The Work of HPS at a Premature Baby Care Unit
Tomoko Terada*Ⅰ．Introduction
In our “Premature Baby Care Unit”, there are 15 beds in NICU (Neonatal Intensive Care Unit)
and 18 beds in GCU (Growing Care Unit) ＊1）. Many infants for various reasons including infants
with severe medical conditions and/or with extremely low birth weight (less than 1,000g at birth) arebrought to our unit by ambulance.
I have worked for the Premature Baby Care Unit for a year and half. Since I was working forother sections of the hospital for a while, I was able to work for infants only two days a week.
Fortunately I have been assigned to the Premature Baby Care Unit on a full time basis since June,and I am mostly engaged with the work of the GCU. In this article, the work of HPS including
preparations for infants is reported.
II. Medical environment with a friendly and bright atmosphere
The first work at the unit was to create a suitable environment for play intervention. When I cameto the unit for the first time, it was just after the construction of the ward and walls and corridors
were blank and empty. There is a long corridor right in front of the entrance of the ward: NICU on
the left and GCU on the right. I wanted to make the long corridor bright and cheerful.
Further, I wanted to alleviate families’ anxieties when they came into the ward. I created theimage of animals and their babies talking together near trees and made the space as if you were in
the open air. The material was cut-out stickers. The silhouette-like images of animals made thewhole atmosphere peaceful. After the completion of the work, a mother and a child, who werewalking along the corridor, were pointing at the wall and talked about animals on the wall. Somehealthcare staffs said to me “it makes me feel at peace”.

Picture 1．Images on the wall of the ward

III. Toys designed corresponding to a level of one’s development
Most babies in the ward had been in our unit since birth. Some were required to stay in thehospital for longer than 6 months or even a year. It is, therefore very important to promote one’sdevelopment through playing because they were staying in such limited environment. Since babies
there often had a problem with handling commercially available toys because they were too weak,
we designed and created toys based on the level of one’s development and conditions.
For example, we used light materials such as thin tubes, handles of a jumping rope, clips and asmall plastic bottle to make a rattle, filled by beads and spangles. We often use a toy made of
a washing board attached with beads on a string rubber that would make some sounds when you
touched it gently. Toys were made to let babies feel changes when they touched them. We encouragethem to have some interest in various things around them through playing. It is important for thebabies to continue practicing every day play so that eventually they would try to reach out theirfavorite toys when they gained enough physical strength.

Pictures 2．Hand-made toys
IV. Communication with siblings
There is concern in cases where a child has been in the hospital since birth. The longer the baby
stays in the hospital, the more natural for siblings and even for the family to live their day-to-day life
without the baby even though they know their younger sibling was there somewhere. To solve theproblem, a role to communicate with siblings about their younger sister/brother was considered to beimportant.
Since there are visitation restrictions due to infection prevention, children especially under school
age have difficulty with visiting their sibling(s) on a continuous basis. Accordingly, we invited
siblings for continuous participation in the “group of siblings” organized by HPS, children’s nurses
and CLS. Eventually the group became the bridge to reach out to their younger siblings.
In the group, we came up with the idea of how to communicate with each other. We took videos ofboth sides and showed it to each other. The video of children in hospital showed scenes when they
were playing and the video of their siblings showed that they talked to and sent messages to theirsiblings in hospital. In the future, we would like to provide messages from other healthcareprofessionals involved in the Premature Baby Care Unit to the siblings in order to indicate ourrecognition of their efforts and cooperation. The continuation of such communication between
children in hospital and their siblings is worth the investment since it is a preparation for the day
when a baby in hospital finally goes home and joins the team “home”.

Picture 3．Communication with siblings
V. Play preparation for an infant: Case example of a type of play that strengthens a bond between agirl and her mother
１．Subject：5 months old female
２．Family：Father and Mother
３．Medical/physical status
The girl was born with neonatal asphyxia and with severe impairment. Though the girl was notable to move any part of her body, occasionally it had been seen that she opened her eyes slightly.
４．Work of HPS
I sang various children’s songs to her. Because her feet were very rigid, I softly touched hershoulders that were less stiff, I touched her initially with one finger then two and more fingers. Since
the attending nurse requested me to teach a kind of play that the mother and the child could play
together, I introduced this “sing and touch” communication. When I had an opportunity to meet themother and we played together with the girl, the mother said to me “it is really fun” with a smile onher face. Since then it had been seen that the mother singing quietly for her daughter while
giving the baby’s limbs a gentle massage.
Since it was obvious that the girl had to stay in hospital for some time, staff in the ward often helda conference to discuss any other way for mother to communicate with her child. Based on thediscussion result, at least one new type of toy at a time such as soap bubbles, balloons, and apinwheel was to be offered to them in order for the mother to create a new atmosphere when withher child.
On the monthly birthday of the girl, staff decorated the girl’s room with play-dough hand-prints
and put the image of fireworks on the wall by a projector. Many staff in the hospital gathered in thegirl’s room and celebrated her monthly birthday together. The major focus as the work of HPS was
how we could help her mother make a bond through playing.

５．Discussion
Because of the specific physical conditions that the girl was suffering, even very simple caretaking
behaviors including carrying her in our arms were not easily provided to her. Under suchcircumstances and because of the long-term hospitalization, to construct a firm bond between themother and the child through playing seemed crucial. Matsudaira (2012) states that play
preparations are not for the infant but for the mother since it provides an opportunity to build
confidence as a parent. Playing together with the child may loosen the mother’s tension andeventually it contributes to the establishment of good parent-child relationship that may eventuallypromote the mother’s confidence in child rearing.
There are very few previous studies and literature regarding play preparation based on theperspective described above. Additionally, in the current medical situation, the importance oftreatment is heavily prioritized to the importance of playing and communication with one’s siblings.
Further studies in a practical manner are surely required in this field.
VI. Conclusion
In the Premature Baby Care Unit, the role that bridges between a baby in hospital and his/herparents, siblings, and other related people seems crucial. Initially, to make an efficient approach asHPS to the already established team consisting of medical staffs and baby’s parents seemed achallenge, especially to the mother. Throughout the involvement in the baby’s case however, it wasrevealed that the actual role of HPS was not to cut into the established staff-parent team but toprovide opportunities for parent-child communication through playing.
Cited reference
Chika Mastudaira (2012). Practical Use of Hospital-Play, SOUHEKI-SHA
Remarks*1) GCU (Growing Care Unit): A care unit that observes and treats infants who recover from a
critical condition(s) at and/or after birth. In many cases infants are treated at NICU initially. Once
their conditions become stable, they are transferred to GCU.
*2) The group of siblings:
The group gathering for siblings has been held 8 times a year since three years ago. The objectivesof the group gathering are 1) to acknowledge efforts of siblings and families, 2) to create a place
where siblings can express their feelings openly, 3) to share their experiences and feelings with those
who are in similar situations and 4) to help members release their stresses through playing. So far
we have held many events including handicraft sessions, festivals and hospital tours.
With time, more and more people are participating. Currently more than ten people attend thegroup gathering each time. Ages of participants vary from toddlers to around grade 4,5. When a childparticipates once, he/she often comes to the next meeting. As a result, many people in the hospital
have recognized the gathering as a regular hospital event.