Ho spit al Pl ay Speci ali st No .3

Introduction of “Leave Board” and its Effect‐The Leave Board “Sunshine Village” is the proof of children’s great effort‐
KazukoSuwabe*

Ⅰ．Introduction
Children come and go everyday for examinations and surgery to our circulatory organ
department. Many are repeatedly hospitalized. No matter how many times they have been
hospitalized, children and families seem to feel anxious every time when the admission day comesup.
Their anxiety and nervousness toward a surgery and hospitalization could be alleviated if they
were aware that they had overcome the same procedure before. To do this, I would like to visualize
children’s efforts to encourage them. I made a big tree from cardboard for children to place theirown cards on the tree and to bring them back when they went back home.
However, there were too many children for one HPS to handle on the ward. A wise manager of theward suggested placing a “leave board” instead of the paper tree in order to retain the original idea
and to operate it efficiently. The idea was that children put a mark on the “leave board” on the daywhen they were going back home, indicating their completion of the treatment in the hospital: “I didit!” “ I overcame the whole procedure!”. It was also designed to encourage children including times
when they had to come back to the hospital.
To make the “leave board” familiar for children, it was named “Sunshine Village” in a conference.
The idea was well accepted and it was decided to introduce it to other departments of the hospitalas well. It has been over a year since the “leave board” was officially placed in the pediatric ward.
This is a report of a survey regarding the “leave board” implemented for the children, their families
and healthcare staff in order to evaluate the effectiveness of the board at the moment.
Ⅱ．Objectives
Since January 2010, the “leave board” has been placed in a general ward of the Circulatory Organ
Center. Children were instructed to choose their own mark and to place it on the board when they
were going back home after their hospitalization.
In this report, the meaning and effectiveness of the board were studied through conducting asurvey of children, families and healthcare staff. Current issues and future challenges were also
reviewed and discussed.
Ⅲ．Method
1. Subjects：85 children who went home after staying in the ward, and their families, 25 nurses and14 doctors.
2. Period of Study：From April 2011 to December 2011
3. Method：
1) For children and their families: Children and families were asked to complete a questionnaire
sheet and bring it back to the hospital after filling it out on a voluntary basis. A collection box wasplaced at the out-patient entrance.
2) For healthcare staff: A questionnaire sheet was given directly to staff. After filing it out they wereinstructed to put in the collection bag.
4. Survey content: Differing types of questionnaires were prepared for children/families, medicalSuwa region：Introduction of “Leave Board” and its Effectpractitioners (doctors), and nurses respectively (Appendix 1 ~3)
Ⅳ．Result
35 out of 85 (41%) children and families completed and submitted the questionnaire. Of those
who retunred the questionnaire, 23 children (66%) were before school age and 12 (34%) were older.
60% of children had a history of previous hospitalization. Among healthcare professionals, 31 peopleanswered the questionnaire (9 doctors and 22 nurses).
Regarding marking on the board, 94 % of children and families answered “good idea” even those
who had to stay on the hospital for treatments or a surgery. In the free answer section, there weremany positive comments such as “It is encouraging to see that many people have been here andeventually went home (12 y/o child)”, “It visually makes children feel that their life in the hospital isover (a parent of 8 y/o)”, “It is nice because it tells that we did it all together. It is encouraging as
being in hospital isn’t easy for everyone (a parent of both 1 y/o and 8 y/o who had been in hospital)”,“I was filled with the sense of fulfillment (a parent of 0 y/o)”, “My child was happy for that (a parentof 5 y/o)”. There was a family saying “We put a mark beside the one that we had put in the previoustime (family of 3 y/o)”.
Regarding the questionnaire for healthcare staff, though just 55% of doctors acknowledged the“leave board”, there were some positive comments such as “It brings a sense of happiness andachievement”, “I feel happy when I see sheep and flowers on the board gradually increasing becausethat shows a number of children who got well and went home finally”, “ The continuation of thisactivity shall encourage families and healthcare staff a lot”. Most of all, all respondents agreed withthe continuation of the “leave board” hooray.
All nurses responded “I felt relieved when I saw children leaving their marks on the board”, “Itfeels nice”, “Children seemed very content”. There were many other comments in the free answer
section including this one: “I’m always swamped with work, but when I see the board showing thatso many children went home from this hospital, I feel a sense of fulfillment at the same time”.

Pic.１. Leave Mark (Choose one and put it on the board)

Pic.2. Leave Board

Pic. 3. Father and daughter placing a mark together
Pic.4. Names and comments are also written on the board

Suwa region：Introduction of “Leave Board” and its Effect

Ⅴ．Discussion
Once a child is ready for going home, healthcare staff congratulate the child. Then he/she choosesa mark from a box and puts it on the “leave board”. Three objectives of the “leave board” are as
follows:(1) To make children aware of their efforts during the period of hospitalization by placing their own
mark (a child can choose from either sheep or a flower) on the board.
(2) To encourage and to reduce anxiety of children and their families when they are first admitted tothe hospital.
(3) To provide a sense of fulfillment and happiness to healthcare professionals.
Under the “leave board” located outside the corridor on the ward, there were often children andtheir families talking happily about where they should put their mark on the board. Younger
children were carried by a parent and put the mark on their favorite place. It was as if they weresharing the sense of their achievement together. For children who were too small to put his/hermark on by him/herself, their older siblings often place it on behalf of their younger siblings. Whenstaff told them “thank you for your corporation”, they smiled shyly.
Such moments told us that siblings are also having an important part of the whole picture.
It was often seen that the whole family took a photograph in front of the board. A family whosechild was required to be hospitalized sometime later said “We’ll be back” and children who waved
at us by saying “good bye” with a happy smile indicated they had at least positively accepted theirexperiences of the hospitalization.
Since the board was placed in front of the waiting room, children saw the board while waiting foradministrative procedures. Some of the children even requested “I want my mark to be the sheep
when I go home” as soon as they were admitted to the ward. In the questionnaire, a family whosechild had to stay in hospital again wrote that they could tell the child “You did it before, so way
don’t you this time?”. Though children get nervous when they are admitted to the hospital, theyare looking forward to placing their own mark on the board. By having seen behaviors of children
and families who have used the board, it has demonstrated that the board has fulfilled its
objectives.
A patient suffering from cardiovascular disease is often required to undergo a surgery after
hospitalization for routine tests and catheterization. For children who face such situations, play
preparation, distractions during treatments and a stamp rally game for examinations have been
introduced so that they were encouraged and were able to go through the procedure smoothly.
Now when children finally got to go home, they gained a sense of achievement by seeing theirefforts on “Sunshine Village”. In addition, for those who had to stay in the hospital again in thefuture, it reduced their anxiety and provided courage to go through it again.
In the questionnaire for healthcare professionals, some useful advice and ideas were also seen
including “It may be a good idea to divide it into age groups. It can be encouraging for families ofbabies to see other babies’ marks” “How about showing a monthly result?”
It has been over three years since the “leave board” was introduced. The monthly result,requested by one of healthcare professionals, started from this year. In a mark and on the board,children and families can write their names and comments for encouragement to other children. It
has provided evidence that children, family and healthcare staff encourage each other and work
together. To have a medical environment that respects children’s needs is our continuous challenge
and is definitely on its way.
Reference
Kazuaki Sugiura (Ed.) (2003) Introductory of Clinical Psychology. Chuohoki Press.

Ho spit al Pl ay Speci ali st No .3

Appendix 1： Questionnaire items relating to the Leave Board （ For Children and families）（Age）

Male ・Female

Date:

Please circle or write down your answer for the following questions.
Ⅰ．Have you ever been hospitalized in West-Ward 3 of our hospital?
(1) YES※ Number of hospitalization（times ）(2) NO
Ⅱ．Have you ever placed your own mark on the Leave Board when you were leaving the hospital?
(1) YES(2) NO

Ⅱ－１．How did you feel when you chose your own mark from the box?
① Happy ② Relieved ③ Satisfied ④ Glad to be discharged⑤ Novel ⑥ Nothing in particular ⑦ Other (free-answer)
Ⅱ－２．How did you feel when you placed your mark on the Leave Board?
① Happy ② Relieved ③ Satisfied ④ Glad to be discharged⑤ Novel ⑥ Nothing in particular ⑦ Other (free-answer)
Ⅲ．Have you seen the Leave Board before your admission to the hospital?
(1) YES(2) NO

Ⅲ－１．Did you and your child talk about the Leave Board at home?
If so, please write down the detail of the episode.
Ⅳ．What do you think about the idea of a mark placing on the board?
①Good idea②

Don’t Know③

Not a good idea

Ⅳ－１．Please write down the reason○Any comment or/and concern about the Leave Board

Thank you for your cooperation.

Suwa region：Introduction of “Leave Board” and its EffectAppendix 2：Evaluation on the Leave Board (The Sunshine Village) For doctors
１．Have you seen that children or their families placed a mark on the Leave Board?
・YES・NO

２．Do you have any particular feeling when you see the board as a medical practitioner?
・YES （In detail:）・NO
３．Do you agree with the continuation of the Leave Board?
・YES・NO）

Reason（4．Please write any comment on the “Leave Board (The Sunshine Village)”.
Thank you for your cooperation
Appendix 3：Evaluation on the Leave Board (The Sunshine Village)

For nurses

1. Did you give a mark to a patient when he/she was leaving the hospital?
・YES・NO

2. What did you feel when you handed it to the patient?
・Relieved・Content

・Nothing in particular

・Glad the patient was discharged
・Other（In detail:）

3. How did you feel when you saw the reactions of the patient (when he/she was choosing their mark, when they
were placing their mark on the board)?
・Relieved・Content

・Nothing in particular

・Glad the patient was discharged
・Other（In detail:）

4. Do you have any particular feeling when you see the board as a healthcare professional?
・YES（In detail:）・NO

5. Do you agree with the continuation of the Leave Board?
・YES

・NO

Reason（）6．Please write any comment on the “Leave Board (The Sunshine Village)”.
Thank you for your cooperation