Play was identified as one of the most important activities of a flourishing society as far back as 1938 in a seminal paper, ‘Homo Ludens: A study of the play-element in culture’ by Johan Huizinga. Play is also identified as important in the animal kingdom (Nijhof et al., 2018). Thus, researchers posit that play is important for children’s physical, emotional, cognitive, and social development. Children with chronic diseases have a significantly higher risk of experiencing physical, emotional, cognitive, and social problems. The problems may be caused by the disease’s physical presentation, e.g., pain or fatigue, stressful situations such as hospitalizations or medical procedures, and changing environments such as hyper-anxious parents. Children and adolescents with mental health issues such as depression, autism, attention-deficit/hyperactivity disorder (ADHD), and others also experience impaired play (Nijhof et al., 2018). The importance of play is well-understood, and one area where nurses can make a difference is ensuring play during hospitalization. Nijhof et al. (2018) show that the benefits of play help children develop skills to deal with challenging situations, which helps them build resilience and confidence.
Play is crucial to developing strong brain architecture and networks, promoting lifelong health, and building resilience. However, it continues to be underlooked, even worse for hospitalized children (Center on the Developing Child, 2022). Building resilience in children is so important that it is one of the Healthy People 2030 objectives. Objective EMC‑D07 aims to “increase the proportion of children and adolescents who show resilience to challenges and stress” (Office of Disease Prevention and Health Promotion (ODPHP), n.d.). Thus, facilitating play for children during hospitalization supports achieving this goal.
The play has unique significance among hospitalized children. Williams et al. (2019) show that play helps hospitalized children ease anxiety through medical play. Medical play involves exploring medical supplies and touching hospital equipment. This provides children with familiarity with their setting and an understanding of what is happening. Encouraging fantasy play also allows children to come to terms with their reality which helps them process overwhelming situations more effectively (da Silva et al., 2018). Furthermore, play promotes hope among sick children, contributing to positive psychology and allowing children to look forward to a better future. Thus, children can develop communication, social, and problem-solving skills that help them cope with challenging situations better, thus helping develop resilience that serves them in and out of the hospital setting.
More importantly, hospitalized children require all the support they can get to deal with the condition, improve healing, and continue to support their growth and development. Play among hospitalized children also serves as a therapeutic intervention (Godino-Iáñez et al., 2020; Williams et al., 2019). Play plays an intrapersonal and interpersonal role for children. The former is seen when children play and explore their situation. It also allows the development of interpersonal relationships that bring the children comfort. It allows children to thrive better despite their circumstances. Play also allows parents and healthcare providers to create therapeutic relationships with hospitalized children to improve outcomes.
There are numerous opportunities to incorporate play in the hospital setting. In their research, Williams et al. (2019) provide a case study involving a child hospitalized for Acute Myeloid Leukemia. The child refuses to eat, medication, and nap time, and he is seen to be deteriorating. However, introducing medical play and family-centered play improves food intake; the child can express his feelings and has better coping skills during painful procedures, which helps improve the nursing process. Play improved his behavior and attitude, an important outcome of incorporating play (Godino-Iáñez et al., 2020). Thus, play also improves the nursing process, which helps to make a nurse’s work easier.
The research shows that nurses must engage hospitalized children and their families in play. Godino-Iáñez et al. (2020) show that nurses must develop the skills to promote play. Additionally, play should be incorporated based on a patient’s needs, development levels, illness and treatments, preferences, and psychological state (Williams et al., 2019). The suitability of play depends on a child’s situation. For example, playing with blocks may not be suitable for an immobile child. Thus, even during play, nurses must consider these different factors.
Play is a significant intervention by and for nurses as research shows that engaging a child in play results in better communication between the patient and provider. The use of leisure therapy helps diminish the fear of the white coat for a child resulting in a better patient-provider relationship. Moreover, nurses can use therapeutic toys which help the patient understand the situation better, reduce fear, and promote well-being. Electronic equipment is great for children who cannot leave the bed or are fatigued and cannot physically exert themselves (da Silva et al., 2018). Play results in humanized care that also benefits the parents and guardians. When parents see their previously uncommunicative and uncooperative child in better spirits, it reduces caregiver stress, further contributing to improved outcomes for children (da Silva et al., 2018). therefore, nurses should facilitate play for hospitalized children as it improves outcomes, promotes relationships between the patient and the provider, and reduces caregiver stress. The benefits outweigh any barriers that may exist to facilitating the incorporation of play and serve to achieve objective EMC‑D07 in this vulnerable population.
References
Center on the Developing Child. (2022, February 23). The brain architects: Building resilience through play. Center on the Developing Child at Harvard University. Retrieved April 25, 2023, from https://developingchild.harvard.edu/resources/podcast-resilience-play/
da Silva, D. O., Nunes Gama, D. O., Batista Pereira, R., & Colombo Camarão, Y. P. H. (2018). The importance of play in the context of child hospitalization. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 12(12).
Godino-Iáñez, M. J., Martos-Cabrera, M. B., Suleiman-Martos, N., Gómez-Urquiza, J. L., Vargas-Román, K., Membrive-Jiménez, M. J., & Albendín-García, L. (2020, July). Play therapy as an intervention in hospitalized children: a systematic review. In Healthcare (Vol. 8, No. 3, p. 239). Mdpi. https://doi.org/10.3390/healthcare8030239
Nijhof, S. L., Vinkers, C. H., van Geelen, S. M., Duijff, S. N., Achterberg, E. M., Van Der Net, J., … & Lesscher, H. M. (2018). Healthy play, better coping: The importance of play for the development of children in health and disease. Neuroscience & Biobehavioral Reviews, 95, 421-429.
Office of Disease Prevention and Health Promotion (ODPHP). (n.d.). Increase the proportion of children and adolescents who show resilience to challenges and stress – EMC‑D07. Increase the proportion of children and adolescents who show resilience to challenges and stress – EMC‑D07 – Healthy People 2030. Retrieved April 25, 2023, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/children/increase-proportion-children-and-adolescents-who-show-resilience-challenges-and-stress-emc-d07
Williams, N. A., Brik, A. B., Petkus, J. M., & Clark, H. (2019). Importance of play for young children facing illness and hospitalization: rationale, opportunities, and a case study illustration. Early Child Development and Care. Doi: https://doi.org/10.1080/03004430.2019.1601088
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