The necessity and possibilities of playfulness in narrative care with older adults.

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long-term care, we show the possibilities of playfulness in the co-composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times.

Systematic review of the impact of unstructured play interventions to improve young children's physical, social, and emotional wellbeing.

This review aimed to examine the effectiveness of unstructured play interventions on young children's physical, emotional and social wellbeing in various community settings. Eligibility criteria of articles included (1) studies which included young children aged three to seven years; (2) intervention studies which involved unstructured, free or loose parts play; (3) experimental or randomized controlled trial designs, with or without random allocation to groups; and (4) target variables of the study should include measurable physical, social or psychological constructs as modifiable outcomes. Electronic searches were conducted from June 2018 to March 2019 in ERIC, MEDLINE, PubMed, ProQuest, Sage Publications, Web of Science, Scopus, and Sociological Abstracts. Data were extracted from the included studies independently by using a pilot form. The study outcome measures of unstructured play in the eight selected articles were categorized into three aspects of children's physical health, social skills and emotional wellbeing. All studies reported positive impacts on children's physical activity level, social engagement and emotional wellbeing. We conclude that our review with identified impacts would assist future research directions and policy implementation in this promising field..

The Effects of Casual Videogames on Anxiety, Depression, Stress, and Low Mood: A Systematic Review.

Background: Despite the variety of available treatments for mental health symptoms, many individuals do not engage with treatment and among those who do, dropout rates are often high. Therefore, providing alternative opportunities to access treatment is imperative. Research interest in the therapeutic effects of digital mental health initiatives and serious games has grown in recent years, but the potential of simple, easy-to-use casual videogames (CVGs) that can be played in short bursts of time has seldom been considered. Objective: The objective of the present study is to provide a systematic review of the literature examining the effects of CVGs on treating anxiety, depression, stress, and low mood. Method: A systematic search was conducted, using the terms (casual gam* or casual videogam* or mini gam* or minigam* or mini-gam* or gamif*) and (mental health or anx* or depress* or stress or mood) and (study or trial or treatment or prescribed or prevention) as "Title," "Abstracts," "Keywords," or "Topic" words across all years. A Google search was also completed to check for articles that may have been missed. Results: N = 13 studies met inclusion criteria (no studies were added via the Google search). These studies reported findings for nine different CVGs, with six studies aimed at reducing anxiety, two examining effects for depression, and four investigating the effects of CVGs on treating stress or low mood. Promising effects were identified. Conclusion: CVGs may have promise for treating anxiety, depression, stress, and low mood.

Parental Knowledge Influenced the Effectiveness of Therapeutic Sociodramatic Play on Diarrheal Preventive Behavior in School-Age Children.

Healthy and clean living behaviors among school-aged children are still relatively low in Indonesia, exposing them to the risk of experiencing health problems in the future, such as diarrhea. This school-age period is actually the earliest phase in which children can develop healthy behaviors, hence making this phase a strategic target for health improvements. School-aged children are in a period of concrete operational development and they require specific health education methods that can reflect real and interactive experiences. The aim of the study was to determine the most influential factors to effectiveness therapeutic sociodramatic play on diarrheal preventive behaviors among school-aged children (6-12 years). The study design was quasi-experimental with pre- and post-tests, involving 102 school-age children who were divided into an intervention group and control group. Multistage random sampling was used to determine the research area and school where the research was conducted, while the research subject was selected using simple random sampling. The results showed that parental knowledge had a significant effect on therapeutic sociodramatic play improving students' knowledge (p = 0.001), attitudes (p = 0.004), and diarrheal prevention skills (p = 0.003). Therapeutic sociodramatic play will be more effective when followed by good parental knowledge. The study recommends that therapeutic sociodramatic play could be applied in an effort to enhance healthy and clean living behaviors and to prevent diarrhea among school-aged children, and it could be integrated into school nursing services.

Differences in Step Counts, Motor Competence, and Enjoyment Between an Exergaming Group and a Non-Exergaming Group.

OBJECTIVE: The purpose of this study was to examine the effect of an exergaming program on physical activity, motor competence, and enjoyment in preschool children. MATERIALS AND METHODS: A sample of 65 preschool children was recruited from an urban preschool located in the Western United States. Children were randomly assigned to either an exergaming (n = 36) or a free-play group (n = 29). The intervention was 30 min/day, 5 days/week for 12 weeks for both groups, and all outcome variables were measured once during the final week of the intervention. The exergaming program included three active videogames: GoNoodles, Adventure to Fitness, and Cosmic Kids Yoga. Children in the free-play group were offered a variety of sport activities. School-day step counts were recorded using pedometers, motor competence was assessed by the Test for Gross Motor Development-Edition 3 (TGMD-3), and enjoyment was accessed using one subscale of the Intrinsic Motivational Inventory. A 2 × 2 multivariate analysis of variance (MANOVA) test was employed to examine the differences between sexes and groups on the outcome variables. RESULTS: The omnibus MANOVA yielded a statistically significant multivariate group main effect (F = 3.71, P = 0.016). Follow-up tests revealed statistically significant differences between groups on average school step counts (mean difference = 785 steps, P = 0.003, d = 0.68) and total TGMD-3 scores (mean difference = 8.7, P = 0.019, d = 0.51), with the exergaming group displaying higher mean scores compared with the free-play group. CONCLUSION: Young children who were randomly assigned to the exergaming group demonstrated higher school-day step counts and higher motor competence levels compared with the free-play group. These results support the use of this modality in childcare settings.

Proposal of an Extended Taxonomy of Serious Games for Health Rehabilitation.

OBJECTIVE: Serious Games is a field of research that has evolved substantially with valuable contributions to many application domains and areas. Patients often consider traditional rehabilitation approaches to be repetitive and boring, making it difficult for them to maintain their ongoing interest and assure the completion of the treatment program. Since the publication of our first taxonomy of Serious Games for Health Rehabilitation (SGHR), many studies have been published with game prototypes in this area. Based on literature review, our goal is to propose an updated taxonomy taking into account the works, updates, and innovations in game criteria that have been researched since our first publication in 2010. In addition, we aim to present the validation mechanism used for the proposed extended taxonomy. MATERIALS AND METHODS: Based on a literature review in the area and on the analysis of the contributions made by other researchers, we propose an extended taxonomy for SGHR. For validating the taxonomy proposal, a questionnaire was designed to use on a survey among experts in the area. RESULTS: An extended taxonomy for SGHR was proposed. As we have identified that, in general, and besides the mechanisms associated with the adoption of a given taxonomy, there were no reported validation mechanisms for the proposals, we designed a mechanism to validate our proposal. The mechanism uses a questionnaire addressed to a sample of researchers and professionals with experience and expertise in domains of knowledge interrelated with SGHR, such as Computer Graphics, Game Design, Interaction Design, Computer Programming, and Health Rehabilitation. CONCLUSION: The extended taxonomy proposal for health rehabilitation serious games provides the research community with a tool to fully characterize serious games. The mechanism designed for validating the taxonomy proposal is another contribution of this work.

Serious Games for Children with Chronic Diseases: A Systematic Review.

OBJECTIVE: The purpose of this study was to systematically review the literature to assess if serious games impact health outcomes for children less than 18 years of age with chronic diseases. Additionally, the impact of self-efficacy, adherence, knowledge, use of theory, parent involvement, and study quality was also examined. MATERIALS AND METHODS: Searches were conducted in databases EBSCO, PubMed, and Web of Science between June and August 2016. Randomized controlled trials using a serious game as an intervention, for participants under 18 years of age, to improve their chronic disease were included. RESULTS: Data were extracted by two independent researchers, including: Title, author, and publication year; chronic disease; game description; number and age of participants; intervention duration; significant findings; parent involvement; theory; and study quality. Any disagreements were tackled and consensus was achieved. Eighteen studies were included in the review. The areas of health addressed included cerebral palsy, asthma, diabetes, developmental coordination disorders, and vision disorders. In these articles, eight health outcome variables were measured, including: lung function, glycemic control, hospital visits, motor proficiency, and visual acuity. Psychosocial variables that were assessed included self-efficacy and knowledge. Two articles included parents in the intervention, and three articles used theory. Six studies had significant health outcome finding, and four studies found a significant change in one psychosocial variable. CONCLUSION: This review demonstrates the potential for games to improve health outcomes of young individuals. However, the mixed results suggest that more serious game interventions need to be better designed and rigorously tested to support their impact on improving health outcomes.

Influence of Therapeutic Play on the anxiety of hospitalized school-age children: Clinical trial / Influencia del Juguete Terapéutico en la ansiedad de niños en edad escolar hospitalizados: Ensayo clínico / Influência do Brinquedo Terapêutico na ansiedade de crianças escolares hospitalizadas: Ensaio clínico

ABSTRACT Objective: To evaluate the effects of Dramatic Therapeutic Play (DTP) technique on the degree of anxiety in hospitalized school-age children. Method: Randomized clinical trial performed in two hospitals ofSão Paulo, between May and October 2015. The intervention consisted of the application of DTP and the outcome was evaluated through the Child Drawing: Hospital (CD: H) instrument. The Wilcoxon-Mann Whitney, Corrected t, Fisher's exact and Chi-square tests were used in the analysis. Statistical significance was set at 5%. Results: In all, 28 children participated in the study. The majority of children (75%) had a low anxiety score, with a mean CD: H score of 73.9 and 69.4 in the intervention and control groups respectively, and with no significant difference. Conclusion: Children submitted to DTP had the same degree of anxiety as those in the control group. However, it is suggested that new studies be performed with a larger number of children in different hospitalization scenarios.

RESUMEN Objetivo: Evaluar los efectos de la aplicación de la técnica del Juguete Terapéutico Dramático (BTD) en el grado de ansiedad en niños en edad escolar hospitalizados. Método: Ensayo clínico aleatorizado realizado en dos hospitales de São Paulo, entre mayo y octubre de 2015. La intervención consistió en la aplicación del BTD y el resultado fue evaluado por medio del instrumento Child Drawing: Hospital (CD:H). Se utilizó en el análisis los testesWilcoxon-Mann Whitney, T corregido, Exacto de Fisher y Qui-cuadrado con significancia de 5%. Resultados: Participaron del estudio 28 niños. La mayoría de los niños de ambos los grupos (75%) presentó clasificación de bajo grado de ansiedad, siendo la puntuación media del instrumento CD:H en el grupo intervención de 73,9 y en el grupo control de 69,4, sin diferencia significativa. Conclusión: Los niños sometidos al BTD presentaron el mismo grado de ansiedad que los del grupo control. Sin embargo, se sugiere que nuevos estudios sean realizados con mayor número de niños en variados escenarios de la hospitalización.

RESUMO Objetivo: Avaliar os efeitos da aplicação da técnica do Brinquedo Terapêutico Dramático (BTD) no grau de ansiedade em crianças escolares hospitalizadas. Método: Ensaio clínico randomizado realizado em dois hospitais de São Paulo, entre maio e outubro de 2015. A intervenção consistiu na aplicação do BTD e o desfecho foi avaliado por meio do instrumento Child Drawing: Hospital (CD:H). Utilizaram-se na análise os testes Wilcoxon-Mann Whitney, T corrigido, Exato de Fisher e Qui-quadrado com significância de 5%. Resultados: Participaram do estudo 28 crianças. A maioria das crianças de ambos os grupos (75%) apresentou classificação de baixo grau de ansiedade, sendo o escore médio do instrumento CD: H no grupo intervenção de 73,9 e no grupo controle de 69,4, sem diferença significativa. Conclusão: As crianças submetidas ao BTD apresentaram o mesmo grau de ansiedade que as do grupo controle. Entretanto, sugere-se que novos estudos sejam realizados com maior número de crianças em variados cenários da hospitalização.

Influence of Therapeutic Play on the anxiety of hospitalized school-age children: Clinical trial.

OBJECTIVE: To evaluate the effects of Dramatic Therapeutic Play (DTP) technique on the degree of anxiety in hospitalized school-age children. METHOD: Randomized clinical trial performed in two hospitals ofSão Paulo, between May and October 2015. The intervention consisted of the application of DTP and the outcome was evaluated through the Child Drawing: Hospital (CD: H) instrument. The Wilcoxon-Mann Whitney, Corrected t, Fisher's exact and Chi-square tests were used in the analysis. Statistical significance was set at 5%. RESULTS: In all, 28 children participated in the study. The majority of children (75%) had a low anxiety score, with a mean CD: H score of 73.9 and 69.4 in the intervention and control groups respectively, and with no significant difference. CONCLUSION: Children submitted to DTP had the same degree of anxiety as those in the control group. However, it is suggested that new studies be performed with a larger number of children in different hospitalization scenarios.

Brinquedo terapêutico no procedimento de punção venosa: estratégia para reduzir alterações comportamentais / Juguete terapéutico durante el procedimiento de punción venosa: estrategia para reducir alteraciones de comportamiento / Therapeutic toy during the procedure of venipuncture: a strategy to reduce behavioral changes

Introdução: A enfermagem pediátrica deve estar atenta aos subsídios da assistência que tornem possível um melhor manejo da dor e da ansiedade oriundas da hospitalização infantil, geralmente, causadas pela realização de procedimentos invasivos como a punção venosa. O uso do Brinquedo Terapêutico Instrucional (BTI) pode representar uma intervenção eficaz para lidar com os efeitos negativos da hospitalização. Objetivo: Comparar as reações manifestadas pela criança frente ao preparo para punção venosa antes e após o uso do BTI. Materiais e Métodos: A pesquisa é analítica, exploratória e de abordagem quantitativa. Para análise dos dados foi utilizado o teste de McNemar. A amostra consistiu de 21 crianças hospitalizadas, pré-escolares e escolares, a coleta deu-se entre junho e agosto de 2012, em unidade de internação pediátrica do Crato, CE (Brasil). Resultados e Discussão: Após o uso do BTI, observou-se uma redução na frequência de variáveis comportamentais que indicam menor adaptação ao procedimento, com significância estatística em especial para: “Solicita a presença Materna” e “Evita olhar para o Profissional” (p<0,001). A realização das sessões também potencializou a frequência de, praticamente, todos os comportamentos associados a uma melhor aceitação ao preparo ou realização da punção venosa, com destaque para “Observa o Profissional” (p<0,001) e “Sorri” (p<0,005). Conclusões: O BTI constitui relevante intervenção para a enfermagem pediátrica, sendo necessário, para sua aplicação sistematizada, articular ações que visem uma maior sensibilização dos órgãos gestores dos serviços de pediatria, maior capacitação dos profissionais envolvidos e melhor abordagem do ensino do brinquedo terapêutico nos cursos de graduação de enfermagem.

Introducción: La enfermería pediátrica debe conocer los recursos de asistencia que permitan mejor manejo del dolor y la ansiedad ocasionada de una hospitalización infantil, generalmente, causadas por realización de procedimientos invasivos, como la punción venosa. El uso del Juego Terapéutico Instruccional (JTI) puede representar una intervención eficaz para hacer frente a efectos negativos de la hospitalización. Objetivo: Comparar las reacciones manifestadas por el niño sometido a punción venosa antes y después del uso del JTI. Materiales y Métodos: El estudio es analítico, exploratorio y cuantitativo. Para el análisis de datos se empleó el test de McNemar. La muestra consistió en 21 niños hospitalizados, pre-escolares y escolares, la recolección de datos ocurrió entre junio y agosto de 2012 en unidad pediátrica de Crato, CE (Brasil). Resultados y Discusión: Después del uso del JTI, se observó una reducción en la frecuencia de las variables de comportamiento que indican una adaptación menor al procedimiento de punción venosa, estadísticamente significativo: “Solicita la presencia Materna” y “Evita mirar el Profesional” (p <0,001). La realización de las sesiones también potencializó la frecuencia de prácticamente todos los comportamientos asociados a una mejor aceptación a la preparación o realización de la punción venosa: “Observa el Profesional” (p <0,001) y “Sonríe” (p <0,005). Conclusiones: El JTI constituye una intervención relevante para la enfermería pediátrica, siendo necesario para su aplicación, articular acciones destinadas a aumentar la sensibilización entre los administradores de los servicios de pediatría, mayor capacitación de los profesionales y un mejor abordaje en la educación del juguete terapéutico en los pregrados de enfermería.

Introduction: Pediatric nurses should always be attentive to the care subsidies that make possible a better control of pain and anxiety generated by infant hospitalization. Generally, these adverse feeling in children are caused by the realization of intrusive procedures, such as venipuncture. The use of the Therapeutic Toy Instructional (TTI) may represent an effective intervention to deal with the negatives effects of hospitalization. Objective: To compare the reactions expressed by the child, exposed to venipuncture, before and after the use of TTI. Materials and Methods: The research is analytical, exploratory and quantitative approach. For analysis of the data was employed the McNemar test. The sample consisted of 21 hospitalized children, pre-school and school ages, the process of data was collected between June and August of 2012 in a pediatric unit from Crato, CE (Brazil). Results and Discussion: After using the TTI, there was a reduction in frequency of behavioral variables that indicate less adaptation to the procedure, particularly for “Require the presence of mother" and "Try not to look for the Professional" (p <0.001). The realization of the sessions also increased the frequency of many behaviors associated with better acceptance of the procedure, especially: "Look for the Professional" (p <0.001) and "Smile" (p <0.005). Conclusions: The TTI is a relevant intervention for pediatric nursing; to use it in a systematic way is needed: planning actions aimed at increasing awareness among managers of pediatric services, better training of professionals and the inclusion of teaching of therapeutic toy in nursing courses.

Estudio piloto sobre la implementación de un programa lúdico en el contexto escolar para la estimulación del lenguaje / Pilot study of the implementation of an educational play-based program for language stimulation in the school setting

En el presente estudio se ha diseñado y aplicado un programa lúdico-educativo con el fin de estimular el lenguaje de niños de último curso de educación infantil con y sin dificultad específica. Este programa pretende responder a la necesidad de herramientas en el aula que, de forma atractiva y dinámica, actúen sobre las dificultades que pueden aparecer durante el desarrollo del lenguaje oral de los niños. Para ello, se empleó un diseño pre-post con una muestra de 25 alumnos de tercer curso de educación infantil. Las evaluaciones se realizaron a través de un registro de observación del lenguaje y de la Prueba de lenguaje oral de Navarra revisada. Las actividades del programa lúdico están basadas en el juego dirigido y se centran en aspectos como la atención, el reconocimiento visual, la lateralidad, el ritmo y la fluidez del habla, la discriminación auditiva, etc. Su duración ha sido de un mes, con 2 sesiones semanales de 45 min. Los resultados reflejan diferencias estadísticamente significativas en la mayoría de las variables objeto de intervención. Si bien se trata de un estudio piloto, los resultados parecen apoyar la utilidad de intervenciones breves de tipo lúdico-educativo aplicadas a nivel grupal en el contexto escolar para la estimulación del lenguaje (AU)

In the present study, an educational play-based program was designed and implemented to stimulate the language of children with or without specific difficulties in the last year of primary education. This program aimed to respond to the need for dynamic tools in the classroom to correct difficulties that may arise during the development of children's oral language. To do this, a pre-post design was used with a sample of 25 students in their third year of primary education. Evaluations were performed by the Revised Navarre oral language test and an observational procedure specifically designed for this study. The program's activities were based on directed play and focused on aspects such as attention, visual recognition, laterality, rhythm and fluency of speech, auditory discrimination, etc. The program lasted for 1 month with two weekly sessions of 45 min each.Statistically significant differences were found in most of the variables. Although this was a pilot study, the results seem to support the usefulness of brief interventions for language stimulation applied at the group level in schools (AU)

Assessing play-based activities, child talk, and single session outcome in family therapy with young children.

This exploratory, observational study was designed to reveal descriptive information regarding therapists' actual practices with preschool- and school-aged children in a single session of family therapy and to investigate change mechanisms in family play therapy that have been proposed to make this approach effective. A purposive sample of 30 families receiving family therapy was recruited and video-taped during a family session where at least one child between the ages of 4 and 12 was present. Following the session, the therapist and parent(s) completed questionnaires while one of the children (aged 4-12) was interviewed. Session recordings were coded, minute-by-minute, for participant talk time, visual aids or props used, and therapy technique type (e.g., play-based/activity vs. talk-only techniques). Hierarchical regression and canonical correlational analyses revealed evidence supporting the theory that play-based techniques promote young children's participation, enhance the quality of the child-therapist relationship, and build positive emotional experiences in family therapy.

Psychosocial implications of pediatric surgical hospitalization.

The prevalence of childhood surgical illness and injury requiring hospitalization suggests the need for implementation of an applied intervention to decrease levels of anxiety in these patients. When psychological concerns are not addressed in the present moment, potential for long-term negative psychological effects occur. To respond to the psychosocial needs of pediatric surgical patients it is important to understand foundational stages of development. Age is not always directly correlated with developmental stage and attunement to this subtle differentiation is essential. Some medical facilities offer services to pediatric surgical patients that include education about upcoming procedures as well as medical play which offers the opportunity to express emotions correlated with the hospitalization experience. This approach is directive in nature and controls the process of making sense of the medical environment. An alternative is Child Centered Play Therapy (CCPT) which creates an outlet for any emotions the children choose to express. CCPT offers comprehensive mental health care through a developmentally-appropriate, undirected intervention carried out by a mental health therapist and has been shown to reduce perceived and actual psychological trauma, anxiety, and behavioral issues in children preparing for surgery.

Enhancing the state of play in children's nursing.

Play is recognised as an essential component of a child's life. Playing with children in hospital can aid nurses in assessing, communicating and providing nursing care. Play workshops can facilitate nursing students' understanding of the importance and benefits of play. Play can benefit children, health carers and parents in the hospital setting. Play workshops encourage children's nurses to view play as an integral part of their role.

The transition from nonoral to oral feeding in children.

In this single-subject study, an evaluation was completed to determine the effect of occupational therapy intervention on the oral intake of 3 children who had their nutritional needs met by nonoral methods prior to the administration of an oral feeding program. Treatment consisted of a gradual increase of food presentation with the application of behavioral management methods and the presentation of developmentally appropriate play activities. Oral intake was measured during baseline and intervention phases to establish the effect of intervention. An analysis indicated an increase in oral intake in the intervention phase in 2 of the 3 children. The results, that occupational therapy intervention can increase the oral intake of children in transition from nonoral to oral feeding, might be strengthened through the replication of this study on larger populations.