UNIVERSA MEDICINA
Univ Med 2025.
44:16-25
pISSN: 1907-3062 / eISSN: 2407-2230 DOI: https://doi.
org/10.
18051/UnivMed.
ORIGINAL ARTICLE
Assessment of nursesAo knowledge about therapeutic play in pediatric services of a training and research hospital Ayenur TAyNI1 and Selen ynZAKAR AKyNA2* Department of Child Health and Diseases Nursing.
Institute of Health Sciences.
Hitit University.
Corum.
Turkey Department of Child Health and Diseases Nursing.
Faculty of Health Sciences.
Hitit University.
Corum.
Turkey * Correspondence Author:
selenozakar@hotmail.
Date of first submission.
July 29, 2024 Date of final revised submission.
February 3, 2025 Date of acceptance.
February 20, 2025 Cite this article as: TASCI A.
OZAKAR AKCA S.
Assessment of nursesAo knowledge about therapeutic play in pediatric services of a training and research hospital.
Univ Med 2025.
44:16-25
ABSTRACT
BACKGROUND
Hospitalization disrupts childrenAos lives and can produce feelings of anxiety, fear, or pain.
Playing is an important part of childrenAos lives.
It is necessary for nurses to provide holistic and quality care, including therapeutic play, which contributes to the recovery of children by relaxing them both physically and The aim of this study was to determine the level of knowledge of pediatric nurses about therapeutic play and find out the relations of therapeutic play with nursesAoage, educational level, marriage status, and length of employment.
METHODS
This cross-sectional study was conducted with 126 pediatric nurses working in the pediatric service of a training and research hospital.
The data of the study were collected with the "Nurse Introductory Information Form" and "Questionnaire for Determining the Level of Knowledge of Therapeutic Play".
Descriptive statistical tests and nonparametric tests were used to analyze the data.
Statistical significance was set at p<0.
RESULTS
In this study, 88.
1% of the nurses stated that they did not receive training in therapeutic play, and 79.
4% stated that they wanted to receive training in therapeutic play.
The nursesAo level of knowledge about therapeutic play significantly decreased with age and increased with educational level .
<0.
CONCLUSIONS
The knowledge level of the nurses participating in the study about therapeutic play is above average, but is low regarding the integration of therapeutic play into care.
It is recommended that nurses receive in-service training in therapeutic play.
Keywords: Therapeutic play, child, child nursing, therapeutic play knowledge level Copyright@Author.
- https://univmed.
org/ejurnal/index.
php/medicina/article/view/1619 NursesAo Knowledge of Therapeutic Play
INTRODUCTION
Upon admission to the hospital, children may experience behavioral and emotional traumas, anger, aggression, anxiety, regression, and introversion stemming from stress, fear, and .
Therapeutic play (TP) has emerged in order to minimize the stress levels of children that occur due to illness and hospitalization.
Therapeutic play is a planned intervention to promote the psychological, social and physical well-being of the child in the hospital setting.
By integrating the interventions with TP, it becomes easier for the child to tolerate the procedures, adapt to the hospitalization, prepare for invasive interventions after hospitalization, and manage pain and anxiety during invasive .
It is reported that TP contributes to the recovery of children by relaxing them both physically and emotionally, and is necessary for nurses to provide holistic and quality care.
Aiming to keep the growth and development of children at the highest possible level, nurses should integrate therapeutic play into care.
To this end, it is important for nurses to have a sufficient knowledge about TP in order to provide holistic and quality care.
To increase the quality of care, nurses should master therapeutic play in all its aspects, use it in child-related practices, and use play as a communication tool in .
The nurses should accept the importance of play for a hospitalized child, observe the child playing, understand the childAos interests and needs, know how to activate the child, and use different play elements in changing situations.
The nurses should execute and plan intervention programs where play is .
In this way, the childAos verbal or non-verbal expression of feelings and thoughts will reduce communication problems between the child and the nurse, develop a sense of control in the child, increase harmony and childAos .
Considering the benefits of TP to the child, family, and healthcare personnel, it is necessary to benefit from TP in all procedures during the hospitalization and discharge in order to support the development of the child, reduce the anxiety caused by the hospital environment, minimize the negative effects of the interventions, and support the child's coping.
For this reason, it is essential to determine the knowledge level of nurses about therapeutic play.
In the study conducted by Godino-Iyyez et al.
a systematic review found that TP has a beneficial impact on the care of hospitalized children and should be implemented in pediatric units after assessing the resources and training needed for pediatric nurses.
However, although the literature is vast regarding the advantages and benefits of play in the hospital, it remains little used in practice, due to some difficulties pointed out by health professionals, such as the lack of time for play and lack of preparation for the use of TP.
Understanding the importance of play in the practice of pediatric nursing care, and being aware of the difficulties faced by health professionals to insert it in their daily schedule, the authors developed this study to explore nursesAo perceptions regarding the use of play in the care of hospitalized children.
This study aimed to determine the knowledge level of nurses about therapeutic play and to raise awareness of it.
METHODS
Research Design This cross-sectional study was performed at the pediatric services of a training and research hospital in the Central Anatolia Region of Turkey between January and December 2021.
Reseach subjects The study population consisted of all nurses working in the pediatric services of a training and research hospital in the Central Anatolia Region of Turkey between January and December 2021 (N = The sample size was calculated using the sample formula for a known population, namely n=N.
q/d2(N-.
q, where n= number of individuals to be included in the study sample.
N= study population, p=prevalence of occurrence, q= prevalence of non-occurrence, t= theoretical value found in the t-table at a certain degree of freedom and error level, d=accuracy according to the incidence of the event.
When the data.
N=128, p=0.
64 q=0.
36 t=1.
96 d=0.
05, were entered into the formula, it was seen that the sample size should be n=94.
In order to make the sample size much stronger in revealing the relationship between the variables, it was decided that a total of 126 nurses constituted an appropriate sample Inclusion criteria: nurses who worked in TASCI A.
OZAKAR AKCA S pediatric services between the dates of the study (January-December 2.
, who agreed to participate in the study, and who filled out the questionnaires completely, were included in the Nurses who were on leave at the time of the study and those who did not agree to participate were excluded from the study.
Instruments The "Introductory Information Form for the Nurse" and "The Questionnaire for Determining the Level of Knowledge of Therapeutic Play" prepared by the researchers after reviewing the literature .
-7,12,13,19,.
and expert opinions .
professors in pediatric nursin.
were used as data collection tools.
The Introductory Information Form for the Nurse, developed by the researchers, consists of two parts to determine nurses' introductory characteristics and therapeutic play The Questionnaire for Determining the Level of Knowledge of Therapeutic Play, developed in line with expert opinions and literature, consists of 30 items.
-7,12,13,19,.
Fourteen items in the questionnaire aim to determine the general knowledge level of nurses about therapeutic play, 8 items aim to determine their knowledge level about the benefits of therapeutic play, and 8 items aim to determine their knowledge level about the practice of therapeutic play.
Nurses were asked to answer the items in the questionnaire with AutrueAy.
AufalseAy or Audon't knowAy.
In the questionnaire, the correct answers to items 1, 3, 9, 11, 13, 15, 17, 18, 19, 20, 21, 22 are true, and to items 2, 4, 5, 6, 7, 8, 10, 12, 14, 16, 23, 24, 25, 26, 27, 28, 29, 30 are In scoring the questionnaire, correct answers were scored Au1Ay, wrong answers and "don't know" options were scored "0".
Evaluation was made over the total score.
A maximum of 30 and a minimum of 0 points can thus be obtained from the questionnaire.
The field expert determined 15 as the average value.
A score above 15 points was considered high and a score below 15 points was considered low.
The higher the score, the higher the nurses' level of knowledge about therapeutic In order to determine the comprehensibility and application time of the questionnaire form prepared for the study, a pilot study was conducted with 5 nurses who met the inclusion criteria and no changes were needed on the data collection The data collected in the pilot study were included in the study proper because there was no change in the form.
Data collection The data were collected by the researchers during face-to-face interviews with the nurses working in the pediatric wards of a training and research hospital at the time of the study.
Before data collection, participants were informed about the study and written consent was obtained.
The data were collected at appropriate time intervals during working hours within an average of 15-20 minutes in a suitable environment.
In answering the questionnaire, the nurses were asked to read and answer the questionnaires themselves in order not to be affected by the researchers and the other The forms were initially applied to 5 nurses in order to determine the clarity of the questions and the time to be allowed for answering the questionnaire.
Since no corrections were made in pilot testing, the 5 nurses who were subjected to the pilot testing were included in the study.
Statistical analysis Statistical analysis was performed with IBM SPSS Statistics for Windows version 21 (Armonk.
NY: IBM Corp.
USA).
Descriptive statistics of numerical variables obtained with "Introductory Information Form for the Nurse" and "The Questionnaire for Determining the Level of Knowledge of Therapeutic Play" were reported using the median .
inimum - maximu.
or mean A standard deviation in accordance with the normality of the data distribution.
The frequency distributions of the categorical variables obtained through AuIntroductory Information Form for the NurseAy socio-demographic characteristics and the responses to the questionnaire were presented as numbers and percentages (%).
The normality of the distribution of numerical data was evaluated with Kolmogorov-Smirnov and Shapiro-Wilks tests.
Since parametric test assumptions were not provided, the Mann Whitney U test was used to compare numeric data between two independent In the comparison of numeric data between more than two independent groups.
Kruskal-Wallis test was used, because parametric test assumptions were not provided.
DunnBonferroni post-hoc multiple comparison tests were used to identify the groups from which the difference stemmed after the Kruskal-Wallis test.
The reliability of the AuThe Questionnaire for Determining the Level of Knowledge of Therapeutic PlayAy was evaluated based on the Cronbach alpha reliability coefficient.
The value Universa Medicina.
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1, 2025
NursesAo Knowledge of Therapeutic Play of p<0.
05 was accepted as the statistical significance limit.
Ethical clearance In order to conduct the study, the investigators obtained approval from the Ethics Committee .
2019/2019-.
and written permission from the Training and Research Hospital .
2019/83369.
, which is the institution where the research was to be Informed consent was obtained from the nurses who agreed to participate in the study, by providing information about the purpose of the study and the confidentiality of the information.
RESULTS
Table 1 shows the distribution of the sample The mean age of the nurses participating in the study was 30.
80 A 6.
21 years.
Of the participating nurses, 56.
3% were younger than 29 years old, 67.
5% were married, 42.
1% did not have children, while 61.
9% were at undergraduate level and 42.
9% had been working in the pediatric ward for more than 5 years.
Furthermore, 53.
2 % of the nurses stated that they had not heard of therapeutic play before, and 9% .
of nurses who knew about therapeutic play stated that they heard of this term for the first time during in-service training and from social media.
In addition, 88.
1% of the nurses stated that they did not receive training on therapeutic play, and 79.
4 % stated that they were willing to receive training on therapeutic play (Table .
It was determined that nurses gave correct answers to at least 8 and at most 30 items from the AuThe Questionnaire for Determining the Level of Knowledge of Therapeutic PlayAy, and that the total mean score was 19.
22 A 4.
15, which was above the average .
ata not show.
Table 1.
Distribution of subject characteristics .
Characteristics Age .
O 29
Ou 40 Marital status Married Single Having Children Yes Education .
Health vocational high school .
Associate .
Bachelor .
Master/ Doctoral .
Length of employment in the pediatric service .
Prior exposure to the therapeutic play concept Yes Place of initial exposure to the therapeutic play concept .
= .
Education In-service training Social media Received in-service training in therapeutic play Yes Agree to receive training in therapeutic play Yes TASCI A.
OZAKAR AKCA S
Table 2.
Distribution of nurses' responses on therapeutic play Items General knowledge of therapeutic play Play is a form of learning for children.
There are two types of therapeutic play: creative play and dramatic Play is a reflection of the child's inner world and mental Therapeutic play is used only for the development of cognitive functions of children.
The need for play disappears in hospitalized children.
Therapeutic play is defined as spontaneous activities using toys, without predefined goals.
Therapeutic play can be benefited by children of all age groups.
Therapeutic play can be benefited by all hospitalized children.
The application of therapeutic play differs according to the developmental stages of the child.
Therapeutic play is used only in preparing children for Asking the child three wishes is one of the verbal therapeutic play An example of creative play is the child playing the role of a nurse/physician and dressing a baby.
In therapeutic play, adolescents should be given as much information as they need and can tolerate The use of therapeutic play is not appropriate in the pre-operational Benefits of therapeutic play Therapeutic play allows children to express their feelings and knowledge about their illness.
Play interferes with the professional relationship between the child and the healthcare professional.
Therapeutic play helps relieve tension and stress.
Therapeutic play reduces the trauma associated with illness and hospitalization in children.
Therapeutic play is effective in understanding the child's feelings and thoughts about the intervention to be applied.
Therapeutic play facilitates the child's healing process.
Therapeutic play helps children develop positive behaviors.
Parents of children benefiting from therapeutic play have higher satisfaction levels.
Practice of therapeutic play Therapeutic play can only be practiced by play therapists.
Therapeutic play is applied when play therapy cannot be applied.
Therapeutic play is used in a controlled environment to treat children with emotional disorders.
Every game played with children in the hospital is therapeutic play.
Active participation of the hospitalized child in therapeutic play is not essential.
Play hours should be determined for hospitalized children, and these hours should not be exceeded.
A well-equipped play room is needed for therapeutic play to be Therapeutic play should be applied in the presence of a specialist True False Universa Medicina.
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NursesAo Knowledge of Therapeutic Play Table 2 shows the distribution of the responses about therapeutic play given by the The comparative mean scores of knowledge levels of therapeutic play according to the introductory characteristics of the nurses in the study is given in Table 3.
The mean score of knowledge level of nurses aged 29 years and younger was .
69 A 3.
, which is significantly higher than that of those aged 30-39 years .
and of those aged 40 years and over .
A 4.
=0.
It was determined that the differences in the mean scores of therapeutic play knowledge level by the nursesAo marital status, number of children, and length of employment in the pediatric service, were statistically not significant .
>0.
The mean score of knowledge level of high school-graduate nurses .
71 A 3.
was found to be significantly lower than that of nurses with associate degree .
, undergraduates .
33A3.
, graduates/ nurses with doctoral degree .
91A4.
=0.
Table .
Table 3.
Comparative mean scores of knowledge levels of therapeutic play by nursesAo characteristics Characteristics Age .
O 29 Ou 40 Marital status Married Single Having children Yes Education .
Health vocational high school Associate Bachelor Master/ Doctoral Length of employment in the pediatric service .
Mean ASD Median (Min.
- Max.
p value 69 A 3.
57 A 4.
67 A 4.
06 A 4.
56 A 3.
82 A 4.
77 A 3.
71 A 3.
56 A 4.
33 A 3.
91 A 4.
67 A 2.
47 A 3.
72 A 4.
Table 4.
Comparison of the mean scores of the level of knowledge of therapeutic play by the nursesAo experiences in therapeutic play Characteristics Mean ASD The state of hearing about therapeutic playAo concept before Yes 81 A 3.
84 A 4.
Where she/he first heard of therapeutic play' concept .
Education 54 A 3.
In-service training 67 A 2.
Social media 36 A 4.
Therapeutic play in- service training received status Receiving 73 A 2.
Non-receiving 75 A 4.
The state of willing to receive training on therapeutic play Willing 13 A 4.
Unwilling 58 A 3.
Median (Min.
- Max.
p value 20 .
< 0.
< 0.
aMann Whitney U test.
bDunn-Bonferroni post-hoc test.
c Kruskal Wallis test TASCI A.
OZAKAR AKCA S
Among the nurses in the study, the mean knowledge level of those who had heard about the term therapeutic play before .
81A3.
was significantly higher than those who did not .
A4.
<0.
The mean knowledge level of nurses who heard about therapeutic play during inservice training .
67A2.
was significantly higher than the level of those who heard it during their education .
54 A 3.
36A4.
on social media .
=0.
The mean knowledge level of nurses who received in-service training on therapeutic play .
73A2.
was significantly higher than those who did not .
75A4.
<0.
Table .
DISCUSSION