Preanesthetic nurse communication with children and parents--an observational study

The impact of communication within the perioperative period is an area of increasing research interest. Suggestions are phrases or actions that can lead to subconscious nonvolitional changes in patient perception, mood, and/or behavior. Statements functioning as suggestions may induce positive or negative perceptual responses and experiences. Children and anxious patients are particularly responsive to the effects of suggestion. We aimed to identify positively and negatively worded statements used during the provision of preoperative information by nursing staff in a tertiary referral center for pediatric care.

Audio recordings of preoperative consultations between nurses, children, and their parents were made between February and May 2014. Two researchers independently reviewed the transcripts and identified positively and negatively worded suggestions. Examples of negative suggestions were, 'he is going to be sore for a week or two' or 'normal to feel a bit sick....', and a positive suggestion was 'so she will be feeling quite comfortable...'.

There were 51 consultations transcribed and analyzed. Of the 130 suggestions independently agreed by both researchers to be either positive or negative, 40 were identified as positive (31%) and 90 negative (69%). Commonly occurring negative suggestions described: pain in 21 consultations (41%); nausea and sickness in 19 (37%); and irritability or agitation in nine (18%). Positive suggestions included a description of a return of normal activities such as eating and drinking in 14 (28%), comfort in nine (18%), and well-being in nine (18%). Twelve consultations (24%) contained only negative suggestions, while four (8%) had only positive suggestions.

This is the first prospective observational study investigating the language used by nurses during the preoperative child-parent encounter. Suggestions for negative perceptual experiences were frequently used during the preoperative nurse consultations. Education of nurses regarding awareness and understanding of negative suggestions and their potential adverse effects is recommended.