Activities Report on a Playroom Creation for Adolescents- To Create a Place for Teenage/Young Adult Patients –Sanae Sugibuchi* ・ Noriko Kinuma**
I. Introduction
It has been five years since Tokyo Metropolitan Children’s Medical Center opened. Rooms andbeds are almost always full and an increasing number of children have been repeatedly hospitalized.
For those who stay in hospital for a long time, a hospital is not only a place to receive treatment but aliving area, playground and a study room. Children sent to the department of hematology & oncology
and the department of nephrology are often forced to undergo a long-term/repeating hospitalizationand many enter adolescence.
In our ward, there is a wide range of age groups including infants, school children, teenagers, andyoung adults. You hear crying babies all day and children are playing during the day. It is difficult toprovide a place for adolescents. In fact, there is no place for them to relax other thantheir own room.
Children’s nurses of each department are in charge of coordinating a playroom depending on theconditions of patients. Mostly a playroom is designed for infants and small children, usuallydecorated by children’s nurses and hospital staffs. It is however, that there are few playrooms foradolescents in Japan and existing playrooms do not offer much to them. It is hard to say thatplayrooms are comfortable enough for adolescents. It is important for a patient to have a place where
one can relax other than one’s own room because such space refreshes one’s feelings, provides a goodrest after a hard treatment and gives a chance to meet friends. Since a place for adolescents in
hospital is often overlooked, we planned to create a playroom for adolescents so that they are able tolive their life in accordance with their ages and needs.
What types of playrooms do adolescents who stay in hospital for a long time and often undergo
painful medical treatments want? In order to clarify this, we interviewed adolescents and discussedwith them. This report shows the procedure to create a playroom for adolescents and its result.
II. Objectives
1. To create a place where teenage/young adult patients, who do not have a place to relax in hospital,
can stay and enjoy in accordance with their own age.
2. To consider the way to create a playroom for teenage/young adult patients through interviews
and discussions with actual patients who stay in the hospital for a long time.

III. Method
１．Subjects
12 teenage/young adult patients, both male and female, who had been hospitalized for a long timein the department of hematology & oncology and the department of nephrology were subjects for thisstudy. The age range of the subjects was from 12 to 22. The average was 16.4 years old.
２．Period of Study
From March 2014 to November 2014
３．Method１）Ethical Considerations
We obtained consent from patients and their families after the verbal explanation about theobjectives of the study and securing personal information.
２）Collecting and sharing information with healthcare staffs of other departments
We explained to healthcare staff that we were planning to create a playroom outside the ward forteenage/young adult patients and asked to provide information that they had received from otherhospitals, nursing associations, and so on. We discussed with healthcare staff working in the sameward and shared our objectives regarding the playroom.
３）Discussion with subjects
The 1st meeting in the department of hematology & oncology: We gave a notice to all
subjects beforehand and obtained consent from patients and their families about the objectives of thestudy. Though some people did not seem to attend at the first meeting for medical reasons, we set adate when comparatively many people seemed available. The meeting was held in a meeting room of
the ward.
The 2nd meeting in the department of hematology & oncology: the meeting was held in a cafeteriathat had more open space than the previous meeting room. For those who couldn’t attend at themeeting due to medical treatments and a sleepover, we interviewed them beforehand.
The 3rd meeting in the department of hematology & oncology: Some patients who attended theprevious meeting left the hospital and 5 new teenage patients joined. In a patient’s room, we
explained the objectives of the playroom for teenage patients to these new members and interviewed
them what type of room and what kind of items they wished to have.
A day-to-day meeting in a patient’s room in the department of nephrology was held to explain theobjectives of the playroom for teenage/young adult patients and the current status of discussions
with other teenage/young adult patients. We also asked what they wish to have in the playroom.
IV. Result
1. Information-gathering and information sharing from other healthcare staff
We explained to other healthcare staffs (doctors, nurses and psychologists) about the plan tocreate a playroom for teenage/young adult patients outside the ward. Since the number of actualcases of playrooms for adolescents is extremely limited in Japan, we obtained the information of only
three facilities. One of these facilities uses their playroom as a study space for every evening. Thoughpatients are allowed to use the place after time for lights-out, there are not particular materials forteenage/young adult patients other than desks and chairs for study.
Doctors working at the department of hematology & oncology told us that they have received
inquiries regarding a place for teenage patients in our hospital. Since our hospital is designated as acore hospital for pediatric cancer, we are expected to lead the field of teenage patients as one of themissions of a core hospital.
2. Discussions with teenage and young adult patients
There is a branch school inside the hospital. Children up to grade 12 learn at the branch school
and they spend large amount of time outside their room for study and for medical treatment. It is
however that teenage/young adult patients older than grade 12 mostly stay in their room and seldom
have a chance to talk to other patients. Even in the same ward when they pass by in a corridor,
teenagers do not talk to each other. When a meeting was held for the first time, teenage patients
seemed nervous.
A young male patient who had the previous history of hospitalization in another hospital provided
his own experiences in the previous hospital. In that hospital, there were many patients around yourage because patients were divided according to age no matter what department you were in andhow long you had been in the hospital. There were also many occasions to get together with thosepatients and sometimes played a board game together. When we asked a question to participants
such as “We are planning to create a space for teenage/young adult patients. What kind of place doyou wish to have? What do you wish to have there?” a 21 year-old young female who actively involvedin our discussion answered some beauty/relaxation products such as footbath, air purifiers producing
negative ions, a facial massager. She said to us “Girls like things that make them pretty”. Teenage
girls tend to be highly interested in how they look. Those requests indicated characteristics of typicalteenagers.
The second meeting was held in a cafeteria in order for them to relax a little. The open space andsome music that we prepared beforehand seemed to help participants relax and we talked in a casualmanner. While taking about random things, many said that they wished to have a better Internet
environment.
Regarding things that they wished to have in a playroom, a patient said to us “It doesn’t feel like aplace to hang out with a group of people. I want to spend my time quietly there, so DVD and comic
books would be nice to have”. Though teenagers value friendships, friends for those young patients
meant those in school and their home neighbors. It indicated that they had not established any“friendship” with people in the hospital. For patients who were forced to stay for long in the hospital,
to provide opportunities to make friends, to have similar experiences, and opportunities to meetsomeone who would share fun moment and help each other during hard time seemed anotherresponsibility for us. The current status of teenage patients was however, that they wished to bealone in a playroom rather than getting together with others to play a game.
A male patient who had several hospitalization before provided some comments based on his own
experiences: “Regarding comics, it shall not be serial ones because patients are busy for medical
treatments and so on and we don’t really have time to read serial stories. Even when you think you
have some spare time, the maximum would be around an hour, I guess”. Others agreed and said to
us “That’s right. Once you come back from branch school, we have to take a bath soon after afternoon
snack. I don’t think I have time to visit a playroom”. A patient who went to a branch junior highschool frankly said “There is little spare time during daytime. It would be nice if the playroom isavailable even during nighttime”. Further, there were comments such as “ I want stories of comics
and DVD with happy ending so that I can feel cheered up” “I would like to play Sugoroku (Japanesebackgammon), a board game and a pool game” “Games like Wii-U for you to play alone. It would benice if there were some software so that you could choose”.
Some patients requested to have relaxation devices such as a massage chair that they can stretch
their limbs. The existing TV could be still used but every one definitely preferred a Blu-ray player toa standard player. According to a male patient who had a detailed knowledge of home electronics
said “Once you experience to see the image of Blu-ray disc that is so sharp and beautiful, it’s hard togo back to the image of standard DVDs”. Further, there were various comments including “The colorof the room should be grey or something calming” “ I want to read mystery novels, written by some
popular writer like Keigo Higashino” “I want to do an image training with some DVDs, comics andDisneyland Guide Book since I’ve been hospitalized for a long time. (It’s hard to determine what kindof magazine we shall have in the room because) The preferences of magazines vary depending on an
individual” “How about creating a request box, so that we can request what kind of book we would
like to read” “A Galileo thermometer. It drew my attention in a store. It is soothing to watch” then heshowed the image of Galileo thermometer by his smart phone. Participants were relaxed when theytalked about their wishes above.
We summarized our conversation in a below table. Each item reflects particular opinions
and comments of adolescents.

DVDs and books
Popular DVDs ofwhich the stories are
not serial ones
Movies and soap
opera
Teenage magazines
Comic books
Guide books
NovelsTable 1．The wish list for a playroom
Toys and games
Materials
Rules
and devices
SugorokuTV
Eat and
Board game
Blu-ray
drink OK
WiiU
playerCell phone
Game software
BeautyOK
Instrument
product(electric/acoustic Massage
guitar,chair
keyboard)
Comfortablecushions
and chairs
Materials
for room
decorating

System/construction-related
wi-fi
Beverage vending machine
To change light bulbs of
rooms(they want their roombrighter)

３．Making rules for utilization of the room
Discussion meetings for rules of the playroom were held twice. At the present stage, we decided to
set up a trial period. Some adjustment of rules with other departments in accordance with theevaluation of the trial will be required.
V. Discussion
For our plan to create a playroom for teenage/young-adult patients we focused on the voice ofactual teenagers and we implemented interview sessions/discussions with them. It was because we
did not create the room from the view of healthcare professionals. We asked questions to the young
patients “what kind of place are you looking for?”We received many comments and requests from patients. Because of structural reasons, somerequests seemed difficult to realize. Some requests sounded too luxury for us and it was not possible
to fulfill every request. Considering ages of those patients however, it was us who were fixated toconventional thoughts that were out of date to some extent.
For example, beauty products that a female patient suggested made us realize that it was naturalfor teenage girls to be self-conscious about their appearances. Especially for those who experienced
physical changes due to medical treatments, it should be a serious matter. Regarding a massage
chair that a male patient requested, it shall not be that luxury. In a children’s hospital in UK, there
is a relaxation room where people can take massage and try some aromatherapies. Patients andtheir family are allowed to use the room. A professional massager practices the therapy there.
It is important to understand the feelings of our young patients who want to have pleasant time asmuch as they could in hospital where they often suffer from anxiety, nervousness, pain anddiscomfort. Of course every wish and request is not immediately fulfilled due to budget limitation,
the shortage of space, system availability and so on. The efforts to create a comfortable place forteenagers in hospital, however, shall be continued based on the feelings and ideas of actual
teenage/young adult patients.
At the same time, it is also crucial for us to consider the issues of infections, the aspect of hygiene
and safety as a healthcare professional. Teenage/young adult patients are not in one section or
department of a hospital. They are in any department depending on their conditions. It is preferable
that every department or ward has a playroom for teenagers but it is hard to realize due to thelack of available spaces. Consequently we decided to make one such room outside theward. Considering the playroom set outside the ward and it will be shared with teenage patientsfrom numerous departments and wards, to make sure hygiene and safety of the place is our
responsibility. Further, we must construct rules based on the background described above.
The length of hospitalization, types of disease and treatment vary largely depending on a ward.
Rules for the playroom shall be flexible enough to adapt to such different situations among teenage
patients. In such a case, it is important for people involving in the playroom including healthcare
staffs, patients and their families to understand and accept unique situation and conditions of others.
Some patients wished to have the playroom in their ward so that they would be able to use it
whenever they wanted to use. Though the playroom that we have planned to make will be placedoutside the ward, we shall continue paying our attention to create a little oasis for adolescents in an
each ward.
VI. Conclusion
When we made our morning round of visits in the ward before, teenage patients often shut thecurtains and it was difficult for us to approach directly. Though we were concerned about them, theplayroom that we worked for was made for small children and that was filled with toys and cartoon
characters that were focused on small children.
Two years ago, we took a training course in a hospital in UK where the same department was
divided into two: for teenage patients and for younger age children. Accordingly there were two
playrooms set out for both age groups. In a playroom for teenage patients, there were fitness
machines and similar age patients were having a birthday party together. At the outpatient
department, each group, teenagers and younger ones, had a waiting room respectively. There was ahealthcare specialist for teenage patients and various support for adolescents was provided. It
indicated that teenage/young adult patients were well respected and cared for. What about ourcountry? How much do we consider for teenage/young adult patients in Japan? In my opinion, it is
not much at all.
When we discussed the playroom with adolescents, we received various comments and theirthoughts. Those who used to shut curtains of their rooms openly and honestly talked about what
they were hoping for the playroom. To ensure that young patients’ honest desires are not for naught,
we should certainly respect and reflect what they told us.

To create an appropriate place for patients in adolescence is one thing but what they do in theplayroom is another. It is important for patients to feel “It is fun to be here” “I can do this and that in
the playroom” “I can meet friends in this place” and “I have a special role here”. We would like tomake sure to create a place where patients were willing to spend time. We shall ensure both enoughspace and proper activities for those who are at sensitive periods of their lives.
It requires some more time until the playroom is available for adolescents in our hospital. In themeantime, we sure continue supporting young patients while collecting ideas for activities in theplayroom.
＜Reference＞
Japanese Society of Pediatric Oncology Nursing (2012). Nursing-Care Guideline for PediatricCancer: Nursing-Care Aiming to Improve the QOL of Children with Cancer.