My Daycase Operation - A Resource for Children with Learning Difficulty

DISCLAIMER: This leaflet was originally prepared by individual anaesthetists for the use of patients in their own hospital. The RCoA has not been directly involved in its production, however it has been recognised by the College as useful for wider distribution.

A resource designed to assist with the preparation and management of children attending for day surgery who have learning disability or language and communication difficulty. For these children, conventional information leaflets are inappropriate or inaccessible. This resource provides a symbol time line showing the structure of a day surgery experience, using symbols to illustrate each step in the process. There is a time line booklet, a post-operative communication chart and a set of accompanying flash cards which indicate each step in turn.

Although much recent effort has been spent developing information for children about anaesthesia, there still remains a gap in resource provision for children with learning disability or language and communication disorders, for whom conventional information leaflets are inappropriate or inaccessible. These children may need to be shown how to manage a hospital visit and an anaesthetic, rather than needing complex explanations and information about procedures. We wished to provide some communication resources for children with special needs and looked to special needs education for ideas. We visited a local special primary school and saw a range of augmentative and alternative communication methods in use in the classroom. We were particularly impressed by the way symbol time-lines were used to help children to make sense of the structure of the school day. We then surveyed the parents of every child in a special school in Sheffield, to investigate how parents introduce new experiences to their children at home. We found that although most parents rely on explaining things to their children themselves, nearly 40% also use Makaton sign language and 26% use symbol systems or the picture exchange communication system. 82% stated that they would like appropriate resources to use at home to help their children to prepare for hospital treatment.

The resources consist of a time-line leaflet which can be used at home to introduce the structure of the day at the hospital, along with the symbols that represent some of the procedures and people the child will meet. The accompanying flashcards can then be used on the day to identify each step as it happens, as a guide and prompt to the activity required. The number of flashcards used can be tailored to the needs and abilities of each child, as some children will require more detail than others. They can be laminated and used in a physical time-line, for instance stuck to a velcro strip on a wall, or they can be attached to a keyring so the child can work through them in turn. As each step is completed, the associated flashcard can be discarded. The final steps should be the positive events of eating, drinking and going home. The sequence is important, rather than any specific timings, and the use of the flashcards will allow for any local differences in the admission process compared with the leaflet. The postoperative communication chart is designed to allow children with limited verbal skills to indicate their feelings, wants and needs to their caregivers.

Additional resources covering hospital treatment for adults with learning and communication difficulties is available via the Widgit website.

Dr J Short, Consultant Paediatric Anaesthetist, Sheffield Children's Hospital
This resource is correct as of September 2016

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