Diversional activity deficit - the European Oncology Nursing Society

Diversional activity deficit
Recreation and activities in the oncology setting
Patrizia D’Amico, Roberto Quarisa, Servizio di Oncologia Medica, Ospedale di Ivrea (TO), Italia, translation of the original version of
Sarah Liptrott, European Oncology Institute, Milano
“Diversional activity deficit” is one of the nursing diagnoses identified
from the NANDA in 2005 (00097, II, 2005).
The work of ‘recreation’ has progressed now for 10 years in the
department of oncology at Ivrea Hospital, near Torino, and is a
concrete response to this diagnosis. It consists of a general series of
interventions, between the areas of creative activity and occupational
therapy, to be performed when the onset of inadequate activity of the
patient is identified or anticipated.
We work in a medical oncology department, composed of an
inpatient unit with twelve beds, a day hospital, an outpatient service
and a service welcome centre (CAS). Our ‘users’ are adults, usually
over 50 years of age.
Participating can take attention away from the symptom – it can be
reduced or disappear temporarily. Also immobility is not an obstacle,
some small pieces of work can be carried out in bed, surpassing
physical handicap. Sometimes the participation stimulates leaving the
bed area and taking individuals to a communal area.
Carrying out this activity allows us to go and to act in an environment
that constantly changes because it is staged and modified according
to the different seasons and for the different events that characterize
our lives. The time outside of the ward becomes lived also inside with
preparations created by the patients and personnel. The seasons –
holidays like Christmas, Epiphany and carnival, so important in our
town for the oranges-battle! – are remembered in our ward: the snow
that comes down from above, the flags of the carnival, grapes and
autumnal leaves… recreate symbolic objects that evoke the “time” of
daily life.
In alternative to these moments, each person researches topics
around which to create the objects of the projects: Threedimensional animals made with card, rubbish bags, glue, coloured
card, plastic bottles; coloured stained-glass windows made with card
and tissue paper;
Larger objects; showcases for the postcards and for the photographs;
large cardboard silhouettes.
Usually they use cheap materials, recovered, recycled (above all
packing materials), easily available. However we have available for
every activity scissors, glue, staplers, string, adhesive tape, wire,
thumb tacks, fishing line, coloured cards, tempera, paint, felt-tip pen,
tissue paper, crepe paper.
In our hospital as in the majority of hospital departments in Italy, the
absence of pleasant and diversional activites and the cold and clinical
environment, emphasize and sometimes increase the perception of
the symptoms and the sense of isolation that oncological illness can
cause. Also if the range of service ‘users are diverse in relation to age
and social status’ , the problem can be amplified. Depressed states
and apathy are often present in these types of patients.
The choice of the topic to be developed is by chance – a proposal
from whoever has an idea: users, family, personnel… will find idea
or activity they like, begin work and leave it on the table in the
department and very slowly it is built upon. We aim to realize every
proposal, looking not to be repetitive, and for this reason, at the
end of the period, the arrangement is dismantled completely and
eliminated, recycling only the material still useable. In this way
we do not run the risk of same projects every year, stimulating the
construction of new ideas.
Throughout these activities, we aim to face the onset of these
inconvenient situations. Our recreational interventions aim
essentially to make participants profit from light creative activity to fill
the long empty spaces of hospitalization.
Often the project is not of high quality and during its realisation small
inconveniences occur or the aesthetic result is not that desired. , For
us it is not important, the thing that we aim for is participation in the
accomplishment…all that is realized, is meaningful for the individual.
The activity is proposed to every individual, dedicating the time
deemed convenient; it is personalized allowing creativity, manual
ability, artistic skill and potential, even if this means discovering an
ability that they did not think they had. Also where there are high
levels of fatigue, they can participate, showing therefore that even the
presence of the symptoms leaves some margin for activity.
•The long moments of inactivity that characterize a hospitalization
bring into focus the changes in life that cancer causes, redefining
long term objectives and often favouring a state of depression.
These recreational interventions aim to allow individuals who
wish to participate in different activities, to avoid the situation of
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This happens not only with the creation of projects, but also with
different interventions that involve the user in social games, the
accomplishment of a puzzle, reading of a book chosen from the
many available in the library. There are then moments of fun in which
to assist like onlookers listening to some songs, musical groups or
watching entertainment shows.
The structural interventions are aimed to be more welcoming to
the environment, the work of collaboration between personnel and
users for the accomplishment of the projects, participation as simple
onlookers to the events: are all elements that contribute to change
the “atmosphere”. The climate is defined as an integration between
physical environment and social aspects, relations and emotions that
characterize an organization.
Our intention is to create a family atmosphere, warm and attentive
to the human dimension in providing a positive quality care
environment.. Sometimes during the recreational activity, nurses,
patients and carers find themselves around a table together, which
breaks down the professional/institutional structure and allows a
more human dimension providing exchange and ‘chatting’ to know
more personal aspects, taste, episodes of life not usually recalled in
normal hospital interactions.
It is these “chats”, exchanged in friendship, that often help to
establish answers to inexplicable reactions, reveal family dynamics,
unexpressed fears, elements that become a valid help for our activity,
and that allow better individualised care.
The participation in recreational activity otherwise allows different
users to know, or to be familiar with them, to go out from their rooms
and to share with the others….
This recreation often takes place also with the family, for them this
represents a diversion that allows temporary removal of the attention
of worries bound to the illness of the person for whom they care.
The project started in 1997, driven by
the corporate training center and aimed
at students participation. The initial
stages included some nurses and the
activity was aimed at group-work and
playing rediscovery . The project was then
managed totally by nurses in the general
medicine department and successively in
oncology, and from the start it has been
self-financed. The time dedicated is almost
entirely within normal working hours, due
to diversional activity being developed
concomitantly with the activity in the department.
Within the Italian Oncology Nurses Association (AIIO), a study group
named Grano (oncology recreation group) established in 2004
collected information about the Italian reality of the development of
existing light, artistic, and recreational activities.
One of the first objectives of the group was to map within Italy the
consistency of the diversional activity in non-paediatric oncology
departments. This enquiry has emphasized the scarce attention to
this problem and the scarce interest, maybe correlated to a lack
of knowledge in this subject that this aspect of humanisation and
related activity are covered in the nursing profession.
The AIIO National Congresses of and other educational courses
have been organized with the objective of conveying theory and
techniques of recreational interventions to make nurses aware of
these less ‘scientific’ aspects of care, but that are equally important
for our activity. After these episodes of training/education, the
reality has begun to dawn on their services. To increase further the
circulation of the awareness of the diversional techniques, they have
been put onto the AIIO website – a space that collects the blog of
some services. Besides documenting activity carried out, the blog
constitutes a cue for those who want to begin to enliven the actual
working reality. The site AIIO is found at: htpp://www.aiio.it
The carrying out of recreational activity has been valid help to
improve the work of the team, all the activities are carried out thanks
to the support of the health care professionals.
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