When Sean Tierney’s eight-year-old son was discharged from Cork University Hospital in May, the dad of three felt “just saying thank you on the way out” wasn’t enough.
Right from the start of Isaiah’s four-day stay on Puffin Ward, the Midleton-based dad was impressed by the way play and games were brought to the patients’ bedsides.
“Seeing a young woman go around to the bedsides, play Connect 4 and cards with the children – to see her sit down, really relaxed, with a great bedside manner and interact with the patients, I thought that’s money well spent.
“It was refreshing to see staff dedicated to play, because it is just as critical to the children’s wellbeing as the clinical and medical side.”
Isaiah – who has 15-year-old twin sisters – was admitted to CUH emergency department after he got hand sanitiser in his eye. And, while being seen by SouthDoc, he’d lost the power of his legs. “In the end what happened with his legs was unexplained. Isaiah had an MRI – everything came back clear and the problem resolved after three days,” says Sean.
But seeing CUH play specialist Rachel Griffin prepare his son for the MRI experience – “she had a folder of photos and diagrams” – made an impression on Sean. A helicopter pilot with a chemical engineering background, he had built himself a helicopter simulator for training purposes – and for fun. His instinct upon Isaiah’s discharge to give something back to the children’s ward crystallised in a decision to make an MRI simulator.
“Sometimes you can be fired up about something and then you get distracted and the good intentions wane. So I said ‘right, I have to get this achieved’ and my wife, Jen, told me to crack on with it too.”
With materials supplied free of charge by local Ballinacurra businessman Ronan O’Sullivan, Sean made the rainbow-shaped simulator out of safe, durable plastic that can be easily wiped clean. And he also downloaded actual MRI sounds, which he explains can be played in the simulator by using a Bluetooth speaker – placed next to the child’s head – and a mobile phone.
The simulator was ready within two weeks of Isaiah coming home. It is a big hit with young patients who see it as a tunnel or cave that they can bring toys into. Recreating the visual and auditory aspects of MRI, explains Sean, was all about tricking the visual and auditory senses to feel as if you're in the actual environment. “It’s set up so it can be brought to the child’s bed, because when a child comes into hospital their bed very soon becomes the new micro-environment where they feel secure,” says Sean.
Rachel Griffin says the MRI simulator has “massively helped” patients, giving them a gradual introduction to what an actual MRI will be like but in a safe, playful way. “I put it on the child’s bed. The child gets to lie on the bed and I push it over them as if they were sliding into the actual machine. So they get the experience of being in a small confined space and the sounds are playing.”
The only play specialist at CUH – though she’ll soon be joined by seven Children in Hospital Ireland-trained volunteers – Rachel follows the play interests of each individual child. Even when it comes to MRI sounds. “There’s a lot of banging and clanking and knocking. To make these sounds less frightening, I get children to relate them to things of interest. One child loves Sonic the Hedgehog so he related the sounds to Dr Robotnik’s machine gun.”
Rachel works on Puffin Ward, site of the hospital’s playroom and catering for two to 16-year-olds, as well as on the babies’ ward Ladybird and on Seahorse, the children’s outpatient department. “I also do two burns-dressing clinics. This involves distraction play – using distraction techniques while children are getting dressings changed.”
Part of a multidisciplinary team, Rachel works first with children referred to her by colleagues and then with other children on the wards or in the playroom. Her place of work revolves between the patient’s bedside, a baby’s bedroom (Ladybird patients each have their own room) and the playroom. “With babies, I’m sometimes on a mat on the floor or on the physio ball, or they’re in their cot or we play lap games.”
She says play is a very powerful tool in a hospital environment.
Before ever engaging a child in play, Rachel chats with them and with their parent to get to know the child’s interests. “I don’t come with an agenda. I follow the child’s lead.”
She says younger children – two to four-year-olds – love coming to the playroom for the kitchen, the workbench, ball games and play dough.
Older children like messy play, slime, construction games like Lego and Meccano, and arts and crafts. “They like to take their art home with them, almost as a souvenir of their time here,” she says.
The first step in working with children is to build a rapport. Rachel employs a variety of strategies to do this. First, she observes the child, to see their style of interaction. “Some children are chatty and sociable. Others are cautious around new people, especially in hospital."
A child’s communication isn’t always verbal so Rachel looks for non-verbal cues. “When I walk into a room, I’m conscious of my position. I like to stand back from the bed and give them a bit of space.” And when she does approach, she’s at their level. “I’m either bending down or on my knees or on the floor. Playing with toddlers I’m often on my belly – I’m less intimidating that way and I can read their non-verbal cues.”
Even after explaining that she’s here to play some children are still cautious. “I have to build their trust. I comment on something I see on their bed – a teddy bear, toy, their pyjamas.” Commenting is very powerful, she says – it’s not like a question, which puts a “communication demand” on a child.
“By commenting, we’re leaving it open to the child to start a conversation. If I say, ‘Oh, I see you have Paw Patrol pyjamas’, the child might respond, ‘Yes, but I have pink slippers’ or ‘I have a Paw Patrol teddy too’. And then I might comment again, or simply say ‘Oh’- and wait. A lot of what I do is waiting – because in a medical setting a child with typically developing language may sometimes not articulate the way they would outside the hospital. So you need to give them time to find their voice again.”
When the new CUH children’s hospital comes on stream, Rachel will have many more spaces for play. “I’ll be able to plan and resource the rooms. It’ll give me more scope to adapt the environment for play that supports the children’s needs. And we’ll also have an outdoor play space, which will be amazing.”
Meanwhile, she loves her work. “I get to play every day with the most amazing children. There was a boy in the playroom the other day. It took 20 minutes before he began talking – and when he started he didn’t stop. He told me a lot about his needle phobia.
“My job is to create a safe space where they can play and where they’re more comfortable to express themselves. And out of nowhere, they’ll start a conversation – about the medicine they had to take that morning and didn’t like, or that the doctor did surgery on their legs.”
Working with children in this way brings many rewards, as Sean Tierney experienced when he was told about how astonished one mum was to find her little boy underwent an MRI without sedation – all because the MRI simulator had calmed his anxiety. “Hearing that gave me a lump in the back of my throat,” says Sean. “Hearing that was my reward.”
Play therapist Rachel Griffin says play gives children a positive experience in hospital. “So they have some fun and laughter and don’t associate hospital with painful experiences only.”
Play is a powerful tool and great for helping children express themselves and use their imagination. “It works on their cognitive, emotional and physical wellbeing. We use play to motivate those not yet up-and-moving post-surgery to use their motor skills. The physiotherapist will often link in with me to help get children back into their physio programme. This can be done really powerfully through play.”
Children who are referred to the play specialist need extra support around preparation for – and distraction from – medical procedures, for example, blood tests, ultrasounds. Using play in this way helps reduce anxiety.
Play gives children a sense of control and autonomy. “This can be taken from them in a medical setting, where they feel people are ‘doing things’ to them. When they have an opportunity to play, you can really see them empowered again.”