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Communication and child behaviour associated with unwillingness to take premedication.
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
Department of Health and Behaviour Sciences, University of Kalmar, Kalmar, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
2008 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 9, 1238-1242 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To see how dominance in adult communication and child behaviour during premedication affects the child's unwillingness to take premedication.

Method: Ninety-five children scheduled for ENT surgery were video-filmed during premedication. All communication was translated verbatim and the communication was grouped according to; if the parent or nurse directed their communication towards the child or not, or; if they talked about nonprocedural matters or procedural matters.

Results: Unwillingness to take premedication was associated with more parent communication and less anaesthetic nurse communication compared to willingness to take premedication. There was a heighten risk that the child took their premedication unwillingly if their parent talked more directly to the child (OR = 4.9, p < or = 0.01), the child gave hesitant eye contact with the anaesthetic nurse (OR = 4.5, p < or = 0.05), the child had experienced an earlier traumatic medical procedure (OR = 4.1. p < or = 0.001) or if the child placed her/himself nearby their parent (OR = 4.0, p < or = 0.001).

Conclusion: Together with behaviour that could be signs of shyness and earlier medical traumatic experience, parents that are actively communicating with their child before premedication may heighten the risk that the child will take the premedication unwillingly.

Place, publisher, year, edition, pages
WileyScience , 2008. Vol. 97, no 9, 1238-1242 p.
Keyword [en]
Behaviour, Child, Compliance, Communication, Premedication
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17362DOI: 10.1111/j.1651-2227.2008.00896.xPubMedID: 18540904OAI: oai:DiVA.org:liu-17362DiVA: diva2:208825
Available from: 2009-03-20 Created: 2009-03-20 Last updated: 2017-12-13Bibliographically approved
In thesis
1. The Process of Anaesthetic induction with Children
Open this publication in new window or tab >>The Process of Anaesthetic induction with Children
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anaesthetic induction is one of the most stressful experiences a child can have during hospitalization. High anxiety is seen in 50–60% of the children and is associated with less compliance/cooperation during anaesthetic induction. It can also lead to behaviour problems after surgery.

Important factors that are associated with high anxiety are younger age, withdrawn shy temperament, previous negative experience in the hospital and certain kinds of adult behaviour. This thesis has been done to further illuminate the anaesthetic process and gain more knowledge about child behaviour, parent and staff communication, nurse anaesthetist decision-making communication and the reactions of children after anaesthesia and surgery.

Materials/Methods: One-hundred and two children between the ages of 3–6 that were scheduled for ENT surgery were video filmed. Screening instruments about child behaviour, fears and parental anxiety were used before the anaesthetic procedure. All children were video filmed during the process until they were at asleep. Parents were interviewed during the operation. Forty-nine children came 14 days after the surgery for a play session that also was video filmed. The video films were then analysed to identify critical situations and behaviours. Parents and nurse communication were categorized. Decision-making communications from the nurse anaethetist were also identified and categorized.

Results: Four critical situations or reactions were identified, premedication, degree of sedation, compliance during needle insertion or mask on child´s face and the child’s reactions when going to sleep. Each of the situations influenced the next following situation, predicting a higher risk for developing a vicious circle. The first (taking the premedication) was predicted by earlier traumatic hospital experience, if the child placed him/herself nearby or in parent’s lap, hesitant eye contact and highly active parents. The most common type of decision-making category was information, followed by negotiation. Unwillingness to take premedication was associated with more negotiation and less information. A child who takes premedication unwillingly had more often avoidant reactions toward anaesthetic equipment and anaesthetic play after surgery. An anaesthetic induction process is complex and transactional. Previous experience will together with the process of anaesthesia create a new learning history.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1099
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17365 (URN)978-91-7393-701-6 (ISBN)
Public defence
2009-02-27, Qulturum, Länssjukhuset Ryhov, Jönköping, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-20 Created: 2009-03-20 Last updated: 2009-08-21Bibliographically approved

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Proczkowska-Björklund, MarieGustafsson, Per ASvedin, Carl Göran

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