This Podcast is brought to you by the GOSH Learning Academy.
SA: Hello and welcome to a brand new series on GOSHpods - PlayPods.
The play team are an indispensable part of the MDT at both Great Ormond Street Hospital and in children's wards across the country. We're very lucky at GOSH that we have a play team that's been around for almost 50 years and is entirely funded by the GOSH charity. Play is vital for promoting wellbeing in babies, children, young people, and their families. It offers a safe outlet for big emotions, a space to feel grounded, and it can act as a means of understanding and navigating the complicated and scary world of healthcare.
In this four-episode series, we're going to explore the power of play and the role of the play team at Great Ormond Street Hospital.
I'm Dr. Sarah Ahmed, a paediatric registrar, and the current digital learning education fellow here at GOSH, and in every episode I'll be talking to members of the play team.
In today's episode, we're going to be talking about the role of play in procedures.
Thank you everyone for joining us today. I wondered if we could start off with a round of introductions because I'm joined by some wonderful members of the play team. So if you could just tell us a little bit about yourselves, that would be great.
HP: Hi, I'm Holly. I'm a play specialist at Great Ormond Street on Pelican Ward.
CH: I'm Charlotte. I'm a Senior Health Place Specialist at GOSH on Eagle Ward.
SSL: And hi, I'm Sian and I'm super pleased to be able to share experiences and knowledge on behalf of Cheryl, who is a play specialist on Bear, Flamingo and Walrus.
SA: Amazing. So you all work in different areas and you've all had kind of various journeys getting here. Do you want to just go around and just tell us a little bit more about the roles in which you work?
HP: Yeah, definitely. I'm Holly. I have been at GOSH for five years now. I started the career quite young, as soon as I discovered the job I knew it was something that I was really passionate about and I've been here at GOSH ever since. I work on Pelican ward, which has a variety of specialities, including Rheumatology, Dermatology, Immunology and Infectious Diseases. I support children on the inpatient side where they'll be staying in hospital overnight, perhaps for long periods of times, and I also might help prepare them for general anaesthetics or coming to terms with their new diagnosis of their medical condition. And then I also support them on the outpatient side when returning for their treatment. I'll often support children having cannulas, blood tests, injections and skin biopsies.
CH: And I'm Charlotte. I've been qualified for nearly six years and I've worked at GOSH for all this time. I work with patients who have kidney problems and they're either on dialysis, they might need a transplant, have kidney disease, have an acute kidney injury or another condition relating to their kidneys. I work mainly on the ward but also in pre-transplant and surgical clinics and I work really closely with the wider MDT team. Most of my work is with our dialysis and transplant patients, and I often get to know these families really well over long periods of time. A transplant can seem really daunting, so it's nice to be able to help ease some of these worries and anxieties. It's such a rewarding journey to be on with these children and young people.
SSL: And on behalf of Cheryl, so Cheryl has been qualified since 2001 and she's worked at GOSH ever since, all through GOSH on wards like oncology and uh, BMT, but certainly for the last 14 years she's worked in cardiology. And her patients range from infants with congenital heart defects coming in for surgery and those that have got assisted devices and heart transplants. And she splits her time actually between outpatients and inpatient wards and helps us support children through bloods, diagnostic tests and preparing them for surgery. So in the inpatient ward, she also does post procedural play and therapeutic play but we'll get onto more of that later.
SA: Yes. Well, getting onto some of that we tend to start these podcasts by talking about learning outcomes because we want this to be informative, but also an educational resource as well. And so what would you like people to get out of listening to today's episode?
HP: I think we would love for people to be able to understand more about our role as play specialists and what this means when children and young people need hospital procedures. We hope that we can explain a bit more about the different ways that we can support and the techniques we use to support patients before, during, and after these procedures.
We would love to create a message that coming into hospital and having treatments or a long-term health condition doesn't have to be a negative thing. As play specialists, we can help to provide skills and support patients to cope.
We would also, of course, love to inspire others to get into a very special, unique job role.
SSL: It’s such a special, unique job role so having the opportunity to talk like this is brilliant. And one of Cheryl's wishes is that it's really important that we are able to share and explain how we help and support lots of the clinical teams that we work with and that we advocate for the child and young person as a whole.
CH: I think we also want to be able to help people to understand how anxiety and worry in hospital can be reduced to make the hospital a much more positive experience. It doesn't always have to be a scary place every time you visit and actually we can support children and young people to cope with their hospital experience by providing them with their own set of skills to make their hospital stays much easier. It's so important for them to be heard and so our job role involves a lot of listening and understanding their feelings as well as reassurance that it's okay to feel a certain way.
SA: Yeah, I think that's so important. Everything that you've said, especially about how it's really important for these kids to be heard. And, and that is okay to feel a certain way because hospitals can be scary and procedures can be scary.
Can you maybe tell us a little bit more about some of the different types of play in healthcare and some of the ways that you in the play team get involved and support children?
SSL: Yeah, sure. So, you know, there's really three main types of play as a play specialist would be involved in. And these are distraction play, preparation play, and something that we call post procedural play. And Cheryl has shared that she uses distraction play a lot during a procedure to distract the child or young person, or if an intervention is about to happen. And she uses distraction play a lot with her cardiac patients to help divert the child's attention away from something that might be worrying or anxiety producing or painful.
HP: Preparation play is used before a procedure to help prepare a child for the procedure happening. This could be in a role play way, maybe using the child’s favourite teddy, toy or doll. For example, if a child was having a cannula to have an infusion that day, I would often use a real life medical cannula with the needle taken out, age dependent. And sometimes preparation play may also involve using social stories, which is a storybook made often with the patient as the main character using photos to explain what the procedure that they're having looks like. The aim of preparation play is to give the child as much information needed for them to feel aware of what is happening to them.
CH: And then the last type of play that Sian mentioned is post procedural play, which is used after a child has had a procedure to help them recover from that procedure, but also to give them a space to reflect on what happened and make sense of that particular hospital experience. It's a really useful time to be able to chat with a child and see if there is anything they would like to do differently next time, or maybe even to reflect on if anything went slightly better than they thought, which is always a really rewarding conversation to have.
SA: It's really enlightening hearing all these different types of play and just the amount of work that you guys do in the play team. Could you go into a little bit more detail and just tell us a little bit more about some of these different types of play?
CH: Absolutely. So preparation play is actually the type of play that I probably use the most. I work with kidney transplant patients and so preparing these children for the journey ahead is really important. I'm lucky that I'm fortunate to have time on my side and I can work with patients over a number of years for their transplant. Lots of the patients that we all work with will have long journeys ahead of them and so we want to be able to help them as soon as we can before any trauma is made and the best way to do this is with preparation.
Equally, some of the children we work with will have never spent time in hospital before and so helping to prepare them for something new is really valuable.
Our main goal of preparation play is to help that patient understand their condition and increase their ability to be able to cope with the treatment, allowing them a safe space to ask questions and feel their wants are being listened to is really important. And the difference that it can make is massive.
SSL: Yeah, it's so important that we break down those different types of play because they're so unique. And when I was talking with Cheryl, she shared that she uses lots of different ways to prepare her cardiac patients. She often uses medical kits to let them play out the procedure. And this really helps with becoming familiar with the instruments and the steps involved in that and visual aids, such as models and dolls, actually, to show what happens. And explaining in a language that is really appropriate for the child's age and understanding.
I know that she loves to do ward tours and when she arranges them, the child and the parents often visit beforehand so it gives them a real sense of what their environment looks like, how it feels, the sounds and the smells. And reading books that depict characters is really important, especially if they're undergoing similar procedures to what they are coming in to do. And there's a book from the British Heart Foundation that actually Cheryl and another colleague helped to create which is really impactful.
CH: I actually also have a prep book that I used that was created by someone who had a kidney transplant at GOSH when they were younger. It's such a useful resource and it's specific to Eagle wards and I find this really helpful, particularly for a child friendly way of showing them what they might look like when they wake up from a transplant. And my favourite part is there's a picture of a teddy and it shows all of the lines that they'll wake up with. We also have a teenage version of the book as it's important to recognize that teenagers need more in depth preparation and most of the time like to understand things in a lot more detail. By using these books, it opens up a space to talk about their procedure or diagnosis and an opportunity to ask any questions that they might have, as well as allowing them to understand much more about their journey.
HP: Yeah, and I often make prep books too using the patient. So we take photos of the patients and use them in their actual story. And they love getting involved, taking photos of their treatment to create their own book all about it. I also find while creating the book together, the child is learning a lot more about their own condition.
Um, and then we have distraction play, which is slightly different. So the aim of distraction play is to take the child's focus away from the procedure taking place. However, I would always give my patients the choice if they want to look what is happening or if they'd rather look away. This can also be really tricky for some patients as some will want to have the initial control of being able to see what is happening but will not want to add to their anxiety by watching. So sometimes I'll often distract, let's say with a search and find it book. I have one all about emoji poo and that is a really big hit. So we will use that by blocking their view and concentrating on the book and trying to find the emoji poo. But I will let them know when and what is happening if they choose to know. And on the other hand, some patients will want to be completely distracted and not be told anything about their procedure. It is really their choice. I think it's really important to always give the patient a choice and to not suggest that they shouldn't look, as this may create more anxiety around the procedure than needed. And half the time, the patient is so interested in the book, or the game, or the iPad, that they actually distract themselves without even realising.
Distraction play is a great tool, when used correctly, to support children in hospital. And there's quite a few methods of distraction play, and I tend to fit this around the procedure that the child's having and the age of the child. So we may use an iPad to cover and sing songs for a baby and use sensory toys to distract. Whereas, on the other end of the scale with a very anxious teenager, we have used guided imagery to completely distract and imagine that they are completely somewhere else while having the blood test. This can be really effective, especially for a patient having weekly blood tests. We can keep going back to their favourite place and adding more to the story or change it.
SSL: Guided imagery is such a powerful tool that a lot of the team are able to use and um, this method of distraction can involve engaging the child in, in lots of different activities or games, but in a different setting. So it captures their interest and focus.
Cheryl was sharing with me that there are lots of examples of distraction play that she does with patients. And Holly's talked about tablets and handheld devices, but interactive stories, listening to music, watching a favourite film, something that's age appropriate that they really enjoy that they're able to connect with means that they get to choose the activity you know, and making choices and helping them do that is, is super important.
Then you have post procedural play, which is probably the type of play that Cheryl uses the most, and she feels that the post procedural is just as important as play as it plays a really crucial role in, the overall hospital experience and recovery and it actually complements all the other play that happens. So after a procedure, children and young people really do need that time and space to actually process what's happened and what they've experienced and post procedural play helps them to understand that, and also make sense of all the different feelings, which is actually really essential for their well being. And Cheryl's role will be to go along and sit alongside them, whether they're on the inpatient ward or in outpatients to talk through what's happened and to provide lots of reassurance and emotional support. So it really does help them feel safe and cared for and held really nurturingly. So positive post procedural experience can actually help to inform and provide positive aspects to their experience. You know, it may have been the first time they came into hospital. They may have been here multiple times. But it also can help towards that successful pain management and how they communicate that with other people and how we can support them in that. And actually, you know, one of the things that Cheryl shared with me was it really does help to reduce the fear and anxiety about any future procedures.
CH: Yeah, I think I'd absolutely agree with what Sian's saying. It's so helpful post procedural play and particularly if a child has a, had a more traumatic experience to be able to then spend some time with them afterwards and talk through what's happened and even ways that we can improve for the next time if they were to need this procedure or something similar again. I often chat with them about tips on helping other children too. It makes them feel really special and that they've achieved something massive, which of course they have, but it allows me to also understand what they were thinking and how I can help other children who might be feeling the same way. I think we can learn so much from our children and young people, and actually they're always so honest.
HP: Yeah, I would definitely agree. Also, it gives the patients time to reflect and discuss anything they needed to with us. Sometimes just popping back and saying hello, maybe just playing a game of Uno can help the patient de stress from the procedure that may have happened earlier that day. It can also help the child to separate you from the procedure and know that we're also here to support them, but also here to have fun.
For my patients who come back regularly, post procedural play is so important to add something positive to their regular visits. And I think it's really good that it also symbolizes that the procedure is over and there is a clear end to that.
CH: I think actually what Holly's saying about playing a game there is really important as well, and going back and spending that time with them. And my favourite post procedural activity that I've done before is actually creating a game with a group of long term patients on Eagle that's based around the ward and kidneys and medical items that they'd come in contact with. It really allowed them to connect with each other, talk about what hospital means to them, but it also normalized the medical equipment and the staff who loved getting involved too.
SA: I really love all the different examples you're giving and especially creating things with the patient like stories and games. I just think that's so empowering.
You've talked about this a little bit about some patients who are long term, some who might be in hospital for the first time. Does that change how you would approach a child or a young person when you're offering these kinds of play?
SSL: Yes, it's a really good question, isn't it? And I think each of us do things in a different way and there's often a difference between how you approach any patient because each one of them is individual. But if it's their first visit compared to a long term patient this may be a very different approach in how you are able to instigate that support.
CH: Yeah, absolutely. And I think a long term patient like mine on dialysis will be so familiar with the hospital environment and hopefully quite comfortable with visiting the hospital. I find that my support with these patients is then less preparation and distraction, but more psychological support as it can be really tough being a child or young person growing up with a long term health condition. Having this safe space for them to talk with somebody they've learned to trust is really so important.
Although being a long term patient also means that you've had a lot more experience of being in hospital and that can be both good and bad. Therefore, we might find that some patients get anticipatory fear of a procedure because they've had a previous bad experience. Often having a procedure more than once doesn't actually make it easier each time and sometimes for some young people, it can be made harder as they know what's coming and so the anticipation creates a lot more anxiety.
HP: Yeah, I see a lot of new patients who come to us for their first visit, and they also struggle with anticipatory fear, as it's something unknown to them. I'll definitely take it slow with these children and introduce myself, perhaps do some general play activities, which are always really important. And then I'd get to know the patient and see what support I can offer. My patients’ often admitted for a short term stay and then they returned for treatment options on the outpatients department. I do a lot of work with these patients and their families, preparing them for their routine blood tests and infusions that they have monthly. So we often create like a contract on how they would like their procedure each month. I think it's really important as it gives the patient some control over their long term medical condition. Often these patients will come for years, each month, so we really try and make it as fun and inclusive to them as possible.
CH: I think I absolutely agree with what you're saying about getting to know a patient and that being so important. Often when they come to hospital as a new patient, everyone speaks about the medical condition a lot and actually, it's really important for them to find out who they are. So by asking about their pets, their siblings, their friends, or even their school, you can really build an instant rapport with them because you're showing them that you care.
SSL: Yeah, it's so important start that connection really early on. So Cheryl has shared that if she has a new patient coming into the three areas that she works across, she would introduce them and their family to the hospital environment and the routine and the staff as it's, she thinks it's so important to offer reassurance and actually give space and time to answer any questions that they might have, or if they might be anxious about the visit. And sometimes we don't know that initially. Showing empathy and understanding towards the feelings and fears is really important and using age-appropriate language to explain those things. And actually, you can also educate and provide some resources on material so they can understand the situation a little better but also go away, take time to read that and then come back with any questions they might have.
Cheryl also shared that if she's working with long term patients, she tries to actually maintain that consistency in care. Because what we know about being in hospital is that things happen at all different times and you can't always plan them. And so being familiar with the child's medical history and any past experiences is a great way to offer continued support if needed. The feeling is by understanding and addressing the unique needs and experiences of both those first time patients and those long term patients we can provide effective and compassionate care.
SA: Yeah, I completely agree. Do you think we can maybe bring this all together and talk about it in terms of specific examples? So I think the biggest procedures I can think of in paediatrics for my work as a paeds reg is bloods and cannulas. And I've been in so many different um experiences with children who are terrified about what's going to happen. Does your approach differ depending on what procedure it is that you're going to do?
CH: Yeah, absolutely. We all have different ways I think of approaching different children in hospital and particularly for different procedures and there are many different ways that we can help them. I'll talk a little bit about blood tests. So blood tests are one of the most frequent procedures that happen in hospital and can often be one of the most traumatic for some patients. Blood tests are also often, or at least I find, one of the hardest to prep for. With a patient having a new line or a scan, you can show them the medical item or equipment, and it can be quite helpful for them to see and feel it. Whereas with a blood test, needles are much harder to do preparation with as they can look very scary. We have ways around this though, and for my youngest patients I have prep books, which we've spoken about before, which are a little bit like a storybook and they help explain step by step for a certain character what happens during that blood test. Whereas for the slightly older children and our young people, I have a blood hand, which is made from model magic and means that teenagers can safely use a real needle, insert it into the pretend hand and actually use a syringe to pull back the pretend blood. This can be quite fun to do together and often parents and siblings will join in as well.
I also create plans for children on how they would like their blood test done and give them as much choice as possible. It's always good to try and do this in advance of the blood test when they are feeling calmer as it means that they are able to make the decisions and choices that they would like for themselves. These could include options like having the cream or the spray, whether they might like to sit on somebody's lap or by themselves on the bed and also if they would like to watch the blood test happening or as Holly mentioned before looking away and maybe engaging in a find it book. I often then print it out so they have a copy to show medical professionals involved in their care in case I'm not present during the procedure.
HP: As mentioned for preparation play, I would often use the real life medical equipment to prepare the child as this will be the same one used in the procedure. While using the real life equipment, it often helps the child desensitize from the cannula being so scary. I would often set up a tray identical to the one that the healthcare professional will use. And in a roleplay manner, the patient and I would practice using the equipment to cannulate their toy or teddy or even parent. It's always really good to get the parents involved. When the patient can see and carry out the step by step procedure themselves, I find that anxieties often reduce. It is usually the preconceived idea that this procedure is going to be bad that makes us so anxious.
I also love getting creative with preparation play. I use the cannula with watery paints to create cannula painting. It's a really fun way of using the cannulas and syringes to, again, desensitise from the equipment and have some fun. We use big sheets of paper or sheets and cover them in paint splats. The children really enjoy this and it also gives them an opportunity to see how the cannula works. I think the most rewarding thing about preparation play is meeting a child who may be incredibly anxious that they have just been told that they'll need the cannula, and by spending some time with them explaining, showing, and playing, you are able to relieve even a tiny bit of anxiety in order to support them in their procedure.
CH: I absolutely also love cannula painting as a way to prepare, although I'm often in trouble with the cleaners when it's all over the ceiling and walls, but the children think it's hilarious. And so as long as they're having fun, that's all that matters.
SSL: It is the best activity ever. That's all I'm going to say.
So, I talked with Cheryl about long term patients and, and the support that she gives them during cannulas of blood tests and, it's really important, I think, to have consistent explanations of what's going on and acknowledging that it's unfamiliar and familiar in the same vein. So Cheryl would do some medical play, but with a more advanced and detailed explanation often, if appropriate, to the level of understanding and, and any of the previous experiences that they have had. She uses more sophisticated distractions, such as guided imagery, which we've talked about already, and breathing techniques, and just continuing to provide that ongoing emotional support and validation.
If she's working with a new patient, she's provides therapeutic play, undergoing a blood test or having a cannula and actually it helps her to gather lots of information. As we've said all along, you know, picking up those nuggets of information and assessing as we go along is really important. And language is really important and it being age appropriate. And how the different steps happen and when they happen, I think for children and young people, it's what's going to happen now, next and later, which is really important. And Cheryl, interestingly said that acknowledging the child's feelings actually is okay, or the anxiety that they shows and reassuring them that some of those feelings are normal, but that they're safe and you know, we're going to work together through what's going to happen next.
SA: I love that. I think as someone who often does the procedures, doing it on a patient who's scared or has anxieties, and they're not being appropriately supported through it, it's really difficult. And so knowing that you guys in the play team have tips and tricks and techniques in order to help those children get through something that is really very scary is really wonderful to hear. But there's only so many of you and you can't be everywhere at once. And we're very lucky at Great Ormond Street with the fantastic play team that we have that's funded by the charity, but other hospitals may not have as many play workers around or as available or it might be the middle of the night or something. And so is there anything that a non-play trained healthcare professional like myself, like a doctor or a nurse, can do if they're supporting a child while they're having a blood test or a cannula, or if they're even the person doing the blood test or the cannula?
HP: Yeah, I think it's so important to involve a play specialist as early as possible when you notice a child is anxious, as it can help prevent further trauma. However, anyone can make a hospital environment friendly. I think it's important to remember, although we work here every day, to a child or young person, stepping foot inside a hospital building can be a really, really scary thing. It's always a great place to start interacting with the child in order to connect with them, perhaps noticing an item of clothing or a toy that they have with them and pointing this out and engaging in a conversation from this can really help a child feel at ease with you. Asking about pets or hobbies can also help create that initial connection with the patients and families. I'm a dog lover and I'm a dog mom, so I'll always ask my patients if they like dogs and what type of dog they might have.
CH: I definitely agree with Holly. Those early connections are key to building trust and rapport, and we should all be having those interactions with the child or young person. It really will make such a difference to their hospital experience.
SA: I'd love to keep talking about this, but we do need to wrap things up a little bit. Is there anywhere that people can go to find out a little bit more about what we've spoken about today?
SSL: I think something that's really important throughout these episodes and this podcast is that there are play teams up and down the country and they are super friendly and will always say hello and welcome you and support you as much as they can. It is really all about teamwork. And children and young people who have long term health needs, know what works for them. And so listening to them and asking them about what they want to happen is really super important. And making that connection with the child and young person in the family is key to everything that we do with children and young people.
SA: So finally, just to completely wrap things up, do you guys have any takeaway learning points for our listeners?
CH: Oh um, I think for me, it's always to make sure a child's voice in hospital is heard and that we speak up and advocate for them. It's so important and will make such a difference to their hospital journey.
HP: Yeah, I also agree with that. And I think hospital, it can be a really fun place. It doesn't always have to be scary. And being a place specialist really is the best job in the world.
SSL: And I agree with all of those things. And I think that, you know, communication and connection makes such a difference for children and young people. And actually, play is that thread that brings all those things together. Play is all around us and it's what children and young people know. So having access to it and bringing it to the forefront can only be a good thing.
SA: This has been so fantastic and what wonderful sentiments to end on. Holly, Charlotte, Sian and Cheryl, thank you so very much for talking with me today.
SSL/CH/HP: Thank you
SA: Thank you for listening to this episode of GOSHpods PlayPods. You can find out more about the play team at their Instagram page @GOSHPlayTeam. We would love to get your feedback on the podcast and any ideas you may have for future episodes. You can find a link to the feedback page in the episode description or email us at
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We hope you enjoyed this episode and we'll see you next time. Goodbye.
