Semester

Fall

Date of Graduation

2023

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Committee Chair

Billie Vance

Committee Member

James Cain

Abstract

ABSTRACT

ONE VOICE Training to Enable Nurses and Anesthesia Providers to Mitigate Pediatric Presurgical Anxiety

Sarah E. Hinnant

Background: Children in the preoperative area experience presurgical anxiety at rates of up to seventy-five percent. Increased pediatric anxiety is directly linked to increased anesthetic requirements, increased risk for development of emergence delirium, and increased time spent in the post anesthesia care unit. Numerous high-quality studies show that intervention by a certified child life specialist mitigates preoperative pediatric anxiety. Often child life specialists are not available to meet with all children prior to surgery. Registered nurses (RNs) and certified registered nurse anesthesiologists (CRNAs) are present in the presurgical area and have the potential to reduce pediatric presurgical anxiety.

Purpose: The purpose of this quality improvement project was to increase provider adherence to the ONE VOICE intervention and to reduce pediatric presurgical anxiety.

Methods/Interventions: This prospective quality improvement project used an unpaired cohort design to evaluate the effectiveness of the ONE VOICE intervention on pediatric presurgical anxiety. A group of trained raters used the modified Yale Preoperative Anxiety Scale-short form (m-YPAS-sf) to assess baseline anxiety. Pediatric RNs and CRNAs completed a self-assessment of baseline adherence to the ONE VOICE intervention. Then the RNs and CRNAs were trained on the ONE VOICE intervention. After one month, the RNs and CRNAs took the self-assessment again. Next, post intervention pediatric anxiety was assessed using the m-YPAS-sf.

Results: Implementation of the ONE VOICE teaching mnemonic led to a statistically significant increase in RN and CRNA adherence to ‘educating the child before the procedure about what is going to happen.’ A self-assessment Likert survey distributed via Qualtrics survey software, pointed to a clinically significant increase in adherence of seven of the eight ONE VOICE components. Pediatric anxiety in the presurgical area at West Virginia University Medicine (WVUM) Children’s was reduced by 28.3%.

Conclusion: Use of the m-YPAS-sf in the preoperative area at WVUM Children’s would allow more metrics to be evaluated. Medication requirement, length of stay, incidence of emergence delirium, and development of pediatric medical traumatic stress are areas of study showing a correlation to pediatric presurgical anxiety. Continued evaluation of this project should focus on measuring the impact of the ONE VOICE intervention on medication requirement, length of stay, and the incidence of emergence delirium.

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