Beyond the Doll: Maximizing the effectiveness
of Medical Play in the Pre-Operative Area
Jessica Oviatt, MA, MEd CCLS
Introduction
• Outline
• CHOC Childrens− Two surgery areas
▪ Surgical Short Stay Unit
▪ Outpatient Pavilion
− Anywhere from 15-35 patients a day
− Policies▪ IV 8 years and above
▪ Mask induction 7 years and under
▪ All heart caths and GI procedures get IV’s before
▪ Limited parent presence in OR
Traditional Medical Play• Types
− Directed vs. Non-directed5
− Normative vs. Therapeutic
− Symbolic
− Familiarization vs. Dramatic4
• Uses− Normalization/Exploration
− Education/Preparation
− Information gathering
− Reinforcement/Introduction of ideas
Traditional Medical Play cont…• Influences on Medical Play
− Gender3
− Past experience/exposure3,4
− Developmental level
− Acuity4
• Research− Children have less anxiety2, less emotional distress1 and more
cooperation1,2 when given chances for medical play
Pre-Surgery Environment• Prioritization
− Age
− Anxiety level
− Past experience
− Pre-Medication
• Pace− How many people does the CLS see in pre-op area
− How early do they come
− What steps are required from of the patient and family
− How many patients are present
• Policies− Parental presence during induction, IV vs. mask induction, use of pre-
medication
Limitations of Medical Play in Pre-op
• Time
• Space
• Heightened anxiety
• Acuity
• Interruptions
• Medications
Modifying Medical Play• Ultimate goal: to incorporate the environmental factors and
medical play influences while balancing the medical play and the limitations associated with the pre-op area.
• Different play paradigms− Play as Flow6
− Play as Comfort6
• What to know…− Know the population
▪ Gender, age, developmental level
− Know the recovery▪ Bodily changes, bandages, procedures, pain, etc.
− Know the doctors
Accommodating Limitations• Environment
− Minimize distractions− Set up a medical play zone
• Plan ahead− Surgery schedule, nurse information− Common diagnosis bins
• Post-op medical play− Desensitization, normalization
• Other opportunities for play before day of surgery− Market child life in the surgery environment
Opportunities for Medical Play in Advance
• Tours− General vs. In-depth
• Surgery Preparation Clinics− Hello hospital, teddy bear clinics,
etc.
• Inpatient− Medical play while
preparing/educating
− Scheduled surgeries
Other Areas for Modified Medical Play
• Emergency Department
• Outpatient Clinics
• Orthopedic Clinic
Examples of Pre-Op Medical Play
• Surgery related:− Decorating face masks and hats
− Decorating anesthesia mask
− ID bracelet for stuffed animal/doll
− Getting to know me sheets
− Mask play
− IV play
− Surgery bag coloring sheet
− Body part coloring sheet
− Pre-op checklist
− Mask animals
− Appendix jar
Examples of Pre-Op Medical Play cont…
• Recovery related− Cast glove art
− Casting
− Decorating crutches, halo, etc.
− Tension ball
− Ph probe on a doll
− Dressing change play
− Recovery ladder
▪ Group idea sharing…..
• Hospital Environment related:− Medical coasters
− Band-aid art
− Collages
− Door hangers
− Hospital scrapbook
− Hospital Jewelry
− Mind in a bottle
Questions?
References
1. Chance, P. (1979) What is play? Learning Through Play. New York: Gardner Press, Inc.
2. Gaynard,L.; Wolfer, J.; Goldberger, J.; Thompson, R.; Reldburn, L. & Laidley, L. (1990) Psychosocial Care of Children in Hospitals: A Clinical Practice Manual. Rockville: Child Life Council, Inc.
3. Goleman, D. (1995) The Master Aptitude. Emotional Intelligence. New York: Bantam Books.
4. Lynch, M. (1994). Preparing Children for Day Surgery. Children’s Healthcare, 23(2), 75-85.
5. Mahajan, L., Wyllie, R., Steffen, R., Kay, M., Kitaoka, G., Dettorre, J., Sarigol, S., and McCue, K. (1998). The Effects of a Psychological Preparation Program on Anxiety in Children and Adolescents Undergoing Gastrointestinal Endoscopy. Journal of Pediatric Gastroenterology & Nutrition vol 27(2), 161-165.
6. Pass, M. & Bolig, R. (1993) A Comparison of Play Behaviors in two Child Life Program Variations. Children’s Healthcare, 22(1), 5-17.
7. McGrath, P. & Huff, N. (2001). “What is it?”: Findings on preschoolers’ responses to play with medical equipment. Child: Care, Health, and Development 27(5), 451- 462.
8. Jessee, P., Wilson, H., & Morgan, D. (2000). Medical Play for Young Children. Childhood Education 76(4), 215-218.
9. Jessee, P. & Gaynard, L. (2009). Paradigms of Play. The Handbook of Child Life: A Guide for Pediatric Psychosocial Care. Springfield, IL: Charles C Thomas Publishers, LTD.