Opinion

Calming influence Dragana Nikolic on training nurses in Serbia how to use play and reassurance to prepare children before surgery IN MAY 2013 I entered a pre-medication room for surgery. Ten children, aged two to ten, had been separated from their mothers at the door and were waiting for intravenous (IV) anaesthesia. Several were crying hysterically and another was fighting with the nurse and doctor. It was a nightmare for staff and children. Having taught nurses at different hospitals about child- and family-centred procedures, I knew the scene I encountered was unnecessary. I asked one of the anaesthesiologists if I could meet the families of children scheduled for operations the next day to prepare them for surgery. Some parents know it is important to explain to their child what will happen, but many do nothing and children are often left with the impression that they are just having a routine check-up. So when they are separated from their mothers outside the pre-medication unit, the situation is stressful and difficult for everyone. The night before surgery, I gathered all the children and parents, introduced myself and gave the children toys. I explained to the parents what to expect the next day and then began to prepare the children through play. I demonstrated with a doll what will happen and how an IV is placed. The children liked pretending to place an IV

on the doll and we agreed to do it again the next day. I promised to meet them and help them during the IV procedure. The next morning I greeted them all in their rooms and waited with them outside the pre-medication room. No one was crying when they had to leave their mothers, because I was there with the toys. They knew that the siting of an IV – with children we call it a butterfly – is the next step. We had agreed the night before that ‘the butterfly will fly down easier’ if we blow bubbles that help reduce pain. Placing the IVs was easy and took place without having to hold crying children down. The bubbles helped a lot, as did other distraction techniques and toys. The children were calm and not particularly scared before they fell asleep in the operating room. New practices Despite this success, bringing child- and family-centred care to Serbia is not easy because hospitals lack adequate numbers of nurses, and training is limited. It can also be difficult for nurses to adopt new practices. I have now taught more than 20 courses to nurses in Serbia, each comprising six modules lasting four hours each. The topics covered include: ■■ Rights of children in a hospital setting.

Course evolution timeline 2009 Curriculum drafted by a team of experts from the Johns Hopkins Children’s Hospitals in the United States and the Swiss NGO Partnerships in Health, and approved by the Serbian Ministry of Health. 2010 Baseline survey conducted with 23 Serbian children’s wards and hospitals. The curriculum’s authors complete a five-day NURSING CHILDREN AND YOUNG PEOPLE

trainer course for multidisciplinary teams from six Serbian and two Macedonian hospitals. 2011/13 Five hundred nurses trained in six hospitals, including the two largest tertiary children’s hospitals in Serbia. 2013 First group of anaesthesiologists and doctors; the Ministry of Health accepted nationwide launch of the project.

■■ A developmental perspective on health, illness and hospitalisation. ■■ Preparation and coping with procedures. ■■ Pain relief. ■■ Play and learning in the hospital. ■■ Fundamental principles of childand family-centred care. ■■ Communication. My teaching method includes showing videos, discussing case studies and role play. And I listen to nurses: we problem solve, and I suggest how they can support children and families better during stressful admissions. At the start of every course, nurses say they are too busy to integrate new techniques, that things cannot be changed, that children should know little about what will happen to them, and that parents cause more problems and should not be in the intervention room. As the course progresses, I ask them to try techniques on the ward the next day; they come back with success stories to share. Change is difficult, but the Serbian Ministry of Health has accepted the need for change and is likely to take on a lead role in further implementation. Dragana Nikolic is executive director of the non-governmental organisation Partnerstvo za zdravlje (Partnerships in Health), Belgrade, Serbia April 2013 | Volume 26 | Number 3 15

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