Nixi’s virtual reality project to reduce children’s fear before surgery in Vall d’Hebron is announced at TMB

Uncertainty is one of the emotions that children can experience before entering a operating room. "What will happen when I get to the hospital? What will I have to do when I get to the operating room? Will I feel pain?" Feeling uncertainty when we do not know what awaits us is normal, but if we understand what we are in front of, it's more tolerable. With this philosophy, BHH member Nixi for Children lands in the pediatric operating rooms of the Vall d’Hebron Children’s Hospital, with the help of the Fundació "la Caixa", in collaboration with the Barcelona Institutions Centre at CaixaBank.

Children from 4 to 12 years old who have a surgical intervention programmed by the Pediatric Surgery Service will have NixiKit at their disposal. Inside, they will find a virtual reality experience that leads Nixi, a 3D animation character that accompanies children to discover what they will find in the operating room and answers their questions. The kit has folding glasses to immerse yourself in virtual reality and an informative triptych designed to help the little ones express their feelings through play and creativity. They will be able to see from a operating room inside the process of induction to anesthesia.

Mental preparation and the accompaniment of professionals to patients and their families before entering the operating room is key to reducing anxiety and fear. Dr. Gabriel Guillén, head of Paediatric Surgery at Vall d’Hebron, explains that "surgical intervention is an experience that escapes from our day to day and can generate nerves. With this material we want to reduce states of anxiety and similar disorders that pediatric patients and their families can suffer from surgical intervention."

Scientific literature states that providing adequate information to children before treatment or intervention can reduce anxiety, empower and engage. And virtual reality makes it easier. Mari Ángeles Aceituno, attached to the Nursing Department, states: "We know that anticipating children what will happen to them, explaining what they will live, who will attend them and the sequence they will find reduces preoperative anxiety."

"The pediatric patient is very variable and unpredictable," says Dr. Núria Montferrer, head of Anesthesiology and Paediatric Resuscitation at Vall d’Hebron. He also points out that "experience tells us that one of the things that is most afraid of them is the loss of control, waiting in a stretcher, not knowing what happens or what will happen," he says. Dr. Núria Montferrer also stresses the importance of informing families and companions, because they will have tools to answer children's questions.

In fact, the NixiKit contemplates informative triptychs for children and their caregivers. It is recommended that parents or guardians see the video to be able to talk about it, because when the child has seen it, doubts or curiosity can arise and it is important to let him express what he feels in the situation he has to face. "With this material we want to help manage the emotions and doubts that children and adults may have, and if there are doubts they encourage them to speak openly," says Ariadna Torres, clinical psychologist specializing in paediatric patients. "Occasionally, the anxiety that a child may suffer is transmitted by parents or caregivers, so we encourage them to see the content," he says. "In Vall d’Hebron, we have adapted the contents so that all families understand them. Instead of imagining, we offer a virtual visit. The human being likes to have answers and with the NixiKit we offer explanations so that they have a feeling of control," says Ariadna Torres. Families are also accompanied throughout the process.

A project adapted to the Paediatric Surgery Service of Vall d'Hebron

Behind Nixi for Children is the startup of entrepreneur Tomàs Lóbez, who four years ago started the project with the mission of creating immersive content for patients. Recently, the results of a clinical trial in Radiotherapy Oncology have been published that validate the effectiveness of the tool to reduce anxiety in paediatric patients. Now, with the help of the Fundació "la Caixa", he arrives at Paediatric Surgery, with some changes. A team made up of Paediatric Surgery, Anaesthesiology and Paediatric Resuscitation, Nursing and Psychology has adapted the script and materials. Three materials have been recorded according to the type of surgery that the patient has to face: a surgery without admission, with admission the day before or admission the same day, with images of the maeix hospital and with the team that will attend the children.

Dr. Gabriela Guillén explains that in the preoperative visit, the surgeon or surgeon specified what video they should see according to the type of surgery. The videos are designed for scenes and, in each of them, a professional explains what will be lived in that space and answers Nixi’s questions, the cartoon that accompanies children.

Let's make a "Hospital Amable"

TheVall d’Hebron Children’s Hospital, Center, Service or Reference Unit (CSUR) in 11 paediatric specialties in Spain, involved more than 3000 children in 2023, of which the Pediatric Surgery Service performed about 1500 surgeries: 466 outpatient surgeries; 605 inpatient surgeries, and 429 emergency surgery. With the help of the "Hospital Amable" program, which looks after the emotional well-being of patients and families, this virtual reality project will be extended to other paediatric specialties: Traumatology, Neurosurgery, Ophthalmology or Plastic Surgery. The Amable Hospital is funded thanks to the contributions of people, companies and entities that make initiatives like this a reality.

TMB during Hospitalized Children's Week

Coinciding with Hospitalized Child Day, from May 13 to 19, Nixi for Children and Transports Metropolitans de Barcelona (TMB) invited users, through the Mou TV screens and megaphone messages, to put themselves in the shoes of children who have to undergo surgery.

Messages were issued to listen to Nixi’s character through the Metro network’s megaphone, in an action that aims to support pediatric patients and their families. In addition, Nixi is also present at the Montbau station, the closest to the Vall d’Hebron Children’s Hospital, with different vinyl from the charismatic characters that appear in the virtual reality video to make the hospital stay of the children lighter.