Preparation Through Exposure and Medical Play

Play is a vehicle for self-expression, allowing children to express their thoughts and feelings, assimilate reality, resolve internal conflicts, and achieve mastery. Medical play allows children an opportunity to examine medical equipment that they may experience during the planned procedure. Play serves to familiarize the child with the equipment and provides the child with an opportunity of gaining mastery over the feared objects. Exposure to the equipment helps to desensitize the child, with the result that there is a less fearful reaction at the time of the procedure. Medical play is further utilized as a way to prepare children for procedures by using

Table 31-1. Guidelines for teaching children about medical procedures

Information should be provided in a developmentally appropriate format.

Explanations should include what the child will hear, see, and smell as well as sensations he or she will feel prior to, during, and after the procedure.

Language should be simple and nonthreatening, with no ambiguity.

The child should be encouraged to repeat back what he or she learned and to ask questions in order to correct any misconceptions.

To enhance learning and memory, visual aids and actual medical equipment should be used when available.

the equipment in role-playing with a doll or another person. This is a particularly useful activity with younger children who learn best by doing. In general, real medical equipment should be used as part of these preparation strategies. However, it is important to keep in mind that some children may find the real equipment overly threatening and may prefer toy replicas.

To examine the effectiveness of play to prepare a child for a medical intervention, Li and Lopez (2008) conducted a randomized, controlled study in which 203 children (ages 7-12 years) were assigned either to a therapeutic play intervention or to a control group that received routine informational preparation. The children in the therapeutic playgroup participated in a visit to the operating room, were shown a demonstration of anesthesia induction with a doll, and were given the opportunity to handle and play with the medical equipment. Results indicated that children who received the therapeutic play intervention reported lower levels of anxiety in both the pre- and postoperative periods than children in the information-only group. The same finding was reported for parents of the children in the two groups. Taken together, these results suggest that preparation that includes play and exposure to medical equipment is more effective in reducing both child and parental anxiety than preparation that relies solely on the provision of information.

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