I am one of four Play Specialists working at The Whittington hospital in London. We work on a 22 bedded General Children's unit, including Day Surgery, a busy Paediatric Out-Patients (which includes: baby clinics, special needs and the oncology clinic) and a progressive Neonatal Unit, and are also on-call to the A&E Department.
At the Whittington, we work very closely with the Paediatric Consultants and other members of the multi-disciplinary team. We work with all in-patient cases, as well as taking individual referrals for specific reasons, for example to complement the consultant's assessment of a child and help give them 'the whole picture' surrounding a child and their family situation.
We may also be asked, by the consultants, to do a general developmental assessment on a child.
Central to the role of the Hospital Play Specialist is listening to what the child is saying and watching for verbal or non verbal signs of anxiety during play and, if apparent, to take appropriate action and pass on any relevant information.
We also work closely with the Speech and Language Therapist and Dietician with older babies, whose feeding aversions can be lessened by the introduction of different tactile stimulation such as painting/messy play.
CASE STUDY 1
Steven, a 4 year old boy, was confined to bed following surgery to his abdomen. He became very restless and short tempered with his mother and the nursing staff, wanting to be with the other children in the playroom.
We were having a foot printing session in the playroom with a group of children and, not wanting to leave Steven out, we pulled his bed into the playroom, with drips and drains attached. Placing him near the low window, I was able to turn him slightly so that his feet could reach the window.
I was then able to paint Steven's feet and print them straight onto the window-pane.
This was a very successful messy play session, which enabled Steven to be with his peers, have fun and, at the same time, to relieve the frustration and boredom of being confined to bed.
He was very proud of his work, calling everyone in to admire HIS window.
By teaching a child/adolescent relaxation techniques, it teaches them to take control of a situation. Thus relaxation will increase their confidence. In turn, if a child is seen to be coping with their illness, the parent often does too.
Children soon realise that we are not there to inflict pain on them, but are there to help, and often to help relieve or prevent the pain.
Play Specialists are trained in child development. We are also able to assess the child in his most natural state-at play.
We use therapeutic play appropriate to the child's age and medical condition. Our observations form the basis of our own approach to the child and the planned programme.
We may also help the doctor's diagnosis and decisions about which other members of the multi-disciplinary team may need to be involved in the child's care plan; for example the Speech and Language Therapist, Physiotherapist or Social Worker.
If physiotherapy is required, we work alongside the Physiotherapist so that the exercises may be done through therapeutic play and/or music, singing and movement. In this way, the child becomes less distressed at the prospect of physiotherapy, which in some cases can be quite upsetting and painful for the child.
Play Specialists can introduce physically and developmentally appropriate exercise without the child realising.
CASE STUDY 2
Hayley, a 6 year old girl with burns to her right side and right arm, was very reluctant to get out of bed to exercise. The Physiotherapist was very concerned about her lack of mobility and asked for our advice.
We had formed a good relationship with Hayley during her admission and, knowing her great sense of fun and how she loved testing the nurses out, we suggested to Hayley that we should go around the ward with a tape recorder, recording all sorts of sounds and noises, trying not to let the nurses see us.
Once we had recorded as many sounds as possible, Hayley then played them back to the nurses, who in turn had to guess what they were. Hayley thought this was a great game, but said it would be even better if she could charge 5p for each wrong answer! After a great deal of effort on Hayley's part and a few tears, that session was the start of her mobilising, much to the Physiotherapists delight, each day she was able to achieve more and more.
CASE STUDY 3
Rahema, a 15 month old Asian child, came into hospital failing to thrive and developmentally delayed. Her mother seemed tired, depressed and unable to cope with Rahema. We joined forces with the Dietician to help both mother and child with their nutritional and developmental needs.
Rahema mainly had a milk diet and was very disinterested in solids. Working with the Dietician, Rahema and her mother, I encouraged Rahema to play with some finger foods in the playroom and let her do exactly what she wanted to. After many of these sessions, she began to feed herself, still not using her spoon, but fingers seemed to do just as well.
It was soon apparent to me that her mother did not know how to play, perhaps because she had never had the opportunity when she was young, because she had the responsibility of caring for the home and her younger siblings. I spent a lot of time working with Rahema's mother teaching her how to relax and have some fun with her daughter. After a three week admission, mother and daughter left hospital happier, healthier and enjoying each other much more.
One of our aims is to prevent a child from regressing while they are in hospital. We plan developmental play programmes suited to their individual needs, ensuring normal development continues while they are hospitalised.
We also aim to reduce the stress associated with fear of the unknown, and encourage positive coping strategies.
CASE STUDY 4
Russell, aged 9 was admitted for surgery to correct prominent ears. When I started to prepare him for surgery the following morning, I asked his mother what she had already told her son. She informed me that she had not told Russell much about the operation because she was not quite sure what was going to happen herself. It had been explained by the surgeon, but she did not understand what he meant and did not like to ask again because he seemed a very busy man!
I found some photographs of a previous child who had the same operation and spent time with both Russell and his mother explaining the whole procedure. Asked if there was anything that was worrying him, he said that he felt much better about it now, because his friend at school had told him that the doctors would cut off his ears and then sew them back properly!
Thankfully, I was able to reassure him as to exactly how the surgeons would correct his ears!
I keep play records and documentation of the work done with patients, and pass on relevant information and observations to the doctors and other colleagues at the weekly multi-disciplinary meeting we all attend, and on a day to day basis.
CASE STUDY 5
Danny a is 13 year old boy with a fractured femur, following a Road Traffic Accident. During his stay he became very withdrawn, not wanting to take part in activities.
Ward staff shared their concern about his regression with the Play Specialists, who were able to spend alot of time with Danny and discovered his main interest was football. His class teacher came to visit one day and we got into conversation and found out that Danny was the captain of the school junior team. The next morning was spent talking to Danny about his interest in football, and covering all his feelings about the accident. He became very upset and I realised that Danny's biggest fear was that he might never play football again.
I passed this observation on to the orthopaedic surgeons, who told me that, even though it was a bad break, Danny would be able to play football again. I asked them to talk to Danny. After their chat, Danny's mood improved considerably.
The Hospital Play Specialist is a very important link person, acting as the child's advocate, we have the time to listen and the skill to act.
Helen Withey, Play Specialist on Ifor ward. The Whittington Hospital, London June 2000