Analysis Of Pediatrics Play Project

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The patient is a four year old male. Expected physical milestones at this age including being toilet trained, being able hop on one foot, and the ability to draw various shapes include diamonds, squares, and crosses(Wong, 2015). The child's actual behaviors meet expected behaviors as this child is toilet trained, can hop on one foot, although there is some weakness in the right lower extremity, and has the ability to draw various shapes. According to Piaget, a four year old child should have a clearer understanding of time, be less egocentric, and have the ability to count without understanding of the value of numbers(Wong, 2015). This child is able to understand time, as evidenced by the child verbalizing that he has been in the hospital for two days. The child does demonstrate a lessening amount of egocentrism, which is evidenced by the child allowing his father to play with one of his toys instead of keeping it for himself. The child is able to count objects that are on the screen in his video game, but does not understand if it is a large number or small number.

According to Erikson, a four year old likes to learn new things, focuses more on do’s and don’ts, and becomes more independent in activities(Wong, 2015). This child demonstrates enjoyment of learning new things when his Dad teaches him to use the new toy he brought for him and how to use it. Once he learned how to use the toy, he was very eager to use it on his own, which meets the milestone of independence. He also listens when his parents tell him what or what not to do, such as when he is told not to make loud noises, or when he is told to sit in his bed.

In terms of social development, at four years of age a child is expected to use associative play, be selfish, and like showing off(Wong, 2015). The child does use associative play, demonstrated by him playing with his toys with his father and the student nurse and sharing toys with them as well. He can be selfish which was shown when his mother offered candy to others and the child responded by saying that the candy belonged to him and that he did not want to share. The child was showing off by making loud noises with his toy in order to draw attention to himself.

Impact of hospitalization: The hospitalization has disrupted the family in that the mother has been spending the night at the hospital with the boy instead of at home with her husband. The husband has been coming from work to visit the child but has not been staying at night in the hospital. The child and mother have been away from the home and the husband has been staying at the home, which has put affected the time the mother, husband, and child spend together. Spiritually, this experience has caused the family to spend more time praying for the child, however it has put some strain on their faith as they question why this is happening to their child.

Current health status and reason for admission: Gait changes, right leg weakness. Past medical history includes asthma, vaccinations on 10/7, and recent travel to Lebanon. Assessment findings include decreased muscle strength in the right lower extremity and weakness upon ambulation. A lumbar puncture on 10/10 showed signs of suspected Acute disseminated encephalomyelitis. Acute disseminated encephalomyelitis is an autoimmune condition that leads to inflammation of the spinal cord and brain that often occurs after an infection. This condition leads to symptoms of weakness and gait changes due to inflammation and destruction of the coating of nerve fibers in the spinal cord(Cleveland Clinic, 2014). Labs included a calcium level of 9. 5, potassium of 4. 5, and WBC of 15,000.

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The illness has affected the ability to ambulate to some degree due to weakness in the right lower extremity. The hospitalization and illness has disrupted the child's routine and affected the childs socialization by separating the child from home and school where the child gets interaction with other children. The child has missed out on usual play opportunities with other children, which is important at this age because the child is now practicing associative play, which requires other playmates. Play is also important for physical growth at this age, examples being riding bikes, running, and playing sports, which the child cannot do while in the hospital setting. The childs routine is also interrupted and affected by common hospital disturbances such as procedures, medication administration, and assessments, which affects normal sleep patterns. The weakness and gait changes that come along with this illness have affected this childs activity and ambulation abilities. The child has also displayed signs of regression particularly with bed wetting. Expected reaction to hospitalization at age four includes regression to behavior from an earlier age, refusing to eat or eating less, and trouble sleeping(Wong, 2015). The patient did display regression on the first day of hospitalization by wetting the bed. The patient has been eating less than usual according to the patients mother, but the patient has not displayed trouble sleeping or refusal to sleep.

Parental and nurse interactions with patient: The mother of the patient was seen holding the child in her lap and tickling the child. The father of the child spent a lot of time playing games with the child, such as video games on his iPad and games with his toy remote control truck. The mother and father both told jokes to the child and also verbally explained to the child what he would have to do when he was given medication or had to be physically assessed, and the parents also explained to the child that he had to sit still and be quiet when vital signs were being taken. Both parents were very attentive to the child's needs and frequently asked the child about the need for food, water, or toileting. The father was more hands off in caring for the child, and the mother was more hands on and physically affectionate seen by her picking up the child and holding him and kissing him, which made the child smile and laugh. The father was less physically affectionate compared to the mother, he did not pick up or kiss the child, but he did spend a lot of time playing games with the child, which the child enjoyed as evidenced by the child smiling and laughing along with his Dad.

The patient was very talkative and initiated many conversations with the nurse about games, eating, toys, and questions about different equipment that was used on him, such as the blood pressure cuff, and what the purpose of the equipment was. The nurse explained to the child how various equipment worked in a way the child understood. Nurse interactions with the child included explaining procedures to the child in a way that he could understand, such as letting him see and play with the stethoscope or blood pressure cuff before it was used on him, and letting the patient use the stethoscope on the nurse to familiarize the patient and decrease anxiety. The nurse had conversations with the child about the games that he was playing on his ipad by asking him questions about the game, and he would use his iPad to show the nurse how the game worked. The nurse also asked the patient questions about his toy truck, and the patient demonstrated to the nurse how to play with it. The nurse asked the patient questions about what he had to eat, how he was feeling, and the patient was very willing to answer questions and talk with the nurse about what he had to eat that day and how he was feeling. Nonverbal interactions of the nurse included smiling at the patient, tickling the patient, and playing with toys with the patient and watching the child play his game on his Ipad.

Theory of Play: There are three various types of play that are commonly used for hospitalized children. One of the types that has been shown to be beneficial is normative play, or play activities that the child generally enjoys when not in the hospital and can include playing video games, puzzles, and board games(Burns-Nader & Hernandez-Reif, 2016). This type of play is beneficial because it is familiar to the child and it continues the promotion of healthy development that was being fostered outside of the hospital with these same activities(Burns-Nader & Hernandez-Reif, 2016). Another type of play, medical play, is used to relieve anxiety by familiarizing children with medical equipment and tools, and the child is allowed to play with the tools and explore how they work by testing them on the healthcare worker((Burns-Nader & Hernandez-Reif, 2016). A third type of play used in the hospital setting is therapeutic play, which is used mainly to reduce anxiety in the hospitalized child by encouraging expression of emotions through art or playing with dolls(Burns-Nader & Hernandez-Reif, 2016). The benefits of play in a hospitalized child include emotional expression, and anxiety relief(Coral, Fontes, & Toso(2015). Play is also beneficial in the hospitalized child because it decreases anxiety and therefore has been shown to shorten hospital stays and recovery times following in hospital procedures, and provides the child with a sense of familiarity and comfort when away from home(Burns-Nader & Hernandez-Reif, 2016). One method of play appropriate for four year old children is the use of puppets to allow the child to verbalize their feelings and emotions to the puppet, which they feel is friendly and funny, rather than to a healthcare professional that they may not be comfortable with(Heidke, Lane-Krebs, & Reid-Searl, 2012). Using puppets and having puppet in play relaxes the child and provides comfort and humor, which assists the healthcare team in gathering information and allowing emotional expression from the child about how they are feeling when the child is not comfortable communicating with the healthcare team. Puppets can also be used to perform healthcare teaching about different medical conditions and prepare children for surgery(Dwyer, Parson, & Tilbrook et al. ,2017). Another effective method of play is music therapy. Music can be used for the hospitalized child to encourage emotional expression, give a sense of comfort and familiarity to the child, and improve the child’s mood(Hendon & Bohon, 2008). The children are encouraged to play instruments along with the music leader, and doctors and nurses are not permitted to come into the playroom, which lets music be a comfort to the child where no medical procedures take place(Hendon & Bohon, 2008). Using medical play with stuffed animals or dolls and medical equipment and allowing the child to use the equipment on the doll or animal allows the child to feel more in control and helps them know what to expect when it comes to medical procedures like injections, blood draws, and surgery(Burns-Nader & Hernandez-Reif, 2016).

Play intervention plan: The goal of play was to develop a trusting nurse patient relationship, and promote a sense of familiarity in the unfamiliar hospital setting, the rationale being that children of this age often demonstrate anxiety around new people and in new settings, and positive interaction with those working in the healthcare setting helps decrease anxiety and allow the development of trusting relationships between the patient and hospital staff. The student nurse began by asking questions about what games the child liked to play in order to develop a rapport with the patient. Necessary materials for play included the patients toy truck and remote control. The time involvement was around fifteen minutes. The setting was in the patients room with the toys on the bed and the child sitting in the bed. The student nurse asked the patient to demonstrate how to use the toy truck with the remote control. The child then allowed the student nurse to have a turn with the truck, and the student nurse and patient took turns with the truck while the student nurse talked with the patient about how he was feeling, his family, and his feelings about being in the hospital.

Evaluation: The play activity was successful in that it helped the child feel more comfortable with the student nurse, and it allowed the child to verbalize feelings about being in the hospital with someone they feel comfortable with. The activity was therapeutic because it centered around an activity the child enjoyed outside of the hospital setting, which let the child have some of the comforts of home with him in the hospital. Potential changes to the activity could have been bringing the activity out of the patients room and into the playroom because medical procedures that cause pain and anxiety also take place in the patient room, and the patient may begin to associate play with the negative emotions of fear or pain, and the child may no longer feel comfortable playing in the hospital room. Other types of play that would be beneficial for this child include using coloring pages, play dough, allowing the child to play with medical equipment, and drawing.

Conclusion: In caring for this child I had to use the Franciscan Value of respecting the dignity of each person and reverence for creation, because even though the patient and family had 8different religious and cultural beliefs than I did, I still had to respect their differing beliefs and honor any wishes they had regarding the child's medical care. I also used the Franciscan Value of the love of God used to assist all people, and using education to serve others in providing care to the patient and family. I learned the importance of play in hospitalized children in that playing with a child helps develop a trusting relationship between the nurse and the patient. This level of comfort between the nurse and patient developed through play will help the patient feel comfortable telling the nurse about how he is feeling, and will help the patient to trust the nurse during procedures such as medication administration. I will use the knowledge I gained from this activity in my future nursing career because it helped me realize that these holistic, non pharmacological interventions can be just as important in helping the patient recover from their illness or injury as pharmacological interventions can be in helping to heal the patient and promote health.

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