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.

Powerful, Evolving, Play Partnerships.

Making and forming active, co-productive partnerships is time consuming- but the benefits outweigh the negatives- outcomes are priceless, awe inspiring at times.
The negatives teach us, form us, allow us to improve our practise, impact on our very being, and in turn stay with us.

There are many professional partnerships that engage HCP's and inturn impact on the relationships of work in our lives and the way forward.
There are also many people we will meet,  along the way that will impact our lives forever.

Leaders, families, children and young people become my Powerful, Evolving, Play Partners.
They encourage me- and support me to tap into my inner self, my practise and my inner child, my creative self- this has an impact on the type of care I offer and give.

Play and its impact in Healthcare also evolves and changes, sometimes at an alarming rate, as HCP'S we work with a diverse and amazing range of individuals, patients, and professionals.
It also grows and collects inner strength as more is shared and experienced.

In recent months I have added to my learning, to the way I share my knowledge, I have been enriched by this experience, and this impacts on the way I can support C&YP and their families.
I take inspiration from many things to enhance my practise, to provide rich opportunities for specialised play moments.
I recall "Hunter Patch Adams"

" Waiting in line is a great opportunity to meet people, daydream or play"
 

I have had many conversations this week about the balance of life and work.
Particularly this week as we Welcome new doctors and nurses to our teams.

Some say that there should be a clear definable line that exists, to show when work starts and finishes, downtime should be present and what allows you joy and happiness should fill this downtime.

We spend many hours in our place of work, how do we as HCP's define downtime?

We all have different ways of managing and working through our "things to do" lists- are we realistically observing and recognising our stress levels.

I refer to this quote- as this is where I would sit- if there were a see-saw of work/downtime balance.

I recognise that there are many levels of stress, that this is real, it exists, and I can only comment on my experiences at work.
I have felt at times engulfed with workload- I turned to those who could support my passion.

When I spend time with C&YP, I feel an immense amount of joy, of contentment- in many ways they are my fuel, they enrich me as a person, and my life. 
I feel I am lucky to work in this field of care and support.

With the new doctors in mind I started to think about "3 enabling tips"
We can use these, everyone can..

1.
Practicing gratitude gives you a happiness advantage

you may be tired,  have a list that is forever being added to- but it is this list, this record of all that you are involved in - that is a driving force in your levels of happiness, sense of self and passion, even if none of the boxes get ticks.

The passion to engage, to make a difference, however small.

2. Each end of day/shift- 2 "moments" that will remind you in the months to come- just why we do this, this will be like an energy bar- for the tough times.

3. Find that someone or something, that you can spend 10mins with fuelling your inner child, that someone may be a human, an animal, a twitter buddy.
Dance, sing, draw, create, jump up and down, write, cook, explore, have a water fight with, walk, - It will impact on your training, it will encourage a healthy play outlet, it will enhance you as a HCP.



Downtime - for me its, writing, reading, exploring, playing.
It's my work- its who I am.


Sian Spencer-Little.

Trauma Sea's- Steady the Ship.

 

"The future depends on what we do in the present"

Mahatma Gandhi

 
 

The word trauma on its own can mean many things- we all could examine and explain it differently, its impact, it's loss, the anger and disbelief it produces.Research indicates to us that trauma in C&YP can have an impact on their development, ability to learn,emotional well being, resilience and their capacity to engage and trust.

There are some C&YP who are less effected than others we are informed- and we may witness this in our vocational  lives.... I would be bold enough to say that this is not entirely true.

 

It too has the same impact on adults alike, the extended family and the care givers.

I include those HCP's who observe and engage with C&YP who are in the midst of unimaginable trauma.

As a Specialised Play Practitioner (SPP) I see trauma in the many forms it takes.

The unstable sick child or young person, the pre- operative C&YP worried about "going to sleep and waking up during an operation ", the YP who has lived with a long term health condition, and has "had enough of being sick all the time"

The YP who feels so isolated that the only way to feel anything- is to harm themselves, and then tell no one.

 

C&YP look at situations that build stress levels and add to their emotional breakdown as "the worst thing that has ever happened to me".

 

A YP recently shared that he felt so let down by adults-

"who are supposed to be grown ups" he felt better leaving and sitting on the pavement in the middle of the road " because at least I can be seen"

 

When C&YP share those most intimate of thoughts with you, it can at times be overwhelming as the care giver, for those feelings lie deep within, and at times never leave.

 

 

As HCP's we could describe working alongside a C&YP in trauma in the following way-Being at the bow of the ship it may take a turn through uncharted waters sometimes, it may drop anchor and rest for a while, there may be storms,  and sometimes sunshine and blue sky's- but it may always be bumpy for some, it may always produce fears and anxieties.

As a SPP- working in a multi- skilled acute paediatric ward- the team and I help navigate and steer, support and explain- the why's and where's - the who's and whens'.

Sometimes we cannot answer everything, sometimes we don't know why..... What we can do is offer time,  be honest, be present and be prepared.

Trauma is also somewhat sneaky - it lerks like a Giant Jellyfish- underneath the calm waters of our ship- waiting - to glide through the water, and slowly tentacle by tentacle it latches on to the ship- making it sway, and rock and sting.

We are the ones charged with the elements, the abilities to listen, to engage, to care, to be kind, to tame the Jellyfish.

We are also the ones who have to be realistic, we are acutely aware of the constraints we face as HCP.

Health Play Specialists work alongside this trauma,  supporting the medical and clinical teams, providing a safer passage through stormy seas.

Explaining- listening, working through fears, and why they occur- the answer to that may be never known- that's the thing with Trauma - remember it's sneaky and if not shown the right way to swim- it may sting too much.

Recently I have been spending lots of time with families where trauma has occurred- many times over.

The look of horror, of disbelief will always remain my instigator to be who I am with these families- and how they allow me to be alongside them.

To gain a deeper level of understanding I have also had to do lots of reading and research- always learning and growing are what makes me able to continue to work with kindness and compassion.

Colby Pearce writes "It is not what children do, but why they do it- it is crucial to understanding them, and where intervening successfully with them"

Play will always remain my shining light- no matter of age or ability.

In trauma C&YP loose the ability to play, as a SPP I have the task of helping and supporting C&YP to restore the gift they have for play.

To use it - as it is the most powerful tool to use to build understanding and to process events- however negative and destructive they may be.

This week has seen Trauma and Resilience discussed on a larger scale at the recent conference of school nursing- #SNIC15- amazing work and processes have come out of that conference - and I was thrilled that we were able to read and take part via SoMe, @wecypns.

Our very own Children's Commissioner discussed how within the education and PSHE setting we can help to build resilience.

 

I finish this week with a few things- a sentence shared from a recent day I attended at The Institute of Arts in Therapy and Education

 

"Can a patient use the therapist to co-regulate fear and feeling?

They have to re-live the trauma to face, express, experience and arrive on the other side- and then they can regulate with support"

 

 A photograph of amazing courage- and growth- I am privileged to be part of.

 

 

 

Lastly 5 tips for the new HCP's who join our teams this week and will work alongside patients and there families who may be experiences many levels of trauma.

 

1- Always share #Hellomynameis and smile.

2. A favourite thing- begins conversations and breaks down clinical barriers

3. Clear and simple explanations- what is happening next and why. 

4. Stickers are amazing to give and receive ( TY @karmicgirl for reminding me)

5. There are never ever any silly questions.

 

Sian Spencer-Little

Engaging Souls.

I often spend moments reflecting on the weeks events, of the things I have observed and listened to, of moments I have been part of.
Some of these things, stay with me for a while, and some impact on my practise, and on my very being.

I have shared with learned colleagues this week, the "small stuff" with the most "powerful punch", and how that challenges others.

How small droplets of attitude change- can become down pours of happiness and compassion.

From as early as I can remember - Kindness, Care, and Compassion where words that I felt I could be part of.

They were of the very essence of what I wanted to achieve in my working journey.

 How my working journey, actually defined who I am, and what I stand for, of how I want to be.

It is me, if I were a cake, and you took a slice, I would hope that you would see that for yourselves.

If we look at some of the words to define Compassion- it encompasses care, concern, benevolence- I want to share my definition.

To offer, time, care, understanding.
To be alongside someone on a journey, of the twists and turns that road may take
To provide a space, to be, to explore feelings, both positive and at times destructive- and to support that.
To celebrate the good, to acknowledge the tough stuff.

Others who go to work, do their tasks, and then leave at the end of the day- they struggle to appreciate or understand someone who - to some degree is always working, sharing skills, talking about their vocation, and it is just that a vocation, a way of life for me, its what I feel I am here for.

We all have experiences, that shape who we are, how we react, how we behave, so its really up to us to chose how this effects us as human beings- how we pass on the baton.
You may wonder - what does that have to do with Engaging Souls......

My soul has been filled with wonder, care, love, warmth and moments of laughter and light- but equally with trauma, sadness and darkness over time- but I choose to use all these elements to teach and to share- sometimes it is exhausting- but also excelerating.

I also want to acknowledge how difficult life can be.

This week I found my voice.

I was able to lead my very first- Engaging Souls Teaching Session- I call it this because I had hoped that it would have this effect- I was fortunate to meet a cohort of student nurses- over 60 of them!
I was unsure of how they would respond to my style of teaching, and sharing of experience and skills.
I spoke about a subject that has great meaning for me- it shapes me and underpins the type of Healthcare Practitioner I strive to be.

Specialised Play- the impact on the child.
How we as HCP's  can shape a hospital experience.
What can we do to support preparation of the hospital experience.
Specialised distraction techniques that we can.

The buzz in the room was electrifying.

The students were engaged and showed amazing skills- we talked and discussed hospital experiences, and together shared skills.

They also came along for the creative ride with energy and drive- and showed great respect and care for each other.

Feedback is so important for the trainer- Thank you.

An Engaged Soul HCP.

 

 

"Hunter" Patch Adams, always shapes the tone of the training, of always seeing the person, not the illness, or disease.
As HCP's sometimes we loose that essence ........ I am just trying to help and support us to find it, and for it to shape healthcare for children and families.

I talk about the Patient Experience all the time, about listening, about opportunities to seek feedback, and how this can in time change processes.
I feel very proud to have met the students this week, I thank them for their time and enthusiasm, their honesty and their engagement.
I feel empowered by the support of my managers- to deliver in the way that I do and for the opportunity to share.

Engaged Soul HCP's Feedback.

 

 

Just take a moment - look at the expression on the face of the next generation of HCP's, of how we can evoke those emotions, and how the "small stuff" packs the punch, effects change, and impacts on the experience for our patients.

 

Sian Spencer-Little.

Specialised Play and Activities Practitioner.

 

What fills you with Joy?- Impact and Feeling

This week I have thought about how we describe joy, the essence of it, how it makes us feel, and what impact that feeling has on us.
How do we ask C&YP about this?

Joy- A feeling of great pleasure, and happiness.

Does limited joy impact on how we feel each day, how we cope with things when they are tricky, does it allow us to take a breath, or do we struggle even if we think we have it- but it's so hidden that the struggle in finding it is to much.
For C&YP that have experienced loss or fear, to ask them what they do that gives them joy, perhaps is the hardest question to be asked, in fact some might think that it is wrong to ask such a question, because in some way you are not respecting or honouring the loss- I feel to honour and respect, you must listen and there must be hope, that through sadness and the darkest times, there were moments of joy, and that there will be again.

Flowers, colour, art, music, smells, food, texture, photographs- all evoke deep feelings- can joy be found in these?

Each day I do my best, and each day I strive to make a difference.
The following day I strive to do my best, again, and so on.
This week I had the privilege to support and work alongside a young person who was facing a challenge.
Several years of ill health and lots of tests had left a impact on this young person, the ability to identify happiness and joy was the challenge, the question had never been asked before.
Initially - I received some strange looks........... but I continued to support this pathway.

The reason I asked - I wanted to empower this young person to draw on joy, happiness and the feelings these evoked, to celebrate these "moments of joy" and use them to support energy levels, pain management and relief and strength to ask for support.
We spent several "bite sized sessions" together, talking through what was joy, and how each person found it.
I was asked if there was such a thing, and how could it possibly help me, "I have been living with this illness for 8 years".
During these "bite sized sessions" I listened, I was present, I never once interrupted, there were moments of silence, they did not need filling, and slowly I built trust, I showed understanding and I shared my "moments of joy"

I was able to do this- as I too understand the world of living with a disability, of challenges, of changes a person has to make.
It is not very often that you feel as a HCP you are able to share such intimate parts of your life with a patient, but when you work alongside C&YP it becomes who you are and how you work.
As we know C&YP are honest, they ask questions, and I am always honest- no matter what the outcome or impact.

We discussed happiness, the feeling this gave, the colours used to describe happiness, how did our facial expressions change when you had a "happy thought".
Slowly together with family members we begun to build a "Tower of Joyful Jenga" , music, activities, food- all things that created happiness and a feeling of joy.
It all sounds so simple- and yet so difficult all at the same time, to plug into a C&YP's deep emotions and feelings is not easy, but then again, how easy is it for them to share that with HCP's.

I ask a simple question to open up conversations with C&YP
" what do you do, watch, listen to, or experience to give you a deep sense of joy"
As HCP's we need to be ready for the answer- to support the journey, and not always want an outcome, but to have the conversation- as this will be the start of their journey.

This week I have read many things, some joyous, some remarkable, some uplifting, powerful and upsetting.
I have been amazed at strength and astonished at bravery. 
I thank them for their honesty, and for the impact sharing their story has had.

I have also been asked to share my work, and how I ask those difficult questions, I feel at times overwhelmed, but also joy in the fact that I may just share a little joy with someone else.

My shares for this week..... Thank You for your honesty and for sharing- the impact you have is priceless.

Mefirst.org.uk- brilliant resource for HCP's - and a platform for C&YP.

The Brandon Trust- visited an amazing photography exhibition in London celebrating the trusts work and promotion of positive and freeing change in disability.

Headspace-perspective.com - Raising awareness of birth trauma, and premature babies, and of life and loss.

Towers of Strength- Jenga Style.

So having spent a day yesterday sharing and listening to real time feedback from children and young people on the subject of communication- from other HCP's and the fantastic mefirst.org.uk 

I am re-posting the Jenga Blog as it resonated well with the subject matter.

Please take the time to visit mefirst it's a fantastic resource and a way of opening up conversations - good meaningful conversations with C&YP - involving them in their healthcare, their journey,

Time this week has been also working alongside both clinical and therapy teams.

We have been discussing particularly what it's like being a young person now, the many stresses and worries we see presented to us- and the ability to be able to sign post and offer support.

Our "Bucket of Well Being" wall has had some really positive feedback and I have observed many young people as well as parents - spending time looking at the display, without worrying if any of the team were suddenly going to ask them any questions.

We chose the place on the ward which had privacy and wasn't overlooked that way time could be spent.

 

When I offer support,and work alongside a young person, I always share with them that I work honestly and with permission from them I will share information with the clinical team to assist them in working together to a good outcome- a shared working group with the YP and the team.

I often talk about a "Jenga Tower"- when C&YP are struggling to share worries or anxiety so I thought I would share it with you.

• Sometimes in our lives we carry a few pieces, our support networks help share the load and add a few pieces so we build a tower that is strong, supportive.

• Then an event, or need to deal with an significant issue, or a worry happens.
• Sometimes we feel it's coming, other times it sneaks up on us.

• Our "coping tower" stands tall, it may wobble, but people around us bring re-enforced blocks, that may be family, or friends.

• But sometimes we don't acknowledge worries, especially if we feel they are small and perhaps insignificant, or that we do not know where to take them.

• Those small worries are like a little seed, and they grow, they grow under the "coping tower". 

• They get bigger, even though they started off small- and with this the worry builds and the "Coping tower" wobbles.

• The worry now starts to remove some of the blocks - and you carry on a little unsteady- but ok.

• Then for example- you have an exam and have to study- or you have a disagreement and you worry a bit about that.

• The "coping tower" now leans a bit- and the first worry is growing- a few of the blocks are very loose.

• Now you are feeling unsure of all the worries that seem to be getting bigger.

                                      Who can you share this with?

• Then the "coping tower" looses a block, and you find yourself unable to make it stable, and your strong blocks - well they just don't know how to help-  and you suddenly find that you are alone- and have lots of feelings and thoughts.

                This may be the reason you find yourself at the hospital as things have almost  become impossible, and you react in a way that frightens you and your friends and family.

As health care professionals we can support the "coping tower" to build strength, and signpost C&YP to others who can help.

I use this over a period of time during relaxed creative sessions sometimes in the playroom or school room, or at bedside.
Our C&YP have to deal with so many influences many positive, some negative, some confusing and some they just are unable to deal with alone, as HCP's we have an amazing opportunity and honour to walk beside them during this part of their journey.

This week has seen much "Twitter Power" sharing the #CYPexp, with young people using their voices,sharing artwork and feedback with HCP's.
It has been amazing to watch from the wings at all the positive energy support from many HCP's including Head of Patient Experience for Children, and Maternity Services at NHS England, @kathevans2 and @_common_room with an amazing resource-  
mefirst.org.uk - which is dedicated to improving communication between HCP's and C&YP.

It has also been  a week of kindness, care, compassion and engagement, and professional friendship,building these are the values we all hold dear and support us in our work, Thank you  @johnwalsh88 and all the HCP's I have been chatting with.
 

I look forward to the next few months.
 

Final thoughts........

The imagination of two 8yr olds.

Mr Jelly the Jellyfish 

Doug the Dragon

Bob the snail

The fish with no face called Plaice!

Childhood, Compassion, Care, Resilience #CCCR

Many words would describe a environment that supports development, encourages growth and learning, listens, shares, and celebrates achievements.
The idea that a health environment should incorporate these, enabled me and directed me to a career in care, in compassion- to offer support when C&YP and their families needed it the most.
It began in acute nursing, and took in early years, primary health, child protection, and paediatric palliative care.
I have been a care giver and received care, and had the opportunity to make a difference at the very beginning of life and at the very end- and feel humbled and honoured to have done so.
This week I have thought a lot about Person Centred Care, about compassion, the roles I have worked within and the teams and fellow colleagues I have worked alongside.
I was thrilled to attend my first debate at London's South Bank University, with fellow colleagues and professionals working in and interested in the NHS, and posed the question "Is Health and Social Care person centred?" , it was also a huge pleasure to meet Kath Evans, and John Walsh.
I wanted to share my views, the experiences of care, and what I felt PCC ( person centred care) was.
I listened intently, to both sides of the debate, I acknowledge the need for changes, and that this should be recognised, the impact a reduction in services and staff can have on PCC, but more importantly the impact on the child, the young person and their families.

It was an impassioned debate.
So I came away thinking about a PCC 10 point Care List, which can easily be added to-this is with C&YP and their families in mind, but is multi patient use.
Its like the 6C's- a extension of it.
These are some of the things I think about when I approach and work alongside C&YP.

• Being present in the moment.
• Listening to the thoughts of C&YP and those they may share.
• Observing behaviour and the reaction you give, how you communicate your reaction.
• Individual needs
• Support
• Care
• Respect
• Plan
• Sharing
• Recognition

It was also an important week on the ward.
 For some time we have wanted to acknowledge some of the issues raised by C&YP - some of the issues they find the most difficult to cope with during the sometimes bumpy road through adolescence, the things important to them.
It is difficult sometimes to imagine the impact a loss of confidence can have, a lost friend, isolation and workload.
With the help of literature from Young Minds UK, and PAPYRUS, and a much better artist then me! ( Lucy U ROCK!)
Here is our Resilience display- with our very own "Bucket of Well-Being"
We adapted this - so it highlighted key elements shared with us.

 

This is collaborative working at its best, Specialised Play and Education.
Supporting new ideas, ways to communicate and support new ideas, just because we have always done it, does not mean things cannot change and be developed.
This week- Things I have learnt...................

1. Kindness
2. Trainable Triangle of Care.
3. The need to change and recognise the change.
4. Sharing and celebrating achievements.
5. Listen to patients voices, and experiences.

My word of the week.... Communication 
My share forward resource........ www.mefirst.org.uk
My thought......... How quickly we forget the magic of Childhood.

Sian Spencer-Little
with thanks to Lucy Haslam.