**4. The psychological focus on interdisciplinary care in pediatric surgery**

The psychologist works together with the interdisciplinary team, both on an outpatient basis and in the infirmary.

The following take place in the clinic:

170 Complementary Pediatrics

Table 1. Protocol for psychological preparation of the pre-surgery child - HCFMRPUSP

by the psychological team.

fantasies regarding the experience.

Also assessed during this meeting are the issues of the child's global development, and necessary referrals are made to ensure the best possible neuro-psycho-motor development. Only after all these issues have been met and forwarded to the appropriate clinical followup services can the child be discharged from the Pediatric Surgery Interdisciplinary Team. When the child has an organic impairment that requires surgical treatment, the care of the team, in addition to that which is listed above, also includes an interdisciplinary reception and guidance where the illness, procedures, processes, treatments and invasive interventions are clarified in simple and didactic terms, first by the medical team and later

In this context, parents/caregivers and children are guided through questions about the child's health, the treatment processes, and the hospitalization. During this first meeting of the child to be operated on, a psycho-emotional assessment of the parents and the child about the diagnosis, the pre-operative, operative, and post-operative procedures, and the hospitalization is performed in order to explain and reduce any doubts or possible negative

It is often the case that this work is not concluded after only one session, and returns become necessary so that the staff, the child, and the parents are all aware, accepting, and

The process of Psychological Intervention is applied to the child and its parents through

comfortable with the procedures and its possible risks and benefits.

psycho-educational guidelines, or information for caregivers and children.


The specific objectives of the orientation and psychological counseling are:


The following are used as educational materials for working with children and families:

Interdisciplinary Model of Attention for Children Undergoing Hospitalized Surgical Procedures 173

• Familiarization with the hospital accommodations (bedroom, infirmary playroom, outdoor playground, pre-anesthetic room and recovery room) where the doctor and nurse discuss what happens in each environment; Interactive activities that provide information about the affinity between pairs of children, so that staff can properly select

In the infirmary, follow-up care and treatment of patients seen in preoperative groups or individually in the clinic is continued, and also, when necessary new treatments are initiated, using the same criteria from the clinic for patients that begin their treatment

Over 13 years of work (1998-2011) improvements has been observed, with the procedures that were adopted, both for pre-operative preparation and for the treatment of chronic patients.

For out-patient follow-ups and in the infirmary, the improvements were in the affective development of emotional conflicts, fears, illusions, prejudices against the disease; facilitation of desensitization to procedures and to the hospital setting; lower levels of anxiety in both patients and parents, who demonstrated awareness and comfortableness regarding the procedures; hospitalizations with fewer complications and faster recoveries. This data shows the importance of the performance of an interdisciplinary staff in the

The importance of intervention procedures aimed at the pre-operative preparation of children and their families is increasingly recognized. We should stress the need for this process to be carried out by a specialist in psychology who does not only stop to provide

It is necessary that intervention programs provide conditions in which the parents and children can express their fears and anxieties about the situation that they are experiencing

Psychological Intervention, performed by a professional who is qualified to identify the emotional characteristics of parents and children in a systematic manner and with interdisciplinary support, can reduce the harmful effects to the child-family-professional bonds and can also reduce the undesirable aspects of hospitalization and surgery and

The presence of a psychology professional together with the surgical team is fundamental when attempting to provide effective treatment to pediatric patients and their families, providing them with an effective understanding of procedures, better interaction with the staff, greater adherence to treatment, and consequently fewer risks to the emotional

This team believes that the interdisciplinary treatment in pediatric surgery is of utmost importance, because surgery is a time of crisis for parents and children, during which they

are frightened and concerned about the necessity of a surgical intervention.

**5. Importance of interdisciplinary care in pediatric surgery** 

treatment of a pediatric surgery patient and his/her family.

consequently support the healthy development of the child.

development of the child as a result of hospitalization.

pairs that should be roomed together;

• Closing play with the staff.

through a transfer from another center.

information about clinical procedures.

so that they can understand it more effectively.


The orientation and guidance therapy is performed primarily in groups, optimizing in this way the care offered to patients despite the high demand of the clinic. This form of care matches the data published in literature that demonstrates that group activities, beyond permitting a greater comprehensiveness of care, assists the patient in identifying with other people with the same needs, providing a space for clarification of doubts and exchange about similar situations between families.

For these pre-operative guidance and orientation groups, three meetings are generally held, following the procedures described below.


Informational meeting with the parents about the illness, hospitalization, and surgery of their children, as well as the goals of the group meetings with the children. The objective of this first meeting is for the parents to have a better understanding of their children's illness and the procedures that will be performed by the team, at the same time becoming aware that their children are not the only ones affected by the problem, so that they may thus act more appropriately toward the children's doubts.

#### - **2nd Meeting** – Children

This meeting is aimed at assessing the children's level of anxiety and understanding, as well as the children's own awareness of their health problem, the proposed treatment, and finally their reaction to the hospital. The order of activities is:


The goal of this meeting is to evaluate the degree of comprehension of information received and to visit the hospital, in the following order:


• Playful/didactic hospital supplies that replicate those actually used in real procedures; • Life-size cloth dolls of that represent a child of approximately one (1) meter in height

The orientation and guidance therapy is performed primarily in groups, optimizing in this way the care offered to patients despite the high demand of the clinic. This form of care matches the data published in literature that demonstrates that group activities, beyond permitting a greater comprehensiveness of care, assists the patient in identifying with other people with the same needs, providing a space for clarification of doubts and exchange

For these pre-operative guidance and orientation groups, three meetings are generally held,

Informational meeting with the parents about the illness, hospitalization, and surgery of their children, as well as the goals of the group meetings with the children. The objective of this first meeting is for the parents to have a better understanding of their children's illness and the procedures that will be performed by the team, at the same time becoming aware that their children are not the only ones affected by the problem, so that they may thus act

This meeting is aimed at assessing the children's level of anxiety and understanding, as well as the children's own awareness of their health problem, the proposed treatment, and finally

• Evaluation of the knowledge and understanding of the children of their own disease;

• Explanation in a playful and didactic manner, provided by the doctor with the aid of mannequins, about the procedures which the children will go through during hospitalization (pre-anesthetic fasting, venous access, surgery, dressings, care and post-

The goal of this meeting is to evaluate the degree of comprehension of information received

• Investigation into the absorbed information and, when necessary, more illustrative

• Explanation in a fun and didactic manner, provided by the nurse in charge of pediatric surgery, with mannequins and hospital equipment, about the procedures and stay in

• Creating awareness that other children are suffering from the same problem; • Fun activities with hospital toys that promote desensitization to hospitalization;

• Investigation into the expectations of hospitalization and surgery;

• Orientation about the sequence of surgery, return visits, and discharge;

• Final fun activity where the children simulate hospitalization.

with internal organs that replicate the human body;

• Real hospital equipment


operative changes);

the infirmary;


and to visit the hospital, in the following order:

repetition of anything not understood;

about similar situations between families.

following the procedures described below.


more appropriately toward the children's doubts.

their reaction to the hospital. The order of activities is: • Introductions and meeting of the children and staff; In the infirmary, follow-up care and treatment of patients seen in preoperative groups or individually in the clinic is continued, and also, when necessary new treatments are initiated, using the same criteria from the clinic for patients that begin their treatment through a transfer from another center.
