Search Strategy
For the purpose of completion of this assignment, Google scholar is extensively used to search for the articles and the journals. Along with the searches done on google scholar, a separate and exhaustive search is also performed on PubMed online database and this yielded 71 search results (see appendix). However, there was no need to perform an additional advanced search, the search results already included the results that were desired. The searches were not delimited to any particular range of year. The keywords used for the search are: virtual reality and anaesthesia, these keywords were used to keep the searches restricted to the articles that were completely based on the articles that provided research on the usage and the benefit of using the virtual reality before the anaesthesia is administered to a particular patient. According to the expectation, a lot of the articles popped up in the search results and the articles were shortlisted based on the title and the abstract provided. These articles were then selected for an extensive critical analysis and for an in-depth critical analysis an article authored by Ryu et al. (2017) was selected.
Anxiety before an operation is obvious and the case is same for a patient when he or she is undergoing an operation. While anxiety after going through operation is also common in patients irrespective of age. Especially children complain a bit more than the adults regarding the anxiety they face a significant amount of distress in the perioperative holding area and also when children are moving into the anaesthesia area. High levels of anxiety are harmful to the children and at the same time, it manifests into an emotional trauma for the parents and the children. the different kinds of the behaviour that are experienced by the children escape behaviour, fighting behaviour, shivering, crying, agitation. Also, it is important to note that the perioperative behaviour is also associated with other kinds of adverse effects on the children. Such adverse effects can be attributed to the psychological, behavioural, and clinical effects on the children. Thus, such complications and the issues needed an additional research so that it can be addressed effectively. Thus, to carry out such an action the article of Ryu et al. (2017) was followed.
Sampling Strategy
A randomized control trial was conducted after the approval of the institutional review board of the Seoul National University Bundang Hospital. The approval was also registered at the Clinical Trials Registry. Informed consent in the written form was obtained from the guardians and the parents of all the children that are admitted to the hospital. The consent form was collected on the day of surgery and also before the day of surgery. The consent forms were collected from the children that are 7 years old or more. The full procedure of the study was explained to the parents of the children that were undergoing the perioperative procedures. The study was conducted in the Bundang Hospital of the Seoul National University for over a period of 4 months. The time period selected for the was from January 2017 to April 2017. The total number of the patients (children) considered for the study is 70 (Ryu et al. 2017). Randomized control trial or the RCTs are considered as the gold standard for the purpose of performing clinical research. It has a high impact on the clinical study (Faraoni and Schaefer 2016).
Rationale and Justification
The sampling strategy that is aged between the 4 to 10 years that are having the ASA fitness grade of II or I were selected for the elective surgery and the general anaesthesia was considered for the study. The exclusion criteria selected for the study consisted of the children that are already undergoing the major perioperative intensive care and that requires a major surgery. The children that also had the congenital disease, history of seizure and epilepsy, psychoactive medications, anaesthetic previously, intellectual developmental disabilities, cognitive deficits, hearing impairments and a short history of prematurity are also excluded from the study. It is also important to note that the authors have stick to a single place for the conduct of the study. Single source and the single data collecton method can be effective for certain studies, however the data collection from a single source has inherent limitations. One of the major limitation is the ruling out the variance interpretations of the findings. Single souce data collection removes the opportunity of examinig a number of the interesting hypothesis (Holmbeck et al. 2002).
The research methodology followed in this study is a randomized control test. The methodology also included a virtual reality (VR) tour through a 360-degree movie which is shown for the purpose of the further perioperative preparation and explanation. The 4-minute video was prepared along with the assistance of IONIX and a virtual reality producing company in Seoul. The video consists of a cartoon character named Porono, who is a little penguin and this penguin acts as a paediatric patient. This cartoon character is scheduled for the tour into the operation theatre. This video intervention was utilized and implemented by the anaesthesia experts (part of the research team) just 1 hour before the administration of the anaesthesia. Whereas the parents/guardians of the children that are allocated to the control group are provided with the general information of anaesthetic procedure and surgery. The children that belonged to the intervention group are provided with the virtual reality tour. The virtual reality tour was given to the patients via the virtual reality headset mounted with a smartphone application that already has the video in it. The parents and the guardians of the children selected for the study were told to ask a question based on the surgical and the anaesthetic procedures. The researcher should mention the and clearly state the purpose and aim of the study (Hek and Moule 2011) and likewise this article also maintains the same. According to Maurice-Szamburski (2018), most of the patients that are undergoing the surgery are anxious. Thus, delivering information through a virtual reality immersive medium improves the experience of the patient about the perioperative care. It has been found that another author Bekelis et al. (2017) mentioned that patients that are exposed to a perioperative virtual reality also showed reduced stress and it enhanced the perioperative experience.
Critique of Research Rigour
The modified version of the Yale perioperative Anxiety Scale (m-YPAS) provided the score for the study. The scale was used to measure the children in the reception area of the theatre after the 30 min of the intervention provided to each of the children. A blinded assessor performed the duty of collecting the observational scores in order to maintain the uniformity and consistency. The data were collected just 3o minutes before the anaesthesia was administered in order to assess the anxiety. Them-YPAS is constituted of the 27 different items divided into 5 different domains which include the use of parents and vocalizations, state of arousal, emotional expressivity, activity. All the domains have the score value of 1 to 4 expect the use of parents and vocalizations have a score value ranging from 1 to 6. The study included the Korean version of them-YPAS and the scale has an intraobserver and interobserver validity and reliability which is based on a good to excellent scale. This scale or the tool is effective in order to measure the anxiety of the children that were held within the perioperative area (Gao et al. 2014). When the children were inducted into the anaesthesia, a checklist is performed which measures the compliance of the children and their behaviour. These scores are measured by a blinded observer. The induction compliance checklist is a scale that describes a children’s condition and the high scores are considered to be showing poor behaviour. The Yale perioperative Anxiety Scale has been found to be having good psychometric properties and valid instrument and reliable for the assessment of the perioperative assessment in children (Jung et al. 2016). This is a reliable, valid, rigorous method of data collection, minimising bias and ensure more accuracy of the results (Rees 2011). Accordingly, the scales were adequately described and seem appropriate to the outcomes measured, which is important to maintain the validity of the outcomes (Parahoo 2014).
A statistical analysis was done based on data collected from the m-YPAS score. The decrease in the score of the data of the m-YPAS shows that the virtual reality is effective in reducing the anxiety among the children. in order to test the continuity of the variables (induction time, height, weight, age) Mann-Whitney U is used.
In order to minimize the biases, randomization was performed in the study. The randomization is incorporated into an independent anaesthetist which was not included in the trail. A computer-generated randomization code is used to bring the randomization to the study. A software called the Random Allocation Software is used. Opaque envelops that contained the numbers serially were used for the study. Also, the results were collected by a single blinded assessor so that the observational scores are maintained in a uniform and consistent way. Also during the recording, the scores of the induction compliance checklist. In order to reduce the biases, the scores were recorded by a blinded observer. The computer programs have helped in the minimization of biasness and increasing the randomization of the study, however a few aspects of the software needs attention to make it acceptable for the clinical researches (Saghaei 2011). The tests taken act to reduce bias in terms of assessment of investigated intervention (Polit and Beck 2014).
Research Methods
The authors explicitly targeted and addressed the detailed discussion of the explanation and the findings of the study. The inclusion of the pictures, flowchart and tables enhances and makes it easy to grab the important points which are presented by the author. The work here is presented well headings and subheadings. The coloured fonts and style added an extra appeal to the content presentation (DePoy and Gitlin 2015).
The final data is collected from the 69 children for the purpose of the analysis. According to the findings, there was no differentiation in the presentation of the data in terms of the induction time and the ASA grade, sex, height, weight, age, and patient characteristics that existed within the two groups. Them-YAPS reveal that there is a big reduction in the score presented by the Virtual reality group in comparison to the control group, that was held in the perioperative area before the conduct of anaesthesia. When the anaesthesia was administered there was a significant presence of the high level of distress and compliance. A number of children in the virtual reality area posed more compliance with the study. The procedural behaviour and rating scale showed that there is a significant reduction in the score in comparison to the controls. The results also show that there was no report of any adverse event during the induction or intervention of anaesthesia (Ryu et al. 2017).
The usage of the virtual reality headset to a large extent reduced the anxiety that previously used to deter the children from moving into the operation theatre. The virtual reality psychologically gave an insight if the operation theatre and this has reduced the anxiety and at the same time increased the compliance with the conventional perioperative administration of anaesthesia. It is a known fact that the administration of anaesthesia is a fearful experience for the children and as well as for the guardians and the parents. The presence of the parents during the full conduct of the study worked as a psychological support that reduced the level of anxiety among the children of the different randomized groups (Bekelis et al. 2017).
After performing a critical analysis, it is found that strategies that are explicitly directed to take care of certain medical complications that cannot be solved through the conventional methods lead to a positive outcome. The anaesthesia given just before the operation is a major cause of fear for the children that are fearful and do not have any previous experience. With respect to such children that experience the high levels of anxiety, fear and depression need to be consoled and given proper intervention. Thus a novel method of providing the children with a virtual tour of the operation theatre and that too in the form of a cartoon character helps the children to significantly reduce their fear.
Data Collection and Processing
The usage of the virtual reality is a welcome change that is embraced well by the children and is also evident from the results. The intervention provided by the study team is a novel idea and acted as a change of practice with respect to the conventional practice (Maurice-Szamburski 2018).
Taking into account that the human element is used in the study, in order to reduce the gross ethical violations a prior consent is always considered before the conduct of the study. The consent forms provide an option for the children and their parent whether to opt in or out of the study. The responses provided by the responder are analysed in an unbiased manner and the responses are kept secret and used for the study purpose only (Miller et al. 2012). Polit and Beck (2014), indicated that informed consent from the participants or their legal authorized relatives should cover their rights, confidentiality, and not put the participants at risk of harm.
Conclusion
Thus, form the study it can be concluded that the in children there is a persistent fear regarding the operation theatre. There is the huge scope of research and study which are needed to address such situation. And this can be achieved only when something different is used other than the conventional method. The usage of the virtual reality proved to be beneficial for the children and the parents as well. This novel idea reduced the anxiety and fear that the children previously used to fear of.
Reference
Bekelis, K., Calnan, D., Simmons, N., MacKenzie, T.A. and Kakoulides, G., 2017. Effect of an immersive preoperative virtual reality experience on patient-reported outcomes: a randomized controlled trial. Annals of surgery, 265(6), pp.1068-1073.
DePoy, E. and Gitlin, L.N., 2015. Introduction to Research-E-Book: Understanding and Applying Multiple Strategies. Elsevier Health Sciences.
Faraoni, D. and Schaefer, S.T., 2016. Randomized controlled trials vs. observational studies: why not just live together?. BMC anesthesiology, 16(1), p.102.
Gao, X.L., Liu, Y., Tian, S., Zhang, D.Q. and Wu, Q.P., 2014. Effect of interesting games on relief of preoperative anxiety in preschool children. International Journal of Nursing Sciences, 1(1), pp.89-92.
Holmbeck, G.N., Li, S.T., Schurman, J.V., Friedman, D. and Coakley, R.M., 2002. Collecting and managing multisource and multimethod data in studies of pediatric populations. Journal of Pediatric Psychology, 27(1), pp.5-18.
Jung, K., Im, M.H., Hwang, J.M., Oh, A.Y., Park, M.S., Jeong, W.J., Kim, S.C., Jung, S.W., Sohn, H., Yoon, M.O. and Jang, M.S., 2016. Reliability and validity of Korean version of modified: Yale preoperative anxiety scale. Annals of surgical treatment and research, 90(1), pp.43-48.
Maurice-Szamburski, A., 2018. Preoperative virtual reality experience may improve patient satisfaction and reduce anxiety. Evidence-based nursing, 21(1), pp.14-14.
Miller, T., Birch, M., Mauthner, M. and Jessop, J. eds., 2012. Ethics in qualitative research. Sage.
Moule, P. and Hek, G., 2011. Making sense of research: an introduction for health and social care practitioners. Sage.
Parahoo, K. 2014. Nursing research: principles, process and issues. 3rd ed. Basingstoke: Palgrave Macmillan.
Polit, D. and Beck, C. 2014. Essentials of nursing research: appraising evidence for nursing practice. 9th ed. London: Wolters Kluwer Health/Lippincott Williams and Wilkins.
Rees, C. 2011. An introduction to research for midwives. Edinburgh: Churchill Livingstone/Elsevier.
Ryu, J.H., Park, S.J., Park, J.W., Kim, J.W., Yoo, H.J., Kim, T.W., Hong, J.S. and Han, S.H., 2017. Randomized clinical trial of immersive virtual reality tour of the operating theatre in children before anaesthesia. BJS, 104(12), pp.1628-1633.
Saghaei, M., 2011. An overview of randomization and minimization programs for randomized clinical trials. Journal of medical signals and sensors, 1(1), p.55.
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