Play and playfulness among hospitalized children: A mixed method analysis
Play is one of the most important childhood occupations. Children who are hospitalized are at risk for decreased opportunities to play and exude playfulness. The purpose of these three inter-related studies was to investigate how play occurred within the hospital and to evaluate if playfulness was different between the home and hospital environments. Study one 1 utilized an ethnographic qualitative design and sought to answer the question, "How does play occur among hospitalized children? Multiple videos were taken of three participants throughout the course of their hospitalization and analyzed. Thematic analysis revealed 25 themes that emerged related to the environment, physical, social, toys, and pleasure categories. Overall, the children were found to play even without structured support and cooperative play was found to improve overtime. Study 2 evaluated the level of playfulness in the home compared to the hospital among eight participants. The Test of Playfulness was utilized to evaluate the children's playfulness during 15 minute video observations taken prior to hospitalization, at
admission, and at discharge. Findings revealed that playfulness was significantly similar in both the home and the hospital and that playfulness increased from admission to discharge. Study 3 involved watching the same participants' videos as in Study 2 to evaluate the positive and negative elements of the environmental supportiveness. The Test of Environmental Supportiveness was used to analyze the positive and negative elements of the environment. Results indicated there were no differences in positive or negative elements of the environment across time or within different settings. Additionally, no significant relationships were found between playfulness and positive or negative elements of the environment indicating that the children were playful independent of the elements of environmental supportiveness. Finally, Chapter 6 offers an overview of the findings of all three studies, synthesizes the information in relation to previous literature about play among hospitalized children, addresses limitations, provides implications for future research, and discusses the clinical implications of this study for the occupational therapy profession as well as other health care professions to maximize the playfulness of hospitalized children.