Encasing your leg in plaster when you haven't broken any bones may seema strange thing to do, but that's what Alison Price did. As a hospitalplay specialist in the children's outpatient unit at Queen's MedicalCentre in Nottingham, Price wanted to get a better insight into howpatients feel when they come to visit the fracture clinic. The processof removing her cast has now been immortalised in a picture story book,which she shows to children who are waiting at the clinic to get theirown casts removed.
It is, she says, a useful tool that helps to allay the anxiety felt bymany children about the procedure. For instance, the noise made by thesaw used to cut open their cast can be distressing for the childrenwaiting their turn. "The saw is extremely loud, it sounds like thebuilders are in," explains Price.
"As the children are waiting they can hear the noise and they startgetting worried. But they can look through the book and it demystifiesthe process. I think it also helps that they can see it's me in the book- they can ask me what it feels like, and I can reassure them that itdoesn't hurt, it's just a vibrating sensation."
Distraction and relaxation
Preparing children for clinical procedures is just one of the taskscarried out by hospital play specialists like Price. As well as basicplay activities to keep children in hospital relaxed or amused, playspecialists also carry out distraction therapy, where they employ arange of techniques to distract the child during clinical procedures'such as blood tests.
The therapeutic benefits are multiple. As well as helping to familiarisechildren with procedures and assimilate information, play activitiesoffer children a safe outlet in which to express their fears and helpthem adjust to what can be a potentially frightening environment. Playspecialists can also provide developmental assessments of a child'sprogress and evidence indicates that access to an effective play servicespeeds recovery.
In the children's national service framework, the Government underscoredits faith in hospital play by backing a recommendation that all childrenin hospital should have daily access to a play specialist. However, thelatest figures indicate that access remains limited; a 2004 HealthcareCommission report indicated that nearly half the children surveyed wereunable to access a play specialist during their stay in hospital and, ata time of NHS belt-tightening, concerns remain over whether hospitaltrusts have the finances to implement and sustain an effective playservice.
Pamela Barnes, chair of Action for Sick Children, believes it'sabsolutely essential for children in hospital to have access to playspecialists.
"It's a bridge between home and hospital," she says. But she revealsthat it has been an uphill struggle getting the role of play specialistsrecognised and, although they're now broadly respected by both medicalpractitioners and the Government, Barnes is concerned that the number ofstaff in post is still inadequate. "Most play specialists areover-stretched and I am concerned by the current financial troubles inthe NHS."
While ensuring there are ample NHS funds is one way of bolsteringnumbers, making sure that training is easily accessible is another. Playspecialists typically have a childcare, healthcare or teachingbackground, but to become fully qualified they must undertake theEdexcel Professional Diploma in Specialised Play for Sick Children andYoung People. A nine-month course, the diploma is undertaken on a dayrelease basis, enabling students to gain hands-on practical experiencewhile studying. The qualification leads to registration with theHospital Play Staff Education Trust (HPSET) and an increasing number ofNHS trusts now stipulate that recruits must hold the diploma. However,only six colleges in the UK offer the qualification, which has made itdifficult for many of the 1,856 students that have undertaken thecourse.
Suzanne Storer, chair of HPSET, confirms that it's not easy for manystudents. "People travel a long way. The nearest college to Wales is inLondon, for example, so that's tough." But it's unlikely that many morecolleges will offer the course as it is expensive to run and doesn'tattract much funding, she adds.
Storer is pragmatic about the limitations of funding at ward level aswell. "The Government will never produce millions of pounds ofringfenced funds. You have to manage with the resources you have."
Using resources wisely
Coping with financial constraints is something you get used to in theNHS, admits Sue Ware, acting play services manager at Great OrmondStreet Hospital. In a bid to ensure resources can be used mosteffectively, the play service she oversees is currently undergoing areview. The aim is to make the service more flexible to the needs ofpatients and to ensure that caseloads are evenly spread.
However, as one of the leading children's hospitals in Britain, GreatOrmond Street already has a well-resourced play service, bringingtogether 28 play specialists and three play assistants. And as well asoffering play programmes, preparation and distraction therapy tochildren and young people on the wards, the hospital houses an activitycentre and offers a den for adolescents. There are organised activitieson hand, but the aim behind the centre is to give children freedom to dowhat they want, explains Ware. "The underlying ethos is to give childrenchoice and control - they don't get that much on the wards."
Identifying those in need
Ware explains that basic play activities - both on the ward and at theactivity centre - are an important way of assessing children's needs.Not all children are traumatised by a hospital admission or need supportfrom play specialists, but an informal assessment helps to identifythose who would benefit from intervention. "Until we start communicatingwith children we don't know. It's not always easy to see the childrenwho aren't coping, so although the assessment is informal, it isessential."
Building up a rapport with individual patients is clearly fundamental tothe success of the work carried out by play specialists. In Nottingham,Price has found that working in the outpatients unit can make it easierto connect with children because she has more time to develop a bondwith them. "It's a unique opportunity that I have in children'soutpatients; because the treatment isn't as urgent I can take them offto a side room, talk to them and help them understand what's happeningif I need to. Often the children on wards have had lots of proceduresalready and they don't want any more and there's a lot more stressattached to that," she adds.
Joanne Thomas is also a hospital play specialist at Great OrmondStreet.
She doesn't work on a ward either, but is based in the daycare unit forchildren with haematology or oncology conditions. Although the childrendon't stay overnight, their health problems mean that many of them makeregular visits, enabling Thomas to build up a strong rapport withthem.
"I try to build a relationship when they first visit because manychildren have been through a lot by the time they come to us."
What's more, as Thomas points out, it's not just about working with thechildren, but their siblings and parents as well. Inevitably, parentscan be very anxious during hospital appointments, and this can heightenthe child's fears. "I try and give the parents the skills to help themhelp their children," explains Thomas. "But it's hard because, in asense, it's the first time in their life that they've had to allowpeople to hurt their child. So, I can give them permission not bepresent in the treatment if, for example, they have a fear of needles,which the child could pick up on."
Despite the challenges, the role of the play specialist is a rewardingone. Although Thomas says that she has had to attend funerals, she iskeen to emphasise the positive aspects of her job. It gives her greatsatisfaction to see former patients - now healthy - coming back forfollow-up appointments.
"You can lose sight of the children who actually do fantastically well.But it's great to see them coming back to the ward when they're better -it shows there's a light at the end of the tunnel."
CHILDREN'S VOICES
Children at Great Ormond Street Hospital and the Queen's Medical Centrein Nottingham reveal how hospital play specialists have helped them
- "If you're ever down or worried, all you have to do is ask for theplay specialist. They will help you through any problems, and make youhappy and cheerful all day" - Joseph, 12 "Alison is a friend of mine whoplays with me" - George, 4
- "I would like to thank you for your support when I had the needles inmy knees. You are there for me all the time and look after me" - Josh,8
- "I chat with the hospital play specialist - she is a nice person.She's friendly and she does the toys. If they didn't have any toys thelittle kids wouldn't cope with sitting around, they would get bored andrun around" - Michael, 16
- "I was very scared of blood tests, then Alison talked to me aboutthinking positively and being in control. When I have my blood taken Ialways look at the Where's Wally book and that distracts me. I'm not soscared now" - Peter, 10.
