How a healthcare assistant made the operating theatre a less scary place for children

Healthcare assistant Lisa Morgan's innovations help to ease the anxieties of children arriving at an operating theatre for cardiac surgery

• Children and parents had felt anxious and afraid on arriving at theatre
• Changes include a training day for theatre staff and visits to families
• Children receive toy bear who features in a story of the journey through theatre

A healthcare assistant who won an award at the RCNi Nurse Awards has improved the care and support of children facing cardiac surgery – and their families – through a comprehensive training package for care and support staff and a number of evidence-based initiatives that ease anxiety before theatre.

Lisa Morgan’s commitment to family-centred care at the cardiothoracic theatres of Newcastle upon Tyne Hospitals NHS Foundation Trust has seen her develop multilingual resources and comfort toys that children can take into theatre.

‘The quality of care and going the extra mile is so important to our patients and families,’ says Ms Morgan.

‘On my first day in paediatrics alarm bells were ringing’

She was proud to join the adult cardiothoracic theatre team when she returned to working in healthcare in 2016 after seven years in teaching and was thrilled to be invited to join the paediatric team 18 months later.

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‘We perform heart surgery on the most complex cases, adults and children, in the world, and I was looking forward to bringing my experience in palliative care and teaching to support patients and families, but on my first day in paediatrics alarm bells were ringing,’ she recalls.

‘The theatre felt cold and intimidating. Scrub staff were setting up equipment and wore masks, talking among themselves and not to the patient or relatives. There was no eye contact with the patient.’

‘Staff were focusing on task-related jobs when their priority should have been the patient’

‘I could not believe what I was witnessing. Where was the care and compassion? Staff were focusing on task-related jobs when their priority should have been the patient.’

She went home and that night cried for the patient and their family before waking up the following day determined to change the experience of these families.

‘I spent four months researching the psychological and emotional effects of coming to theatre for the child and parent and talking to the theatre staff and senior management about what we could introduce to help alleviate their fear and anxiety,’ she says. She also worked on wards and the paediatric intensive care unit (PICU) to understand pre- and postoperative routines.

‘This gave me the opportunity to talk to the children and their families to understand their perception of our practice,’ Ms Morgan says. ‘I found that parents were supported before and after surgery in clinics and on the wards but when they felt at their most vulnerable and helpless they were handing their child over to a stranger for theatre.’

Ms Morgan has made sure that this is no longer the case. Over the following few months she produced a plan of action, introducing herself to the ward, clinic liaison team and PICU team to explain her findings and plans. She devised new protocols with senior nurses.

‘We now have a family-centred care forum team with representatives from all areas,’ says Ms Morgan. ‘I produced a training day for all cardio theatre staff to attend, including porters, healthcare assistants, receptionists, the scrub team, the anaesthetic team and all senior management. For this to work, we all had to reflect and change together.’

One challenge was communicating with families who spoke little English

She makes time to visit families before and after procedures. ‘These introductions have gone a long way to reducing anxiety,’ she says. ‘A friendly face goes a long way.’

Ms Morgan has also created a book in which children can follow a character named Baggins Bear through clinic, to the theatre and home again so they know what to expect and can see pictures of the theatre staff. The bear is waiting for them in theatre and they are allowed to keep it afterwards, as well as receiving a certificate.

One challenge was communicating with families who spoke little English.

Family-centered care has flourished

‘I used pictures and role play to try to explain what was going to happen but it was difficult,’ Ms Morgan explains. ‘Using parent feedback I began to create a new book on a tablet. It's been translated into many different languages. It has been a revelation in the care we can deliver and well received by all involved, especially the families.’

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Feedback from families has been 100% positive. Ms Morgan’s colleagues from across the multidisciplinary team also testify to her commitment and passion and say her work has hugely improved care and the experience – especially for children facing the daunting prospect of heart surgery.

Senior sister Sandra Thompson says: ‘Family-centered care has flourished under Lisa’s enthusiasm and dedication to ensure that every child and family have an easier journey through what is for most an overwhelming experience. We’ve surpassed every expectation in achieving a fantastic service improvement with her as its champion.

‘As a nurse I am proud of all the positive feedback Lisa and the team receive about the support and compassion shown to our patients and their families.’

Consultant cardiac anaesthetist Claire Barker agrees. ‘The cardiac operating theatre is a scary, busy place and Lisa has worked to prepare children and parents for this and also to alter the environment so it is as quiet and calm as possible as the children are anaesthetised,’ she says.

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‘As well as hugely improving the child and parent experience Lisa has made my job considerably easier. The children arrive calm and cooperative, the parents are prepared and Lisa supports them as they leave the theatre, freeing up anaesthetic staff to concentrate on the usually very sick child.’

Ms Morgan’s work saw her named as the 2019 winner of the Healthcare Assistant category of the RCNi Nurse Awards. She says winning the award ‘has brought pride and joy to myself, the trust and every family I have supported past and present’ and shows how every member of the team can improve patients’ experience.