Child: care, health and development 1975, i , 233-237
The hospital play therapist
MARY DIGBY Play Therapist, Moorfields Eye Hospital, City Road, London E2 Accepted for publication 16 May 1975
The Save The Children Fund provides qualified hospital playleaders tointerest and occupy children of all ages in the wards, and to try to help the medical and nursing staff to support the children through ordeals they must inevitably undergo while they are in hospital. This work is entirely centred on the children; their needs and their activities. They are the only people who are not called away from the children to perform other duties. The playleaders can only make a full contribution to the welfare of the children if they know a few simple facts about their illnesses and any imusual circumstances in their home backgrounds. They are prepared to report observations on the behaviour and development of the patients if this should be required of them. They are responsible for their own equipment, which they maintain, renew, distribute and clear away. They clean up after each play session. Adequate storage space must be provided by the hospital. Many of the playleaders are qualified nursery nurses, teachers or those who have studied child care and child development. They are all carefully selected for this work. All groups are under the supervision of a qualified teacher and are visited regularly. The playleader's main concern is the emotional welfare of all children on her ward; this includes infants and teenagers. In all of the following responsibilities she attempts to maintain the child's contact with home and family and to help ease the adjustment to a strange and sometimes frightening environment. As a member of the permanent ward staff, she works vmder the guidance of the ward sister. As an employee of Save The Children Fund she is responsible to the play adviser who visits regularly. GENERAL RESPONSIBILITIES
These include: I Provision of play and activities on the ward and in the playroom. She 233
234
Mary Digby
creates a comfortable and stimulating environment for all children, in the playroom, on the ward and in the cubicles. She may take the children on visits to local shops, museums and parks. 2 Selection and care of play equipment. Each playleader receives on arrival an allowance which she spends on equipment as she wishes, sometimes consulting her play adviser. She is responsible for her own locked cupboards, leaving certain toys to be available when she is not there. J Forming a helpful relationship with parents and supplementing the mother's care: a She encourages parents to participate in play and to take part in the normal routine in caring for their child. b She provides a 'listening ear' for anxious mothers and gives support to parents in distress. c She helps the nursing staff to explain ward routine to new mothers. d She suggests ideas for home play, emphasizing the hopeful side of growth and development in even the very sick child. 4
She may request that the family be referred to the social worker.
5 She supports medical treatment and the medical/nursing staff: a She may be asked to make observations on the children's behaviour for the medical staff. b She may explain reasons for treatment or the nature of the illness on a level that the child can imderstand. c She may encourage dramatic play, sometimes with the hospital equipment to help children overcome feelings of fear and anger. (In both b and c the playleader is in close consultation with the ward sister.) d She may be asked to hold a child for painful treatment or escort him to another department. e She encourages nursing staff and students to participate in play. She sometimes gives talks about her work to nurses and medical students. Playleaders should attend ward reports. They attend by invitation a monthly seminar in the evening given by a paediatrician for all Save The Children Fund hospital playleaders. They are encouraged to attend relevant conferences and to visit other children's wards and hospitals.
The hospital play therapist
235
They work usually from 9 a.m. to 4 p.m. with four weeks holiday in addition to bank holidays. Playleaders wear their own clothes and a name tag.
PERSONAL EXPERIENCE
With eighteen years of experience of working with mothers and children I found myself in an entirely new. situation: now I was a 'playlady' on a ward for children, all with eye problems. Children who could see, others with impaired vision and others who could not see. The first few weeks were very painful; there was so much—too much—to learn, and it was a long time before I began to feel confident to deal with the task before me. Young and sick children are emotionally dependent on adults, they need love and affection, sympathy and understanding, someone who will play and devote time in talking to them. At least I could offer those needs and my first piece of play equipment became my lap. At a specialist hospital such as Moorfields, children come from far and wide; very few come from the local area. I remember being as shocked to find parents travelling sometimes as often as six times a year and even more from all over the British Isles, as I was amazed to find children from all parts of the world. Where one could not communicate verbally with the children, it was the lap and the smile that was the beginning of a play situation. I had to train myself to remember each child's name, to remember him on readmission and to retain the knowledge of what he enjoyed and to ask about brothers and sisters, pets and friends. After six years this comes qviite naturally and no longer is the effort as great. Gradually I began to acquire the play equipment. A painting easel, plenty of paper and paints as well as pencils, crayons and felt pens all proved to be popular. We are never short of artists and our playroom walls are filled with colour, their presentation never failing to attract the newcomers to the ward. The 'home corner' is constantly in use. Those cups, saucers and saucepans are often played with by the older children. A 12-year-old boy quite recently was viewed very critically by his two friends, 'look at him, Mary playing with girls' things'. When I told them it was a boy's 'special', they joined in and all three played together in a 'bachelor fiat'. We have basically a simple toy cupboard, all the toys are used and enjoyed. The games are simple and thanks to my two volunteers, we have 'grown-up' participation and supervision four times a week. The favourites are bagatelle, speed, snap, ludo, snakes and ladders, snail game, frustration and simple
236
Mary Digby
card games. New admissions join in and almost immediately become involved —somehow we never have problems of 'odd man out', or teasing, bullying or fighting. Most of the children are short-term admissions, so ±ey really do not have time to become irritated with each other. As a playleader I study each child as a unit in a family group, not just the condition of the child's eye problem and the reason for the child having to be admitted into hospital. It must always be remembered that children in hospital are ill and accordingly need special thought and care. The bodily needs and bonds of mother md child are so strong that a mother substitute caimot replace the emotional dependence affected by separation. Therefore it is important that as much observation as possible is made of each mother and child before the mother leaves. We have many regular admissions on our wards and it becomes less difficult to relate with these mothers. The playlady therefore must have knowledge of child development and must ask 'Who is this child ? What stage of development has he reached before and after admission ? How does he react ? What are his relationships with parents, staff, and other children ? What is his attitude to himself and his own body ? How does he react to circumstances ?' Only with this knowledge can one assess a child and learn from his play how he is feeling and reacting. It should be possible for all medical staff to observe the child as a whole, his play, drawing, painting, conversations, general activities, reactions, acceptances, rejections, adjustments to being ill and the necessity of being away from parents and home whilst brothers and sisters remain at home and often are not allowed to visit. I feel responsible for creating a play situation, making it possible for all staff to participate in their patients' interests. Painting and drawing helps the hospitalized child to express himself, to improve muscle control, stimulate his hand-eye coordination and help gain his independence, after a long period of illness or following surgery, and this activity provides a way of making observations of the child in general, and especially his eyes. Certain precautions need to be taken in the play setting: there are more dangers when the age range is so varied. Scissors for example must be supervised. The same applies to water play. There is the danger of drinking the water prior to premedication and in spilling and slipping. Extra precautions are especially necessary when dealing in a play situation where all the children have some visual problem, either slight or severe and with such a mixed age group. Children who are blind and partially sighted spend a great deal of time in hospital. Treatment, checks and surgery bring these children back to Moorfields many times throughout their childhood. As the playleader, I offer
The hospital play therapist
237
companionship and continuing friendship to these children and their families. Adults are bewildered and lost in more than one way when entering hospital; for children there are far more handicaps and disadvantages. Often the children are handicapped by partial or total loss of vision and of their independence. It is far from a normal situation to meet children in hospital, and in many cases they suffer from a loss of identity. Frightened of so many things, apart from the anticipation of surgery, treatment, medicines, injections, temperature-taking and being cared for by strangers who wear uniforms, they are apprehensive of 'doctors and nurses', strange beds, strange food, often served in far too large portions, strange bathrooms and a bath-time that has no relationship with bath-time at home, the strangeness of different lavatories and pot-routine. Often it is necessary to accompany children to the lavatory; they find going alone a frightening and bewildering experience and they may well need help with-their clothing. When questions are asked they must always be answered truthfully; questions asked about treatment and progress should be answered by nursing staff, ideally discussed with the consultant and registrar. Children need to be told about operations; an operation, however small, is a serious thing. Comforting, loving words and imderstanding are needed. 'Grown-ups' are the buffer during the period when a child is in a confused state of mind as to what is wrong and as to what is happening to his eye. We who work with children in hospital must never forget to be constantly alert to emotional distress that children suffer.
The hospital play therapist
MARY DIGBY Play Therapist, Moorfields Eye Hospital, City Road, London E2 Accepted for publication 16 May 1975
The Save The Children Fund provides qualified hospital playleaders tointerest and occupy children of all ages in the wards, and to try to help the medical and nursing staff to support the children through ordeals they must inevitably undergo while they are in hospital. This work is entirely centred on the children; their needs and their activities. They are the only people who are not called away from the children to perform other duties. The playleaders can only make a full contribution to the welfare of the children if they know a few simple facts about their illnesses and any imusual circumstances in their home backgrounds. They are prepared to report observations on the behaviour and development of the patients if this should be required of them. They are responsible for their own equipment, which they maintain, renew, distribute and clear away. They clean up after each play session. Adequate storage space must be provided by the hospital. Many of the playleaders are qualified nursery nurses, teachers or those who have studied child care and child development. They are all carefully selected for this work. All groups are under the supervision of a qualified teacher and are visited regularly. The playleader's main concern is the emotional welfare of all children on her ward; this includes infants and teenagers. In all of the following responsibilities she attempts to maintain the child's contact with home and family and to help ease the adjustment to a strange and sometimes frightening environment. As a member of the permanent ward staff, she works vmder the guidance of the ward sister. As an employee of Save The Children Fund she is responsible to the play adviser who visits regularly. GENERAL RESPONSIBILITIES
These include: I Provision of play and activities on the ward and in the playroom. She 233
234
Mary Digby
creates a comfortable and stimulating environment for all children, in the playroom, on the ward and in the cubicles. She may take the children on visits to local shops, museums and parks. 2 Selection and care of play equipment. Each playleader receives on arrival an allowance which she spends on equipment as she wishes, sometimes consulting her play adviser. She is responsible for her own locked cupboards, leaving certain toys to be available when she is not there. J Forming a helpful relationship with parents and supplementing the mother's care: a She encourages parents to participate in play and to take part in the normal routine in caring for their child. b She provides a 'listening ear' for anxious mothers and gives support to parents in distress. c She helps the nursing staff to explain ward routine to new mothers. d She suggests ideas for home play, emphasizing the hopeful side of growth and development in even the very sick child. 4
She may request that the family be referred to the social worker.
5 She supports medical treatment and the medical/nursing staff: a She may be asked to make observations on the children's behaviour for the medical staff. b She may explain reasons for treatment or the nature of the illness on a level that the child can imderstand. c She may encourage dramatic play, sometimes with the hospital equipment to help children overcome feelings of fear and anger. (In both b and c the playleader is in close consultation with the ward sister.) d She may be asked to hold a child for painful treatment or escort him to another department. e She encourages nursing staff and students to participate in play. She sometimes gives talks about her work to nurses and medical students. Playleaders should attend ward reports. They attend by invitation a monthly seminar in the evening given by a paediatrician for all Save The Children Fund hospital playleaders. They are encouraged to attend relevant conferences and to visit other children's wards and hospitals.
The hospital play therapist
235
They work usually from 9 a.m. to 4 p.m. with four weeks holiday in addition to bank holidays. Playleaders wear their own clothes and a name tag.
PERSONAL EXPERIENCE
With eighteen years of experience of working with mothers and children I found myself in an entirely new. situation: now I was a 'playlady' on a ward for children, all with eye problems. Children who could see, others with impaired vision and others who could not see. The first few weeks were very painful; there was so much—too much—to learn, and it was a long time before I began to feel confident to deal with the task before me. Young and sick children are emotionally dependent on adults, they need love and affection, sympathy and understanding, someone who will play and devote time in talking to them. At least I could offer those needs and my first piece of play equipment became my lap. At a specialist hospital such as Moorfields, children come from far and wide; very few come from the local area. I remember being as shocked to find parents travelling sometimes as often as six times a year and even more from all over the British Isles, as I was amazed to find children from all parts of the world. Where one could not communicate verbally with the children, it was the lap and the smile that was the beginning of a play situation. I had to train myself to remember each child's name, to remember him on readmission and to retain the knowledge of what he enjoyed and to ask about brothers and sisters, pets and friends. After six years this comes qviite naturally and no longer is the effort as great. Gradually I began to acquire the play equipment. A painting easel, plenty of paper and paints as well as pencils, crayons and felt pens all proved to be popular. We are never short of artists and our playroom walls are filled with colour, their presentation never failing to attract the newcomers to the ward. The 'home corner' is constantly in use. Those cups, saucers and saucepans are often played with by the older children. A 12-year-old boy quite recently was viewed very critically by his two friends, 'look at him, Mary playing with girls' things'. When I told them it was a boy's 'special', they joined in and all three played together in a 'bachelor fiat'. We have basically a simple toy cupboard, all the toys are used and enjoyed. The games are simple and thanks to my two volunteers, we have 'grown-up' participation and supervision four times a week. The favourites are bagatelle, speed, snap, ludo, snakes and ladders, snail game, frustration and simple
236
Mary Digby
card games. New admissions join in and almost immediately become involved —somehow we never have problems of 'odd man out', or teasing, bullying or fighting. Most of the children are short-term admissions, so ±ey really do not have time to become irritated with each other. As a playleader I study each child as a unit in a family group, not just the condition of the child's eye problem and the reason for the child having to be admitted into hospital. It must always be remembered that children in hospital are ill and accordingly need special thought and care. The bodily needs and bonds of mother md child are so strong that a mother substitute caimot replace the emotional dependence affected by separation. Therefore it is important that as much observation as possible is made of each mother and child before the mother leaves. We have many regular admissions on our wards and it becomes less difficult to relate with these mothers. The playlady therefore must have knowledge of child development and must ask 'Who is this child ? What stage of development has he reached before and after admission ? How does he react ? What are his relationships with parents, staff, and other children ? What is his attitude to himself and his own body ? How does he react to circumstances ?' Only with this knowledge can one assess a child and learn from his play how he is feeling and reacting. It should be possible for all medical staff to observe the child as a whole, his play, drawing, painting, conversations, general activities, reactions, acceptances, rejections, adjustments to being ill and the necessity of being away from parents and home whilst brothers and sisters remain at home and often are not allowed to visit. I feel responsible for creating a play situation, making it possible for all staff to participate in their patients' interests. Painting and drawing helps the hospitalized child to express himself, to improve muscle control, stimulate his hand-eye coordination and help gain his independence, after a long period of illness or following surgery, and this activity provides a way of making observations of the child in general, and especially his eyes. Certain precautions need to be taken in the play setting: there are more dangers when the age range is so varied. Scissors for example must be supervised. The same applies to water play. There is the danger of drinking the water prior to premedication and in spilling and slipping. Extra precautions are especially necessary when dealing in a play situation where all the children have some visual problem, either slight or severe and with such a mixed age group. Children who are blind and partially sighted spend a great deal of time in hospital. Treatment, checks and surgery bring these children back to Moorfields many times throughout their childhood. As the playleader, I offer
The hospital play therapist
237
companionship and continuing friendship to these children and their families. Adults are bewildered and lost in more than one way when entering hospital; for children there are far more handicaps and disadvantages. Often the children are handicapped by partial or total loss of vision and of their independence. It is far from a normal situation to meet children in hospital, and in many cases they suffer from a loss of identity. Frightened of so many things, apart from the anticipation of surgery, treatment, medicines, injections, temperature-taking and being cared for by strangers who wear uniforms, they are apprehensive of 'doctors and nurses', strange beds, strange food, often served in far too large portions, strange bathrooms and a bath-time that has no relationship with bath-time at home, the strangeness of different lavatories and pot-routine. Often it is necessary to accompany children to the lavatory; they find going alone a frightening and bewildering experience and they may well need help with-their clothing. When questions are asked they must always be answered truthfully; questions asked about treatment and progress should be answered by nursing staff, ideally discussed with the consultant and registrar. Children need to be told about operations; an operation, however small, is a serious thing. Comforting, loving words and imderstanding are needed. 'Grown-ups' are the buffer during the period when a child is in a confused state of mind as to what is wrong and as to what is happening to his eye. We who work with children in hospital must never forget to be constantly alert to emotional distress that children suffer.
