited text no. 7
Berger J, Wilson D, Potts L, Polivka B. Wacky Wednesday: Use of distraction through humor to reduce preoperative anxiety in children and their parents. J Perianesth Nurs 2014;29:285-91.  Back to cited text no. 8
O'Shea M, Cummins A, Kelleher A. The perceived effectiveness of a pre-admission visit for children (and their parents) undergoing day surgery procedures. J Perioper Pract 2011;21:244-8.  Back to cited text no. 9
Franck LS, Spencer C. Informing parents about anesthesia for children's surgery: A critical literature review. Patient Educ Couns 2005;59:117-25.  Back to cited text no. 10
Chan C, Molassiotis A. The effects of an educational programme on the anxiety and satisfaction level of parents having parent present induction and visitation in a post anaesthesia care unit. Paediatr Anaesth 2002;12:131-9.  Back to cited text no. 11
Fincher W, Shaw J, Ramelet AS. The effectiveness of a standardised preoperative preparation in reducing child and parent anxiety: A single blind randomised controlled trial. J Clin Nurs 2012;21:946-55.  Back to cited text no. 12
Ellerton ML, Merriam C. Preparing children and families psychologically for day surgery: An evaluation. J Adv Nurs 1994;19:1057-62.  Back to cited text no. 13
Kain ZN, Caramlco LA, Mayes LC, Genevro JL, Bornstein MH, Hofstadter MB. Preoperative preparation programs in children: A comparative examination. Anesth Analg 1998;87:1249-55.  Back to cited text no. 14
Kain ZN, Caldwell-Andrews AA. Preoperative psychological preparation of the child for surgery. Anesthesiol Clin North America 2005;23:597-614, vii.  Back to cited text no. 15
Pinto RP, Hollandsworth JG Jr. Using videotape modeling to prepare children psychologically for surgery: Influence of parents and costs versus benefits of providing preparation services. Health Psychology 1989;8:79-95.  Back to cited text no. 16
Cassady JF Jr, Wysocki TT, Miller KM, Cancel DD, Izenberg N. Use of preanesthetic video for facilitation of parental education and anxiolysis before pediatric ambulatory surgery. Anesth Analg 1999;88:246-50.  Back to cited text no. 17
Litke J, Pikulska A, Wegner T. Management of perioperative stress in children and parents. Part I--the preoperative period. Anaesthesiol Intensive Ther 2012;44:165-9.  Back to cited text no. 18
Caldwell-Andrews AA, Kain ZN, Mayes LC, Kerns RD, Ng D. Motivation and maternal presence during induction of anaesthesia. Anaesthesiology 2005;103:478-83.  Back to cited text no. 19
William Li HC, Lopez V, Lee TL. Effects of preoperative therapeutic play on outcomes of school-age children undergoing day surgery. Res Nurs Health 2007;30:320-32.  Back to cited text no. 20
McEwen A, Moorthy C, Quantock C, Rose H, Kavanagh R. The effect of videotaped preoperative information on parental anxiety during anesthesia induction for elective pediatric procedures. Paediatr Anesth 2007;17:534-9.  Back to cited text no. 21
Scrimin M, Haynes M, Altoè G, Bornstein MH, Axia G. Anxiety and stress in mothers and fathers in the 24 h after their child's surgery. Child Care Health Dev 2009;35: 227-33.  Back to cited text no. 22
Zuwala R, Barber KR. Reducing anxiety in parents before and during paediatric anesthesia induction. AANA J 2001;69:21-5.  Back to cited text no. 23
Dsouza P, Bhaduri A, George A, Renu G, D'Cru A. Parental anxiety during children's surgery: The effect of preoperative cognitive behavioural programme. IJLPHL 2013;2:1-7.  Back to cited text no. 24


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  [Table 1], [Table 2], [Table 3]

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