Exemplar Profiles

Daily, I see every patient that is going to theatre. I assess the situation to decide which method of preparation I am going to use. I then prepare the patient for the GA, the surgery and the post operative experiences. I am constantly answering questions from the patient and family members. I liaise with the nursing staff to see if any of the in patients require any special help that day. This could be distraction, preparation or emotional support. After this, I prepare the play room with activities. I then give handover to the ward school. I visit every patient and provide activities. The rest of the shift is spent largely in response to the needs of the patients, or other members of the MDT. I am often asked to help encourage patients during a physio session etc. In addition to the above duties, I am now responsible for the provision of play in other areas as the Senior HPS. I take referrals from CNS (Clinical Nurse Specialists) and attend clinics. I also support patients having non-GA MRI’s at a monthly clinic. Calls contacting TCI patients (prospective Admissions) that are anxious is now part of my job, being referred by medical staff.

I work 37.5 hours a week, Monday- Friday on a Medical Day Case Unit. I am a lone worker. The patients range in age from 0 months to 18yrs. I provide age and developmentally suitable activities for the patients attending the ward. When possible, I will invite Arts for Health sessions onto the ward. I celebrate occasions and festivals were appropriate. I am responsible for the receiving of referrals from the medical directorate and distributing them amongst the medical play specialist team. I hold the play specialist team bleep twice a month and have the responsibility of managing the play team on a rota basis with other members of the senior team. I conduct PDR’s (Performance Development Reviews) for members of the team, and I have had training for this. I receive clinical supervision from the psychology team, and I provide supervision groups for members of our team on a monthly basis. I have received training to do this. I attend regular play meetings. I have regular meetings with the MDT’s who access to the ward. I teach medical students and nursing students regarding the need for good communication with patients. I have health play specialist shadow me regularly. My mandatory training is up to date.

I have eighteen years’ experience of practising as a Health Play Specialist in various hospital settings but I am currently taking a career break to care full time for a family member. To maintain my CPD as a Health Play Specialist in line with [HPSET’s] requirements I am now volunteering as a play specialist on a sessional basis. Confidential content removed. As part of my volunteer role, a practising Registered Senior Paediatric Community Nurse has agreed to mentor me. This nurse is also a qualified play specialist and has a background in hospital play.

After learning about a new admission, I asked the practitioner for a teaching session. This was because a spinal injury patient was being admitted with an injury that I had not experienced before. The practitioner set out the levels of spinal injury and how this would affect the patient. She then moved onto the risks of autonomic dysreflexia. This was a brief insight, and I knew I needed to proceed to further detailed research. This training was important as this patient was to be rehabilitated whilst on the ward and this meant putting a play programme into place. I wanted to be able to plan appropriately within the realms of their physical ability. With this information now at hand I suggested to my colleague that we have a meeting where I could pass on that information, which we then did. I was able to answer their questions, which I was only able to do because of my 1:1 teaching session with the practitioner. I was then able to take the lead in planning the play programme. On admission, when meeting the patient, who was 15 years old, I was able to fully comprehend medically his restrictions. The play programme I had devised had to be altered slightly, to fit his character, preferences and his timetable.

Research online for information to support Teenage Mental health as we as a department have seen a huge uplift in numbers of children and young people attending, and the age of some children getting younger. I looked on a variety of websites like, Mind, We Can Talk and No Panic where i found lots of useful tools to help enable conversation, looking at distraction and boredom techniques, information on anxiety, panic attacks and the flight or fight response. Also spoke to Psychologists and well-being team and worked alongside one of the paediatric consultants to put together resources. (See reflection 2 for more information).

This was a book geared towards talking children through feeling angry in different situations and circumstances. It was aimed towards parents and carers, also some suggestions for teachers. I felt this was a valuable resource as quite often children in hospital can feel angry and upset at having to have treatment they do not like, for example, a blood test or operation. There were a lot of activities and exercises in the book which have given me a good source of ideas of how to better support and try help focus and work through these feeling with children. The book covered ways to talk about feeling angry and out of control and that it is ok to express these emotion’s and to talk through them. There were examples of ways to help children safely express anger in physical ways as well as writing and breathing activities. It covered trying to help give children some control over the situation they are in if possible. e.g., role play or discussing some steps or aspects of what will happen and be guided by them if possible. There were some helpful visualisation and breathing exercises which I feel could be very helpful in de-escalating a difficult situation and to give children the freedom and support to say how they are feeling. I feel this book has given me some fresh ideas and insight into how I may do things differently and the confidence to try new things.

While working on the Day Surgery Unit, I was referred an 8-year-old autistic girl who was going to be having a tonsillectomy. Her mum was very anxious and worried that the day was going to be traumatic and difficult. I reassured her that it doesn’t have to be like that, and that I could support the child in various ways, such as preparation, distraction, reward chart, etc. I was able to engage the child with medical play, as well as creative play. We played with the anaesthetic mask, and she enjoyed practicing on it, blowing up the balloon. I was later informed that she would be having sedation, so I prepared her for that by keeping it simple, saying words such as “water in the nose” or “medicine to help take the worry away” or “in the cheek and rub, rub, rub”. We made a reward sticker chart for every medical step that she completed, and she enjoyed choosing a sticker and writing the accomplished task. The whole day went smoothly, and she was proud of herself. Mum was sincerely pleased and thankful, she thanked me “for helping things to go well and saving the day from being a traumatic experience.” I was pleased to see that things went well and reflected that this child just needed a little bit more effort and input. Since then, I have used the idea of a sticker chart with other children who are finding it hard to cope. I especially use it with children who have additional needs, as many times it helps them to see their accomplishments/tasks on paper, or as a tick box exercise, or as pictures, in a step by step, predictable, safe manner. Offering simple choices such as “Which nostril?” also helps them feel empowered.

The renal ANP I had previously worked with had retired. A new ANP had been appointed. He had been a dialysis nurse, and I had worked with him in his dialysis role. I had not worked with him regarding transplant patients. I had met monthly with the former ANP. We had discussed the transplant list patients and what support they needed. It was a good system. It kept me up to date with transplant dates. The date of transplant enabled me to prepare the patient in a timely manner. Since her retirement there had been no one in the role to share information. Now a new ANP had been appointed he was keen to reintroduce the meetings. He said that the feedback he had from the Consultants and the families had reported that some of the patients had refused certain procedures due to lack of preparation for it. He reported that parents had asked for my involvement as I had “done a good job ” of preparing their child for other procedures. He said that feedback from the hospital where the patients had their transplant had noticed a “difference” in a child who was prepared for the transplant and a patient who had not. It had been reported that they cope much better with all aspects of the surgery. We have begun to meet monthly as before. It is working well again. Two patients have been transplanted. Both families have reported that the prep has helped them cope with the surgery better than they thought they would. They think this is because they knew what was to happen.

I received positive feedback from a clinical incident report I put in after a patient’s bad experience in the anaesthetic room. The incident involved a teenager who had needle phobia, and I had prepared him and agreed strategies to help have a cannula. We agreed that we would put EMLA cream on early to ensure that his hand was numb. We also agreed to take a phone for distraction, and he asked me to accompany him too. However, these strategies did not strictly happen hence the reason for putting in the incident report. Unfortunately, the teenager got called down to theatre before we had time to get the cream on. I explained that he could have numbing spray and fortunately he was alright with this alternative. However, when I asked the anaesthetist to use spray, he dismissed me and said in front of the patient and his mum “We don’t need to bother with that, let’s just get on with it, it’s only a small needle”. This made the child understandably anxious, however I managed to distract him using his phone to get a cannula in. Mum was angry at the anaesthetist’s behaviour and asked me how to make a formal complaint. I put in an incident report due to the bad behaviour and failure to listen to my suggestions. Following the report, the feedback I received was from the Anaesthetic Consultant who requested a meeting to discuss the incident and resolve the issue. The meeting was positive and together we agreed that I would do a teaching session to the anaesthetists and theatre staff to highlight the importance and value of listening to the HPS and voice of the child. So even though this was negative feedback initially I have done something positive to ensure it doesn’t happen again.

In my work with children in hospital, I get to have lots of conversations with children and families, while carrying out my role as a Play Specialist. I am finding that building positive relationships is an integral part of the job. In fact, I sometimes feel that half the job is to maintain a good relationship with service users, and the other half is the professional knowledge and skills, tools, play, thinking on my feet, problem solving, being a part of the MDT, etc. There is a similar belief in Counselling, where they say that the relationship is central to everything, without the relationship, even the most effective approach in Counselling is somewhat useless if the relationship between therapist and client is not a good one.

Building trust and good rapport is what motivates change, promotes good practice, and helps the patient. I believe this certainly applies to the work of the Play Specialist too. As described in Section 2.4 of the HPSET and NAHPS Professional Standards, “Recognise that relationships with all service-users should be based on mutual respect and trust, and be able to maintain high standards of care, even in situations of personal incompatibility.”

I feel that my experience of having done part of a Counselling Degree has really helped me to naturally and easily connect with parents and children. Together with many years of working as a Play Specialist, building positive connections, has become second nature. During my experience of working as a Counsellor, I learned to create a space for active listening, and being fully present for the client which is something that I also use in my work with service users, as well as my colleagues.

I have learned to be patient and tolerant of colleagues who might be new to the area and are still getting used to my role. I use that opportunity to teach them what I do, and how it fits in with the way things run. For example, working in MRI, the Radiographers rotate between hospitals and services, therefore do not always have a lot of experience of working with children. I try to keep them informed about how my role helps the children cope when I use preparation play, and that I am usually the first person they meet on arrival. It can sometimes feel frustrating having to do this every time there is a new Radiographer on board, but it is necessary, and I can now approach this from a place of understanding and being helpful, knowing it will help things run smoothly for the patients. As stated in Principle 2.4 of the HPSET and NAHPS Code of Professional Conduct, “Respect other professionals and the public; be polite and considerate. To ensure care is delivered effectively, work in partnership by sharing your skills, knowledge and expertise where appropriate.”

My background in Counselling has also given me the ability to empathise with people. I am able to see things through the other person’s perspective and to understand their thoughts and feelings, without judgement. This comes in very useful in many situations, such as challenging behaviour, or frustrated parents, or colleagues who are feeling tired or stressed. It also helps me to empathise with myself and to be self-aware enough to know when I might need a few minutes to myself, and to self-care. Counselling also opened my eyes to the matrix of factors that contribute to wellbeing and mental health, as well as the interplay between mental and physical health.

In my volunteering role as a play specialist for a child who has development delay, I developed a blood test preparation booklet to help describe the process in a step-by-step way. I included visual aids (photographs) and used simple language which the child could easily understand to prepare the child for the procedure. Both parents had identified that having more information about having a blood test (presented in a way that they could easily understand) would help their child with future blood tests. When the preparation tool was completed, I sat down with both parents to make sure they were happy before I went through the booklet with the child. One of the parents felt that the booklet being laminated meant that therapeutic texture couldn’t be added to the booklet. The other parent felt that the preparation booklet did not need to be tactile on this occasion as it would be explained as a story to break down the information of having a blood test. I suggested providing a therapeutic props bag for when the child used the preparation book at home as this could be a way to incorporate both parents feedback and still comply to infection control when the booklet is used in a healthcare environment. Both parents agreed that the idea of having a prop bag would be a good addition.

As a registered Health Play Specialist, I have a responsibility to maintain my own personal professional development in line with section 3.2 of the HPSET & NAHPS 2019 Code of Professional Conduct for Registered Practitioners and Students ‘Be responsible for maintaining your registration and continually reflect and improve your practice.’ As well as it being a requirement for continued registration with HPSET, it is very important to me that I can continue to use my play specialist experience and skills to be able to develop resources and tools such as preparation blood test booklets for children and young people to help them better understand and cope with medical procedures and treatments.

Developing the blood test play preparation booklet within my volunteer role gave me great satisfaction. I was able to help a child with development delay access more information and understanding about a procedure that they found difficult to cope with. The child fully engaged with the blood test preparation booklet. It was important to develop a booklet that conveyed the information in a simple, visual format that a child with development delay can more easily understand and retain. This is in accordance with the HPSET & NAHPS 2019 Health Play Specialist Standards of Proficiency Professional Standards, section 4.2 ‘To be able to initiate, continue, modify, and cease play, based on the developmental needs of the child, using normalising interventions, preparation, distraction and post procedural play techniques.’ The blood test preparation booklet was a tool that was not only a visual aid but also used simple language as a communication tool to help prepare the child for a blood test. One of the parent’s feedback highlighted their concern about the preparation booklet not being therapeutic enough because the booklet was laminated. I felt the parent raised an excellent point which I was able to address by the addition of a props bag for use at home. Both parents gave positive feedback and felt the preparation booklet had achieved what it had set out to do, which was to provide step-by-step preparation guidance to help the child understand more about having a blood test.

The learning for me would be to consider, when developing similar tools in the future within my volunteering role as a play specialist, to clearly explain the aim of the tool and discuss any potential concerns that the parents may have, such as laminating the booklet, at the beginning of the process before any booklets/ tools are developed. I always have review meetings with the parents and try to take on board their suggestions and requests, where possible. It was important that the parent’s concern about the lamination of the booklet was raised and discussed. However, it was equally important that, as a registered practitioner and knowing that the booklet would be used in healthcare environments, I was able to explain that it was important to ensure the booklet complied with infection control guidelines. It was clear that both parents had different viewpoints on what they felt was the priority need in the process of the development of the preparation blood test booklet.

Being able to discuss the above process with my mentor in my regular professional mentor sessions gave me a space to reflect. My mentor felt that I acted appropriately, respected both parents’ views and was able to give a recommendation that ensured that both parents’ concerns were addressed whilst making sure that the child got the right preparation information. Moving forward I will document this as part of my CPD and use the experience as a reflection for future reference when developing other preparation tools.

Looking back at my referrals I am being asked more and more to work with children with complex needs who are non-compliant with using an NIV (Non-Invasive) mask. For these children, it is not lifesaving but life enhancing. If they get a better night sleep, they can be more productive and lead more fulfilled lives in the day. The difficulty is that they cannot measure or visually see the benefits of wearing a mask all night. Many have limited understanding and are proving to be tricky customers: HPSET Professional Standard 5:1, Understand the requirement to adapt practice to meet the needs of different groups and individuals.

Often, I have been asked to get involved once it has failed! “Get [the HPS] involved now and see if she can work her magic. We will give it 3 months before we admit defeat”! I see this regularly on the Outpatients feedback form disseminated to the team after clinic. It feels like this is too late. Professional Standard 2:1, Understand the need to act in the best interest of babies. infants, children, young people and their families at all times.

Having shared with a couple of the team, I think we could look to put together a protocol of when to introduce my role and the work that needs doing before we introduce NIV to the children. Discussions were held with the OT (Occupational Therapist) around sensory issues and how we can overcome some of them. For example, one little girl will fall to sleep with her mask on but wakes as soon as her mum tries to place the straps on. We agreed that joint working at the point of referral would be very useful as part of the protocol. Professional Standard 4:1, To be able to assess a professional situation, to determine the nature and severity of a problem and to act within your professional scope of practice at all times. Professional Standard 4:5, Be able to work in partnership with other professionals to ensure that clinical procedures are planned and managed, enabling a consistent and compassionate approach by the team.

I have found working closely with school staff very beneficial. Most of the children who are non-compliant go to Special Schools and the teachers and support staff get to know these children really well. Professional Standard 3:1, Understand the need to maintain high standards of personal and professional conduct. They are the ones who know what will and won’t work. As an experienced play specialist, I see my role is to suggest the stages needed and to be guided by them as to how they carry that stage out. One girl loves swimming so as part of the “Getting to know and tolerate wearing my mask” phase, they encouraged her to wear the mask on the journey to the pool and back again. This proved to work very well. Professional Standard 8:2, Understand how communication skills affect assessment and engagement of all service users and how the methods of communication should be modified to address and take account of factors such as, age, capacity, learning ability, physical ability and English as an additional language. Code of Professional Conduct 5:3, Work in a collaborative and cooperative manner with other professionals, respecting and recognising their expertise and contributions.

Going into the schools and seeing children in their own environment is such an eye opener. Many staff are so encouraging and often say that the child is more likely to conform for them being in a structured environment than they would at home. If we can reach a time where the child will wear the mask and turn the ventilator on in school, we are half way there. Professional Standard 9:1, Be able to work in partnership with service users and other professionals and organisations.