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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.
THANK YOU