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1.RESEARCH TOPIC
Restorative Benefits of Paediatric Ward as a Play Environment in Nigerian Hospital
2. RESEARCH AIM
The aim of this study is to investigate the restorative benefits inherent with play activities in a paediatric hospital setting.
3. RESEARCH OBJECTIVES
The following objectives are formulated, to achieve the stated aim.
i. To identify the problems patients and caregivers are facing due to lack of play and activities in a hospital ward;
ii. To observe the benefits of play using “loose parts” as it affects children and improves their restoration towards a feeling of well being; and
iii. To develop a guideline as to how future paediatric hospital settings will be designed to provide restoration based on children's preferences.
4. ASSUMPTION
There is growing evidence that stress and anxiety has attracted attention from researchers, health care provider, and designers. Which shows that hospitalized children are faced with psychological challenges which affect their hospital stay? This is as a result of their new and unfamiliar settings, which add stress and in return delay their restoration (Dise-Lewis, 1988; Varni and Katz, 1997; Varni, Rappaport, and Talbot, 1991).
It isfor now an assumption that if the paediatric ward can be changedinto a play environment, where patients can play with elements and materials from the theory of “loose parts” under monitoring in line with hospital and medical protocol. It can improveon a child's ability in coping with stress, and to adjust their emotional state, social connection, physical development, trust and acceptance of routine medication.
5. RESEARCH QUESTIONS
i. Why would a paediatric ward being conceived as a play environment have an effect on patients psychologically, and improve on their feeling of well being?
ii. What are the measures taken in providing children with play experience in the paediatric ward?
iii. How would children perceive the hospital ward, looking at setting as a play environment?
6. RESEARCH BACKGROUND
Most of the present paediatric ward settings in Nigerian hospitals deliver health care in relation to protocols and medical norms. The hospital only considers pathogenic approach in the format of biomedical treatment of illness and control of the spread of disease. With emphasis on the provision of equipment and facilities that adds functionality to some extent, but psychologically inefficient to improving the well being of patients. The formal introduction of western medicine in Nigeria was dated back to the 1860s, when the sacred heart hospital was established by the Roman Catholic missionaries in western Nigeria. The first set of catholic priests arrived in Abeokuta on the 29th of June 1880 and the first catholic missionary sisters on the 3rd of March 1886. It was at that time that health care delivery entered Nigeria, by meeting the medical needs of the communities, especially children at the mission homes. The missionaries were the first health visitors to bring western medicine to Nigeria, they played a vital task in providing modern health care in Nigeria inthe 1960s, they operate about 40% of the total number of missions based hospitals (Manuwa,1971).
The mission also played a vital role in the training and education of medical personnel and with further advanced training abroad; these were based in areas that they have religious influence and other activities. By 1954, almost all the hospitals were operated by the Catholicmissionaries, the Roman Catholic with the Sudan interior mission operated other facilities in the northern part of the in the country which remain as part of health care facilities up to the 1990s (Manuwa, 1971).
Figure 1: The Sacred Heart Hospital, Abeokuta, Nigeria Established in 1880, this shows the indoor setting of the ward.
The present day architecture and settings of the paediatric hospital environment is of the traditional missionary style improved upon through the last five decades after independence. As shown in Figure 1, emphasis is on the provision of medical care, and prevention of the spread of disease. As such the environment is more for treatment and housing of medical equipment, beds, cabins, hangers, nurses’ station, and aisle for movement, toilets and bathrooms, doctors call rooms, dressingroom.As such the spaceprovided and distance from one bed to the next does not allow for room and spaces, especially in the children’s ward for free movement and play activities.
There is a lack or minimal consideration givento other environmental and physical features that naturally improvethe healing process and patients feeling of well-being.This shows enough reason for caregivers, hospital management and designers to start looking for avenue of changing the present hospital settings with features and conditions for creating a restorative environment(Monjour and Yisong, 2012).
It is evident that the hospital designs have failed to incorporate an enabling environment to neutralize unsuited seen that positively affects the psychological needs of patients, caregiver and family members(Monjour and Yisong, 2012). The paediatric ward design is based on adopted conventional format, adults’ views, health policies and protocols (Figure 2).
Figure 2: A view of nurses’ station, beds spacing and condition of the hospital ward
The contribution of the physical environment to the healing process has been accepted for many years. In 1863, Florence Nightingale discovered and practices the benefits of exposing patients to fresh air, sunlight, water body, vegetation, and animals. Exposing patients to environmental factors and features, as well as socializing with other patients and caregivers to enhance their recovery processes. It means that physical settings can enhance the effect of medical treatment and recovery statue of a patient. Studies in the field of human medicine and other related areas like human development, environmental psychology and health care,hasindicated that there is relationship between nature, human, and well being. The Biophilia hypothesisof (Wilson, 1984). Stated that human beings have a natural instinct with nature for their psychological, emotional and spiritual needs (Derr and Kellert, 2012). Human desire for natural settings has been established by much research work, which shows that nature offers an avenue for a feeling of well-being and re-cooperating from the effect of acquired stress (Joye and van den Berg, 2011). A further study on health outcome and feeling of well-being is the Antonorsky’ssalutogenic concept, an approach to health. The emphasis here is that well-being has a relationship with human activities, social relationship andwith a strong belief and good will from family and friends human health can improvetowards feeling of well-being (Dunleavy et al, 2012).
7. PROBLEM STATEMENT
The thought of conceptualizing a paediatric ward as a play environment is to fosterrestoration to hospitalized children in Nigerian paediatric hospital wards. This can be attained by changing the present hospital ward settings with positive distraction, such as play activities for paediatric patients as part of their normal hospital ward.This is as a result of lack of provision of any kind of features or settings that can improve on children’s coping skills and distract their attention in a positive manner.As children are taken to hospital, they noticed that the environment is different and away from their home and school environment,which is familiar and give them room for playfulness, and to a new environment that is unknown and unfriendly. They are highly introduced to different foreign objects and different, unfamiliarpeople potentially causing them considerable fear, stress and anxiety. For a child with a vivid imagination, anything can be terrifying.The usual practice is set of personnel all dressed up neatly in white uniforms with hypodermic injections with needles for blood draw, temperature thermometers and weight measurement scales or posture still for scanning and X-ray test. As such, they consider the hospital environment threatening and they can develop additional stress and trauma during a doctor's appointment orhospitalization (Said, 2006).
Children need an environment that can direct their attention away from pain and anxiety, which can be achieved by exploring the use of structured playusing elements from loose partsto enhance children's performance. In connection to the childrenphysical, cognitive and social functioning.Despite the many positive research carried out in developed economies around the worldson improving children hospitalization.In relation to minimizing their stress, painful experience and reducing their length of hospital stay (i) it is evident that such efforts in the Nigerian paediatric health care environment have not been givenmuch priority, and (ii) the climatic condition in the study area does not allow an enabling environment to employ finding from studies conducted in other developed economies around the world such as Malaysia in the areas of garden and landscapemostly outside the ward. Because of the shorter periodof raining season within a year, and lack of enough water provision which makes it very expensive to maintain either a garden or landscape in almost all the hospital environment.
Playing in an organized setting in an indoor environment can be used to replace the outdoor play features that are found in gardens and landscape environments. And children need not to come out into the harsh whether to play.The provisions of synthetic loose parts indoors can be used to trigger their attention positively to attain the needed objective of restoration in relation to their healing. The hospitalenvironment and settings should be able to assist with their restoration towards improving their physical, social, and cognitive development.This forms the three main features of human development which expands during the process of human growth.The physical development involves physical growth and maturation which include gross motor skills, which involves large muscles of the legs and arms that are used in running and walking, and fine motor skills which have to do with fingers, toes, eyes and other parts like the brainthose are used for activities such as drawing, writing, grasping objects, throwing and catching. The cognitive development is linked to changes in person ability to reason which involves stages such as a sensory motor stage, the pre operational stage, concrete operational stage and the formal operational stage. And the social development is linked to the changes that occurs as a result of person ability to control his or her feelings. The three areas of development are different in a way, but they work together and influence each other.The physical development of the brain, allows cognitive advancement to progress and think of a solutions in different ways, and the same cognitive involvement gives room for better social and emotional feelings (Mcdevitt and Ormrod, 2004).
A child's health care environment restoration can be defined as stress reduction in an unthreatening environment which allows for physical movement and exercise (Ulrich, 2002). It is as a result of locomotion, physical and social interaction of person with the features and element of the environment. Which can be explored through play, as play is the most important activity in the lives of children and as a medium of interaction with their environment. On the other hand, healing or restorationis defined “as the casual relationship of man with the environment, the cause is the physical elements and the natural forces of the environment” (Said, 2006). Studieshave shownthat restorative environment is conceived as places that provide an avenue for recovering from stress, and renewal of health, and the ability to focus attention (Hipp and Ogunseitan, 2011).
The health benefits of restorative environment are highlighted by the attention restorative theory (ART) of Kaplan and Kaplan (1989) and Kaplan (1995).The theorymaintains that coming in contact with the natural environment has the ability to improve patient’s cognitive attention, which promotes human interpersonal and social functioning.The theory argued that an experience in an environment which is compatible with one's preferencecan enhance physical, psychological and social wellbeing especially when there is amount of time spent in that environment (Hansen-Ketchum et al, 2011).
The participants in this study explainthat places in nature or activities that providedthem with the sense of feeling like being away from the stress of modern life.Relayson participant preferences which include a chance for unstructured play, view of water bodies and quietness among others. Further studies on the restorative environment as explained by (Said, 2008).“Is that the restorative environment, restorative garden, therapeutic landscape, therapeutic garden, healing garden, healing landscape, often refers to the same thing and carry a similar meaning, which means, recovery from illness, diseases, injury, or other impairment.”
Studies in paediatric nursing have shown that medical protocol and the hospital settings, increase stress and negativehealth effect on children. They show signs of aggressiveness, fear of pain, emotional regression, loss of appetite and sleep which further result in adding more illness (Nandineni, 2013).Such problems were due to factors like fear of illness, new environment, and changes in their usual activities. Anxiety has been reported to be the most stress related child’s experience, many developing nations such as Nigeria, have their peculiar problems which increases the level of anxiety experience among hospitalized children. Examples are lack of proper funding, high poverty level and implementation of few conducted research. A compilation of the causes of child hospital stress by Coyne (2006) in(Jolley, 2006). Found the following as the causes of stress during children hospitalization.
(i) Separation from family and friends:Disruption to the family routine, normal activities, peer relationships, school achievement;
(ii) Being in an unfamiliar environment:fear of the unknown, strange environment,professionals, noisy ward, and bright lights at night, hot environment, inadequate play facilities,and food;
(iii) Receiving investigations and treatments: Fears of operations, needles, mistakes in treatment, harm to body, pain, dying; and
(iv) Loss of self-determination: loss of independence, restricted activities, lacking control over personal needs, lacking control over sleeping and waking time, lacking control over food / meal times, lacking control over timing of procedures.
Because of the extended family system practiced around the study area in Nigeria. Where people stay together in a large family house and children grow up among many age groups and peers, it is very difficult for a child to cope with isolation as a result of being sick. Being in a different environment, and not use to eating or sleeping alone without their siblings and friend. Fear of the unfamiliar and unforeseen, not able to play at will among peers and move around at the child’s own time. Such situations may add up to his worries and additional stress during hospital stay.