Healthcare For Children

E – Early days of play for children in hospital – resource

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Recently, I dipped back into the 1970s archives and looked at early work on play for children in hospital. Information unearthed was about the importance of play, the role of play workers/leaders and why play workers needed to be established as a paid profession as well as allocation of space for play.  Silvia Nash outlined a 1970s view of the role of play workers who have a primary concern for the emotional needs and development of the child. The play worker helps and encourages parents and families to support and participate in the care of their child acting as a buffer. Play workers explain treatments to children to fit their understanding and support nursing and medical staff. In the UK, the National Association of Hospital Play Staff has documented milestones celebrating 50 years of work.

In Canada and North America child life programs were designed to meet the social, emotional and physical activity needs of children in hospital and to help children and their parents adjust and cope with illness. Hospitalized children need the continuing presence of someone important to them, as well as a rich and stimulating environment and opportunities for exploratory behaviour and play. The Child Life Council has produced a timeline and history of the profession.

In 1976 AWCH held a seminar Play in Hospital, a first in Australia. AWCH was instrumental in bringing together a wide range of people, making recommendations for unified guidelines and including roles and training. AWCH went on to write a Policy relating to the provision of play for children in hospitals in 1986.

A new beginning for the profession in Australia took place in 2015. The evolution of the hospital play profession in Australia was celebrated during Child Life Therapy week including the launch of a new name and website. Look to the Association of Child Life Therapists Australia as the peak body of health care professionals specialising in child development, who utilize their knowledge and skills to work with children in the hospital…. ACLTA has produced a short history of hospital play in Australia.

 

Early days and resources at the AWCH Child Health Library

AWCH Child Health Library holds foundational resources including:

Important resources that identify the needs of children in hospital

Recent resources available for loan include:

Related resources can be borrowed on preparation for hospital, relaxation, mindfulness, coping with grief and living with serious illness.


Jillian Rattray
AWCH librarian
http://Library.awch.org.au
May 2015

A is for anxious parents & children

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Parents’ emotional response to child’s hospitalization
Helen Gofman, Wilma Buckman, George H. Schade

What was it like for children in hospital in the late 1950’s? This article is from the Pediatric Mental Health Unit, University of California Medical Center. In 1957, understanding of children’s emotional response to hospitalization as well as parents was little understood.

This interesting article looks at parents’ perceptions and what it was like for families with hospitalized children. Parents were interviewed and questions asked included what information was provided by doctors as well as admission procedures. Interestingly, as the study progressed researchers became aware of the impact of separating children from their parents without preparation of any kind and modified their admission procedure. There were one hundred parents who were interviewed at the time of their child’s admission and 68 parents were interviewed again at discharge from hospital.

This is a very touching article, with parent vignettes. Readers can see how difficult it was for both child and parent to be separated, vulnerable and fearful. The article describes the traumatic admission procedure where children were placed in bed in an isolation unit and parents were escorted to a nearby waiting room where they could hear their child crying calling for them but could not see or be with them. The modified procedure led to a more gradual separation. The changed procedure involved a nurse being assigned to the care of the child and parents, accompanying them to a room where the child was no longer isolated. The child shared a room with others of a similar age and the nurse acquainted the child with roommates before assisting parents to put the child in bed. Parents were encouraged to stay until the physician was available.
The article describes visiting hours and the success of a “further extension of visiting hours”, some of the nursing staff were sceptical about the extension.

In the summary section of the article major points made were children and parents needed adequate preparation for hospitalization;

  •  An admission procedure which allowed for a more gradual separation of parent and child;
  • During hospitalization health personnel needed to focus on both the child’s emotional and physical needs;
  • Continuing preparation of child and parent throughout hospital procedures and treatment;

At discharge, health professionals provide understanding of findings and implications both orally and in writing for further care of the child at home.

This article has been cited approximately 35 times, Google scholar.

Link to first page of article to read more:
http://archpedi.jamanetwork.com/article.aspx?articleid=498653

View the record in the AWCH catalogue or contact the AWCH Librarian for more information:
http://awch.intersearch.com.au/cgi-bin/koha/opac-detail.pl?biblionumber=13531


Jillian Rattray
AWCH librarian
August 2014

Jessica’s X-ray – review

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By Pat Zonta, artwork by Clive Dobson
Firefly books, 2006. 27 p. ISBN 10: 1552975770

 

Jessica’s X-Ray is a great book for children and families to read and familiarise themselves with what an x-ray does and when it is used. Readers follow Jessica as she experiences an
x-ray for her broken arm and accompany her on a hospital tour to find out about radiology and other x-ray techniques including CAT-scan, MRI and ultrasound.
 
 “X-rays are invisible waves of energy that travel at the speed of light”
Primary school children will find the best feature of the book is the six real x-rays on printed film. Many children are fascinated by broken bones and the human body and they will like taking a look and finding out facts about different types of x-rays. By the end of the book they will have read about identifying bones, muscles and soft tissue from x-rays.
No-fuss information and warm colour illustrations are a feature. The author combines her experience of working in children’s and teaching hospitals as a Medical Radiation Technologist and author of several children’s books. This short book would be a useful addition to a primary school or public library.
Jessica’s X-Ray is available for loan from the AWCH library:
Review by:
Jillian Rattray

 

AWCH Librarian

 

Extreme parenting: parenting your child with a chronic illness

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By Sharon Dempsey
London, Jessica Kingsley Publishers, 2008. ISBN 9781843106197.

Written in a thoughtful and calm manner, Extreme parenting is a book that will support parents and families of children living with chronic illness. The book aims to identify areas of common concern to families and to develop an approach that will encourage children to develop and lead a full life. Parents who read Extreme parenting will gain insight into the author Sharon Dempsey’s experience of parenting her young son Owen through hospitalisations, returning to school, family life, medical necessities and home care. Quotes from other parents who have children with chronic illnesses also add depth and a personal dimension. Although written in a British context, the experiences are also relevant to Australian families. Communication strategies and advocacy are common themes throughout the book.

Extended families and close friends will find this book helpful in developing an understanding of what supportive care means. People genuinely wanting to help can gain insight into areas where they may be able to assist, depending on the needs of the family. It was thought provoking to read about how helping the siblings and parents in daily life will also benefit the child who has a chronic illness.

The section on schooling is important. It draws attention to the role school plays in academic learning as well as social interaction and friendships. Children need understanding and to feel like they are included. A child who is chronically ill and has repeated hospitalisations may experience fear and anxiety on return to school. Teachers and students who are prepared and understand about the child’s illness are in a better position to make returning to school a more positive experience for everyone. Dempsey gives examples as to why teachers may be reluctant to have a child with a chronic illness in their class. She also draws on her family’s experience to provide examples of how Owen’s teachers and friends enabled Owen to feel part of his school life even when away from school. Parents can advocate for their child and foster understanding within the school by providing information and updates.

Medical professionals who read Extreme parenting will be able to think about the child within the context of their family as well as the role parents play in doing the best for their child within the healthcare environment and at home. The aim is to help parents do the best job they can so that the child is given the best possible care. Some of the psychological issues facing families and the role of the child in participation in treatment decisions is considered. Adolescents, in particular, will benefit from taking part in decisions about treatment and care plans. Special considerations regarding privacy, peers etc. are also relevant to adolescent development and hospital care.

For families who have a child with a terminal illness, there is a section on hospice or palliative care. This chapter is written in a compassionate and supportive manner.

Find at the end of each chapter Action points that will review the main themes and direct readers into action. These pointers are helpful reminders and make organising easier. Contact organisations, reference and bibliography lists at the back, not only show the book is well researched but guide readers to other interesting resources.

Extreme parenting is a book written to benefit families with a child with a chronic illness. As growing numbers of families find themselves meeting challenges addressed in this book, our communities will gain much needed awareness by reading this book and others like it.

Reviewed by Jillian Rattray
AWCH Librarian
November, 2013

Thanks A Million

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As AWCH celebrates its 40th anniversary during 2013, it is timely to reflect on all the AWCH volunteers past and present who have contributed to the improvements made in the care of children in Australian hospitals over the last 40 years.

 

From the very first meeting in 1973 when a bunch of concerned men and women got together to form an association, AWCH volunteers have worked hard to make things so much better for children and their families.

 In the words of Doris Hart, first Secretary and National Organiser of AWCH – the moving force behind the Association’s initiatives from 1973 to 1983 – there was a dark underside to children’s hospitalisation….

 
‘In the newspapers and magazines of the 1960s/70s, information about children in hospital centred around hospital success stories; visits of royalty and film stars; Easter bunnies delivering a surfeit of Easter eggs; and Father Christmas and his helpers with an abundance of toys and good cheer. The stories conveyed images of hospitals working near miracles; of everyone caring about children in hospital and of the kindness shown by hospitals for their child patients.
 

All of this was true but it hid a very dark underside to the hospitalisation of children – long term, often devastating, emotional trauma.

 

In Australia, the need for change was heralded by the concern expressed in 1970 by the Aust. & N.Z. College of Psychiatrists. Their Position Statement entitled “The admission of mothers to hospital with their young children” accused hospitals of……doing more damage in one year than all the psychiatrists together could undo in several years. . .

That hospitalisation could have such devastating effects on young children was well known to me. In the late 1960’s I worked for three years in the children’s unit of a psychiatric hospital handling the most severely emotionally disturbed children in the State. Hospitalisation at an early age appeared regularly in the case histories of these children.

One would have expected the psychiatrists’ position statement to bring forth cries for an immediate enquiry and remedial action. Instead, it was virtually ignored. The hospitals’ case was that parents upset children who were soon settled and better off without them. A fallacy already forcefully disproved by the published works, both written and audiovisual, of James and Joyce Robertson https://www.awch.org.au/2-year-old-goes-to-hospital.php
 

The “cage” cot with a wire frame 1976

If the mother (or the child’s caring person) was not admitted, how did hospitals cope? Nurses did their best in an often impossible situation. For the most part, children simply cried until they became withdrawn and “settled”. Distressed toddlers were particularly difficult to manage. In their anguish they often tried to climb out of the cot. Fearing that they would harm themselves they were sometimes put in restrainers. Documented cases of children choking to death in them discouraged the practice. Another method was to put a wire frame over the top of the cot thus making it into a cage.

 In the 1970’s, I saw one of these in a regional hospital in NSW, another one in Victoria. In each case, the hospitals saw the cage as a perfectly valid solution that ensured the child’s safety, even though there were empty beds at the side of the cot which could have been used by a parent. Indeed, in Victoria I was told the cage was used because the child was the only one in the ward so, instead of having a nurse there just for one patient, the sister in the adult ward kept popping in. When I asked why they hadn’t admitted the child’s mother in these circumstances, I was told it wasn’t hospital policy. The nurse admitted she would willingly have let the mother stay (had it been allowed) as the toddler was a nuisance disturbing and upsetting her patients all night.

Of course, most hospitals did not use restrainers or cages, but there were still very distressing sights associated with necessary treatments. I remember seeing a very young child in a side ward with his eyes swathed in bandages and his wrists tied to the sides of the cot so that he did not pull off the bandages. He was kept heavily sedated but one couldn’t help wondering what fears or dreams he was having in that twilight state. I felt sure his mother holding his hand and comforting him would have helped.
 

Cracking the system

In the literature, the problems of hospitalisation of children had been identified and the solutions outlined. As hospitals failed to implement more humane policies, there were various attempts by individuals and groups to force action but none had been successful. Hospital boards were thought to be omnipotent. To challenge them from inside the hospital was to invite personal disaster career-wise; to challenge from the outside was to invite ridicule as a trouble-maker.

At the first meeting of the group which subsequently became AWCH I voiced my strongly held convictions:

  • that infants and young children needed their mothers in hospital and that need had to be met
  • that parents and professionals must work together publicly if the above aim was to be achieved

I believed that we could do better by drawing upon Australia’s egalitarian ethos and creating a platform from which all could speak on behalf of the children, free of professional, personal or vested interests.

Thus AWCH was born in the belief that parents and professionals together could crack the system’ for the good of the children.’

During this national volunteers week 2013 AWCH would like to thank all our volunteers both past and present

 

 
If you were an AWCH volunteer between 1973-2013 or know of someone who was please contact AWCH and let us know how you helped awch through your volunteering.

Therapeutic activities for children and teens coping with health issues

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Therapeutic activities for children and teens coping with health issues
By Robyn Hart and Judy Rollins.
John Wiley & Sons, Hoboken, New Jersey, 2011, 379 p. ISBN 9780470555002.
Bibliography, pp  339-364. Includes CD-ROM.

“Therapeutic activities for children and teens coping with health issues” is a book richly filled with activities to assist health professionals, child life therapists, counsellors and social workers in their work with families. Activities and related information promote adaptation and coping for children, adolescents and their families in hospital or living with health issues. It is great to see so many ideas presented in an easily readable format, with over 200 practical activities to choose from.

Chapters focus on promoting understanding and coping for adolescents and children through different aspects of their healthcare experiences. Topics of the 16 chapters include separation and anxiety, self expression, socialization and help with many aspects of coping with illness. Set out in a clear way, each topic covers an overview, special considerations and coping interventions. The theoretical framework behind each topic is outlined. Activities are set out using an easy-to-read table which includes: therapeutic goals, age group, adult/child ratio, required time, restrictions and precautions and materials. You will also find an extensive bibliography (pp  339-364) as well as black and white illustrations and photographs. The accompanying CD has activity sheets and templates that can be customised.

With a great mix of theory and hands on, this book is sure to be a helpful reference tool and provide both information and inspiration. In fact I think I’ll gather up my supplies and try my hand at making a volcano.

About the authors
Robyn Hart, director of Child Life at Rush University Medical Center in Chicago. Judy Rollins, coordinator of the Studio G Artist in Residence Program at Georgetown University Hospital and Adjunct Professor at Georgetown University School of Medicine. This is the second  book they have worked together on, the previous award winning book is entitled, Therapeutic play activities for hospitalized children.

Keywords: Activities; Adaptation, psychology; Adolescent psychology; Bereavement; Body image; Child life; Child, hospitalised; Child psychology; Culture; Death; Families; Group work; Hospitalization; Medical art; Medical equipment; Mental health; Pain; Patients; Play therapy; Self-esteem; Self-expression; Therapeutic activities; Therapy

Awards
Winner of the American Journal of Nursing Book of the Year 2011
(Category: Maternal And Child Health)

Other titles also by Judy Rollins available for loan from the AWCH collection:
Meeting children’s psychosocial needs: across the health-care continuum / Judy A. Rollins, Rosemary Bolig and Carmel C. Mahan. Austin, Texas: Pro-ed, 2005. xv, 551 p.: Includes bibliographical references and index. Call number: 618.92 ROL 1
Core curriculum for the nursing care of children and their families / Marion E. Broome, Judy A. Rollins, Editors. Pitman, New Jersey: Jannetti Publications Inc., 1999. Call number: 610.7362 BRO 2

Review By:
Jillian Rattray
AWCH Librarian
March, 2013

 

Social Media for Children in Hospital

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Should children and young people have access to the internet and social media while they are in hospital?

Social support during hospitalisation has always been a critical factor for children and young people. The rights of children and young people in healthcare have been enshrined in polices and standards developed by AWCH and other like minded organisations over many years.

Reducing feelings of isolation from friends and family members, especially for older children and teens is an important consideration. For older children, contact with school friends and access to facilities they may have at home (e.g. the internet) can also help normalise the hospital experience. This is important to reduce the possible negative effects associated with childhood hospitalisation.

The new technologies can provide young patients with increased access to family, peers and entertainment and have been shown to enhance communication and social connection. With internet access, children can also keep up with their school work.

Recent surveys about technology and social media have found that:

It is clear that the internet is a huge part of young lives. Arguably young people who do not have such access may be disadvantaged. Strategies that enable equitable access to the internet for children and young people during hospitalisation have the potential to reduce isolation and interruption to education.

Should access to these important technologies, which enable social connectedness, as well as educational opportunities, be available to all children and young people while they are in hospital?

What do you think?

Advocating for the needs of children, young people and their families within the healthcare system

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