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Children's fears and fantasies
- fear of punishment -90%
- fear of abandonment
- fear of physical limitations
- fear of death
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Reason for child life interventions
minimize stress and anxiety experienced by children to assure optimal growth and development
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History of CL
- as early as 1917
- Emma Plank and Mary Brooks during 50s and 60s
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Primary objectives of CL
- to help child cope with stress and anxiety of hospital experience
- promote child's normal growth and development while in health care setting and after returning home
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Helping to cope
- provide materials and guidance for play
- prepare children for hospitalization
- lending emotional support for siblings and family
- advocating child's point of view
- maintaining a receptive environment for children and their families
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Play is a mechanism in which children
- learn
- socialize
- express concerns
- test growing bodies
- cope
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Overt or active responses to hospital stimulation
- crying
- screaming
- whining
- clinging to parents
- resisting meds/treatment
- being self-destructive
- being destructive of environment
- fighting
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passive responses to hospital stimulation
- excessive sleeping
- decreased communication
- decreased activity
- decreased eating
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Regressive behavior to hospital stimulation
- alterations in sleeping patterns
- eating too much or too little
- being tense, anxious, restless
- manifesting fears
- being overly concerned with one's body
- displaying compulsive behavior
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Elements related to degree of psychological upset
- unfamiliarity of hospital setting
- separation from parents
- age
- pre-hospital personality
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Physical and procedural unfamiliarity
- physical: when they see all of the hospital things, machines, unfamiliar faces, etc
- procedural: vital signs, blood tests, dressing changes
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*****Three stages of children's response to separation***
Bowlby
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Protest
- Initial phase may last few hours-week or more
- overt/active behavior
- acute distress, crying, screaming, kicking
- suggests strong expectation that mother will return
- rejects all alternative figures, though some cling to nurses
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Despair
- if parents don't return during period of protest
- increasing hopelessness
- quiet and withdrawn, crying intermittently
- superficial calm
- presumed to be a decrease in stress
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Detachment
- appear to be making recovery
- become active and interested in surroundings
- problem noted at return of parents
- respond with indifference upon parents' return
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Three stage process helps explain
- upset of a previously calm child upon arrival of parents
- child's greater interest in presents and material goods than in the parents upon visitation
- "highly social" child who has suffered a prolonged separation
- reluctance of a child to leave hospital with parents upon discharge
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upset child
- visit of parents brings to surface feelings of intense grief/anger.
- protest is positive; child hasn't entered despair or detachment
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child's interest in material goods
- clue that he/she might be in the detachment stage
- when left without parents, children become self-centered and tend to develop some preoccupations
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"Highly social" child
- allows anyone in and out
- "socially superficial and promiscuous"
- may be in detachment phase
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Child reluctant to leave
- protests leaving hospital
- detachment
- comfort zone is the hospital
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Most susceptible to rigors of hospitalization
7 months-3-4 years
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Infants
older infants cry more, feeding issues, negative responses to observers
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Toddlers/preschoolers
- aware of separation, incapable of accepting explanations
- concept of time
- need for parents
- fantasies
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school-age
- better equipped
- develop relationships
- better able to test reality
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adolescents
- struggle for independence
- becoming dependent
- cut off from social activities
- how will it affect their appearance
- sexual identity
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Importance of parental involvement
- source of strength and familiarity in a strange
- environment
- can interpret new experiences to child
- defuse fantasies of abandonment
- provide info to staff of child’s likes/dislikes
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Sibling involvement
- Siblings are not immune to the difficulties
- experienced by parent and hospitalized child
- Siblings suffer pain of separation
- Endure increased parental irritability
- Temporary neglect of siblings
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sibling reactions: normal
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conspiracy of silence
no one is talking, it must be bad
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Information and support needed by all parents
- Less than peak of their capacities of understanding
- things
- Parents inability to voice complaints
- Afraid nurses will retaliate
- Parents need an ally among hospital staff who
- can provide info concerning available services and give emo support. (social worker)
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What causes most stress for families?
lack of information
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two mechanisms for providing info
- Pre-admission preparation booklet
- Pre-admission familiarization program or hospital
- tour
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Topics of pre-admission booklet
- What to tell their child
- What to wear, bring
- Whom to turn to (and when) for accurate info and
- support
- How to behave on the unit
- How to help one’s child (parenting plans)
- What are parents expect to do? What are they
- allowed to do?
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Child life's role of imparting info to parents
- Continually remind colleagues of parents’ need
- for open communication
- Concern expressed by parents can be reported to
- the appropriate parties
- When child life specialist senses a parent is
- reluctant to ask questions of people, offer support
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Guidelines to supportive listening
- Keep the focus of conversation on the parent
- Look directly at speaker
- Nod your head and give affirmative signals
- Don’t be afraid of silence
- Draw out the parent with questions. Ask open
- ended questions
- If you disagree with parent, avoid using
- questions that lead them to your way of thinking
- Restate what you have heard (perception check)
- Respond to feeling messages
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ultimate goal in involving parents
parent-child relationships
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Child life considerations regarding parents' roles
- Be aware of their discomfort and their
- insecurities as they attempt to become “parents in the hospital”
- Encourage family involvement in preparation or
- play sessions
- Avoid usurping parents’ role as a provider of
- play
- Teach parents new ways of playing with children
- –quadriplegic
- Serve as a role model for parents who may feel
- uncomfortable with play activities
- Teaching these skills will hopefully follow the
- family home from the hospital
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Play facilitates
- Child’s self-expression
- Provides mechanism for coping with difficulties
- Active participant (vs. passive one)
- Normal growth and development
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Characteristics of play
- Play is pleasurable
- Play has no extrinsic goals. Motivations are
- intrinsic and serve no other objectives
- Spontaneous and voluntary
- Involves some active engagement on part of the
- player
- Play has certain systematic relations to what is
- not play (things you gain…cognitive development, etc)
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Role of play in CL
- Play and physical development
- Play and intellectual development
- Play and social development
- Play and emotional development
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Play and physical development
- provides motivation necessary to exercise body
- and facilitate development
- child does not play in order to develop but
- rather for pure pleasure inherent in the play…just a bi-product
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Play and intellectual development
- Piaget states: children learn about the world
- around them through their own actions and explorations
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two process that take place in play
- Assimilation- taking in new information
- Accommodation- altering patters of thinking
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Piaget
- Sensorimotor stage
- Pre-operational
- Concrete-operational
- Formal-operational
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Sensorimotor
- Birth-2
- Children move from dominances of reflex
- mechanisms to deliberate manipulation of objects
- Object permanence is developed
- Connection between his or her actions and their
- effects on objects: cause and effect
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Pre operational
- 2-7
- has greater ability to hold and recall image of
- objects
- symbolization –dramatic play, etc
- egocentric
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Concrete-operational
- 7-12
- conservation
- increasingly able to think logically but only in
- the concrete realm
- better able to understand a thorough prep for
- surgery
- able to understand sequencing- large to small,
- etc
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formal operational
- 12- adulthood
- no longer rely on presence of physical objects
- to demonstrate logical though
- abstract thought
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CATEGORIES OF PLAY BEHAVIOR
- unoccupied
- onlooker
- solitary independent
- parallel
- associative
- cooperative or organized supplementary
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onlooker
- not actively involved, but watching more and
- focused on play activities of others. Remain close to a group
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solitary independent
- No effort to interact with others.
- Play alone
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parallel activity
- Play in same area with like materials, but with
- each using material in an independent manner.
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associative play
- Children interact with each other while engaged
- in common activity
- Play is not organized
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cooperative and organized
- Group goal is developed
- Usually directed by one or two of the players
- Characterized by differentiated roles
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Staff response to play
- Monitor regression
- Understanding fears and feelings
- Enhancing communication
- Education and preparation
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3 types of play beneficial to stress reduction
- recreational play
- therapeutic play
- play therapy
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Recreational play
- spontaneous, unstructured
- occurs naturally, its content and form are affected by developmental level of child
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Therapeutic play
- occurs when an adult structures activity for specific purpose
- CLS
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Play therapy
- interpreting child's play and recommending appropriate interventions
- skilled therapists use play to help children understand their own behavior and change those behaviors that are inapproproate
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Types of medical play
- role rehearsal/role reversal
- medical fantasy play
- indirect medical play
- medical art
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role rehearsal/role reversal
- real medical equipment or play equipment
- introduce child to equipment to create sense of safety
- encourage to play
- assess reactions or feelings
- ask open ended questions giving them control-master
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medical fantasy play
- no props of medical equipment is used
- need medical oriented theme
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indirect medical play
- more structure, more at risk to overwhelm the child
- dolls
- play function should be pleasurable and positive, not as structured
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medical art
use of medical supplies into art work
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