Main description:

This book helps support developmentally sensitive nursing and allied health practice by integrating the therapeutic powers of play into child and adolescent health care service provision. It is designed to link play, child development, neuroscience, biopsychosocial and attachment theories with the biomedical model of health.

Nurses and allied health professionals work with children aged between 0-18 years and with diverse childhood illnesses, injuries, diseases, disorders, and conditions, and are therefore in a prime position to understand and support children through potentially painful and traumatic health care experiences. Understanding of the role of play and the application of the therapeutic powers of play in communicating with children and families has the potential to significantly optimise paediatric care. The theory and play based strategies, tools and techniques presented in this book assist nurses and health care professionals to engage with children in an age-appropriate manner and 'speak' with children through their natural language of play, to enhance comprehension, coping, resiliency, and healing.

Play is recognised as a sequentially developing ability and can be aligned with the child's age and stage of life. Play based approaches can be placed on a continuum from fully child led or non-directive play to adult facilitated educative play. Medical information can be tailored according to the various points along this continuum to inform clinical reasoning and to help children prepare for procedures, recover from medical interventions and / or make sense of their diagnosis.

Whilst this book is directed at nurses and allied health professionals who work with children and their families, it may also be a valuable resource for medical and other professionals in community or educational settings to work systemically as a team. The book takes the reader on a journey to illustrate various professional and therapeutic roles in how to playfully engage children through a range of case vignettes.

Contents:

Forward
Dr Athena A Drewes dr.athena.drewes@gmail.com Introduction
Natalie Hadiprodjo, Belinda Dean and Judi Parson
natalie.hadiprodjo@deakin.edu.au

Section 1 Theoretical Background Each chapters in this section will follow a specific format to provide uniformity.

* At the beginning of the chapter please write 3 or 4 objectives:

* Introduction

Topic 1

Topic 2

Topic 3

Topic 4

* Chapter Summary

* References

* Key terms

* Reflective questions and activities

* Additional resources

Chapter 1. Setting the scene
Judi Parson judi.parson@deakin.edu.au This chapter will provide an overview of the book including the theoretical orientation to introduce the overarching humanistic, childhood developmental and neuroscientific approaches that will set the scene. It will provide the context in relation to the various health care settings where nurses and other health care professionals meet child clients and their families, i.e. primary, secondary and tertiary health care services, and justify the need for interpersonal, interprofessional and transdisciplinary interactions to deliver holistic care. It will introduce the how, what, why, when, and where, to include therapeutic skills using a developmentally sensitive approach to care for children. This chapter also orients the reader to the structure of the book.

Chapter 2. Therapeutic Play
Fi Melita & Judi Parson
fmelita@deakin.edu.au This chapter presents a definition of overview of play including differentiating normative, therapeutic and educative play as well as play therapy, medical play therapy, Filial Therapy, and Child life Therapy as relevant in health care settings. It also provides the historical development of the Therapeutic Powers of Play as a model based on the work of Charles E Schaefer and Athena Drewes (2011). It then examines how the therapeutic powers of play model may be integrated into nursing care to provide the important linkage between theory and practice. A list of the twenty core agents of change in four domains, namely that play facilitates communication; fosters emotional wellness; increases personal strengths and enhances social relationships (Schaefer & Drewes, 2011) will be presented.

Chapter 3. Caring for children, families and health care professionals
Kerry Reid-Searl k.reid-searl@cqu.edu.au This chapter will provide an overview of the role of caring in nursing and allied health as the philosophical basis for paediatric health care provision. It presents the five C's of caring - commitment, conscience, competence, compassion, and confidence (Roach, 2002) and situates caring with and introduces the humanistic therapeutic play skills that may be adapted and used in everyday nursing practice. The play relationship is core to this practice and is discussed with reflective questions and activities. This chapter also includes caring for self as well as others.

Chapter 4. Assessing the sick or vulnerable child
Belinda Dean and Judi Parson
belinda.dean@deakin.edu.au Nurses are required to undertake paediatric physical assessments, which may seem strange to the child and therefore this chapter introduces some playful but practical ways to examine the child from head to toe. Nurses may also be responsible for assessing the child's development, psychosocial and mental health of the child where the same or similar approaches may be integrated. This chapter incorporates the United Nations Convention of the Rights of the Child to frame the vulnerable child in health care settings. Reflective practice questions are used to guide discussion points.

Chapter 5. Attachment in the health care setting
Natalie Hadiprodjo natalie.hadiprodjo@deakin.edu.au This chapter will provide an introduction and overview of attachment theory in simple terms and how an understanding of the wider family system may inform paediatric health care provision. It will provide an overview of the Dynamic Maturational Model of Attachment and Adaptation (DMM) developed by Patricia Crittenden and how various strategies of attachment (i.e. ways of being with others to get our needs met) develop across the lifespan. The chapter will include reflective activities that encourage the health care professional to reflect on their own strategy of attachment and how this may inform the way that they respond to the children and families they care for. It will also examine how parent strategies of attachment may impact on how they respond and care for their own child within a health care setting, and how a child's strategy of attachment may impact on how they respond to medical intervention. It will also explore how chronic, repeated medical intervention may also play a role in shaping a child's strategy of attachment. The chapter will explore ways that health care professionals can maintain parents as partners and support positive attachments and playful interactions between parents and children.

Section 2 Child Development & Assessment Each chapter will follow a specific format to provide uniformity for each developmental stage.

* At the beginning of the chapter please write 3 or 4 objectives:

* Introduction

* Child development and assessment

o Physical development

o Psychosocial development

o Neurological development

o Play Development

* Considerations for nursing care

o Common fears and anxieties

o Grief and loss / death and dying

o Pain management

* Therapeutic play approaches for clinical practice

o Include parents as partners

* Considerations for referral

* Chapter Summary

* References

* Key terms

* Reflective questions and activities

* Additional resources

Chapter 6. Therapeutic play and maintaining hope in the infant child
Dolores Dooley d.dooley@deakin.edu.au This chapter focuses on caring for the infant child between the ages of 0 - 18 months including, child development and assessment - physical, neurological, attachment and infant play development and incorporating Erikson's psychosocial development stage of trust v mistrust. It also includes considerations for nursing care and the integration of therapeutic play approaches which support infants and their parents as partners.

Chapter 7. Therapeutic play, volition and the toddler
Rhiannon Breguet rhiannon.breguet@deakin.edu.au This chapter focuses on caring for the toddler aged between 18 months - 3 years including, child development and assessment - physical, neurological, toddler play development and incorporating Erikson's psychosocial development stage autonomy versus shame / doubt. It also includes considerations for nursing care and the integration of therapeutic play approaches which support toddlers and their parents as partners.

Chapter 8. Therapeutic play and explaining purpose to the pre-schooler
Leanne Hallowell leanne.hallowell09@gmail.com This chapter focuses on caring for the pre-schooler aged between 3 - 5 years including, child development and assessment - physical, neurological, child play development and incorporating Erikson's psychosocial development stage initiative versus guilt. It also includes considerations for nursing care and the integration of therapeutic play approaches which support young children, siblings and their parents as partners.

Chapter 9. Therapeutic play and instilling competence in the school aged child
Sarah Hickson sairhicks@hotmail.com This chapter focuses on caring for the school aged child between 5 - 13 years including, child development and assessment - physical, neurological, play development and incorporating Erikson's psychosocial development stage industry versus inferiority. It also includes considerations for nursing care and allied health care whilst integrating therapeutic play approaches which supports children, siblings and their parents as partners.

Chapter 10. Therapeutic play, fidelity and the teenager (13-18)
Phoebe Godfrey & Natalie Hadoprodjo Email: phoebe.godfrey@deakin.edu.au This chapter focuses on caring for the young person aged between 13 - 18 years including, child development and assessment - i.e. physical, neurological, pain perception, and incorporating Erikson's psychosocial development stage identity versus confusion, as well as sexuality, spirituality and cultural considerations. It also includes considerations for nursing care and the integration of therapeutic play and creative art expression which supports young people, peers and their parents as partners.

Section 3 Case Presentations & Conceptualisations Each chapter will follow a specific format to provide uniformity for case presentation, conceptualisation and application of therapeutic play interventions for a range of clinical settings

* At the beginning of the chapter please write 3 or 4 objectives:

* Introduction

* Background to the clinical setting through the eyes of the child

* Background to the presenting condition and supporting literature

* Case vignette

o Child diagnosis and presenting issues

o Considerations for health care needs based on diagnosis

o Detailed therapeutic play assessment, interventions and strategies specifically used for child and family

* Considerations for referral

* Chapter Summary

* References

* Reflective questions and activities

* Additional resources

Chapter 11. Preparing Jesse for an allergy assessment
Michelle Perrin genevieve.pepin@deakin.edu.au This chapter explores a case study about Jesse (pseudonym) a child who has experienced an allergy assessment which required him to go to the accident and emergency department in a regional hospital and outpatient clinic. It takes the reader on a journey through the eyes of the child and his mother as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic play strategies are tailored for phlebotomy / injection site / pin prick testing.

Reflective questions and activities for this chapter will focus on the basic five senses - what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time).

Paediatric resources for teaching and distracting children whilst having blood tests.

Activities will incorporate caring for the health care professional (compassion fatigue)

Chapter 12. Supporting Evan with pain
Bridget Sarah bridget.sarah@deakin.edu.au This chapter explores a case study about Evan (pseudonym), a child who has experienced developmental delay and Cerebral palsy which required him to go to be admitted directly into a regional and then tertiary hospital for specialised treatment including Botox injections. It takes the reader on a journey through the eyes of the child and his family as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic play strategies are tailored for iatrogenic trauma and attachment assessments. Supportive education for the parent and siblings to manage mental health care needs at home.

Reflective questions and activities for this chapter will focus on the basic five senses - I.e. what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time).

Paediatric resources for teaching and distracting children whilst having medical procedures.

Activities will incorporate caring for the health care professional (compassion fatigue)

Chapter 13. Grace break a leg
Leanne Hallowell leanne.hallowell09@gmail.com This chapter explores a case study about Grace (pseudonym), a child who has experienced a fall from a monkey bar at a local playground, this emergency diagnosed a compound fractured leg - which required her to go to theatre and recover in the paediatric ward of a general hospital. It takes the reader on a journey through the eyes of the child and her family as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic play strategies are tailored for preparing Grace for medical imaging and surgery and post-operative medical play. Additional reflection on preventing iatrogenic trauma. Supportive education for the parent and siblings to manage health care needs at home.
Reflective questions and activities for this chapter will focus on the basic five senses - I.e. what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time).

Paediatric resources for teaching and distracting children whilst having IV canulation.

Activities will incorporate caring for the health care professional (compassion fatigue)

Chapter 14. Bartholomew learns about his sweet blood
Belinda Dean belinda.dean@deakin.edu.au This chapter explores a case study about Bartholomew (pseudonym), a old child who has been newly diagnosed with Diabetes and is admitted directly into a child and adolescent ward in a regional hospital. It takes the reader on a journey through the eyes of the child and his mother and father as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic play strategies are tailored for BSL monitoring and health education. Supportive education for the parent and siblings to manage health care needs at home.

Reflective questions and activities for this chapter will focus on the basic five senses - I.e. what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time).

Paediatric resources for teaching and distracting children whilst having finger blood tests.

Activities will incorporate caring for the health care professional (compassion fatigue)

Chapter 15. Erika begins chemotherapy end of life hospice setting / respite
Erin Butler playtherapywitherin@gmail.com This chapter explores a case study about Erika (pseudonym), a child who has experienced a potentially life limiting disease (Cancer / CF or other) which required her to go to be admitted directly into an oncology ward a tertiary hospital. It takes the reader on a journey through the eyes of Erika and her family as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic play strategies are tailored for biopsies under guided imagery, surgery and chemotherapy. Supportive education for the parent and siblings to manage health care needs at home.

Erin will explore how the therapeutic relationship can help a child to cope with various changes and implications of their life-limiting illness. She will also encourage the reader to reflect on the role that they hold within their current practice and the future relationships they will form with this client group and their families.

Reflective questions and activities for this chapter will focus on the basic five senses - I.e. what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time).

Paediatric resources for teaching and distracting children whilst having chemotherapy.

Activities will incorporate caring for the health care professional (compassion fatigue)

Chapter 16. Connor
Kate Renshaw

This chapter explores a case study about Connor (pseudonym), a child who has been referred by the school due to school refusal and anxiety which indicated the need for a play and attachment assessment (encopresis). It takes the reader on a journey through the eyes of the child and his family as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic play strategies are tailored for attachment assessments. Supportive education for the parent and teachers to manage mental health care needs at home and school.

Reflective questions and activities for this chapter will focus on the basic five senses - I.e. what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time).

Paediatric resources for teaching and distracting children whilst having mental health assessments.

Activities will incorporate caring for the health care professional (compassion fatigue)

Chapter 17. Frida
Natalie Hadiprodjo This chapter explores a case study about Frida (pseudonym), a child who has experienced a multiple Adverse Childhood Experience (abuse / neglect) which required her to go to be assessed for mental health in a community setting. It takes the reader on a journey through the eyes of the child and her family as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic play strategies are tailored for mental health assessment and play therapy. Supportive education for the parent and siblings to manage health care needs at home.

Reflective questions and activities for this chapter will focus on the basic five senses - I.e. what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time). Paediatric resources for teaching and calming children whilst dysregulated. Activities will incorporate caring for the health care professional (compassion fatigue)

Chapter 18. Alice

Genevieve Pepin

Alice is a young person who has experienced anorexia nervosa which required her to access an eating disorder service through CAMHS. It takes the reader on a journey through the eyes of Alice and her family as they encounter various stages of the experience. Following the background information and the presenting issues a range of therapeutic strategies tailored maintaining health and well-being. Supportive education for the family to manage health care needs at home. This chapter will focus on sensory approaches as an adjunct to evidenced-based interventions for eating disorders.

Some reflective questions and activities for this chapter will focus on the basic five senses - I.e. what the child may see, hear, smell, taste, and touch. Additional senses are included where relevant - nociception (pain), equilibrioception (balance), proprioception (kinaesthetic), thermoception (temperature), interoception (internal body senses), and chronoception (time). Paediatric resources for teaching and distracting children whilst having NGT insertion. Activities will incorporate caring for the health care professional (compassion fatigue)

Conclusion
Belinda Dean, Judi Parson and Natalie Hadiprodjo

Appendices

Resources