The Brazilian National Policy for Comprehensive Child Health Care recommends the uninterrupted presence of a accompanying family member during hospitalization, access to information, and accompanying family member involvement in the child’s care.⁽¹⁾The right of accompanying family members to remain with hospitalized children under 18 years of age is guaranteed by Article 12 of Law 8,069/1990^(4,5) and Resolution 41/1995 of the Brazilian National Council for the Rights of Children and Adolescents.⁽⁶⁾Likewise, the Brazilian National Humanization Policy identifies the provision of clear information to patients and their accompanying family members as a strategy for promoting humanized healthcare.⁽⁹⁾Despite these legal provisions, the presence of accompanying family members in the pediatric hospital setting is not always harmonious. Conflicts between accompanying family members and the healthcare team are generally related to accompanying family members’ anxiety, stress, and inadequate preparation.^(10,11)

Hospitalization is a stressful experience for both children and their families, particularly when surgical procedures are involved.⁽¹²⁾However, these challenges can be minimized by adequately preparing accompanying family members and providing them with information about institutional routines, regulations, and the procedures to be performed.⁽¹³⁾Informational videos are valuable tools for delivering such information.

Informational videos are Care-Educational Technologies (CETs) that facilitate knowledge transfer by presenting information in a dynamic format, thereby enhancing understanding.^(18,19)These technologies integrate scientific knowledge generated through the processes of caring for and educating others from a critical, reflective, creative, transformative, and multidimensional perspective,⁽¹¹⁾making them valuable resources for preparing accompanying family members of children undergoing hospitalization.

However, the use of videos to prepare accompanying family members of hospitalized children has rarely been reported in the literature and is seldom observed in clinical practice. In general, accompanying family member preparation is limited to providing verbal or written information about required documentation, laboratory test results, and preoperative instructions. The nursing consultation conducted in the outpatient clinic or during the preoperative period provides an ideal opportunity to prepare accompanying family members by offering clear information and addressing their questions.⁽¹⁷⁾

The use of videos to prepare accompanying family members has proven beneficial across different healthcare settings,⁽¹⁸⁾ although the availability of these resources remains limited. Therefore, this study aimed to develop an informational video on institutional routines and regulations for accompanying family members of children scheduled for surgical procedures. This initiative may encourage the broader adoption of audiovisual educational resources to prepare accompanying family members for pediatric hospitalization.

This was a technological development study,⁽¹⁸⁾conducted with healthcare professionals and accompanying family members of children scheduled for surgical procedures at a public pediatric hospital in Manaus, Amazonas, Brazil, a state referral center.⁽²⁰⁾

A video was selected as the educational resource because it provides clear information on the proposed topic by combining images, audio, narration, and subtitles, thereby facilitating comprehension. In addition, videos can be adapted for different digital platforms and are accessible to individuals with varying educational backgrounds, as well as to those with hearing or visual impairments, among other conditions.⁽²¹⁾The video was developed between September 2023 and February 2024 (CAAE: 12466119.3.0000.5016; Approval 3.674.719). The development process comprised three stages: reality assessment; theorization and technological development; and appraisal and final version (Figure 1).

Figure 1

Stage 1 included a total of 44 participants distributed across three groups. Most healthcare professionals were women (77.78%), were older than 39 years (55.56%), and had worked at the institution for an average of five years. All accompanying family members (100%) were women, and most (92%) were the children’s mothers. The accompanying family members’ mean age was 34 years.

According to most healthcare professionals, accompanying family members do not receive sufficient information before hospitalization (66.70%) and are unfamiliar with the institutional rules and routines governing their stay (77.78%). All professionals agreed that providing information before hospitalization could reduce conflicts between accompanying family members and the healthcare team during the hospital stay (100%). They considered information about what to bring for hospitalization, the child’s meals, rules for shared living, appropriate use of hospital furniture, and suitable clothing for the ward to be essential for a smooth hospital stay.

Among accompanying family members of children scheduled for surgical procedures, all participants reported having received information about hospitalization (100%). However, some still had questions regarding visiting hours and what to bring for personal use (17.65%). Most accompanying family members considered videos (61.12%) and printed brochures (27.78%) to be appropriate educational resources for delivering this information (Table 1).

Table 1

Variables	Accompanying family member preparation before the child’s hospitalization
	Yes(%)	No(%)
Healthcare professionals (N=9)
Accompanying family members receive the necessary information prior to admission	3(33.33)	6(66.70)
Accompanying family members are familiar with institutional rules and routines	2(22.22)	7(77.78)
Advance information can minimize conflicts	9(100)	-
Accompanying family members of children scheduled for surgical procedures (N=17)
Received information about the hospitalization	17(100)	-
Remained with questions regarding the hospitalization	3(17.65)	14(82.35)
Video is an appropriate technology for conveying this information	11(61.12)	6(33.33
A brochure is an appropriate technology for conveying this information	4(27.78)	13(72.22)
Accompanying family members of children after surgical procedures (N=18)
Received information about institutional rules and routines	4(22.22)	14(77.78)
Received information about the admission process	4(22.22)	14(77.78)
Had questions about what to bring from home	16(88.89)	2(11.11)
Had questions about the length of stay at the facility	16(88.89)	2(11.11)
Had questions about meal provision	16(88.89)	2(11.11)
Had questions about visiting hours	16(88.89)	2(11.11)
Would have liked to receive the information via videos and pamphlets	16(88.89)	2(11.11)

Among accompanying family members of children hospitalized after surgery, most reported that they had not received information about institutional rules and routines or about the hospitalization process (77.78%). Most participants also reported having questions about what to bring from home, the expected length of hospitalization, meal entitlements, and visiting hours (88.89%). They stated that they would have preferred to receive this information through videos and printed brochures (88.89%) (Table 1).

Analysis of the data identified 14 emerging themes, which were organized into two thematic groups: “pre-admission information” and “information on the hospital stay and the surgical procedure”. The first group included the following emerging themes: “what to bring to the hospital”, “documents required for hospital admission”, and “hospital admission procedures”. The second group comprised the following themes: “organization, cleanliness, and rules for shared living”; “accommodations, clothing, and meals”; “toys and mobile phones”; “specific needs during hospitalization”; “visits”; “communication with the healthcare team”; and “general guidance on surgical procedures at the institution” (Chart 1).

Chart 1

Thematic group	Emerging theme	Summary of the content
Pre-admission	What to bring to the hospital	Personal items for the child and accompanying family member during hospitalization; permitted amount of luggage
	Documents required for hospital admission	Personal documents; specific legal custody situations; medical tests and institutional documents
	Hospital admission procedures	Schedule, bathing, clothing, performance of medical tests, and pre-anesthetic consultation
Hospital stay and the surgical procedure	Organization, cleanliness, and rules for shared living	Ward organization; use of electronic devices; proper waste disposal
	Accommodations, clothing, and meals	Use of furniture and appropriate clothing during the hospital stay; meal times
	Toys and mobile phones	Risks of sharing toys among patients; rules and precautions regarding cell phone use
	Specific needs during hospitalization	Requests concerning laundry, use of ongoing medications, and meals
	Visits	Schedules and rotation of accompanying family members
	Communication with the healthcare team	Procedures performed; medications; post-operative care
	General guidance on surgical procedures at the institution	Location of the procedure and waiting area for the accompanying family member; duration of the procedure; patient preparation; conditions for the patient’s return to the ward after procedures

The emerging themes guided the review of institutional regulations to develop a concise summary of the content. Based on the pre-admission information thematic group, content was developed addressing the child’s and accompanying family member’s personal belongings to be brought to the hospital, permitted luggage, required personal documents for hospital admission, guidance for specific situations such as children accompanied by someone other than their parents, and institutional rules regarding clothing, diagnostic tests, and procedures. Based on the thematic group information on the hospital stay and the surgical procedure, content was developed addressing organization and cleanliness of the hospital room, use of electronic devices, appropriate clothing, meal schedules, visiting hours, and accompanying family member replacement; the risks associated with sharing toys and the use of mobile phones; guidance on special requests related to laundry services, continuous-use medications, and meals; information about procedures and medications; postoperative care; the location and expected duration of surgical procedures; patient preparation; and the conditions required for returning to the hospital ward after surgery (Chart 1).

In Stage 2, based on the synthesis of the emerging themes, the storyboard and narration script were developed to guide video production. After revision of the material, version 1.0 of the video “Acompanhantes de crianças com indicação cirúrgica: orientações para hospitalização”, was produced. The video had a duration of 7 minutes and 58 seconds, included images, audio, and subtitles, and was saved in MP4 format, allowing easy sharing across different internet-connected devices or via Bluetooth. The visual content was selected by the research team to represent the narrated information through images and colors, thereby facilitating audience comprehension (Figure 2).

Figure 2

In Stage 3, version 1.0 of the video was assessed by expert judges. Participants were between 23 and 50 years of age, most were female (77.8%), held specialist qualifications in pediatric healthcare (90%), and all were directly involved in clinical practice (100%).

Overall, the educational material achieved an IVCES of 87% (AS = +1), indicating that it was valid and appropriate for preparing accompanying family members of children scheduled for surgical procedures. The Objectives domain assessed whether the video addressed the proposed topic, was appropriate for the target audience, clarified accompanying family members’ questions, and encouraged behavioral change. All items reached “Consensus” (+1) among expert judges (Table 2). None of the items was rated as “Inadequate”.

Table 2

Evaluative questions	Adequate	Partially adequate	Score
Objective	n(%)	n(%)
Covers the proposed topic	8(90)	1(11.11)	+1
Adequate for the target audience	9(100)	-	+1
Clarifies questions from the accompanying person	9(100)	-	+1
Promotes reflection on the topic	9(100)	-	+1
Encourages behavioral change	8(90)	1(11.11)	+1
Structure/presentation
Language appropriate for the target audience	8(90)	1(11.11)	+1
Interactive language	9(100)	-	+1
Accurate information	9(100)	-	+1
Objective information	9(100)	-	+1
Clarifying information	9(100)	-	+1
Necessary information	7(80)	2(22.22)	+1
Logical sequence of scenes	9(100)	-	+1
Content and coherence of captions with the scenes	9(100)	-	+1
Caption text length	9(100)	-	+1
Relevance to the accompanying family members’ preparation
Encourages learning	9(100)	-	+1
Contributes to the accompanying family member’s preparation	9(100)	-	+1
Sparks the target audience’s interest	9(100)	-	+1

The Structure/Presentation domain assessed the appropriateness of the language for the target audience, interactivity, the accuracy, objectivity, clarity, necessity, and timeliness of the information, as well as the adequacy of the subtitles. All items in this domain also achieved “Consensus” (+1) among expert judges (Table 2).

The final domain, Relevance, assessed the video’s ability to encourage learning, contribute to accompanying family member preparation, and promote the target audience’s interest in the topic. All items also achieved “Consensus” (+1) among expert judges (Table 2).

Following experts’ assessment, they recommended reducing the video’s duration and incorporating images of the institution’s actual forms. After these revisions, version 2.0 of the video had a total duration of 7 minutes and 50 seconds (https://drive.google.com/file/d/1WAcwn6SZBo3mBYlveZbNfbuKsn8OBJq8/view?usp=sharing).

The findings of this study highlight the need to provide information to accompanying family members of children scheduled for hospitalization for surgical procedures. Preparing accompanying family members by providing information about institutional rules, routines, and procedures before hospitalization may reduce conflicts and difficulties during the hospital stay, as well as alleviate the anxiety, fear, and insecurity commonly experienced during this period.^(13-14)

Pediatric hospitalization affects family dynamics and elicits a wide range of emotions. Access to information that helps prepare accompanying family members also facilitates communication with the healthcare team.^(12,15,22)The findings of this study showed that, although most accompanying family members reported having received information before hospitalization, they considered it insufficient to address their questions and uncertainties regarding the hospitalization process. This finding reinforces the importance of reviewing current strategies for providing pre-admission information.⁽²⁵⁾Informational videos were identified as the preferred educational resource by accompanying family members, a finding that is consistent with the literature. Previous studies have shown that audiovisual resources are perceived as more intuitive and self-explanatory, facilitating information delivery and improving the preparation of both accompanying family members and patients for hospitalization.⁽²³⁾

Educational resources that can be accessed quickly and easily through mobile devices with internet access increase the reach of health information among the target audience.^(17,27)Audiovisual tools are useful, advantageous, and effective resources for health education because they combine images and sound to communicate information, making learning more engaging and easier to understand. These digital resources complement the teaching-learning process, improve the quality of health education, and contribute to patient care in multiple ways.^(26-27)

The study has some limitations. The video was not validated by the target audience, and the educational material will require periodic updates to reflect changes in institutional routines. Nevertheless, the findings may encourage future initiatives aimed at developing audiovisual resources to prepare accompanying family members of pediatric patients scheduled for hospitalization for surgical procedures.

The development of the video was based on a reality assessment, which demonstrated that access to clear and timely information is a need perceived by both accompanying family members and the healthcare team. The review of institutional regulations and the assessment of the content by expert judges ensured that the educational material was consistent with the institutional context and routine clinical practice.

Preparing accompanying family members for the hospitalization of children undergoing surgical procedures contributes to the humanization of healthcare, and informational videos represent an effective strategy for providing information that may reduce insecurity and conflicts with the healthcare team while promoting adherence to treatment. In addition, videos may reduce the time and workload required of healthcare professionals during hospital admission and throughout hospitalization, while representing a low-cost educational resource.