CHILDREN REACTIONS TO HEALTH CARE EXPERIENCE

A large body of theoritical and research literature describing the psychosocial needs of
children and adolescent receiving health care exists in medical, nursing, child life, and
other related publications. The purpose of this overview is not to review this literature
in depth but to describe the major resources that form the theoritical frame-work for
the activities in this book.
The effect of the hospitalization and other health car experiences on children and
adolescents have concerned professionals for many years. Vernon, Foley, Sipowicz,
and Schullman (1965) reviewed research before 1965, with subsequent studies
reviewed by Thompson (1985). Research shows that emotional distress in children is
common during health care experiences and afterward. Long term negative sequelae
lasting from several weeks or months through adolescence may occur.
DEVELOPMENTAL THEORY AND THERAPEUTIC PLAY
Play is one of the most powerful and effective means of stress reduction for children.
Various pschodynamic, developmental and cognitive theories address why this is so.
Pyschoanalytic theorists postulate that play is a means through which children act out
unpleasant experiences and minimize resulting negative psychological impact (Freud,
1955, [vol 18]; Winnicott, 1965). Bolig, Fernie and Klein (1986) note that play can
help increase the internal locus of control of a pediatric patient.
Gibbons and Boren (1985) describe three types of play beneficial for stress reduction.
1.

Recreational Play is spontaneous, unstructured play. It occurs naturally, and its

content and form are affected by the developmental level of the child

2.

Therapeutic Play occurs when an adult structures the activity for a specific
purpose. It can be preparatory or chatartic.

3.

Play Therapy involves interpreting childrens play and reccomending appropriate

interventions, in this type of play, skilled therapists use play to help children
understand their own behaviour and change those behaviours that inappropriate.

Delpo and frick (1988) use the phrase Play as Therapeutic Modality to describe
adults purposeful use of any type of play to facilitate communication with children.
Play allows children to express thoughts and feelings, assimilate reality, resolve
internal conflicts, achieve mastery, and cope effectively. It provides a vehicle for a
childs self expression and is a way in which children and adult can communicate.
Delpo and Frick identify two types of of therapeutic play interventions: directed
therapeutic play and nondirected therapeutic play. In directed therapeutic play the
adult is more active and predetermines the theme and content of the play is that
initiated by the child, the child takes on an active role, while the adult is a participantobserver. Delpo and Frick note thet although the methods and conceptual bases for
both types of theraeutic play differ, the goals are the same: to provide experiences
through which the child can resolve internal conflicts and achieve mastery over
difficult life experiences. Both types of play are important components of a
comprehensive psychosocial approach to working with sick children.
Therapeutic play experiences are an integral part of family centered care.
Proffesionals and family-centered care. Professionals and family members share
activities with each other and participate in them. This participation promotes
parent/professional collaboration and recognizes that families are constant in a childs
life although the health care system is not. Professionals choose activities that reflect
racial, ethnic, and cultural diversity to honor these aspects of children backgrounds.
Therapeutic play activities help the health care professional identify family strengths,
individuality, and coping methods. During the activity the professional can provide
information and model methods for helping children more effectively. Some programs
encourage parents to be involved in group activities that can promote family-to-family
networking via the same techniques used in therapeutic play activities with groups of
children (Ritter & Klinzing, 1980)
ADAPTATION AND COPING WITH ILLNESS
Despite the stress that children undergo during illness, some children are resielent to
the experience and adapt effectively to it. Therapeutic play activities are an essential
component of psychosocial proggaming to enchance childrens ability to adapt and
grow during