Postoperative Recovery in the Youngest: Beyond Technology
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting and Participants
2.3. Data Collection
2.4. Data Analysis
2.5. Ethics
3. Result
3.1. Adequate Grounds for Decisions
3.1.1. Prescriptions and Guidelines
3.1.2. Potential of Technology
3.1.3. Clinical Assessment
3.1.4. The Child’s Health Status
3.1.5. Participating Parents
3.1.6. Situational Awareness
3.2. Inadequate Grounds for Decisions
3.2.1. Limits of Technology
3.2.2. Inappropriate Use of Technology
3.2.3. Decisions Made by a Previous Doctor or Nurse
3.3. Adjusting the Monitoring
3.3.1. Reducing the Interference Caused by Monitoring
3.3.2. Monitoring Based on the Current Situation
3.3.3. Non-Medical Technical Assessment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Median | Range | |
---|---|---|
Age, years | 53 | 30 to >60 |
Number of years of healthcare experience | 34 | 10 to >30 |
Number of years as trained specialist nurse | 20 | 1 to >30 |
Department | ||
Working in PACU at children’s hospital | 9 | |
Working in PACU with both adults and children | 8 |
Subcategories | Category | Main Area |
---|---|---|
Standard monitoring for various interventions (10) * Routines followed (8) Dialogue/prescription with doctor or nurse in charge (8) | Prescriptions and guidelines | Adequate grounds for decisions |
ECG connection providing graph of breathing (6) ECG used for heart rate and rhythm (8) Pulse oximetry as a technical aid (13) | Potential of technology | |
Experience is important (14) Sense of impending change for the worse (11) Transfer to nurse anaesthetists from operation staff for recovery from anaesthesia (4) | Clinical assessment | |
Adaptation to what happened in the intraoperative period (6) Child-centred approach and individualisation (15) Child’s age (5) ASA class, state of ill-health (5) | Child’s health status | |
Parents know their children, are close by, provide security and/or perceive change promptly (8) | Participating parents | |
Need to be prepared for unusual and/or complex emergency situations (7) Keeping calm in critical situations (2) | Situational awareness | |
Delay in readings displayed if child’s condition worsens (3) Positioning may result in incorrect readings (5) Agitated child, pain, hunger, restlessness and/or strange situation causing incorrect readings (4) Difficult to measure blood pressure reliably in very young children (3) Technology must be used at more frequent intervals for correct assessment (1) | Limits of technology | Inadequate grounds for decisions |
Existing scope for monitoring not used (1) Child’s ill-health means that lower saturation level is important; correction of alarm thresholds necessary (1) | Inappropriate use of technology | |
Decision on level of monitoring made intraoperatively (3) Wrong level of care; child who needs more resources than are available (4) Regular unit closes and child has to be transferred from there (1) | Decisions Made by a Previous Doctor or Nurse |
Quotations | Subcategories | Category | Main Area |
---|---|---|---|
“So we disconnect it when they come in from the operation, or we ask the anaesthetic staff not to keep doing the ECGs and blood pressure monitoring. We don’t have it on any children”. | Remove monitoring in advance (1) * | Reducing interference caused by monitoring | Adjusting the monitoring |
“When they get so irritated and cross, and scream and just thrash their feet around, because then there’s a risk of them pulling out the peripheral venous catheters and everything that entails, or the central venous catheters as well, so that you really have to remove the pulse oximeter”. | Remove monitoring (7) | ||
“We have extremely little monitoring—we take off what we can”. | Remove as much as possible (3) | ||
“If they’ve woken up and had something to eat, then they don’t need monitoring any more anyway, generally speaking”. | Remove monitoring when they (the child) are picked up and held (10) | ||
“Because we don’t want to disturb them. They need to get plenty of sleep after having their anaesthetic, with all the medication. If they wake up too early, we get a real uproar here, you see. They toss around, and they’re just not themselves”. | Keep monitoring (8) | ||
“Where something has happened during the operation that results in the child needing to be monitored more clearly”. | Extended monitoring (1) | Monitoring based on the current situation | |
“Usually once you’ve administered the morphine, they calm down and then you can put the pulse oximeter back again”. | Option of reconnecting the equipment (6) | ||
“And then you have to, sort of, just sneak it on for a short while, and then you can take it away again, for instance. Then all you can do is hold still for a couple of seconds and say ‘finished’, and then we take it off, and so it goes on”. | Intermittent checks (7) | ||
“On the other hand, if you were to have masses of children at the PACU on some occasion, that you don’t really have a chance to look at them that much—then perhaps you should be more cautious about removing the monitoring”. | Keep the monitoring equipment on when there are a lot of children in the PACU and/or at night (1) | ||
“Then we send everything with the child to the department as well. So then they can decide when to remove it, because it’s much easier to remove the stuff than to put it back again”. | Keep the monitoring on when the child is sent to the department (1) | ||
“Is it worth waking up the child so as to, perhaps, then take an extra blood pressure reading? Or should we let the child sleep?” | Refrain from monitoring (2) | ||
“And then we ask the doctor whether it’s OK for us just to use a pulse oximeter in here”. | Doctor’s prescription (6) | ||
“Yes, that’s how it is: having had long experience, I’ve learnt a thing or two about what can happen and what should happen. So I don’t always contact the doctor every time”. | Personal decision (4) | ||
“Then you turn them off. You have to be there anyway, keeping an eye on them anyway, all the time”. | Change the alarm limits (4) | ||
“You also do a tremendous lot of watching how the children are breathing, and of course check whether the alae nasi are moving or retracted, whether there’s stridor, and that sort of thing”. | Breathing patterns (7) | Non-medical technical assessment | |
“I watch the child closely, you could say. I touch the child and look, without staring, to see the skin tone, sweat on the forehead, mimicry, rigidity, how the hands are opening and shutting, I take the hands and feel whether they’re tense, and I watch and listen to the breathing”. | Use one’s own senses in the observation (9) | ||
“Then I may skip the monitoring and just look at them. But then you really look at them—then you can’t sit at a distance, in front of the computer or anything like that. You really have to be close by if you don’t have any monitoring on at all”. | Near the child (4) | ||
“You have another person there, after all, but you absolutely mustn’t ask too much of the parents. You’ve got one other person who knows them and who knows about what’s normal and what isn’t”. | Get the parents involved (4) |
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Sjöberg, C.; Ringdal, M.; Jildenstål, P. Postoperative Recovery in the Youngest: Beyond Technology. Children 2024, 11, 1021. https://doi.org/10.3390/children11081021
Sjöberg C, Ringdal M, Jildenstål P. Postoperative Recovery in the Youngest: Beyond Technology. Children. 2024; 11(8):1021. https://doi.org/10.3390/children11081021
Chicago/Turabian StyleSjöberg, Carina, Mona Ringdal, and Pether Jildenstål. 2024. "Postoperative Recovery in the Youngest: Beyond Technology" Children 11, no. 8: 1021. https://doi.org/10.3390/children11081021