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Diversional activity deficitRecreation and activities in the oncology settingPatrizia D’Amico, Roberto Quarisa, Servizio di Oncologia Medica, Ospedale di Ivrea (TO), Italia, translation of the original version ofSarah Liptrott, European Oncology Institute, Milano“Diversional activity deficit” is one of the nursing diagnoses identifiedfrom the NANDA in 2005 (00097, II, 2005).The work of ‘recreation’ has progressed now for 10 years in thedepartment of oncology at Ivrea Hospital, near Torino, and is aconcrete response to this diagnosis. It consists of a general series ofinterventions, between the areas of creative activity and occupationaltherapy, to be performed when the onset of inadequate activity of thepatient is identified or anticipated.We work in a medical oncology department, composed of aninpatient unit with twelve beds, a day hospital, an outpatient serviceand a service welcome centre (CAS). Our ‘users’ are adults, usuallyover 50 years of age.Participating can take attention away from the symptom – it can bereduced or disappear temporarily. Also immobility is not an obstacle,some small pieces of work can be carried out in bed, surpassingphysical handicap. Sometimes the participation stimulates leaving thebed area and taking individuals to a communal area.EnvironmentCarrying out this activity allows us to go and to act in an environmentthat constantly changes because it is staged and modified accordingto the different seasons and for the different events that characterizeour lives. The time outside of the ward becomes lived also inside withpreparations created by the patients and personnel. The seasons –holidays like Christmas, Epiphany and carnival, so important in ourtown for the oranges-battle! – are remembered in our ward: the snowthat comes down from above, the flags of the carnival, grapes andautumnal leaves… recreate symbolic objects that evoke the “time” ofdaily life.In alternative to these moments, each person researches topicsaround which to create the objects of the projects: Threedimensionalanimals made with card, rubbish bags, glue, colouredcard, plastic bottles; coloured stained-glass windows made with cardand tissue paper;Larger objects; showcases for the postcards and for the photographs;large cardboard silhouettes.Usually they use cheap materials, recovered, recycled (above allpacking materials), easily available. However we have available forevery activity scissors, glue, staplers, string, adhesive tape, wire,thumb tacks, fishing line, coloured cards, tempera, paint, felt-tip pen,tissue paper, crepe paper.In our hospital as in the majority of hospital departments in Italy, theabsence of pleasant and diversional activites and the cold and clinicalenvironment, emphasize and sometimes increase the perception ofthe symptoms and the sense of isolation that oncological illness cancause. Also if the range of service ‘users are diverse in relation to ageand social status’ , the problem can be amplified. Depressed statesand apathy are often present in these types of patients.Throughout these activities, we aim to face the onset of theseinconvenient situations. Our recreational interventions aimessentially to make participants profit from light creative activity to fillthe long empty spaces of hospitalization.The activity is proposed to every individual, dedicating the timedeemed convenient; it is personalized allowing creativity, manualability, artistic skill and potential, even if this means discovering anability that they did not think they had. Also where there are highlevels of fatigue, they can participate, showing therefore that even thepresence of the symptoms leaves some margin for activity.The choice of the topic to be developed is by chance – a proposalfrom whoever has an idea: users, family, personnel… will find ideaor activity they like, begin work and leave it on the table in thedepartment and very slowly it is built upon. We aim to realize everyproposal, looking not to be repetitive, and for this reason, at theend of the period, the arrangement is dismantled completely andeliminated, recycling only the material still useable. In this waywe do not run the risk of same projects every year, stimulating theconstruction of new ideas.Often the project is not of high quality and during its realisation smallinconveniences occur or the aesthetic result is not that desired. , Forus it is not important, the thing that we aim for is participation in theaccomplishment…all that is realized, is meaningful for the individual.Timing• The long moments of inactivity that characterize a hospitalizationbring into focus the changes in life that cancer causes, redefininglong term objectives and often favouring a state of depression.These recreational interventions aim to allow individuals whowish to participate in different activities, to avoid the situation ofdepression.- newsletter fall 200816
This happens not only with the creation of projects, but also withdifferent interventions that involve the user in social games, theaccomplishment of a puzzle, reading of a book chosen from themany available in the library. There are then moments of fun in whichto assist like onlookers listening to some songs, musical groups orwatching entertainment shows.AtmosphereThe structural interventions are aimed to be more welcoming tothe environment, the work of collaboration between personnel andusers for the accomplishment of the projects, participation as simpleonlookers to the events: are all elements that contribute to changethe “atmosphere”. The climate is defined as an integration betweenphysical environment and social aspects, relations and emotions thatcharacterize an organization.Our intention is to create a family atmosphere, warm and attentiveto the human dimension in providing a positive quality careenvironment.. Sometimes during the recreational activity, nurses,patients and carers find themselves around a table together, whichbreaks down the professional/institutional structure and allows amore human dimension providing exchange and ‘chatting’ to knowmore personal aspects, taste, episodes of life not usually recalled innormal hospital interactions.It is these “chats”, exchanged in friendship, that often help toestablish answers to inexplicable reactions, reveal family dynamics,unexpressed fears, elements that become a valid help for our activity,and that allow better individualised care.The participation in recreational activity otherwise allows differentusers to know, or to be familiar with them, to go out from their roomsand to share with the others….This recreation often takes place also with the family, for them thisrepresents a diversion that allows temporary removal of the attentionof worries bound to the illness of the person for whom they care.The project started in 1997, driven bythe corporate training center and aimedat students participation. The initialstages included some nurses and theactivity was aimed at group-work andplaying rediscovery . The project was thenmanaged totally by nurses in the generalmedicine department and successively inoncology, and from the start it has beenself-financed. The time dedicated is almostentirely within normal working hours, dueto diversional activity being developedconcomitantly with the activity in the department.Within the Italian Oncology Nurses Association (AIIO), a study groupnamed Grano (oncology recreation group) established in 2004collected information about the Italian reality of the development ofexisting light, artistic, and recreational activities.One of the first objectives of the group was to map within Italy theconsistency of the diversional activity in non-paediatric oncologydepartments. This enquiry has emphasized the scarce attention tothis problem and the scarce interest, maybe correlated to a lackof knowledge in this subject that this aspect of humanisation andrelated activity are covered in the nursing profession.The AIIO National Congresses of and other educational courseshave been organized with the objective of conveying theory andtechniques of recreational interventions to make nurses aware ofthese less ‘scientific’ aspects of care, but that are equally importantfor our activity. After these episodes of training/education, thereality has begun to dawn on their services. To increase further thecirculation of the awareness of the diversional techniques, they havebeen put onto the AIIO website – a space that collects the blog ofsome services. Besides documenting activity carried out, the blogconstitutes a cue for those who want to begin to enliven the actualworking reality. The site AIIO is found at: htpp://www.aiio.itThe carrying out of recreational activity has been valid help toimprove the work of the team, all the activities are carried out thanksto the support of the health care professionals.newsletter fall 2008 -17
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