INTRODUCTION:

“Work while you work and play while you play

That is the way to be happy and gay”.

Play is one of the most important aspects in a child’s life; it is the universal language of children. Play allows children to learn social behaviour, develop cognitive abilities as well as gross and fine motor skills and to work through emotional conflict.

The hospital is an unfamiliar environment and hospitalization is the frightening experience to a child. Play is one of the effective tools for overcoming stress. Play is essential for sick children. The child can express his feelings and aggressions through a play and thereby reduces the trauma caused by hospitalization. Play activity with children allows nurses to make a significant and warm relationship with the child, which generates ease and security and lays the foundation for a close and trusting relationship between the child and the nurse.

Relief of pain and discomfort is a major nursing intervention, the nurses play a pivotal role in kindly observing the child, to determine the play needs and provide play material.

Hospitalized children require more than recreational play because illness and hospitalisation constitute crisis in a child’s life and since these situations are fraught with over whelming stresses children need to play out the fears and anxiety as a means of coping with these stresses. Play also helps to divert their mind from pain and loneliness (Beryl Juliet Sam, 2000’s).

This study was aimed to determine the effect of play on the reduction of post operative pain experienced by children. This would help the nurse to learn to assess the nature and intensity of pain and manage it appropriately. It would also indicate the effectiveness of play therapy in the reduction of post operative pain. It will indicate the necessity of using play as diversion and helping the child cope with, so that the memory of hospitalisation will be a pleasant one.

LITERATURE REVIEW:

Bindu Khurana (2000) stated that when play is used for therapeutic purpose it is called play therapy. This term is based upon the fact that play is a child’s natural medium of self expression. Play is an important diagnostic instrument too. The selection and rejection of a particular play material is significant in the diagnosis of the disorder.

Lahes (1998) study supported the use of puppet shows as therapeutic play to decrease anxiety in hospitalized preschoolers.

Clatworthys study demonstrated that the therapeutic play is a valuable intervention with the hospitalized children.

D’antonio IJ. Stated that play can be a tool to understand and intervene with paediatric patients with emotional and cognitive growth promoting activities which facilitate more positive hospital experience and long term out come.

Lara J. Spagrud et al., (2003) Study suggested that the faces pain scale Revise (FPS – R) is a useful self report tool for assessing pain intensity in preschool and school age children who may not be able to use other pediatric self report pain measurement tools, such as Visual Analog or numeric rating scales.

METHOD:

Qualitative research approach was adopted. Pre experimental design – One group Pre-test post-test research design was used. 30 Children between (2-5 yrs) who underwent surgery and admitted in post operative ward during the study period and who fulfilled the inclusion criteria were selected. The subjects were selected by convenience sampling. The questionnaire had the following items. Part one comprised of socio-demographic variables such as age, sex, type of surgery, no of post operation day. Part two comprised of FLACC behavioural pain assessment scale to assess post operative pain in children. The acronym FLACC represents five categories face, leg, activity, cry, consol ability. The pain was assessed using observation method responses in each category are scored between 0 and 2 for a max total score of 10. Descriptive statistics (frequency and percentage) and inferential statistics (chi square), paired t test were used to analyze the study findings.

RESULTS:

Out of 30 subjects studied majority14 [46.67] children had moderate level of pain, 9[30] experienced severe pain, 7[23.3] experienced mild pain. The mean score of children before play therapy was 5.2[S.D1.98] and after play therapy was0.93 [S.D 1.046] .Paired’ value 20.28 significant at≤0.05 level. Hence it is inferred that play therapy is effective. There was no significant relationship between post operative pain and demographic variables.

DISCUSSION:

A total of 30 samples that fulfilled the inclusion criteria were selected and data were gathered from them Majority 9 (30%) children were 4 yrs, 8 (26.67%) were 2 and 5 yrs children and 5 (16.66%) were 3 yrs children. Regarding sex majority 26 (86.67%) were male children and 4 (13.33%) were female children. Most of the children numbering 27 (90%) underwent congenital anomaly correction surgeries. 2 (6.67%) children underwent other surgery and 1(3.33%) child underwent abdominal surgery. Regarding the post operative day majority 26 (86.67%) children come under 1^st post operative day and the remaining 4 (13.33%) children on 2^nd post operative day. Out of 30 subjects studied a majority 14 (46.67%) children had moderate level of pain, 9 (30%) children experienced severe pain. 7 (23.3%) children experienced mild pain. The mean score of children before play therapy (n=30) was 5.2 (S.D 1.98) and the mean score of children after play therapy n=30 was 0.93 (S.D 1.046). The obtained ‘t’ value is higher than the table value, ‘t’ = 20.28, P £ 0.05. This indicates that there was significant reduction in pain scores and so the play therapy was effective. Maheswari (2003) in her study analysis has concluded that there is effectiveness of play therapy in reducing the post operative pain for children who had under gone minor surgeries. The obtained chi-square value is less than table value at 0.05 levels. This shows that there is no association between the post-operative pain and the selected demographic variables. The investigator identified no association of pain with regard to the child’s age. This may be due to the fact that even though pain is unique, the younger children are not more conscious about their pain. Hence the perception of pain intensity by them is similar. A study conducted by Schumacher and Vande Wijngaar found that the pain intensity is not age related A similar study conducted by Goodenough et al., suggests that no sex difference exists in young children’s ratings of pain intensity and unpleasantness. Hamers et al. found that the more severe the diagnosis the more inclined the nurses were to assess the pain experience as more severe and consequently to justify the administration of an analgesic.

Implications:

Behavioural techniques like distraction, imaginative involvement should be used in the management of pain. They can be used independently or in conjunction with drug therapy. Toys can be provided to the child undergoing a painful procedure in order to divert the child from painful sensation the nursing personnel have to plan and allot time everyday to provide play for children. Comprehensive assessment of the pain of infants and children with special emphasis on play therapy need to be incorporated in nursing curriculum Update the nurse’s knowledge about current practices and treatment through workshop and conferences Though many studies are done in this concept in other countries. Such studies need to be undertaken in India in future.

REFERENCES:

1. Abbot K. (1990) Therapeutic use of play in the psychological preparation of preschool children undergoing cardiac surgery Issues comprehensive pediatrics nursing 13(4): 265-77

2. Adele Pillitteri (2007), Maternal and Child Health Nursing 5^th Edition. Philadelphia. Lippincott Williams and Wilkins (1095-1104. 1159-1176)

3. Cecily Lynn Betz et.al., Family Centered Nursing Care of children. 2^nd edition Philadelphia W.B. Saunders pg.(620-625)

4. Christine Greco, M.D. et.al., (2005) Pain management for hospitalized patient pediatric clinics of North America 52(4) 995-102.

Received on 03.03.2014 Modified on 02.05.2014

Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 288-289