This study was designed to gather information about the nature and content of post-surgical play behaviour displayed by hospitalized pre-school children. Four questions were explored: Are common themes expressed in the play behaviour of hospitalized pre-school children after major surgery? Does the quality and intensity of the play behaviour demonstrated by pre-school children follow a similar pattern? Will pre-school children use play therapy as a medium through which to express fears and concerns about their hospital experience? Do children tend to act out their perceptions of what has happened to them in hospital? The population selected for the study were four girls and one boy between the ages of three and five years, who were admitted for major surgery on the heart or great vessels. During the recovery period after surgery each child had the opportunity to take part in at least five play therapy sessions lasting approximately one hour each. Play therapy took the form of situational play using real or simulated hospital equipment and various dolls representing children and adults. Each child chose the direction and content of play. The investigator took part in play as directed by the child. Parents could join in if they wished. The verbal and non-verbal behaviour displayed by each child during play therapy was recorded by audio tape and by process recordings. Four out of five children in the study participated actively in play therapy. In the course of play they expressed five common themes: intrusive procedures; re-enactment of procedures; testing reality; autonomy: regaining control; separation from home and family; and nurturing activities. The quality and intensity of the children's play behaviour followed a pattern from intense to more relaxed and from aggressive to more gentle play. During play each child expressed some individual fears and concerns about his hospitalization. Intrusive procedures were the most frequent topic of play for all the children. Finally, each child tended to act through specific procedures so that play behaviour became a factual account of the child's hospital experience. One child, the only boy in the study, did not want to participate in play therapy. The reasons for this were not investigated. It was concluded that play therapy is a useful technique which can assist nurses understand the pre-school child's perception of his hospital experience. Play therapy also has potential as a therapeutic intervention to help a child come to terms with the traumatic events of his hospitalization. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this phenomenological study was to determine the meaning parents give to their family's experience when they have a child awaiting corrective heart surgery. A secondary purpose was to identify appropriate interventions for nurses who deal with families during the transition period, from initial diagnosis of congenital heart disease until admission to hospital for corrective heart surgery. A convenience sample of six couples were interviewed at various times during the identified transition period, for a total of 11 interviews. An interview guide of open-ended questions provided some loose structure for the initial interviews. Analysis of the verbatim transcriptions began concurrently with data collection and continued during the formal analytic phase with meaning units emerging from the data. The parents described four facets of the experience: diagnosis of congenital heart disease, adjusting to caring for child once home, living with a child with a chronic condition, and waiting for corrective heart surgery. Not only did parents talk about how they felt during the four facets but they also described the range of coping strategies they employed through their experience. In discussing these findings within the context of other chronic illness experiences it became evident that parents draw from a common pool of coping strategies whether the child is in a chronic or more acute phase of an illness. Most of the parents in discussing their overall impressions of the experience had not found their child's illness to be as disruptive to family life as they had first anticipated. Those families with the most symptomatic infants seemed to have a particular need for an alliance with one health care professional to support them through the transition period. Generally, parents did not spend a lot of time dwelling on the corrective surgery until close to the anticipated date for that event; instead they employed various coping strategies which allowed them to normalize their lives. Implications for nursing practice which arise from these conclusions are multiple. Overall, nurses must assess the meaning that individual families give to their experience, assist families to employ suitable coping strategies, and offer support as necessary. General implications for nursing research are in the realm of studies which will further nurses' understanding of the waiting period for corrective heart surgery both from the parents' and the siblings' perspective. / Applied Science, Faculty of / Nursing, School of / Graduate