Introduction

For children, play is a language that can have considerable therapeutic benefits”
“

- Judit Horvath
Playing is one of the most meaningful aspects in a child's life.
Playing is not only essential for the developmental process but it also helps children adapt to new situations, and
maintain and recover health.
It provides pleasure, relaxation, and favours spontaneity. It is extremely significant in crucial times for children,
such as during painful procedures.
The way children learn and express their suffering is different from that of adults, since they are still incapable of
verbalising feelings.
With playful activities, children find a way to reveal their internal world in a symbolic manner.
 What is Therapeutic Play

Therapeutic play is the specialised play activity by which a child acts out or expresses his unconscious
feelings. It is a central mechanism in which children cope, communicate, learn and master traumatic experience
such as hospitalisation.
It facilitates expression, coping and mastery of the healthcare
experience and helps to facilitate achievement of healthcare goals
 Goals of therapeutic play

provide a family centred approach to help the child to adjust to

hospital care.
help the child to meet the emotional needs in the hospital by
getting to know the child.
Parents are offered a chance to learn new skills to comfort
their children and the ways by which they can encourage their
child’s continued development while the child is recovering in
the hospital.
 How can play be therapeutic

Piaget (1951) suggests that play has restorative powers. It helps children to assimilate new experiences.
The attitudes and feelings that children reveal in their play are full of meaning.
It provides a means for release from the tension and stress encountered through the environment.
In play children can express emotions and release unacceptable impulses in a socially acceptable fashion.
Children are able to experiment and test fearful situations
Children reveal much about themselves in play.
Children are able to communicate to the alert observers through play the needs, fears and desires they are
unable to express with their limited language skills.
 Benefits of therapeutic play

Self-expression
Access to the unconscious
Abreaction
Catharsis
Sublimation
Competence and self control
Creative problem solving
Fantasy compensation
Behavioural rehearsal
Reality testing
 Types of therapeutic play
Therapeutic play differs from normative play in its design and intent. It can be of three types :
• Emotional outlet or dramatic play
•

• Instructional play
•

• Physiological enhancing play

 Emotional outlet or dramatic play

Child uses objects, actions, and language to create imaginary roles

and situations.
Express the child's anxiety to solve conflict and as a diagnostic tool to
identify child is concerned about the illness and hospitalisation.
children find a connection between real and pretend.
Examples of emotional outlet play:
Playing with dolls being a nurse and caring for sick doll with expression
of on feeling, storytelling
Playing house or acting out situations
Puppets
Pretending to be an animal
Re-enacting a story
 Instructional play

Instruction is given for therapeutic play to the children according to their past experiences, coping
abilities and physiological status. It requires keeping a goal in mind, following a step-by-step process to
reach that goal and then looking back afterwards and evaluating what worked and what didn’t.
Educationalists refer to this kind of play as “guided play”

Examples-

use of colour in drawing

drawing in blank paper
Learning the instructions on health habit from TV or
teaching films
 Physiological enhancing play

It is used to maintain and improve physical health and body

functions. It can be selected to treat pathological condition.
Example-
breathing exercise to treat respiratory problems by blowing
bubbles, whistling and laughing.
Squeezing the bath sponge or ball improves neurological
functions
 Techniques of Therapeutic Play

For Infants
Listening to music ,lullabies
Providing familiar toys such as stuffed animals, music,
blankets and rattles
Creating a visually stimulating environment with
mirrors, mobiles and brightly coloured crib toys
Offering rattles, rings and keys
Placing toys to encourage kicking, rolling and crawling
Playing peek-a-boo
For Toddler
Play peek-a-boo or Hide-and-Seek
Read familiar stories
Play with dolls that have similar “illness” as them
Puzzles, building blocks, push-and-pull toys
Play with safe hospital equipment
Providing familiar toys and objects such as stuffed animals
Listening to favourite music
Watching favourite movies or cartoons
Scribbling with crayons and paper
Stacking blocks
Reading books with adults
Bouncing, throwing and kicking a ball
Sculpting with play dough
For Pre-schooler
Play with safe hospital equipment
Crayons and colouring books,
Books and recorded stories
Videos
Listening to favourite music
Watching favourite movies or cartoons
Playing board games such as
Reading with an adult
Building with blocks
Bouncing, throwing and kicking balls
Participating in group activities with peers
Crafting with play dough, painting and drawing
Playing with puppets and dolls, and playing house
Playing with water and sand
School-age
Dolls
Listening to favourite music
Watching favourite movies or cartoons
Playing board games
Playing card games
Playing video games
Reading
Putting together puzzles
Doing arts and crafts
Cooking
Participating in group activities with peers
Sculpting with play dough and clay
Keeping journals and scrapbooks
Adolescent
Listening to favourite music
Watching favourite movies
Playing board games
Playing card games
Playing video games
Participating in group activities, such as art, cooking and
games
Writing in journals and creating scrapbooks
Writing poems and stories
Using computers
 Role of Nurse in Therapeutic play

Organise play facilities for the sick children.

Involve other health team members.
Interact with child
Guide the children
Encourage children to participate
Teach parents and family members
 Research Input 1:

The effectiveness of therapeutic play, using virtual reality computer games, in promoting the
psychological well-being of children hospitalised with cancer
Authors - William HC Li, Joyce OK Chung, Eva KY Ho,
Abstract
Aims. To examine the effectiveness of therapeutic play, using virtual reality computer games, in
minimising anxiety and reducing depressive symptoms in Hong Kong Chinese children hospitalised
with cancer.
Therapeutic play intervention on children's perioperative anxiety, negative emotional manifestation and
Background.pain:
postoperative There has been an controlled
a randomised increase intrial
the use of therapeutic play intervention to help children
cope with the stress of hospitalisation. However, it is not clear whether
Hong-Gu He , Lixia Zhu, Sally Wai-Chi Chan, Joanne Li Wee Liam, Ho Cheung William Li, Saw Sandar Ko, Piyanee Klainin-Yobas, Wenru Wang
therapeutic play is an
appropriate psychological intervention for Chinese children hospitalised with cancer.
Published: Journal of advance nursing , May 2015
Aim: To examine if therapeutic play intervention could reduce peri operative anxiety, negative emotional manifestation
and postoperative pain in children undergoing inpatient elective surgery.
Background: Children undergoing surgery commonly experience anxiety and postoperative pain and exhibit negative
emotional manifestations. Previous studies have shown inconsistent conclusions about the influence of therapeutic play on
children's perioperative anxiety, negative emotional manifestation and postoperative pain.
Design. A non-equivalent control group pretest–post-test, between-subject design was employed.
Method. Hong Kong Chinese Children (8–16 years of age), admitted to a paediatric oncology ward for the
treatment of cancer during a 14-month period, were invited to participate in the study. Of the 122 children, 70
formed the control group receiving routine nursing care and 52 in the experimental group receiving therapeutic
play interventions.
Results. The results showed that children in the experimental group reported statistically significant fewer
depressive symptoms than children in the control group on day 7. The results, however, find no differences in
children’s anxiety scores between the two groups on day 7.
Methods: Suitable children were recruited from November 2011-August 2013. They were randomised to receive
Conclusion. The
either routine carestudy provides
(control group, empirical
n = 47) or aevidence to supportplay
1-hour therapeutic theintervention
effectiveness of therapeutic
(experimental group,play, using
n = 48).
virtual reality
Children's computer
state games, in
anxiety, negative the psychological
emotional preparation
manifestations of children
and postoperative hospitalised
pain were measuredwith cancer, on
at baseline, thus
the dayaofpath
charting surgery and around
towards 24 hours
promoting afterand
holistic surgery.
quality care.
Relevance to clinical
Results: The practice.
time effect of stateThe findings
anxiety heighten the
was significant, butawareness in healthcare
no group and professionals
interaction (group that play is a
x time) effects
very important
between part ofand
the control children’s life and
experimental that were
groups they found.
need play even when
Compared with they are ill.group, children in the
the control
experimental group demonstrated significantly lower scores of negative emotional manifestations prior to
anaesthesia induction and postoperative pain.

Conclusions: Therapeutic play intervention is effective in reducing negative emotional manifestations before
anaesthesia induction and in reducing postoperative pain in children undergoing inpatient elective surgery. These
results suggest that it is useful to give children with therapeutic play intervention prior to inpatient elective
 Research Input 2:

The Effect of Preoperative Training and Therapeutic Play on Children’s Anxiety, Fear, and Pain
Buyuk, Esra Tural PhD; Bolişik, Bahire PhD
Published :Journal of Pediatric Surgical Nursing: April/June 2015 - Volume 4 - Issue 2 - p 78-85
Abstract
Introduction 
The aim of the study was to determine the effectiveness of education and therapeutic play applied in the pre-
operational period to decrease the anxiety, fear, and pain levels of children in the postoperative period.
Methods 
This study was a quasi-experimental and cross-sectional research. Three hundred children aged
7–12 years and suitable for the research criteria, referred to two paediatric hospitals in the
northern region of Turkey for surgery, were the sample of the study. Each group (control group,
training group, and training + play group) was composed of 100 children (N = 300). The
experimental (training and training + play) groups were administered training and play activities
on the operation day before undergoing surgery. The training group was administered training
with video records on things to do before the surgery, the operating room environment,
postoperative room and care, and things to do at home. In the training + game group, the child
was trained on the day of surgery, and the researcher helped him or her play with the toys
selected by the child from the toy basket provided by the researcher.

Results 
In this study, 88.7% of the children were boys, and 76 % of them were referred to the hospital for
circumcision. At the end of the research, compared with control group children, children in the
groups that were prepared for the operation with education and with education together with
therapeutic play displayed decreased levels of anxiety and fear. The result was statistically
significant (p < .001).
DISCHARGE PLANNING
 Introduction

Discharge from a hospital is a complex process. It is not a one-time event, and no single act will make it work
better.
Discharge involves care coordination among hospital staff, between hospital staff and the patient, and family,
between hospital staff and community providers.
It is systematic process for preparing the client to leave the health care agency and for continuity of care.
Discharge planning begins soon after the child’s admission.
Parents will be involved in the decision and planning for discharge including home care arrangements,
medications and follow-up appointments.
 What is Discharge Planning

Discharge planning is the process of identifying and preparing for

a patient’s anticipated health care needs after they leave the
hospital.
Hospital staff cannot plan discharge in isolation from the patient
and family.
Comprehensive discharge planning involving the patient and
family contributes to positive patient outcomes, such as
reductions in unplanned readmissions and increases in caregiver
satisfaction with the health care experience.
 Purpose of Discharge Planning

patient and the family has the information on his or her condition, follow up schedule.

provide for a safe and efficient return of the patient clothing’s

and other valuables
check that all the hospital equipments are back to the hospital.
 cont..
avoid any misunderstanding or difficulty for the patient or hospital
in relation to patient’s release; medicines, bills, dues or referrals etc.
help the patient and family members by making the safest
arrangement possible for patient at the time of discharge.
assist the patient to manage successfully the change from hospital
environment to home environment.
To provide continuity of care.
 Guidelines for an Effective Discharge Planning
Involve the child's healthcare team
Have a discharge conversations with the family members, healthcare providers and anyone else who will be
taking care of the child's health during and after discharge.
Establish roles and responsibilities of discharge care among the child's care team.
 cont..
Specify discharge goals

These are the desired goals to be achieved for the child to safely leave the hospital.
Discharge goals may include achievement of a physiologic state (e.g., no fever for 24 hours), a cognitive or
functional ability (e.g. the ability to eat and drink by mouth without difficulty), or a caregiving competency
(e.g., a parent’s competency to give an oral medication to their child).
Discharge goals may evolve and change during the hospitalisation. Reconciling differences in preferences of
the discharge goals is important.
cont..
Assess discharge needs
These are the medical resources, services and supports that the child will need after they leave the hospital.
Post Discharge Medications
Contingency plans of care
Family leaves from work
follow-up appointments
laboratory or radiographic testing
medical equipment
Nursing at home or school
ongoing care coordination
rehabilitation
Specialised diet and nutrition
Therapies (example physical therapy)
cont..
Address issues that may affect the child's health and safety after discharge
Issues that could affect the child's health, for better or worse and influence the success of hospital
discharge include:
Child's home and school environment
Cultural and religious beliefs
Health literacy
Insurance coverage and procedures
Parents provider communication
Resolution of admission diagnosis
Stability of Childs co-morbid conditions
cont..

Make Discharge plans

Discharge plans should be created to achieve each discharge goal, to meet each discharge need, and to
address each issue that could influence discharge success.

Good discharge plans contain components that specify particular actions, contingencies, things to teach
and learn, and things to remember, clear instructions regarding what to do when concerns, issues, or
problems arise after discharge and whom to call.

Patient and family education is critical to the success of developing and implementing a successful
discharge plan.
 cont..

Monitor discharge progress

Written documentation of discharge progress is central to the
monitoring process.

At a minimum, discharge information to document includes, the

reason for hospitalisation and principal diagnosis; description of the
hospital course of treatment; patient’s condition at discharge,
medication list; list of food, drug, and other allergies; experienced
and potential drug interactions;

Document the discharge goals, needs, issues, plans and progress in

both the discharge summary for providers and the after hospital care
plan for the family.
 cont..
Finalise discharge

As discharge is finalised, the family and inpatient care team should take a “time out” to ensure that the
child is safe and ready to leave the hospital. A checklist or related tool can help standardise how
discharge care is finalised:

The discharge goals were achieved.

Plans are said to meet discharge needs.
The issues that will influence the success of hospital discharge were addressed.
Important discharge information example medications was reconciled.
Discharge documents were exchanged with both the child's family and providers.
The family was able to teach bank discharge plans.
The family confirmed that they are ready for hospital discharge.
 cont.. the child
Discharge
Upon successful completion of the previous steps and care team agreement, proceed
forward with the child's actual discharge.

Follow up after hospital discharge

For at-risk patients, make contact with the family and post discharge providers to
make the child has remained safe and healthy.
phone contact with at risk patients and their principal provider is recommended .
During contact, assessment can occur of the patient’s condition as well as the
comprehension of and adherence to the discharge plan
Steps of Discharge Process
 1. Assessment

Health Data
Personal Data
Environment
Client or Family Knowledge
 Health Data
Health data includes :
Child's age, sex,
height, weight
diagnosis,
past medical history,
current health problems,
surgery,
functional limitations such as amputations, wheelchairs,
or walker.
 Personal Data

Personal data includes :

how the client feels about discharge.
What are their expectations for recovery?
What has been their coping ability in the past?
What are their attitude and beliefs about health and illness?
 Environment

Includes both home and community.

Are there any and structural barriers that would inhibit function like narrow stairs for a
wheelchair
Assistive devices in the bathroom
Hot water, heat, available space
 Client or Family Knowledge

Assess the understanding of treatment plan and care regimen-

Medication
Its side-effects
Client diagnosis
Prognosis
Emergency measures
Complication and symptoms of impending problems
 Nursing Diagnosis

Anxiety related to inability of self-care

Deficient knowledge regarding home care

Ineffective family coping related to financial or personal support system

Self-care deficit example feeding toileting grooming bathing etc.

 Planning

METHOD approach for discharge planning can be utilised.

M - Medication
The child’s family members will know
the drug name what dosage to take and when to take
Purpose of drug intake
Effect the drug should have
Symptoms of possible adverse effect and which one to report
E - Environment

The client will be assured of

Adequate emotional support from parents and other family members
Investigation of sources of economic support to the family.

T - Treatment

The client and family will be able to

Know the purpose of any treatment to be continued at home
Able to demonstrate correct performance of the treatment
H - Health Teaching
Topics for health teaching includes:
Medications and drugs
Diet
Wound care
Using equipments
Taking medications.
Exercise programs.
Physical therapy
Changing dressings / bandages.
Injections or respiratory treatments.
Any home health care.
When to follow up with the doctor.
O - Out patient referral
The family members will be able to:
Know when and where to keep clinical appointments.
Know where and whom to call for medical help.
Take home written discharge instructions.
D - Diet
The family members will be able to:
Describe the purpose of child's prescribed diet.
Plan several typical menus using the prescribed diet.
 Implementation

Before Day of Discharge

Discharge from the hospital should never come unexpectedly to patients and his /her family members. His /her
discharge should be planned from the time of his admission and he should be informed sufficiently early of the
day he or she can leave the hospital. Pre discharge planning includes:
Suggest ways to change physical arrangement of home.
information about community health care resources.
Gives opportunity to practice new readiness to learn
conduct teaching session with client
Day of Discharge-

Let the child and family ask question or discuss issue . Allow for final clarification of related to home
health care.
Check physician’s order for prescription. Make sure that child receive all medicines and know how to
take.
Determine whether family has arranged transportation. If parents have financial problem for arranging
transport at the time of discharge, social worker may be contacted to arrange financial assistance.
Offer assistance as a child dresses and packs. Prevent loss of personal items, personal belongings.
cont..
Check all closets and drawers for belongings. Obtain parents sign, verify receipt of items - copy of
valuable list signed by parents.
Make sure that all the hospital charges are cleared i.e hospital bill, pharmacy bill etc and bill receipt
handed over to family members.
Explain detail about the diet, medication and importance of follow up. If child is unable to walk,
wheelchair or trolley to carry him up to the transport.
As a courtesy, wish him early recovery.
After the discharge of child, the bed has to be to kept ready for next use.
 Evaluation

Ask parents or family member to describe nature of illness, treatment regimen and physical sign or symptom to
be reported to the physician.
Have parents or family member perform any treatment to be continued at home.
 Preparing the Child and family for Discharge

On discharge, children and their parents receive written instructions about home care and copy of retained in the
medical records.
Provide and review educational booklets that give basic health information of a child's disease.
Explain, demonstrate and request to return demonstration of any treatment or procedure to be done at home.
The discharge instructions for parents include:
Follow-up appointment information
Guidelines about when to contact physician or nurse
Diet
Activity level allowed
Medications scheduled
Specific dates for when the child may return to school or daycare.
 Documentation of Discharge

Write date and time of the discharge on following records:

Nurse’s record,
Admission and Discharge register,
Treatment book,
Report book,
The following points should be mentioned in documentation :
Chart the date and time of discharge.
How patient left the facility.
Any special instructions given to the patient.
Make a notation that the patient’s personal belongings were sent with the patient.
 Research input 3:

Better Outcomes for Hospitalised Children through Safe Transitions: A Quality Improvement Project

Authors - Pritt, Audra MD; Johnson, Anthony MD; Kahle, Jordan MS3; Preston, Deborah L. BS-CCRC;
Flesher, Susan MD
Published - Pediatric Quality and Safety: January/February 2021 - Volume 6 - Issue 1 - p e378

Abstract
Better Outcomes for Hospitalised Children through Safe Transitions: A Quality Improvement Project
Introduction: 
Authors - Pritt, Audra MD; Johnson, Anthony MD; Kahle, Jordan MS3; Preston, Deborah L. BS-CCRC;
This project’s
Flesher, Susan goal
MD was to implement an already validated paediatric discharge toolkit to enhance the
effectiveness of transition from hospital to home, thus reducing 30-day readmission rates.
Published - Pediatric Quality and Safety: January/February 2021 - Volume 6 - Issue 1 - p e378
Methods: 
Abstract
This quality improvement study involved implementing a paediatric discharge planning toolkit to improve upon
predetermined
Introduction:  outcome measures. Critical elements in the toolkit included: (1) comprehensive patient risk
assessment on admission; (2) teach-back curriculum; (3) fax or phone call to the primary care physician; (4) 72-
This follow-up
hour project’s goal
calls;was
andto(5)
implement
follow-upanappointments,
already validated scheduledpaediatric discharge
before toolkit
discharge, to enhance
within 2 weeksthe
from
 cont..
Methods: 

This quality improvement study involved implementing a paediatric discharge planning toolkit to improve
upon predetermined outcome measures. Critical elements in the toolkit included: (1) comprehensive patient
risk assessment on admission; (2) teach-back curriculum; (3) fax or phone call to the primary care physician;
(4) 72-hour follow-up calls; and (5) follow-up appointments, scheduled before discharge, within 2 weeks
from discharge from hospital. We used the toolkit to gather data on paediatric patients as they were admitted
and then prepare them for discharge from December 2016 until March 2017. The primary outcome measure
was the 30-day readmissions to the hospital, and the secondary outcome measure was patient satisfaction
scores. Our balancing metrics included follow-up appointments made and length of stay. These measures
Methods: 
were
Thiscompared with pre-intervention
quality improvement hospital
study involved paediatric
implementing administrative
a paediatric data
discharge collected
planning from
toolkit to December 2015
improve upon
predetermined
through outcome measures. Critical elements in the toolkit included: (1) comprehensive patient risk
March 2016.
assessment on admission; (2) teach-back curriculum; (3) fax or phone call to the primary care physician; (4) 72-hour
follow-up calls; and (5) follow-up appointments, scheduled before discharge, within 2 weeks from discharge from
hospital. They used the toolkit to gather data on paediatric patients as they were admitted and then prepared them for
discharge from December 2016 until March 2017. The primary outcome measure was the 30-day readmissions to
the hospital, and the secondary outcome measure was patient satisfaction scores. The balancing metrics included
follow-up appointments made and length of stay. These measures were compared with pre-intervention hospital
paediatric administrative data collected from December 2015 through March 2016.
Results: 
Home Care:
 Introduction

Home Health Care is the provision of medically related professional, para- professional services and
equipments to the children with acute or chronic conditions and their families in their place of residence for the
purpose of promoting, maintaining, or restoring health or of minimising the effects of illness and disability.
Children can need intensive health care at home after they have been in the hospital for many different reasons.
Health care and other community agencies work with the family to provide holistic care.
Respite care can be provided for the primary caregivers.
 Historical perspective of Home Care

Home care was formerly defined as simply providing physical care to the
sick in their homes, but the scope and complexity of the concept and practice
have grown.
Roots of the concept can be traced to the New Testament of the Bible, which
describes visiting the sick as a form of charity.
The first home health care program in the United States was organised in
1796 as the Boston Dispensary.
Home health care facilities were first started in India by India Home Health
Care in 2009.
 Goals of Home Care :

The goals of home health care are :

to help child to improve function and live with greater independence

to promote the child’s optimal level of well-being;

and to assist the child to remain at home,

avoiding hospitalisation or admission to long-term care institutions.

to avoid subsequent hospitalisations

 Physical
Skilled Nursing Therapy Speech
Care Language
Components Therapy
of
Home
Health Care
Occupational Home
Therapy A

Medical social
 cont..
Components of Home Health
Care :

Skilled Nursing Care

A skilled nursing facility is the right fit if the child is living with
a complex medical condition and needs 24/7 care from a
registered nurse.

Physical Therapy
After an illness, surgery or hospitalisation, a rehab care team
will create a personalised plan for the most optimal outcome.
 cont..
Speech Language Therapy
Addresses communication issues and swallowing dysfunction.
Speech and language pathologists design a treatment plan to help
with language ability, provide alternate communication strategies and
give appropriate diet recommendations.

Occupational Therapy
Help adapting to social and physical environments through
specialised therapies for getting dressed, memory training and
coordination exercises.
 cont..
Medical social services
• Medical social workers provide a comprehensive assessment of the child’s needs and work in collaboration
with the parents, other family members, and the healthcare team to create an individualised discharge plan.
•

• This includes coordinating arrangements for caregiving services, medical equipment, transportation, meals,
and counselling needs to make the transition home as seamless as possible.
•

• Once home, medical social workers provide follow-up visits to ensure that patients are adhering to their
care plans and can identify and address any problems that may arise.
Home Health Aide
cont..
• A home health aide is responsible for a number of duties
when spending time with the child.
• They help with the activities of daily living, and provide
basic routine care.
• If a home health aide notices a change in a patient’s
condition, the aide is responsible to document the
change and to notify the family, nurse, or doctor.
 Planning Home Care

The process of getting comfortable with child's home health care

begins at the hospital.

Parents learn from the medical staff by closely observing how they
take care of your child and how they operate the necessary
equipment.

Family caregivers should be prepared for and well-informed about

the care the child requires.

Caregivers will need to know how each machine works, how to

troubleshoot, and how to perform preventive maintenance and any
backup procedures.
 cont..

Factors to consider for preparation for home health care:

Parents may need to make changes in their home to make it accessible for a walker or wheelchair.
child's room may need certain equipment, sufficient electrical outlets, and a backup power supply from a
battery or generator.
It can be helpful if a bathroom or source of water is near the child's room.
Keep a list of emergency numbers by the phone. Consider keeping a phone is in the child’s bedroom so
that someone can call for help without leaving the bedside.
Inform local ambulance company of child's medical condition before any situation comes up where
you need one.
Let cont..
the utility companies know that they have a child requiring medical equipment at home so that
they are a priority in case of an outage.
Make a plan for all types of emergencies, even natural disasters, that would include getting the child
and any life-sustaining equipment out of harm's way.
 Training the Parents and family Members

Training the Parents and family Members

Family members should be taught how to use and maintain all medical equipment. They should be made :
understand the child's medical condition
know how to detect problems
know what to do in emergencies
learn CPR
know when to call the health care provider
 Benefits Of Home Health Care

Provide more freedom

Child feels more freedom and independence to do things

and move around within the home.This freedom keeps
their mind happy. This also facilitates in doing things
that they love and feel recreation.
Better convenience and safety for child

Being at home allows child to have normality in their life. They

feel more safe and secure at home in comparison to hospital.

Prevent unexpected medical expenses

Home care avoids unwanted and unexpected medical expenses as

any health issue can be diagnosed at earliest. This reduces the
chance of getting high risk illness or disease in future, thus avoid
unexpected surgery and medical expense.
 Role of Nurse in Home
Care
The nurse in the home should

- Observe how the parents interact with the child.

- Observe facial expressions and body language.
- Listen to the parents and observe how they attend to the physical needs of the
child.
- Ask questions or answer the apprehensions that the parents may have.
- Be attuned to the needs of other children at home.
- Explore community facilities or support group available.
 Research Input 4:

The Pediatric Home Health Care Process: Perspectives of Prescribers, Providers, and Recipients
Authors - Karen Fratantoni, Jessica C. Raisanen, Renee D. Boss, Jennifer Miller, Kathryn Detwiler, Susan M.
Huff, Kathryn Neubauer and Pamela K. Donohue
Published- Pediatrics September 2019, 144 (3)
Abstract
BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) often require paediatric home
Caregivers
health care experiences
(PHHC) to meet in symptom management
their daily for their
intensive care needs.children who require
Paediatricians medical
are central technology
to planning, at
implementing,
home
and maintaining quality PHHC for CMC, yet a comprehensive road map for this process is lacking. With this
Spratling study,
national
Regena 1 , Jiwonwe
Lee  aim
1 to fill that gap.

Published : Journal for specialist in paediatric nursing , Jan, 2020

Abstract
Purpose: The purpose of this study is to explore the daily care experiences of caregivers of children who
require medical technology. Specific aims were to gain an understanding of their perceptions of (a) how
caregivers manage symptoms for their children who require medical technology at home, (b) why the caregivers
seek emergency department (ED) and hospital care, and (c) what the caregivers need to manage their child's
 METHODS: Semistructured interviews were conducted with parents and professionals from the 10 US
cont..
Health Resources and Services Administration regions. Parents were recruited via advocacy groups for
families of CMC; professionals with experience with PHHC for CMC were identified by using
purposive and snowball sampling. Interview transcripts were qualitatively analysed for themes.

RESULTS: A comprehensive process of prescribing, providing, and maintaining PHHC requires 5

steps: identifying needs, investigating options, developing plans of care, initiating services, and
navigating evolving needs. The success of the PHHC process is built on knowledge, anticipation, and
early identification of needs; communication; care-coordination infrastructure; skilled home health
providers; and the parent-provider relationship.
Results: Three themes were found in the participant interviews. Theme 1 was Knowing my child's
normal and having confidence with daily caregiving. Theme 1 included a sub-theme of Caregivers are
proactive and advocates for their child. Theme 2 was This is much different from my child's normal…
this is an emergency. Theme 3 was We cannot sleep and we are exhausted. In regard to education,
skills, and support, caregivers described their preparation and training in the hospital before their
child's discharge from the hospital with a tracheostomy and feeding tube, but lacked knowledge of
new situations and symptoms at home with medical technology.

Practice implications: This study confirms the need for interventions for these caregivers to enhance
education, skills, and support caregivers need to effectively manage their child's symptoms and
 Conclusion

During hospitalisation, therapeutic play, or as in the form of play therapy, is of high therapeutic value for ill
children, thus contributing to both their physical and emotional well-being and to their speedy recovery.
Effective and early discharge planning provides a seamless hospitalisation experience to the child and helps in
easy transition from hospital to home.
With proper home health care unnecessary medical expenses can be avoided and hospital readmissions can be
reduced significantly.
 Bibliography:

Wong D. L., Whaley F. Lucille; Nursing Care of Infants and Children. 4th ed. St. Louis, Missouri; Mosby, 1991, page no.1172-1173.
https://www.therapeuticplayfoundation.org/

https://playtherapy.org.in/

https://pediatrics.aappublications.org/content/144/3/e20190897

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603147/

https://kidshealth.org/en/parents/coronavirus-stop-spread.html