AN APROACH TO IMPROVE CHILDREN?S HOSPITAL FACILITIES BY INCORPORATING A PLAY SYSTEM WITH STIMULI THAT ALOWS FOR IMAGINATIVE PLAY TO AID IN CHILDREN?S DEVELOPMENT Except where reference is made to the work of others, the work described in this thesis is my own or was done in colaboration with my advisory comite. This thesis does not include proprietary or clasified information. _____________________________________ Louisa Lockhart Stowers Certificate of Aproval: ____________________________ _____________________________ Shea Tilman Tin Man Lau, Chair Asistant Profesor Profesor Industrial Design Industrial Design _____________________________ _____________________________ Tsailu Liu George T. Flowers Asistant Profesor Dean Industrial Design Graduate School AN APROACH IMPROVING CHILDREN?S HOSPITAL FACILITIES BY INCORPORATING A PLAY SYSTEM WITH STIMULI THAT ALOWS FOR IMAGINATIVE PLAY TO AID IN CHILDREN?S DEVELOPMENT Louisa Lockhart Stowers A Thesis Submited to the Graduate Faculty of Auburn University in Partial Fulfilment of the Requirements for the Degre of Master of Industrial Design Auburn, Alabama August 10 th , 2009 ii AN APROACH TO IMPROVE CHILDREN?S HOSPITAL FACILITIES BY INCORPORATING A PLAY SYSTEM WITH STIMULI THAT ALOWS FOR IMAGINATIVE PLAY TO AID IN CHILDREN?S DEVELOPMENT Louisa Lockhart Stowers Permision is granted to Auburn University to make copies of this thesis at its discretion, upon request of individuals or institution and at their expense. The author reserves al publication rights. ___________________________________ Signature of Author ___________________________________ ___________________________ Date of Graduation iv AN APROACH IMPROVING CHILDREN?S HOSPITAL FACILITIES BY INCORPORATING A PLAY SYSTEM WITH STIMULI THAT ALOWS FOR IMAGINATIVE PLAY TO AID IN CHILDREN?S DEVELOPMENT Louisa Lockhart Stowers Master of Industrial Design, August 10, 2009 (B.IND., Auburn University, 2007) 145 Typed Pages Directed by Tin Man Lau Hospitalization can be traumatic for both children and their families. Children require play in children?s hospitals because it is beneficial for their development and crucial for their healing proces. Incorporating play into a children?s hospital can be beneficial for two reasons: it helps children understand why they are in the hospital while acting as a therapist and leads children back to the healthy lifestyle they knew before hospitalization (Pelegrini). The main objective of this project is to create an approach for both designers and playground companies to use if they choose to create a play system in a children?s hospital environment. v When children are playing in hospital playrooms, they are faced with many limitations. There are also limitations of the patients: many children are required to cary an IV, and others have varying handicaps, anything from a cast to a wheelchair. These limitations make it dificult for children to play, especialy in a playground seting. Children?s hospitals are a special entity of their own. They were created because ?Children are diferent. And they need diferent health care that focuses on their unique needs, involves their parents from start to finish and is provided in places designed to be kid-sized and child friendly? (NACHRI 3). While children?s hospitals offer multiple ways of play, outdoor play is an entity within itself that is not available to hospitalized children. An aproach was created in order to guide others through the proces of creating a play system in a children?s hospital. This aproach was then folowed by a design project that used the aproach to create a play system odeled for Vanderbilt Children?s Hospital. The project deliverable is a unique play structure that incorporates activities for the whole family, and in some way this system wil also be an educational outlet for the child, parent and siblings. The objective is for the child to be able to use certain provided elements in order to be creative and make their own environment to play in. This play system wil give children and their families a place to creatively expres themselves and forget about their suffering in the hospital. The play system incorporates the criteria outlined in the approach to make a universaly acesible playground that aids in children?s development. vi ACKNOWLEDGEMENTS This Thesis would not have ben posible if it had not been for the remarkable suport and teachings I have received from the Department of Industrial Design at Auburn University. The past six years of undergraduate and graduate learning have made me into the designer I am now. I would especialy like to thank my commite for al of their suport. I truly admire them and their work. They have ben excelent mentors. I also need to acknowledge my felow students and friends in Walace Center who have ben a constant encouragement for both my undergraduate and graduate studies. Thank you for al of your help, suport and friendship. I am also blesed to have an extremely suportive family and fianc?e who have helped me through it al. Thank you so much for your love and suport. I could not have done this without you, either. vii Style manual or journal used: MLA Computer software used: Microsoft Word Adobe Ilustrator Adobe Photoshop Solid Edge Hypershot Rhinoceros vii TABLE OF CONTENTS LIST OF TABLES AND FIGURES........................................x CHAPTER ONE: INTRODUCTION TO THE PROBLEM......................1 1.1 Problem Statement..................................................1 1.2 Ned For Study.....................................................2 1.3 Objectives of Study..................................................3 1.4 Definitions of Terms.................................................3 1.5 Literature Review...................................................5 1.6 Conclusions......................................................23 CHAPTER TWO: CHILD EVELOPMENT THEORIES......................27 2.1 Jean Piaget.......................................................28 2.2 Maria Montesori..................................................30 CHAPTER THRE: DESIGN RESEARCH.................................33 3.1 Introduction......................................................33 3.2 User Research.....................................................36 3.3 Comparative Product Charts..........................................51 3.4 Design Criteria....................................................51 CHAPTER FOUR: PLAYGROUND SAFETEY.............................55 4.1 Introduction......................................................55 4.2 The Handbook for Public and Playground Safety..........................56 CHAPTER FIVE: THE DESIGN APROACH..............................67 5.1 Introduction and Overview...........................................67 5.2 Overal Criteria....................................................69 5.3 Phase One: Create the Space..........................................72 5.4 Phase Two: Selecting The Components..................................73 5.5 Phase Thre: Create the Layout........................................75 5.6 Phase Four: Implementation..........................................76 5.7 Conclusions......................................................78 CHAPTER SIX: THE DESIGN PROJECT..................................79 6.1 Introduction and Overview...........................................79 6.2 Phase One: Create the Space..........................................79 6.3 Phase Two: Selecting The Components..................................83 6.4 Phase Thre: Selecting A Layout.......................................97 ix CHAPTER SEVEN: FINAL MODEL.....................................111 7.1 Final Model......................................................111 7.2 Universal Acesibility.............................................112 7.3 Child Development................................................118 7.4 Theme..........................................................121 CHAPTER EIGHT: CONCLUSIONS.....................................127 8.1 Closing Summary..................................................127 8.2 Implications and Applications of Study.................................127 8.3 Recommendations for Further Study...................................128 BIBLIOGRAPHY....................................................129 x LIST OF TABLES AND FIGURES Figure 1: Questionnaire From SurveyMonkey.com............................37 Figure 2: Water Halway in Monroe Carel Jr. Children?s Hospital at Vanderbilt.....45 Figure 3: Entrance of Monroe Carel Jr. Children?s Hospital at Vanderbilt..........46 Figure 4: First Floor Sibling Playroom at Monroe Carel Jr. Children?s Hospital at Vanderbilt...........................................................47 Figure 5: Fal Zone for Slides............................................58 Figure 6: Protrusion Test Gauges.........................................59 Figure 7: Protrusion Test................................................60 Figure 8: Areas on Slides Subject to Protrusion...............................60 Figure 9: Ilustrations of Entrapment.......................................61 Figure 10: Smal and Large Probes........................................62 Figure 11: Angle Recommendations.......................................62 Figure 12: The ADA Width Requirements for a Wheelchair.....................65 Figure13: Blank Comparative Product Chart.................................74 Figure 14: Diagram of Approach..........................................78 Figure 15: Entrance of Monroe Carel Jr. Children?s Hospital at Vanderbilt.........80 Figure 16: Floor Plan of The First Floor of Monroe Carel Jr. Children?s Hospital at Vanderbilt...........................................................81 Figure 17: Simplified Floor Plan of the 1 st Floor..............................82 xi Figure 18: 3D Simplified Floor Plan of The 1 st Floor..........................82 Figure 19: Comparative Product Chart of Ground Covers.......................84 Figure 20: Comparative Product Chart of Playground Structures from Game Time....85 Figure 21: Comparative Product Chart of Panels from Game Time ...............86 Figure 22: Comparative Product Chart of Playground Panels from Game Time.......87 Figure 23: Comparative Product Chart of Panels from Game Time................88 Figure 24: Comparative Product Chart of Playground Panels from Litle Tikes.......89 Figure 25: Sketches of Bongo Panels from Game Time and Litle Tikes............91 Figure 26: Sketch of Rain Wheel Panel.....................................92 Figure 27: Sketch of Slide and Slide Roof...................................92 Figure 28: Sketch of Store Panel..........................................93 Figure 29: Sketch of Tic Tac Toe Panel....................................94 Figure 30: Sketch of Wheel Panel.........................................94 Figure 31: Sketch of Baloon Piece........................................95 Figure 32: Sketch of Cloud Roof..........................................96 Figure 33: Sketch of Sky Tunnel with Fun House Mirors.......................96 Figure 34: Comparative Product Chart of Playground Layout from Game Time......98 Figure 35: Comparative Product Chart of Playground Layout from Litle Tikes......99 Figure 36: Layout Shapes...............................................101 Figure 37: Layout Shapes Packet and Placement.............................101 Figure 38: Layout One.................................................102 Figure 39: Layout Two................................................103 Figure 40: Layout Thre................................................103 xii Figure 41: Layout Four................................................104 Figure 42: Layout Five.................................................105 Figure 43: Final Layout Phase One.......................................105 Figure 44: Final Layout................................................106 Figure 45: Drawing with Slanted Rails.....................................108 Figure 46: Drawing with Climber Rails and Rainbows.........................108 Figure 47: Drawing of the Slide with Play System Roof........................109 Figure 48: Final Drawing of The Play System...............................110 Figure 49: Hypershot Rendering of Play System.............................111 Figure 50: Final Model................................................112 Figure 51: Top View of the Ramps.......................................113 Figure 52: Ramp Entrance..............................................113 Figure 53: Side View of Ramps..........................................114 Figure 54: The Big Foot Slide and Sun Roof................................115 Figure 55: Platforms and Designated Wheelchair Area.........................115 Figure 56: Slide Handles...............................................116 Figure 57: Side View of Slide...........................................116 Figure 58: Miror Tunnel...............................................117 Figure 59: Entrance of Tunnel...........................................117 Figure 60: Music Cluster...............................................118 Figure 61: Activity Cluster..............................................119 Figure 62: Second Gizmo Panel..........................................120 Figure 63: Theater Panel...............................................121 xii Figure 64: Ground Cover...............................................122 Figure 65: Cloud Roofing..............................................122 Figure 66: Baloon Pole Toppers.........................................123 Figure 67: Ramp Rainbows.............................................124 Figure 68: Sun Roof...................................................124 Table 1: Critical Heights (in fet) of Tested Materials from the Handbook of Public Playground Safety.....................................................57 1 CHAPTER 1: INTRODUCTION TO THE PROBLEM 1.1 Problem Statement ?You can learn more about a person in an hour of play then in a year of conversation.? -Plato Many children who are hospitalized often experience psychological problems after their hospitalization (Petrilo, Sanger). Many studies show that this is caused by lack of awarenes and the absence of play. Without being aware of their ilnes, children are often scared of things that are misconceived. Play is a natural part of a child?s development and a lack of play can cause a child to be depresed and behind developmentaly (Petrilo, Sanger). There is a specific area in children?s hospitals that could use improvement: the child?s playroom. The playroom is an excelent opportunity for children and their families to come together as a community to aleviate the fear and pain of the hospital. A playroom can serve as an educational and therapeutic facilitator in a way that doctors cannot comprehend. However, as much as playrooms lack, there is also a need for playground play in children?s hospitals. Playground Play is also considered fre play, or imaginative play. This thesis wil take an in-depth look into playgrounds in hopes that one could be created for a children?s hospital. 2 1.2 Ned For Study Children who are hospitalized not only suffer from their procedures and treatments, but also often suffer psychologicaly from their ilneses. This study is to support the importance of play in the everyday lives of children. Play is therapeutic for children mentaly, physicaly, and behavioraly. Children who require medical atention are frequently visiting the hospital, and thus taking time away from their playtime. A specific play system designed for children with special needs in the hospital is not only therapeutic, but also crucial for their healing proces. ?Children are diferent. And they need diferent health care that focuses on their unique neds, involves their parents from start to finish and is provided in places designed to be kid-sized and child friendly? (Pediatrics 5). By studying the importance of play asociated with hospitalization, a new type of play system was developed. This play system incorporates the necesary elements gathered from research of children playing on playgrounds and in other outdoor environments to aleviate the stres for children and their families during their stay in the hospital. Many children suffer psychologicaly because they are unaware of what wil happen to them while they are in the hospital. The American Academy of Pediatrics isued a policy statement that ?urged doctors to relieve needles suffering by helping children beter anticipate and ases pain, creating soothing environments and geting parents more involved? (Warner 2). With a new play system geared to fit children during hospitalization, they wil be les stresed because there wil be means to explain ilnes and therapeutic exercises to help them understand diferent medical problems. By 3 solving these problems, children wil have a more efective hospital stay and wil recuperate faster with les psychological harm. 1.3 Objectives of Study The objectives of this study is to research the experience for children in children?s hospitals. The study wil also incorporate the benefit of play and education in hospitals. The study wil identify the key aspects that either benefit or harm children during hospitalization. There wil be research in specific areas of the hospital and with diferent playground components. After the research a new approach wil be created to aid designers and playground manufacturers to create an innovative playroom that uses education and therapeutic play to aleviate stres on children and their families during their hospital experience. 1.4 Definitions of Terms 1. Child Life Specialist- a person who provides the environment and opportunity to counteract the streses inherent in most hospital experiences 2. Child Life Council- a profesional organization recognized by the American Academy of Pediatrics 3. Distraction Play- play that takes the child?s mind of of the pain from their treatment 4. Inpatient- patient who stays in a hospital while receiving medical care or treatment 5. Outpatient- a patient who receives treatment at a hospital, as in an emergency room or clinic, but is not hospitalized 6. Hospice- a health-care facility for the terminaly il that emphasizes pain control and emotional support for the patient and family, typicaly refraining from taking extraordinary measures to prolong life 4 7. Chronic Ilnes- long lasting ilnes, usualy for life. 8. Play- a dynamic, active and constructive behavior that is an esential and integral part of al children?s healthy growth, development, and learning across al ages, domains and cultures 9. Psychoanalysts- a profesional who studies the method of psychological therapy originated by Sigmund Freud in which fre asociation, dream interpretation, and analysis of resistance and transference are used to explore represed or unconscious impulses, anxieties, and internal conflicts, in order to fre psychic energy for mature love and work. 10. Psychosociologist- a profesional who studies subjects, isues, and problems common to psychology and sociology. 11. Physical Development- the development of a child?s body and physique 12. Social Development- the development of a child?s ability to interact with others 13. Emotional Development- the way a child expreses themselves through their emotions 14. Cognitive Development- planning skils and atitudes along with creativity and divergent thinking 15. Infant- birth to two years of age 16. Toddler- ages 2-4 17. Early School Age- 4-6 years old 18. Sensorimonitor Play- simple but consistent action schemes through trial and eror along with practice 19. Pretend Play- children cary out plans, take on roles, and transform objects as they expres their ideas and felings about their social world. 20. Anxiety- distres or uneasines of mind caused by fear of danger or misfortune 21. Egocentrism- thinking of oneself without thinking of others 22. Universal Acesibility- refers to the ability of al people to have equal opportunity and aces to a service or product from which they can benefit, regardles of their social clas, ethnicity, background or physical disabilities. It is 5 a vision, and is some cases a legal term, that spans many fields, including education, disability, telecommunications, and healthcare. It is tied strongly to the concept of human rights. 1.5 Literature Review Children require play in children?s hospitals because it is beneficial for their development and crucial for their healing proces. Hospitalization is a traumatic experience for people of al ages, especialy for children. A child is developing cognitive behaviors, and events of trauma and stres outside of their normal lives can lead to future psychiatric problems. There are concerns that medical profesionals are not taking this psychological aspect into acount. Harold Geist, a consulting psychologist at the University of California at Berkeley, states, "The magnificent and technical achievements of modern medicine somehow sem to overshadow the human aspect of treatment of disease and nowhere is the psychology of treatment and "humannes" needed more than in the preparation and care of children before, during and after hospitalization" (Geist 4). Many medical profesionals can overlook children?s needs during their hospitalization. Doctors and technicians can talk over the child to where they do not understand what is happening, thus heightening the fear and stres of the child. It is esential for profesionals to create an environment for children that helps them fel a sense of understanding and normalcy while they are undergoing surgeries or treatments. Not only is the special atention of profesionals necesary but also for al other members of the family in order for the child to cope with their hospitalization. The environment of healthcare is substantialy important for the child?s healing proces. By using color theory and environmental psychology, a hospital can become a 6 place of comfort for children and their families, rather than a stresful stark environment. Incorporating play into the everyday treatments and procedures of hospitalization wil help the healing proces for the child. 1.5.1 The Importance of Play ?Play sustains children?s inborn curiosity while they manipulate and change their surroundings? (Boss, Chapman). In today?s society, with new technologies, deforestation, and lack of outdoor areas, children are losing time to play. Adults are forgeting the importance of play in a child?s life. Parents forget that ?play- a dynamic, active, and constructive behavior- is an esential and integral part of al children?s healthy growth, development and learning across al ages, domains, and cultures? (Isenberg, Quisenbery 1). Play is also defined as ?the spontaneous activity of children? (Longo 1). This being said, it is important for a child to constantly have play implemented in their life. Play is how children blindly develop crucial life skils while they think they are just having fun. Incorporating this into the hospitalization proces could be vital for the stres ad fear relief of children. ?The absence of play is an obstacle to the development of healthy and creative individuals? (Isenberg, Quisenbery 1). If a child remains isolated from play, he or she wil lose the opportunity to gain cognitive growth, proper behavior, and problem solving skils. Bev Boss and Jenny Chapman state ?we must advocate for places where children wonder, discover, imagine, construct, and learn by trial and eror so that from their experiences they can develop their own framework of knowledge and a firm sense of self.? In most cases where a child is hospitalized, they are already scared and 7 traumatized. Being in a hospital could mean isolation for the child, and, without play, a child?s development could suffer greatly if play is not implemented into their normal hospital routine. One of the hardest things for adults to grasp is the distinction betwen play and other types of learning. Acording to Isenberg and Quisenbery, there are five behaviors that can qualify play: 1) intrinsicaly motivated and self-initiated, 2) proces oriented, 3) non-literal and pleasurable, 4) exploratory and active, and 5) rule-governed? (2). These qualifications describe how the child learns through play. Play also ?increases peer relationships, releases tensions, advances intelectual development, increases education, and increases chances of children speaking and interacting with each other? (Longo 2). While child psychology plays an important role in children?s play, there are diferent aspects of play. As a child develops, they respond to play in diferent ways, thus proving play?s developmental importance. The foremost qualities that are enhanced when children play are their physical, cognitive, and emotional skils. In terms of a child?s physical development, play is esential in the development of ?motor skils and body awarenes? (Isenberg, Quisenbery 1). In many circumstances, children only have physical education once a wek, and reces is the only time children have the opportunity to get exercise in their day. The amount of play a child is exposed to can significantly afect their physical development because play is their form of exercise. Incorporating play into a child?s daily routine can help decrease the number of obese children. ?Play? is a les offensive word than exercise and can tend to be more appealing to both children and adults. If children are used to physical activity, then there 8 is a greater possibility that they wil continue to exercise as adults. In a hospital, many children lack physical activity, and there are many times when they are solely entertained by television or video games and do not have the chance to play in a physical manner. Many children are also physicaly impaired and do not have the ability to exercise, but by implementing similar means in handicapped playgrounds in an indoor seting there wil be ways to acommodate these children and give them the physical activity they need (Pelegrini). Along with physical development, play also afects social development. Humans are social beings, which forms the meaning of society. By playing, children are forced into social situations with other children and adults. They are forced to learn how to act as a member of a group. In Isenberg and Quisenbery?s paper on play, they state, ?Play provides the rich experience children need to learn social skils; become sensitive to others? needs and values; handle exclusion and dominance; manage their emotions; learn self control; and share power, space, and ideas with others? (3). Many children participate in games on the playground, which teaches children ?How to subordinate their behavior and wishers to the rules of the game? (3). As was stated in the section on child psychology, a child leaving the state of egocentrism is a child who is developing into the concrete operational stage by acepting and understanding the ideas and needs of other children. Many anti-social children have been proven to be susceptible to clinical depresion (Petrilo, Sanger). To engage children with others while he or she is in the hospital could be one of the most succesful and preminent ways to surpas the other elements that could developmentaly hinder a child while he or she is staying in the Hospital(Pelegrini). 9 Play is in many ways asociated with a child?s cognitive development. Cognitive development is the construction of thought proceses, including remembering problem solving and decision making, from childhood through adolescence to adulthood. Play has an important role in child learning on the playground and in the clasroom. ?They identify improvements to atention, planning skils, and atitude creativity and divergent thinking perspective taking, and language development? (Isenberg, Quisenbery 3). These life skils are al very crucial to the child?s social and developmental wel being. ?Children's play depends largely upon the play materials, equipment, and role models available to them. Early exposure to appropriate play activities and materials is important and provides a sound basis for development? (Isenberg, Quisenbery 5). Piaget?s theory in cognitive development states play is one of the most crucial aspects in furthering a child?s problem solving skils. In the preoperational stage, play stimulates identifying objects and imitating others. Children build this knowledge off of each other, and a hospitalized child wil be behind the learning curve if they are not given a chance to play and communicate with other children. As children mature and begin the concrete operational stage, children need to be around others to improve problem-solving skils. Without play, children wil not be with others, and solitude can be one of the worst things for a child?s development (Casey). Play not only efects a child?s physical, social and cognitive development, but it also impinges on children?s emotions. ?It is the happines that children can achieve 10 though play that may be the most important mesage to communicate to parents about the benefits of physical activity in children? (Brunete, Whitaker 3). In many studies for both adults and children, it is been shown that exercise relieves felings of depresion and anxiety. ?These streses experienced by a child?s brain result in a number of physiologic responses in the body collectively refered to as an ?alostatic load? (Brunete, Whitaker, 3). Many children can easily become depresed while they are in a hospital for a long amount of time. The look on a child?s face when they enter a playroom exudes happines because playtime makes children happy, and for a hospital playroom it is crucial for the emotional wel being of a child (Isenberg, Quisenbery). Many studies show that most of the benefits of playing are frequently sen when children are playing outside rather than inside. This can be for numerous reasons, but the most predominant is that we are human beings and our natural element is outdoors. Children se the outdoors as an endles place of exploration and wonder. Whether it is watching animals in their habitats, watching a plant grow, or understanding the importance of the sun, there are many wonders in the outdoors that give children a unique outlet for their imagination and creativity (Bos, Chapman) 1.5.2 Outdoor Play There is a growing need for outdoor space for children to play. In many neighborhoods, parents are scared to let their children go outside. Theresa Casey describes the outdoors as ?Opportunities to develop friendships and negotiate relationships; opportunities to grapple with the full gamut of emotions including those 11 such as jealousy, boredom or anger as wel as happines and satisfaction; opportunities to the risks, have adventures and misadventures; to have contact with nature and the environment? (Casey 6). When discussing a hospital play system, it is important to look at aspects of outdoor and indoor play. There is a sense of wonder that is absent in indoor playrooms, especialy in hospitals. The research conducted in this thesis looked closely at outdoor play that gives children a creative fredom to craft their own environments,and how this imaginative play helps the healing proces of children. Play is an important aspect of a child?s life and becomes even more crucial for children who are hospitalized. Patients have a wide variety of problems but are al on a common ground when it comes to playtime. They require play whether they are mentaly handicapped, a cancer patient, burn victim or patient receiving his or her check up. A hospital has a great chance of inhibiting the children being treated. If mistreated or misled, a child can suffer trauma from a hospital visit aside from the treatment they are already there for. By implementing play in a hospital, a child has the chance to experience normalcy in an environment that can be anything but normal. Children?s hospitals must be aware of the importance of play in their facilities and do everything in their powers to ensure that they provide a superior outlet for children to play. 12 1.5.3 Children?s Hospital Facilities There is a reason why children are set apart from adults. Children lack mature behavioral and developmental skils that need to be nurtured and monitored as they grow into adults. ?Children were not just poor versions of adults, but inhabited a world of their own with its own logic and rules? (Davis 21). This being said, children have many special needs ?Children are not smal adults. Children are unique individuals with their own specialized needs? (NACHRI 1). ?Children are diferent. And they need diferent health care that focuses on their unique needs, involves their parents from start to finish and is provided in places designed to be kid-sized and child friendly. Because they?re growing and developing, children?s health care needs are constantly changing. They require extra time, extra monitoring, specialized medications, and caregivers with the skils and compasion to understand the needs of children. For example, hospitalized children under age 2 require 45 percent more routine nursing care? (NACHRI 3). An article published by the National Asociation of Children?s Hospitals states the importance of pediatric care: ?While children?s hospitals represent les than 5 percent of al hospitals, they acount for more than 40 percent of inpatient days and 50 percent of costs for children hospitalized in the United States - $10 bilion worth of care every year? (NACHRI 3). In the United States there are approximately 250 children?s hospitals, which only acounts for fewer than 5 percent of al hospitals (NACHRI 1). 13 Children?s hospitals are extremely important in that there are a lot of underprivileged children that require medical atention. ?Children?s hospitals protect this unique population. They are dedicated to ensuring that every child has aces to high quality, cost efective, primary, preventive and specialty care services tailored to fit their needs? (NACHRI 4). These underprivileged children are a large number of patients for children?s hospitals. The warmer the environments, the beter off the children are in understanding their ilnes because much of the time they do not always have parents present (NACHRI). ?The children?s hospital in your community is realy thre hospitals in one: a hospital that specializes in treating children with complex, chronic or congenital conditions; a community hospital for al area children providing preventive and primary and acute care; and a safety net hospital for uninsured or underinsured or publicly covered children? (NACHRI 1). Al children who set foot into a hospital are in need of special atention. Those who are in for a long stay need to be reasured that this is a fun place filed with toys and other ways to ease the suffering that awaits them. In Alan G. Davis?s book, Children in Clinics, he discusses in extensive detail the special needs of children in hospitals for both short term and long-term visits. He describes children as ?not just poor versions of adults, but inhabited a world of their own with its logic and rules which the worker sought to grasp to make that the child?s actions sensible? (Davis 21). 14 The environments in children?s hospitals are frequently diferent from other hospital environments. Colors are brighter, furniture is smaler, and there is usualy an underlying theme throughout the space. These are obvious diferences, but important ones. It is the same reason why a child?s bedroom is diferent, and why younger school environments difer from those of a high school. Young children are more comfortable in a bright environment, and they tend to develop in a more eficient manner (Petrilo, Sanger). As medical profesionals begin to understand the special needs of hospitalized children, a profesion is emerging to ease the stres of the hospitalization proces for children and their families. In the 1970?s, studies were administered that proved a les stresful environment wil lesen the stres on a child, increase their surgical outcomes and improve their psychological outcomes. This profesion is titled Child Life. These men and women work alongside the nurses and doctors with the sole purpose of making the child more comfortable. Whether it is using a stuffed animal to explain a medical procedure, or constantly checking in to give the child a sense of security, Child Life Specialists work to improve the environment of the hospital and to make the child at ease, which increases the outcome of their surgical stay (Child Life Council). Child Life Specialists not only work with children but with the parents and families of the hospitalized child. ?Child Life Specialists provide the environment and opportunity to counter act the streses inherent in most hospital experiences,? says Myra Fox, director of Child Life Services at the Children?s Hospital in Boston. ?We incorporate the child?s perspective into the treatment plans. The staf contribute greatly to our understanding of the whole child? (Children?s Hospital Boston 1). 15 Another study in 2001 done by the American Academy of Pediatrics caused the Academy to isue a policy statement that ?urged doctors to relieve needles suffering by helping children beter anticipate and ases pain, creating soothing environments and geting parents more involved? (Warner 2). This is one of many studies that stres the special needs of children. Children?s hospitals cary a greater responsibility than just healing; they are responsible for the entire experience of hospitalization and the efects to follow (Warner). There are ways to aleviate pain and confusion for a child undergoing a hospital procedure. The way to do this is by the environment, distraction, education and reasurance. If the child ses the procedure performed on a doll, then they understand what is about to happen to them, and the idea of the surgery becomes les scary. The Children?s Hospital of Boston gives an example discussing a dialysis patient. ?The two play games, work on projects such as making fashion books, simulate medical procedures on stuffed animals and props and practice deep breathing relaxation techniques? (Children?s Hospital Boston 1). The job of a Child Life Specialist has become beneficial for hospitalized children, and crucial for the best outcome possible of their hospitalization. An example scenario for a Child Life Specialist is as follows: a child life specialist uses lip balm for the children he or she is caring for. ?The point of the lip balm is ?to give the child a sense of control and choice,? Milar says. Together, they smel each lip balm flavor, until Josh chooses his favorite. Milar rubs the balm al over the interior of his 16 induction mask. Holding it to his face, Josh grins. It smels just like cheries? (Herwald 1). Alan Davis discusses the importance of the role of a parent when a child is in the hospital: ?Bearing al these things in mind, it is not surprising that medical work with children and their parents is more oriented to the parents? definition of the child?s status than to the child?s own and his or her experience of ilnes or health? (Davis 26). Child Life Specialists are trained to handle grieving parents. They ?help family members understand their child?s response to treatment and can help parents maintain their care- giving roles by promoting parent/child play sesions and by sharing strategies for comforting their children during medical procedures? (Pediatrics 5). Even siblings need that extra comfort and reasurance. Many Child Life Specialists give them special tours of the ICUs, and dolls are also used to show the sibling what is about to happen to their brother or sister. ?It is important to protect children and families from prolonged or repeated exposure to situations in which they fel overwhelmed, unable to escape, or unable to have choices? (Pediatrics 5). The Child Life program has a vast efect on the hospital and its patients. Acording to Pediatrics Magazine, ?The increased survival rate of chronicaly il patients has resulted in an expanded need for child life specialists in adolescent care? il adolescents are making the transition to the adult health care system. Child 17 life specialists have often played a role with the health care team in helping with that transaction?(Pediatrics 5). The emerging profesion of the Child Life Specialist proves the importance of treatment for children in the hospital. The positive efects of the Child Life Specialist show that with explanations, distractions and special care, the stres level of a hospitalized child is dramaticaly decreased. With this decreasing stres, there are in turn beter results of the child?s hospitalization. ?A 2001 survey by the National Asociation of Children?s Hospitals and Related Institutions found that 95% of 118 responding hospitals employed child life specialists.? ?A ratio of 1 child life specialist to 15-20 inpatients has been used succesfully in some institutions; however, the patient?s age and mobility, the patient population on the unit and the institution?s needs should influence the stafing alocation? (Pediatrics 2). Because of the growing need for more Child Life Specialists it is important to explore other options of play and relieving the stres of hospitalized children, whether it is educating by a child?s playroom, a play system, the hospital room itself or other programs that teach parents ways to aleviate the suffering and confusion of their child without the constant supervision of a Child Life Specialist. As children?s hospitals become more and more focused on the need of children, it is important that every aspect of a children?s hospital caters specificaly to these sick children. By further exploring the 18 options to ease child and family suffering during hospitalization, the children?s hospitals wil become overal more succesful by seting themselves apart (Pediatrics). 1.5.4 Psychological Outcomes of Hospitalized Children ?Psychological preparation is a ?proces of communication, acurate and developmentaly appropriate information, identifying potential stresors, as wel as planning and practicing coping strategies? (Pediatrics 4). The first steps a child takes in the hospital could be one of the most significant points in a child?s hospital stay. This is the first impresion of what this experience wil entail. Geist describes this experience for the child in his book A Child Goes to the Hospital: ?Everything is strange: white uniforms, suggestive equipment and a bewildering amount of activity of strange people? (Geist 29). Studies have shown that the heart rate of a child entering the hospital within the first twenty seconds can predict the possibility of post-traumatic stres disorder in children. ?Recent findings support the ability of initial HR to predict PTSD symptoms in child trauma victims. Specificaly, HR asesed upon admision to the ED significantly predicted PTSD (Post Traumatic Stres Disorder) severity and diagnostic status? (Nugent, Christopher, Delahanty 2). This supports the importance of making the child fel comfortable from the very moment that they step into the hospital. Risking PTSD would undermine the purpose of the Child Life Specialist within the first twenty minutes of being in the hospital (Nugent, Christopher, Delahanty). The goal of a children?s hospital is to convey the totaly opposite experience. From the moment they se the building, al fears are released, and, when they walk into 19 to the lobby, they are excited to be in a new and exciting place. Making the child fel this sense of security is crucial for their psychological development because they view the hospital as a positive experience rather then remembering the fear they felt entering the hospital. 1.4.5 Parental Influence A child in the hospital is as significant and traumatic for the family as it is for the child himself or herself. Many studies and resources stres the relationship and participation of the parents during the child?s hospitalization. Without parental guidance, the child wil have a dificult time deciphering the change his or her body is experiencing. The parent who guides and disciplines him or her on a normal basis is responsible to aid him or her in understanding his or her ilnes. If this occurs then the child wil fel les guilt because he or she understands what his or her body is experiencing and he or she realize it is out of his or her control. Harold Geist writes about a study performed by Prugh concerning one hundred children. They were admited with primary medical needs for eight days. Fifty had regular parental visits and the other half had restricted family visits. Geist describes the results: ?In asesing the influence of hospitalization on both groups, the reactions of the children were divided into severe, moderate and minimal categories. Severe was defined as anxiety after thre months from discharge; moderate was defined as les than thre months and minimal by mild and transient disturbances in adaptation largely in the hospital? In 20 the main, children in both groups who achieved most succesful adjustment on the ward were those who semed to have the most satisfying relationship with their parents, especialy their mother? (Geist 6). The age group most afected by this change were children two to four years old. These children are stil in a highly developmental and dependent stage of their lives. This study might have been set in a standard that was too black and white and also gives minimal statistical data. However, other studies show that without parental guidance, a child is disturbed by their own maleficent behavior. In many cases children are experiencing disorders or taking medications that force them to ornery and malicious behavior. Geist describes Anna Freud?s view on the mater stating, ?To the distres of ilnes is added the distres of separation from the home, and here the child is defenseles. He submits with his body but retreats with his mind? (Geist 35). This study shows some of the early discoveries of parental importance in the hospital. Since then many studies have been conducted to explore options of parental involvement during their child?s hospitalization. For parents, involvement with their child can be dificult, but the psychological outcomes for the child far outweigh the streses on the parent. ?As parents are often the most important source of comfort to the children, it is critical that pediatric intensive care staf are able to identify the predominant sources of parental distres and are able to implement strategies that can help parents to manage these stresful situations in the most constructive way? (Calery 1). 21 In a survey of 6,000 parents in thirty-eight hospitals, parents rated the care they received while they were in the hospital. The parents rated everything contributing to their experience and the results were surprisingly good except for over twenty percent had a problem with the child?s care. The area of care the parents were concerned with was the communication betwen the medical profesionals and their patients. Thirty percent of parents felt that they were not communicating very wel and because of that it was more dificult for them to care for their child during and after hospitalization. Thirty percent might not sem like much at first, but out of the six thousand parents 1.800 of them were not communicating properly, making communication the leading problem for children in the hospital (Children?s Health 1). ?It is subtly implied that they cannot change a drink or change his diaper because no one tels them they may. Sometimes they must ask permision even to visit their child? (JSTOR 1). This database is discussing how nurses and doctors should handle parents. There are many times a parent fels completely helples; their child?s ilnes is out of their control, and they are depending on strangers to help their child. Parents have a sense of importance when they are in control. Many times it is helpful to be personal with the parent. ?Show how Susan likes her bed fixed at night? reminds the parents of their special knowledge about their child and their special capability to make her comfortable?(JSTOR 1). St. Joseph?s hospital in Marshfield, Wisconsin, wrote guidelines to parents who have hospitalized children. They state ?the best way to develop a good relationship with the health care providers is to expres your ideas, concerns and opinions regarding your 22 child?s treatment? (St. Joseph?s 1). They also encourage parents to be as knowledgeable as possible with their child?s ilnes. The more they know, the more they can participate and maintain some of the control they are used to having. As a parent, sometimes it can be dificult to balance atention towards the child. In many cases parents have given too much atention and emphasis during the hospital stay, so the child wil expect the same when they leave the hospital (St. Joseph?s). In many cases the parent and siblings of the hospitalized child wil experience trauma in the hospital. ?Parents and other family members may be highly anxious about the child?s ilnes or the various diagnostic and treatment regimens, and such anxiety can be transmited easily to the patient? (Pediatrics 5). A lot of this stres is due to understanding the ilnes of their child or sibling. A survey of 6,000 parents of children in 38 diferent hospitals shows that ?Overal parental ratings of care were asociated most closely with communication about their child?s condition and involvement in the care of their child? (Children?s Health 1). Parents are scared as it is, and the last thing they need to deal with is the confusion of what is happening to their child. Misconceptions are very inhibiting in the child?s healing proces. For example, ?One girl, she said, thought that she would die as soon as her IV bag ran out. As a result she didn?t slep through the night because she was fearfully watching each drip of her IV disappear? (Warner 2). This is a clasic example of misconceptions and how important it is for the child and the parent to know exactly what is going on for their full stay in the hospital. The misconception of the child who was scared of her IV caused her to lose slep and thus hindered her healing proces. Without proper communication the child 23 and parents could have irational and unreasonable hopes and fears. Robert Priedt describes the situation: ?parents who felt confident talking with doctors, and parents whose child had been previously hospitalized were more likely to play a role in important medical decisions about their children? (Priedt 1). In conclusion, parents play a significant role in the life of their child during hospitalization. The parent is the sole disciplinarian at home, and without their support the child is les likely to be able to cope with their ilnes. ?Ultimately parents are responsible for the care of their child once they leave the hospital. When parents fel informed and empowered they are more likely to be prepared to care for their child? (Priedt 1). 1.6 Conclusions Hospitalization can be one of the most terifying things a child and his or her family could possibly experience. His or her body is acting out of his or her control, and he or she is forced to rely on strangers to fix him or her. A hospital environment has the possibility to be as friendly or as stark as the administration fels. It has been proven that easing stres on the child wil not only help him or her understand their ilnes, but also help him or her heal faster if he or she finds that he or she is more comfortable in the hospital environment. Children?s hospitals were created because children require diferent needs and atention than adults. Because their brain has not fully developed, children are more susceptible to harm or trauma if they are not treated as a child rather than an adult. Children?s hospitals are taking in a large percentage of research funding because working 24 with children is easier to research because children tend to heal faster. These children?s hospitals also act as a safe harbor for underprivileged and uninsured children. Because of the special needs of children, the hospitals that treat them need to cater to their specific needs. The Child Life profesion was created because studies were showing that children were lacking an understanding of what they were experiencing during their hospital stay. What used to be termed ?play ladies? is now one of the most important profesions in the hospital. These Child Life Specialists work to aleviate the stres on both the children and their parents during the hospital stay. By using dolls, toys and other distractions, the Child Life Specialist explains procedures to the child and also acts as a mediator to the parents. As great a concept as this is, these Child Life Specialists are greatly outnumbered, taking up to 30 children at a time. They are also responsible for running the playrooms for the children. If these playrooms could cary some instruction for the parents and children, then the Child Life Specialists could divert some more specific atention to each child, and beter perform their job. Aside from Child Life Specialists, the parents are the most important facet of stres relief and comfort to the child. Parents are the ones who are usualy disciplining and caring for the child, and hospitalization tends to hinder the disciplinary and caring practices of parents. Studies have demonstrated that children require parental influence and participation during their hospitalization. Even though the hospital stay can be even more stresful for the parents than the child, they ned to stay aware of everything that is happening to their child. Self-education is parents of the most important things parents can do; it alows them to participate in the activities of the hospital. The parents often 25 offer crucial advice to the doctors, nurses, and child life specialists, because they are the ones that raised the child. An educational playroom would aid the vital proces of parent and sibling education. Along with education, play is also an important part of a child?s behavioral development. Play incorporated with treatment is a therapeutic way to distract children from the pain and fear of being in the hospital. Play is a natural part of a child?s behavioral development. For children in an inpatient unit, the ability to play is sometimes hard to come by. Therefore, Child Life Specialists are responsible for bringing play to the children. For oncology patients, their white blood cel count is so low they cannot aford to play with other children because their imune system is so low. A playroom that even caters to these patients could help the development of the child. Play afects the physical, psychological and cognitive development of children, and without it a child could become developmentaly behind other children after their hospitalization. Incorporating a playroom catered to hospitalized children wil be beneficial to their developmental skils by alowing them to interact with others and distract themselves from the other dificult aspects of the hospital. Children require play in children?s hospitals because it is beneficial for their development and crucial for their healing proces. Children?s hospitals were created to cater to the special needs of children because they require special care. Children are diferent because their behaviors are not fully developed. As medical profesionals have become more aware of this diference, a new profesion has emerged to lesen the stres of hospitalized children and their families. Child Life Specialists are trained to work as a liaison betwen doctors and the families to facilitate the hospital proces. This is a new 26 profesion, and most of the time the Child Life Specialists are highly outnumbered. Creating a playroom wil facilitate the job of a Child Life Specialist, educate parents and children as wel as further their development by creating an outlet for play. 27 CHAPTER TWO: CHILD EVELOPMENT HEORIES 2.1 Introduction As it has been discussed earlier in this thesis, there is a concern for the development of children who are trapped in a hospital with no place to continue their learning and no place to play. There are many psychologists and teachers who have studied the development of children, but there are two in particular that have extensively impacted child psychology and children?s learning environments. Jean Piaget was a pioneer in early child development and developed his own theory, which categorized children?s learning ability in stages of development. Another pioneer of her time was Maria Montesori. Most elementary and early education facilities are based on her conclusions of almost one hundred years ago. Montesori was a doctor who studied children?s learning environments and made significant conclusions on how to aid a child?s development in an educational seting. Piaget and Montesori were leaders in a movement to give children a beter seting for home, school and play environments. Their theories and conclusions were instrumental in the final project of this thesis. It is crucial to understand the psychology of a child when designing environments for them. Using the findings of Piaget and Montesori, this playroom wil give a child a place where they can create a play environment, which wil enrich their mind as they have an extended stay in the hospital. 28 2.2 Jean Piaget Jean Piaget was originaly a scientist who became both a psychologist and a philosopher. Piaget?s first interest was in marine life, and later became children and their behavior. While teaching in Paris at the Grand-Aux-Beles, he began working on a series of inteligence tests and realized the complexity of children?s answers and became fascinated with their development. ?This suggested to him that younger children were not les knowledgeable, but, instead, answered the questions diferently than their older peers because they thought diferently? (Peligrini 20). Piaget?s greatest contribution to child psychology was his theory of Cognitive Development, which describes a child?s development to adulthood in four diferent stages. The first stage of cognitive development is the sensory monitor stage, which ranges from birth until the child is two years old. The sensory monitor stage is the ?root of al intelectual development? (Wadsworth 33). The sensory monitor stage is a very detailed phase and includes six subcategories. The child enters the world using his or her reflexive behavior, and at two years, the child is moving toward their symbolic reasoning, which is the start of the second phase. The second stage of cognitive development is the preoperational stage that ranges from ages two to seven. This stage begins with symbolic thinking and alows for creative play. At this time, the child is also extremely egocentric. They do not understand the views of others, and many of their actions revolve around themselves. ?The ability for the child to decenter is the beginning of the third phase? (Boere 4). 29 ?Piaget considered that children primarily learn through imitation and play throughout these first two stages as they build up symbolic images through internalized activity.? Most of the activities that involve ages two to seven focus les on language and development and more on symbolic memorization such as colors, shapes and the alphabet. The third stage of cognitive development is the concrete operational stage, which ranges in children ages seven to eleven. The concrete operational stage begins by a child decentering and leaving egocentric thought and concludes with conversation and logical thinking. Children begin to understand the meaning of numbers and how to use them. As they eliminate egocentrism, they begin to understand the perspective of others and can use problem-solving skils, which brings the fourth and final stage. The fourth stage is caled the formal operations stage. This phase begins when children start puberty and can think abstractly on the data they are given. ?Sucesful completion of the formal operations stage is evidenced by an appreciation for decentering views, a general lack of discrimination, creative viewpoints and a confidence in one?s diferences from the mainstream? (Life Script 3). These stages are significant to the design of a playroom because certain stimuli wil pertain to children of diferent ages. To give children the paramount experience, the playrooms must engage their learning abilities without them knowing it. A playroom caters mostly to the children in the second and third stages of development. This is why the project is intended for children ages two to seven. For the children in the preoperative development stage, they require many stimuli that encourage them to learn basic things, like color and numbers. In a playroom, this can 30 be implemented in many ways through the design. The older children from ages seven to eleven are going to require a more in-depth way to play, because they require time with each other and time to explore in order to reach the fourth level of development and master complex problem solving. 2.3 Maria Montesori Maria Montesori began her research with children who had intelectual and developmental disabilities, and through her succes she began to implement her methods to children without disabilities. The Montesori Method bases itself on the self-directed activity of children where the instructor acts more as an observer to the child. There are numerous activities and stimuli involved in the Montesori Method that are based on the developmental needs of the child in order to teach them lesons that help them learn and master tasks as they become more mature. The main concept that is the foundation from the Montesori Method is that children develop and think diferently than adults, and their education needs to be geared toward these diferences. The Montesori Method goes against traditional schooling of discipline and tests, and teaches children through self-directed learning. While the Montesori Method mainly discusses the schooling environment, many of the principles of this method can be incorporated into the design of a hospital playroom. To make the environment adaptable for the child and for the supervisor to act as an observer rather than an instructor can be extremely constructive to the development and healing proces of the child. 31 Montesori was very specific about the atmosphere the clasroom provided. She created a clasroom with smaler furniture for the children to move and create their own spaces. ?I had tables made with solid octagonal legs, spreading in such a way that the tables are at the same time solidly firm and yet very light, so light indeed that two four-year-old children can cary them about?I?m also delighted and had manufactured litle chairs. My first plan for these was to have them cane seated, but experience has shown the wear on these to be so great that now I have chairs made entirely out of wood? (Montesori 82-83). Along with the furniture, Montesori created a smal washstand to fit the children and cubbies for their personal belongings that were low enough for the children to aces. These methods are present in most preschool and elementary school clasrooms. Children require an environment that fits the way they learn. By having child-sized furniture, Montesori claims that children learn to command movements by having things that they can easily move and adapt. If by an awkward movement a child upsets a chair, which fals noisily to the floor, he wil have evident proof of his own incapacity. This can also be said for a hospital playroom. The furniture and environment should be suited for the child. The furniture should be smaler, lighter, and colored for children. The idea for a personal space for the child is another idea that can be implemented in a hospital playroom. To give each child his or her own personal space 32 could give the child an extra sense of security and ownership while they are far away from home. A teaching on which Montesori was extremely adamant is that discipline must come through liberty. ?We do not consider an individual disciplined only when he has been rendered as artificialy silent as a mute and as imovable as a paralytic. He is an individual, annihilated, not disciplined? (Montesori, 85). Along with teaching children that discipline comes through liberty, Montesori also was an advocate for child independence. ?Litle children from the moment which they are weaned are making their way to independence? (Montesori, 97). Montesori believed that al of her teachings lead children on their way towards independence. This should be the role for most educators. Children are learning in schools to become a functional adult member of society. This value of independence is often absent from the hospital. The children require constant care and supervision from others; a hospital playroom is what children need to practice their independence. Playing is the way for children to explore and create. A succesful playroom should offer this for each child to give them independence at a time when they are controlled by so many things at the hospital. 33 CHAPTER THRE: DESIGN RESEARCH 3.1 Introduction Through literary research it is evident that there is a need for a stimulatory play system that improves a child?s and their families? experience in the hospital. Researching the entire experience of hospitalization and the experience of play in a normal seting wil not only further knowledge of the important criteria that wil be necesary to create this play system, but it wil also show the value of play for patients and parents. The value of stimulatory imagination is to ease the stres of the child and parent by creating an outlet for play. This play outlet facilitates parents and children during a time of trauma and mas stres, and it is proven that they wil have a faster recovery period (Petrilo, Sanger). In the beginning of the initial thesis proposal, basic interviews were conducted in order to give insight to the diferent needs in children?s hospitals and specificaly in their playrooms. Through basic research of the role of doctors, nurses, Child Life Specialists and parents of hospitalized children, it was obvious which direction this thesis would take. Doctors had litle to do with the child until they were in their recovery. The doctor starts with a very brief meting with the child, but the rest of their experience is on the medical side. Nurses tend to have a stronger relationship with the patient since they are conducting most of the basic tests with the child. The Child Life Specialist is there to know the child and to explain to them the tests being conducted. The Child Life Specialists are also the ones who encourage and play with the children. Their opinions 34 wil be extremely important in this project. The parents also play a large role in the hospitalization proces of the child. Creating a play system for parents to help their child play could ease their suffering as wel. By researching the roles of diferent groups of profesionals in the hospital, certain conclusions were drawn. Doctors are too busy medicaly to atend to the play of the child. Nurses are busy with medical information and are usualy understafed. The Child Life Specialist is crucial to the comfort of the child, but usualy a Child Life Specialist is taking care of up to 50 children at one time depending on the unit of the hospital. The parents interviewed said that the scariest part of the hospitalization proces was the fact that there were medical profesionals running about and not teling them about the actions they were performing or what was going on. Obviously communication is a big problem in the hospitals. The parents are usualy briefed, but it is dificult to relay al of the information to the parents and to the sick child (Klinzing, Child Life Council). After reading notes on others? observations of children playing, those who are wel, and those who are hospitalized, play is a creative outlet that alows children to take their minds of of the hospital. Play more importantly is a means for self-expresion. It is imperative to closely watch a child as they play. Observations done by Creative Machines Inc. also show that a creative environment is the best way to distract the patients from the hospital. They encourage arts and crafts and a stage for puppet shows and plays (Creative Machines Inc.). In order to start preliminary research for this project it was vital to gain basic understanding of the hospitalization proces. In order to fulfil this need, interviews were 35 conducted with Maggie Butler, a Child life Specialist. This interview as done in the beginning of the research proces in order to atain a direction for the rest of the project. Mis Butler gave understanding of what the Child Life Profesion is like and what helps, hinders the lives and healing proces of hospitalized children Later in the research proces, more interviews were conducted with industry profesionals. Janet Cross, the head of Child Life, and John Sparks, an architect, gave a tour of Vanderbilt Children?s Hospital during which they answered questions and participated in discussions about the project for this thesis. Ron Daniels, a general contractor, was also interviewed about the possibility of this thesis project. These interviews and discussions not only provided answers for the research of this project but also provided sample materials for the product research. After interviewing profesionals and touring hospital facilities, the next step was to begin to aces the market research. Market research consists of four elements: human, technical, marketing, and production functions, and also includes charts of existing product to be sen in the market research section of this thesis. The human factors of the play system would take into acount the needs and behaviors of hospitalized children and wel children. The technical functions would incorporate the social needs and necesary objects for children who have restrictions on their bodies, along with safety hazards ilustrated in the section on playground safety. The marketing functions would discuss the number of playrooms per hospital, per floor, and per unit. How many are necesary? The production functions are the reality of these playrooms, and how creative you can get with the restrictions of the hospital and funding. This is al crucial information when designing a hospital play system. 36 After acesing these functions, it would be helpful to compare the existing playrooms and their components. A S.W.O.T analysis (strengths, weakneses, opportunities and threats) was created to further investigate the components necesary for a succesful play system. After these studies are done, there wil be enough information to create the required performance criteria. The required performance criteria wil incorporate al of the design methods to create a list or guideline for the rest of the design proces. 3.2 User Research 3.2.1 Questionnaires and Surveys After reading a myriad of books and articles about play and hospitals it was evident that the Child Life profesion would be fundamental in understanding the needs of hospitalized children. One of the preliminary methods of research was to send out a survey to Child Life Specialists. This survey was mainly to gather basic understanding about their carer. How many children do they work with? What is the most useful activity? How do they keep the playground clean? Below is the actual survey. 37 38 39 Figure 1: Questionnaire From SurveyMonkey.com This survey was one of the first research components. By creating this survey, knowledge was achieved of the basic day for a Child Life Specialist. Most of the questions were as expected: that the specialists work 9:00 a.m.-5:00 p.m. shifts and do not do much overnight work, parents are important and they get along wel with doctors and nurses. However, some of the answers were surprising, such as each Child life specialist is mostly in control of ten to thirty children and in some cases they are in charge of over fifty sick children. This can be dificult for the Child Life Specialist to control, thus increasing the importance of a play system that alows children to play frely while someone can supervise numerous amounts of children. Another question that was useful was which products are the most efective elements of play. This answer goes against the 40 purpose of this project. Art supplies were the most efective by a landslide. However, later research wil prove that this is the case because there is not adequate indoor play equipment for children with special needs. 3.2.2 Interviews Throughout the beginning of the design research proces, interviews with medical personnel were vital to understanding the hospital experience. The interviews were conducted with Child Life Specialists, doctors and nurses The first interview displayed is in an interview ith Maggie Butler, a Child Life Specialist who works in an emergency unit. The following are basic questions about her profesion; they are as folows. 3.2.2.1 Questions for Maggie Butler 1. What is the main role for Child Life Specialists in a hospital? a. To lesen the traumatic experience of children in the hospital 2. What are the means of easing the stres and suffering for hospitalized children? a. Medical play equipment and play with normal everyday toys 3. What are the most efective tools? a. Gliter wands, bubbles, music, bal with lights 4. What are the age groups that you deal with? a. Birth to 18 years 5. Which children experience the most problems dealing with their ilneses? 41 a. Very sick children, sleping, secures, stitches, bones (bones reduced and IV) b. Traumas, people who are in a stretcher around doctors and nurses, no family 6. What are the roles of doctors and nurses with Child Life? a. We work together, they collaborate with the Child Life Specialists, 6 doctors and 4 treatment rooms, they have to wait on us to take care of certain situations, nurses and IV?s. I let them know when the child is in too much pain and needs more medicine. 7. What are the roles of the parents? a. They have a large role. They are the number one support system. They know the child beter then the doctors and specialists and their cooling mechanism 8. What are the roles of the siblings? a. They get in the way? Same thing as the parents?they are encouraging; what to do with the sibling is one of the hardest parts. 9. What is the general time period a child spends in the hospital? a. 30 sec. to 6 hours or days. 10. How many children are you in charge of at one time? a. Anywhere from 1 to 35 or 40, every child in the hospital b. 7 specialists c. 2 emergency room specialists 42 After the first interview, further reading was conducted and a second interview was performed with more in-depth questions. Below is that second interview Part I 11. Who is in charge of running the playrooms at the hospital? a. Child Life runs the playrooms 12. Are there any problems regarding the playrooms in the hospital? a. Infection control and cleaning b. Toys that are geting recaled 13. What toys are found in the playrooms a. Toys in general i. Video games i. Nintendo ii. Art and crafts iv. Etc. 14. In your daily routine is there anything that slows down your work proces? Why? a. Having to clean toys 15. Are there restrictions for the types of toys children can use while they are in the hospital? a. Kids who are contagious cannot play in the playroom i. Contact precaution i. Oncology kids cannot come into the playroom 1. Imune system is down 43 16. Is it dificult to find toys that are suitable for children in the hospital? a. They only get toys that can be sanitized b. Everything has to be wiped of and sanitized i. No stuffed animals 17. Do you have specialized toys for Child Life? a. Zanie dolls i. Have al the body parts heart etc. i. Puppets, which are cloth 18. Where do you find specialized toys? a. Zanie dolls from diferent companies 19. Do children ever have any bad reactions to the toys you bring? a. Kids that don?t like clowns are usualy scared b. Don?t pretend that she is a real person 20. Could an educational playroom facilitate your job? a. Anything that they can do to empower the parents. They are sometimes helples. This helps bring them together. The interview ith Maggie Butler is the most thorough interview that was conducted throughout the preliminary interview proces. Ms. Butler was interviewed on two separate occasions; once after very basic primary research, and the second time was after more in depth research. The first interview provided a basic understanding of the Child Life profesion: How many children she works for, her hours, and the most efective tools to ease the stres on the child. The second interview as discussing the 44 specific tasks and hold-ups of the child life profesion. The second interview showed that there are important factors for a Child Life Specialist in the playrooms. One of the most obvious, yet surprising, is the isue of sanitation. As the supervisor of the playrooms, Ms. Butler is required to sanitize toys after each use. The drugs and treatments given to the children cause their white blood cel count to be low. This means their imune system is not as strong as it is normaly. The sanitation slows down her work proces and takes away from the time she should be spending with the children. The second interview also streses the importance of toys in a playroom. The toys that sem to be the most efective are the plastic ones that are easy to clean. There are also very efective toys that Ms. Butler uses caled Zanie dolls. They are equipped with every body part and organ so the child can learn what their body is about to experience. The importance of these dolls proves the importance of education. If there were a program or room that alowed parents in to use these dolls to explain the procedures, both parties would have a beter understanding of the procedure, which is proven to create an easier recovery period. 3.2.2.2 Tour of Vanderbilt Children?s Hospital For the ideal play system, it was critical to have a facility in mind while working through the design proces. Because of connections and location, Monroe Carel Jr. Children?s Hospital at Vanderbilt was the hospital of choice. Contact was made with John Sparks, one of the lead architects in building the hospital, and Janet Cross, the head of Child Life Services at the hospital. Mr. Sparks, and Mrs. Cross gave a thorough tour of the hospital, describing the design aspects and themes of the hospital. The main focus of 45 this tour was the Child Life Playrooms. This was very helpful in the research of this thesis project and alowed for a concrete place to kep in mind while designing this play system. There were five playrooms, which were separated depending on certain age groups. There were also two outdoor areas; one was an outdoor garden, and the other was an outdoor playground with limited play areas. Not only were these playrooms an outlet for play and imagination, but also the entire hospital was geared towards children. The theme of the hospital was Tennese nature, which changed on each floor. Figure 2 is an example of the first floor that represents water. Each floor has thre ?neighborhoods? for easy navigation by color, number and shapes. Each follows the theme ?ribbons of healing, rivers of hope.? Figure 2: Water Hallway in Monroe Carrel Jr. Children?s Hospital at Vanderbilt Along with the themes on the floors there was an overal theme in the entranceway of the hospital that wil cary through the themes in the design project. The theme in the grand entranceway that is the entrance from the emergency room is a magic 46 theme with bold color and magical stars. The grad staircase is the ?piece de resistance? of the entire hospital. The pilars make you fel like you are entering a magical land, and not a hospital. The ribbons that flow around the pilars are covered in stars. The stars represent the children that are being cared for in the hospital. ?The children are the stars of this hospital? (John Sparks). The magical theme is one that wil be caried throughout the project. It is a theme that alows for more imagination than a theme such as pirates, baloons and castles. Below is an image of the main staircase. Figure 3: Entrance of Monroe Carrel Jr. Children?s Hospital at Vanderbilt. The focus of the tour was to atain special aces to the Child Life playrooms on each floor of the hospital. The first playroom was a sibling playroom in the bottom floor. The size of the playroom was smaler than expected, and this was going to be the case for the rest of the hospital. The sibling playroom consisted of smaler tables, a fish tank, a table with a train set, and cubbies where games and art supplies were stored. Many Child 47 Life Specialists believe that games, arts and crafts are very beneficial for sick children, but this is not always the case. There was no area where the children could run and exercise their imagination. Below is an image of the sibling playroom. Figure 4: First Floor Sibling Playroom at Monroe Carrel Jr. Children?s Hospital at Vanderbilt The second floor playroom was designed for infant to preschool children, which includes children from newborn to four years old. The types of toys provided in these rooms were smal walkers, mobiles for infants and toddler games. The school age playroom was similar to the preschool playroom. This playroom was meant for children ages five to eleven. The furniture was a litle larger and there were more advanced games and play equipment. The ten room was diferent because of the amount of electronics in the room. There was every game system imaginable along with a pool table and large TV. Al of these play rooms have adequate equipment for entertainment purposes and basic types of play. However, there is no play system or outlet for creative and imaginative play besides art supplies. If each room had a play system that was diferent 48 than the regular activities then the child would be more likely to use their imagination to play. Each playroom was equipped with very concrete means of play. It is important for children to experience fre play while they are in the hospital, and many of these playrooms did not alow for that. The playrooms were also extremely smal; there would hardly be enough room for a play place. The Child Life Specialists stresed a need for space because they had to store so many things for the art projects and games they play. If the child had the fredom to play by their own means, then there would not have to be specific art projects and not such a large need for storage. There was one main waiting room for the children?s hospital. It was surprising that there was a lack of play equipment there, too. Under the main stairwel there was a smal waiting/play area. However, the area under the stairs was not acesible for children in wheelchairs, and Mrs. Cross said it had been unsuccesful. There was also a large train set that had some interactive components but not many. There were some smaler stations with boring activities, but nowhere in the waiting rooms for children to play. 3.2.2.3 Meting with Ron Daniels, General Contractor for Litle Tikes Mr. Daniels is a general contractor for a company caled Custom Recreation who instals Litle Tikes play equipment in Hendersonvile, Tennese. The meting with Mr. Daniels was important because he has instaled many playgrounds for children with disabilities and knows a lot about mas production and instalation of park structures. He 49 has been in the busines for twenty-thre years and had a lot of important pointers about designing playgrounds for indoor and outdoor use. The meting with Mr. Daniels took place in a restaurant while having a cup of coffe. The meting began by discussing a basic overview of Mr. Daniels?s job and responsibilities in order to enhance the interview. Mr. Daniels supplied the most recent materials for Litle Tikes, including some samples for ground covers and, most importantly, safety information. Safety was one of the first isues discussed, and Mr. Daniels explained the responsibility that fals to the playground company when it comes to injuries. Numerous precautions need to be made when designing this equipment. Mr. Daniels explained the thre main categories of acidents on playgrounds: acesibility, fal zone and entrapment. Acesibility is how easily children can move and flow through the playground. It is also important for children with disabilities to have acesibility for al components of the playground, especialy for this thesis project. Fal zone is the area that children could fal on while climbing on structures that are above a certain height. More information wil be provided in the safety section of this thesis. Entrapment is also a dangerous category of acidents when it comes to playgrounds. Holes and gaps have to be a specific measurement, and there can be no ropes or anything that is a strangling hazard. Se section 2.5 for more information on playground safety. Mr. Daniels also discussed the importance of sanitation in both outdoor and indoor playgrounds. He instaled a playground in a Chick-fil-A that had to be presure washed and fully sanitized once a month. He said that the drainage of an indoor playground is more important than the drainage of an outdoor playground. Many indoor 50 playgrounds can become a ?Petrie dish? for bacteria if they do not receive the proper measures of sanitation. The ground covers for these play structures play a large part in the drainage, sanitation and safety. Mr. Daniels provided samples discussing the best options for indoor playgrounds. He stated that workers lock tiles or pour-in-place rubber would be the best option for an indoor playground in a hospital. They both provide an adequate cushion for fal heights, create good drainage for sanitation and can be made into any diferent customizable designs. Mr. Daniels also discussed the importance of marketing and told stories of crazy clients that he has had to deal with in the past. His main argument was that products are not marketed to the child, but ideas have to be marketed to adults, and then they provide the equipment for the child. The child is secondary in terms of seling the idea and marketing the playground. This is something that was studied in- depth for this thesis and wil be discussed in further research of this thesis. Mr. Daniels wil continue to give fedback for this project as it is developed. 3.3 Comparative Product Charts A Comparative Product Chart is a means of research to explore the strengths, weakneses and potential changes in existing products. It investigates the designs of competing products in the early stage of the design proces and provides a picture of where the designer is to begin and shows how he or she can improve the product already in the market. Below are comparative product charts for diferent elements of the 51 playground: layouts, structures, panels, and ground coverings. These charts are idealy going to create improvements and ideas for the project of this thesis. For each chart, the product was chosen from two of the most popular playground companies: Litle Tikes and Game Time. The products chosen are the products that were the most interesting and the most suited for this project. 3.4 Design Criteria Design Criteria are the restraints and qualities that are required when designing a product. The Design Criteria of this thesis wil summarize the atributes that are necesary for the project to be succesful. The Design Criteria wil pull from the research that was conducted to give a set of guidelines while designing the play system. The Criteria wil keep the project on track without any additional components that could hinder the succes of the project. When determining the Design Criteria, there are a few diferent areas, the user, the activities of the play system, the form of the play system, and the location and its constraints on the play system. Seting criteria points to met for each of these areas wil aid the design proces in a succesful direction. The first area of criteria is the user. Who is this play system designed for? Children is the obvious answer but it is critical to also look at which types of children wil play on this system because it is going to be placed in a hospital. The play system needs to alow for needs of healthy children, sick children and severely handicapped children. Not only is it important to look at the children, but also taking the parents into acount is equaly as important. The parents are in charge of the child and determine 52 whether or not the child is able to play. Parents often enjoy playing with their child, so the play system should also acommodate those things. The first criterion for the user is that it is fun. If the project isn?t appealing and fun, then what is the point of a playground? The idea of the ?fun? criterion wil reappear in each section of the design criteria. Aside from that, the size of the playground should suit the anthropometric data of the child. There is a possibility that the playground wil be for children ages two through twelve; therefore, the activities and components need to suit the size of the user. There should be no child that fels hindered for being too litle or too smal for any of the equipment. As Janet Cross, the Child Life Specialist, stated, ?it is vital that you do not taunt any child. Each play area should be for everyone.? There are specific anthropometric data for children, which is included in the third section of this chapter. Most of the existing playground material adheres to these requirements, but the new designs of this playground should also comply with these regulations. Because children are not fully developed and wil tend to use the play equipment in diferent ways than what it was meant for, the safety of the playground is also an important factor. The play system should adhere to the safety restrictions as outlined in the Chapter on Playground Safetey. No holes should be betwen 3.5 and 9 inches to avoid entrapment, there should be proper landing areas around al equipment, and the ground cover must be a certain depth to ensure the fal heights of the playground system, even though this play system wil be at one level. Protrusions of the hardware should be non-existent. These are al design criteria for the project in relation to safety for the user. 53 The users are the key factor in the design criteria of this project, but there is also the question of what is the user supposed to do? What activities are supposed to be supported in this thesis project? The activities for this project are activities that stimulate senses and encourage creative thinking during play. Many of the activities that were chosen in the comparative products research were chosen due to the activity that they supplied for the child and the outcomes of the child performing the activity. Stimulating senses is any activity that triggers sight, hearing, taste, smel and touch. It is proven in the literature review of this thesis that stimulation of a child?s senses aid in their development. Along with stimulating a child?s development, these activities should encourage and develop the child?s imagination. It was stated in the literature review of this thesis that imaginative play is beneficial for a child?s development, and by seing a child play through imagination it can help parent?s, doctors, and Child Life Specialists understand the healing of children and se if they are experiencing any type of trauma. The next criterion to be addresed is the question of what is the system supposed to look like? The play system wil rely on the form of existing equipment, but in order to support the child?s imagination and the existing theme of Vanderbilt children?s hospital, a magical fantasyland theme wil be the concentration of the play system. The children?s hospital already contains a grand entranceway that looks like an entrance into a fantasyland, and the play system wil incorporate these same elements to match the theme of the hospital, which supports the idea of imagination and stimulating the senses. The color scheme wil consist of bright vibrant colors and include shapes that entice children to play. 54 As it has been stated, this play system wil be placed in the Monroe Carel Jr. Children?s Hospital at Vanderbilt. For the design criteria, it is vital to state the location of the play system in order to understand the scale and space constraints of the play system. Mr. John Sparks, the architect of the children?s hospital, supplied the floor plans of the building while giving a tour. The area for the play system is to have a large configuration. The play system wil be placed on one of the larger waiting rooms on the second floor of the hospital. This play system wil have more of the components than the smaler system designed for the playroom. 55 CHAPTER FOUR: PLAYGROUND SAFETY 4.1 Introduction In every interview conducted for user research, each profesional seriously stresed the isue of safety. Many school and children?s environments are stering away form playgrounds because of the liabilities involved. (SOURCE) However, The U.S Consumer Product Safety Commision has created a Handbook for Public Playground Safety, which was first published in 1981. The handbook offers safety recommendations for most play structures and explains the hazards of equipment. The Handbook for Public and Playground Safety begins with an introduction and history of the guidelines. Then there is a general discussion on playground safety, and the handbook states, ?because al playgrounds present some chalenge and because children can be expected to use equipment in unintended ways adult supervision is recommended.? This is particularly important to this project because it wil be extremely necesary to make sure that this play system is to be placed in a supervised environment because it is going to have to suit special needs children. The discussion not only recounts the need for children safety, but also the reason children need playgrounds, and how to make the playground live up to its full benefits. 56 4.2 The Handbook for Public and Playground Safety The next section discusses the main injuries on playgrounds and states that fals are the primary injury on playgrounds today. Other hazards are impacts by swings and other moving equipment as wel as ?pinch points, sharp edges, hot surfaces and debris.? It is imperative that when designing this play system that these elements and hazards need to be completely avoided because this play system wil be used by sick children and its liabilities wil be even higher than that of any other average playground. There is an entire section dedicated to defining terms of playground areas and equipment. The U.S. Consumer Product Safety Comision felt this was necesary in order to create a common language betwen contractors, designers and the instalers. The following section is one of the most important sections in the handbook, which is on surfacing. This is the most important section because it is previously stated that faling on playgrounds creates the most injuries. The surfacing component is the element the child fals on and therefore a life saving element crucial for this project. One of the main factors for the surfacing of a playground is the critical height and the shock absorbency of certain materials. Acording to the Handbook for Public Playground Safety the critical height is ?the fal height below which a life threatening head injury would not be expected to occur.? Below is a chart of critical heights of certain surface materials. 57 Table 1: Critical Heights (in fet) of Tested Materials from the Handbook of Public Playground Safety. This table shows the height a surface must be with these materials underneath for protection. It describes them in a compresed and uncompresed form. However, if a child is at ground level they do not need surfacing materials. For this project surfacing materials wil be required because certain elements of the play system are on the ground, but other elements could be hazardous if children use the equipment in other ways than its intended use. This play system wil be in a hospital so many children could be more susceptible to injury. The next section in the handbook is also a very important section. This is the section on recommended use zones for equipment. The primary pieces of equipment that require use zones are slides, swings, mery-go-rounds and rockers. Slides are the only piece of equipment that could possibly be included in this project. Below is an ilustration for the use zone of a slide. 58 Figure 5: Fall Zone for Slides A subject that is very important and occasionaly overlooked is the instalation and maintenance of the equipment. The best design could be a failure if it is not instaled properly or not properly maintained. The section discusses the importance of clear asembly instructions that should be stored permanently near the site of the playground, and special atention should be given to the stability of the equipment for each facility and environment. As far as maintenance, the handbook states that ?inadequate maintenance of equipment has resulted in injuries on playgrounds.? Therefore the indicated maintenance schedules should be strictly adhered to. Checklists are recommended in order to give an orderly and exact way to check al of the equipment. 59 These checklists and inspections should be filed in case there is injury, especialy those that result in a lawsuit. Hardware should be covered as to not have any sharp points, corners or edges on the playground because they can al be extremely hazardous. Many children have their clothes tangled on these points and edges, which could involve a serious entanglement injury. ?Protrusions or projections on the playground equipment should not be capable of entangling children?s clothing because such entanglement can cause death by strangulation? (Handbook for Playground Safetey 8). There are very specific measurements for these protrusion tests. Below are diagrams of these gauges. Figure 6: Protrusion Test Gauges. 60 Figure 7: Protrusion Test Another diagram demonstration of the rules of entanglement and protrusions is that of a slide area. Because there are slides used in the final project this diagram is particularly relevant. 61 Figure 8: Areas on Slides Subject to Protrusion In the Litle Tikes Safety Handbook, which is generaly the same as the Handbook for Public Playground Safety, there is a supplemental ilustration of the definition of entrapment. 62 Figure 9: Ilustrations of Entrapment Figure 10: Small and Large Probes Along with bariers and large hoes for entrapment, certain angle measurements are forbidden due to the risk of entrapment. The smalest angle alowed on a playground is fifty-five degres. If an angle is les than that, then it is imperative to have a shield for that particular angle where it reaches below fifty-five degres. Below is an ilustration depiction the use of angles. 63 Figure 11: Angle Recommendations The Handbook concludes with appendices on certain aspects that were not included in the 1997 handbook. There are detailed acounts of new materials and new equipment. This handbook is necesary for al individuals involved in playgrounds from the design proces to the instalation and then towards the maintenance. This handbook has saved many children?s lives and wil be an imperative aspect of this thesis project. Every measurement and recommendation wil be taken into acount, especialy those appropriate to indoor and handicapped playgrounds. The back cover of the Handbook of Public Playground Safety lists a public safety checklist and it is as follows. ?Here are 10 important tips for parents and community groups to keep in mind to help playground safety. 1. Make sure surfaces around playground equipment have at least 12 inches of woodchips, sand or pea gravel, or are mats made of safety-tested rubber or rubber-like materials. 2. Check that the protective surfacing extends at least 6 fet in al directions from play equipment. For swings, be sure surfacing extends, in back and front twice the height f the suspending bar. 3. Make sure play structures more than 30 inches high are spaced at lease 9 fet apart 64 4. Check for dangerous hardware, like open ?s? hooks or protruding bolt ends. 5. Make sure space that could trap children, such as openings in guardrails or betwen ladder rungs, measure les than 3.5 inches or more than 9 inches. 6. Check for sharp points or edges in equipment. 7. Look for tripping hazards, like exposed concrete footings, tre stumps, and rocks. 8. Make sure elevated surfaces, like platforms and ramps, have guardrails to prevent fals. 9. Check playgrounds regularly to se that equipment and surfacing are in good condition. 10. Carefully supervise children on playgrounds to make sure they?re safe.? (Handbook for Playground Safety 13). 4.3 ADA Handbook Another design criterion for the user is acesibility. Because this play system is going to be designed for healthy, sick and disabled children, the play system needs to be designed to suit al of these children?s needs so no child is excluded from the play system. The Americans with Disabilities Act includes a section (section 15) of 65 guidelines for playgrounds and regulations for wheelchair aces. The guidelines that pertain to this project are as follows: 1. For ground components there needs to be a minimum of 60? width a. For areas les than 1,000 sq. fet then the width should be 44? b. For elevated components, the width should be 36? 2. For transfer stations, there should be at least 24? of space 3. Handrails should be .95? to1.5 inches 4. Each transfer step should be at least 8? tal 5. Platforms should have at least 14? of level 6. Seats should be 11?-14? (Slides do not comply) The figure below demonstrates the area for a wheelchair as given in the ADA guidelines provided by the Self-Insured School of California. Figure 12: The ADA Width Requirements for a Whelchair 66 Aside from the ADA requirements, it is esential to keep in mind the possibility of a child atached to an IV. There are many cases where the child can be mobile but must remain atached to a catheter or to an IV stand. The smalest an IV stand wil go is approximately 50?; therefore, al ground components should alow for this clearance height. The playground safety requirements are crucial for this thesis because the succes of the model project depends on it. Without paying atention to every detail of this chapter, the play system would be obsolete if any component were to cause harm to a child. 67 CHAPTER FIVE: DESIGN APROACH 5.1 Introduction and Overview The goal of the previous chapters is to support the reasoning and theories behind this approach, which was used in the design project to create a stimulating and acesible playground for a children?s hospital. This approach is created for a specific environment, which is a large indoor area of the hospital where there is enough room for a play system, include the surrounding areas and fal zones. It should be noted that the proces, components and cleaning recommendations are specific for a hospital environment. The approach is built by modifying basic approaches from playground companies while adding additional constraints in order to create the ideal environment for a children?s hospital. There are thre overal necesary components that apply to each stage of this approach. These are universal acesibility, aid in child development and compliance of a theme. The most important aspect of this project is the acesibility. It is the factor that makes the project unique. Universal acesibility is a rarity among playgrounds and is particularly imperative for a hospital environment. Another important factor to include in each step of the proces is the child?s development. As it has already been discussed in the chapter on children?s development, there are many theories to a child development. This project followed the ideas and teachings of Maria Montesori and Jean Piaget. Al of the components of the 68 play system have a special purpose to trigger the child?s senses and appeal to their needs, both of which are key atributes in both Montesori and Piaget?s theories. Lastly, most succesful playgrounds have a common theme. As it is stated on the website for Fawns Safe Play, ?Creating the right environment for the children to indulge their vivid imagination and providing props for their role-play is crucial to ensure they maximize the fre play opportunities? (Fawns Safe Play 1). As it was stated in the previous chapters, fre play is crucial for children?s development. These thre categories should be caried out and set as top priorities when designing using this approach. There are four stages that follow the overal criteria. These stages are space selection, components, layout and implementation. The space selection stage is where the location is selected by using another set of criteria, which is to be discussed further in this chapter. The components stage is to decide which company and which components best fit the theme and needs for the children who wil use the play system. After the components are selected, the next stage is the layout stage. This is the stage where the location and relationships of the components are selected. The final stage is the implementation of the playground and the plan of instalation and upkeep is determined. In order to prove the method of this approach, folowing this chapter wil be an example project that follows each phase or criteria where it wil be demonstrated how this should be followed. Because research was done with profesionals at Vanderbilt Children?s hospital, this wil be the location of the play system. The components used and manipulated in this are from Game Time due to previous experience with their products and the imense choices of acesible components. 69 5.2 Overall Criteria As it has been previously discussed in the introduction of this chapter there are thre components to the overal criteria in this approach. These categories are universal acesibility, aid in child development and compliance of a theme. These are overal criteria because in literary and design research these thre aspects sem to be the recurring items of importance. In each phase of this approach it is crucial for the individual following this approach that they are constantly revisiting these facets in order to achieve succes. The first and most important criterion is the acesibility of the play system. As stated in the introduction of this chapter, the factor of acesibility is what makes this approach original. Others have explored diferent ways to make universaly acesible play systems, but it is rare to include a play system in a hospital while manipulating other existing equipment that beter defines the user. Acesibility not only includes making al components available for children with special needs, but it wil also not minimize the use and developmental enhancement of individuals who are not physicaly hindered. Al ramps and panels and manipulated components must al have the same fun factor and interest for the child. As discussed in the chapter on playground safety, the acesibility of the playground should comply with the Handbook for Playground Safety and the ADA Handbook. By achieving the goal of full universal acesibility, no child wil be left behind. To once again quote Janet Cross, the head of Child Life services at Vanderbilt Children?s Hospital, ?the worst thing you can do with play is taunting a child.? This is not refering to individuals, but to the equipment that is used to stimulate play for the child. 70 Vanderbilt Children?s Hospital is an advocate in universal acesibility. The following project wil implement this throughout the design approach to ensure that al children can enjoy this play system. After the importance of universal acesibility, atention needs to be given to the child?s development while using the play system. The literature review and design research includes questions and statements that stres the need to support a child?s development during play and the potential danger of being hindered developmentaly by a prolonged or traumatic stay in the hospital. Most hospitals are not equipped with fre play facilities and alowing a play system in a hospital alows for the needs of fre play to be met. Maria Montesori discusses the teaching method of learning through experiences and leting the child remain in control and the instructor playing the role of overseing the clasroom rather than instructing it. Jean Piaget described the stages of cognitive development, and each stage is progresed and trumped through experiences that alow the child to react in certain ways in order to gain experiences, which alow him or her to progresively develop. The play system is built for the child and would be useles if it did not help the child play, which is proven to aid in their development. In the project asociated with this approach, each phase wil revert back to the theories and teachings of Montesori and Piaget to maximize the development of a child when he or she uses this play system. The last criterion that should be followed throughout the approach is the theme of the playground. Scatered components that do not flow usualy do not appeal to the child upon entering the play system. The play system should interest he child when they first 71 lay eyes on the play system. A theme could have more than one definition. A theme could be a color scheme with certain colors to convey a specific mood. It could also be a theme that matches the rest of the hospital to add continuity and appeal to the child. The theme could also be specific to itself to entice the child. The rest of the proces is easier once deciding on a theme. In the area of playgrounds and play systems, there is a vast pool of components and ideas. Deciding on a theme can help narow down the decisions that need to be made for the rest of the development of the play system. The theme of this play system wil miic the theme of the main entrance and include other components to create a Whimsical Sky theme. The name of the playground wil be ?HOPE HEALS.? The name of the play system follows with the whimsical theme to help children fel apart from the earth and apart from their sicknes. Al components and properties should constantly revert back to this theme. This theme wil inspire hope to children using the idea of taking them away from this earth where their sicknes is real. This play system wil help children and their families escape the reality of the reason they are in the hospital. The criteria are critical to remember while using the following approach. Without them the general purpose for the play system wil be lost. The play system should be acesible for al children while alowing the maximum use of play. The components for play should stimulate the child in order to aid in their development, and the play system should have a theme in order to narow down components and entice the child. These criteria wil be clearly asociated with the implementation of the approach in designing a play system for Vanderbilt Children?s Hospital. 72 5.3 Phase One: Create the Space The first part of this approach is to decide on the location of the play system. A children?s hospital is very specific in terms of placement, technology and flow. Choosing a location where people frequent and are not limited is the beter option for a large play system. Waiting areas and common spaces are ideal. These spaces are preferable because they are visited by the most people and can aid children who are staying long term or children who are just visiting for the day. For specific-needs children who cannot interact with others a smaler unit of this play system could be instaled in a specific sterile environment. When choosing a space there are certain things one should keep in mind. What is surrounding the area of the play system? Where is the trafic flow? The use of the play system should be maximized without causing a disruption to the flow of the hospital. Acesibility is once again important because the area of the play system should be universaly acesible if the play system streses universal acesibility. It is also important to understand if the play system is going in an existing space or in a new space. A way to beter understand the space is to atain a floor plan of the facility for the play system; by comparing diferent spaces it wil be easier to select the space. Once a floor plan is atained, it is important to simplify that floor plan so one is not confused by al of the other elements of the floor plan and can concentrate on the space for the play system. The theme can be altered depending on what type of space is to be used and should follow the existing elements of the hospital. Choosing the right place for the play system wil add to the succes of the play system. 73 5.4 Phase Two: Selecting Components The second phase for this approach is the component selection proces. There are vast amounts of existing playground equipment and making the decision can be dificult without a direction of guidelines. The thre main criteria should stil apply to the choices of components. In many situations, the criteria that have been addresed wil not alow for diferent types of existing equipment. There are thre categories of components that are necesary to create a play system while following the thre main criteria. These are, ground covers, play structures and panels. A children?s hospital is a very specific location, and limits the choices when it comes to the isue of universal acesibility, and al of these categories should include components that apply to the criteria of acesibility, child development and theme of the play system. In general, when designing a play system it is important to use one company for components because each company has diferent sets of patented hardware. In order for ease of asembly and layout, using one company is highly recommended. In the project following this approach, the two companies that ofered the most in terms of the thre main criteria were Game Time and Litle Tikes. Both companies offered the most in terms of acesibility and also offered means of manipulation in their products. However, GameTime offered the most components of universal acesibility; therefore, they were the company chosen for the example play system. In this approach, the component selection proces was made easier by creating comparative product charts, a common way of categorizing and comparing products in design methodology. A Comparative Product Chart is a chart to compare components by listing the strengths, weakneses and potential changes. By charting out 74 the strengths and weakneses it was easier to select which components would be succesful for a hospital seting and which components could be manipulated to be universaly acesible. Below is a blank comparative product chart, which shows the methods that wil be used in chapter six to create the example play system. Figure13: Blank Comparative Product Chart Out of the four diferent components that are relevant to a hospital seting, the first to be addresed is the ground cover. Most playground companies do not produce their ground covers and atain it from other companies. Therefore outside research mush be done in order to atain the numerous types of ground covers for the play system. The ground covers that are most suitable for a play system are the ones that have exceptional drainage and those that can be customizable. The drainage fits into the acesibility 75 category and it is also nice to have a customizable ground cover in order to fit the theme of the play system. The second category of components is the play structures category. There are not many structures that are universaly acesible. Some that are universaly acesible are slides and swings, and mery-go-rounds; however, many of these structures require large use zones and take up too much space to be placed indoors. The components selected for this category should have smal use zones, not require too much additional equipment and of course be universaly acesible. A recommended component is a slide; they have use zone of only six fet. A swing set requires a much larger use zone and is therefore not ideal for a hospital. Smal interactive climbers are acepted but not preferable. Because so many structures are not acesible, it is also possible to create alternate equipment using existing structures. Some companies would be wiling to work with the customer to make customized equipment. There are some features of the example play system that wil incorporate diferent components to make an acesible structure. With al of the components selected the next step is to decide where the components should be placed. 5.5 Phase Thre: Create a Layout After the components for the play system are selected, the next part of the approach is to create the layout. There are numerous aspects to keep in mind when creating the layout because, without a proper layout, the components selection is useles. The things to keep in mind while creating a layout are the categories of the components and where are they placed acording to other activities to maximize the use of the 76 components. Another important thing to the layout is the flow of the play system. By understanding the user flow, a designer can actualy determine where the user walks and what he or she wil se. Space is also a key factor when designing a play system is the space. The space where each component is place is extremely important when considering the safety specifications and use zones for particular equipment. While considering these things, the first step to create a succesful layout is to use the comparative product chart method to compare other playground layouts and compare what is succesful and what is not succesful. After layout comparison, it is important to select the components for the play system and make a list of those selected components. With the list of components it is important to explore as many layouts as possible to atain the corect one. Create numerous layouts and compare them to one another to decide what works and what does not. Once a proper layout is created, then one needs to look into the implementation phase of the play system. 5.6 Phase Four: Implementation For the implementation stage of this approach there are two factors that are crucial to ensure that the play system wil be able to withstand time and use. The first factor is the instalation. Both profesionals and volunters instal many play systems. Because this play system wil be in a children?s hospital, it is crucial, if not mandatory, that there be mostly profesionals who instal this play system. The instaler should take proper precautions to the surroundings while instaling the play system. The ground 77 covers and support system should be an appropriate depth in acordance with the Handbook for Playground Safety, which is outlined in chapter two. Along with the instalation, the maintenance and upkeep is extremely important for the play system. Due to cleaning and sanitation, it is recommended that this play system be cleaned once a wek. This cleaning can take place during a time of day where the playground is not used. Basic sanitation should be done daily. This is extremely important for the succes of the playground due to the ilneses and lack of imune systems for the children who are staying in the hospital. Sanitation checks should be done so frequently that it should be easy to tel when the playground is in need of a tune up for chipped paint and various other aesthetic fixes. The last aspect of implementation is the safety checks. Al playgrounds and play system are required to have a safety check on various hardware and components quite often. It is recommended with this approach that a safety check be performed once a month in order to ensure that the children wil be safe at al times. If al of these aspects of the implementation phase are completed, then the play system wil last longer, have les repairs and benefit more children while they are hospitalized. 78 Figure 14: Diagram of the Aproach 5.7 Conclusions To conclude this approach, it is necesary to restate the thre criteria that are esential to creating a succesful play system for a children's hospital. The first is acesibility. In the tour given by Janet Cross and John Sparks at Vanderbilt Children?s Hospital, it was evident that there was a lack of playground play at the children?s hospital. The next criterion is that the activities and components in this play system aid in the development of the child. Research was conducted in the area of child development, and, in chapter two, the theories of Jean Piaget and Maria Montesori are discussed in detail. Both of these pioneer child psychologists discovered the fundamentals of child development and how to teach children. When a child is hospitalized they are taken Universal Acesibility Child Development Theme Step 1: Space Selection Step 2:Component Selection Step 3: Layout Selection Step 4: Implementation 79 away from their standard environments. If the child experiences long-term hospitalization, then it can hinder their development by blocking their exposure to the outside world and stimuli that alows them to grow mentaly and physicaly. This approach encourages components and stimuli that make children active and encourage them to learn and use their creativity to play. The last criterion is the theme of the play system. A play system that is based and built on a theme that is inspirational and entices children to play wil be a more succesful play system. The Hope Heals play system is based on the whimsical sky, celestial theme which wil take children from this world and away from a place of sicknes into a world of health. In the literature it is described that optimism and hope can have a healing afect on children. One of the goals of this play system is to encourage hope in children and their families in order to aid in their healing proces during their hospital stay. 80 CHAPTER SIX: DESIGN PROJECT 6.1 Introduction and Overview This chapter wil describe the execution of the approach outlined in chapter five to show an example of how succesful the approach can be when implemented properly. This project wil keep in mind the thre main criteria of universal acesibility, aid in child development and compliance of a theme. The project wil also follow each of the phases in detail to prove the succes of the approach. 6.1 Create the Space For the example of this play system, the space that was chosen is the waiting area at Vanderbilt Children?s Hospital. The space that the project wil be modeled after is a section of the waiting room on the first floor. The waiting area is next to the grand entrance, which is a spectacular display of magical emotions. When a patient walks through the doors of the hospital, they enter a place full of color and shapes that miic a fairy tale. As beautiful as the entrance space is, other than the large staircase and a train set, there is hardly a place for the children to play and entertain themselves while they wait. This is an area frequented by the most individuals in the hospital. It is an ideal space because it acommodates play for both inpatients and outpatients. The location is ideal because it is next to a large parking garage and the shops for the hospital. The area next 81 to the waiting room is also an area with minimal trafic. It is the curent waiting room where there are a few chairs and empty space. The play area is also extremely acesible because it is on the first floor and is acesible by elevators and ramps. Because the hospital is new it would be impractical to create a new space for the play system; therefore, an existing space wil be used. The existing area, floor plan, simplified floor plan and 3D model are displayed below. Figure 15: Entrance of Monroe Carrel Jr. Children?s Hospital at Vanderbilt. The photo above is the structure adjacent to where the play system wil go. The theme is extremely prominent and the play system wil follow the existing Whimsical 81 Sky playground. While touring Vanderbilt Children?s Hospital, this area was the most memorable and uplifting. The play system should have succes if the same theme is applied. Below is the floor plan of the first floor. The yelow outlined box indicates the area for the play system. Figure 16: Floor Plan of The First Floor of Monroe Carrel Jr. Children?s Hospital at Vanderbilt As it was stated in the approach, to gain a beter understanding of the floor plan a simplified version of the floor plan was created to beter outline the placement of the play system. This floor plan is displayed below. 82 Figure 17: Simplified floor plan of the 1 st Floor Figure 18: 3D Simplified Floor Plan of The 1 st Floor The 3D image depicting the floor plan gave a beter understanding of the area or the play system and wil also aid in the choices for the components and the layout of the 83 play system. The area for the play system is approximately 38 by 48 fet. By using the approach in chapter five a space was created that is wel suited for the example play system. 6.3 Selecting Components As it was stated in the chapter on the approach to create a play system in a children?s hospital, the component selection is extremely important when designing a play system. The components that are selected in the project follow the categories and criteria that have been previously outlined in this thesis. The categories are ground covers, structures and panels. In this section, comparative product charts were completed for each category. The charts include components selected from both Litle Tikes and GameTime. After acesing al of the components, it was evident that GameTime was the stronger company in terms of universaly acesible components. Therefore, in the final model, the products used are the products from GameTime. After selecting the components to be used to the play system, it was also evident that there were components that could be modified and embelished to create new play equipment. In this section there wil be sketches of both existing equipment and modified equipment for the model play system. To begin the selection proces, comparative product charts are strongly encouraged in the approach for this thesis. The charts and explanations are as follows. 84 Figure 19: Comparative Product Chart of Ground Covers. This is the Comparative Product Chart for the diferent possibilities of ground covers for the example play systems. Both GameTime and Litle Tikes had the ground covers they used advertised in the catalog they provided, which made the research easy. The ground covers in this chart include the standard inexpensive wood chips, pour-in-place rubber, poured rubber tiles and the loose recycled tire ground coverings. After asesing the diferent properties and possibilities for the ground covers, the choice was obvious. The pour-in-place rubber has the option to customize, which is ideal for the non-exact shape of the area, is ADA compliant, is easily cleaned and offers excelent drainage. Loose ground covers are not an option because they are more dificult to clean and the pour-in-place rubber can be customized, which is ideal for the theme criterion discussed in the approach. 85 The next category for component selection is the structures category. As it has been outlined in the approach, there are not many structures that offer universal acesibility. Below is the Comparative Product Chart for the structures. Figure 20: Comparative Product Chart of Playground Structures from Game Time The four components in this chart were selected because of their acesibility and ease of cleaning. The climber was selected because it is low to the ground and could offer some sensory play to a child who is disabled. However, after further investigation, it was obvious that this was an activity that would taunt a child unles some other activity was incorporated. The tunnel is another piece that is not wheelchair acesible; however, it is a component that could be further manipulated to create a tunnel that is universaly acesible. The slide that was chosen for this chart was chosen because of the particular width. The problem with the slide chosen is that the bottom of the slide is raised above the ground, which would be a problem for a child who cannot walk. If a slide is used in 86 this play system, then the slide wil have to be one that touches the ground. The swing was included because it alows a child to swing in a wheelchair. However, this piece of equipment is extremely bulky and ofers no form or play for a child who is not in a wheelchair; therefore, this wil not be a component selected for the play system. The last component category is the panel category. Most of the components for the play system wil consist of panels, which are the most acesible and easiest to sanitize. However, panels tend to be a boring part of the playground, offering minimal activity. The panels chosen wil stimulate the senses and involved the children in the activity. The reason stimulatory play is important is relayed in the chapter two section on children?s development and behavior in reaction to play. The panels selected offered the best acesibility, are easily sanitized and wil stimulate the senses of al children. Figure 21: Comparative Product Chart of Panels from Game Time 87 The panels that were selected in the chart above al include acesible activities that alow the child to create their own play scenarios. The bubble wheel panel alows for the child to imagine that they are moving the playground, and the bubble alows for another imaginary aspect that simulates a window. The bug eye panel is similar but it distorts the vision for the child and the individual viewing them from the outside, which helps teach the child about reflections and light; also, stimulating and altering their vision can help with some of their cognitive development. The Gizmo panel is a new panel created by Game Time to make kids excited about panels. With a new form and new activities, the Gizmo Panel is eye-catching and also alows for multiple activities through one unit. The Gizmo Panel is customizable and easily acesible but incorporating multiple activities the panel maximizes the use of the space. Below is the next Comparative Product Chart of panels. Figure 22: Comparative Products Chart of Playground Panels from Game Time 88 This is another chart of components from Game Time. The first component is another example of a wheel panel that is easily acesible by a wheelchair to pull up to. The rest of the panel uses the same hardware as the previous wheel panels. The next panel is another interactive panel that stimulates the senses. The Rain Wheel panel is a new product for Game Time. It incorporates components that spin while making noise that simulate the sound of rain. Then next panel is another wheel panel, which concaves to alow for another area aside from a platform. The last component is the Wavy Miror panel. This panel has the same sensory benefits as the bubble miror panel. It distorts the child?s vision and is also fun when they se their bodies morph depending on there they move. Below is an additional group of panels from Game Time. Figure 23: Comparative Product Chart of Panels from Game Time 89 This chart incorporated products that are similar to those which have already appeared in previous charts. The first is a flat miror panel that incorporates similar sensory experiences with the wavy miror and other panels. These activities are fun but as stated in the chart, it is an activity that wil not grasp the child?s atention for long. The Space Window panel is also important because a child in a wheelchair can stil be able to se through the window, but the space window also offers monotonous activity. The next panel, a Store and Theater panel, ofers a new creative activity for the child. It is acesible and alows for the child to create their own play environment. The theater window also encourages children to interact with each other, which helps aid in social development. The Tunnel panel offers some activity, but it not universaly acesible. Below is a chart of the panels from Litle Tikes. GameTime offered more variety in terms of panels, which is one of the main reasons that they wil be the chosen company for the components. Figure 24: Comparative Product Chart of playground panels from Litle Tikes 90 These panels were selected for the activity they provide and for the benefit to the child?s developmental skils. Each panel wil be at a height and clearance for al children to play. Some activities wil be lower for children in wheelchairs with higher components for children who are standing. Because panels have smal use zones and are always on the ground they are going to be the main activities for this play system. In the next section the project furthers into where the play system wil be placed and the layout of components. Before that element of the project could start it was esential to list the components that would be included in the project. From this list, the components were narowed down further. From the component research it was necesary to identify he major components and activities that would be incorporated in the play system before the layout was designed. There are thre major components that occupy the majority of the space in the play system. There are seven other activity panels that wil be incorporated into the diferent layouts of the playground. Litle Tikes did not offer as many components as GameTime in terms of acesibility and the thre main criteria that are being followed while designing this play system. However, the first component was one with striking interest. The Bongo panel from Litle Tikes is a much improved from the Bongo panel of Game Time. With more interaction and more surfaces to play this panel offers more stimulatory activity. There is also a Bubble Miror panel, which adds some excitement to the original bubble panel. The Gear panel is has a similar reaction to the Rain Wheel panel and gives a child a chance to manipulate a system which is proven to help in their cognitive development. There is also a Store panel, which miics the one from Game Time and ofers the same activity. 91 After the components were selected with the yelow circles, there were stil aspects of universal acesible activity that were mising from the catalog of Game Time. Therefore, in order to give this project some originality, sketches were done in order to gain a beter understanding of existing products, and also, by sketching, new products were created by manipulating the existing products of Game Time. These sketches are shown below. Figure 25: Sketches of Bongo Panels from Game Time and Litle Tikes These are both of the Bongo panels from Game Time and Litle Tikes as sen in the Comparative Product Charts. The Bongo panel from Litle Tikes is more visualy appealing and offers more in terms of sensory activity; however, in order to be consistent, the Bongo panel from Game Time wil be used in the model play system. 92 Figure 26: Sketch of Rain Whel Panel Above is a sketch of the Game Time Rain Wheel Panel, which stimulates the audio and visual senses. When the child pushes the button the wheel turns creating a sound that miics the sound of rain. Figure 27: Sketch of Slide and Slide Roof 93 This is a sketch of the possibility for a slide in the play system. This slide has a roof that miics a sun. The sun roof miics the theme of the existing seting of the play system, which is a whimsical sky theme. The slide is one that touches the ground so children who cannot walk wil simply glide to the ground until an adult can asist them. The first major component is a slide. One of the most chalenging parts of this thesis wil be how to make a slide acesible for children in wheelchairs, casts and carying IV?s. The slide wil have to be acesible by the second large component, a ramp. The only way to aces the slide wil be by a ramp of fifty-five degres. There wil be thre ramps, one that is eight fet long and two that are twelve fet long. The ramp requires proper railing and width in order to be fully acesible. The third component wil incorporate a tunnel for children of al abilities. Because most tunnels are for children to crawl in, it is important to make a tunnel for children to travel through using a wheelchair, or carying an IV. Therefore a tunnel wil be created with the existing tunnels and panels. The top of the tunnels wil be atached on the sides with panels to create a waled tunnel enclosure. The tunnel wil be 8 fet by 5 fet to alow for multiple children?s use. Figure 28: Sketch of Store Panel 94 The above sketch is of the Store panel in the Game Time Catalog. This Store panel wil also act as a theater where a child can imagine a few diferent scenarios and create their own environment. It is also a place where they can work with their parents and other children. Figure 29: Sketch of Tic Tac Toe Panel The Tic Tac Toe Panel was not originaly in the Comparative Product Charts for GameTime, but was a last minute addition to the component list. This panel ofers a game activity. It alows children who work together to increase social skils and also helps them learn rules, which is a crucial stage in Piaget?s Theory of Cognitive Development that was discussed in chapter two. Figure 30: Sketch of Whel Panel 95 The Wheel panel was sen in multiple places in the Comparative Product Charts. The Wheel panel alows for a child to imagine multiple scenarios while alowing them to move the wheel and manipulate the activity. The wheel atachment wil be used frequently because it is easily atachable and ofers for more activity. These components wil al be incorporated into the play system. The new components wil use existing equipment, and some are new equipment to enhance the play system and the universal acesibility. Below are the components that are new or manipulated other components. Figure 31: Sketch of Balloon Piece The baloon piece is a piece that is going to enhance the theme of a whimsical sky. The baloon unit wil be screwed into the poles and give the ilusion that they are holding up the playground. There wil be ten of these pieces in the final model. 96 Figure 32: Sketch of Cloud Roof Most playgrounds have some sort of roofing on the top of any raised surface. For the roofing on the model play system, a cloud shape was designed in order to miic the Whimsical Sky theme. The cloud roofing wil be rotational molded pieces that atach like panels. The ground cover shape wil also mock this cloud shape. Figure 33: Sketch of Sky Tunel with Fun House Mirors 97 The last new component designed for the new play system is a combination of thre components. The new component is a sky tunnel that is universaly acesible with fun miror wals. This tunnel incorporates multiple activities into one play structure while being acesible to al children. The ceiling in the area where this play system wil be places covered in detail to miic the sky. The outside of this tunnel wil be equipped with mirored stars, which match the stars on the grand staircase and go with the theme stated by the architect, John Sparks. ?We have a lot of stars that stand for the children; they are our stars.? The tunnel consists of two fun house miror panels and two sky view crawl tunnel pieces. The Comparative Product Charts helped with the selection for the playground components, and sketching also furthered the development of the playground in terms of acesibility development and the theme. The thre criteria were prominent in the selection of the components. Al activities are either universaly acesible, stimulate a child?s senses or creativity in order to further a child?s development, and many of the new structures to be incorporated into the play system promote the theme that has been chosen for the play system, a Whimsical Sky theme. Now that the components are selected, the next objective in the approach is to determine the layout. 6.4 Selecting a Layout Following the suggestions given in the approach, the layout was created. The first step was to compare the existing layouts in both Game Time and Litle Tikes and compare them to an ideal layout in a hospital seting. The next step was to list the 98 selected components and create multiple layouts until the proper one was chosen. The layout also follows the thre main criteria given in the approach. Below are the two comparative product charts for playground layouts. As was stated in the component section, these Comparative Product Charts aided in determining the succeses and failures in existing equipment and the possibilities of change. Figure 34: Comparative Products Chart of Playground Layout from Game Time In this Comparative Product Chart the components that were selected ranged from smal-scale play systems with minimal components to large-scale play systems with multiple components. The first layout that was chosen is a smal layout and much smaler than the plan for the new play system. This smal layout was chosen due to the vibrant colors and incorporated activities with the panels of the system. The next layout was selected due to the acesibility it provided. The entire system is ramp acesible; however, this play system is on a much larger scale than the example play system. The 99 next product on the chart is a layout that is not entirely handicap acesible, but incorporates activities into the panels and uses smal steps to reach the smal-scale slide on the end of the play system. The fourth component is also on a smaler scale, but uses numerous activities in the panels. Not having any raised surfaces also creates a very acesible play system. Figure 35: Comparative Product Chart of Playground Layouts from Litle Tikes This is a Comparative Product Chart of some of Litle Tike?s existing playground layouts. The first layout shown was discussed with Ron Daniels in the interview previously discussed in Chapter Two. Gabriel?s Garden is a one hundred percent acesible playground that was designed for children with special needs. The layout of the playground is so large due to al of the ramps that are necesary for al of the components. The second component is an ideal layout for this play system. It incorporates multiple activities in a playground seting that is al on one level. This wil 100 be a starting goal of the model playground. The Fredom Park layout is similar to that of Gabriel?s Garden. There are some acesible components; however, the play system is so large due to the ramps that it takes away from the number of activities that can be placed in the play system. The last play system is chosen due to its color and appeal. One of the main criteria for this approach is the theme. Some of the layouts that have been chosen are acesible; however, they are not visualy appealing to the child. In order to entice a child to the play system, there needs to be a vibrant theme that encourages them to play and use their imagination. The other criterion of development is to make some of the components incorporate the same activity. This helps in children?s development by creating certain areas for activity. In chapter one it is discussed how grouping is a stage in cognitive development. If the layout groups activities together, then it helps the child group and aces the activities. The acesibility plays an imense factor in the layout of the play system. For any raised surface to be universaly acesible, there must be ramps included in the play system. Ramps take up space and minimize activity. For the example play system, the ramps should try to utilize activity space while increasing acesibility. The next step in creating a layout for the play system is to decide which components go where and how many units of each. In order to do this in an eficient manner, a sample poster of the simplified floor plan was created along with diferent shapes that represented diferent parts of the play system. Below are photos from this proces, which begins with a sheet of components and is then followed by the layout proces and the layout that were created from this proces. 101 Figure 36: Layout Shapes These are the main components that wil be in the play system which were selected from the product comparison charts in the component selection proces of this approach. There are multiple components, not al of which wil be used in the play system; however, there are enough to sustain multiple layouts until the right one has been determined. Figure 37: Layout Shapes Packet and Placement 102 By creating diferent layouts using the packets created from the larger image of shape, it was easier to picture the play system in terms of the trafic flow and components. Below are the initial layouts created for the sample play system. Figure 38: Layout One This layout includes a slide component and multiple activity clusters. The tunnel is the center of the play system with two raised platforms. However, the clusters of panels are not distributed evenly, and the main cluster of panels block the flow of the tunnel. The ramp wil require a platform, and there it not enough above area for children to move comfortably before sliding. 103 Figure 39: Layout Two In layout two, the tunnel is no longer the center of the play system. There are panels that are aranged to fit into the given space with enough of a fal zone for the equipment that requires an extra surrounding area. The flaws with this design is that there is not enough platform space for complete aces and the panels can tend to be closed off due to the isue of the user flow. Some activities might be cut off if numerous children are playing on this play system. Figure 40: Layout Thre 104 This layout incorporates the most components, but most of them are completely closed off. There is only one platform and two ramps that do not have a common platform. This layout could potentialy hinder the acesibility of the child. There should be more above platform space and a platform betwen each ramp. Figure 41: Layout Four This layout incorporates more platform space and a platform betwen the two ramps. The tunnel is centraly located and the platforms are in a specific cluster. This would be a more succesful layout if there were more components in the platforms and ramp system. 105 Figure 42: Layout Five This layout incorporates more components and platform space, while adding a platform to the ramps. However, for the final layout, the flow of the panels and other components wil have to be improved. The double tunnel is unnecesary within the given space. The final layout wil improve the size and shapes of this layout. Below is the preliminary simple drawing for the final layout. 106 Figure 43: Final Layout Phase One This is the preliminary layout that wil continue to the final design of the play system. The panels are incorporated into the sides of the platform, and there is plenty of raised space for disabled children to frely move on these large platforms. The components were chosen for the play system and placed in a layout that alows activities to be in clusters based on what the activity pertains to. The Music panel, the Rain Wheel, and Bongo panels are places next to each other because the child can simulate motion with the other panel. This wil help the child work with others and aid in their cognitive development by stimulating their brain through sound and motion. The theater panel is placed separately from other because it is an area where children work together but do not require other equipment. The Bug Eye Bubble panel and the Tic Tac Toe are the same as the Theater panel; they stand alone because no other panels complement it. The Wheel panel can be placed anywhere and is frequently placed to maximize activity in specific areas. There were some improvements that needed to be made on the first layout, and then the final layout was produced. 107 Figure 44: Final Layout This is the final layout for the example play system using the approach outlined in this thesis. There have been adjustments made from each of the layouts to create what is an ideal layout for this approach. The thre criteria, acesibility, development and theme, are al expresed in this layout. The layout is acesible due to the thre ramps and transfer stations that are at the end of each ramp. Al raised platforms are five fet wide, which is the area required for a person in a wheelchair to do a full turn and for two wheelchairs to be able to pas one another. Al of the panels are acesible from both sides and alow for improved movement for children of al abilities. The second criterion is the development of the child. Each panel chosen in some way stimulates children?s minds and creative thinking. There is a music station equipped with bongo drums and a rain wheel. There is a theater panel, which wil alow children to creatively expres themselves. As was stated in the literature review, creative expresion is important for children in hospitals. Creative expresion alows children to beter understand why they are in the hospital. Most of the space is designated for play except for the ramp which runs along the outside the playground. For the theme, the layout incorporates many celestial elements in order to enhance the theme of the playground. The layout fits wel into the cloud shaped ground cover that is the base of the playground. Below are some drawings of these layouts that developed the theme of the playground into the final design. 108 Figure 45: Drawing with Slanted Rails This sketch was drawn to incorporate the celestial theme into some of the components. The roofing wil consist of cloud and baloon pieces to give the feling that the children are away from the earth and the physical elements that hinder them on a daily basis. The ramps are colorful and slanted; however, there is too large of a gap betwen the rails, which could be harmful to the children. 109 Figure 46: Drawing with Climber Rails and Rainbows This is another drawing without the use of baloons and incorporates climber rail covered by a rainbow arch. This is a smaler scale of the final layout and the drawing is of one of the first layouts created, but seing the 3D version of the layout imediately showed the flaws. The cluster of panels and tight spaces wil make the play system ore dificult to maneuver. Figure 47: Drawing of the slide with Play System Roof This image is ilustrating the top platform, and the ideas for the slide that wil be incorporated in the play system. Some of the other panels can also be sen. The slide wil be required to fully touch the ground in order to be acesible and safe for children to use even if they are in a wheelchair. The top platform area wil be complete with clouds and baloons as the roofing on the play system. 110 Figure 48: Final Drawing of The Play System This is an image that follows the theme of the example play system, but the layout is slightly diferent. The rainbow arches, baloons and cloud roofing wil be incorporated in the final design. These ilustrations were to understand the theme of the play system rather than the line drawings that were to understand the precise layout. However, both aspects are important to this particular approach. After the layout was selected, the example play system was built in Solid Edge, a 3D CAD program. The following chapter wil discuss in more detail the aspects of the final design. The following chapter wil reveal a computer model and a physical model and discuss the final design in more detail. 111 CHAPTER SEVEN: FINAL MODEL 7.1 Final Model. In order to fully display the final outcomes of this approach, the final play system was built in solid edge and rendered in Hypershot. After the model was built in the computer, a physical model was created. The computer model was created to aid in the fabrication of the physical model and to create photorealistic computer renderings. Below are the photos of the areas discussed in the previous chapters. Figure 49: Hypershot Rendering of Play System 112 Figure 50: Final Model This is the final model of the play system built with foam plastic wood and other craft pieces. The final model followed the thre overal criteria of the approach given in this thesis. The images and explanations are as follows. 7.2 Universal Acesibility The first pieces of this play system that involve universal acesibility are the ramps that are incorporated in this play system. The ramps alow universal aces to the top platform and slide component of the play system. The images of the ramps are shown below. 113 Figure 51: Top View of the Ramps Figure 52: Ramp Entrance 114 Figure 53: Side View of Ramps The next component that incorporates universal acesibility is the slide component. The ramps create aces to the slide, and there are platforms on either side of the slide for wheelchairs. For children in a wheelchair to slide, they need parental asistance. The parent would wheel them to the slide, and they would use the handlebars to slide down. The Big Foot slide was chosen because it slides al the way to the ground for a safer landing. Photos of the slide are as follows. 115 Figure 54: The Big Foot Slide and Sun Roof Figure 55: Platforms and Designated Whelchair Area 116 Figure 56: Slide Handles Figure 57: Side View of Slide 117 The next component for this system is a new design that incorporates both the sky view tunnel and a fun house miror. There are two sky panel units and four fun house miror units. They create a secluded tunnel that is universaly acesible. The images of the tunnel are as follows. Figure 58: Miror Tunel Figure 59: Entrance of Tunel 118 Al of the panel components are also acesible. The components shown were intended for this play system to increase the universal acesibility and make this playground fun and stimulating for al children. 7.3 Child Development The second criterion outlined in the approach is child development. It is esential that these components al stimulate the child and aid in their development. Through literary research, it was proven earlier in this thesis that play aids in child development, and there are certain stimuli that are esential to include in the play system. The components that aid in a child?s development are as follows. Figure 60: Music Cluster 119 This music cluster includes both a rain wheel and bongo panel. Each of these components makes noise, and children can work together to create rhythms. Music is a stimulatory activity that aids in both social and cognitive development. Figure 61: Activity Cluster This activity cluster includes a Tic Tac Toe panel, a wheel panel and a Gizmo panel. The Tic Tac Toe panel encourages group play and aids in children?s development by teaching strategy. The Wheel panel alows for creative role-play. The Gizmo panel not only utilizes ramp space, but also incorporates multiple activities on one panel. Another view of the Gizmo panel is displayed below. 120 Figure 62: Second Gizmo Panel This second gizmo panel offers more activities and also helps take up space that was occupied by the ramps. In front of the Gizmo panel is the theater panel, which like the wheel panel inspires creative role-play. An inclusive photo of the theater panel is shown below. 121 Figure 63: Theater Panel 7.4 Theme The last criterion for the approach is the theme of the play system. There are many elements that enhance the Whimsical Sky theme that is modeled after the existing architecture of Vanderbilt Children?s Hospital. The name of the play system is the Hope Heals Playground. The whimsical sky elements are as follows. 122 Figure 64: Ground Cover The Ground Cover was the first component that was inspired by the whimsical sky theme of the playground. The Ground Cover resembles the shape of a cloud in order to make the playground appear as if it is floating in the sky. 123 Figure 65: Cloud Roofing The cloud roofing miics the cloud ground cover on a smaler level. The clouds are to aid the image of a floating playground in the sky. The clouds then atach to both the main poles and railings on the platforms. Figure 66: Balloon Pole Toppers The Baloon Pole Toppers add another celestial air to the playground. These baloons are what is supposed to be suspending the play system in the air. They also add a splash of color as wel as the rainbow pieces that connect the ramps in the following image. 124 Figure 67: Ramp Rainbows The last element that shows the theme of the play system is the sun that hangs over the slide. The sun reflects some of the architectural detail in the play system and adds a bright contrast to the colors of the ramp and platforms. Figure 68: Sun Roof 125 This play system succesfully followed the approach outlined in this thesis by creating a play system with universaly acesible components and activities that stimulate children and aid in their development while abiding by a common theme to inspire children and their families. 126 CHAPTER EIGHT: CONCLUSIONS 8.1 Closing Sumary Chapter one discussed the importance of play for a child regardles of their environment or health situation, along with the absence of play in hospitals and the individuals in charge of play and how it is implemented in a healthcare environment. Chapter two discussed the importance of child development and two pioneers of child psychology and their theories. Chapter thre included research conducted by surveys, tours and interviews to gain a beter understanding of play in hospitals and the reality behind playground building. Chapter tour summarized playground safety and the ADA requirements that are crucial for the succes of the play system approach. Chapter five outlined the approach created for the thesis project. The approach was followed by an example project that is outlined in chapter six. Chapter seven shows the final project in both a computer model and physical model. 8.3 Implications and Aplication of Study This approach was created to aid both designers and playground companies to create a play system for a children?s hospital. In this thesis there are two diferent areas of component selection and design. For companies, it is beter to focus on existing equipment and themes that have already been produced. For a designer, there is the possibility to create new themes and components as shown in the thesis. This approach 127 wil also aid other health care individuals in creating a play space for children in hospitals. 8.2 Recommendations for Further Study There are stil further studies that can be done with the subject of play systems in children?s hospitals. There is a need for further development of components that are one hundred percent universaly acesible. Many companies claim that they can incorporate acesible components, but the reality is that there are very few components that are fun for children of al ages and abilities. This is a chalenge that is fully encouraged for further study in this subject. 128 BIBLIOGRAPHY ?Al Children Ned Children?s Hospitals? NACHRI . American Academy of Pediatrics, Hospital Care of Children and Youth, Elk Grove Vilage, IL, 1986. Boss, Bev and Jenny Chapman, Tumbling Over the Edge: A Rant For Children?s Play, Shingle Springs, CA, 2005. Casey, Theresa, Environments for Outdoor Play: A Practical Guide for Making Space for Children, London, England, 2007. Calery, Peter, ?Caring for parents of hospitalized children: a hidden area of nursing work.? Journal of Advances Nursing 1997. ?Child specialists make hospitals les scary.? The Asociated Pres July 2004. MSNBC. ?Children Learn Through Play.? St. Jude Children?s Research Hospital 2003. Children?s Hospital Boston, ?Making a child?s (hospital) life a litle easier? Children?s News 2004. Davis, Alan G., Children in Clinics, Cambridge, England, 1982. 129 Fisher, Marc, ?Toys in Hand, Staf Helps Patients through Fear and Pain.? The Washington Post October, 2006. <> Geist, Harold, A Child Goes to the Hospital. Springfield, IL: Bannerstone House, 1965. Fort Lauderdale FL: Nachez Publication House. Go Fawns Safe Play, Herwald, Margi, ?A Hand To Hold: Child-life specialists strive to make hospitals les scary for kids and parents? Cleveland Jewish News June 2004. Isenberg, Joan Packer and Nancy Quisenbery, ?Play: Esential For Al Children.? Asociation for Childhood Education International 2002. Klinzing, Dennis R. and Dene G., The Hospitalized Child: Communication Techniques for Health Profesionals. Englewood Clifs, NJ. 1977. Komiske, Bruce King, Designing the Worlds Best Children?s Hospitals. Australia: the images publishing group, 2005. Komiske, Bruce King, Designing the Worlds Best Children?s Hospitals 2. Australia: the images publishing group, 2005. Lindheim, Roslyn, Helen H. Glaser and Christie Coffin, Changing Hospital Environments for Children, Cambridge, MA, 1972. Longo, Mary F. ?Children and Play.? Ohio State University Extension Factsheet. 130 MacKinnon, Donna Jean, ?There?s no place like home but SickKids tries; Dream playroom with TV, Kitchen and computers lets patients just be kids? Toronto Star March 2007. Lexis Nexis. Oremland, Evelyn K. and Jerome D, The Efects of Hospitalization on Children. Springfield, IL, 1973. Peligrini, Anthony, Reces: Its Role in Education and Development. Mawah, NJ, 2005. Petrilo, Madeline and Sirgay Sanger, Emotional Care of Hospitalized Children. Philadelphia PA 1980. Ramer, Holly, ?Helping Kids Cope With Pain.? CBS News June 2004 Schwalenstocker, Elen, ?Transparency for children?s Hospitals: What Wil It Take?? Children?s Hospital?s Today Spring 2007: NACHRI Thompson, Richard H. and Gene Stanford, Child Life in Hospitals, Springfeild, IL, 1950 Vuong, Mary, ?A Comfort to the Kids: Making a diference.? The Houston Chronicle 2005. Wadsworth, Bary J., Piaget?s Theory of Cognitive and Afective Development. White Plains NY 1996 Wareham, Laura, and Donna Shelton, ?What Makes a Relationship Betwen a Children?s Hospital and System Succesful?? Children?s Hospital?s Today Spring 2007: NACHRI. <> Warner, Laura, ?Child-Life specialists ease stres for young patients.? Deseret Morning News November 2004. 131 Wilson, Jeriann M, ?Child Life Services (POLICY STATEMENT).? Pediatrics October 2007. Expanded Academic ASAP.