Revisión de Programas hospitalarios para tratar la ansiedad infantil

¿Es evidente todo lo que reluce?

Abstract

RESUMEN

La OMS define la salud como el estado de bienestar físico, mental y social, y no solamente la ausencia de enfermedad. Es por ello que hay que cuidar las implicaciones de la actividad quirúrgica más allá de las físicas. Algunos autores defienden que únicamente la inducción anestésica produce niveles de ansiedad clínicamente visibles en un 40-60% de los pacientes que son sometidos a una anestesia. Este hecho es más evidente en la población infantil donde los mecanismos de protección frente a situaciones estresantes no están desarrollados. Para abordar este tema hay que ofrecer al personal hospitalario herramientas que funcionen, y parece, que los programas de preparación preoperatoria y algunas técnicas de distracción funcionan, todas con sus limitaciones y sus beneficios particulares

Cuando se quiere implantar un programa que ayude a los niños a afrontar el proceso quirúrgico hay que hacerlo bajo un prisma basado en la evidencia científica. El principal problema al que nos enfrentamos sobre la utilidad de estos programas e iniciativas es la gran heterogeneidad que existe entre los distintos estudios, originado por la gran cantidad de variables implicadas en el proceso psicológico del ser humano.

Los autores tratan de buscar respuestas a la efectividad y al origen de los programas de preparación quirúrgica que existen actualmente mediante la búsqueda y el análisis de los estudios existentes en las bases de datos: MEDLINE, Web of Knowledge, COCHRANE, EMBASE hasta diciembre de 2016 sin año de restricción. Se incluyeron aquellos trabajos que evaluaban la ansiedad perioperatoria infantil y fueran estudios randomizados, con una puntuación 4-5 en la escala de JADAD.

TITLE: Hospital programs to treat childhood anxiety. Review of evidence

ABSTRACT

There are still few hospitals that consider it important to include in their services a program that helps to decrease the level of anxiety in the patients. However, recently it is possible to find different initiatives and programs in the pediatric area for this purpose. Initiatives born under the current "humanization of hospitals" trying to achieve, with greater or lesser fortune, a closeness and better assimilation of the surgical protocols present in a hospital. Personally we believe that there is nothing more human than to exercise our office. Exercising medicine and curing a disease implies humanity in itself, even if it is applied under scientific evidence and seeking an adequate effectiveness. There is nothing more human than the fact of healing others, although in that way science is prioritized over comfort and closeness. Therefore, the authors are in favor of the new, and poorly called, humanization of health but, first ensuring, proper care.

We are therefore witnessing the birth of proposals and initiatives that try to reduce the anxiety level of our smaller patients, who try to bring our medical activity closer to the daily life and try to transform the instrumentalization and modernization of medicine into something understandable to all. Something positive and desirable.

However we can not forget that medicine is based on the scientific method, and that without it, these initiatives can remain in a mere superficial marketing. They may even endanger the performance and health outcomes of the health care activity itself. This does not mean in any way that the aspects that concern the psyche and the emotional part of the patient are not important. In fact they are a fundamental part of the medical activity but always from a scientific and consensual point of view.

That is why it is always desirable to quantify results and evaluate aspects that aim to improve our work. In the case of childhood preoperative anxiety, initiatives and protocols have been developed that try to alleviate the causes and their consequences. The development of stories, toys, the presence of parents in anesthetic induction and other actions seem to be a current trend developed by some hospitals concerned about this issue. But what is the truth about it? How are these initiatives properly developed? And above all ... What is true in all this?