The purpose of this study was to determine the effects of needle play in reducing pre-school children's anxiety concerning injections. The Pre-school Observational Scale of Anxiety was used to measure the degree of anxiety experienced by the children. The hypothesis stated that there would be a significant decrease in anxiety of pre-school children who participated in needle play as compared with the anxiety scores of pre-school children who did not participate in needle play.The sample consisted of 20 pre-school children who were receiving routine health care and injections for immunizations or PPDs (purified protein derivative) at a county health department in the southeast. After obtaining informed consent, children were randomly assigned to either a control group (n = 10) or experimental group (n = 10). The control group was involved in putting together a puzzle with the investigator prior to their injection. The experimental group participated in needle play with the investigator prior to their injection. The Pre-school Observational Scale of Anxiety (POSA) which specifies behavioral indicators of anxiety in children was used on all subjects immediately prior to the actual needle penetration and a score was given to each subject.The scores on the Pre-school Observational Scale of Anxiety showed no statistically significant difference between the control group and the experimental group when analyzed using the Mann-Whitney U Test. On the basis of these findings, the hypothesis that pre-school children who participate in needle play immediately prior to receiving an injection would show a significant decrease in anxiety when compared to pre-school children who did not-participate in needle play prior to an injection was not accepted.

Play can be beneficial and effective for children experiencing the stress, fears, and anxieties associated with illness or death by expressing their feelings into activity (Brown 2018). It can be difficult for children to verbally communicate complex emotions because they usually are unsure of what words to say to express their emotions. Therapeutic play is a great coping mechanism for coping with death because it allows children to express their emotions through play. Professionals working with children would be better equipped to meet children’s needs with a firmer understanding on the ways in which therapeutic play techniques can be incorporated into their practice. The impact therapeutic play makes can also be beneficial for families as it can help the families understand what the children comprehend which can lead to more efficient communication between members of the family. Professionals aim to assist children in reaching optimal outcomes, which in turn has beneficial impacts for the family overall.

Aim: To evaluate the efficacy of therapeutic play in alleviating pain or anxiety in the pediatric cancer patient. Background: Therapeutic play is an intervention often incorporated within the care of pediatric cancer patients and children with other disease processes to promote well-being. Even though play therapy is supported by research, nurses have the option to implement nursing care interventions in a play-like manner. Therapeutic play is an individualized technique that provides an intentional opportunity for children to express their emotional responses in a controlled environment. Method: The databases used in this search included CINAHL, MEDLINE, APA PsycINFO, ERIC, and Education sources. A total of 59 articles were kept for review. One additional article held for review was obtained through a secondary search of the same databases listed. Articles that did not specifically address cancer were not included. Key Issues: Including therapeutic play interventions in the treatment of pediatric oncology patients is not a mandatory practice. If nurses perceive play therapy as an effective treatment option, an increased value may be placed on the approach. The usefulness of the intervention and the nurse's ability to execute it is essential in determining the overall efficacy. Conclusions: Therapeutic play contributes to many favorable outcomes when used in practice during pediatric cancer treatment. While the reduction of pain and anxiety is supported, other beneficial effects include increased positive coping mechanisms, patient satisfaction, compliance, self-efficacy, social skills, and improved communication. Keywords: Therapeutic play, play therapy, cancer, oncology, pain, anxiety, pediatric, nurse

Background: Play is the child’s natural world. According to psychoanalytical studies, play has an important role in children’s development, and the absence of play during a child’s life could lead to severe pathological implications. Based on this theory and being aware that physiotherapy treatment programs could be long lasting, tiresome and lacking motivation for children, this literature review presents a perspective regarding the integration of play within physiotherapy programs and examines the physical and emotional outcomes during this integration. Aim: To investigate the outcomes of integrating play in physiotherapy for children with chronic health conditions. Method: The research strategy for this review was a thorough search of peer-reviewed articles in the databases CINAHL and AMED which include articles from the fields of allied and complementary medicine, as well as the database Scope Med. Participants were children with chronic health conditions, ranging from 2-18 years old. In the term ‘play’ virtual reality and video game activities were included due to the lack of research. In addition, articles from a previous literature review conducted by the author were also included in the present paper. Results: The focus of researchers on children with CP and the lack of evidence for children with other health conditions, the persistence of physiotherapists to assess mainly physical outcomes and not emotional needs of children, and the measurement tools used for this purpose are presented. Conclusions: For children with chronic health conditions who attend physiotherapy sessions, play could serve as a mediate and an appropriate developmental approach in order to achieve physical and emotional changes. There is a need for physiotherapists to balance physical and emotional needs, and have a more ‘human’ relationship, rather than a ‘bodily’ - strict professional relationship with children. Although the information presented in this review is not considered as sufficient to draw conclusions, it could serve as a first step for researchers to study this integration in greater depth, and to focus on children with conditions other than CP.

Made available in DSpace on 2015-07-22T20:50:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-05-25 / A Anemia Falciforme é uma doença caracterizada pela Anemia hemolítica crônica, causada por uma hemoglobina anômala, a HbS. Suas complicações resultam em crises dolorosas derivadas de episódios vasoclusivos que atingem vários órgãos e articulações, podendo levar a infecções e promovem grande sofrimento à criança e sua família. Este estudo, de abordagem qualitativa, teve como objetivo compreender o significado de ter Anemia falciforme para a criança. Utilizou como referencial teórico o Interacionismo Simbólico e como referencial metodológico, a Teoria Fundamentada nos Dados (Grounded Theory). Os sujeitos foram oito crianças de 4 A 10 anos de idade e as estratégias utilizadas para coleta dos dados foram: a observação participante, a entrevista com a criança, intermediada pelo Brinquedo Terapêutico e a entrevista semiestruturada realizada com um de seus pais, na qualidade de informante da experiência da criança. A análise comparativa dos dados permitiu a identificação da categoria conceitual Uma vida dominada pela dor e revelou que, para a criança, ter Anemia falciforme é uma experiência de muito sofrimento; que a dor é o maior fardo vivenciado por ela e determina que fique muito triste por interagir, constantemente com um corpo que dói e necessita de um contínum de cuidados, medicamentos, hospitalização e de tratamento ambulatorial, os quais a expõe a procedimentos dolorosos, intrusivos e estressantes, mas, que ela própria reconhece necessários para o alívio da dor; que sofre também por conviver com o estigma familiar da doença e por saber que o tratamento é apenas paliativo e a dor sempre poderá voltar. Para enfrentar o sofrimento, a criança encontra em sua mãe um porto seguro, apoia-se na fé, tenta ser forte e almeja que a cura definitiva da Anemia falciforme seja alcançada. Reitera-se a importância da família ser apoiada, para que possa auxiliar a criança no enfrentamento dessa doença e do Brinquedo Terapêutico integrar, sistematicamente, o planejamento da assistência de enfermagem a essa população infantil. / Sickle-cell anemia is characterized by chronic hemolytic anemia caused by anomalous red blood cells, HbS. Its complications result in painful crises as a result of vasoclusive episodes that affect several organs and articulations and that can lead to infections thus causing deep suffering for the child and his/her family. The present study, a qualitative research project, aimed to understand the meaning the child attributes to having sickle-cell anemia. The Symbolic Interactionism was used as the theoretical framework and the Grounded Theory, as the methodological one. Subjects were eight children whose age ranged from 4 to 10 years old and the strategies used for data collection were: observant participation, interviews with the child mediated by the use of the Therapeutic Play and semi-structured interviews with their parents, as informants of the child’s experience. Data comparative analysis allowed the identification of A life dominated by pain as the conceptual category and revealed that having sickle-cell anemia is a very painful experience for the child. Data also showed that pain is the heaviest burden the child experiences and makes him/her very sad due to the constant interaction with a painful body requiring continuous care, drugs, hospital admissions and outpatient care. Such interventions expose the child to equally painful, invasive and stressing procedures that the child himself/herself recognizes as necessary to relieve pain. Moreover, the category also reveals that the child suffers for having to deal the family stigma related to the illness and for being aware that the treatment is just palliative care and that a relapse may occur at any time. To face suffering, the child feels the mother is a “safe harbor”, relies on faith, tries to be strong and hopes that the definitive cure for sickle-cell anemia will be achieved. Results emphasize the importance of providing support to the family so that they can help the child cope with this illness. The systematic use of the Therapeutic Play to plan nursing interventions aimed at this population of children is equally important. / TEDE / BV UNIFESP: Teses e dissertações