Optimizing Childhood Surgical Recovery

by Nicole Blomerus 2 years ago in how to

10 Practical Tips to Safely Speed the Process

Optimizing Childhood Surgical Recovery

No matter if it’s the first time, fifth time, or a small or large operation, knowing some practical tips for navigating your child’s surgical recovery is crucial. As a parent, you can safely and proactively help your child feel more confident and work towards independence and improvement. Not to mention, give yourself a little more peace of mind.

The recovery process from any surgery in any child has numerous factors that influence each one’s ability to heal. No two children will recover in the same way or at the same speed; just like the same child will not recover exactly the same through multiple surgical procedures. Plus different types of operations are much more involved or are in a much more delicate area, causing a much longer healing period. The body’s response each and every time will be somewhere between slightly and drastically different.

But with that in mind, certain guidelines can make it all easier no matter what the particular circumstances are. Having your child admitted to hospital has costs for everyone involved, and it’s no fun for anybody. Getting back home to your normal life as quickly as possible will make everyone happy. Just remember that before you proceed with performing any aspect of your child’s care, make sure to get permission from their doctor first.

A printable format of the tips list is included at the end of this article so that you can easily take a short version copy with you to hospital.

1. Ask the surgeon to see you in the recovery room to answer your questions.

• Do this before your child goes into the operating room so the surgeon can incorporate enough time afterwards. Most will do this without you asking, but ask anyway.

• Ask the surgeon for as much or as little as you want to know about how the procedure went, whether there were any problems, and any specifics.

2. Ask the surgeon and/or team doctor what time rounds will be done every morning.

• Make sure you get to your child’s room on time and have any questions you want to ask written down so you don’t forget them. Time will be approximate.

• Hunting the doctor down later on in the day may prove to be difficult and there are some questions you will want more timely answers to.

3. When can the nurses decrease the frequency of taking vital signs at night time?

• Your child needs as much uninterrupted sleep as possible to recover adequately.

• They will be more receptive and able to do physiotherapy, etc., if they have rested well, and they’ll be way less grumpy as well.

4. Can my child have extra pain medication before engaging in painful activities such as walking or performing grooming activities?

• Pain can be a huge hurdle to recovery causing your child to refuse to even sit up in bed.

• Plan ahead and give your child pain medication 30–60 minutes ahead of these activities to enable them to perform better.

• This does not refer to the scheduled pain medication they get on a regular basis every so many hours; ask for either “breakthrough” or “PRN” pain meds. This is the extra little boost to get them over the edge.

5. Speak to the unit charge nurse to find out if they utilize any kind of “Core Nurses” system.

• Core Nurses are handpicked by the parents and children. They are naturally discovered after experiences with individual nurses. They are the nurses that you and your child feel most comfortable with, the ones who are just a really good fit.

• If a system like this is in place on your unit, you can then add nurses to the list as you see fit. You can also choose to have certain nurses on a “do not assign” list if they really just aren’t a good fit for whatever reason.

• What then happens is that if one of the nurses you’ve selected as a core nurse is available, they would be automatically assigned to your child.

• At any age, having nurses we trust, like, and feel comfortable with is important. But it is even more so with children, especially young children who have much less ability to understand why and what is happening to them. Having the right team in place can drastically affect your child’s health outcomes.

• Core Nurses are at the heart of the concept of “continuity of care,” a philosophy that’s taught but not always practiced in the real world.

• If your unit does not utilize this kind of system and you feel comfortable doing so, speak to the unit educator or your social worker or the unit manager about the concept (or even higher up hospital administrators). Maybe with your encouragement, it will be a topic they can discuss and implement in the future!

6. Every day determine safe steps with the team for pushing forward, including all body systems.

• Always work towards discharge. The smart way to be admitted is start your discharge planning right away. What do we have to do to get back home?

• It doesn’t matter what body system you’re dealing with — respiratory, cardiac, urinary, gastrointestinal...anything. Always ask the question “can we safely push forward today, and if so, to where?”

• It might not be safe to move forward with one thing, but yes for another. So ask about everything (examples):

  • Can they sit up on the side of the bed today?
  • Can they walk today and if yes, how far?
  • Can the IV come out today?
  • Can they increase their diet today?
  • Can we wean them off the ventilator?
  • Can we discontinue the oxygen or certain medications today?

7. Maintain your home routines together.

• Stability and routine will help your child’s whole system get on track, including its ability to heal.

• Don’t make your child adjust to the system, make the system adjust to your child (where possible).

• Have people visit just like at home; love makes everything better!

• Whatever their bedtime is at home, keep it the same at hospital. Just make sure your nurses know so that they can do any required tasks (like vital signs) beforehand.

• If they normally have a bath every night before bed, do it.

Get Moving!

8. Mobilize, mobilize, mobilize! Early mobilization (walking) is one of the key things for getting better after surgery. Once your doctor gives permission, get going!

• If necessary, help your child get to the sitting and standing position. Remember their incision may be very sore and inhibit their ability.

• Start slow, even if your child thinks they can go further. Their balance, strength, and tolerance can be severely diminished from normal. In the beginning just do test distances and then rest again until you see what can be tolerated.

• Keep pushing forward and walk as much as possible every day.

• Remember that mobilizing doesn’t just help them get strong; it aids digestion, improves wound healing, and improves their mood and more!

• If full mobilization isn’t possible, then work with the physiotherapist to perform alternatives to build strength and work towards mobilization.

9. Set reasonable boundaries with all staff such as nurses, housekeeping, or dietary about rest times and entering the room.

• As pointed out before, adequate uninterrupted sleep is critical to your child’s recovery.

• Most staff jobs can be shifted to accommodate these times.

• Nurses need to be aware of usual rest times so they can schedule medications, dressing changes, vital signs or other activities while your child is awake. Ask for this to be entered into their care plan.

• If vital signs are still being taken frequently, ask to have the Blood Pressure (BP) cuff left on your child’s arm through the night so that the nurse can quietly enter room and take the BP without having to disturb your child.

• Ask for the night nurses to be as quiet and gentle as possible when performing tasks at night. Only flashlights or night lights should be used for visualization of anything.

• For all other staff, create a sign to be posted on your child’s bedroom door during rest periods. It should be polite but outline your requests. Something simple such as “<____> is sleeping now, please do not enter room to deliver food, empty garbage, or clean. Please come back when door is open and lights are on. THANK-YOU!!”

10. Teach nurses your specifics.

• Every single parent and nurse does things a little differently, but the best thing for your child is consistency.

• If you have a very certain way of diapering or bathing or doing dressing change or of hooking them up to lines or tubes, teach your nurses and provide written instructions for your absences.

• Be willing to hear the nurses’ suggestions for making things easier or better in some way; remember that they have learned the basics and the tricks, not just in school but from dozens of families over their careers.

Following just a few general guidelines when your child has surgery can greatly improve positive outcomes. If you combine these guidelines with proactive participation with your child’s team, you can make a huge difference. The fact that your child is hospitalized doesn’t mean that your participation ends and hospital staff takes over; it just means you have to adapt and learn as things change. Always remember that nobody knows your child as well as you do, and it’s you who can pull it all together and get them back to normal life smoothly and as quickly as possible.

Surgical Recovery Optimization Checklist

 Talk to surgeon in recovery room; ask questions.

 Determine time of daily rounds.

 Decrease night time vital signs checks.

 Pain medication before activities if needed.

 Find out about "Core Nurses" list on your unit.

 Can something push forward today?

 Maintain home routines.

 Mobilize with permission.

 Set reasonable boundaries.

 Teach nurses your home routines and practices.

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Nicole Blomerus

I retired early from a 20 year Nursing career to take care of our daughter, who was born with medical complications. I hope that my years of nursing experience, plus my personal experience can help other families navigate their struggles.

See all posts by Nicole Blomerus