1. NURSERY NURSES IN PLAY THERAPY ROOMS

Three playrooms were originally opened by volunteers from England in 1993 and from the summer 1994 have been run by graduates from the Bacau NNEB College or by those with similar qualifications.
It was initially important to establish our position within the hospital, to emphasis the importance and usefulness of children spending supervised time in the playrooms. The hospital staff quickly accepted us appreciated our work and formed a close working relationship.

2. THE SIGNIFICANCE OF PLAY THERAPY ROOMS IN THE PAEDIATRIC WARDS

It is important, useful and necessary that children admitted in the paediatric ward should have a play routine.
" Children need to play, regardless their age.
" Physical and mental stress caused by illness and admission in hospital can create difficulties for the child. Thus, children are moving fast from a family environment - loving and familiar - to a hospital environment - unknown and unfriendly. Parents cannot always prepare the children enough for this transition. This is where we try to help, bringing a warm, friendly atmosphere in the playrooms.
" The time we spend together through play towards the children can create a close friendship based on trust, which can help them get over the fear of hospital. That enables them to express their feelings and thoughts and we can try and solve together any problem or misunderstanding.
" Children have the opportunity to attend various activities that can help them continue their normal development and aid their recovery.
" For many, time appears to go faster when in the playroom. They are active and in control and not having something done to them (medical check-ups, treatments).
" Accidents or injuries can be reduced as children are under permanent supervision while attending the playrooms.
" They can also meet other children make new friends and often the older children help with the younger ones, offering their support and friendship.
" Playing is an antidote for boredom and pain. It has a real therapeutic contribution to the child: it may bring joy, entertainment, fascination, and reduce tensions and aggression and gives more normal activities through the period of hospitalization. Creative role play games offers the possibility to the children to prepare themselves, psychologically, for the treatments and procedures through play.
" The hospitalization may be constructive for the child's health through the intervention of the adults (medical personnel, parents and us). The medical staff has the chance to enter the playrooms and observe the normal behaviour of a child playing, when he or she is more relaxed. This can contribute to a correct diagnosis and the right treatment.
" Parents are pleased that the children have some relaxing and pleasurable time while in the playroom.

3. PLAY ROOMS. DAILY PROGRAMME

There are two playrooms in each Paediatric Ward:

- one playroom for childrThere are two playrooms in each Paediatric Ward:

- one playroom for children between 0-3 years;
- one playroom for children between 3-16 years.

The daily program for these playrooms is as follows:

	Playrooms for children between 0-3 years old	Playrooms for children between 3-16 years old
WARD I	14,00 - 16,00	9,30 - 12,30
WARD II

The timing is set to fit in with for medical visits, treatment, meals and sleeping programme. The basic idea is to maintain the playrooms open much of the time, in order to offer the children a full time programme of playing.

For children immobilized in bed in the intensive care unit we have developed a special program.

4. ACTIVITIES DEVELOPED IN THE PLAY ROOMS.

These are some of the activities offered to the children taking into account their age, diagnosis and treatment, as well as the children's needs and requests. All the activities are planned and recorded in weekly diaries. None of these activities are compulsory.
At present, a large proportion of the children attend the activities in the playrooms:

- Drawing and painting
The subjects can be chosen either by the child or suggested by the therapist
Finger painting for the younger ones.
They can express their feelings through various messages in their works (images from everyday life, favorite characters, landscapes etc.)

- Clay modeling
Non-toxic homemade plasticine, made out of flour, salt and water.
Improving handling skills, imagination and creativity.
Handling plasticine can have a therapeutic effect.

- Collage
Cutting and sticking re-usable materials such as: coloured maps, fabrics, different shapes of pasta, dried-up flowers and leaves, seeds, etc.
This particular type of activity can re-enforce imaginative ability on children

- Learning songs, poems and games
Children can relax.
Challenges and develop their memory..
Can include schoolwork, providing continuity while in hospital.
It is fun and entertaining.

- Playing with water and sand
Children can acquire sensory experience.
Although often new, children love this type of activity, especially the younger ones.
We have two large plastic containers for water and sand, various shapes and colours plastic toys, plastic aprons for protecting children's clothes.

- Logic games
Eliminate boredom and challenges their thinking and concentration skills.

- Music and PE
Children are doing physical exercises; they are playing games using balls or mattresses with to background music.
Can organize competitions.
Provides continuity of physical development.

- Puzzles and bricks
Use of plastic, wooden, cardboard shapes and figurines that can emphasize creativity, concentration and handling skills.
Sorting them according shape, colour and size can help develop the concept of these parameters

- Writing and reading
Mostly for school children who are in hospital for longer periods of time.
Provides continuity of psychological development.

- Imaginative play
Playing roles or using puppets.
Children can make use of their imagination, taking the role and behaviour of a person they would like to be (doctor, teacher, cartoon character etc.)
We make our own puppets or borrow from the Puppet Theatre in Bacau.

- Watching films
Using our own videotapes, a VCR and a TV.
This is often the favourite activity especially cartoons.

- Health education
Weekly hygiene lessons separately for the girls and boys.
Various games and discussions where we talk about body hygiene and general cleaning.
The aim is to create more knowledge and improve hygiene both while in the hospital and after in the future.

Their works (paintings, drawings etc) are exhibited in the ward, playrooms and hallways. Meantime, the older children are helping us preparing materials for the next activity.
Those children, who do not go to the playroom either because of their illness or inclination, can have their chosen toys, games or books at the ward and we give them individual attention as well.
When the playrooms are closed (at weekend and in the evenings) they can borrow games and books. Our team decorated the hallways and admission rooms in Paediatric Wards and Children's Clinic with paintings of famous cartoon characters.

5. OTHER PROJECTS

"PLAYING HIGH"

The hospital rooftop has been turned into an outdoor playground for the children admitted in hospital. This was financed by The Norwich Support Group in UK spearheaded by Brenda Ford. Work on this project took five months and safety and security of "The Terrace" project were one of the main concerns. It has been fitted with outdoor equipment such as slides, seesaw, bicycles and tricycles, balls, mattresses, play cots for the babies, water and sand tanks etc. The terrace has been decorated in pastel colours and there are tables and chairs where children can sit and choose their games and toys. Children enjoy playing outdoors and the fresh air. The children are carefully supervised between the wards and while on the terrace. The terrace replaces the playrooms during the summer, from around mid May to mid September. We also take the children for a walk in the nearby park with the permission of the doctors.

"PLAYING AS AN AUXILIARY THERAPY"

In September 1998 we extended our activity in the Paediatric Surgery unit.
Although there are no playrooms, we work with children in the wards. As most of the children are confined to bed their activities have to be modified but the programmes are similar to the ones in the Paediatric Wards. These children are often particularly scared and therefore more attention and understanding is needed and time is spent trying to reduce their anxiety and apprehension by preparing them for their treatment or surgery. Simple explanations and a reassuring presence can be very helpful and comfort to the child.

In June 2000 a playroom in the children ward at the TB Hospital in Bacau was started. As the children's admission is often many weeks more attention is paid to continuing their education as well as play activities but overall their programme is similar than to the other wards.

"CELEBRATIONS FOR THE HEART"

Every year at Christmas, Easter, 1st and 8th of March and 1st of June we organise parties and carnivals for the children admitted in hospital with lots of surprises and presents. Many of these activities are paid by local sponsors to whom we are very grateful.


TOU NNEB team