Children's Anxiety in the Perioperative Environment: A Qualitative Exploration With Children, Parents and Staff at a Tertiary Paediatric Hospital

Perioperative anxiety is a common and distressing aspect of anaesthesia for many children, resulting in management challenges at the time of anaesthesia and potential physical and psychological adverse outcomes. We conducted this qualitative phenomenological study to explore the perspectives of children, parents and staff on perioperative anxiety in our institution. Planned recruitment was 20 each of children who had undergone elective anaesthesia, their parents and staff. We conducted semi-structured interviews, recorded and transcribed verbatim and subjected to qualitative analysis using the Framework Method. Inductive coding was performed, codes were charted onto the Framework Matrix, and themes were derived. The planned recruitment was completed, and data saturation was reached. Children, parents and staff were all aware of anxiety as an issue in the perioperative environment. The key themes that emerged were: Anxiety due to loss of certainty; responding with comfort, distraction and engagement; the role of parents in managing anxiety; and a changing anxiety environment. The loss of certainty was key a driver of anxiety in the perioperative environment. The use of comfort, distraction and engagement by children, parents and staff in order to alleviate anxiety, should be key targets for the development of interventions that seek to address children's perioperative anxiety. Parental presence and the role of parents in preparing children for their perioperative experience were also emphasised. This occurs within a changing social and mental health environment, which clinicians must be responsive to. EDITORIAL COMMENT: This explorative qualitative assessment presents reported experience from anesthesia contact focused on children as patients and anxiety, also including reporting from parents and staff. Factors which appear to contribute to anxiety, as well some that may reduce anxiety, were explored.