Play in Hospital

Children in hospital: a guide for family & carers – review

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Children in hospital: a guide for family and carers by Richard Lansdown
Oxford University Press (Oxford Medical Press) (1996) ISBN: 0-19-262357-5

“Matching the intervention to the child”…


Children in hospital: a guide for family and carers is an information-packed book combining research and personal experience. Written by Richard Lansdown, formerly consultant Psychologist at Great Ormond St Hospital London, one of the world’s leading children’s hospitals.

Although the book is over 20 years old, families, healthcare professionals, early childhood educators and students will find a useful overview supporting children in hospital and healthcare. Researchers continue to read this book today.

 
 

Child rights

Have we come to expect child-friendly services? Lansdown writes about early hospitals and emotional aspects such as separation and the battle of early visitors, this gives a significant background. Development of child rights in hospital, saw the emergence of advocacy organisations and the Charter for children in hospitals, NAWCH 1984.

In Australia, AWCH promoted child rights and better healthcare with Health care policy relating to children and their families published 1974, revised 1999 and Charter on the rights of children and young people in healthcare services, 2010. Understanding child rights in healthcare is essential. An 11 year old girl on a children’s ward in the UK asks “aren’t we kids supposed to have a bill of rights when we are in hospital?”, Children’s hospital charter revisited.

 
 

Fear and coping

Children and families going to hospital or healthcare appointments may be fearful, Lansdown approaches the topic from a child’s perspective without being simplistic. You will find practical information about children’s understanding of health, illness and treatment. Play in hospital and play specialists (also known as child life therapists or specialists) guide children towards meeting their emotional needs.

Pain

Parents and carers can be supportive when a child is in pain and often know what techniques are likely to distract their child during medical procedures such as injections. Children turn to their parents or carers to see if it is safe and to know what to do.

The chapter on pain gives an understanding of its impact on children. Information and support are based on the child’s developmental stage and what works for them. Supportive strategies for children facing painful procedures include active distraction. This may involve reading books, toys, songs, stories, video games, mobile apps and new technologies such as video goggles. Other supportive strategies are participation, desensitization and modelling, watching a film that shows other children and mastery coping or coping models (initial anxiety then coping). Being noisy (counting out loud), guided imagery, relaxation and breathing techniques are some more options to consider.

A combination of distraction strategies might be used such as bubble blowing and guided imagery. For example, a child is asked to visualize the colour of the pain and places it on a bubble as though it was an imaginary cloud floating away. As the pain moves off, the bubble changes to the child’s favourite colour, blowing away pain and fear (p 116).

 

Talking with children

Summaries of pain assessment tools show how children rate their pain. Why ask children about pain? Adults usually explain how important a procedure is but there could be a gap in the child’s thinking. For example, a finger prick/injection to take blood may leave some children wanting information about why it is being done and what will happen next with the blood.

 
Children in hospital: a guide for family and carers reviews literature and includes bibliographical references providing a quick source of information for healthcare professionals and students. Families will find it is easy to dip into relevant sections. This book gives a valuable overview on the wellbeing of children in healthcare and also shows glimpses of what a good children’s healthcare service should look like.

More information

For more information about supporting children through medical procedures, see Needles and Needle-Related Medical Procedures links.

AWCH also holds a copy of Needles: helping to take away the fear, a booklet for parents based on information provided by Dr Richard Lansdown produced by Action for Sick Children, 1994.

 
 
 
Jillian Rattray
AWCH librarian
Email: Jillian@awch.com.au
AWCH Library
 

 

My trip to hospital – DVD resource

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Queensland Health, Lady Cilento Children’s Hospital
Nic, 8 years old, was recently admitted to hospital after an accident. Nic watched My trip to hospital DVD at home shortly after the hospital visit to Emergency in a Sydney hospital. His older sister was with him in the Emergency waiting room and also watched the DVD…
They had different parts about going to hospital that most kids would not know. Probably they would only know about tongues, ears and temperatures and scales. Probably they need to show a little bit more about cuts, twisted ankles and broken bones since most accidents happen that way. I thought it was funny when they sang about radiology and you got to know all about hospital equipment.
Nic’s sister (aged 13 years) 

The DVD was good, they looked at the ward and I think one of the things worth knowing about was the rollout bed where your parents could stay. It was comforting to know that your parents could sleep there. They showed you hospital equipment and told you the needles were only going to hurt for a short time, the pain would be over and done with. Another thing was they told you about waiting and what your parents would be doing, ‘more paper work’. You are prepared because you know what to bring, pyjamas and a book. The playroom is great because hospital is not just about going and staying in a bed doing nothing, there are other things to do besides just sitting there. You could ask the nurse to go to the play area with you and you can be with your siblings and be with other children in your age group.

My trip to hospital DVD and books can be borrowed from the AWCH library. Visit Queensland Health, Lady Cilento Children’s Hospital for the My trip to hospital program.  Find useful information about preparing your child for hospital, written for children, young people, parents and families. Importantly, there are some general tips about when to tell your child and what to tell them about going to hospital.

Other preparation includes medical play with stuffed animals and toys, reading books and helping to pack the hospital bag.

 

Jillian Rattray
AWCH librarian
May 2015


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

Childlife Awareness Month

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This month is Childlife Awareness Month. Childlife or Hospital Play has existed in hospitals that care for children since early in the 20th century often starting out as volunteer programs. However in Australia up until the second half of the 20th century and even now in the 21st century play programs are not always available in hospitals that care for children. Play gives children and adolescents the opportunity to express some of their apprehensions arising from the stress of illness. It also provides ‘normal’ everyday activities as a diversion from health care issues.

AWCH recognised the importance of play in hospital from its very early days and held a residential seminar at Armidale on play in hospital in 1976.  A first in Australia, it brought together a wide range of hospital staff, teachers and students in various disciplines and others interested in both the theoretical and practical aspects of play in hospital. It was through this seminar that play workers from a variety of hospitals and institutions and in widely differing positions became aware of each other’s existence and made recommendations for unified guidelines to be established as to their status in the hospital system. Today the Australian Association of Hospital Play Specialists promotes the importance of developmental play activities, therapeutic play, play preparation programs, medical play, diversion and distraction activities, and pre-
admission programs. In April 2013, AAHPS is holding its 7th biennial international conference, Connect and Collaborate A Hospital Wide Approach to Psychosocial Care in Melbourne.

So currently, where are we at with hospital play services in Australia? The AWCH 2005 National Survey Report on the Psychosocial Care of Children and Their Families in Hospital reported on the state of hospital play in Australia. The report found that just under 25% of surveyed hospitals had play or recreation staff and just over half provided a separate play room in or near the ward for child patients. Just a note here that these were all hospitals who provided care for children and young people. Of concern is the fact that just under 15% of those surveyed did not provide any separate play space for child patients.

AWCH made several recommendations:

  • Hospitals admitting paediatric patients should allocate a suitable space for play and recreation activities
  • Hospitals providing care for paediatric patients should employ appropriately qualified staff to conduct play activities, preparation for specific medical tests and procedures, medical play and distraction
  •  Hospitals providing care for paediatric patients should allocate appropriate play space, as recommended by the American Academy of Pediatrics
  • In areas where children are required to wait, suitably qualified play staff and/or suitable play or recreation space should be available to provide developmental, medical and preparation activities

So…are we doing any better in 2013? Does every hospital that cares for children and young people have play and recreation services available? What is the state of ‘play’ at your local hospital?

Anne Cutler
Program Manager AWCH

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

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