Beyond the Doll: Maximizing the effectiveness

of Medical Play in the Pre-Operative Area

Jessica Oviatt, MA, MEd CCLS

Introduction

• Outline

• CHOC Childrens− Two surgery areas

▪ Surgical Short Stay Unit

▪ Outpatient Pavilion

− Anywhere from 15-35 patients a day

− Policies▪ IV 8 years and above

▪ Mask induction 7 years and under

▪ All heart caths and GI procedures get IV’s before

▪ Limited parent presence in OR

Traditional Medical Play• Types

− Directed vs. Non-directed5

− Normative vs. Therapeutic

− Symbolic

− Familiarization vs. Dramatic4

• Uses− Normalization/Exploration

− Education/Preparation

− Information gathering

− Reinforcement/Introduction of ideas

Traditional Medical Play cont…• Influences on Medical Play

− Gender3

− Past experience/exposure3,4

− Developmental level

− Acuity4

• Research− Children have less anxiety2, less emotional distress1 and more

cooperation1,2 when given chances for medical play

Pre-Surgery Environment• Prioritization

− Age

− Anxiety level

− Past experience

− Pre-Medication

• Pace− How many people does the CLS see in pre-op area

− How early do they come

− What steps are required from of the patient and family

− How many patients are present

• Policies− Parental presence during induction, IV vs. mask induction, use of pre-

medication

Limitations of Medical Play in Pre-op

• Time

• Space

• Heightened anxiety

• Acuity

• Interruptions

• Medications

Modifying Medical Play• Ultimate goal: to incorporate the environmental factors and

medical play influences while balancing the medical play and the limitations associated with the pre-op area.

• Different play paradigms− Play as Flow6

− Play as Comfort6

• What to know…− Know the population

▪ Gender, age, developmental level

− Know the recovery▪ Bodily changes, bandages, procedures, pain, etc.

− Know the doctors

Accommodating Limitations• Environment

− Minimize distractions− Set up a medical play zone

• Plan ahead− Surgery schedule, nurse information− Common diagnosis bins

• Post-op medical play− Desensitization, normalization

• Other opportunities for play before day of surgery− Market child life in the surgery environment

Opportunities for Medical Play in Advance

• Tours− General vs. In-depth

• Surgery Preparation Clinics− Hello hospital, teddy bear clinics,

etc.

• Inpatient− Medical play while

preparing/educating

− Scheduled surgeries

Other Areas for Modified Medical Play

• Emergency Department

• Outpatient Clinics

• Orthopedic Clinic

Examples of Pre-Op Medical Play

• Surgery related:− Decorating face masks and hats

− Decorating anesthesia mask

− ID bracelet for stuffed animal/doll

− Getting to know me sheets

− Mask play

− IV play

− Surgery bag coloring sheet

− Body part coloring sheet

− Pre-op checklist

− Mask animals

− Appendix jar

Examples of Pre-Op Medical Play cont…

• Recovery related− Cast glove art

− Casting

− Decorating crutches, halo, etc.

− Tension ball

− Ph probe on a doll

− Dressing change play

− Recovery ladder

▪ Group idea sharing…..

• Hospital Environment related:− Medical coasters

− Band-aid art

− Collages

− Door hangers

− Hospital scrapbook

− Hospital Jewelry

− Mind in a bottle

Questions?

References

1. Chance, P. (1979) What is play? Learning Through Play. New York: Gardner Press, Inc.

2. Gaynard,L.; Wolfer, J.; Goldberger, J.; Thompson, R.; Reldburn, L. & Laidley, L. (1990) Psychosocial Care of Children in Hospitals: A Clinical Practice Manual. Rockville: Child Life Council, Inc.

3. Goleman, D. (1995) The Master Aptitude. Emotional Intelligence. New York: Bantam Books.

4. Lynch, M. (1994). Preparing Children for Day Surgery. Children’s Healthcare, 23(2), 75-85.

5. Mahajan, L., Wyllie, R., Steffen, R., Kay, M., Kitaoka, G., Dettorre, J., Sarigol, S., and McCue, K. (1998). The Effects of a Psychological Preparation Program on Anxiety in Children and Adolescents Undergoing Gastrointestinal Endoscopy. Journal of Pediatric Gastroenterology & Nutrition vol 27(2), 161-165.

6. Pass, M. & Bolig, R. (1993) A Comparison of Play Behaviors in two Child Life Program Variations. Children’s Healthcare, 22(1), 5-17.

7. McGrath, P. & Huff, N. (2001). “What is it?”: Findings on preschoolers’ responses to play with medical equipment. Child: Care, Health, and Development 27(5), 451- 462.

8. Jessee, P., Wilson, H., & Morgan, D. (2000). Medical Play for Young Children. Childhood Education 76(4), 215-218.

9. Jessee, P. & Gaynard, L. (2009). Paradigms of Play. The Handbook of Child Life: A Guide for Pediatric Psychosocial Care. Springfield, IL: Charles C Thomas Publishers, LTD.