A Silent Wish.

When those around us need help

When those around us are in pain.

We should listen for the sounds , when they ask again,we should watch for the signs.

For we may have missed their silent call for care.

We may have missed the very essence of their need, and slowly they disappear.

They may be our patients, they may be our colleagues.

 It could be us, as we send a silent wish.

We all spend so much time - reaching out with kindness and care, that even in the deepest times of despair and discomfort - we miss the importance of what is being said.

I have spent many months this year calling to my colleagues, picking up the banton of patient first and experience-  waving it frantically at times.

Sometimes it is taken and great things have happened- and at times it has fallen to the floor.

Over this last year there have been huge strides, and there have been times for me that have been so difficult and distructive, that some days I have felt like I have carried the biggest of boulders in my bag.

Throughout the year I have grown, discovered a strength deep within,that I didn't think was there, have collaborated with inspiring peers- and have learnt that being true to what you believe and feel is both freeing and frightening in equal measure.

I recall a conversation with a family. 

"You see Sian it's easy to "act" like you are giving the best performance of your life, but really you want and need the permission to strip that costume and at times  feel naked and all consumed in order to let it all out"

I thought about how honest this family had been with me- how trust plays a huge part of patient care and support.

Then I reflected on my month, my year.

I thought about how do we really allow families to feel free enough to be able to strip away there performance - and allow us to see the core of need.

I haven't got all the answers- but I know that one way could be providing an environment that allows honesty and opportunities - that listens and that doesn't promise the magic wand action.

I have been reading lots and collaborating with great minds- I have also been listening - and taking time to explore authenticity- and how this impacts patient care.

My silent wish for the new year- to continue with planting those seeds- of providing them with food and fuel- of nurturing them and supporting the start of the growth.

Wishing you many moments of peace, joy and happiness in equal measure.

Sian.

Conversations that matter.

"Vulnerability is not a weakness, and the uncertainty, risk, and emotional exposure we face every day are not optional.
Our only choice is a question of engagement."
Brene Brown 2012.

When we work with and engage with children, young people and their families we are seeing them at there most exposed, raw, and vulnerable.
As health care professionals, we may walk alongside them, to offer a hand or to simply listen and to help carry that emotional suitcase that is at bursting point, but we do not have the power to make everything better- for it all to go away.

But we can impact the experience.

It is at this point we engage with them, and those first moments need to be as honest and kind as possible- however having walked alongside many I feel that as an individual I have to also be at my most exposed and at times vulnerable.

I don't know what they will ask me, or what they want help and support with?
I don't know what path we shall walk, and if there may be many twists and turns in it.
Brene Brown  talks about choices and Daring Greatly- I feel that as an individual I dare greatly most days, I also observe my colleagues do this sometimes on a hourly basis.
As health care professionals we have codes of conduct, pathways and policies to follow that are there not only to protect ourselves - but also to ensure the safety of patients and clients we work with.

But they do not mention over exposure or vulnerability as we would understand it- so we have to make sure we have pathways in place to support us as professionals. 

But sometimes we are thrown curveballs- and we don't see them coming,  however experienced we are.
Having conversations that matter are all exposing and engagement is the key, without it the most important elements are missed, and the family or individual you are caring for also gets lost in the unknown.

I recall some recent conversations with a family, the things that matter, the vulnerability of the conversation - the courage shown to talk - and to say the most emotively charged things, in a space that can be held- in the middle of a busy ward environment - it was not easy, but it was spontaneous, and organic in its content.
How do we know what to do and say in these moments?

I can only share my experiences- and over the past few weeks I have had to spend time looking at my vulnerability and to not be afraid of it, to have the courage to expose it to some of my colleagues.
It can sometimes be misread, it is can also at times become over consuming- and feels quite alien to me.
To feel in a vulnerable state, also throws up feelings of anxiety, being frightened, out of control, unsure, and can be exhausting.

Recalling tough conversations that matter with children and young people, and their families, these feelings are expressed in many different ways, but when striped back their sense of feeling exposed and vulnerable- translates into fear and anger as they are unable to control what happens next.

Conversations that matter can be minutes in length, seconds, it can be a comment as you engage in an activity , whilst doing observations, walking past- but the impact may be powerful.
Over the last 8 years- I have watched as large groups of doctors approach children and young people at bedside.
Those that decrease in size.
Say hello to the child/young person.
Ask how they feel.
 They are the ones who dare greatly, and have courage to hold the vulnerable - which equally transforms the relationship, the art of it.

The parents and families we work with are exposed to the very core.
 To have a sick child in hospital, and not know what's happening- or what day of the week it is.
 They have emotional suitcases that are bursting at the seams.

In order for us to support them, we need to be supported.

Vulnerability is not a weakness, it is a true strength, our children and families will feel a great sense of this when in hospital- so our conversations that matter will invite that strength to be exposed, and we will do our best to bring purpose and meaning to events for them- hearing the unheard, and being ok with that.


Sian Spencer-Little.

In Health, In Trauma, Play is essential.

Play is an essential component, it is instinctive and powerful- in the development of the whole child and must continue wherever possible in sickness and in ill health, trauma and both when there are long or short term issues.

It is critical and crucial in helping to support children and young people - to provide coping strategies and opportunities to explore, to find out

the mechanisms of why we each react differently to environments and procedures.

All members of the team whether that be in healthcare, support work, overseas volunteering are involved in the wrap around care elements of children and young people within health/aid settings they can utilise play and it's components.

Members of the Specialised Health Play Team hold enhanced responsibilities, experience and rich knowledge to share and promote essential skills.

Judy Walker shared with us that essential functions of play are built into the fabric of the child and young persons journey through the hospital and health experience.

Normalising Play is at the very centre of a child's world- to have it removed - to have been part of a traumatic experience or for play to be unobtainable means to deprive and remove the ability to explore, engage and experience.

Children and Young People accessing hospital and health care often feel disjointed from the experience- when I talk about this I also want to include the following.

Recent world challenges throws up questions.

I wonder how children and young people feel ,who have had to leave the place they know, the people they know, where they play, to be led away to travel, on such a long and at times frightening journey- How do they feel?

To leave their homes without the adults whom they love and trust who provide a safe loving feeling.

They may have lost the ability to play and in turn are not able to express or play out their worries?

They may have become so shut down and withdrawn that to experience joy, have fun, or smile- is lost.

This will have a huge impact on the way they develop, grow and for their stories to be told- we have to listen, sometimes to the unheard- and sometimes this takes a long time.

Listening to the unheard is often difficult - for the HCP's involved - but how difficult and frightening for the child or young person and their families to tell it- to let us into their inner world.

We have to do this within healthcare too- to assist the healing journey of trauma - to past experiences and look at how it impacts the future of their care.

It's important when working with children, young people and their families that we look at how long a hospital stay will be, will they need regular input within a clinical environment .

Individual Play Programmes are a way of listening to what they have to say- how treatments make them feel- what works well for them to support preparation and distraction- likes and dislikes.

A lengthy stay in hospital or repeated hospital admissions may lead to a decline in reaching developmental milestones - Developmental Play Programmes can help and support to address this.

 They are formulated to ensure delelopmental progress is maintained, and opportunities to explore,have fun and maximise learning in a non- threatening way.

The Art of the Relationship

                                            

 

 

In many walks of life we come across and meet interesting and amazing characters, in my working life I have met such wonderful, bright and strong children, young people and their families.

 

They have brought so much joy and meaning to the work I love, they spur me on each day- to try and create a safe haven, a ripple of understanding, a place to be.

They have also given me a deeper understanding of their pain, and at times sorrow and despair, they have shone a small light on how it is for them, right now in this moment. 

 

With this in mind it felt natural to take a walk along the  therapeutic road and commence a journey of my own, of deeper understanding of ways to offer that safe "just being" place within my role as a Specialised Play and Activities Practitioner within a healthcare setting.

Its not always easy, and sometimes I see children and young people for such a short time, that I wanted that time to be solely for them, to choose and explore in a safe way, and if anything allowing a little of their story to be heard.

 

Stories are talked about as having such powerful meanings to those telling- but also to those receiving.

This weekend I have been sharing my story , and learning about using different creative techniques- ways a child or young person might choose to share a little of themselves or what matters to them.

The over riding theme this weekend- has been be curious, don't make assumptions about how a child or young person feels.

Learn how to play as adults so we learn through a child's eyes.

Take time to really imagine how or what story we are being shown.

I have also be able to share a little of myself with a group of equally amazing Health Care Professionals and colleagues who work in education.

 

Our core aim appeared to be the same, yet I was very aware we had all come together as strangers, and at times it felt uncomfortable, a little frightening and raw, then taking a step back- these are just some of the feelings a child or young person might have-so  how can we extend the listening ear, how can we support and help children and young people explore their emotions, in a way that is unassuming and safe?

We were about to find out.

 

Any relationship takes time, 

understanding, to grow meaning.

 

To be secure, to have your own sense of self- for some that is asking the impossible. -  there are so many external forces asking us to change, to be something we are not, impacting on our learning and growth, and so our sense of self gets distorted and lost.

For children and young people they have to have the opportunity to explore their own sense of self, of identity, and for some facing unimaginable trauma and ill health this is just to painful and to difficult.

 

I wanted to share some of the key points I have had time to process from this weekend- these are just a few! 

They may assist or resonate with some of you during your working week, or any long term work you are doing-

 

• Be present with the child or young person- the relationship, the quality of this, be curious.
• Keep shining a light on the process- wonder what its like to be that child or young person.
• How are we seen by children and young people- are we number 10 in a long line of adults that have been in their lives?
• To grow the depth of understanding- and the relationship , always check in with yourself- how does it feel.
• The use of image and the arts allows us to be alongside a child or young person using metaphor.
• Use the creative process to allow a child or young person to express what they feel, their story.
• Allow that to be heard with reflective listening.
• Be playful- it allows more freedom, this in turn makes the experience richer.
• Don't make assumptions.

 

We always have room to learn and develop...................take the moment.

 

 

 

Sian Spencer-Little

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Play4C&YP in Health.: Making a Difference.

Play4C&YP in Health.: Making a Difference.:                                              I am a strong believer in positive thoughts, words, deeds and actions. Like the most h...

Making a Difference.

                                          

 

I am a strong believer in positive thoughts, words, deeds and actions.

Like the most humblest of people Mahatma Gandhi's very core was about values, beliefs and truth.

I believe that these values have an ability to impact on a situation, to offer a supportive hand, to simplify overwhelming episodes and experiences and support the learning process.

Equally I believe that I am honoured to work in a profession that allows me a small but intimate window into family life, sometimes during immeasurable heartache and pain, but equally at times of joy and relief.

 

During this last week, I have been what some might call a "steady hand" both for my colleagues at work, but also some families I have been fortunate enough to have met and supported ,but not necessarily for myself.

 

At times I have had to process lots of information and emotion in a very short time and with little breaks in-between to work with another family, child and young person.

I realise that we all do this on a daily basis- in many walks of life and work- so I wondered

- if I am struggling with this, if I take a few steps back, how much of a struggle and difficult road must it be to walk when you are a child, or young person, family member or student nurse?

The 6C's of nursing are...... Care, Compassion ,Competence, Communication, Courage, Commitment.

So as I try to make a difference, and be a supportive presence, I never forget why I do what I do and how, I thought about some of the words I have used this week, of the moments in time when I have sat with a child, or a nurse, a family member, a colleague, and how could I share this on a larger platform.

Time, support, care, understanding, respect, journey, process, courage- just some of the words I have said and heard this week.

 

A note to myself- I should never under-estimate the impact this work has on you, the individual, and the experiences of a family, how they share, how they educate, and how they touch your inner core.

As HCP's we are not in a position to call on a superhero with a protective shield when the going gets tough.( even though we might like to- but equally those superhero's are not always there for families either)

 

So here are my Top 6 ~ #SSC ( Sian's steps to self care)

 

 

1. Take a moment to regulate your breathing- this will help you deal with the next part of the journey you take with a child, young person and their family.

2. Give yourself a break- you are human- and in order to support and show empathy and compassion standing back for 5 or 10 min's will allow you to recognise sometimes the enormity of the situation in front of you- and seek advice from your peers.

 

3. Please don't feel you are alone in this journey.

 

4. A process diary is a really good way of getting all of the "tough stuff" we deal with out and down on paper- it can help to make things clearer- and can be helpful in understanding this complicated episode, and enhance your learning and impact your experiences- if this is to difficult, find someone who can sit alongside you.

 

5. Try and see some daylight/sunshine each day- even if it means walking the long way round to the car/ toilet/restaurant/shop/path lab/pharmacy - you get the idea!

 

6. Remind your colleagues and peers to do steps 1-6!!

 

 

 

Sian Spencer-Little

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

Bubbles for Joe

This week  I wanted to share with you a story..

A story about loss, and of honouring, of memories and of new beginnings- it formed part of my work previously with loss and hospice care.


Bubbles for Joe.


"This is me, my name is Phillip, and it may seem quite strange to you that I am sharing this photograph with you, especially as I am blowing bubbles.

Why, you may ask?

Well this is my best friends garden, I come here a lot you know, here I can shout, stamp my feet, think, here I can remember.

Molly helped me find this place, I call it my safe place, she lets me call her Molly Moo.

I am 11 years old, my best friend, was, is 10, and I come to this garden to remember him, because he is not here anymore, he has died and it took me a long time to say the D word.

The bubbles you see, are for him, in each one is a message, sometimes I tell him about what I am doing at school, or about the horrible school dinners, or maybe I might just tell him I have a new football, or that I ate loads of popcorn at the Cinema.

Today I am sending him a message about the summer, how hot it has been, that I went to the beach and ate ice cream, and how much I miss him and wish he was here.

I have blown 8 bubbles, but if you look carefully you can see or imagine that there is 2 bubbles together , it looks like an upside down snowman.

That is a special one, that's only meant for me and Joe.



After these bubbles fly towards the sky, I am going to have a water fight in his garden with his brother, we are going to get soaked, so he will be able to see, even though he is not here with me.

I do feel sad sometimes, and cross, very cross, and I miss him.
Molly Moo says it is ok to feel those things, but I still like to laugh sometimes too, just like Joe and I did together.

Sometimes my tummy used to make really strange noises when I was sad, and it felt like a washing machine, with lots of things going round and round, but when I blow the bubbles, and send Joe the messages it helps to make me not so sad, and then things start to calm down.

Soon I am going to be moving house, and I wont be able to come to Joe's garden anymore.

But there are lots of hills where my new house will be, and I will always have the photograph to remind me of my safe place in my head.

My new garden is on top of the highest hill, and you can see for miles and miles across all the tree tops.



So I can go, and blow bubbles.

Bubbles for my best friend Joe, and I can remember all the times we laughed.

On days when I feel sad I can climb to the top of the hill, and a little part of me will always remember Joe's garden and the fantastic summers we had".

The End



Sian Spencer-Little

Little Boxes

      
Over the past few weeks there have been many moments of brightness, contrasting with confusion, unexplained actions and fear.
If we look at impact, and I often talk about this in real time, the consequences to that are, the person effected is left dazed, unable to process and fearful of the future.

Each of us are unique, we carry with us and hold deep within us an ability to behave in a certain way, to re-act to situations, to process and to respond.

Often then, unique people are placed in little boxes- which they cannot seem to find their way out of, this can often result in their character and essence being closed away - rather then being explored, allowed to evolve, celebrated,  and shared.

"Experience growth and the will is far greater than the ability to shut down every time you are scared and want to play it safe"

 I am relating this to a unique group of children and young people I have the honour of sharing there journey with.
                Sometimes they are put in little boxes.

I spend lots of time observing C&YP who are living with long term health conditions, I sit alongside them during treatments and admissions to hospital.
I observe how they are greeted, and the affect it has on them with yet another admission to face.
I spend time with their families, and siblings as they too form part of this journey.

How does this impact on their "non-hospital life", the life away from blood tests, blood pressure checks, treatment, cannulas, more nurses, more doctors.

Do they want to have polite conversations with nurses and doctors who have been with them since they were a baby, when they are now 14!

I have explored this with C&YP this week as I have walked alongside them to support them through there latest stay in hospital, I have been an observer and student.
This has enabled me to really listen to what they need, how they would like to be heard, and what they want from their routine admissions in hospital.

" I like coming here because I get to see some of the nurses and doctors I know, but I wish they wouldn't keep telling the same jokes"

" I just want to get it over and done with, Iv got so much work to do for school"

"Yippee this means I get to go to the hospital school, I love it"

These are just some of the comments shared with me, and so in giving them the opportunity to say how they feel, allows them not to carry so many worries with them, it also says to them, you are unique, and your thoughts and opinions do matter.

"Sian I know I said I don't need you, but if your not busy will you help me with my cannula"
I have known this patient for 8 years, they have a active procedural plan in place and on the last 3 admissions they have said " I'm ok I don't need you"

Each of them is unique and ever evolving- and its ok to ask for help now and then.
Giving C&YP the luxury of time and space, during an admission goes towards non- verbal actions of being present and in the moment.

I may have just been walking past the treatment room, and popped my head round the door " Hi, anything I can do?"

For some of those living with a long term conditions- coming into hospital for even short periods of time is a huge disruption in their lives which they are trying to live as non- clinically as possible.

" Please ask me if I would like to talk,then please ask me how I am today"

Sometimes they don't want to have conversations, sometimes they just want to "get on with it" - can we work towards this which does not involve words and conversations- but by actions.

Can we understand why sometimes they don't want to talk, is it because an opportunity hasn't be offered?

Sometimes they want to have a conversation.
Can we as HCP have those conversations freely, openly and honestly, do we know how to say certain things, are we equipped with the right language

This week I was honoured to attend the official launch of MeFirst.org.uk
this is a brilliant organisation set up to assist and support.
To share skills with HCP who work with and are part of C&YP's lives, it was also thought provoking to hear and gave deep meaning when listening to how C&YP would like to be listened to and supported through their lives within health.
It was also refreshing to meet and see how many of us are doing the most amazing job at supporting C&YP, and how together we can continue the movement forwards.
 
Within my role, I can offer time and space, tools to express, set up discussions with other HCPs to understand C&YP - what are their needs and how can we make being in hospital a more rounded experience.

Effort only fully releases its reward after a person refuses to quit.

"With ordinary talent and extraordinary perseverance, all things are attainable"
Thomas Foxwell Buxton.


Sian Spencer-Little
 








                      

Expression and Story Through Play.

"The Sandtray - tiny grains of sand, like huge diamonds are so powerful, yet it   appears uncomplicated, natural and after all ,its just a tray of sand!"

My thoughts, before I  took part in a Sandtray session many years ago- how wrong was I, and how totally unprepared I was for what followed- it is difficult to even put into words- as its a deep and powerful experience, that cannot be taught- it has to be felt, words do not allow for the impact it has.

Over the last 10 years we have grown to learn more about the expressive tools that can be used and offered to children and young people, experiencing "tough times"


Many professionals within the field of trauma work and neuroscience have shared research and key findings on the impact trauma has on the brain and our ability as human beings to process and cope with that impact.
How it can impact our learning, our processing and for some become a block to growth and development.

Much of this work and research has come from collaborative work alongside children, young people and their families. ( Violet Oaklander, Dr Margot Sunderland, Dr Garry Landreth to name but a few)

I have been fortunate to have been a student with some of these teachers, and have embarked on further training and therapy within the vast area of Therapeutic Play.
As I grow - it is an area of work I am continually learning from as a practitioner.
It is not an area to approach without training, and teaching, supervision or personal therapy opportunity. 

When I think about trauma, and perhaps what a child or young person has experienced, I look at subtle trauma, those short episodes, those things that seem unimportant to others- these are often the beginnings, and then other short episodes arise, little incidents, and they begin to build, much like the "Tower of Jenga" I have spoke about previously.
Then all of a sudden it has grown to enormous height, is so loud that nothing else can be heard.

We all have different ways of dealing with our own episodes- moments in our lives where we have needed an extra hand, an arm to guide us- however for some children and families this is an invisible image- one that is too difficult to locate or see, or accept.

When working with play skills- we open up the dialogue between the two worlds.
Children and young people often reveal things about themselves that they wouldn't normally do, they sometimes use metaphors and objects, as adults we feel the urge to be able to fix them- and within Therapeutic Play sessions its really important to try and resist that urge deep within us.
That is asking a lot of us, and for some playing does not come easy.

If you have not had the opportunity to be free with objects, to explore, to imagine to re-inact with puppets, dance, sing, paint, play with sand- how do you allow yourselves to be free with the medium you wish to invite the child to explore and use.

When delivering a therapeutic session, a space, its important to acknowledge that the simplest of things has the biggest impact.

Allowing children and young people the opportunity to play, take a puppet, share a feeling, the name of the puppet, what is it doing- you are inviting them on a journey of play.
To offer paint, clay ,a drum alongside a child, to listen as the drum becomes a tool an extension of their feelings is a powerful moment.
Here you will both discover individuality, imagination, the role of this character or feeling- how it  plays, its likes and dislikes, the volume of their voice, or instrument, the tone, the language.
Here you begin to do the wonderings for the child or young person.
Symbolising feelings allows children to choose to join in or create conversations about their emotional world.

Working within the metaphor has a feeling of safety, as you speak as an object.

I will be sharing further thoughts and insights in the coming weeks using my blog to explore these, share and grow as a practitioner.




"Trauma makes you fight the last battle, over and over again"
Bessel Van der Kolk 1999.


Further Reading-

Margaret Lowenfeld - Understanding Children's SandPlay
Violet Oaklander- Windows to our children.

Take a moment- see the beauty on a "TwitterBlogVacation"

Time away from computers and blogging is something I thought I would struggle with.
However I feel it has given me some space to really see things through different eyes.

As I sat over looking the ocean- and thought about the last 6 months of work, of the NHS, of pieces of work I have been involved in, new people and peers whom I have worked alongside, I feel really privileged to have had all these opportunities.

I asked my partner the following question.

What allows us to inhale- take a deep breath- look at what is often right in front of our noses?

 

For me- the sea, the waves and the fact that there is nothing on the horizon.

A deep breath- a cleansing sigh to me that says " ok- breath, relax and restore"

The reply from my partner was - "getting into my own bed"

I pose a question- "but what allows you to feel truly relaxed"?

Reply- " I have never really thought about it in that way"

In healthcare and as professionals I wonder if we ever truly have that moment of looking out and seeing nothing on the Horizon- no lists of things to do, projects to complete, patients to spend time with.

I am a bit of a workaholic if that's the right word, I love all the projects I am involved in, and work like crazy in an environment that is highly charged at times- and I love it- wouldn't ever think of anything else, the challenges, the teaching, the patient care- these are all music to my ears.

However - we all need that space in time, that gap, that moment of stillness- in order to do what we do, to recharge our batteries, and see our families, in order to top up our "cup of kindness and compassion"

I then got to thinking about how creative we could be in our workspaces to provide a moment of calm, a breathing space.
We would all have different things, images or ideas about what could make this happen for us.

I have recently shared a blog space with @johnwalsh88 - it was so uplifting, and a learning experience to write alongside him, and we shared our thoughts of creativity, kindness and compassion.

Perhaps we could all do with a place to take a breath.
 A sign on a door " Horizon Space" where you can go for a few moments just to be.........
How effective would it be?

Creativity comes to us in many different ways- over the next few weeks I will be using mine to celebrate and highlight the Power and Passion for Play In Hospitals- with National Play In Hospital Week.
We will be welcoming visitors and working alongside Music In Hospitals to create a space of joy and support for C&YP and their families.

Sian Spencer-Little.



 

The Creativity Flow

The Creativity Flow.

'The most childlike thing about a child is his curiosity and his appetite and his power of wonder at the world' - G K Chesterton


"I can do great things- great things. You can't stop my dreams and ambitions" - NehrurianDoom


We all value and love creativity although there may be creative expressions we don't like. The artists, singers and writers we enjoy are often people of deep creative power. This power is often created deep in their souls by painful and traumatic events. This sense of disjointedness gives birth to desire and design. It leads to attempts to porray and capture. We are allowed to experience and view this in many different forms and platforms.

  If we think of the history of music  - whether it is reggae or rock, opera or oriental metal  - whether we love or hate it we see a constant experimentation and creation of new forms and shapes of music. When we think of those artists who touch our soul what is it that does so? There are probably many things. One answer is creativity. There is something powerful there and it is not like other things. Creativity opens new portals and vistas and communicates itself to others. Mihaly Csikszentmihalyi the psychologist has written extensively on creativity - one of his books is called 'Creativity: Flow and the Psychology of Discovery and Invention.' He notes how 'most of the things that are interesting, important, and human are the results of creativity.' This blog will offer a few thoughts on creativity and how we might start or continue its flow in our lives.


Ken Robinson the educationalist links creativity with imagination. He says 'Creativity is putting your imagination to work, and it's produced the most extraordinary results in human culture'. Imagination is a tremendous resource that humanity has. It allows us to dream and soar. Imagination has birthed all the dramas, books, songs and films that relate to us in potent ways. Imagination links us to another key aspect of creativity - meaning. Creativity is all about meaning. Csikszentmihalyi notes how creativity is 'a central source of meaning in our lives'. This connection with meaning is so important as creativity allows us to make sense of life and the universe. This tells us something about the human mind and spirit. We often see the mind as a  complex computer. While this is a helpful image there is another image to complement it. It is the phrase of the English psychologist Charles Sherrrington who spoke of the mind as an enchanted loom. A loom which was forever making sense of what we were seeing and experiencing. A weaving loom spinning patterns of meaning. Creativity is all about joining up the dots and making seeing meaningful shapes. 



Creativity can be a very demanding activity. Csikszentmihalyi in his work notes how creative people tend to have two things - curiosity and drive. That they take intuition as a serious and key source. That they become authorities in their areas so that they can see their subject from every aspect and angle. Can we then be creative in our lives with all the challenges and pain? Yes we believe we can. It is true that culture and patronage play a big part in big creative expansions and explosions. It is said that if Michelangelo was born 50 years earlier there would not have been the culture of patronage for the arts for him to grow and flourish in. In terms of our everyday life we can think of two ways in which creative activity and actualisation can start to happen or grow. There are many others but we will focus on two. They are pictures and moments. They are all about seeing the picture and seizing the moment.



The first way is all about finding the canvass. One of the authors found this quote many years ago - "You were born to use this life to refine or improve yourself. You were born to use this life as a canvas to paint yourself across." It sums up so well the first way. These beautiful words tell us how our life is a canvass which we paint every moment. Our thoughts, words and actions are the brushes we use. The strokes made and paint used a vehicle for trying to express the journey, the struggle and the hope. The canvas can shimmer with the inner dispositions and emotions freely displayed. In this world we are very fortunate that many decide to paint with kindness, goodness and love. They bring a brightness to dark places. This creative painting impacts what we do in our day to day working and personal lives. It can be found in the smallest of things and the biggest of acts. The second thing is how we can use moments to have that drive and curiosity that true creativity is all about. Of course the heavy demands and pressure of work can take away our moments for reflection and creative action. We may well need to make a conscious decision to have these moments for creative possibility and power. If life or work won't give them we may have to carve them out ourselves. One of the authors recently met someone who shared how each evening he makes ten minutes of writing to reflect on the day, the days lessons and how he can grow. He spoke of it as a key part of his development. This is creative space. This man was and is practising creative inquiry and we are sure much good flows from those moments where he is there in reflection and openness.



There is a famous fresco painting by Michelangelo in the Sistine Chapel called 'The Creation of Adam.' In it there is Adam and God - a chasm separates them. Both are reaching out to connect. This touch will be electric and wondrously creative. To us there is a picture here of our own creativity. Lying deep within us all lies a deep source. If we can make the contact the creativity flow can start or spread. It is part of the 'vast inner resources' that Carl Rogers spoke of. To reach and touch this reservoir of potency and creativity brings magic into our life.



One of the  authors is a Specialised Play and Activities Practitioner within an acute children's ward at a district general hospital. She speaks of how creativity and play are connected within healthcare and symptom control. How it can they can be invaluable in supporting a child or young person share and manage long term conditions and lengthy admissions into hospital. She writes ' 'The use of live music and the the sound and feeling it creates leads to the vibrations that can be felt across the ward. Paint and painting makes you feel free- it allows freedom to make mess, within the sterile boundaries of a clinical setting. How sharing a song, or humming softly whilst soothing a baby is an act of deepest significance. It allows the child, young person and family a creative space  - a special moment in time. How using a drum to allow expression of feelings when words alone are just not enough. As a practitioner hearing that anger/sorrow that comes from the very core of a young person. Being there and with that young person looking for ways forward - ways from within and outside the box.' Creativity is all about imagination and intuition. It is all about using the gifts we have - from intellect to emotions - as paint for the canvass. Creativity whether in a laboratory or a commune often has an element of play about it. Creativity is part of that dance that we as humanity is engaged in -  that work to create, dream and make meaning . We have the tools and resources - its really about being open to find our place in the creativity flow and to let that flow operate in us.

 In finishing we recall the words of that American dreamer and creative artist Maya Angelou - 'You can't use up creativity. The more you use, the more you have.'    

Sian Spencer-Little

John Walsh.

Words and Time.

" Thank you so much, you really put his mind at rest, he now understands"

Time taken and given to C&YP in hospital is a rare commodity, I say this as in an ever changing and fast paced environment such as acute inpatient care- I believe it is, this is not to single out an individual , or team but an observation.

I have heard such conversations, they wished there was a little more time, to explain, adjust, prepare themselves as HCP's as well as their patients and families.
This is not always possible- what if it presents as an emergency?

I feel like I want to turn this on its head a little, so stay with me on this!

As a Specialised Play Practitioner I observe the impact a hospital admission or procedure has on C&YP when it is an acute admission or procedure.
All of a sudden they are informed that a procedure, operation or blood test needs to happen.
At that very moment- everything changes for them, their families and the HCP's caring for them.

As HCP's we don't always know significant history in terms of previous experience or trauma.

However I observe the fear, the apprehension,  I listen to the questions, the slight adjustment in level of voices, pitch, volume- I watch intently to the change in size of their pupil reaction, the flushed colour in their cheeks, the silence that takes over them.
The body language, the breathing rate.

All this occurs immediately after they are told about the procedure- I call this the "golden 5 minutes"- in this time, whilst the HCP's are preparing themselves, as they too experience all or some of the above-the C&YP needs preparing- so how we manage this next episode of care is crucial for us as practitioners, and for the child or young person.

Simple language to explain "what happens next"
Words are so very important at this stage- how we describe things, there are some words that we should not use.

Key words are the only thing parents and C&YP remember, I discussed this during the week with a family, they shared with me  " tube" " mask"  " blood"  " prick" being the most they remember in times of fear.

Tube, Mask, Blood, Prick.

This was a child who will have to come into hospital on a regular basis, for the rest of his life, and these are the words he will remember each time he prepares to visit the hospital.

What if words are not the medium- Photographs, drawings, signs, PECS (picture exchange communication system), Makaton , BSL and so on.

The "golden 5 minutes" should be for the need to know now information.
Why, What, When, How.

These are ideas, and a continual work in progress- because they can and should be adapted to each individual healthcare setting, and individual child or young person.
I should also say that I do observe, HCP's taking the time - and the results speak for themselves.

Change in practise, communication and preparation is always an adventure- it asks us to think differently, use words and language we may not have previously used ,or indeed how we would choose to describe events or actions, at times we might feel silly or self conscious, but we as adults can process that- C&YP cannot when fear and trauma takes over.

Recall what I said about turning this subject on its head........................ what would the outcomes be?

If we have a "golden 5 minutes" just imagine what impact that would have in "time" spent calming a child or young person down, when they refuse to allow HCP's to carry out observations, procedures, examinations?
Time spent encouraging a child to allow that process to happen.



If the "time" was there to prepare as HCP's then it should be there for the C&YP?
Health Play Specialists, Play Specialists, Play workers can be the time keepers.
We are also really good at sharing our skills and knowledge with the wider MDT.

 Trauma in Children is a deep and ever evolving study and research experience, - when we meet C&YP and their families for the first time we do not know what trauma, if any they have experienced, or the family history, but research and studies show us that it impacts on their very being, and ability to cope with new experiences, and how we draw on those, the fight or flight we display.

There are many battles that our patients may have fought and won, there are also many that they are still fighting and living with on a daily and hourly basis when they reach us.

Play4C&YP will be taking a few weeks break, to recharge, to reconnect, and to read!
Recommended read................
Waking the Tiger= Healing Trauma
Peter A. Levine


Sian Spencer-Little

The Parent , The Patient ,The Teacher

I have observed this week creative, thoughtful, moving moments, sorrowful times, sadness and technical skills, experience and medical interventions.

I have witnessed my peers work long hours, with unfaltering  commitment, passion and compassion.

I have watched the bond between a child and their parents- I have been honoured to sit alongside and provide time and space- a moment of relief- of joy.

A smile, an eye movement- a moment of pain free bliss.

Then after- the time to reflect, to process- I look at the junior team of doctors and nurses - the expression on their faces- do they know they have just been part of a moment in time that could enhance to the very core their work- how they develop relationships with patients.

I look at the parents, the patients- and I know they have taught us this week.

I think about the 6C's- each and everyday I walk alongside healthcare and medicine.

I look to my left- to 2 HCP's who stand so still, but breathless, small beads of perspiration fall, the expression on their faces, of concern, of professionalism of care, of passion when an emergency arises.
Sometimes I catch my breath- sometimes I cannot believe that I get to come to work, and be part of this amazing team.

I think about storytelling, sharing experiences, moments in history that all pave the way to learning, and challenging how we react, what are the circumstances, and access to fears and feelings.

 

This week I have read many things- but this section from Dr Tanya Byron's book "The Skeleton Cupboard" stood out for me.

Many paragraphs stand out for me- particularly about hearing patients stories, and providing the platform for them to tell them.

 

I have also spent time sharing my story, with student nurses, junior doctors, they ask me why I work in the way that I do, how does this effect a hospital experience,  impact on the levels of care, what can they do to assist.

We have discussed the difference between changes in careers and how we explain the things that have impacted our lives, events, experiences and how they shape us as HCP's.

So I carry this with me- like a beacon of hope, of understanding and of learning

"When we are no longer able to change a situation- we are challenged to change ourselves"
Viktor E Frankl.


Sian Spencer-Little

 

The Art of Distraction Play.

Distraction in all it's different forms is an art form, but also an effective tool and skill in use by many of my Play Specialist colleagues, and indeed many HCP's.

When seeking a "definition" I have found  many focus on one point- and there is a huge difference.

"a thing that prevents someone from concentrating on something else."

Is one such explanation.

This in it's simplicity sounds a good solid definition. However when using Distraction Therapy with C&YP it takes on a whole new meaning and complexity.

I have my own way of describing it- it works for me- but won't for everyone.

A method, a tool for C&YP, an enabler, a "take some control" button.

Something that you keep in your pocket, and can pull out at very short notice!

For HCP's it's another element to add to the "Rucksack of Skills" we already carry in our working lives.

In our lives both at work and at play many of us become distracted- a piece of music, a book, a telephone conversation, social media ( my ever present distraction!) and  even cake! All these things can become very pleasant distractions from those tasks we are not too joyous to complete, then there are those distractions that become unpleasant- and difficult.

When working alongside C&YP it's important as a Specialsied Play Practitioner to acknowledge the levels of anxiety and identify triggers that may cause this anxiety to escalate.

It can be isolated.

History plays a large part, the environment , what words are used to describe things, images and time frames, pain and increase of symptoms are just some of the anxiety inducing elements that have been shared with me by C&YP and their families.

I use the art of distraction through out my working day, introductions in the morning, "look at that teddy bear- he is so cuddly- what's his name"

"#hello my name is Sian- but sometimes I am called "Nutnut" or "Nitty Nutty Nora"

"Hi- I get a sense that things are not right, what can you tell me so that I might be able to help and support you"

When supporting  examinations- often I look to the lead doctor to "join me" in my story building- the feedback from families and C&YP is that it shows they are "human beings"

"oh and a bit silly too"

This breakdowns massive fear inducing barriers and changes the images that C&YP build in their imaginations about hospitals and procedures.

 

When we gain consent to carry out invasive procedures on C&YP at the same time we are assessing the need or level of support they will require prior to starting- we also need to be asking them how they would like things to happen.

As HCP's striking up a conversation about their favourite colour, game, music, book is a great start.

Picking out something in the room- making up a story asking them to think of names, characters, what can happen next? Distraction, Pretend Play and Imagination- all have a place.

Acknowledging that right now- it's a bit rubbish, and working alongside those feelings with C&YP.

There are times - in emergencies when procedures need to happen quickly and safely, asking for input from a Health PlaySpecialist or practitioner will support that journey, the use of language, and the level of distraction required.

We are also skilled at supporting our medical and clinical collegeues, so that skills are shared and learning acquired.

 

In an everchanging fast paced approach to Social Media- there is some train of thought that write IPhones and IPads actually distract from the skills needed to carry out distraction.

Following your assessment of the mood, the anxiety level, the approach you will use- and the environment ........ A decision should be made by the HCP's 

My own view -I am the facilitator, the support mechanism for C&YP in times of anxiety, fear and pain- sometimes I am also their voice- and we must listen.

I have many skills- the teams I am part of, have many skills and I also need support to offer these - my complete focus is to minimalise trauma impact- for the child or young person sitting next to me- I use whatever I can that will enhance that experience and lessen the trauma.

IPads, Apps, Red noses, Pom-poms, Stickers, Bubbles, Music and Standing on one leg.

If it helps- then let's use it!

Suggested Apps- recommend by the C&YP! 

#justsayin!

• Minion Rush
• CBeebies Playtime and Story time
• Kids Doodle
• Jelly Splash
• Angry Birds- Starwars
• Peppa Pigs Paint box
• Hairy Phonics
• Four in a line
• Talking Pocoyo.

There are many more.........  please share them
These are all free!

Articles of further reading and exploration.

Interactive verses Passive Distraction for Acute Pain Management in Young Children
The role of selective attention and development 
Karen A. Wohlheiter; PhD; Lynnda M. Dahlquist; PhD | Disclosures

J Pediatr Psychol. 2013;38(2):202-212

Sian Spencer-Little.