Knowledge and Attitude of Staff Nurses Towards the Implementation of Play Therapy on Children

Salmiah Binti Awang*, Regidor III Dioso, Faridah Mohd Said

Faculty of Nursing, Lincoln University College, 47301 Petaling Jaya, Malaysia

*Corresponding Author's Email: salmiah74@yahoo.com.my

ABSTRACT

Play promotes healing and helps the child to cope with stressful experiences. The study aimed to assess the knowledge and attitude on the implementation of play therapy for children delivered by staff nurses in the Training Institute of the Ministry of Health Malaysia at Kubang Kerian, Kota Bharu, Kelantan. Collected data retrieved from Google survey form from the 95 respondents. There is a relationship between knowledge and attitude (sig<0.05) in the implementation of play therapy for children delivered by staff nurses. Therefore it is concluded that the staff nurses should implement play therapy with the correct knowledge and proper attitude among children confined in the hospital settings.

Keywords: Knowledge; Attitude; Nursing; Play Therapy

INTRODUCTION

Therapeutic play is a form of therapy primarily geared toward children (Godino-Iáñez et al., 2020). In this style of therapy, a therapist enables a child to investigate past experiences that might have an impact on the present in a way and at a pace that the child chooses, primarily via play but also through language (Senko & Bethany, 2019). Because it can aid in communication, the exploration of repressed emotions, the addressing of unresolved trauma, and the experience of personal growth, therapeutic play is widely considered as an essential, effective, and developmentally appropriate mental health treatment (Wilson & Ray, 2018).

Up to the age of six, children will play; after that, they will start school and start studying (Swank, Cheung & Williams, 2018). Children who receive play therapy are more relaxed, and so are their parents. The play activities may be suggested by the therapist or left up to the child's choice, depending on the situation and the child (Koukourikos et al., 2021).

In order to get to know the child and help them cope with their issues, the therapist can use play therapy in a variety of ways. It could be as simple as asking questions while the child is drawing or painting to try to gain insights into their thought process (Allen & Barber, 2015), or play various games with the child to encourage problem-solving, cooperation, and social skills (Cochran & Cochran, 2017).

The importance of play therapy with the objectives of assessing the level of knowledge and attitude on play therapy among hospitalized children, is sought to pave new avenues for the nursing discipline.

METHODOLOGY

This study implemented a cross sectional survey design. A total of 95 respondents were used. Statistical Analysis Software version 26 was used for a descriptive data analysis. Purposive sampling techique was used with inclusion and exclusion criteria.

Inclusion Criteria:

Samples were taken from 5 categories identified including: Nursing clinical lecturer, staff nurses, support and administrative nursing staff were included.

Exclusion Criteria:

Radicare and cleaner services working at the training Institute of Ministry of Health Malaysia Kubang Kerian Kota Bharu Kelantan were excluded.

Organization of Data Analysis

This analysis process involves 4 types of analysis according to the following stages:

Stage 1: Reliability Analysis. Stage 2: Normality test.

Stage 3: Descriptive analysis of the demographic data. Stage 4: Pearson correlation test.

Ethical Clearance

Lincoln University College approved the use of human subjects for this study and the Malaysian Research Ethics Committee with a reference number of 111200619290L/1902 on the 19th of December 2021.

RESULTS

Reliability test

This analysis was primarily done to ensure that each survey questions used were reliable and unambigious. The value of Cronbach’s alpha is 0.803. The result showed that the 27 total number of survey questions were reliable.

Normality test

This analysis was performed to determine that the entire data of the respondents obtained were in a normal distribution. Since there are 27 survey questions the graphical histogram was plotted to show the normal distribution of data representing 95 respondents' answers obtained as shown in table 1.

Table 1: Tests of Normality

a. Lilliefors Significance Correction

Figure 1: Knowledge of Staff on Play Therapy

Figure 2: Attitude of Staff on Play Therapy

Based on firgures 1 and 2, the respondent was not normally distributed. This was evidenced by the uneven bells curve shown on both histogram figures. The significant value on table 1 was <0.05 that agreed with the histograms. While in the survey for attitudes, this also showed that most respondents agreed with all the items in the survey questions.

The scale was between 4 (Agree) and 5 (Strongly agree). The value of Kolomogorov- Smirnov and Shapiro-Wilk for the knowledge and attitude were 0.092, 0.12, 0.97, and 0.955 respectively.

In addition to the histogram graph in the plot, "Skewness" and "Kurtosis" were done to support the normality test (refer to table 2). If the value of skewness and kurtosis is near to zero, the distribution of measurement scores is considered normal.

The skewness and kurtosis ranged from -1.96 to +1.96. Although the maximum values were not greater than one, this was still considered normal. Because data are normal, parametric testing was possible.

Table 2: Skewness and Kurotosis

Demographic data

Table 3 shows the demographic data.

Table 3: Demographic Data

Of the 95 respondents, 38 (40%) were 21-25 years old, while 39 (41.1%) were 26-30 years old, and 14 (14.7%) were 31-35 years old, and the rest were 4 (4.2%) 36-40 years old.

Regarding distribution of gender predominantly 62 (65.3%) were female and rest 33 (34.7%) were male. In related to the religion dominantly 91 (95.8%) were Muslim, 2 (2.1%) were Buddhist and 2 (2.1%) were Christian.

Correlation test

Table 4 showed that there was a relationship between knowledge and attitude among staff nurses on the implementation of play therapy.

Table 4: Correlation Test

**. Correlation is Significant at the 0.01 Level (2-Tailed).

DISCUSSION

Data obtained from the questionnaire analyzed and presented were limited in the pediatric setting with different diseases of children at a government hospital. Staff nurses’ religious affiliations were also limited to Islam, Bhuddist, and Christians. Therefore, if the study findings should be used in other settings with multiple demographic data, it should be taken with caution.

From the questionnaires distributed via google form through the WhatsApp web application, a total of 95 among staff in the Training Institute of Ministry of Health Malaysia Kubang Kerian Kota Bharu Kelantan provided feedback was required. Therefore, the respondents of this study who represent several categories of services, namely professional, administrative, service support and non -graduate nurse trainees were also the limitations of this study. These professional backgrounds could have affected the results that knowledge was significantly related to the attitude of staff nurses in implementing play therapy.

The respondents consisted of 33 males (34.7%), while a total of 62 respondents (65.3%) were female. This indicated that the total distribution of the respondents selected was unbalanced between the two genders that may also had affected the results. Females were more affectionate in terms of taking care of children with disorders that needed play therapy (Bacus et al., 2022; Davidson & Stagnitti, 2021; Wedge et al., 2021).

In terms of age, more than half of the respondents, (n39, 41.1%) were between 26 - 30 years, while n38 (40%) between 21 - 25 years, n14 (14.7%) less than 31-35 years and 36 - 40 years had n4 (4.2%). The older the staff the more dedicated they are in implementing play therapy especially to chlidren with neurologic disorders (McCoy et al., 2020).

In terms of religion, more than half of the respondents, (n91, 95.8%) were Muslim, n2 (2.1%) were Buddhist, and n2 (2.1%) were Christian. This shows that many staff were Muslims in the Training Institute of Ministry of Health Malaysia at Kubang Kerian Kota Bharu Kelantan that showed religious staff affected the implementation of play therapy (Godino-Iáñez et al., 2020).

CONCLUSION

There are significant knowledge and attitude on the importance of play therapy on children delivered by staff nurses in the Training Institute of Ministry of Health Malaysia Kubang Kerian Kota Bharu Kelantan.

Conflict of Interests

The authors declare that they have no conflict of interests.

ACKNOWLEDGEMENT

The authors are thankful to the Training Institute of Ministry of Health Malaysia Kubang Kerian Kota Bharu Kelantan for the facilities. They would also like to thank the Lincoln University College, for all their support.

REFERENCES

Allen, K. B., & Barber, C. R. (2015). Examining the use of play activities to increase appropriate classroom behaviors. International Journal of Play Therapy, 24(1), 1-12. https://doi.org/10.1037/a0038466

Bacus, I. P., Mahomed, H., Murphy, A. M., Connolly, M., Neylon, O., & O’Gorman, C. (2022). Play, art, music and exercise therapy impact on children with diabetes. Irish Journal of Medical Science (1971-), 1-6. https://doi.org/10.1007/s11845-021-02889-5

Cochran, J. L., & Cochran, N. H. (2017). Effects of child-centered play therapy for students with highly-disruptive behavior in high-poverty schools. International Journal of Play Therapy, 26(2), 59-72. https://doi.org/10.1037/pla0000052

Davidson, D., & Stagnitti, K. (2021). The process of Learn to Play Therapy with parent–child dyads with children who have autism spectrum disorder. Australian Occupational Therapy Journal, 68(5), 419-433. https://doi.org/10.1111/1440-1630.12751

Godino-Iáñez, M. J., Martos-Cabrera, M. B., Suleiman-Martos, N., Gómez-Urquiza, J. L., Vargas-Román, K., Membrive-Jiménez, M. J., & Albendín-García, L. (2020, July). Play therapy as an intervention in hospitalized children: a systematic review. In Healthcare (Vol. 8, No. 3, p. 239). Mdpi. https://doi.org/10.3390/healthcare8030239

Koukourikos, K., Tsaloglidou, A., Tzeha, L., Iliadis, C., Frantzana, A., Katsimbeli, A., & Kourkouta, L. (2021). An overview of play therapy. Materia socio-medica, 33(4), 293-297. https://doi.org/10.5455/msm.2021.33.293-297

McCoy, S. W., Palisano, R., Avery, L., Jeffries, L., Laforme Fiss, A., Chiarello, L., & Hanna, S. (2020). Physical, occupational, and speech therapy for children with cerebral palsy. Developmental Medicine & Child Neurology, 62(1), 140-146.https://doi.org/10.1111/dmcn.14325

Senko, K., & Bethany, H. (2019). Play therapy: An illustrative case. Innovations in Clinical Neuroscience, 16(5-6), 38-40.

Swank, J. M., Cheung, C., & Williams, S. A. (2018). Play therapy and psychoeducational school-based group interventions: A comparison of treatment effectiveness. The Journal for Specialists in Group Work, 43(3), 230-249. https://doi.org/10.1097/JSA.0000000000000303

Wedge, C., Crowell, M., Mason, J., & Pitt, W. (2021). Rehabilitation and Return to Play Following Meniscus Repair. Sports Medicine and Arthroscopy Review, 29(3), 173-179. https://doi.org/10.1097/JSA.0000000000000303

Wilson, B. J., & Ray, D. (2018). Child‐centered play therapy: Aggression, empathy, and self‐regulation. Journal of Counseling & Development, 96(4), 399-409.https://doi.org/10.1002/jcad.12222