Lisbet Andersson portait photo

Small changes in the healthcare can increase the sense of safety for children who are about to have surgery

Let the child hold the breathing mask and decide on what finger to place the pulse oximeter. Lisbet Andersson’s dissertation in health science provides an answer to how small measures can improve a child’s experience of the surgical environment, without jeopardising patient safety.

Each year, some 100,000 children have surgery in Sweden. For many of them, this is a situation associated with worry and a feeling of powerlessness. The operating room is an unfamiliar and unknown environment with which the child has rarely been in contact before. It contains a lot of technical equipment that is difficult to understand. At anesthesia, the child is to lay down in this unfamiliar environment, surrounded by staff that he or she has never met before.

Lisbet Andersson has worked as nurse anesthesia for more than 20 years and has been in charge of the child section at the central hospital in Växjö. She has recently defended her doctoral thesis in which she studies the interplay between child, parents, and healthcare staff in connection to anesthesia. The aim is to find methods for a safer surgery environment. In her dissertation, she combines video observations, questionnaire studies, and in-depth interviews to gain an understanding of the situation for everyone involved.

“My dissertation has resulted in concrete advise that are easily applicable and that all surgery departments can introduce. It shows that small changes can make a major difference for both children and parents, without jeopardising patient safety”, Andersson explains.

Short time to establish a safe environment

Andersson’s observations show that it takes roughly eight minutes from when the child enters the surgery room until it has been anesthetised. In this period of time, the healthcare staff informs about the surgery and connects the technical equipment.  Everything goes fast and often several nurses work in parallel with each other.

The task of the anaesthesia staff is twofold, Andersson says. In addition to the medical task, they must also establish a safe situation in which the child and parents feel trust. Andersson’s study shows that the anaesthesia staff in general is positive to the parents’ presence, but they can become better at involving the child and parents.

“What I have seen is that the staff in the operating room does not involve the child and parents to any large extent. Often, they do not ask the child about its experience, whether he or she has been in a similar situation before or what he or she is thinking about. Instead, the staff takes on the role of educators and informers”, Andersson continues.

Other ways to make children more involved

The solution is to involve the child and parents, to explain to them what they see and what will happen in the surgery room. Small, simple changes to the interplay between anaesthesia staff and child can be very important to create a sense of safety.

“Instead of having the child lay down on the operating table, which contributes to a feeling of powerlessness, you can let the child sit. In this way, the child will be level with the staff. When children are to be anesthetised, a breathing mask with oxygen is held over the child’s mouth. This mask could be held by the child, with support from the staff. A child could also take part in deciding on what finger to place the pulse oximeter”, says Andersson.

Changes like this will give the child certain control over the situation, which largely affects how the situation is experienced by the child. What is more, this can be implemented without jeopardising patient safety, according to Andersson.

“There does not have to be opposition between participation and patient safety. If the staff is flexible, child and parents can be more involved, without this affecting the medical part or patient safety”, Andersson continues. 

Important with the right amount of information

When anaesthesia staff make children more involved it is important to remember that too much information can increase the child’s anxiety”, Andersson points out.

“The key is to involve the child, and that the staff have the courage to ask the child questions like: “How much do you want to know?”, “How much do already know about this room in which you are going to sleep?” In this way, the child becomes empowered and can decide how much he or she wants to know. It becomes a way of providing individualised care”, Andersson explains.

Four pieces of advice for children and parents before surgery

Lisbet Andersson, senior lecturer in health sciences, offers advice:

  • Visit the hospital in advance. Some surgery departments offer presurgical visits at the department. I would recommend parents to do this with their child. At such a visit, you will have the opportunity to become acquainted with the surgery room and how things work, without the child being anesthetised at that visit. When you later show up for the surgery, the environment will be familiar.
  • Take part of the information. is an example of a website that explains what happens during a surgery. Many hospitals also send out information aimed at children who are to be anesthetised. Read this information together with your child.
  • Be emotionally open. Many children get a pain in their stomach or have trouble going to school before they are going to be anesthetised. Ask your child what he or she is worried about.
  • Bring an object that offers a sense of safety. This can be a stuffed animal, a blanket, or something else that the child normally wants nearby when it is time to sleep. The object becomes a familiar thing to bring into an unfamiliar situation.