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 premedication
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
• Hospital Environment related:
− Cast glove art
− Medical coasters
− Casting
− Band-aid art
− Decorating crutches, halo, etc.
− Collages
− Tension ball
− Door hangers
− Ph probe on a doll
− Hospital scrapbook
− Dressing change play
− Hospital Jewelry
− Recovery ladder
− Mind in a bottle
▪ Group idea sharing…..
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.