Exemplar Profiles

The Children’s unit consists of a general medical inpatient ward with 27 beds and an Observation and Assessment unit with 6 beds and a discharge lounge. Although we are a Medical ward, we also have planned dental surgical admissions once per week and orthopaedic and other emergencies daily. As a Health Play Specialist, I provide preparation and distraction on the Observation and Assessment Unit for those who require a blood test. I also provide normalising play and recreation during their short stay. I provide therapeutic and specialised play for all patients admitted onto the ward. I assess development then plan and prepare activities using play programmes for those who are anticipated to require a longer stay. I provide age/ability appropriate play/recreation and try to create a friendly environment to help ensure a positive patient experience. I help patients cope with illness and treatment, working closely with the MDT. I prepare and distract patients for surgery and invasive procedures and help them deal with their anxieties and fears, helping them form coping strategies. I create opportunities for play and socialisation by providing activities in the playroom, teenage room and on the large play tables in each bay. I also provide individualised developmental activities at bedsides and in cubicles. As a play team we provide normalising activities for patients and their families in the playroom and teenage room. We plan monthly, in conjunction with festivals/celebrations and Awareness days and use the end products on our displays. As part of this, I plan events and entertainment for special occasions. I provide teaching sessions for new starters and students promoting our role and the importance of distraction during invasive procedures.

I hold a Targeted Specialist Play caseload of children who I see in the community or hospice. Referrals can be made to me for several reasons, including support with medical procedures, reducing isolation, and supporting families whose children have life limiting/life threatening conditions and where their abilities have changed significantly. I also receive referrals of bereaved and non-bereaved siblings and use a range of strategies to support them with processing the journeys of dying and bereavement. I provide one to one and group activities, always considering the holistic needs of the child, and I support members of the care team in providing appropriate activities for the children they are caring for in the hospice or community. I run the hospice sibling groups for bereaved and non-bereaved children. These have a therapeutic framework and provide an opportunity for children to become familiar with the hospice, whilst having a child centred day, away from caring duties. I work alongside a music therapist, in running a monthly ‘Playdays’ group for pre-school children and their families, aimed at reducing isolation and giving parents increased confidence in exploring play and music activities in their homes. I assist with the planning and delivery of regular events held for bereaved families. I am a care coordinator for a caseload of hospice families. This includes keeping in regular contact, co-ordinating the development, monitoring and review of the child’s care plans and participation in external multi professional and multi-agency meetings. I regularly attend a local multi-professional panel meeting and attend a weekly systemic case consultation meeting I carry out end of life and post death memory making in the hospice, home or community I am involved in the recruiting and support of volunteers and provide peer support to an activity co-ordinator.

I manage a large play team, about half of which are registered Healthcare Play Specialists. I also have ultimate responsibility for play specialist students through their mentor. I hold overall responsibility for play service staffing, recruitment, rostering, appraisal, and supervision in line with trust policy. I am responsible for the safe practice of the play service team, ensuring mandatory training is up to date and that registered staff hold a current HPSET registration. Also, for ensuring that risk assessments are in place and reviewed annually and action plans for major events and visits are completed liaising where required with other departments within the trust. I manage visits and visiting activities, ensuring that a Memorandum of Understanding is in place or that visitors are closely supervised including Christmas and Easter donations and other major events. I am a signatory for the Play Team charity fund, working closely with the Charitable Trust to ensure that the play service is appropriately resourced. I am a practicing Healthcare Play Specialist with responsibilities for managing and delivering therapeutic play referrals, supporting ward and clinic areas when staff are absent and for maintaining my continuing professional development and registration. I mentor HPS students, attending update training to ensure I am informed of any changes or developments.

I feel that this one-day training, specifically for Healthcare Play Specialists, was especially valuable to me as I do not work in a hospital setting. Whilst I am experienced and confident in supporting the emotional well-being of children with cancer, the presentations on Radiotherapy, Proton Therapy and The Role of Therapeutic Play in Radiotherapy have given me a greater insight into the actual processes that children have to go through as part of their treatment. I have been able to share this knowledge with colleagues such as art and music therapists, and counsellors. I found the presentation on Addressing Trauma in Children’s Cancer Therapy to be extremely helpful. The statistics on child cancer survivors who are diagnosed with PTSD (15% to20%) surprised me. I have since reflected on how I have been involved in conversations with parents celebrating the fact that their child no longer meets hospice criteria due to successful physical treatment, but I wonder if I have given them enough information as to where and how to seek support for the ongoing emotional wellbeing of the child and other family members. I have reflected on this in supervision and will now be more mindful in future situations. Since the study day I have undertaken further research on the emotional impact of the cancer journey for children and their families and have found some particularly informative articles on the Children’s Cancer and Leukaemia Group website.

Learning:
• How to tailor a presentation to a subject that is given to you and not of your own choosing.
• The process that you must adhere to, when speaking at an international conference.
• How the Child Life Specialists at a Canadian hospital work with siblings and support them through group work.
• How children are prepared for renal transplant in America.

This was a private learning activity involving online research. I researched information on the Bardet-Biedl syndrome as I provided play specialist input for a child with this condition. I had never heard of this condition before and wanted to know more about it. This syndrome affects many parts of the body, it is an inherited genetic condition. “Bardet-Biedl syndrome is named after Georges Louis Bardet” (www.evidence.nhs.uk). Signs and symptoms can be quite different for those that are affected by this, even if they are from the same family. Loss of vision and obesity are major features of this syndrome. Obesity can then lead to further health issues such as type 2 diabetes, high blood pressure and high cholesterol levels. Bardet-Biedl syndrome can also include other features e.g. impaired speech, delayed development of gross motor skills, as well as poor co-ordination which can result in clumsiness. Behaviour can also become affected leading to outbursts that are inappropriate, as well as emotional development being delayed. The heart, liver and digestive system are affected too. Many medical specialists can be involved with a patient that has this syndrome as many parts of the body and organs are affected. There is no cure for this syndrome at present, however children and adults that have the syndrome can benefit from various types of therapy including physiotherapy, occupational therapy, and speech therapy to help them cope with everyday life. Exercise and diet are also especially important as this can help with maintaining weight and weight loss. Ongoing research is being undertaken to help determine at which point the cells become affected that then cause Bardet-Biedl syndrome. This research will help treatments in the future. This research has given me a better understanding of what the symptoms are and how different parts of the body are affected by this syndrome.

References: www.uhb.nhs.uk > crd-bardetbiedl.symdrome www.rarediseases.info.nih.gov > diseases > bardet-biedl-syndrome www.evidence.nhs.uk www.england.nhs.uk www.bardetbiedl.org

When I joined the play team, they were involved in a trial of a Virtual Reality headsets which included distraction and relaxation techniques. I was able to shadow the play team to see how this technology worked and to witness the positive effect it had on children and young people. One patient verbalised how it had helped him to relax and focus on something, vastly reducing his pain. Following this shadowing opportunity I went away and did some online research to find out more about the benefits of using a Virtual Reality headset for children and young people in hospital, including that it can lower heart rate and reduce behavioural distress.

Attended study day about renal transplantation in paediatrics. The day was delivered by various members of the MDT including consultant nephrologist, surgeon, transplant coordinator, psychologist, nurse, and dietician. They gave an in depth look at the MDT approach throughout the transplant process, and the support provided to the families before, during and after the surgery. Although I already had a good level of knowledge in this area having worked in this field for some time, the day helped to confirm the knowledge I already have, but there were also lots of points that I found very interesting and which will help with my continuing work with our families. Details around the operation, how the matching process takes place, and the paired exchange programme. I recognise and ‘understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team’ as stated in the HPSET’s Professional Standards. Working with the wider MDT ensures that we deliver a good quality service to all of our families.

It was useful to find out what medical and nursing teams had said about the information they wanted documented. I compared the WISE documentation approach discussed in the article and the documentation training used for the play team and concluded that all aspects of documentation outlined in this article were covered in the play team documentation we use. I presented this as a learning opportunity for my team in the ‘Journal Club’ section of the new Play Team training day; dividing the group into 3 and asking them to read and feedback a brief outline. I facilitated a group discussion around the article comparing with how the team currently document and play team documentation training. The team agreed that we covered the same content as the WISE approach. Further discussion led to the team suggesting a new smart text prompt in the electronic notes. I will take this to the remaining team members at the next training day (the training is delivered across 2 days, dividing the team in 2 so that the service is maintained). I feel that this is a really useful idea and demonstrated the value of presenting the article.

Completing this training validated my thoughts about how to manage interactions with children and young people with mental health problems and has given me the confidence to be open, honest, and direct in the interactions I have. It made me quite cross hearing the negative experiences as surely, we should be working with care, compassion and providing information to all our patients. Unfortunately, I was not surprised. This training encouraged me to consider how negative experiences are in themselves a safeguarding concern, as children and young people are less likely to seek help when in crisis following a negative experience. For me, the ’Elephant in the Room’ analogy will act as a prompt to include openness, honesty and not to skirt around the subject but also to reassure myself that short interactions are valid, even at times when the child or young person is not communicative.

During a recent presentation to student nurses, I received constructive feedback on the lack of structure and relevant content in my delivery. It was also mentioned that my fellow presenter and I were talking over one another during the presentation and the Q&A. This led me to revisit my presentation training and to adjust the structure and organisation of my PowerPoint presentation and targeted handouts. We set aside time to practice the delivery, role-playing this with colleagues and family members to ensure it remained engaging and well-timed. Further to this, I collated a series of presentations that are now tailored to suit specific audiences. For example, where I deliver to supporters of the hospital charity, I am more focused on patient outcomes and engagement statistics, using graphs and visual aids, whereas a presentation to MDT’s may be more focused on preparation play techniques and how this can reduce underlying anxieties in patients and avoid procedures being cancelled due to CYP and their families feeling under-prepared for treatment.

Having referred a 5-year-old boy to ‘Harvey’s Gang’ for a visit to the pathology lab it was rewarding to receive feedback as to how it had benefitted him. ‘Harvey’s Gang’ is an initiative whereby children/young people can visit and explore the labs and have hands on experience of the equipment/machines used to analyse blood. The boy I referred has Idiopathic Thrombocytopenic Purpura (ICP) and a frequent visitor to hospital. ITP causes low blood platelets and results in recurrent bruising and bleeding. His mum mentioned to me how he was really interested to know what happens to his blood when they take samples, so I suggested a visit to the labs via Harvey’s Gang. After his visit I received a letter of thanks from his mum to say how much he had enjoyed the experience. She felt it had helped him to understand his condition more and the need for him to provide so many blood samples. As an HPS it is an important part of my role to provide support and help to educate children/young people and their families about their condition/treatment using different play techniques and various resources. Allowing children to explore equipment used in their treatment desensitises them and can help to reduce their fear and anxiety. It may help to make their experience of hospital a more positive one. As a result of the feedback I received, I have referred other children/young people to Harvey’s Gang who I feel would benefit from this valuable service.

Positive feedback from parent about the care of their child who was a 14-year-old young man who has autism. His family said they ‘usually find hospitals a very stressful experience’. Within the last few months, I have started to put together a bag of sensory equipment within the department, having realised that we had a limited supply of resources. This young man loved anything sensory, so I was able to give him the sensory bag, and he immediately relaxed while he was exploring the bag. He was able to take the bag to x-ray which kept him calm throughout. This meant we were able to do the examinations we needed. This showed me the importance of the sensory bag and how much of a difference it made to not only the child but also the family who have had “too many bad experiences to mention”. However, the family reported that their visit “filled me with hope and a little joy.

I received a Gr8x (staff greatix, positive datix) award in recognition of excellent care. These awards are anonymous, so you don’t always know who is nominating you, but they are colleagues. The reason given for the award was that I ‘work hard to ensure all patients on [my] ward have the best possible hospital experience.’ This was a particularly lovely award to receive as it wasn’t linked to one specific area of work, just general praise. I was honoured to receive this award as I often personally struggle with whether I am getting the balance of my senior team leader responsibilities and my ward/ patient workload, right. I can sometimes feel that I struggle to get an even distribution on these, so for a colleague to praise me in this area is particularly rewarding. I will continue to strive to ensure I strike the balance in this.

I was asked to capture the voice of the child throughout some of the paediatric areas to gain some feedback from the children regarding their hospital experience. This was a trial to see how effective and constructive the feedback would be, if it would be useful, and if we would be able to act on it to improve the care delivered to the children and improve their overall hospital experience.

I was recently asked to trial a method of capturing the voice of the child regarding their hospital experience on the children’s ward and the children’s assessment unit. The ‘Signs of Safety’ tool was recommended by a colleague as it is an effective tool to capture children’s voices. The information is split into three areas: hospital of worries, hospital of good things and hospital of dreams. I recognise the importance of collecting feedback from patients as it helps improve the quality of service provided and ensures children receive the best possible care. Article 12 of the United Nations Convention on the Rights of the Child states “the right of every child to freely express her or his views in all matters affecting her or him”. I strongly believe this to be true and feel within my role as a play specialist I can display this on a daily basis. I gave the signs of safety tool out to children over the age of ten as myself and colleagues felt this would enable us to capture the child’s version of their hospital stay rather than parents/carers. I was aware that I would have to assess each child and would offer support if they required it. I gained signed consent from parents and carers to allow the children to fill in the signs of safety tool but also for our patient experience team to look at the information gathered. I handed the forms out over a month on the days I worked on the children’s ward and children’s assessment unit. I feel due to me being the only one handing out the forms our feedback wasn’t as successful as it could have been. This was either consent forms not being signed, forms being discarded or children leaving before filling the forms in as there was only myself following up with the forms. However, we did receive some constructive feedback which as a service we will be able to act on.
Working as a play specialist and following the code of professional conduct I am aware how important patient feedback is. This is emphasised in principle 5, Standard of Practice, in particular 5.5, ‘Listen to service-users, their families and carers and take account of their needs and wishes’. I believe the Signs of Safety tool did this as it allowed me to collect evidence on how they felt about their hospital experience.
Due to feedback gathered, and the positive response received from the children on how easy the form was to fill in, it has been decided that this is something we will continue to do across children’s services. I gained an insight into how the play service impacts the children’s hospital stay and how it helps create a positive experience for the children during their hospital stay. The Picker principles recommends ‘patients’ involvement in decisions and respect for preferences’. I feel that play helps this as sometimes when children have no control over there hospital treatment, they do have control over the play activities and interventions they receive. Moving forward, the Signs of Safety tool will continue to be used every six months in different areas of children’s services to help capture the child’s voice. I will present the findings in a patient experience meeting and display how we are acting on the information received on the children’s ward. In the future the whole play team will be involved in handing out Signs of Safety tool forms as I feel this will aid in collecting more feedback from the children which will enable us to deliver the best possible care catered around the needs of the child.

References:
• Convention on the Rights of the Child Committee on the Right of the Child Fifty First Session Geneva, 25th May-12th June 2009 https://ww2.ohchr.org.pdf (accessed 18th Jan 2020)
• HPSET (2019) Healthcare Play Specialist Education Trust and National Association of Health Play Specialists Code of Professional Conduct for Registered Practitioners and Students.
• Picker, Influence, Inspire, Empower Impact Report 2017-2018 Picker Institute Europe.

I joined the Health Play Specialist Trailblazer group and with this group designed, submitted, and had the higher apprenticeship training approved.

I felt privileged to be asked to be part of the trailblazer group who as a team developed the health care play specialist higher level apprenticeship. We met as a group of 10 NHS Managers/Senior Play Specialists representing several different NHS employers and organisations across the UK. I represented my own NHS Trust as well as the play specialist profession. During meetings and workshops in both London and Leeds the trailblazer group brought together the required information to submit an application for the higher apprenticeship training. I worked with the trailblazer group to develop the framework and application to submit to the Institute for apprenticeships (IFA). I used my individual skills, knowledge, and experience as an advanced play practitioner, sharing my ideas, opinions, and experience with the group. The application process itself involved writing the occupational standards, occupational duties as well as the knowledge, skills and behaviours required for a health play specialist higher apprenticeship course.
I had to work in a completely new and different way which made me think in detail about my role over the years as a play specialist, my own professional experiences and ways in which I can impart my newly acquired knowledge and experience to others. As part of a collaborative working party we were successful in our higher apprenticeship submission. Working in a collaborative manner with a range of professionals across the UK has made me reflect on my own knowledge and skills and how I could improve on how I share my knowledge and experiences with others. I had to understand the process of how to apply for an apprenticeship and meet the requirements for the application process, a completely new challenge for me and an area I had little knowledge of. I took responsibility to read around the subject of apprenticeships to gain a greater understanding of the process required and gained new knowledge from sharing ideas and information with my peers. I had to promote play to a standard that is recognised at a national level and discuss and explain the profession to those who had no understanding of the role of the play specialist. It made me analyse my teaching skills and abilities on sharing information particularly when disseminating new information about the apprenticeship to others, for example the Trust apprenticeship lead, education manager and other play staff. I had to help individuals and groups understand the changes, address any concerns they may have and discuss the benefits of the new course and how it could benefit the Trust I work in.
As a continuing part of my learning I reflected on the Health Play Specialists Code of Professional Conduct for registered practitioners on sharing professional insights and observations and standards of practice for working collaboratively with other professionals and organisations (3.6, 5.3). I also reviewed the health play specialist standards for working appropriately with others (standard 9), as I have a responsibility to ensure that I am always continually working to deliver a safe and effective practice. I also had to understand my own organisations guidelines and policies relating to apprenticeships. Reflecting on my understating and the theory behind the apprenticeship application process I utilised the Institute for Apprenticeships website regularly (see below) to ensure I was familiar with what was required and the most up to date information. Using this website I was also able to review other approved apprenticeship courses which gave me a better understanding of what was required and made me reflect on what I felt I would want the play specialist apprentice to have achieved at the end of their course to be ready for a substantive play specialist post. I also regularly met with my Trust education manager and Apprentice Lead to ensure I had appropriate knowledge and understanding of the requirements for apprenticeship training at a local level. I gained a whole new level of information and experience from being part of the trailblazer group.
The working group had an excellent ethos for collaborative working and a shared interest in setting high standards for the play specialist apprenticeship training. It was an enlightening experience having conversations with those in my team and other staff who did not fully understanding the changes occurring in the play specialist training. I recognised as a professional lead and advanced practitioner in play that I had a responsibility to share my knowledge and skills and experience in a more global way drawing on my leadership skills. I was also able to support a play worker develop her training and education as part of their move towards applying for the apprenticeship training. I was able to help the individual understand more about apprenticeships and support her application process.
I personally was also very well supported during the process from two departments in my Trust, the Education Manager for Paediatrics and the apprenticeships lead for the Trust who were able to give me insight into apprenticeships outside of the play profession. Now that the play specialist higher apprenticeship course has been approved by the UK government, I would like to be able to spread the word on the training, what it entails and what is required. I would also like to ensure it becomes part of my own play team’s professional development pathway. I hope in the future to partake in other play apprenticeship trailblazer groups.

References.
• https://www.instituteforapprenticeships.org Online, available: (accessed frequently – November 2018 to August 2019)
• HPSET (2019) Healthcare Play Specialist Education Trust and National Association of Health Play Specialists Code of Professional Conduct for Registered Practitioners and Students. Online, Available: https://hpset.org.uk/HPSET_copc.pdf https://hpset.org.uk/HPSET_ps.pdf
• Trust Policy & Guidelines (information not submitted for confidentiality reasons)

I was invited to speak as part of the nurses’ meeting at the above conference in Vancouver and attended the main conference over 4 days.
The title given to me to speak on was ‘The Role of the Play Therapy in helping children to adapt to the chronicity of transplant’

I was invited to speak at the conference in Vancouver and was given my title by the organizers. Speaking at conference is not unusual for me but I had always chosen my own topic to speak on and the topic given seemed enormous to fit into 45 minutes. I struggled to begin with because I felt that I had responsibility to demonstrate the role of the play specialist to nurses, clinicians and psychologists who may not know anything about the profession or its benefits, but I still needed to ensure that I didn’t go too far off the title given to me. There were many professionals from Europe where psychologists seem to do much of the work of the play specialist. I began preparing by extending my reading on the effects of chronic illness on children and their families and began my presentation with this. This extra reading meant that I was improving my professional knowledge in accordance with the Play Specialist Code of Professional conduct for registered practitioners and students, (principle 5, 5.2.).
I then looked at all the areas of my work that are involved with transplantation: the preparation, the education and the support, not just of the patient, but also the parents and siblings and how all of these things contribute to the patient’s care. I talked about how I assess the patient’s understanding and ensure that all the information I give is tailored to that child’s individual needs, age, and abilities. I showed tools that I had designed and made to help the child or young person cope with the procedures. I also presented a case study to demonstrate how some of the strategies were implemented but was mindful of confidentiality so that the patient could not be identified.
I felt confident that the talk went well; there were many questions and I had a lot of positive feedback. The European psychologists really felt that play specialists were needed in their services. It was great to share ideas and thoughts with other professionals from varying disciplines from around the world and to learn about their working practices. Thinking about chronic illness I used a couple of articles (e.g. Meijer et al 2000) about a child’s social functioning when they have a chronic illness and how parental reports of social anxiety and social self-esteem don’t corollate with the researchers’ results. I tend to think that every child should be seen as an individual.
I feel I have gained confidence through the process of preparing to speak and of giving the talk. I struggled to begin with, but I then got a clear plan of how to proceed. As a play specialist, I have a responsibility to advocate for the profession whenever the occasions arise. I am immensely proud of the work we do with our children, young people and their families. In the future I would like to support and encourage other play specialists to write abstracts and present talks not only to further the development of staff but also people’s knowledge and understanding of our profession and the invaluable services that we provide within the NHS.”

References
• Meijer, Gerben, o.Bijstra, Gideon and Mellenbergh 2000, Journal of child psychology and psychiatry, volume 41.

Child was 8 years old and taking part in research programme within the hospital as part of their treatment. There is no regular Play Specialist based in the research department, although the need for a Play Specialist to be based in the area is recognised. On this day, I agreed to work an extra shift. This test takes about 1 hour, and the child and parent need to sit in the room in total darkness which means no mobile phone, no laptops, no iPad. The room needs to be in total darkness with only a special blue light. So, what distraction could I offer, if any?
I went over to the department, which is in the adult waiting area, and introduced myself to mum and the child. At first mum said there was no need for me, and they were quite happy to wait. The child had undergone the test previously and mum and daughter just talked for the hour. I explained that there is another area with activities where they could wait in between tests. Mum said they do not have much of a wait in-between tests as they are given a timetable of when and where each test is being done.
I requested the opportunity to take part in the process to see how I might help and to learn how to help other children in the future. I was honest with them both and explained that I have never seen this test before and would like to learn more about it. I explained this would also help my further training. Mum agreed and I also asked the child if it was ok with her if I came in and watch, which she also agreed. (Professional Standards 5.5: Listen to service-users, their families and carers and take account of their needs and wishes.) We had about half-an-hour before the test, so we talked about how this test was last time, what they did together: I asked the child what they sang and talked about. Then suddenly, I had a light bulb moment: listening to a story on the CD player. I checked with the technician who was doing the test and she said it was great idea. I went and got a selection of CD story books and songs we had on the ward. We now had a Plan.

I had what I thought was a good plan, although I didn’t feel I had a lot of knowledge of the test that was being done. (Professional Standards 4.1: Be able to assess a professional situation, to determine the nature and severity of a problem, and to act within your professional scope of practise at all times.) I was a little out of my comfort zone and felt I was more focused on the play and activities outside the room. However, I did have a plan for this test: I brought along a selection of story books and songs and when the child decided she only wanted the story books, we put them in the order she would like to hear them.
This went well as at the end of this test mum and child both had a positive experience. Mum said she didn’t think the story tapes would work, but they did work, and she thought it was a great idea. She commented that when they came back next time if I wasn’t around, she would ask for it.
The next time this child came to clinic, I was unable to see her but, my colleague was covering this clinic and I was able to pass on what worked well, and what went wrong. My work colleague took this on board, and she was prepared. (Professional Standards 9.1: Be able to work in partnership with service-users, other professionals, and organisations)
For myself next time, I will contact the department well in advance, get more information on the child, age, the test which is being done and check out more information. I would also like to know if this is their first time here and, if not, how thy have been on previous times. (Professional conduct 5.3: Work in a collaborative and cooperative manner with other professionals, respecting and recognising their expertise and contributions.) One of the stories on the CD player did not work and I was annoyed with myself for not checking this. I presumed that, as it was new book, it would work. I was not as prepared as I thought I was and thinking back I didn’t allow enough time to properly prepare for these tests, as each test is different. I also did not expect that I would be sitting in with this test and while in the darkened room I could not really find the buttons I to press when I needed to. (Professional Standards 15.3: Be able to work safely, including being able to select appropriate hazard control and risk management, reduction or elimination techniques in a safe manner, and in accordance with health and safety legislation.)

Whilst working as a qualified Healthcare Play Specialist on the High Dependency Unit, a child was admitted to the ward who had a tracheostomy in situ and was unable to communicate verbally. The child relied on Makaton signing to communicate. When going over to the child to ask if he wanted any activities, the child could understand me, but I was unable to understand his reply. The carer would have to translate for me, and this made it difficult when the carer was not present as I found it difficult to understand what the child was trying to explain to me. I had some basic knowledge of Makaton but not to the level at which he was communicating. When the carer returned I was able to understand what the child was trying to tell me, and it was that he was worried about having a blood test later in the day. I was then able to answer the questions which the child had about the blood test with help with translation from his carer. She suggested it would be a good idea to have more knowledge in relation to Makaton signing so that this situation would not occur again. I ensured that from this situation I would access Makaton signs in relation to my job role and also gain more knowledge about Makaton to ensure that I was better equipped with knowledge on this specific subject.

I have a professional obligation to maintain my registration and continually reflect and improve your practice (HPSET, PRINCIPLE 3 – DUTY OF CARE AND PROFESSIONALISM 3.2 Be responsible for maintaining your registration and continually reflect and improve your practice. You must keep up to date with revised and new legislation, policies, advice, and guidance). I reflected on the situation that had occurred and knew that I would need to improve my practice by conducting my own research around Makaton and accessing someone who had knowledge of signs that were specific to my job role. Looking at the specific part of the HPSET Code of Conduct, (HPSET, PRINCIPLE 2 – ETHICAL PRINCIPLES, EQUALITY AND DISCRIMINATION 2.5 Treat children, young people and their families and carers with respect and compassion), I felt that by not having the understanding of what this child was trying to communicate during his first visit I had not done enough in my role to support this statement.

I understood that I did not have enough knowledge to communicate effectively with this child, so I sought advice from an old colleague who I knew had the relevant knowledge that I needed. I ‘knew the limits of my practice and when to seek advice or refer to another professional (HPSET, STANDARDS OF PROFICIENCY, 1. Be able to practise safely and effectively within their scope of practice. 1:1 Know the limits of their practice and when to seek advice or refer to another professional). Also, by conducting my own research I could be more informed and better prepared in future. When the child was admitted again, and I was able to demonstrate that I had done some research and could communicate better, I felt that I was treating the child and family with respect as I was trying to communicate on their level to help them feel more at ease during their stay.

Looking at Maslow’s hierarchy of needs (1943), it states the social need to feel as if one belongs in a chosen social group and in various other relationships that are a part of human life. There is a need to be accepted, otherwise people are prone to negative effects like depression and loneliness (Mcleod, 2007). When I was unable to understand what the child was trying to tell me via Makaton signing, he would not have felt accepted, and this would have led to him feeling negatively about his hospital stay. However, when he was re-admitted, and I was able to communicate better and have a better understanding of what he was telling me, this meant this need was met.

I have taken forward that it is paramount that I have access to, or knowledge of, different ways in which children communicate and that this can be verbal or non-verbal. Having a knowledge of Makaton is extremely useful in my role especially working with children that have tracheostomies and have to communicate via Makaton or sign language. The only downside to this is that children use Makaton to suit them and their family so not all signs will fit for each individual child, but having some basic knowledge of how to communicate better with these children will help in the future. I will continue to develop my knowledge around Makaton and seek advice from the families with whom I work, to show me new signs that I might not already know. I will be able to support colleagues and other families during their time in hospital by teaching colleagues some signs related to our role and also if they need some support with a particular patient then this can also be offered.

References.

• HPSET. Principle 2 Ethical Principles, Equality and Discrimination 2.5 Healthcare Play Specialist Education Trust and National Association of Health Play Specialists Code of Professional Conduct for Registered Practitioners and Students. Available at: https://hpset.org.uk/HPSET_copc.pdf (Accessed: 10 July 2019).
• HPSET. Standards of Proficiency 1. Be able to Practice safely and effectively within their scope of practice. Health Play Specialist Standards of Proficiency Professional Standards, 1:1 Know the limits of their practice and when to seek advice or refer to another professional. Available at: https://hpset.org.uk/HPSET_ps.pdf (Accessed: 10 July 2019).
• Mcleod, S. 2007 Maslow’s Hierarchy of Needs Available at: https://www.simplypsychology.org/maslow.html (Accessed: 10 July 2019).