ABSTRACTSome patients with orofacial clefts undergo orthognathic surgery between 9-12 years of age that requires the patient to wear an external Halo distraction device for 3-4 months after surgery (1). This master’s project aims to provide a developmentally appropriate pre-surgical education intervention for these patients and their care providers. The pre-surgical education intervention, through interdisciplinary collaboration, was designed to reduce anxiety related to pre-surgical worry, reduce psychosomatic complaints, as well as improve caregivers’ ability to provide home aftercare. In a survey administered pre-surgery, patients and caregivers reported feeling less anxious about the surgical procedure and more prepared for the surgery and post-operative home care. The long-term goals of this project include assessment of patients’ pain and anxiety post-operatively as well as examination of length of hospital stay to determine whether the intervention is effective in reducing post-operative pain.

PICO QUESTIONIn patients with orofacial clefts scheduled for orthognathic surgery (P), will a pre-surgical education intervention for the patient and caregiver (I) help decrease anxiety and improve coping (O).

LITERATURE REVIEWThe literature review supported education interventions; that when provided to patients and caregivers, result in decreased anxiety (2,3,4) and improved readiness (4) for surgery. Preparatory education material provided to children and caregivers increase satisfaction scores (3). Pre-surgical psychological support also increases patient cooperation (4). Lastly, pre-surgical preparation through education interventions results in increased patient and caregivers’ satisfaction with hospital and surgical experience(5). Different methods for education were considered and evaluated through the literature review. The literature review support providing education in several formats including written, verbal, and via different types of media.

INTERDISCIPLINARY DEVELOPMENT OF A PRE-SURGICAL INTERVENTION FOR PATIENTS

UNDERGOING ORTHOGNATHIC SURGERY AT PRIMARY CHILDREN’S HOSPITAL

Natalee F. Lyon, BSN, RN, MSN Student

Plan and Development• Partner with CCLS to develop age-

appropriate educational materials including booklet, doll, and micro-learning video. Involve Pediatric Education Services to develop script and film micro-learning video.

• Partner with members of the Primary Children’s Hospital (PCH) Cleft/Craniofacial team to develop educational handouts for caregivers.

• Educate PCH Cleft/Craniofacial team members about availability of education for their patients scheduled for orthognathic surgery.

• Develop survey to evaluate patient and caregiver response to the intervention.

Evaluation• Survey families after receiving pre-surgical

intervention from CCLS and RN. • Interview families after surgery to evaluate

response to intervention and improve educational materials.

• Present survey results to PCH Cleft/Craniofacial team member via newsletter and at team meeting.

• Present information about the intervention to nurse leaders on the Children’s Surgical Unit at PCH.

THEORETICAL FRAMEWORK• Kolcaba’s Theory of Comfort defines comfort

as an outcome of care that promotes or facilitates health seeking behaviors (6).

• The 3 main types of comfort are relief, ease, and transcendence (6).

• When concern and anxiety are relieved, transcendence can be achieved. Transcendence is strengthening of the patient as well as supporting endurance of the patient and caregiver (7).

• When patients and family members engage in health-seeking behaviors, they have better health outcomes (8).

CONCLUSIONSPatients with orofacial clefts who undergo LeFort I distraction with halo benefit from a pre-surgical education intervention. The intervention assists with a reduction of pre-surgical anxiety for both patients and caregivers by providing developmentally appropriate education (9). The education intervention can empower patients to feel more prepared pre-surgically and empowered post-surgically to take a more active role in self-care (10). Further study of pre- and post-surgical anxiety levels and pain medication usage are needed to evaluate retention and effectiveness of the intervention between the pre- and post-surgical periods.

REFERENCES1. Bennett, K., Harbaugh, C., Hu, H., Buchman, S., & Waljee, J. (2018). Persistent

opioid use among children and adolescents after common cleft operations. The Cleft Palate-Craniofacial Journal, 55 (S), 5. doi: 10.117/1055665618761376

2. Ferland, C., Saran, N., Voils, T., Botte, S., Chorney, J. . . .Ouellet, J. (2017). Preoperative distress factors predicting pain in adolescents undergoing surgery: A preliminary study. Journal of Pediatric Health Care, 31 (1), 5-15. doi: 10/1016/j.ped.hc.2015.12.008.

3. Wolfer, J., & Visintainer, M. (1979). Prehospital psychological preparation for tonsillectomy patietns: Effects on children’s and parents’ adjustment. American Academy of Pediatrics, 64 (5), 646-655.

4. Cuzzocrea, F., Gugliandolo, M., Larcan, R., Romeo, C., Turiaco, N. & Dominici, T. (2013). A psychological preoperative program: Effects on anxiety and cooperative behaviors. Pediatric Anesthesia 23 (2), 139-143. doi: 10.1111/pan.12100.

5. Espinel, A., Shah, R., McCormick, M., Krakovitz, P., & Boss, E. (2014). Patient satisfaction in pediatric surgical care: A systemic review. Otolaryngology-Head and Neck Surgery, 150 (5), 739-749. doi: 10.1177/0194599814527232

6. Kolcaba, K. (2001). Evolution of the mid-range theory of comfort for outcomes research. Nursing Outlook, 49 (2), 86-92.

7. Kolcaba, K. & DiMarco, M. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing, 31 (3), 187-194.

8. McEwan, M. & Willis, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia PA: Wolters Kluwer Health.

9. Justus, R., Wyles, D., Wilson, J., Rode, D., Walther, V., & Lim-Sulit, N. (2006). Preparing children and families for surgery: Mount Sinai’s multidisciplinary perspective. Pediatric Nursing, 32 (1), 32-43.

10. Pereira, L., Figueiredo-Bragab, M., & Carvalho, I. (2014). Preoperative anxiety in ambulatory surgery: The impact of an empathetic patient-centered approach to psychological and clinical outcomes. Patient Education and Counseling, 99 (5), 732-738. doi: 10.106/j.pec.2015.11.016

PROJECT METHODOLOGYPediatric patients with orofacial clefts with maxillary hypoplasia and orthodontic malocclusion often need to undergo orthognathic surgery between the ages of 9-12. This invasive surgery results in the patient wearing an external halo distraction device post-surgically for 3-4 months (1). Anticipation of the surgery and lack of information about the surgery and post-surgical activity and diet restrictions may cause increased anxiety and reduce coping (2).

The literature review supports the concept that pre-surgical education can decrease anxiety and improve coping. Project methodology included a collaborative effort to plan, develop, and evaluate education materials for patients and caregivers, as well as educating the Cleft/Craniofacial team members about the availability of the pre-surgical education intervention and education resources.

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