Play in Hospital - Through the Looking-Glass: Exploring Children and Young People’s Perspectives regarding their Interactions with Health Play Professionals

Abstract

Background: Children and young people are confronted and challenged, on many levels, by illness and hospitalisation. Child-focused anthropologists have described how children utilise play and imagination as tools to cope and make meaning of their illness experiences. Over time, research on the presence and use of play in hospitals has expanded, yet few studies have explored the role of Health Play Professionals (HPP) — healthcare professionals who advocate for children and use playful methods to improve communication with, and transform the lived experience of, children in hospitals. Purpose: This doctoral research explores the role of play in paediatric healthcare, focusing on children’s perspectives regarding their interactions with all members of the Play Team— Health Play Specialists (HPS) and Play Workers (PW). Rooted in clinical paediatrics, research, and medical anthropology, this study aims to amplify the voices of hospitalised children and explore the implications for paediatric clinical practice and healthcare professionals’ education. This dissertation draws on creative analogies — Alice’s Adventures in Wonderland and Through the Looking-Glass — to reframe the hospital experience to a child’s point of view. Methodology: The research questions — "How do children behave before, during, and after they interact with Health Play Professionals?" and "What do children have to say about these playful interactions?" — were addressed through child-focused hospital ethnography. This involved 274 hours of participant observation across various paediatric wards in a UK hospital, with children ranging from two-weeks to seventeen-years-old, as well as 14 play-based interviews with children aged three to seventeen. The sample included observations of approximately 446 children and young people, with in-depth analyses conducted on 46 of them to capture their perspectives. Key findings: The findings provide an overview of both playful and not-so-playful interactions, introducing a novel framework to explore how these interactions occur directly and indirectly, expanding like a ripple effect. Children’s experiences offer six key lessons on how they navigate hospitalisation and how play can shape these experiences: (1) the uncertainty they feel and their need to promptly discern the intentions of approaching adults; (2) the gradual construction of illness narratives and meaning-making processes, which require clear and empathetic communication; (3) a sensory analysis of hospital experiences and the importance of sensory awareness in understanding children’s perspectives; (4) the challenges of extensive waiting times, which children navigate through play, choice, and autonomy; (5) the significance of relationships formed with toys and material objects in a highly unfamiliar environment; and (6) the empowerment and joy derived from uninterrupted free-play when faced with adversity. Conclusion: This work contributes to the growing academic conversation on the complex and multi-dimensional role of play in healthcare settings, highlighting the importance of adopting a children’s perspective and a rights-based approach to healthcare delivery. This dissertation advocates for a shift towards a more child-centred approach that prioritises children’s autonomy, choice, and emotional well-being. It stresses the need to develop empathetic clinical practices that foster an environment which protects and encourages play, particularly therapeutic play. Implications: These findings offer a novel perspective that could be added to the training and education of healthcare professionals, including Health Play Professionals. Incorporating children’s perspectives into their training and the design of play interventions can reduce the psychosocial impact of hospitalisation and prevent healthcare-related trauma. Ultimately, this dissertation provides valuable insight to inform more holistic, patient-centred paediatric healthcare delivery.