Compreendendo a sensibilização do enfermeiro para o uso do brinquedo terapêutico na prática assistencial à criança

Nurses' perspectives for the role of play with children in an onco-hematology department: A qualitative study

PURPOSE

to describe nurses' perceptions of using play in a pediatric onco-hematology setting.

DESIGN AND METHODS

A qualitative descriptive study was conducted in the pediatric onco-hematology department of a tertiary hospital in northern Italy. Eleven nurses working in the involved department were recruited via convenience sampling. Data were gathered through face-to-face interviews using a semi-structured guide. Data were analyzed using a descriptive qualitative approach.

RESULTS

Four major themes emerged from the analysis: 1) The different purposes in using play, 2) A matter of time, 3) Choosing the most suitable game, and 4) Sharing celebrative moments as moments of interprofessional development. Nurses described play as a means to build trust, relieve parents, serve as an educational tool, and address children's needs. Although nurses recognized the limited time available, they wanted to manage their workload to accommodate play. They emphasized the importance of choosing suitable games and using playful moments as opportunities for fun and professional growth.

CONCLUSIONS

Therapeutic play should be systematically integrated into pediatric oncology care as it fosters trust, provides joy and relief, and supports the child and their parents.

PRACTICE IMPLICATIONS

Play should be incorporated into routine practice, ensuring children can access peer interaction and age-appropriate games. A multidisciplinary approach, with the involvement of trained professionals, should be fostered to support play-based care in pediatric oncology settings.

Percepção da criança hospitalizada acerca do brinquedo terapêutico instrucional na terapia intravenosa

Resumo Objetivo analisar a percepção da criança hospitalizada quanto ao uso do brinquedo terapêutico instrucional no preparo para a terapia intravenosa. Método estudo descritivo, com abordagem qualitativa, realizado em um hospital pediátrico público no município de Juazeiro do Norte - Ceará, entre os meses de julho a setembro de 2019. Participaram do estudo 31 crianças em idade pré-escolar e escolar. Os dados foram coletados por meio de uma entrevista semiestruturada e, posteriormente, analisados por meio do software IRAMUTEQ. Resultados diante da percepção das crianças acerca da terapia intravenosa, foi averiguado que elas compreenderam a técnica a partir da utilização do brinquedo terapêutico instrucional. Quando a criança tem a oportunidade de brincar e dramatizar a terapia intravenosa, por meio do brinquedo terapêutico instrucional, a ansiedade, a dor, a angústia, a solidão, o medo e o choro são atenuados. Conclusões e implicações para a prática orientar as crianças quanto à realização da terapia intravenosa favorece sua compreensão quanto aos reais benefícios desta técnica para a sua saúde, possibilitando, ainda, a compreensão do enfermeiro quanto às condições que representam riscos para a criança e intervenha em tempo hábil por meio da utilização de estratégias que favoreçam a recuperação da saúde e a minimização de traumas subsequentes advindos da hospitalização.

Therapeutic play to teach children with type 1 diabetes insulin self-injection: A pilot trial in a developing country

PURPOSE

Child participation in type 1 diabetes (T1D) self-care is needed in developing countries due to a lack of resources, especially during the school day. This pilot study evaluated the feasibility of a therapeutic play intervention (ITP) versus standard education (SE) on the ability of children with T1D to correctly perform insulin injection technique.

DESIGN AND METHODS

Children with T1D (7-12 years) were recruited at two diabetes clinics in Brazil and randomized to ITP or SE. Registered nurses received protocol training to deliver the intervention and perform data collection. ITP group received an education that included a story about a child with T1D who self-injects insulin at school; SE group received routine clinic-based education. Preintervention, children were video-recorded giving insulin injections to a doll; postintervention, children were rerecorded giving the doll an injection. The research team reviewed the videos and assessed the injection technique using validated checklists. Parents reported children's self-injection practices at baseline and 30 days.

RESULTS

Children (N = 20, 40% male) were 9.6 ± 1.3 years old and had T1D for 3.6 ± 2.3 years; HbA1c was 9.1 ± 2.0%; 20% of ITP and 50% of SE children used syringes (vs. pens) for injections. At baseline, 80% of both groups knew how to self-inject; most were taught by a parent/relative. Injection technique scores were low in both groups; ITP group increased their scores significantly postintervention. Practices of self-injection did not change in either group after 30 days.

PRACTICE IMPLICATIONS

The play-based intervention appeared to improve the injection technique in the short-term. Pilot findings support the development of a larger trial to evaluate the effectiveness of ITP on educating children on insulin injections.

Play Effects on Hospitalized Children With Acute Respiratory Infection: An Experimental Design Study

Acute respiratory infection is a major health issue and a primary cause of morbidity and mortality among preschool-aged children worldwide. Disease and hospitalization are chief stressors for children during their development. Therapeutic play has been used in pediatric care processes and has been demonstrated to be effective by most studies that have targeted children undergoing surgeries or invasive medical treatments. Currently, few published studies have focused on children receiving acute inpatient care. Additionally, not all types of therapeutic play produce significant results, and few studies have elaborated on the purposes, principles, and concrete measures of therapeutic play. Therefore, this study aimed to design therapeutic play that would reduce the stress responses of preschool-aged children hospitalized with acute respiratory infection. An experimental design with a pretest/posttest was conducted with 105 preschool children recruited from a regional teaching hospital in southern Taiwan. The children in the experimental group received the therapeutic play, while those in the control group received routine nursing care. Children in the experimental group showed significantly greater reductions in their physiological, psychological, and behavioral stress responses than those in the control group. Future studies could apply therapeutic play to children from different age groups with diverse health issues before recommending it be used in pediatric health settings.

Play Therapy as an Intervention in Hospitalized Children: A Systematic Review

Background: Hospitalization disrupts children’s lives and can produce feelings such as anxiety, fear, or pain. Playing is an important part of children’s lives. Thus, it is necessary to ensure holistic care during the process, including play therapy. The aim of this study was to analyze the effect of therapeutic play in hospitalized children. Methods: A systematic review was performed. The search was conducted in CINAHL (Cumulative Index of Nursing and Allied Health Literature), CUIDEN, and PubMed (Medline). The search equation was “pediatric nurs* AND play therapy”. The search was performed in March 2020. Results: n = 14 studies were included in the review. The studies reveal that the application of therapeutic play in hospitalized children decreases postoperative pain, improves behavior and attitude, and reduces anxiety during the hospital stay. Conclusions: play therapy has a beneficial impact on the care of hospitalized children and should be implemented in pediatric units after assessing the resources and training needed for pediatric nurses.

Contribution of structured therapeutic play in a nursing care model for hospitalised children

Objective To analyse how therapeutic play structured in a nursing care model contributes to the care of hospitalised children. Method This is a qualitative study based on convergent care research (CCR). Seven children participated in the study. Data were collected in September and October of 2014 by means of interviews with open-end questions and participant observation of therapeutic and dramatic play sessions and/or instructional play sessions based on the stages "Welcoming/Playing/Concluding" of the nursing model Care with Play. Data were analysed according to the analysis and interpretation stages of the CCR. Results The following three categories emerged: Meanings attributed by the child to hospitalisation and its influence on nursing care; Perception of the therapeutic procedures through therapeutic play, and Importance of the family in care. Final considerations It is concluded that the application of therapeutic play structured in the care model contributes to systematic and specialised nursing care.

REVEALING THE WORLD OF ONCOLOGICAL TREATMENT THROUGH DRAMATIC THERAPEUTIC PLAY

ABSTRACT This study aimed to understand the play of the preschool child undergoing oncological treatment through dramatic therapeutic play. A total of five preschool age children with cancer participated in the dramatic therapeutic play sessions, between January and May 2013. The material was analyzed using the framework of phenomenology: analysis of the structure of the phenomenon in place. The following categories emerged from the sessions: Immersing oneself in the world of the disease and the oncological treatment; and Remembering the world without the disease. The study learned that becoming ill with cancer is a process which generates pain and suffering for the child, leading her to feel small and fragile in the face of the discomforts of the numerous procedures to which she is subjected. Therapeutic play was an important resource for revealing how the child with cancer feels during the treatment, and showed the children's difficulty in interacting with the unknown, and how this difficulty makes the balance between the points of health and illness complex.

Therapeutic play: preparing the child for the vaccine

OBJECTIVE

To identify and compare behaviors of children during vaccination, who were prepared or not for the procedure using an instructional therapeutic play.

METHODS

A quasi experimental study, with quantitative approach of 60 children aged 3 to 6 years. The child's reactions were recorded in a checklist. Data were analyzed using descriptive and inferential statistics and Fisher's test.

RESULTS

The main reactions in the experimental group were stay still (25;83%) and spontaneously collaborate (24;80%). In the control group, the main reactions were cries and cling to parents (15; 50%), flushing (11;36.67%) and moving the body/agitated (10;33.3%).

CONCLUSION

The reactions of cooperation were more frequent in the experimental group, while low acceptance was observed only in the control group. Therapeutic play has proved an important tool in preparing for the vaccine.

[Play as a care strategy for children with cancer]

OBJECTIVE

To understand the influence of play in the care process as perceived by children with cancer.

METHOD

A descriptive, exploratory and qualitative study conducted in a children's cancer unit in Natal, Rio Grande do Norte, Brazil. Data were collected between October 2013 and January 2014 by means of photographic records and semi-structured interviews with eight children, and content analysis with emphasis on two categories: Auxiliary instruments during play; and The influence of play in the process of care.

RESULTS

Recreational activities involve watching television, using computers, games and toys, drawing, the playroom and the clown, which provide fun, feelings of joy, distraction and interaction with other people.

CONCLUSION

There are several activities at the hospital that are considered play-related and, for the children, they all benefit their care process.