A special kind of care is dispensed to children in hospital, as play specialists Kerrie Waby and Claire Hardy explain their work
Play is an important part of every child's life. Within a hospital setting it is also a vital part of a child's overall treatment and care.
When a child is admitted or visits a hospital as a patient, play is an essential communication tool to ensure they understand what is happening and to help them to express any worries or concerns.
The National Association of Hospital Play Staff states that play in hospital:
- Creates an environment where stress and anxiety are reduced
- Helps the child to cope with illness and hospital attendance
- Helps the child to regain confidence, independence and self-esteem
- Provides an outlet for feelings of anger and frustration
- Aids in assessment and diagnosis
- Speeds recovery and rehabilitation
- Encourages parents to be involved in their child's care.
Here at Nottingham City Hospital NHS Trust, the play staff team is led by one senior play specialist and six nursery nurses. We provide a service for up to ten hours a day, six days a week in a variety of settings. Our roles vary between wards and departments, as each area has a different speciality:
Millard ward
This is a general surgery and plastic surgery children's ward, specialising in cleft lip and palate repairs. The nursery nurse on the ward helps prepare the children and their families for procedures including various operations, dressing changes, removal of stitches, and rehabilitation after injuries and trauma.
The nursery nurse also attends the day surgery unit weekly to prepare children for minor surgery. This involves carrying out distractions while they are anaesthetised and ensuring they have no concerns once the procedure is complete.
'I find my job very rewarding and feel privileged to be in a position where I am part of a team that helps children and parents through a stressful time. It's great being able to put a smile on their faces,' says nursery nurse Sarah Kabon.
Lambley ward
The 11-bed children and young people's renal and urology unit is covered by the senior play specialist and a nursery nurse. They work together to provide a range of activities and support for everyone who attends the ward and haemodialysis unit.
Their role includes carrying out preparation, distraction and post-procedural play for patients (and their siblings) who attend the unit for painful and invasive procedures and treatments such as kidney biopsy, haemodialysis and peritoneal dialysis, kidney transplant, bladder pressure study, clean intermittent catheterisation, isotope injections, operations, blood taking and dressing changes.
The play specialists also visit patients at home, to ensure that preparation for forthcoming operations and procedures can be carried out in an atmosphere which is familiar and relaxing.
'The play specialists on the children's renal and urology ward have established how essential their role is in preparing all children for procedures - they are not just needed, they are essential,' says consultant paediatric nephrologist Dr Alan Watson.
Papplewick ward
The nursery nurse on this busy general medical ward works with children and young people admitted with conditions including asthma, diabetes and epilepsy. The hospital is also the regional centre for cystic fibrosis patients who are admitted for two weeks at a time for treatment.
'During this time relationships are built with children and their parents. I try to make their stay in hospital a positive experience,' says Becky Cooper. 'I provide play opportunities for children in the playroom and in their cubicles as some of the patients are unable to mix because of their illness.'
Linby ward
The children are usually transferred to this high dependency unit because they need one-to-one nursing care. Play is still a vital part of the children's day and they have personal developmental play programmes written by the nursery nurse.
Outpatients department
A nursery nurse also attends the children and young people's outpatients department, which is very different from the wards.
Each day there are a variety of clinics including cleft lip and palate, cystic fibrosis and renal.
Nursery nurse Sam Ward says, 'My role is to make clinic appointments fun. The waiting area has different activities set out each day so regular patients don't get bored. I also use distraction when anyone needs treatment such as immunisations and blood tests.'
Peripatetic
Finally, we have a peripatetic nursery nurse who steps into colleagues' shoes in any ward or department at a moment's notice. She covers sickness, annual leave or busy periods.
'On a daily basis I work alongside new people, so I have to learn every department's individual routine, ' says nursery nurse Michelle Needham.
Types of play
The routines of the play staff team may be different, but the main types of play we all carry out are the same:
Preparation play
The charity Action for Sick Children states, 'Play preparation offers the chance for all children to be included in decisions affecting their lives in an age appropriate way.'
It is used to prepare patients and family for a forthcoming procedure or treatment.
Tools used include:
- Photograph diaries showing children going through specific treatments and procedures
- Specialised dolls and teddy bears made to enable patients and staff to demonstrate procedures such as passing nasogastric tubes or taking blood tests
- Specially made storybooks explaining procedures and treatments in a story format
- Small-world toys, especially the hospital sets which are great for role play
- Videos that detail patients' personal experiences of treatments and procedures.
Just about anything can be used for preparation play, whether a child's favourite toy or engaging in a conversation which encourages them to express themselves. It is not so much about what you use but how you carry out such a session. Preparation play can take place in the hospital or the home, depending on the procedure and what the patient and their family feel most comfortable with.
Distraction play
This is a method used to distract a child from a painful or invasive procedure, such as blood taking. It encourages them to concentrate on something else and helps take their mind off the pain.
Tools used include:
- Bubbles which are inexpensive and enjoyed by all ages. We encourage children to blow the bubbles to help control their breathing. It is also fun and it is a good pain distraction for children to focus on popping the bubbles as they float towards them
- Noisy and multi-textured toys
- Computer games and interactive books are enjoyed by older children and young people
- Picture projectors and disco balls distract all ages, including parents!
- Relaxation techniques that we use include deep breathing exercises and listening to a range of music, such as nature sounds.
- Guided imagery is also an important tool where we encourage patients to use their imagination to concentrate their thoughts on a favourite person or item or a familiar place. With guidance and support the patient can evoke their senses and even smell things related to the place they are thinking about.
Some patients just enjoy listening to a story, singing, telling jokes or talking about their hobbies.
Post-procedural play
All patients are offered this in an indirect manner by simply giving them time to discuss what they have experienced and to answer any questions which may have arisen as a result of the treatment. Home visits are arranged for children who need a more in-depth discussion.
Developmental play
This encourages all patients to continue to develop skills during their stay. It also gives us the opportunity to do in-depth sessions with patients who need more encouragement to meet their developmental goals.
Working together
To carry out the role of the play specialist successfully, it is essential to work closely with other members of the multi-disciplinary team to meet the needs of patients and their families.
Above all, our aim is to have fun with the children and make their stay in hospital as relaxed and enjoyable as possible.
