Play is an essential component in the child’s life. It enables him/her to make sense of the outside world. Communication, tolerance, co-operation, and other life skills are all experienced and developed through play. As well as being good fun, it is a very familiar and emotionally balancing activity.
When a child is admitted to hospital, s/he is faced with many unfamiliar factors; such as strange sights, sounds, smells and medical procedures. These can all be a very real source of fear for them.
As a Hospital Play Specialist (H.P.S), my aim is to meet the emotional needs of the hospitalised child and family. In my experience, fears or misconceptions concerning the hospital admission or medical procedures cause the child to worry. Left alone, these worries do not go away, but instead tend to build up. The child may then become increasingly resistant and defensive, and, if this happens, will often fight against having any kind of medical intervention. It is then more difficult to calm the situation and remove the fears, as the child will have already had a traumatic experience. So wherever possible, as soon as the child is admitted to the ward, we become involved. Supplying toys and bringing as much normality as possible; we seek to establish a warm, welcoming atmosphere. We invite the children to explore the playroom, or teenage room, where there are many varied activities to be enjoyed. We present ourselves in a non-threatening manner, dressed in casual clothing. We guide rather than force a situation. Using play, we seek to establish a relationship with the child, using this to support them throughout their time in hospital. With this relationship established, it is possible to talk about and play through any procedures that the child may face, such as blood tests or surgery. As a result of our rapport and observation of the child, we can present our preparation in a way which is appropriate to their understanding. Through preparation, we endeavour to maintain the safe and reassuring feeling of play. The aim is to infuse the child with a sense of confidence by providing as much normality as possible. Where appropriate, we will make a plan of action with the child, and will describe the oncoming event, possibly using photographs. Using this approach, much of the unknown is removed - the gaps are filled, and any fantasies that the child may harbour about the procedure, may come to light. We can then reassure them about the reality of the situation, and provide coping strategies, which will often make events far less threatening. The child may even be completely distracted from the cause of fear; i.e., the blood test, and because of the magic cream (anaesthetic cream) used to numb the area, have the test without any trauma at all. One common example of this is when the child is still waiting for the blood test to happen, when it has already been completed. When we explain that the test has been done, and present them with a certificate, the child often seems amazed. A positive experience like this may mean that future medical tests are faced far more calmly.
The work of the H.P.S is diverse and requires flexibility and imagination. Children need an approach that is suited to them, that will attract their attention. The wrong approach can mean that a barrier may be formed, that will prevent a therapeutic relationship from being established.
A little girl demonstrated one extreme example of this. Whilst on holiday abroad with her parents, she had to be hospitalised. The approach toward non-compliant children in this hospital was similar to that of England in times past. Fearful of having a blood test, this girl of seven years, refused it, and tried to get away. The response was that the medical team separated her from her distressed parents. She was then secured; head, arms and legs to the bed, using sheets. A blood test was obtained against her will. This was routine procedure. It was no surprise that when this girl needed more treatment in Kingston Hospital, she was extremely traumatised. Working with the H.P.S meant that she was given the time and support to work through her fears. Her blood test was later obtained whilst she sat cuddling her mother, being distracted in a way she had decided upon. There was very little trauma involved, and later on she helped other children to feel better about having their blood tests.
It is evident that, when the right approach is used, a very positive experience of hospital can be gained. As one child illustrated beautifully, “I go to the hospital to play, oh, and while I am there I see the doctor”.
Patrick Barry, Play Specialist, Kingston Hospital, Surrey.
June 2000