A study to assess the effectiveness of self instructional module regarding importance of needs of play among parents of hospitalized children in selected hospitals of Wardha

 

Ms. Madhavi Ghorpade

Lecturer, Sadhu Vaswani College of Nursing, 10-10/1 Koregaon Road, Pune 411001

*Corresponding Author Email: madhavighorpade@yahoo.com

 

ABSTRACT:

Play means spontaneous or voluntary recreational activities pursued for enjoyment and accessories or equipment used in the activities; includes games, toys, etc. Play has the power not only to aid in normal child development but also to help alleviate emotional and behavioral difficulties.  For over six decades, play therapy has been recognized as the oldest and most popular form of child therapy in clinical practice 

Hospitalized children require more than recreational play because illness and hospitalization constitute crisis in a child's life and since these situations are fraught with overwhelming stresses, children need to play out their fears and anxieties as a means of coping with these stresses. Play also helps temporarily to divert their mind from pain and loneliness.

Research title: A study to assess the effectiveness of self instructional module regarding importance of needs of play among parents of hospitalized children in selected hospitals of Wardha.

Objectives :

1.      To assess the knowledge of parents regarding importance of play needs in hospitalized children.

2.      To evaluate the effect of self instructional module on the knowledge of parents of hospitalized children.

3.      To associate knowledge with selected demographic variables regarding importance of play needs in hospitalized children.

Methods:

Pre-experimental one group pretest design was adopted to accomplish the objectives of the study. A sample of 60 parents whose children were hospitalized were selected by convenient sampling technique. initial knowledge of the parents on knowledge of play for hospitalized children was assessed by administering self structured questionnaire. A self instructional module was given on importance of play for hospitalized children.

Results:

The results of the study revealed that the significant difference between the mean pretest and mean post test knowledge scores which was statistically tested using paired 't' test was found to highly significant at 0.05 level of significance.

 

KEYWORDS: Knowledge, Effectiveness, Self instructional module, Play.

 

INTRODUCTION:

Play means spontaneous or voluntary recreational activities pursued for enjoyment and accessories or equipment used in the activities; includes games, toys, etc. Play has the power not only to aid in normal child development but also to help alleviate emotional and behavioral difficulties.  For over six decades, play therapy has been recognized as the oldest and most popular form of child therapy in clinical practice.  Health and illness underpin our everyday existence. health allows us to live full lives and to function as social beings. Illness disrupts our lives, sometimes seriously. healthy children become healthy adults improving the health of children is one  responsibility among many.

 

Hospitalized children require more than recreational play because illness and hospitalization constitute crisis in a child's life and since these situations are fraught with overwhelming stresses, children need to play out their fears and anxieties as a means of coping with these stresses. Play also helps temporarily to divert their mind from pain and loneliness.

 

We do not have to be taught to play. It is a universal activity, although it takes many forms. Indeed, children of every culture engage in play. It is true play is the most influential in learning and development. It is the most effective and powerful way for young children to learn. Often it is said that play is the work of childhood, the primary method for them to learn about themselves, others and their world. Some scientists have found evidence that play can sculpt the brain and build denser webs of neural connections. When we play, we literally exercise our brain cells. The nerve cells in the brain actually thicken and grow as we learn.

 

NEED FOR THE STUDY:

Beryl Juliet Sam (2004) describes in importance of play for hospitalized children the study was conducted in the pediatric wards of the Christian Medical College and Hospital, Vellore. All mothers, fathers or mother substitutes were staying with the child in the hospital. There were 51.85% of parents who felt that playing with other children was not good as their child would learn bad language and bad habits, and also have conflicts while playing which would lead to misunderstanding among the parents and their neighbors. Some (48.15%) parents felt that allowing a sick hospitalized child to play with medical equipment like stethoscope, spatula, syringes etc will help in alleviating the child's fears. The findings show that the practice of 31.48% of parents was adequate and the practice of 68.52% of parents in relation to providing toys, bringing the child's toys to the hospital on admission and allowing the child to play with other children was moderately adequate. The findings regarding the socio-economic status revealed that majority (74.98%) of the parents of these children receive a monthly income of less than four thousand rupees and that could be a reason for being unable to spend on toys.

 

Annette M, Natasha (2002) explored the effects of play therapy on pediatric pain, a quantitative data was collected on pediatric pain, anxiety, heart rate, blood oxygenation level through measurement tools and interviews. Finally, the parents, guardians and nurses involved in the study reported that music therapy helped them to feel more relaxed as well. As play is an integral part of children’s lives, it seems only natural that it is to be used as a method for dealing with children problem in a therapy setting. Play is universal for all children. It is pleasurable and enjoyable aspect of child’s life and essential to promote growth and development. Play is the activity that has no serious motive and from which there is no material gain. Play helps in development of children in various aspects i.e. physical, intellectual or educational, emotional, moral and social.

 

The investigator felt that if the parents carry out the interventions of play for hospitalized children, they  will be able to accept the hospitalization and cope with the traumatic experiences and also comply with the treatment offered. The incorporation of play in every aspect of care will also help in hastening the child’s recovery process, which is the ultimate goal of the hospitalization. These measures will enhance the ability of nursing personnel in providing quality care, not only in terms of meeting the physical needs of the child but also in the overall mental and social development of child.

 

OBJECTIVES:

1.      To assess the knowledge of parents regarding importance of play needs in hospitalized children.

2.      To evaluate the effect of self instructional module on the knowledge of parents of hospitalized children.

3.      To associate knowledge with selected demographic variables regarding importance of play needs in hospitalized children.

 

HYPOTHESIS:

H0 - There is no significant difference in the knowledge of parents regarding play needs of hospitalized children after administration of Self instructional module.

 

ASSUMPTION:

1)     The parent’s possess inadequate knowledge regarding importance of play needs of hospitalized children.

2)     The effect of self-instructional module will improve knowledge of parents regarding importance of play needs of hospitalized children.

 

ETHICAL ASPECT:

·        The study proposal has sanctioned by the ethical committee of the college.

·        Informed consent has been taken from the participants.

·        Information about the study is given to participant.

·        Permission obtained from the concerned authority of Acharya Vinoba Bhave rural hospital, Kasturba memorial hospital, Civil hospital Wardha.

 

CONCEPTUAL FRAMEWORK:

The study aims at developing and evaluating a self-instructional module for the parents of hospitalized children. The framework of the present study is based on the systems model for the development of learning materials/ modules program for the continuing education.

 

REVIEW OF LITERATURE:

Marlow (2004) , describes in values of play that children develop the intellectual and physical activities during play. They develop moral values through play with others. Play can help develop creativity and provide the therapeutic release from stress and tension. Play can provide a release from stress and tension for individuals of all ages. Children especially use play to work through their life experiences in order to understand and master them. Children may assume the role of “teacher” and hospitalized child may assume the role of “nurse” or “doctor”. During play children can express their emotions and test out frightening situations in a way that peers and adults can accept. Children reveal themselves through play. Nurses who carefully observe the play of children can determine the needs, concerns, and feelings that cannot be put into words. Nurses as well as other caregivers must protect children if their play becomes too aggressive and guide them in to less destructive types of play activities.   

 

Parul Datta (2004), describes from the book pediatric nursing, that play is universal for all children. It is work for them and ways for their living. It is pleasurable and enjoyable aspect of child’s life and essential to promote growth and development. Play is the activity that has no serious motive and from which there is no material gain. The distinction between work and play however lies in the mental attitude. Play helps in the development of children in various aspects i.e. physical, intellectual or educational, emotional, moral, and social.

 

Ginsburg (2006) , describes in importance of play in promoting healthy child development and maintaining strong parent-child bonds. Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. Play also offers an ideal opportunity for parents to engage fully with their children. Despite the benefits derived from play for both children and parents, time for free play has been markedly reduced for some children. This report addresses a variety of factors that have reduced play, including a hurried lifestyle, changes in family structure, and increased attention to academics and enrichment activities at the expense of recess or free child-centered play. This report offers guidelines on how pediatricians can advocate for children by helping families, school systems, and communities consider how best to ensure that play is protected as they seek the balance in children's lives to create the optimal developmental milieu.

 

Edda Bomtempo (2003), explains in the importance of children's play for medical procedures and hospitalization. In the past year there has been great concern in creating play therapy programs for children under stress situations like hospitalization. However, many health professionals are not conscious of the importance of such situations. The present work has the objective of researching and suggesting a psychological intervention program involving play as an important tool for the recovery of the hospitalized child. The research was carried out in a public hospital in the outskirts of Londrina, Brazil, with the help of Psychology students from the State University of Londrina. The results showed a high level of acceptance of the treatment proposed by the program (they facilitate or respond more easily to the invading medical procedures) and a low level of treatment resistance (responses which can cause difficulties, delays or impediments to the invading medical procedures).

 

John Carol (2005), describes in importance of play therapy in hospital setting illness itself, can produce stress in all of us and when hospitalization is added to illness, that stress is increased. So it is not unusual for a child to react to being in hospital by expressions of protest such as crying, sucking, bed wetting, refusing to eat, self biting, shaking, thumb sucking bed wetting refusing to eat being withdraw and rejection the adult around them.

 

All of these reactions are common in hospitalized children but with the help of play therapy techniques we can reduce these stresses. Play help children in hospital to: adjust to a strange environment, express their concerns about being in hospital, and familiarize them with hospital staff and their roles. Cope with hospital routine; learn about their illness and how to cope with treatment. As well as providing normal play activities for hospitalized children, play therapist may be able to offer distraction for children undergoing treatment, medical preparation through play medical play activities.

 

Hendon and Bohon (2008), assessed hospitalized children's mood differences during play and music therapy. Pediatric hospitals are concerned with both the physical and social well-being of their young patients. These institutions often provide play and music therapy to enhance the child's sense of normality. The purpose of this study was to test whether children in a hospital were happier during music rather than play therapy. Sixty children were observed either during play or music therapy. Happiness was operationally defined as the frequency of smiles during a 3 minute period. The results showed that music therapy (M = 12.43, SD = 4.83) led to significantly more smiles than did play therapy (M = 5.83, SD = 3.10). Increasing the amount of time hospitals provide music therapy for child patients may be a way to increase positive effect and ultimately to increase mental and physical well-being in hospitalized children.

 

Tambudwadkar,(1999) explains play as important component in child’s life. Play helps in the physical, psychological, social, intellectual development. Also explains about selection of toys in a particular age. It has special importance in the hospital to help sick children to grow and develop, to preserve the sense of wholeness, to understand hospital procedures and act out emotions.

 

Peggy O. Jessee et.all (2000), describes that play promotes normal child development and can help alleviate emotional and behavioral difficulties. Even so, play-based interventions have often been criticized for the lack of an empirical base to prove their efficacy. In an era of cost-containment, the need to provide evidence of the effectiveness of interventions is increasingly important in order to gain the general acceptance of third-party payers, mental health professionals, and consumers.

 

Maria Forsner (2005), describes children’s illness has been investigated through the eyes of parents and nurses but the child’s own perspective has been largely ignored. The aim of this study is to illuminate the 7-10-year-olds’ experiences of being ill. Three girls and four boys were interviewed and narrated their experience about short-term illness. The data obtained was subjected to a thematic qualitative content analysis. The analysis suggests that the children combined reality and imagination and contrasts seemed to coexist such as being scared/confident, sad/cozy and hurt/having fun. They felt caught and tried to escape. The experience of illness as narrated by children can lead to a richer understanding and influence the way care provided for pediatric.

 

Hurlock  (2005), explains in values of play that play is not the waste of time. Nor is it just a way to keep young children busy or out of mischief while parents take care of responsibilities. Instead, play is essential to the development of normal, well-adjusted personality. It gives the child a chance to develop physically, emotionally, mentally, socially and morally in a way that no other single type of activity can. The child who has little chance to play is far less likely to become a well-adjusted adult than is the child who spends most of the day playing. Play has many values for young children. Such as outlet of extra energy, developments of all parts of the body bones, muscles and internal organs, exercise which develops good appetite and healthful sleep, chance to learn to control the body, development of many skills that will be useful all through life. It also helps in the development of ability to keep the mind on the task at hand, encouragement of creativity, chance to discover, meaning about things in the environment and way to get rid of anger, fear, jealousy and grief.

 

METHODOLOGY:

Research Design: The research design selected for study was pre experimental design with one group pretest post test design.

 

Sampling technique: Simple convenient sampling

 

Sample size: 60 parents of children got hospitalized in selected hospitals of Wardha city.

 

Variables:

Dependent variables: Parents knowledge regarding play for hospitalized children.

 

Independent variables: Self instructional module on play for hospitalized children.

 

Demographic variables: Age of the parents, age of the children, education of the parents, residence, Number of children in family, frequency of hospitalization,  type of family, occupation, ,Monthly income, Religion.

 

Setting: The study was conducted in 3 hospitals of Wardha.

·        Acharya Vinoba Bhave Rural hospital pediatric ward.

·        Kasturba Memorial Hospital pediatric ward.

·        Civil Hospital Wardha pediatric ward.

 

The population:

The population in the present study was parents of hospitalized children.

 

Criteria for Sample Selection:

Inclusion criteria:

1.      Parents those are able to read to write Marathi.

2.      Parents those are willing to participate.

3.      Parents having children with normal milestones.

4.      Parents having children between 1-12 years of age.

 

Exclusion criteria:

1.      Parents having critically ill children.

2.      Children with care takers.

3.      Parents having children with special care needs.

 

Data collection technique:

The data gathering was constructed by the investigator in the light of the literature reviewed and experience in the clinical filed to ensure the adequacy and reliability of the content.

The tool consisted of semi structured interview and questionnaire which had five sections.

 

Section I

It consist of demographic characteristics of sample such as age, education, occupation, monthly income, religion, type of family, residential area, frequency of child’s hospitalization, number of children in family, age of child.

Section II

It consists of knowledge aspect containing 5 items.

Section III

It consists of importance of play containing three items.

Section IV.

It consists of play for hospitalized child containing ten items.

Section V

It consists of selection of play material containing four items.

 

Plan for data analysis:

The collected data was organized, tabulated and analyzed by using descriptive and inferential statistics. Significant difference between pre and post test was tested by using‘t’ test .The inferential statistics i.e. one way ANOVA (Analysis of varience) and multiple comparision was done by using Tukey multiple comparision test. ANOVA was used to find out the association between knowledge and selected demographic variables of parents of hospitalized children. The data was planned to be presented in the form of tables and figures.

 

RESULTS:

Section I -  Tables

Table: 1 Distribution of parents in relation to demographic data in frequency and percentage                                                 n = 60

Parents of hospitalized children

Number of parents

Percentage(%)

Age in years

 

 

20-25

13

21.67

26-30

23

38.33

31-35

15

25.00

36-40

8

13.33

41-45

 1

1.67

Relationship with child

 

 

 

Father

16

26.67

Mother

44

73.33

Education

 

 

Primary

31

51.67

Secondary

23

38.33%

HSC

2

3.33%

Graduate

4

6.67

Post Graduate

-

-

Residence

 

 

Urban

10

16.67

Rural

50

83.33

Number  of children in the family

 

 

1

11

18.33

2

36

60.00

3

10

16.67

4

3

5.00

Frequency of hospitalization

1

26

43.33

2

15

25.00

3

10

16.67

> 3 times

9

15.00

Type of family

 

 

Nuclear

29

48.33

Joint

31

51.67

Occupation

 

 

Homemaker

17

28.33

Farmer

18

30.00

Self employment

20

33.33

Private employee

3

5.00

Government employee

2

3.33

Monthly income

 

 

Rs. 1000-2000

31

51.67

Rs 2001-3000

13

21.67

Rs. 3001-4000

6

10.00

Rs > 4001

10

16.67

Religion

 

 

Hindu

46

76.67

Christian

2

3.33

Muslim

3

5.00

Buddhist

9

15.00

Hospitalized Children’s age (years)

 

 

1-5

25                  

41.67

5.1-10

28

46.67

> 10

7

11.67


Table 2: Area wise pretest knowledge and posttest score of parents of hospitalized children. n=60

Area wise

Pretest

Post test

t-test

p- value

 

Mean

SD

mean

SD

 

 

Knowledge aspect

2.00

1.40

3.93

1.16

9.33

0.000 S, p<0.05

Importance of play

0.90

0.91

2.40

0.90

10.74

0.000 S, p<0.05

Play for hospitalized children

5.31

2.07

8.11

1.79

8.48

0.000 S, p<0.05

Selection of play material

2.20

0.87

2.85

0.77

3.95

0.000 S, p<0.05

Total

10.41

3.14

17.30

3.29

13.28

0.000 S, p<0.05


 


Table 3: Level of knowledge score of parents of hospitalized children in relation to total knowledge score n=60

Level of knowledge score

Poor (0-25%)

Average (26-50%)

Good (51-75%)

Excellent (76-100%)

Pre test

1 (1.66%)

36 (60%)

21 (35%)

2 (3.33%)

Post test

-

7 (11.67%)

10 (16.67%)

43 (71.66%)

 


Section II

Association of knowledge with selected demographic variables.

One way ANOVA was used to associate knowledge  with age, education, occupation of parents and monthly income were having non significant association with the knowledge score of parents of hospitalized children at 0.05 level.

 

CONCLUSION

·        Majority of the samples are mothers which constitute about (44) 73.33% of the population and (16) 26.67% of the population belong to fathers. The education of parents of hospitalized children shows 31 (51.67%) parents having primary education and 2 (3.33%) of population consist of higher secondary education.

·        The above findings of the study showed that the self instructional module. The mean knowledge score in relation to all the areas shows that in pretest 10.41±3.14 and in post test 17.30±3.29, by using students paired ‘t’ test significant difference is found in mean knowledge score in pre and post test t=13.28 and p valve is 0.000 which is less than 0.05 hence H1 is accepted. Thus it is concluded that the self instructional module is effective. Further analysis is made for each area to find out the difference between the means. The p-value (0.00 S,p<0.05) is found to be highly significant in the area of knowledge aspect, importance of play, play for hospitalized children and selection of play material.

·        Effectiveness of self instructional module is assessed by comparing the pretest and posttest knowledge score. The p-value of area wise distribution of knowledge score. P-value of knowledge aspect is less than 0.05 which is significant. The p-value of importance of play is less than 0.05 which is again significant. P-value of play for hospitalized children and selection of play material is less than 0.05, shows significance. Hence the hypothesis is accepted.

·        Comparison of significance of difference between knowledge score in relation to demographic variable, by using one way ANOVA method significant variation is found in all the age groups (f=0.97, p= 0.41) by using Tukey multiple comparison test, statistically non significant difference is found in the age group between 20-25 years, 26-30 years,31-35 years, 35-40 years, 41-45 years.

·        Non significant difference is found  between knowledge regarding importance of play for hospitalized children in relation to education, by using one way ANOVA method (F= 0.37, p-value= 0.76, NS, p>0.05).

 

 

RECOMMENDATIONS:

1.      A similar study can be replicated with a control group and on a larger population.

2.      A similar study can be conducted only on fathers to assess the knowledge regarding importance of play for hospitalized children

3.      A similar study can be replicated with control group an on larger scale with planned teaching as intervention to the parents.

4.      A similar study can be conducted in community with a non literate group using different mode of communication.

5.      A comparative study can be conducted between employed and unemployed parents.

6.      A similar study can be done to assess the knowledge, attitude and practice of student nurses in relation to provision of play for children.

 

 

REFERENCES:

1.       Marilyn Hockenberry et.al. (2003). Wong’s Nursing Care Of Infants and Children: 7th edition, Elsevier publications. pp 1069-72

2.       Marilyn J et.al. (2005). Wong’s Essentials of Pediatric Nursing: 7th edition, Mosby publications. pp681-91.

3.       Marlow R.  Dorothy & Barbara. A Redding. (2002). Textbook of Pediatric Nursing: 6th edition, Elsevier publications Philadelphia, pp 252-54.

4.       Townsend C. Mary. (2007). Psychiatric Mental Health Nursing Concepts of Care In Evidence-Based Practice: 5th edition, Jaypee publication (New Delhi). pp 381-382.

5.       Beryl Juliet Sam. (2007). Importance of play for hospitalized children: The nursing journal of India, vol. XCVIII no. 10, pp 224-226.

6.       Edda Bomtempo. et.al. (2003) The Importance of Children's Play for Medical Procedures and Hospitalization: TASP Annual conference, Charleston South Carolina.

7.       Hendon and Bohon. (2008) Hospitalized children's mood differences during play and music therapy, Child: care, health and development, vol 34. pp 141-4.

8.       Kenneth R Ginsburg. (2007) The importance of play in promoting healthy child development and maintaining strong parent-child bonds: Pediatrics  vol 119. pp 182-91.

 

 

 

 


 

Received on 19.01.2016           Modified on 25.01.2016

Accepted on 21.02.2016           © A&V Publication all right reserved

Int. J. Nur. Edu. and Research.2016; 4(2):181-186.

DOI: 10.5958/2454-2660.2016.00037.5