Nurse Adriana Ramos 

Master’s Student in Nursing 
in Child and Paediatric Health

Caring and playing in pandemic times
Necessary and healthy

HPA Magazine 15

On the 11th March 2020, the coronavirus infection was declared a pandemic by the World Health Organization. This new virus has led to the need for changes in everyone's lifestyle. A pandemic inevitably has an impact on any population, leading to a reorganization of the various institutions and services, namely health services, with new rules and increased precautions. All these changes require health professionals to quickly adapt to a new reality, until now unknown, and to readjust the health care they provide. 

In Paediatrics, childcare needs special attention and a reinforcement of humanized care. The concept of the child as such, has undergone changes over the years, from an individual with no interest to society, until today, where children hold an important position in society, with rights of their own. Nursing care has therefore ceased to focus on the biomedical model, disease and dressings and is now focused also on prevention, well-being and the relationship with the environment, having developed a holistic view of the individual.
When taking care of a hospitalized child, we find a human being and his family immersed in emotions, physical exhaustion and social vulnerability, which requires that the nurse not only understands the disease, but must also recognises and is sensitive to the peculiarities of each individual.
Illness, hospitalization and pain are stress factors for children. The child's exposure to repeated traumatic episodes, activates biological stress responses, resulting in behaviour alterations and emotional consequences and trauma. The stress response consists of the interaction of a set of systems that aim to alert and protect the organism against external threats. In a child, who is in the development stage, the repeated activation of these systems will condition the development of the structure and functioning of his brain, with consequences in the way the child relates to himself, to others and to the environment. The main causes of stress in children that are hospitalized is a fear of the unknown and the loss of control. Depending on age and cognitive development, children have several fears during medical care, including physical injury, pain, nursing procedures, separation from parents, an unknown environment, instruments and equipment and loss self-determination.
 

It is the nurses' responsibility to carry out interventions aimed at reducing the impact of the unknown on the child’s fears, such as the use of therapeutic play.
Therapeutic play can be defined as a set of interventions aimed at promoting the child's well-being during hospitalization, such as a set of activities structured according to the child's health, age and development. Thus, it is not just a recreational activity, but an activity which is planned with a goal.
Numerous studies show that therapeutic play helps to improve the child’s attitude and behaviour, since it is through play that children can understand and accept situation they are experiencing during their stay in hospital and learn to express their feelings and emotions on the various procedures.
In face of the current pandemic, the need to use Personal Protective Equipment can be seen as a barrier between the relationship of the nurse and the child.
The play provided by health professionals can improve the nurse-child relationship, increasing confidence while providing the child with the medical care needed. Thus, it is important to know the effectiveness of therapeutic play to transform paediatric hospital units into a pleasant, attractive and playful environment, in order to achieve better results and humanize care.
Thus, in this pandemic phase where the repercussions of hospitalization are even more marked, there is a need to intervene in order to reduce the impact that resorting to a hospital care currently has on children. That said, paediatric nurses can use play as a strategy for hospitalized children, with its numerous advantages. Parents as a figure of protection for the child, play a fundamental role in therapeutic play, where their approval and participation are the most facilitating in the child's acceptance of therapeutic play during medical care and treatment. 
The need arises, for both health professionals and parents, to see themselves a little bit as children and to demystify the figure of the caregiver in the hospital, in order to allay the child’s fears. We are all responsible for the development of the trauma-free child.