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PLAY

THERAPEUTIC PLAY:

Therapeutic play is the specialised play activities by which a child acts out or expresses his unconscious feelings. It is a central mechanism in which children cope, communicate, learn & master a traumatic experience such as hospitalisation.

IMPORTANCE OF PLAY:

CHILD: Enhance coping abilities Express fear, anxiety, tension, anger,

fantasies. Understand hospital procedures. Communicate & reduce emotional

trauma. Continue growth & development. Get rid of boredom.

IMPORTANCE OF PLAY:

Health team members: Gain co-operation & trust of the child. Diagnose child’s feelings & behaviour. Find out & correct misconceptions &

beliefs Reassure the parent Promote parent participation in child care

FUNCTIONS 0F PLAY: Provides diversion Brings about relaxation Helps feel secure Lessen stress of separation & home sickness Release tension, expression of feelings Encourages interaction Develop positive attitudes towards others Outlet for creative ideas or interests Opportunity for choices & be in control Accomplish therapeutic goals.

TYPES OF PLAYS:

Emotional outlet/dramatic play: Used to express child’s anxiety Solve conflicts Diagnostic tool

Instructional play: Instruction is given for therapeutic play

according to their past experiences, coping abilities & physiological status

Physiological enhancing play: Used to improve & maintain physical

health & body functions Selected to treat pathological condition

SOCIAL PLAYS:

1. Onlooker play: Watch other children play No interest in participation

2. Solitary play: Play alone with different toys used by

other children Enjoys others presence but no effort to

speak or get close

3. Parallel play: Children play independently with toys

as that of other children No group association Characteristic play of toddlers

4. Associative play: Play together & engaged in similar

activities Never directs others action or

establishes rules No group goal, one child initiates an

activity & others follow

5. Co-operative play: Organised & they play in groups Set goals & try to attain it Organisation of activities, division of

labour & playing roles Leader follower relationship is

established

PLAY THERAPY:

Non-directive play therapy: Client centred or unstructured play

therapy If allowed to play freely, children

resolve their own problem & work towards their own solution

Few boundaries & can be used at any age

Directive play therapy: Directions given for play Causes faster change & more

structured than non-directive play Games chosen by the child, therapists

give directions

CATEGORIES OF PLAY:

Physical play: Social in nature- involves other children Provides exercise, which is essential for

normal development Eg. Run, jump etc.

Expressive play: Gives opportunity to express feelings Parents take an active role Eg. Play using coloured pencils,

crayons, markers, water colours etc..

Manipulative play: Children control or master their

environment Starts in infancy Move objects like puzzle pieces to

understand it better Eg: Drops a toy, Wait for the parent to

pick it, clean it & return it, & they drop it again.

Symbolic play: Helps explain child’s problem in a

symbolic way No rules, can use to reinforce, learn

about, & imaginatively alter painful experiences

Dramatic play: Child act out situations experienced by

them Either spontaneous, guided or

therapeutic

Surrogate play: For children who are severely ill Parent/another child is a surrogate Watching the surrogate play, stimulates

the sick child

COMMON PROBLEMS:

Challenge, as child cant voluntarily engage

Parents need to understand the importance

Play activities vary depending on cultural & socio-economic circumstances

Not knowing the group languages

SAFETY ISSUES:

Should be washable Should have no sharp edges & no small

parts Tossing ball to a child with cast

fall Chasing ball falls, collisions If toy is used for a long time, can use it

in unsafe way

NURSES RESPONSIBILITIES:

Organise play activities Flexibility in play time Play materials should b placed in separate room Age appropriate play articles should be provided Involve all members for play Interact during play Observe & record child’s behaviour Protect & guide children when aggressive Participate with the children during play Teach the importance of play

NURSING CARE & FAMILY PRINCIPLES & PRACTICES:

PREVENTING OR MINIMIZING SEPARATION

Primary goal Welcome the presence of parents Family centred care Provide support- both parents & child Frequent parental visits Leave a favourite article, if the parents

can’t room-in

MINIMIZING LOSS OF CONTROL:

Promoting freedom of movements Place child on parent’s lap during

procedures Mechanical freedom can be provided Maintain child’s routines Encouraging independence Concept of self care Promote understanding Inform children about their rights

PREVENTING OR MINIMIZING FEAR OF BODILY INJURY:

Preparation of children for painful procedures

Manipulating procedural techniques Stress the reason for a procedure &

evaluate child’s understanding Employ pain reduction techniques

STRATEGIES TO COPING & NORMAL DEVELOPMENT:

Focus on physiological, psychosocial & developmental needs

Promote effective coping Provide developmentally appropriate

activities like rooming in, therapeutic play & therapeutic recreation & child life programs

CHILD LIFE PROGRAMS:

Focuses on psychosocial needs of hospitalised child

Professional child specialist, Para professionals & volunteers –staff

Plan age appropriate play Assist children in working through feeling

about illness Eg. Playing with medical equipment Child specialist & nurses together assist

children in their needs

ROOMING IN:

Have a parent stay in child’s hospital room

Parent should assist in child care Communication between nurse &

parent, so that parent’s desire for involvement is supported

THERAPEUTIC PLAY:

Helps reduce stress Means to learn about health care,

express anxieties, achieve mastery over control & frightening

Helps assess child’s knowledge of his/her illness

THERAPEUTIC RECREATION:

Planned recreation program for adolescents to meet development needs during hospitalisation

Telephone contact & visits from friends Interaction with the teenagers Physical activities that provide an outlet for stress

recommended Assist to regain control Giving options & letting to choose promotes feeling of

independence Acutely ill child may enjoy listening to stories Children must be taught to take care of their toys Nurse should participate in play activities

REFERENCES:

1. Marlow R Dorothy, Redding A Barbara. Textbook of Paediatric Nursing. 6st ed.

2. Datta Parul. Paediatric Nursing. 2nd ed.3. Gupta Piyush. Essential Paediatric

Nursing. 2nd ed.4. Terri Kyle. Essentials of Paediatric

Nursing.1st ed.5. Tom Lissauer, Graham Clayden.

Illustrated Textbook of Paediatric. 3rd ed

JOURNALS:

Hirani Shela Akbar Ali. International Journal Of Nursing Care. Vol1, Issue1. Apl3, 2013. Use of play therapy in educating asthmatic & diabetic pediatric patients

Sylvia Cassel. Journal of Paediatrics. Vol71, Issue2. The role of puppet therapy on the emotional responses of children hospitalised for cardiac catherisation

RESEARCH STUDIES

The role of puppet therapy on the emotional responses of children hospitalized for cardiac catheterization

Use of play therapy in educating asthmatic & diabetic pediatric patients.

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