INTRODUCTION

“Shape the future of life,

Healthy environment for children

The children of today,

Are the adult of tomorrow.

They deserve to inherit

a safer, fairer and healthy world.

There is no task more important

than providing healthful environment”2.

By

Gro Harlem Brundt land.

Director general

WHO (2003)

Play is the key centre of a healthy child’s life. Play provides the opportunities to be free, creative and expressive. In play children expand their understanding of themselves and others, their ability to communicate with peers and adults. Play is the business of the childhood, allowing your child free rein to experiment with the world around him and the emotional world inside him, says Linda Acredolo professor of Psychology at the university of California. In play children expand their understanding of themselves and others, their knowledge of physical world and their ability to communicate with peers and adults. Play is crusial for your child social, emotional, physical, cognitive growth.

Children under five years of age constitute the 15-20% of total population. Morbidity rate among them is 35-65% of children population. In the history of health services of many developing countries their social and health needs were realized rather later. Now ministry of health in India has focuses attention to provide better health services to this group because “A healthy child is a sure future” is one of the themes of WHO. To make the child healthy quality child care is needed. One of the important parts of child’s development is play.

It is often seems that all children do is play. They play until they are five or six, then they go off to school and start to learn. They play until they are big enough to really begins to do things. Play helps children to relax which makes parents to relax4.“Play is a child’s work and this is not a trivial pursuit”, says Alfored Adler. Play is synonyms with being a child and it is the universal language of children. Hospitalization to any child is very unpleasant and traumatic experience. The child undergoes break from his normal routine due to illness but also separated from his peer group and friends3.

Essential child care needs play therapy should be included with medical therapy in hospitals. Mothers should be enhanced to provide play needs during hospitalization to lessen the emotions.

6.1 NEED FOR STUDY

Health care of children has been markedly changed in developed countries. There is a change in the view of children from, “miniature adults”, to “unique individuals” with special needs and qualities.

The child care has prime importance, as the mortality and morbidity are higher in this group. In India the mortality rate under five is 105 per 1000, while in Japan it is 6 per 1000.(W.H.O.2003)This can be reduced by demonstration, health education and guidance to the parents and creating awareness and making changes towards the health care branches.

Play is a very important component of children’s life. It is the most essential activities for the physical emotional and social development to the child.

It has special importance in the hospital to help sick children to continue to grow anddevelop, to preserve their sense of wholeness to understand hospital procedures,and to act out emotions. The separation of the family during hospitalization cause an anxiety in the young children and may disturb parent child relationship.

Beryl Julliet Sam(2007). Assistant Professor Child health nursing department Coimbatore, Tamil Nadu conducted case study to assess the knowledge attitude and practice of the parents and nursing personnel regarding importance of play needs in hospitalized children. He assessed that 86.11% of nursing personnel had adequate knowledge, 13.89% had moderate knowledge.But 94.44% of them shows favorable attitude towards the importance of play during hospitalization6

There are now ample research to demonstrate that hospitalization has considerable potential to cause long lasting emotional damage(Vernon,1966 Douglas, 1975; Thomason 1986). A child most often looks dull anxious, afraid or angry.Mothers feel that their children become passive after the admission to the hospital7.

Bradshaw’s and Silva,1980,Thomson and Standford (1981), says we know the experience of being in hospital is , itself , a major stress for children which is additional to the stress of illness. More over he is subjected to lot of interventions which are directed to the promotion of his health but aggravate his pain and sufferings8.

Singer. J , (2000) conducted a case study on a play therapy on Massachusettrs GeneralHospital, Boston. They found that parents have knowledge of play for children. 74.98% of the parents knew the importance of play for their child, but only 28.53% parents have favorable attitude to provide during hospitalization to the children9.

Keyes, Marianne, NewZealand (1991)says in their studies-that all children do play. Play is vital to life, it is child’s life.During hospitalization child exploring and elevate the crisis of hospitalization by play. Play also helps in speedy recovery. The recovery rate is more in children who got play therapy during their hospitalization. Hospitalized children require more than recreational play because illness and hospitalization constitute crisis in child’s life. These situations are fraught with over whelming stresses. Children need to play out their fear, angers and anxieties as a means of coping with these stresses. Play also helps temporarily to divert their mind from pain and loneliness. Mothers play a major role in providing play to children because child feels secure and confident in mother’s lap.

Dr. Harish chellani, Professor from Safdarjung hospitalDelhi (2007) spoke on the concept, Integrated Management of Neo-natal and Childhood illness at training course organized by TNAI with collaboration of Common Wealth Secretarial London, he stressed that the health services should include play therapy with cure therapy for children1.

Haiat H, Bar-Mor G, Shochat M,(1991) Dina Academic school of Nursing says that the world of a child is a world of play even in the hospital. Hospitalization to any child is very unpleasant and traumatic experience. The child’s familiar routine are interpreted, they are surroundedstrange and often frightening people, equipment, sounds, smells. Opportunity for playand exploration isseverelycurtailed or non existent10.

`After investigation the research studies , review of literature regarding importance of play in child’s life the investigator found the need for study.

6.2 REVIEW OF LIERATURE

The review of literature is a key step research process. It is defined as a broad comprehensive in depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, audiovisual materials and personal communications.

Review of literature is an essential activity of scientific research project; help to familiarize with the practical issue related to the problem and enable the researcher to avoid unintentional duplication of studies.

Knowing the importance of play in childs life during hospitalization the investigator has review the available literature in the following-

  • Review of literature related to importanceof play for children under five
  • Review of literature related to curtail of play and its effect on under five children during hospitalization.
  • Review of literature related to attitude and practice of mothers regarding play needs during hospitalization.
  1. REVIEW OF LITERATURE RELATED TO IMPORTANCE OF PLAY FOR CHILDREN UNDER FIVE

Dorthy R.Marlow says that the play helps the children to form concept, classification, and contrast and compare relationship among objects, cause effect relationship. Concept of time, object characteristics andproblem solving.

Garvey (1984) conducted a study regarding toys and plays and expressed his ideas that play and play toys develop the ability to represent experience symbolically. Theyexpressed their ideas and feelings about the social world around. King, 1986 said that children learn during play to negotiate offensive alternatives and need for defense11.

Piaget (1962), Bergen (1988) states through their study that children expand their understandings of themselves and others, their knowledge of physical world and their ability to communicate with peers and adults. At 9 month infants learn that a ballrolls away, a rattle make noise. At 12 months objects bring forth more specific and differentiated actions. By the age of 4 or 5, child’s ideas about the social word initiate most pretend play. In Toddler, there is growing awareness. They share, communicate, expresses anger or joy through play.

Caldwell,B.,(1977)conducted a case study on children under five in kindergarden at Lucasa. He found that children under five shows their aggression and hostility through play either throwing toys or snatching toys form other children. He conducted the study on 20 children age 3-5 years, by giving them only one Barbie doll. 12 out 20 eagerly get up to get, snatching and pushing each other for toy, but five remained sitting silently ,threeout of twenty not shown any interest,but they remain silent and looking towards the others. It shows that toys attract the children. They enjoy as a fun for them14.

B. Review of literature related to curtail of play and its effect on under five
children during hospitalization.

Keys, Marianne, (1991) conducted a case study in New Zealand and concluded that children requiring extensive hospitalization to understand cope with their illness, treatment and hospital experiences. He conducted a study on three children who have to stay long time in the hospital for recurrent surgery. The children who participate in play programmes have three to five years of age. One is 4 years old female who had congenital problem who requires repeated surgery, the second a boy who need correction of oesophageal atresia and the third is five years old boy who had congenital cardiac anomalies. After 11 month, the author evaluated the result. The four years girl who has attended play therapy during her hospitalization regularly shows speedy recovery and healthy growth than the others two who have not attended the play therapy. This shows that play during hospitalization helps to cure faster than the others15.

A report published by American Academy of Pediatrics (9.10.06) the importance of play in promoting healthy child development and maintaining strong parent- child bonds-Mother play an important role because the child feels more secure and confident in the presence of mother. Play brings you closer to your child. It helps them to become more independent. They more able to work problems out, to develop their own concentration and imaginations7.

Vernon, (1966), Doglas, (1975) Quinton and Rutter, (1976), Golden, (1983) and Thomson, (1986) did research on role of play in assisting children requiring extensive hospitalization in Auckland Children’s Hospital. They say that we know that the experience of being in hospital is itself a major stress for children which are additional to stress of the illness. Children respond to this stress in varies ways according their age, personality emotional state and their previous experience in hospital, and the attitude to those caring for them. Play is the best alternative to cope with stresses16.

Barker (1974), Beuf (1979), Simons, Bradshaw and Silva(1980), Thomson and Standford (1981) says that it is not surprising that developmental regression is common and the emotional withdrawl may be adapted as a way of shutting out experiences with which the child is ill equipped to cope. Play therapy helps them to communicate with them and cope with emotional hazards17.

Bergan D (1988)states in his study that play is an important part of the care we provide to the children which allow them acknowledge and deal with their illness and treatment through play. They keep children occupied, they help them to cope with pain, anxiety and fear, to make friends to regain skills they have last as a result of their illness and learn new skills

  1. REVIEW OF LITERATURE RELATED TO ATTITUDE AND PRACTICE OF MOTHERS REGARDING PLAY NEEDS DURING HOSPITALIZATION.

Rev Esc Enfern USP (1999Dec), 33(4):364-9. “Playing in hospital: addition to nursing care”.Playing is one of the essential activities for physical, emotional and social development to a child. The empiric data collection realized through the participant observation of 11 children. They identified that the act to play has repercussions into the child, nurse and hospital; to the child it is not obstruct the development, helps it in the understanding about what is occurring with itself. They discharge tension, fear, anxiety and frustration, promote satisfaction, funny and spontaneity and allow it transforms experiences that should support inactive in active discharge. To the nurse it is tool of intervention and way of communication. More necessary is to initiate the play. Mother can play a vital role in it18.

Dorthy R.Marlow, says, the presence of an adult in the play of toddler facilitates release of aggression, while helping expression impulses by under control. Guidance should not inhibit self directed activity. It is important for adults to provide material which children can explore and adopt in the play.

ERIC # Journal Articles: Reports- Evaluation, “Use of Art of Play therapy in oncology”.Two play therapies applied by parents for darkness phobia in young children are compared. 27 children between the ages of 4-6 years were recruited from 27 schools. The participants were randomly assigned to three experimental conditions bibliotherapy and games, emotive performance and no treatment. The treatments were applied at home by parents who were trained previously and it last for 5 weeks and took place in three 20 minutes alternate weekly session. Both therapy shows significant result. The study shows that art and play has great effect on children under five. They can cope up with their problems easily through play they become more understandable and confident19.

Calwell 1997) said that adults should identify play which has led to problems for particular children. They should check materials, equipment for safety. Adult should make children aware of any hidden risk in physical challenges they set for themselves.

According to PMID:1340875 a child’s play is recognized as a useful tool for nurses in the diagnostic process of making judgments about a hospitalized child’s compliance with medical procedures, adjustments to the hospitals, environment, degree of pain, and level of psychosocial functioning. However, the bases that is required to effectively help a pediatric patient “play” in a therapeutic mode appears to be extremely limited for most nurses and is rarely addressed in a substantive manner in nursing education. Educational programs must be willing to incorporate a “developmentally appropriate, culturally sensitive, and family-centered approach” using clinical experiences and professional role modes in their nursing curricula. The end product should be nurses who are competent in a much wider range of learn to play. They can take the help of mothers.

Nursing Clin North Am 1984 Jun,say that play for most hospitalized children centers around self and stressful situations as perceived by the child and is restricted in terms of what the environment and physical limitations so the child present. Play can be a tool to understand and intervene with pediatric patients. Collaboration with nurses who are clinical specialists, early childhood educators, and others who have expert knowledge of children and play equipment is useful to plan purposeful play programs or programs or play sessions for the special need of hospitalized children. Such collaboration will insure that play will be carried out in consistent growth promoting manner. For some children, hospitalization is an challenging experience that promotes a sense of competence. For other children, hospitalization is an experience that results in a negative outcome.

An American Association Nursing care of children and families, (2000) describes that, “hospital play is an important part of medical care”20. Play can really make a difference-

  • Create an environment where stress and anxiety are reduced.
  • Help the child to regain confidence and self esteem.
  • Provide an outlet for feelings for anger and frustration.
  • Help the child understand the treatment and illness through play.
  • Aids in assessment and diagnosis.
  • Speed recovery.
  • Advance physical development.
  • Promoted social skills.
  • Build imagination.

STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE KNOWLEDGE, ATTITUDE AND PRACTICE AMONG MOTHERS OF UNDER FIVE CHILDREN ON THE IMPORTANCE OF PLAY NEEDS DURING HOSPITALIZATION IN SELECTED HOSPITALS IN KOLAR”.

6.3 OBJECTIVE:

  1. To assess the knowledge, attitude and practice amongmothers of under five children regarding importance of play needs during hospitalization.
  2. To evaluate the effectiveness of planned teaching programme regarding the importance of play needs for under five children.
  3. To find out the association between knowledge, attitude and practice with certain demographic variables.

OPERATIONAL DEFINITION:

1. KNOWLEDGE

In this study knowledge refers to the awareness among mothers of under five children regarding importanceof play needs during hospitalization.

2. UNDER FIVE CHILDREN

In this study under child means a child who is less than five years of age.

3. Mothers

In this study a mother means a motherwho has child less than five years of age

4. Play needs

In this study importance of play need means creative activities which divert their attention and helps in speedy recovery.

5. Practice

In this study practice refers to doing or fulfilling the play needs of children during hospitalization.

6. Attitude

In this study attitude refers to mother’s tendency to provide play needs to under five children during hospitalization.

6.4 HYPOTHESIS:

There will be significant difference in pre and post test knowledge score of the mothers of under five children regarding importance of play needs to children during their hospitalization.

6.5 ASSUMPTIONS:

Mothers of under five children have some knowledge regarding importance of play needs for children under five.

The knowledge will differ according to the background of the subject.

There is a significant association between the knowledge of mothers of under five with selected variables.