Stress management training for parents and their children undergoing cardiac catheterization.

Abstract

A program to prepare school age patients for cardiac catheterization is described and evaluated. Children and their parents were provided with a combination of interventions including information, supportive counseling, and stress management training. A team approach was used to reduce anxiety and upset and to increase cooperation of pediatric patients in the hospital and following discharge.

Recommendations for Preparing Children and Adolescents for Invasive Cardiac Procedures

“…Active coaching during the actual procedure is usually needed, and this is a role that parents may be trained to assume. 7 Although guided imagery has proved beneficial in decreasing emotional and behavioral distress during bone marrow aspiration and lumbar puncture in children with cancer, 76 when used alone, it has not proved effective in decreasing anxiety for children undergoing heart catheterization. 42,77 This may be because of the relatively long duration of the procedure, because relaxation achieved by guided imagery usually cannot be sustained in children longer than 15 to 20 minutes.…”

“…9,63 Parents can provide positive reinforcement for coping strategies, act as supportive role models, and may function as "coaches" for cognitive behavioral interventions, such as relaxation exercises. 7,8 Thus, engagement of parents in the preparation process is effective and offers practical benefits that are particularly important given the limitations of available preparation resources. Interventions aimed at facilitating parental coping are anticipated to be of particular importance for younger children (ie, preschoolers) because of their limited ability to use internal coping strategies.…”

“…These techniques help the child to anticipate, recognize, and more effectively manage distressing physiological, behavioral, emotional, and cognitive responses to stressful circumstances. Numerous studies document increased efficacy when preprocedure preparation includes training in cognitive-behavioral interventions, 7,49,72 particularly for children and adolescents with previous medical experience. 45,73,74 The therapeutic effects achieved by use of cognitive behavioral interventions have been attributed to a variety of cognitive and physiological responses, including decreased pain secondary to muscle relaxation, habituation of body sensations, distraction, altered perception of the event, increased positive reinforcement from self and others, and enhanced sense of mastery or internal locus of control.…”

“…44 Experts conclude that experienced children may benefit most from preparation that includes not only procedural information but also instruction about coping techniques such as relaxation techniques, guided imagery, and conscious breathing techniques. 7,9,49 …”

“…In addition, children may be particularly vulnerable to the stress associated with invasive medical procedures; several studies document frequent and persistent severe distress reactions after aversive hospital experiences. [1][2][3][4][5][6] Although numerous studies document the efficacy of psychological preprocedure preparation for children and adolescents, [7][8][9][10][11][12] implementation of these interventions remains inconsistent. 13 The following guidelines, based on review of the literature and expert consensus, were developed to facilitate systematic implementation of preprocedure preparation for pediatric patients undergoing invasive cardiac procedures.…”