Research progress Presentation Restorative Benefits of Paediatric ward

Research progress Presentation Restorative Benefits of Paediatric ward as Play Environment in Nigerian hospital Candidate: Usman Bukar Wakawa (PB 123031) Ph. D candidate Landscape Architecture Semester 4/6 Supervisor: Assoc. Prof. Dr. Ismail Said Faculty of Built Environment, FAB

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. And Participatory Strategies for the design of child care facilities by Henry Sanof.

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: WARD CONDITION. Limited space. Crowdedness. Confinement. Unfamiliar setting. Unfamiliar equipment. Unpleasant sound STRESS BEHAVIOUR. Fear. Anxiety. Boredom. Crying. Bad Mood. Depression. Restlessness. Clinging to parent OUTCOME. Low cognitive performance. Low social performance. Low physical performance

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

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

RESEARCH DESIGN: Objective #1 General Knowledge Research Objectives Research Question(s) Objective #2 Context Objective #4 Objective #3 Synthesis To identify the problem of children hospital ward without positive intervention distraction; To investigate the behavioural response of children due to norms and protocols in the ward and the level of their influence in a hospital ward setting; To examine the changes in behavioral responses of children after experiencing of natural play materials indoors. What are the challenges of such wards on children hospitalization experience? What are the behaviour of children in the ward without the natural play intervention? How can natural play indoors influences children coping abilities to hospitalization? How can the ward as play environment influence children’s behaviour during hospitalisation? How can natural play indoors improves children hospitalization experiences? Evaluation To propose a guideline for ward restoration process through indoor natural play to enhance on children physical, cognitive, and social performance.

Objective #1 Objective #2 Objective #3 Objective #4 Data Collection Method 1. Literature review 2. Observation from Pilot study 1. Background survey 1. Survey Questionnaire 2. Observation - photograph - video recording 3. Interview 1. Children’s Drawing Analysis Method 1. 2. 1. Content analysis 1. AHP 2. Content analysis 1. Synthesis 2. Content analysis Expected Findings Have a better understanding of the ward condition faced by children, parents and their caregivers. Identify the shortcomings of the existing paediatric ward setting. To have the avenue of showing stakeholders the benefits of physical and social environment given the needed stimulation on patients health outcome and coping abilities that may reduced medication intake and reduce the length of stay. Hospital ward design framework that may improve on children physical, social and cognitive performance. Related Theories ART (Kaplan and Kaplan). Being away, fascination, extend, and compatibility. SCRT (Ulrich). Sense of security, Sense of control, Social support, Physical movement and exercise. PPH in child care center design (Olds). Where children develop by interacting with the social and physical environment upon materials and events. Participatory Strategies for the design of child care facilities (Sanof). Where research findings can be integrated into design decision processes. Inference Content analysis

Scope of Study sites - Paediatric Ward, ATBUTH Bauchi * the hospital started from health Centre in the 1940 s 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. Respondents 1. Early childhood to Middle-childhood children (3 -11 year old. n=17) 2. Caregivers (Nurses. and Doctors) 3. Parents 4. Other hospital staffs

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

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.

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