Restorative Benefits of Paediatric ward as Play Environment in Nigerian hospit al

1. Research progress Presentation Restorative Benefits of Paediatric ward as Play Environment in Nigerian hospital Candidate: Usman Bukar Wakawa (PB123031) PhD candidate Landscape Architecture Semester 4/6 Supervisor: Assoc. Prof. Dr. Ismail Said Faculty of Built Environment, FAB

2. RESEARCH AIM: The aim of this research is to determine the restorative benefits inherent with loose play items on early and middle childhood paediatric patients indoors (aged 3-12) that can improve their physical, social and cognitive performance in a paediatric hospital ward settings. RESEARCH QUESTION: How can a ward as play environment, using loose items (natural/conventional materials) along side hospital protocols and norms improve children coping abilities, adjust their social, cognitive and physical performance? RESEARCH UNDERPINNING Research is designed around the psycho-physiological stress reduction framework which involves two theories. Attention restorative theory; (ART) by Kaplan and Kaplan, 1989 and Stress coping reduction theory, (SCRT) by Ulrich, 1999. The third is the Psychological and Physiological harmony in child care center design; (PPH) by Anita Rui Olds. AndParticipatory Strategies for the design of child care facilities by Henry Sanof.

3. RESEARCH BACKGROUND: Studies have shown that hospitalised children are faced with psychological challenges which affect their hospital stay? (Dise-Lewis, 1988; Varni & Katz, 1997; Varni, Rappaport, and Talbot, 1991) Most of the present paediatric ward settings in Nigerian hospitals deliver healthcare in connection to protocols and medical codes. Paediatric ward settings does not provide adequate bed spacing that can allow for free movement and play activities. RESEARCH PROBLEMS: BEHAVIOUR . Fear . Anxiety . Boredom . Crying . Bad Mood . Depression . Restlessness .Clinging to parent OUTCOME . Low cognitive performance . Low social performance . Low physical performance WARD CONDITION . Limited space . Crowdedness . Confinement .Unfamiliar setting .Unfamiliar equipment .Unpleasant sound STRESS

4. RESEARCH GAP Environmental healthcare research that involves therapeutic, restoration and healing are concentrated on the provision of outdoor facilities such as Garden, Landscape, Playscape and Ecotherapy. Examples are: 00’s 80’s 90’s Keep. Kellert Ulrich Jay Cooper Effect of healthcare on Environment The Biophilia hypothesis Moore Windows in the intensive Therapy unit The experience of Landscape Moore Healing Gardens said Plant for play A prison Environments effect on healthcare Ulrich. Restorative Gardens Ulrich. Moore Effects of hospital environment On patient well-being R.Kaplan Influence of passive experiences Reasons to smile at Tear drops R.Kaplan Kelly Accessible play: No more watching from sideline S.Kaplan. S.Kaplan. With people in Mind Psychological benefit of a wilderness experience Perkins Jay Perkins The physical environment as a therapeutic Epstein “Getting serious about therapeutic practice” Housing as if people mattered Cooper. Cooper. Healing Gardens smith Jane. Health and nature Effects of hospital environment On patient well-being Kamp Healing environment, Restorative Gardens Dijkstra Stress reducing effect of indoor plants in the built environment Thoday Epstein Therapeutic Gardens in the Acute Garden Use of Garden for disable Bowers Fried Hartig Therapeutic Gardens in the Acute Garden Landscape view and prison response Burt Calkins. Mooney Kate West Edward

5. Human Development theory • THEORITICAL FRAME WORK Lev Vygotsky (1896-1934) Jean Piaget (1896-1980) Psychoanalytic theory Behavioral theory Humanistic theory Cognitive theory Sociocultural theory Abraham Maslow (1908-1970) Sigmund Freud (1856-1939) Ivan Parlor (1847-1939) Human Development Carl Rogers (1902-1987) John Watson (1878-1958) Erik Erikson (1902-1994) Jay Appleton (1975) Prospect Refused theory Environmental psychology Attention Restorative theory and Environmental Preference Theory Kaplan and kaplan (1989) Healthcare Stress coping Reduction theory Ulrich, Rogers . S. (1999)

6. RESEARCH DESIGN:

8. Scope of Study Study sites - Paediatric Ward, ATBUTH Bauchi * the hospital started from health Centre in the 1940s to general hospital, and later to specialist hospital and finally to a teaching hospital * one out of the two teaching hospital in North-East of of Nigeria. * Proximity to Data and source of information. Respondents1. Early childhood to Middle-childhood children (3-11 year old. n=17) 2. Caregivers (Nurses. and Doctors) 3. Parents 4. Other hospital staffs

9. The ward without play intervention Children always stick to their beds almost all the day Chidren frequently develop excessive fear, change in mood and facial expression. Less cooperating to acceptance of routine medication, treatment and dressing of wound. Children show the sign of being restless, bored and stressed

10. Findings - The ward with play intervention provided six times more positive behavior and five times more performances level than the ward without play intervention. - Play intervention has provided a playful environment that enhances children behavior and performances from low to higher level. - Positive changes noticed in their physical, cognitive and social performances, from low in the ward without play intervention to higher in the ward with play intervention. - Children interaction with nature inclined activities such as sand, water, wooden logs and stones have shown to improve on their hospitalization. - Physically, they have changed from staying in their beds to being active with desire to run, jump, crawl and manipulate the play items. - Cognitively, they have changed from being depressed, bored, fearful, and restless in the ward to being calm, relaxed, comfortable and cheerful. - Socially, the change is noticeable from being alone and keeping to themselves to playing with peers and cooperating with their caregivers and parents in the ward. The play activities represent a useful technique for a more friendlier and restorative hospital environment which can reduce the negative effect of children hospitalization experiences.

11. Result Physical performance Social performance Cognitive performance Stress coping Reduction theory Restoration Ulrich, Rogers . S. (1999) Play activity Play activity PPH in child care center design (Olds). Anita Rui Olds (1989) PSD child care facilities (Sanof). H. Sanof (1989) Play activity Hospitalization Attention Restorative theory Kaplan and kaplan (1989)