Research Methods RES725 Dr. Crawford April 29, 2011

1. Will muslin puppets better elicit the communication of emotions from children facing medical interventions than will muslin dolls? Gail Windmueller Wheelock College Research Methods RES725 Dr. Crawford April 29, 2011

3. Literature Review Map

4. Benefits of Play • Play helps children • Express emotions • Increase psychological well-being • Helps Children process situations • Helps Children gain mastery over experiences • Koller (2008) • Reduces stress • Benefits of expressing emotions • Improves attitude and behavior during future hospital visits • Coyne (2006) • Increases Cooperation • Koller (2008) Increases immune system and rate of healing Weinman, Ebrecht, Scott, Walburn, and Dyson (2008 )

5. Use of Muslin Dolls Muslin Dolls Description • Develop trusting relationship with patient and family • Patients express emotions • Patents share misconceptions and misunderstandings and child life specialist can correct them • Assessment • Medical preparation and play • Improve children’s emotional state before a medical intervention occurs. • Preparation for tension-producing medical interventions • CLC, 2006 Benefits • Beige or brown muslin fabrics • Filled with polyester fiberfill. • Often made by volunteers and donated to the child life department. • Colored and decorated by children Gaynard, Goldberger, & Laidley (1991)

6. Puppets are used in the hospital setting • Puppets Research • Bernard the Hospital Puppet used by child life specialist Diana Chiles-helps children and their families to freely express their feelings, concerns, and questions • Karen Abbot (1990) demonstrated that therapeutic play with puppets is helpful in assessing and understanding misconceptions, while encouraging the expression of stress and the use of coping methods • Epstein, Stevens, McKeever, Baruchel, and Jones (2008) found that children using a puppet to talk appeared more comfortable sharing rich details about their camp experience , including unpleasant ones • Linda Synovitz (1999) uses puppets to teach a variety of health issues. She explains that puppetry “helps to foster social, emotional, cognitive and literacy development, promotes storytelling abilities, creative thinking and problem solving, and builds self-esteem in children” • Susan Linn “The impulse for honest expression and the sense that a puppet’s ‘separate’ personality is a safe haven for that expression occur together spontaneously, instantaneously, and often without conscious realization” (Linn, 2008,p.134-135). • Brounley(in Rollins, Bolig & Mahan, 2005),who does puppet therapy with hospitalized children, explained that because the puppet does not have a real personality, children feel that there is no risk or threat of conflict by speaking for the puppet. • Sara Reynolds and Judith Ross CCLS “Puppets act as a spokesperson for the child giving voice to unanswered questions or frustrations” (Reynolds & Ross, 2009)

7. Use of Puppets Puppets • Beige or brown muslin fabrics • Head filled with polyester fiberfill. • Could be made by volunteers and donated to the child life department. • Colored and decorated by children Could be used for assessment Could be used for medical preparation and play Could be used to help to improve children’s emotional state before a medical intervention occurs. Could be used for preparation for tension-producing medical interventions Could be used to assess misconceptions and misunderstandings.

9. Hypothesis H0 Muslin dolls will better or equally elicit the communication of emotions from children facing medical interventions than will muslin puppets. H1Muslin puppets will better elicit the communication of emotions from children facing medical interventions than will muslin dolls. H0 puppetsdolls H1puppetsdolls puppets = population mean of children’s expression ofemotions when playing with a muslin puppet dolls = population mean of children’s expression ofemotions when playing with a muslin doll

10. Subjects • A convenience sample of forty children (n=40) • 6-9 years old • ½ male and ½ female • Randomly assigned to control (dolls) or experimental group (puppets) • First time experiencing the placement of an intravenous line (IV). • Methodology • Ethics: • Designed so that there are minimal risks • Only risk is discomfort in the play environment • Reminded that they may withdraw from the project at any time • Receive contact information of the primary investigator and the Institutional Review Board. • Share strategies for participant confidentiality • Benefit of contributing to the field of Child Life • Benefits of medical preparation and play for participants • demonstrated to reduces stress • increases understand of interventions • may provide opportunities to correct children’s misconceptions. • contributes to a more positive perception of their hospital experience Study Design

11. Instrument Aldrich and Tanenbaum (2006) defined a message unit as “an individual speech act with a single thought that was bound by its intonation.” • Two researchers blind to the control versus experimental grouping • evaluate the message units • emotion category to ensure consistent inter-rater

13. ANOVAS will test the following: • The mean number of negative emotion words per message unit communicated by the children who used a doll versus those who used a puppet. • The mean number of positive emotion words per message units communicated by the children who used a doll versus those who used a puppet. • The mean number of emotion words (positive + negative) per message units communicated by the children who used a doll versus those who used a puppet. If the data rejects the null hypothesis at  = 0.05, one can conclude with 95% confidence that puppets elicit communication of emotions more readily than do dolls.

14. References Abbott, K. (1990). Therapeutic use of play in the psychological preparation of preschool children undergoing cardiac surgery. Issues in Comprehensive Pediatric Nursing, 13(4), 265-277. Aldrich, N. J., & Tenenbaum, H. R. (2006). Sadness, Anger, and Frustration: Gendered Patterns in Early Adolescents’ and Their Parents’ Emotion Talk. Sex Roles, 55(11-12), 775-785. Bolig, R., Yolton, K., & Nissen, H. (1991). Medical play and preparation: Questions and issues. Children's Health Care, 20(4), 225. Carlson-Sabelli, L. (1998). Children's therapeutic puppet theatre- Action, interaction, and cocreation. International Journal of Action Methods, 51(3), 91-112. Retrieved from EBSCOhost. Child Life Council (CLC). (2006). Policy statement: Child Life Services. Pediatrics, 118(4), 1757-1763. Chiles, D. (a). Bernard, the Hospital Puppet. Retrieved October 30, 2009 from http://www.hospitalpuppet.com/ Chiles, D. (b). Puppet therapy. Retrieved October 30, 2009 from http://www.hospitalpuppet.com/ Coyne, I. (2006). Children's experiences of hospitalization. Journal of Child Health Care, 10(4), 326-336. Retrieved from EBSCOhost. Epstein, I., Stevens, B., McKeever, P., Baruchel, S., & Jones, H. (2008). Using puppetry to elicit children's talk for research. Nursing Inquiry, 15(1), 49-56. Gaynard, L., Goldberger, J., & Laidley, L. N. (1991). The Use of Stuffed, Body-Outline Dolls With Hospitalized Children and Adolescents. Children's Health Care, 20(4), 216. Retrieved from EBSCOhost. Kolk, A. M., van Hoof, R., & FiedeldijDop, M. J. C. (2000). Preparing children for venepuncture. The effect of an integrated intervention on distress before and during venepuncture. Child: Care, Health and Development, 26(3), 251-260. Koller,. D. (2008). Therapeutic Play in Pediatric Health Care: The Essence of Child Life Practice. Child Life Council Evidence-Based Practice Statement. Retrieved from http://www.childlife.org/files/EBPPlayStatement-Complete.pdf Linn, S. (2009). A case for make-believe: saving play in a commercialized world. New York, NY: The New Press.

15.  Reynolds, S. & Ross, J.R. (2009). Beyond Sesame Street: The therapeutic use of  puppets in healthcare. PowerPoint presentation given at Child Life Council 27th Annual Conference on Professional Issues. Boston, MA. April 29, 2009. Rollins, J. A., Bolig, R. & Mahan, C. C. (2005). Meeting children’s psychosocial needs across the health-are continuum. Austin, Texas: Pro-Ed International Publisher. Synovitz, L. (1999). Using puppetry in a coordinated school health program. Journal ofSchool Health, 69(4), 145. Walburn, J., Vedhara, K., Hankins, M., Rixon, L., & Weinman, J. (2009). Psychological stress and wound healing in humans: A systematic review and meta-analysis. Journal of Psychosomatic Research, 67(3), 253-271. Weinman, J., Ebrecht, M., Scott, S., Walburn, J., & Dyson, M. (2008). Enhanced wound healing after emotional disclosure intervention. British Journal of Health Psychology, 13(1), 95-102. Windmueller, G. (2009). The Use of Dolls and Puppets in Medical Play. Unpublished draft, Wheelock College, Boston, MA.