Expressive and recreational activities in inpatient children with cleft lip and palate: family point of view. This study aims to verify the family's point of view regarding the importance of expressive and recreational activities during hospitalization and recovery from surgery of children with cleft lip and palate CLP , so as to identify how such activities are beneficial during pre and postoperative period. The results show that most of the interviewees preferred that some kind of activity be conducted with the children while waiting for surgery, because they were conducive to the expression of positive feelings during this period. According to those interviewed, recreational and expressive activities during preoperative treatment helped the children feel calmer, and they observed improvement in the children's emotional state.
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The reactions of cooperation were more frequent in the experimental group, while low acceptance was observed only in the control group. Therapeutic play has proved an important tool in preparing for the vaccine.
Playing is one of the most meaningful aspects in a child's life. It is as important as hygiene, feeding, sleeping, and other basic needs. Playful activities are essential for the development of children; by playing, children relate with people and the surrounding environment since their early years of life.
By playing, children learn things that cannot be taught about their world and about themselves: what they can do, how to interact with things and in specific situations, and how to adapt to social demands. Playing is not only essential for the developmental process; it also helps children adapt to new situations, and maintain and recover health. Playing provides pleasure, relaxation, and favors spontaneity.
It is extremely significant in crucial times for children, such as during painful procedures. The way children learn and express their suffering is different from that of adults, since they are still incapable of verbalizing feelings. With playful activities, children find a way to reveal their internal world in a symbolic manner.
Therefore, it becomes clear that it is crucial for children to play in order to meet their social and psychological needs by providing a restructured experience that helps overcome suffering in moments of tension. There are several kinds of playing that are classified in different manners. Several studies showed that therapeutic play are often used by healthcare professionals, specially nurses. Although therapeutic play and play therapy are terms used inadvertently as synonyms, their concept and applicability differ.
It is developed in a controlled environment, and used to treat children with emotional disorders neurosis or psychosis. One of the several uses of therapeutic play is to prepare children for therapeutic and painful procedures. This type of playing is called instructional. One of the stages of development that benefit most from the use of therapeutic play is the preschool phase, comprising children aged 3 to 5 years, when magical thinking prevails.
In this stage of life, the cognitive and psychoemotional structure of the child is still under development, and therefore their resources to face painful situations are limited; moreover, they are not able to understand reality, very often relying on fantasy.
Painful procedures cause fear and physical and emotional suffering to children, mainly when the procedure is not explained to them, and they are not prepared or supported properly. Based on the understanding that the toy is the main means of communication between the child and the professional, the authors of this study proposed to explore the use of therapeutic play to prepare children for vaccination, as well as the influence of this activity on their behavior during the procedure.
To identify behaviors of children during vaccination after preparation with an instructional therapeuticplay; to compare these behaviors in children who were prepared and those who were not prepared. This is a quasi experimental study of quantitative approach.
The analysis of the independent variable use of toy in preparation for the procedure and the dependent variable child's reactions using the toy or not involved the participation of a control group. However, subjects were not randomly selected, and therefore this is not a true experimental study.
Our sample was composed of 60 children aged from 3 to 6 years and 11 months, submitted to vaccination, whose legal guardians agreed to and authorized participating in the study, and signed the Informed Consent Form.
Children were distributed to an experimental group, with 30 children taking part in an instructional therapeutic play session before vaccination, and to a control group, with 30 children who did not receive any kind of previous emotional preparation.
Data were collected by means of observation of the child during vaccination and interview with their legal guardians. Data were recorded in a form with information about identification of child and the reactions during vaccination.
After informing children and their legal guardians about the study and their participation, those selected for the experimental group were invited to play.
Instructional therapeutic play sessions were carried out individually, using a doll, disposable syringes, needles, cotton, and bandages for venal puncture. The researcher showed the procedure in the doll and asked the child to participate and repeat the procedure at the end of the role play. After the instructional therapeutic play session that lasted, on average, 20 minutes, the child and the companion were referred to the vaccination room, where the child was individually observed by the researcher during vaccination.
Children in the control group and their companions were referred straight to the vaccination room with the researcher, who also observed their reactions during the procedure. Data were quantitatively analyzed by descriptive and inferential statistical techniques using Fisher's exact test, which assesses the differences between the incidence of children's reactions in experimental and control groups.
The characteristics of the children showed a very close gender-related distribution, with a slight prevalence of boys 31; The mean age was 4. Most children 40; Aggression-related reactions during injection were only observed in the control group, and included mainly pushing 8; Some children kicked 2;6. Figure 2 shows that reactions involving verbal expression were more frequent in the control group; the most prevalent reactions were screaming 8; Compared to the control group, fewer children in the experimental group cried during the procedure 11; Most reactions related to a greater acceptance of the procedure, such as staying still, smiling, collaborating, and being at ease, were more frequent in the experimental group.
Some of the reactions that show less acceptance of the procedure were not observed in the experimental group, such as hitting, kicking, pushing, biting, pulling the hand of the professional, clinging to their parents, asking for cuddling and showing muscle stiffness, pallor, and perspiration. Reactions indicating aggression pushing and agitation were observed more often in the control group when compared to the experimental group, in which children stayed more still and at ease, and collaborated with the procedure.
This finding highlights the importance of explaining what will be done to them previously. In the instructional therapeutic play session, children from the experimental group had the opportunity to deal with the painful experience beforehand, reducing stress and fear.
These feelings are very often triggered by magical thinking, typical of the pre-school stage. A study on the behavior of children during postoperative dressing showed that after preparation with the instructional therapeutic play, manifestations indicating greater adaptation and acceptance were more frequent, in agreement with our findings.
Children observed the professional carefully, verbalized their feelings, showed relaxed posture and facial expressions, played, asked questions to their mothers and to the professional, and assisted with the procedure spontaneously.
Reactions related to expressing feelings also indicate their state of tension and fear. These reactions were identified more often in the control group and included screaming, crying, saying it would hurt, and also perspiration, pallor, and flushing. Considering the study mentioned previously, 17 behaviors of lower adaptation and acceptance were also more frequent in the control group, in which children were not prepared with the therapeutic play before dressing.
Children collaborated passively, stayed quiet, and adopted protective behaviors, facial expressions of fear, and muscle tension, requesting the presence of their mothers. The more children know about what is going to happen, the less afraid they feel. The toys help them deal with reality, allowing them to experience the painful procedure in a concrete way. A study carried out with oncologic children on the use of therapeutic play to relieve pain shows that besides scoring lower in pain assessment after playing, other pain-related characteristics were also less frequent, such as crying, facial expressions, defensive behaviors, and verbal reports.
By reducing children's fear and anxiety and improving their mood, the therapeutic play provides pain relief. Another study carried out with toddlers prepared with the therapeutic play before outpatient chemotherapy showed more positive behaviors towards the procedure while playing.
Children cooperated with the professional when acting out the procedures, kept a relaxed posture, and smiled. This study highlights the importance of playing to establish a bond of trust between the child and the professional, helping children understand what will happen to them and feel less cautious. Similar data were found in another study also carried out with toddlers recently admitted to hospital and submitted to the therapeutic play. After playing, children were happier, focused on what was happening around them, and responded better to stimuli and requests, indicating higher interaction with professionals and the environment.
Besides favoring interactions, playing also helped children accept treatment and perceive admission as less scary. In our study, actions indicating greater emotional control were prevalent in the experimental group as opposed to the control group.
The literature shows that after preparation with the toy, children can better control their emotions and collaborate with the procedure. When allowed to express themselves freely while playing, children give adults the opportunity to clarify misconceptions that cause fear and apprehension, reducing negative behaviors during procedures. However, although the toy allows children to express their emotions freely, one should not expect that they would never cry or scream during the procedure after preparation, as observed in some children from our experimental group.
Children trust the person who plays with them; they feel understood and at ease to react freely, without being afraid of professionals telling them off. Children prepared with the instructional therapeutic play before vaccination had reactions that indicated higher acceptance during the procedure.
They stayed still, collaborated spontaneously, showed to be at ease, and smiled. Reactions related to lower acceptance of the procedure prevailed among children who were not prepared with the instructional therapeutic play. These reactions included crying, pushing, agitation, muscle tension, flushing, and perspiration.
The therapeutic play was shown to be efficient to prepare children for vaccination, highlighting its value in child care. It is recommended that this practice becomes a routine not only in hospital settings, but also in all different contexts of child care. Trata-se de um estudo quasi experimental, de abordagem quantitativa. Read article at publisher's site DOI : Rev Bras Enferm , 71 suppl 3 , 01 Jan Cited by: 0 articles PMID: J Pediatr Rio J , 93 1 , 30 Jul Cited by 2 articles PMID: To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Therapeutic play: preparing the child for the vaccine.
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