Play
Key concerns in planning a play space
-Key population characteristics
-Appraise anticipated limitations
-Expected medical equipment demands
-Desired Activities
-Necessary supervising and attending parent space
-Storage space
-Issues of safety
Space supervision plans
-Hours of operation
-Adequate proximity to medical staff/care areas
What is a memory symbol? Give 3 examples.
Representation of memorializing a person
Possible examples: Lighting candle, planting flowers, creating a quilt square-- on the anniversary days important to their loved one.
Views of hospitalized children in first half of 20th century and Beverly's work (1936)
-Children seen but not heard
-Limited parental visits, not allowed to stay
-Children often unaware that they were sick
-No family support
-Beverly researched children's responses to medical/hospital events, discovered lasting emotional trauma and adverse effects
7 steps in preparing and accompanying siblings for an ICU visit (may include demise)
1. gather information
2. prepare support persons and materials
3. offer choices
4. meet in quiet place to review, confirm desire to visit, assess understanding
5. structure actual visit
6. follow-up contact
7. providing support if death occurs
An absence of a clearly-defined course of action.
Deficits and gaps in children's healthcare play?
1. drop in numbers of students/professionals conducting healthcare play research
2. lack in consistent definitions, types, and subtypes of the field of child play and relevant processes/roles/activities
3. predisposition to use play as mediating variable in research designs
4. virtual dearth of studies exploring post-treatment and/or post-discharge adjustment
5. predisposition to study outpatient settings
6. lack in children's play in long-term in care/home care settings
7. lack in studies related to parental presence related to play patterns
Piaget's sensorimotor stage: understanding of death
(0 to 2 years) infants explore the world via senses and perceive relationships via attachment-based "here or not here" constructs
Describe the care of hospitalized children currently (21st century)
-Progress in medical technology
-Outpatient services valued
-Home care is utilized often
-Child life used in a range of settings
Sibling reactions to hospitalization of child as arising from the nature of their own relationship with the child (Close relationships/age)
-Typically experience greatest level of stress, especially if room space or activities are often shared
Goal of ethics in child life
To engage in a process of thinking about what "should" occur when faced with difficult situation, with support from appropriate and necessarily rigorous pondering, consideration, and discussion before decisions are made.
Theoretical orientations to the role of purpose and play: Classical theory
Children's play renews energies, revitalizes, and is a means of rehearing for adulthood
Piaget pre-operational: understanding of death
(2 to 6 years) children now gain language skills but remain incapable of logical reasoning, leaving persistent egocentric beliefs of death as temporary and reversible
Current average pediatric hospital stay
3.5 days
Younger sibling reactions to hospitalization of child as arising from the nature of their own relationship with the child (ill older sibling)
-Patient who babysits or supports younger sibling, hospitalization may make sibling feel unloved, unimportant, or punished
-Resulting in separation anxiety
3 reasons for the increased need for ethical awareness
1. advances in medicine
2. existing laws, policies, and protocols requiring appropriate address
3. ever-expanding court rulings and new legislation
Theoretical orientations to the role of purpose and play: Competence Motivation Theory
Acting upon their environment through play enable children to develop competency, to enhance feelings of efficacy and control, and thereby enables them to derive personal satisfaction regardless of other rewards.
Piaget concrete operational: understanding of death
(6 to 12 years) logic begins to emerge along with learning by observation, predisposing a greater understanding of death
Primary goals in ACLP mission statement
Reduction of distress and trauma arising from difficult life events that may otherwise hinder or prevent normal development, health and wellbeing by use of play (seen as a healing modality), pursued through assessment, intervention, prevention, advocacy, and education
Examples of ways to minimize sibling stress that arises from the hospitalization of an ill child
-given opportunity to talk, share gears, and receive reassurances
-address misconceptions
Describe an ethics committee model for deliberation and response (4)
1. establish a mutually acceptable meeting time and place
2. identify the primary issue
3. address major conflicts
4. conclude with consensus building
Theoretical orientations to the role of purpose and play: Arousal-Seeking Theory
Posits that children are innately driven toward information seeking, environmental stirrumation, and arousal, and play is the mechanism by which levels of stimulation can be mediated and moderated to an optimum level.
Children's play is seen as a source of progress, adaptation, power, imagination growth, and physical, emotional, and social development as well as optimizing personal learning
(12 to 18 years) abstract thinking emerges, with adult understandings and beliefs about death
Child life organizations throughout the years and their name changes
Association for the Well-Being of Hospitalized Children and their Families (1965)
Association for the Care of Children in Hospitals (1967)
Child Life Council (1982)
Association of Child Life Professionals (2016)
Issues related to sibling grief related to cause and timing of death
Resentment, guilt, fear of contracting illness, impact of NASH
N-Natural
A-Accidental
S-Suicide
H-Homocide
Purpose of a hospital ethics committee
Provide a standing forum in which to address ethical issues and reduce conflicts