AHRC Workshop 1: Hospital/Medical Perspectives

AHRC_workshop 1

We had our first workshop/talk day which focused on hospital and medical perspectives on Wednesday 26th of March. It brought together play specialists with artists and academics and featured short talks and workshops to inspire participants on the project’s main goal/focus:

  • The potential of play for supporting children in hospital and recovery space.
  • How to inform the game industry for creating content for the design of videogames which blends both traditional and digital form of play.

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To start with, Kevin Hartshorn from Sheffield Children’s Hospital talked about his practice as Play Specialist and emphasised the potential of play in hospital context. According to him, play can certainly help patients to understand and cope with stressful situation and encourage them to express their feelings, helping them to recover quickier. He described different types of play such as development and rehabilitation play, post-procedural play and bereavement play as well as distraction play where for example play specialists use techniques to divert patient’s attention from their situation by focusing on something else, using for example musical games and books. Play specialists use a variety of activities which involve free play to encourage the children to express themselves such as handprint and hand casting. Other activities such as memory box can involve the family to participate in the making process.

Some questions/answers and important points:

  • To what extent children are allowed to customize their space? Children are encouraged to personalise the walls with personal things which are sometimes used as talking point.
  • Personalised play program? Looking at developmental stages the patient is at and grouping them in different categories (physical, personal social and emotional, communication and language, cognitive and intellectual). Also looking at what activities can meet their development/important to record what progress patients have made and also set up some targets with them. Records of preparation and distraction would be kept to allow consistency eg. if needs to change the terminology, phrasing with a child so the right term is used by the specialist when talking to the child.

Challenges and complications:

  • Using stories to illustrate difficult subject – be sensitive to people’s belief (eg. religion)
  • Physical and communication restriction
  • Challenge in capturing patients’ interest – everyone is unique
  • Engage different children (age groups)
  • Encourage social connection – becarful with social network

IMG_6932Current hospital play and ideas for future hospital play. Susan Davies from Birmingham Children’s Hospital.

Following Kevin Hartshor, a group of play specialists talked about their current practice at the Birmingham Children’s Hospital and emphasised the change made in the last twelve months in their practice. Their team of qualified play specialists split into different categories: medical, surgery and youth services. They deal with both outpatients that are refered to them for preparation to treatment they are going to have and inpatients they see on a more daily basis. The environment the group described sounded amazing: they have a play centre and playground which allow the children to keep playing outside when the centre closes. The centre features multi sensory areas, kitchen amongst other exciting things and the play specialist usually works with young people in the hospital to design those spaces. They also propose a lot of creative activities and spaces for people to come down from their ward. In terms of technology they have TVs, iPad to take around the wards and recently got a 3d TV and some special game controller for patient with limitted movement.

Some challenging and important points were raised:

  • Some children cannot always mix (eg. illness).
  • Important for teenager to socialise in and outside the hospital.
  • Encourage the children to get dirty, messy play: “if they were at home they would stick their feet in mud and eat worms, but what we tend to find with the younger children is after being there a long time they don’t like getting messy anymore”.
  • Needle play : assess their understanding before but this gives them choice, control and understanding of the procedure, making them more familiar with it all. Role play is also used as a technique to teach children how to behave when they receive the treatment.
  • How to break the routine in the hospital (boredom).
  • Give the child responsabilities eg. Reporting on what happened with their treatment/procedure to their parents.

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After lunch, Medikidz Digital Director Adrien Raudashi introduced the children medical education company Medikidz. Its aims are to teach children about children’s medical condition, by giving them access to information in a format they understand, thus they are more likely to retain information. Adrien highlighted in the past the lack on the market of patient information specifically designed to deliver medical information to children. Prior creating the company, studies were conducted and results described the two things children wanted to see the most: super hero and comic book. Thus, these studies informed the Medikidz concept. In the comic, each super hero represents a different part of the body and takes the child on a metaphorical journey. Visually appealling, the comic book is accessible, easy to read and the narative guides the reader throughout the illness. All their stories are based on real people’s stories.

Some challenges and relevant points:

  • Creating content: how to take this very complicated facts and transfer them into a meaningful narrative for the reader?
  • Comic: breaks down barriers between peers.
  • Digital potential (user experience). Considering the medium = phone vs laptop screen not the same experience for the users.
  • What makes game appealing? Take them down to their fundamental route and think how to re-apply those ideas to other formats?
  • Short term vs long term engagement. Narrative is powerful: hold a person’s engagment much longer.
  • Different types of feedback short vs long term feedback, contribute to people’s engagement.
  • Taking social network in consideration where children have their own voice.
  • Partnership with Oculus for affordable virtual reality to simulate immersive environment.

Later in the afternoon, Sarah McNicol also recognised the power of Comics in her talk “Journeys, Battles and Engines: The potential impact on graphic medicine on patient emotions”. Before looking at the different examples that dealt with comics and health, she introduced her background in bibliotherapy where books are used as a form of therapy, a method widely recognised since the 50s. The presentation featured examples that questionned ways of how to deal with emotion around the illness and where again, Comics were used as a medium to create a more intuitive and direct engagement with the patients. Comics allow the patients to have different interpretations about the story which encourage creativity and imagination. Sarah also highlighted the use of metaphore in the Comics as being useful, a way of taking something difficult and scientific to make it understandable to a wider audience, to make it more memorable.

Finally Jo Birch presented some research she did on the use of space in Sheffield Children’s Hospital. She introduced some findings from “Space to Care” (2007), a project which looked at everyday children experience in hospital. Her research promotes co-design approach and was concerned in how to make hospital more child centred, child friendly environment. For this project, she used interviews supported by field notes and child drawings with 255 in and outpatients accross three sites. She mentioned hospital as challenging settings for research with children. Her study looked at what children would ideally like from hospital spaces. Using pictures, children and teenagers were asked to reflect on different spaces in and out hospital, looking at the look of the room, the different elements and what kind of things would be scary for them. They found that decoration and emblems such as clown or long plain corridor would be an increasing factor of pain. However emblems that were familiar or cultural icons would decrease the feeling of fear. They also looked at the hospital layout, the notion of order and tidiness, hospital sitting (…). The study emphasised that children have an important role in shaping their own experience of spaces. The kind of environement they like would always feature familiar elements, not only from home but from any other familiar spaces such as school or shops. The study shows that people would always try to keep them occupied and to maintain daily routine. Jo emphasised that sometimes children would just sleep and watch TV, those things they would be doing when ill at home.

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Workshop let by Andrew Godfrey.

During the day, two artists gave short talks about their practice and led drawing workshop. First Isobel Williams talked about her Kancer Sutra project and show examples of her work that she drawn from “an uncomfortable position” (eg. Supreme Court). Through her activities she challenged us to think about our childhood, what kind of” comforter” we used and still use, but also about darker themes. Later, Andrew Godfrey got us to draw a series of self portraits in 20, 10, 5 and 2 lines. Then, for the second exercice, he gave us a scale of pain (from happy to sad faces) and asked us to create a short comic, conversation between two characters but the main constraint was to use the opposite emotion of what the characters were supposed to feel.

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Participant’s self portrait drawing. Workshop led by Andrew Godfrey.

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Slide from Andrew Godfrey

 

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Participant’s drawing featuring a short coming where faces of what characters were supposed to feel are swapted. Workshop led by Andrew Godfrey.

 

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For our wrap up at the end of the day we projected a constellation of keywords from all the talks and workshops on the walls and we gave each table a set of cards we recycled from our little movie Dreamland. We asked everyone to have conversation and write down words to finally build a little model together out of the cards. We gave them ten minutes and then, we asked each group to talk about their model in order to conclude on the day. The list of keywords we projected was meant to help them to start conversation on key points from the day.We also displayed our own model from the day, each tower represents a talk or workshop and features keywords from it.

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The first group emphasised the importance of recognising children’s imagined space, physical one but also meanings children put on their experiences.

emotional journeys/independence/objects/home/flexibility/narrative is placed/words are not enough/adult as expert/imagined space.

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One participant from group 2 explained “were very uncollaborative, we wrote our own words and built them together at the end”. They talked about entertainment vs quietness. According to them, it is not always about feeling things and talking about it. This group emphasised the important of paying attention to children and being attentive to what is going on without necessary engaging a conversation which some children will find difficult.

Culture/sugar coating illness/rights/institution alised/escapism/quiet/listening/connection/everyday/authorities/voice/hear me/stories/things/stuff/space/safe guarding/social/space/assumptions/smile/expectations/creativity/enjoyment/beliefs/stones/feelings

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Group 3 also stuck everything together a bit randomnly. One participant explained that the fact of doing it « the simple pleasure of putting things together » was interesting and stimulate conversation. Also we noticed that words get randomly next to each other which make encourage imagintation and new idea to emerge.

narrative situation/emotions/engagement/needle/practice/med info/no words/empathy/identification/social/isolation/sound/the function of play/into practice/narrative/agency/play/parallel lines/familiar/parent /ill/active/solipsistic/dissonance/peer/euphemism/play/earnest/augment/small/alienated/environment/metaphors/clowns/needles/graphic/simplicity/play/inpatient/emotion/grotesque/fear/only images/gamification/passive/children/childs’ perspective/playing with fear/actual fear/needles and pins/whose narratives?/size/scale/prospective/ways of knowing adult/children/gifts/panels/selective/mute.

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Finally the last group embraced the concept of free play. One participant added : « we have played, that’s what we’ve done ! »

young people/blood/communication/honest/control/social/exciting/interactive/hospital heights/draw

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Below more participants’ drawing.

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