Publication Date



Open access

Degree Type


Degree Name

Doctor of Philosophy (PHD)


Nursing (Nursing)

Date of Defense


First Committee Member

Elias P. Vasquez

Second Committee Member

Joseph De Santis

Third Committee Member

Kandyce M. Richards

Fourth Committee Member

Frank Wang


Invasive procedures are often painful and distressing for children and disturbing for their parents. The purpose of this study was to develop a substantive theory of parental perceptions of their school-aged child's responses to an outpatient minor surgical procedure with nitrous oxide. The sample included 22 parents of 21 children who underwent a nitrous procedure. Participants were recruited from the pediatric surgery department at a children's hospital. Semi-structured, audio-recorded interviews were conducted with each participant. Grounded theory method was used to simultaneously collect and analyze the data using the constant comparative method. The findings of the study revealed parental impressions involving a process of various emotions and behaviors. The identified process began at procedural scheduling, progressing through the procedure, and terminated going home. The core category derived from the data was Weathering the Storm before the Calm by Securing Connections. This core category describes the complexity of parental impressions and all categories subsumed by the core category. Six major categories and seven subcategories derived from the data represent parental impressions. Parental feelings of anxiety and fear arose during initial phases of the process. Parents attempted to deal with these stormy feelings in several ways. Parents experienced a sense of calmness after the procedure upon realizing their child was safe. The theme that weaves through the entire process is the parental-child connection and parental presence during the nitrous procedure. Parents also identified barriers and facilitators they faced during this process. The substantive theory that emerged provides nurses with an understanding of the stormy and subsequent calm phases parents endured. This information offers clinicians unique interventions to help parents get through this process. Future research needs extension to other settings such as radiology and other specialties such as plastic surgery and urology. Further research warrants investigating children's perceptions to their procedure with nitrous oxide.


Grounded Theory; Analgesia; Nitrous Oxide; Minor Surgical Procedures; School-aged Children; Parent Impressions