CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
A STUDY ON THE NEED FOR A MANUAL
OF CREATIVE ARTS
FOR PEDIATRIC NURSING
A thesis submitted in partial satisfaction of the
requirements for the degree of Master of Arts in
Art
by
Hazar M. Hijazi Abukurah
May, 1988
The thesis of Hazar M. Hijazi Abukurah is approved:
Colleen Bercsi, Advisor
California State University, Northridge
ii
DEDICATION
To my husband Abdul Razzak Abukurah, M.D.
and our sons Omar and Ammar Abukurah.
iii
ACKNOWLEDGMENTS
In writing this paper I have sought assistance from many
people, all of whom have given generously of their time and
knowledge.
Some of the work could not have been done without
their help.
Thanks to so many.
To Dr. Lenore Sorenson who has given me constant support
and has contributed many
great
example
of
a
ideas,
children's
and for
art
her being such a
expert herself,
a
most
motivting influence.
To Dr.
Donna Ruedy who has also contributed many ideas
and who gave me the feeling of constant support.
To Mrs. Colleen Bercsi who has given me an inspiration
through her own writings on art education and who has helped
me in editing this paper.
To
several
other
faculty
members
at
California State
University, Northridge.
To the Art General Department staff in general, and to
Jacqueline Stemm and Elizabeth Queen in particular.
Their
devotion in assisting students is most appreciated.
To Elizabeth Hilborn for whom I will always be grateful
for
introducing
me
to
the
nursing
belief in me throughout.
iv
profession and for
her
To
many
of
the
faculty
members
at
Wayne
State
University, Detroit, Michigan, particularly to Irene Beland,
a great teacher, and
whose book in "clinical nursing" that
she wrote years ago will be an inspiration to nurses for many
years to come.
Above all to my family:
In memory of my parents Dr. Mohammad and Mrs. Kheirieh
Hijazi for instilling in me the love and respect of people;
for my father for his lifetime struggle for the principles he
believed in;
courage
and
for my mother for setting an example of love,
perseverence
to
her
generation
and
for
generations to come;
To my two sisters Leila and Faihaa, and my brother Talal
Hijazi
and
their
families
for
their
continued
love
and
friendship;
To my cousin Afaf Hijazi for introducing me to art and
encouraging me since I was a little girl, and by setting an
example of being an accomplished artist herself.
Most
importantly,
to
my
husband
Dr.
Abdul
Razzak
Abukurah for his continuous support and encouragement,
and
for being the great example for our sons and for myself and
many others, personally and professionally.
To my sons Omar and Ammar Abukurah, for everything about
them that makes me love them and be proud and thankful for
being their mother.
v
And last, but not least, to Carol Ellis for typing this
paper.
To each and every one of them I will always be grateful
for being a part of my life.
vi
PREFACE
The point of view of the author of this paper is that of
an artist and of a professional nurse.
There is a need to
combine the professional skills of nursing with that of art.
After all, nursing has always been considered an "art and a
science."
The "art" of nursing has been mostly an intangible
element included in a
nursing books.
of
nursing,
empathizing,
long list with broad definitions in
This list covers only the humanistic aspects
including
the
sympathizing
and
arts
of
giving,
caring.
Being
loving,
s~nsitive,
understanding, and perfecting and anticipating needs is also
part of the long list.
these
rather
The assumption here is that many of
"so-called"
attitudes
can
be
incorporated in
nursing care when one takes the time to be with a child to
perform some kind of an art acitvity.
This is one of the
best things for the child as art builds self-esteem, and can
act as an agent for self-actualization.
The author does not presume that art is a cure for all
ailments.
It does, however, do the following:
It frees the spirit and makes individuals do something
because they want to do it;
It expresses the uniqueness of each individual because
through the force of art we express the unique spark of our
vii
humanity;
It engages the emotions, and encourages the growth of a
healthy individual through improvement of self-esteem.
viii
TABLE OF CONTENTS
DEDICATION
iii
ACKNOWLEDGMENTS
iv
vii
PREFACE
ix
TABLE OF CONTENTS
xiv
ABSTRACT
CHAPTER I.
INTRODUCTION
A.
Purpose of Project
B.
The Need for this Project
c.
II.
1
(Justification)
3
The Need of Art for the Sick Child
9
REVIEW OF LITERATURE
A.
III.
1
11
Art Educators on Art and the
Growing Child
11
B.
Art as a Basic Human Need
18
C.
Art for the "Total Person"
20
D.
Artists on Art and Self Actualization
22
CHILD GROWTH AND DEVELOPMENT
25
A.
Introduction
25
B.
Directions
26
c.
Developmental Stages
27
1.
2.
The Toddler hood stage
27
a.
Physical Development
27
b.
Art Development
27
c.
Conclusions Derived
28
The Preschool Stage
ix
29
3.
4.
IV.
a.
Physical Development
29
b.
Art Development
30
c.
Conclusions Derived
31
The Midchildhood Stage
31
a.
Physical Development
31
b.
Art Development
33
c.
Conclusions Derived
34
The Adolescent Stage
35
a.
Physical Development
35
b.
Art Development
38
c.
Conclusions Derived
39
DIRECTIONS FOR PLANNING ART
ACTIVITIES AS RELATED TO CHILD
GROWTH AND DEVELOPMENT
41
A.
Physical and Emotional Factors
41
B.
Nursing Management
43
c.
The Nurse's Role in Planning
Art Activities
D.
48
Accepted Nursing Diagnosis
(As related to planning art
v.
activities)
50
THE CHILD AND ILLNESS
52
A.
Effect of Illness and Hospitalizing
on the Child and His Family
52
1.
General Considerations
52
2.
Nursing Management
54
X
B.
c.
Effect of Illness on Body Image
56
1.
The Child's Concept of His Body
56
2.
Nursing Management
57
Anxiety of the Child and Parents Due
to Illness
VI.
1.
Anxiety of the Child
2.
Manifestation of Anxiety
59
59
in Children
59
3.
Nursing Management
60
4.
Parental Anxiety
61
5.
Nursing Management
61
SELECTING ART PROJECTS ACCORDING
TO ILLNESS AND SPECIAL PROBLEMS
AFFECTING CHILDREN
63
A.
Introduction
63
B.
Categories of Pediatric Disorders
63
c.
Neurological Disorders
64
D.
Pediatric Topics (Another Approach)
64
E.
Selection of Projects According to
Patient's Needs (Using a Simplified
Approach)
VII.
67
1.
The Author's Approach
68
2.
Steps to Follow
69
3.
Example
70
ART MATERIALS
A.
71
Suitable Art Material for Children
xi
B.
According to Age
71
1.
Children 2 - 4 Years Old
71
2.
Children 4 - 8 Years Old
71
3.
Children 8 - 12 Years Old
72
4.
Adolescents
73
Hazards of Art Materials and How
to Work Safely With These Materials
74
1.
Introduction
74
2.
Special Problems of Children
74
3.
Toxic Art Materials
77
a.
Disposal of toxic or
hazardous materials
b.
Toxic art supplies
legislation
VIII.
77
78
4.
List of Hazardous Materials
88
5.
Presenting Materials Effectively
80
6.
Organizing the Physical Setting
80
7.
Variety of Material
81
SUGGESTIONS FOR THE MANUAL
83
A.
Introduction
83
B.
Suggested Kits
83
c.
Plan of Experience
85
D.
Suggested Hospital Forms
for Art Activities
85
1.
Activity Rating Forms
85
2.
Categories Suggested
85
xii
3.
Suggested Nursing Charting
Forms
E.
Suggested Outline for Manual
F.
Detailed Outline of Things
to Do With Paper
IX.
CONCLUSION AND SUMMARY
BIBLIOGRAPHY
86
87
88
89
91
A.
Articles
91
B.
Books
93
c.
Bulletins
96
D.
Suggested Extra Reading for the
97
Manual
97
E.
Suggested Periodicals for
Subscription
xiii
98
ABSTRACT
A STUDY ON THE NEED FOR A MANUAL
OF CREATIVE ARTS FOR PEDIATRIC NURSING
by
Hazar M. Hijazi Abukurah
Master of Arts in Art
California State University, Northridge
The purpose of this thesis is to study the need for a
manual
of
creative
arts
and
crafts
that
can
be
used
by
pediatric nurses for hospitalized children and by families
and friends of sick or disabled children at home or in other
facilities.
This
manual
would
be
suitable
for
children ranging from two years through adolescence.
use
by
Some of
the projects can be used for adult patients as well, but the
emphasis in this paper is on pediatrics.
Knowing that the
comprehensive care of any patient inolves the patient, his
family, and this friends, at times; therefore it is essential
to plan a project that has a continuity in care after the
patient
goes
home.
It has
been
commonly
said among
the
medical population that the discharge plan for the patient
xiv
starts
on
admission.
It
should
suit
the
patient
as
an
individual and as a part of the family unit.
In view of the above, the art projects suggested in this
paper will be applicable in any one or more of the following
setups:
Children
in the
hospital
or discharged at home,
children in special care homes and in confining institutions,
children in dialysis units,
anywhere
where
there
is
in a park,
need
for
in a wheelchair, or
utilizing
time
in
a
constructive and a positive manner.
The person assisting in the procedure
nurse in the hospital, but then,
the following people:
friend,
is usually the
it can also be any one of
a parent, a grandparent, a sibling, a
a family member,
who cares about the child.
a sitter, or a
volunteer~
.. anyone
These people do not need a degree
in fine arts to be able to assist the children in performing
art activities.
With the help of this manual they should be
able to help children use appropriate art media and express
themselves creatively.
XV
I.
A.
INTRODUCTION
PURPOSE OF PROJECT
The question that comes into the mind of most people
caring for a suffering fellow human being is whether or not
everything that is possible is done for the patient.
This
manual
that
is
intended
to
give
the
extra
special
complements the patient's daily routine.
bonus that tells the patient:
how you spend your time."
care
It is almost the
"I do care about you and about
It is to help in those lengthy
hours of pain and suffering, and to reduce the preoccupation
with the illness.
This paper is divided into five parts:
The first part
deals with the review of literature about the importance of
art for children; the second part deals with child's physical
and art development; the third part deals with the effect of
illness on the child's growth and development;
the
part
part
deals
with
art
material;
and
the
last
fourth
is
a
suggested format and content for the manual that the author
is concerned with in this study.
Because
constantly
the
broad
changing
and
field
every
of
medicine
situation
and
nursing
is
and
patient
is
different, the art techniques to be used in the manual need
to
be
only
the
beginning
of
1
a
collection
with
endless
possibilities.
Also, the author recognizes the importance of
a successful relationship between the patient and the nurse
based on knowledge and application of therapeutic principles.
Therefore, the reader needs to refer to specialized books on
these specific subjects for more complete discussion.
A project such as this has some arbitrary restrictions
since
one
cannot
present
all
possible
clinical
problems.
These selections are representative of the most commonly seen
situations.
The person using this manual is advised to keep a copy
on the unit or on a shelf at home.
It is hoped that this, as
well as other nursing manuals will help the nurse to perform
the activities with the intellect, as well as with the hands.
Because the
subject matter is vast,
human life is immeasurable,
and the value of
the study of caring for the ill
can be a lifetime task.
This simple manual is offered to the
practitioner
hope
understanding
disability,
as
in
of
the
the
shejhe
human
that
needs
engages
in
it
will
during
the
increase
their
most
rewarding
challenging of tasks, that of caring for people.
2
illness
the
or
and
B.
THE NEED FOR THIS PROJECT
(JUSTIFICATION)
As
a
previous
nursing
educator
and
as
a
currently
licensed registered nurse in the State of California, I share
the concern of my colleagues with the lack of availability of
comprehensive care plans that are pertinent to the patient.
What is mostly available are standardized care plans that
overlook specific patient/family problems.
In previewing the nursing literature for
years,
one
finds
many
attempts
at
the
last 30
writing
about
individualized care based on knowledge of patient needs.
recent literature is based on the nursing diagnosis.
new
books
enumerate
a
number
of
nursing
diagnoses,
The
Many
then
comprehensive nursing care plans are derived using relevant
situations for the patient.
Most of the time the format can
be adapted to any conceptual framework or practice setting.
The
information
contained
in
the
modern
nursing
literature stresses the importance of the psychosocial and
cultural aspects of the care of patients, as well as their
families.
The commonly used phrases, however, are based on
value statements such as "occupy the patient's time according
to his needs. "
used:
In some cases, more specific suggestions are
"Teach relaxation technique (i.e. imagery, progressive
3
muscle
relaxation,
effort
to
reduce
suggestion,
care. 112
breathing
the
exercises,
client's
meditation)
anxiety.n1
In
in
an
another
"Allow a close family member to participate in
"Refer to psychiatric liaison nurse, support group,
or community agency as needed. 11 3
verbalization of feelings. n4
"Allow opportunities for
Some more statements include:
"Assist client to develop problem-solving skills related to
separation,
individualization
and
conflict
resolution."5
"Encourage sibling/friends and/or parents to play Monopoly
and other board games;
encourage client to build with his
Legos. 116
The previous quotations are only a
interventions
patients.
is
that
relate
to
the
sample of nursing
special
needs
of
the
Awareness of the need to occupy the patient's time
obvious.
Despite
availabale guides
this
necessity,
to follow.
nurses
Therefore,
do
not
have
there is a great
need for a project like this to help fulfill some of these
needs and to save valuable patient-care time.
1 cynthia M. Taylor, Sheila s. Cress, Nursing Diagnosis
Cards, Springhouse Corporation, Springhouse, PA, Nursing 87,
19871 P• 186 •
2 Ibid., p. 316.
3 Ibid., p. 786.
4Ibid., p. 796.
5Agnes G. Rezler, Anna M. Tichy, Nursing Care Plan
Workbook, Appleton-Century-Crofts, A Publishing Division of
Prentice Hall, Inc., 1985, p. 83.
6 Ibid., p. 67.
4
Most of the modern nursing books share the following
concerns regarding the current care:
1.
There is so much to do and so little time to do it;
2.
It is becoming more and more challenging to provide
comprehensive care which incorporates the beliefs
of
professional
nurses,
due
to
the
diminishing
resources of health care;
3.
Nursing
students
experiencing
their
and
limited
families
in
practicing
contact
both
clinicians
are
patients
and
with
hospital
and
ambulatory
settings while being expected to deliver care.
In
many situations the conditions demand that nurses
make maximal use of their contact time, and there
be
an
up-to-date,
information
providing
that
always
can
health
be
care
available
used
for
as
source
the
of
basis
patients
and
for
their
families.
4.
As
health
professionals
increase
their
focus
on
promotion of the patient's physical and emotional
well-being,
families
are
assuming
more
and
more
responsibility for the health care of the family
members.
5.
Hospitalizations are less frequent and are shorter
in length.
6.
Today's
challenge.
pediatric
nurses
face
a
tremendous
They are expected to provide optimal
5
family-oriented comprehensive care.
The pediatric acute care setting has
changed as a result of increased use of
one-day surgery units and out-patient
care.
Hospitalized children are
frequently in for short periods of time,
are much more critically ill than the
average pediatric patient of the past, or
are facing the challenge of living with a
chronic illness.
These changes along
with the technical advances ... make it
difficult for the nurse to confidently
provide care based on current state-ofthe-art knowledge. 7
Considering the above factors in doing such a project,
one does not forget that nurses are very busy with critically
ill patients and that their main concern is to make quick
decisions regarding the patient's care.
Also, teaching and
care that was once extended over a period of time must now be
condensed and modified.
Hence, the care seems to concentrate
on physical emergencies, and very little time can be used for
other patients' needs.
What are the artist's concerns with the humanistic needs
for art in time of difficulty?
discuss
art
for
the
The majority of the art books
artists
themselves.
Very
little
is
mentioned about the necessity of art for everyday life and
for the sick and disabled.
Art Therapy literature, on the
other hand, is very rich in its references.
However, since
art therapy needs to be performed by professionally trained
Art Therapists, and due to shortages of these professionals
7 cindy Smith Greenberg, Applying Nursing Diagnosis,
Nursing and Planning Guides for Children, Baltimore, MD:
Williams and Wilkins Publishing Co., 1988.
6
on the staff in different hospitals or community centers, it
is necessary to pursue other possibilities of utilizing art
in a simpler manner.
To illustrate the need for art from a Therapist's point
of view, I refer to Kramer's statement on art:
The idea that self-expression through art is good
for people and specially for unhappy people has
been widely accepted.
Social workers, family
doctors, psychiatrists, and psychologists advise
their troubled clients to find solace and
satisfaction in art ..• This quest for salvation
through art is gaining ascendary
at a time when
art has all but disappeared as a normal ingredient
of daily life.8
What
Kramer
is
referring
to
is
the
effect
of
industrialization in our life which leads to mass production
and little interest in hand-made products.
Another art educator who is concerned about a similar
problem is Willet W. Ryder whose concern is illustrated in
the following:
In an age of ever increasing complexities, ever
expanding technologies and the loss of individual's
identity, art education must once again strongly
support its role as a self-actualizing agent within
our society ... In fact, the link between art and
self is one of the chief production blocks of our
field. 9
Regardless of our changing world, there is still a place
for art in our lives, not necessarily for productivity, per
se, but as a means of self expression and as an antidote in
8Edi th Kramer, Art as Therapy with Children,
Books, Inc., 1971, p. 1.
Schocken
9Willet W.
Ryder,
"The Role of Art in Self
Actualization," Art Education, March 1987, Vol. 40, No.2, p.22.
7
time of illness or stress as described in here:
Canst thou not ... raise out the written troubles of
the brain, and with some sweet oblivious antidote
cleanse the stuffed of that perilous stuff which
weighs upon the heart?
Shakespeare, Macbeth
Act V, Scene 3
8
C.
THE NEED OF ART FOR THE SICK CHILD
The author believes that parents and pediatric nurses
are concerned about the developing child who is interrupted
by illness or disability.
This interruption, at times, can
often change the whole future of the child.
of nursing,
along with the other medical personnel,
help the child to continue growing.
difficult,
Part of the task
at times,
is to
This task can be very
and the child needs all the help and
support he can get.
The author also believes that incorporating art as part
of
the
daily
children
goals.
can
activities
help
in
for
healthy,
achieving
the
sick,
optimal
a
disabled
developmental
This is not to say that it is the responsibility of
the nurses to educate the children in art.
be
or
continium of
what
the
child has
Art is meant to
learned previously.
This also does not mean that all nurses need to be artists.
However, nurses are trained to be educators, and that is very
helpful in teaching children art.
That same principle might
be applied to parents who are the educators of children at
home.
Both sides, then, can help the child fill a moment of
sadness, pain, emptiness, fear or anxiety, with the pleasure
of self-expression in art.
A glance at the importance of art for growing children:
9
Art has been expressed as the "Universal Language that the
children speak."
Sir Herbert Read quoted Rousseau and added
by
the
saying
that
uniformly human.n10
"child's
perceptual
development
is
Read also refers to writings of Rhoda
Kellogg on lengthy studies done on infants:
... That the expressive gestures of the infant from
the moment that they can be recorded by a crayon or
pencil, evolve from certain basic scribbles toward
consistent symbols.
Over several years of
development, such basic patterns gradually become
the conscious representation of object perceived:
The substitute sign becomes a visual image ... out of
the amorphous scribblings of the infant emerge
first certain basic forms, the circle, the upright
cross, the diagonal cross, the rectangle, etc. 11
10osir Herbert Read, Child Art - The Beginning of Self
Affirmation. Ed. Hilda Present Lewis, Draft A, Berkeley, CA,
1966, p.
23.
11rbid., pp. 24-15.
10
' .
II. REVIEW OF LITERATURE
A.
ART EDUCATORS ON ART AND THE GROWING CHILD
Art educators have been repeatedly expressing their deep
concern in the last two or three decades about two aspects of
how children are
learning art
in the United States.
The
first point of their concern deals with the realization that
children are not exposed enough to art.
on
the
other
hand,
is
Their second point,
regarding
the
educators'
dissatisfaction with the quality of art education provided to
children.
Traditionally, introducing art for the growing child has
been the responsibility of the parents andjor the elementary
school teachers.
However, due to cuts in budgets and other
educational priorities, the arts have been almost cut out of
the curriculum in many schools.
It is used by only some
teachers as a reward if the children finish their school work
early and as an elective among many subjects in the upper
grades.
It is
important to point out that a
children are exposed early to art
schools and day-care centers.
small number of
in some of the private
The media has also been giving
some exposure to art on the educational channels.
11
However,
for· these programs to have a positive value, there is a
need
for the child to utilize what is offered and to experiment
with
the
getting
ideas
less
that
and
are
less
presented.
applicable
This
since
possibility
many
mothers
is
are
working and the children are often left alone with or without
supervision
for
a
long
period of
time.
So,
for
obvious
reasons, these programs do not serve all of their purposes.
The effect of such programs even when utilized at their best
is not nearly as strong as a two-way communication such as
that provided by the parent andjor the teacher and the child.
Here is a glimpse of what our educators have to say on
the importance of art as well as their concerns:
Art activity has long held a secure place ... in the
play of young children.
Scribbling, drawing,
block-building, clay modeling and the like came
naturally to the child ... He seems to discover them
for himself and to derive pleasure from carrying
them out.
The task of parents and teachers is to
find ways of maximizing the child's opportunity to
enjoy art experience and to provide art activities
that contribute to motor, affective, perceptual,
cognitive and aesthetic development. 1
Hilda
Lewis,
in
another
of
her
books,
discusses
education and child development from a different angle.
art
She
tells us that child development is divided by scientists and
educators into component parts, cognitive, motor, affective,
etc.
In young children, the ability to draw is highly
correlated with intelligence.
The Draw-A-Man Test
has for many years indicated readiness for reading.
1 Hilda Present Lewis, Art for the Preprimary,
National Art Education Association, (1972), p. 5.
12
The
Cognitive development is served not only by
activities that are primarily cerebral but by all
stimulating and rewarding experiences.2
While Eisner approaches art for children with concern
about lack of exposure to art in schools:
The arts have not enjoyed a place of prominence in
schools because of the way in which both art and
education have been conceived.
The dichotomies
that have been established between the work of the
head and the work of the hand are manifest in the
role the arts are assigned in schools.3
Eisner goes on with his concern about the quality of the
programs provided in both creativity and appreciation of art:
... It is to argue that an educational program that
neglects the qualitative aspects of intelligence,
one that side-steps the metaphorical and affective
side of life, is only half an education at best.
At worst, it leads to the development of men
callused to the insights of the visually poetic in
life. 4
Irving Kaufman has similar concerns; he says:
Unlike other subject areas ... the content of art
education has been ambivalent and vague, frequently
straying from the broad conditions that mold the
nature of art.
This may be due, in part, to the
unstructured quality of art and the difficulty of
designing
an
art
curriculum . . . Art
education ..• serves as a pipeline for the very
surrounding culture that it supports to upgrade. 5
2Hilda Present Lewis, Editor, Art for the Preprimary
Child, The National Art Education Associai ton, Washington,
D.C., Spring 1971, p. 75.
3 Elliot W. Eisner, Educating Artistic Vision, McMillan
Publishing Co., Inc., London, New York, 1972, p. v.
4 Ibid., p. v.
5 Irving Kaufman, Report of the Commission on Art
Education, ed. by Jerome s. Hausman, Washington, D.C.,
National Art Education Association, 1965, p. 25.
13
John Dewy, on the other hand, writes about art as being
the
greatest
motiveation
for
intellectual
achievement,
saying:
Art is the living and concrete proof that man is
capable of restoring consciously .•. the union of
sense, need, and impulse and action characteristic
of live creatures ... Thus it varies the arts in ways
without end.
But its intervention also in time to
the idea of art as a conscious idea--the greatest
intellectual achievement in the history of
humanity. 6
Viktor
Lowenfeld
expresses
his
concern
about
the
approach to children's art by adults who tend to inhibit the
creative innate impulse the children have.
And
~ven
though
this concern dates back to 1947, contemporary writers seem to
agree with his approach:
If children developed without any interference from
the outside world, no special stimulation for their
creative work would be necessary.
Every child
would use his deeply rooted creative impulse
without inhibition.
Confident in his own kind of
expression ... what civilization has buried we must
try to regain by recreating the natural base
necessary for such free creation. Whenever we hear
children say,
'I can't draw that,' we can be sure
that some kind of interference has occurred in
their lives. 7
Susanne
Langer,
in
her
writings
about
expressiveness
through art symbolism tells us that:
... Artistic form is congruent with the dynamic
forms of our direct senses mental and emotional
life. Works of art are projections of 'felt life,'
as Henry James called it, into spacial temporal,
6John Dewy, Art as Experience, New York, Mir, Balch and
Company, 1934.
7
vik~or Lowenfeld, Creative and Mental Growth, New York,
The McMillan Company, 1947, p. 1.
14
and poetic structures.
They are images of feeling
that formulate it for our cognition.
What is
artistically good is whatever articulates and
presents feeling to our understanding. 8
Peppino Mangravite, in his 1926 book on the children's
art
where
he
children's
objects
books:
to
illustrations
" ... such
confusing to the child. 119
a
situation
to
be
used
cannot
be
on
but
He goes on to say that:
... Children are becoming increasingly less
imaginative ... now they are overwhelmed with
illustrated books, trips to art galleries and
museums, and the like. Art can be brought into the
lives of our children ... by bringing them closer to
nature and life.10
Other writers express their feelings that if more art is
provided in schools, it will reduce people's dissatisfaction
at the school and poor attitudes toward the teachers and that
it will provide the child with a source of pleasure later on
in life.
One
could
go
on
influences
at
on
length
in
children's
presenting
art
in
different
opinions
on
the
United
States.
To conclude, a discussion by Eisner was selected.
Briefly, here ar.e some of his conclusions on children's art:
"Children
draw what
they
8 susanne
New York:
see,
not
what
K.
Langer, Expressiveness, Problems
Charles Scribner's Sons, 1957, p. 25.
they
of
Art,
9peppino Mangravite,
The Artist and the Child,
Progressive Education, April, May, June, 1926. Vol. 3, No. 2,
p. 124.
10 rbid.
15
know.n11 Arnheim.
"Art is a manifestation
Alschuler and Hattwick.
of
personalities.n12
Art is "indicative of concept formation and thus an
indication of general intelligence.n13 Goodenough
and Harris.
"Art ability or art aptitude is a result of an
interaction
between
qenetic
traits
and
environmental conditions.n14 Normal Meier.
People have two different "visual orientations" in
the world ... The Haptic:
relies mainly upon the
affective, kinesthetic responses for contacting his
environment.
Whereas,
the visually minded
perceives the world in a more literary visual way.n15
Viktor Lowenfeld.
According to Lowenfeld, these two types are "genetically
determined."
"Child art
is affected by the particular
personality type the child possesses and by- an
array of primordial images or archetypes, "which
have found their way from the unconscious level of
the mind."
Eisner concludes by
pointing out McFee's "four factors
that affect the child's performance in art:
his readiness,
his ability to handle information, the particular situation
in
which
he
possesses."
is
to
work,
He
adds
that
and
the
these
delineation
points
remind
skills
us
he
that
11Elliot W. Eisner, Educating Artistic Vision, McMilllan
Publishing Co., Inc., London, new York, 1972, pp.94-96.
12 rbid.
13 rbid.
14 rbid.
1 5rbid.
16
"artistic behavior is due to several factors," and that "each
investigator has attempted to account for some or all of the
factors that affect the character of the drawings, paintings,
and sculpture that children produce ... each of the theories
sheds some light on the problem of understanding development
of the children's art.16
16rbid, pp. 94-96.
17
B.
Maslow
ART AS A BASIC .HUMAN NEED
described
a
basic
human
needs
classification
system that may be helpful in planning a patient care.
Cynthia
Taylor
discusses
Maslow's
approach
from
a
nursing point of view.
Maslow sets forth a hierarchy of needs based on the
premise that lower level needs must be satisfied
before a person can attend to higher level needs.
For nursing this has special significance in
decision making and planning for care ... a client
who is short of breath ... is probably not interested
in participation in a discussion about his
spirituality ... a client who is demanding frequent
attention for a seemingly trivial matter may be
exhibiting self-esteem needs.
Need categories-are
not static, and you must be vigilant in assessment,
diagnosis, planning and intervention to meet the
client's need.17
Maslow's hierarchy list is quoted by Cynthia Taylor
follows:
a.
b.
c.
d.
e.
as
Physiologic needs: oxygen, food, elimination,
temperature control, sex, movement, rest,
comfort.
Safety and security:
safety from physiologic
and psychological threat;
protection,
continuity, stability, lack of danger.
Love and belonging.
Affiliation, affection,
intimacy, support and reassurance.
Self-esteem:
sense of self-worth, selfrespect, independence, dignity, privacy, selfreliance.
Self-actualization:
recognition
and
realization of one's potential growth, health
17 cynthia M. Taylor, R.N., M.S., c.s., CNA, Sheila s.
Cress, R.N., M.S.N., C.S., Nursing Diagnosis Cards, The
indispensable care plan guide, Nursing 87, Springhouse
Corporation, PA, 1987, p. vii.
18
and autonomy. 18
Maslow's
hierarchy
list
is
usually
presented
as
a
pyramid with the lowest needs at the base and the highest
ones at the top 1
signifying the necessity for meeting the
lower needs before possibly meeting any needs that go on a
higher level.
18 I b'd
l
•
I
p.
V..
ll.
19
C.
ART FOR THE "TOTAL PERSON"
Recent developments
in health care emphasize the
care of the "total person," with an approach called "holistic
approach."
This approach,
psychologists,
stresses
the
similar to the approach of the
importance
of meeting all the
basic human needs.
The whole individual is equal to_the sum of his or
her parts.
The parts of physical, emotional,
social, mental, and spiritual dimensions of the
person's being and the interaction of these with
each other and with the environment.19
Each dimension, however, must be viewed as part of the
whole.
John
Curtis
discusses
the
total
person concept.
He
refers to Marshal Kreuter of the University of Utah who has
developed a holistic approach to health:
The "total person concept."
He explains that an
understanding of human beings as multidimensional
fosters consideration of human problems as they
affect or be affected by any one dimension.
The
total person concept asserts that each individual
is composed of physical, mental, social, emotional
and spiritual dimensions ... Kreuter considers each
of the five dimensions as a needs system ... The
individual's reactions--emotionally, mentally,
socially, spiritually, and physically will be
positive or negative depending on the type and
19 oaniel A. Girdano and George s. Everly, Controlling
Stress and Tension, A holistic approach:
Englewood Cliffs,
N.J., Prentice Hall, 1979, pp. 91-92.
20
degree of input received.20
20John Curtis D., Richard A. Detert:
How to Relax- A
Holistic Approach to Stress Management:
Mayfield Publishing
Co., First ed., 1981, pp. 4-5.
21
D.
ARTISTS ON ART AND SELF-ACTUALIZATION
Artists
and
art
educators
have
a
great deal
to talk
about art as related to self-esteem and self-actualization.
Willet Ryder,
who wrote her doctoral
dissertation on this
subject says:
In our age of ever increasing complexities, ever
expanding technologies and the loss of individual
identity, art education must once again support its
role as a
self-actualizing agent within our
society ... In fact the link between art and self is
one of the chief foundation blocks of our field. 21
Ryder also talks about self-actualization as was written
by Maslow in 1968 and by Albrecht in 1981.
self-actualization
human
and
degree." 22
to
leads
"realize
Albrecht,
to
making
own
on
Maslow said that
people
potentiality
the
other
hand,
more
to
genuinely
the
felt
highest
that self-
actualization "makes life conditions more meaningful and thus
expands one's individual capabilities.n23
Linderman
process
section:
as
and
related
Herberholz
to
divided
self-actualization
the
into
creative
a
art
four-part
·"Awareness, focus, the working process, and the art
21willet w.
Ryder,
"The Role of Art in SelfActualization," Art Education, March 1987, Vol. 40, No. 2, p.
22.
22rbid, p. 22.
23rbid, p. 22.
22
product. 1124
Rogers, in his book on becoming a person, had recognized
this
process
Herberholz.
sixteen
His
years
earlier
than
Linderman
and
four-point classification of the creative
art process is summed up as:
Being open to thoughts and experiences.
The
encouragement of openness without penalty is a
cornerstone
of
the
creative
art
process ... Reflection and selection, one must
concentrate on a distinct issue and choose those
factors which are most significant ...
... The individual is ready to act upon a
particular idea, with consideration toward the
design, style, and materials to be used ...
. . . The organization of one's ideas in visual
form •.. the success of such a work depends upon how
closely the completed composition matches the
personal inner vision ... 25
Willet Ryder discusses the relationship between art and
self as being:
recognized by both educators and artists for many
years.
Dewe (1958) laid the foundation ... Florence
Cane believed that through involvement in creative
activity, one becomes a more completely developed
and integrated person ... 26
To conclude,
the
importance of art in promoting self-
actualization, the following quotations were selected:
The ultimate value of aesthetic expressions would
then be the discovery of my own personality:
of
those feelings ... which correlate most clearly with
my true self.
The self, then, must be such as to
24E. Linderman, Donald Herberholz.
Developing Artistic
W.M.C. Brown Co.,
and Perceptual Awareness, Dubuque, Iowa:
1977.
25 carl R. Rogers.
On Becoming
Houghton Mifflin Company, 1961, p. 163.
26willet Ryder,·~~ 23.
23
a
Person,
Boston:
be developed by expression.27
In conclusion, art serves to fulfill some of the basic
human
needs
and
the
realization
for
this
need
has
been
discussed by a number of disciplines concerned with the human
being as a whole and with children in particular.
27 E.F. Kaelin, Art and Existence:
Aphenomenological
Aesthetic, Lewisburg, PA:
Bucknell University Press, 1970,
p. 90.
24
III.
CHILD GROWTH AND DEVELOPMENT
A.
INTRODUCTION
The subject matter of child growth and development has been
written
about
by
many
experts
in
including psychologists,
educators,
artists.
one
Where
would
begin
different
physicians,
to
knowledge into a chapter with a few pages?
disciplines
nurses,
condense
all
and
this
The choice had to
be limited to approaching the subject from a combination of
different points of view.
However, one finds conflicts and
vast varieties of opinions even when the same discipline is
used.
Obviously,
this is due to the fact that studies are
done on different groups of people so the results can never
be exactly the same.
The disciplines that were selected were the educational
psychologists,
art educators and nurses.
A combination of
these three areas will be represented in this chapter.
The
material that was extracted will be what is necessary to know
about the child in order to plan an art project, i.e. from a
developmental point of view.
However, if more information is
needed, the references used in this chapter can be used as a
guide.
25
B.
The
following:
stages
(1)
of
development
Toddler,
and (4) Adolescence.
DIRECTONS
(2)
will
be
Preschool,
divided
(3)
into
the
Mid-childhood,
At some point in the discussion some of
the stages will be broken into different years in the same
stage of development.
Each of the above stages is further divided into three
parts:
a.
Physical development as discussed in medical and
nursing books.
b.
Art development as discussed by art educators and
child psychologists.
c.
Conclusions of both disciplines from which nurses
can derive their intervention.
26
C.
DEVELOPMENTAL STAGES
1.
The Toddlerhood
a.
Physical development:
This is the stage of development
between the ages of eighteen months and three
characterized
by
negativism,
tantrums.
fear
short
from
attention
(Erikson's
autonomy
or
.separation
span,
central
independence
versus
from
and
problem
shame
years~
to
the
parents,
possible
be
It is
temper
resolved
or doubt.
in
Special
fears of toddlers are abandonment by parents.
Movement gait is steady;
feet.
walks,
runs,
jumps with both
Can string large beads and begin to use scissors.
Assists with dressing and undressing self, washes and dries
hands.
By the time the child is three years old,
he can
dress himself with help with buttons and zippers and shoe
laces.
Can help with minor tasks such as putting utensils
away.
b.
Art Development:
Scribbling stage:
period between one and two years.
controlled.
action of
The
the
produce art.
lines
arm,
are
but
no
also
This represents the
Practice makes scribbles
longer made
by a
the mind and body decide to
Converses with himself while drawing:
a tree, this is a house."
muscular
"This is
Or sjhe might tell a story about
the markings.
27
When the child has reached this final level of
"naming" scribbles, he will become more capable of
retaining a mental image and thinking about
concrete objects and events, a phase which Piget
refers to as the "intuitive thought" stage within
the "concrete operation period."l
The scribbling period has been divided by art educators
into these recognizable stages:
No control when line is used and materials are just
moved around.
Line control where line is repeated.
Shape
control
where
materials
are
formed
into
shape.
Can string large beads and begin to use scissors.
Naming of scribble or naming of other manipulated
material. 2
c.
Conclusions Derived for Nursing Intervention:
Hospitalization can be very dramatic to the child at
this stage due to his fears of separation.
The child needs constant supervision while dealing with
art materials since poisoning and accidents are common in
this period.
Plan
to
change
activity
frequently
due
to
short
attention span.
Provide a work space where the child can draw without
lDonald Herberholz, Kay Alexander, Developing Artists
and Perceptual Awareness.
Dubuque, Iowa:
William c. Brown
Company, Publishers, 1985, p. 30.
2Ibid, p. 30.
28
fear of getting dirty.
Encourage the child to scribble.
Don't
ask
questions
like,
Show him approval.
"What's
that?"
about
his
child
the
scribbles.
Provide
art
material
that
will
allow
the
freedom to scribble without too many interruptions.
Remember that the child's play is part of his creative
experience
at
this
listening to music,
toys,
riding toys,
stage.
He
can
enjoy
sandbox with toys,
reading
cars,
books,
trucks,
pull
puzzles with large pieces, musicial and
rhythm instruments, dolls, and stuffed animals.
2.
The Preschool Stage
a.
Physical development:
This refers to the stage of development between three
and six years.
Erikson's central problem to be resolved in
this period is initiative versus guilt.
This period is best described as one of individuality.
Motor behavior continues to be more coordinated.
growing
forms.
"wrong."
ability
The
He
to
child
uses
reproduce
begins
to
letters,
numbers
discriminate
blackboard and chalk,
There is a
and
"right"
other
from
activity related
dolls (e.g. can feed and dress), housekeeping toys, wind-up
musical
toys,
mechanical games,
typewriters,
computers,
record
players,
building games such as Lego and Mechano.
Continues interest in more books and puzzles.
By the time the child is five years old, he begins using
29
a knife and fork, can swim, rollerskates, ties shoelaces.
can
draw
a
recognize
recognizable
coinage
of
a
In verbalization,
well.
person,
penny,
counts
nickel,
to
dime.
20
and
Washes
He
may
self
he has a vocabulary of over 2, 000
words and can explain to others the "how" and "why" of games.
b.
Art Development
The symbol stage of art development.
This stage covers
the period from four to eight years.
One day when least expected, the child begins to
draw pictures which can be recognized, and the
adult knows that the child really is no longer just
"scribbling." ... when we look at children's artwork,
it is essential that we also open our minds to the
beauty of their artistic vision. 3
The
child
is
"egocentric and
relies
mostly on motor-
sensory modes of understanding his world."4
Some characteristics of the artwork of children during
this
stage
can be described by the
following according to
Herberholz and Alexander:
They exaggerate the parts that are important to
them.
They draw the sky at the top, air in the middle, and the
ground at the bottom.
They draw objects in the picture on the ground line.
They will omit details or parts of objects if they do
not seem important to them at the time.
They will relate color to objects:
the gras is green,
the sky is blue.5
3 Ibid I p
0
31
0
4Hi 1 da Present Lewis , ~A~r~t==--....,!f:..!o:!,r"'--_t~h~e'--=-P-=r...see...~:p#r...,l=..,.m!!!!:!.a.=r..:zy_~c~h~i!o...,l~d,
Washington, D.c. , The National Art Education Association,
Spring 1972, p. 13.
5Herberholz and Alexander, pp. 29-31.
30
c.
Conclusions Derived for Nursing Intervention
Continue
the
child
supervision and
shows
more
caution
behavior rules simple.
with
the
teacher
abilities and needs.
to
safety precautions,
and
responsibility.
Enforce consistency.
learn
more
although
about
Keep
Perhaps check
child's
progress,
Encourage expression of fear.
Stimulate the child to read and to tell stories and to
watch
animals
and
people
in
action.
Fantasy
plays
an
important part at this stage.
Show the child your enthusiasm about art.
Encourage him
to pursue his ideas independently.
Avoid being overly critical.
the
child
explore
with
all
his
This is the time to help
senses,
discover through manipulation of material.
and
to
help
him
Discovery through
art materials such as clay, playdough, fingerpainting, sponge
painting,
fruits
and
vegetable
prints,
dried
flower
arrangements, papersculpture, reading and listening to music
help the child's imagination to grow.
3.
The Midchildhood Stage
a.
Physical Development
This is commonly referred to as the stage of development
between six to eleven years.
The developmental task of this
period is referred to by Erickson as "the industry versus
inferiority."
Generally speaking,
it
is
characterized by
large muscle ability exceeding fine motor development.
Girls
are ahead of boys in fine motor skills, physical development
31
and achievement.
This stage is also characterized by high
energy level, activity, and impulsiveness, a good balance and
rhythm amd ability to draw a recognizable human figure and
ability to master handling buttons, shoelaces and zippers.
It
is
important
to
remember
that bodily changes
can
start as early as eight years in girls, and as early as ten
years in boys.
stage.
Also,
Competence in school
is important at this
on the whole, at the beginning of this stage
(at around six years) the child plays well alone, but enjoys
both sexes
in small groups;
but by the time the child is
seven or eight years old, he prefers playing with own sex.
Shejhe
wants
more
realism
in
play;
collects
things
for
quantity, not quality like rocks, baseball cards and shells.
Enjoys magic tricks, likes table and card games like dominos;
likes to read books by himself and to watch t.v. and listen
to radio.
By around the age of ten,
variety of
crafts,
and both
sexes
soccer, tag, softball, football.
games,
Using
electronic games,
rewards
rather
the girls start enjoying a
enjoy active play like
Both sides also enjoy board
computer games and t.v.
than
punishments
works
best
watching.
at this
stage.
By the age of eleven years, the child enjoys projects in
metal crafts, wood crafts, ceramics, auto mechanics, knitting
and
crocheting.
Enjoys
jobs
that
participation in all aspects of drama,
32
earn
money.
Likes
enjoys listening to
popular music and attending rock concerts.
It is to be recognized that at this stage the child
rebels
at
routine,
like
doing
following the hospital routines.
and can cry for a simple reason.
homework,
housework
or
Has sudden changes in mood
Can be very critical of
self, own work and skills.
b.
Art Development
The art educators refer to this stage as the newfound
"realistic" approach to drawing.
The children are:
•.• suddenly boy or girl, alive and bursting with a
new social consciousness.
The concept symbols
which satisfied their earlier art works no longer
suffice to represent figures,
animals or
objects . . . thus
creating
new
special
effects .•. notice that the sky touches the horizon.
Observe the more realistic approach to the
figures ... increase of details on specific objects
when that part is important to the child's ideas.
Figures are more in proportion with less
exaggeration; definite sex differences .•. such as
figures with pants or dresses.
There may be
attempts by children to .•. draw shadows, to show
emotion, and to make distant objects smaller.
Often there is awareness of artistic principles
such as repetition of shapes and definite spatial
effects. 6
Eisner,
in reference to Lowenfeld,
suggests that this .
stage is divided into two separate parts:
The schematic style (7-9 years of age.)
The gang age (9-11 years of age.)7
In brief, the children during the "realistic" stage do
6Herberholz and Alexander, Op. Cit., et. al., p. 36.
7 Elliott w. Eisner, Educating Artistic Vision, New York:
McMillan Publishing Company, 1972, p. 8.
33
the following in their work:
Make figures closely resembling reality.
Make distant objects smaller and overlay them to create
spatial effect.
Make farther objects less intense in color than closer
objects.
Use
such
design
principles
as
repetition,
color,
harmony, and texturing.
Include many more objects than before and depict more
details or important objects.
c.
Conclusions Derived for Nursing Intervention
Frequently
reassure
worth and lovability.
resolve
problems.
critical
at
this
the
child
of
hisjher
competence,
Encourage parents to visit school and
Since
stage,
successful
the
school
experience
is
sick child might need to be
encouraged to do some school work in the hospital, or to do
projects
that will
example
of
this
help himjher keep
can
be
making
his competence.
word
puzzles
An
from
his
child
and
accumulated vocabulary lists that he needs to learn.
Make
encourage
some
art
patients
supplies
and
available
visitors
to
for
bring
the
items
for
gifts
instead of candy as listed in the art materials suitable for
this age in the art material section of this paper.
Try to understand and accept the child as shejhe is, and
to explain that moodiness is a part of their growing process.
Encourage the child to express him/herself in art work
..
34
or in talking or writing.
Use
rewards
and
praise
(where
applicable)
instead of
punishment as the reinforcing process.
Since
hospitalization
can
be
very
comforting
to
the
child who is normally very active, understand that it can be
very frustrating to himjher and try to keep him/her busy with
productive projects as a means of expending energy.
Use a bulletin board in the hospital room for the child
to
display
his/her
art
work
and
since
making
money
is
important during this stage, the child can be encouraged to
make projects of sellable items:
crocheting, potpourris, or
the like.
Children
by
around
the
end
of
this
stage
start
practicing criticism in relation to their own work and that
of others, so it is a good idea to give them an opportunity
to practice this skill when working with a group of children
or
when
trying
individually.
to
have
them
evaluate
their
product
This will teach them to make more critical
judgments of their work and of adult art work.
Keep the work that the child produces in the hospital
for the child to take to school and have teacher evaluate
andjor credit the child.
4.
The Adolescence Stage
a.
Physical Development
The adolescence period spans the developmental
period
terminating childhood from twelve through nineteen years.
35
Developmental task to be resolved according to Erikson
is
"Identity
versus
I
identity
diffusion"
want to be?
(e.g.
How am I
Who
am
I
really?
Who do
different from
others?)
The adolescent continues to develop a self-concept
and identity that might be acceptable to him/herself and to
other
people
child's
of
significance.
This
life that shejhe needs
is
the
time
of
the
to decide on what career,
role, and personality characteristics are most desirable.
Acceptance
is
a
critical
element
in
period for the development of self-concept.
conformity
in
dress,
eating
activities,
the
adolescent
Such things as
appearance
and
beliefs are all efforts for acceptance by the peer groups.
The
peer
group
midchildhood,
now
takes
a
different
role
from
that
of
because during adolescence peer relationships
in groups of both sexes serve different needs.
During adolescence the rebellion to authority figures
and rules that started at the end of midchildhood develops
now into severe criticism,
rebellion, and desire to change
the world.
Stress related disorders develop in adolescents (e.g. ,
anxiety,
phobic-reactions,
eating
disorders,
depression,
alcohol and drug abuse, suicidal and delinquent disorders).
The disorders seem to be more prevalent today than in the
past due to increased social pressures and expectations of
peers versus parents.
Adolescence
is
the
time
36
of
childhood
when
the
individuals
go
through
numerous
physical
and
emotional
changes until they develop into unique individuals.
Some of the common behaviors of the children during the
ages of twelve to fifteen years are that the children are
physically active,
posture.
but tire easily, frequently display poor
They enjoy activities centered around peer group
(usually same sex,
events).
dances,
They
gradually mixing at social or sporting
enjoy
concerts,
school-related
plays,
rallies,
activities
and parties.
shopping and talking on the telephone,
grooming,
suntanning,
watching
such
as
They like
listening to music,
soap operas
and other t.v.
programs, movies, cooking, sewing, reading popular magazines,
working on bikes and cars or have other mechanical interests,
watching and playing arcade and computer games.
They also
need time free from adult supervision.
In
socializing,
the
children
at
developing interest in the opposite sex.
with
morality,
restrictions
influences.
parents.
are
religion
and
ethics.
common.
Peer
group
age
start
They are concerned
Conflicts
beliefs
are
over
strong
Show increasing hostility and alienation towards
Hygiene habits and grooming improve as interest in
the opposite sex grows.
and
this
easy-to-obtain
Eating habits are not healthy; junk
foods
are
preferred.
Serious
eating
disorders or crash diets are common.
By the time the children are sixteen to nineteen years
of
age,
they
have
more
energy
37
and
muscular
ability
and
coordination increase.
They
enjoy
recreational
sailing,
sports
activities
tennis,
activities
like
hiking.
like
surfing
Reading,
and
t.v.
beaches
water
challenging
puzzles.
jobs,
games
like
chess,
bridge,
skiing,
watching,
telephone and radio continue to be important.
poker,
and
music,
They enjoy
crossword
Other interests can be doing volunteer work, summer
part-time employment,
and vacation trips.
They enjoy
dancing, concerts and high-risk sports such as car racing.
By
rigid.
they
this
the
peer
group
affiliation
is
not
as
They begin to seek advice and support from parents as
begin
starts.
wait
time,
their
to
adulthood.
Romantic
love
For some permanent relationships develop and others
until
Effort
transition
is
after
college
directed
sufficient.
Career
toward
when
they
becoming
planning
are
self-sufficient.
independent
and balance
and
self-
in time between
pleasure and responsibility is more realistic.
b.
Art Development
Art educators have very little emphasis on this time of
development.
scales.
They start measuring the work almost on adult
The majority of the books stop the discussion on
children's art at the age of twelve years when the children
start doing realistic work.
Lowenfeld refers to this stage as being divided into two
parts:
"The stage of reasoning:
38
eleven to thirteen years"
and "crisis of adolescence."8
c.
Conclusions Derived for Nursing Intervention
Teenagers often need help to
problems,
conflicts,
tensions,
learn that everyone has
and that help is available,
and that shejhe can successfully face hisjher own feelings
and understand and accept him/herself; and that by learning
stress management skills,
she/he can effectively deal with
problems. 9
Encourage
parents
to
accepting a changing body.
provide
reassurance
and help in
An important point is that good
points need to be reinforced, and to seek professional help
for problems.
Realistic, but firm limits can be mutually agreed upon.
Threats are to be avoided.
Encourage independence and allow person to feel shejhe
had control over what happens to himjher.
Provide
honest
answers
to
questions.
Repeat
explanations as necessary.
Continue
to
provide
parental relationship.
and
that
they
are
a
warm,
affectionate,
loving
Tell the children that you love them,
interesting,
Encourage positive mental
worthwhile
attitude.
and
special.
Show them respect by
helping them to build their self-confidence and self-esteem.
8rbid., p. 89.
9cindy Smith Greenberg, Ed. Nursing Care Planning Guide
for Children, Applying Nursing Diagnosis, Baltimore: William
and Wilk, 1983. p. 31.
39
Praise more, criticize less.
Explain
denied,
and
feelings
that
feelings
that
it
of
romantic
anger,
is
need
to
normal
to
irritability,
longings,
be
have
expressed
and
not
varied moods
and
tenderness,
jealousy,
guilt,
sensitivity,
anxiety,
fear,
embarrassment.
Parents
encourage
questions.
coping with
need to understand the child's conflicts,
open
discussion
of
problems,
concerns
so
and
Encourage parents to seek family counseling for
an
adolescent who
has
problems
with drug
or
alcohol abuse, pregnancy, depression, learning handicaps, or
other difficulties.10
10rbid., pp 310-313.
40
IV.
DIRECTIONS FOR PLANNING ART ACTIVITIES
AS RELATED TO CHILD'S GROWTH AND DEVELOPMENT
A.
PHYSICAL AND EMOTIONAL FACTORS
In planning art projects for children, it is necessary
to remember the following:
1.
Children
are
born with
the
ability
to grow and even
though the sequence of growth is very much the same,
each
child has hisjher own rate and pattern of growth.
2.
Children
exhibit
individuality
in
their
growth
and
development:
-acquisition of skill may be early, average, or late
-cultured
patterns
influence
learning
(e.g.,
speech
development
-family social
environment may determine which skills
are to be accomplished by the child;
3.
Growth and development are directional
-cephalocaudal (e.g. arm control before hand control)
-general
to
specific
(e.g.,
vocalization
precedes
speech; standing precedes walking);
4.
Critical period, i.e., favorable time for development of
certain tasks, e.g. learning to walk at around 13-14 months;
5.
Children develop a new task through repetitive practice
(e.g., walking, riding a bicycle);
41
6.
Children develop one task at a time;
7.
Children might be influenced by environment in focusing
on task
(e.g. ,
the blind child experiences his environment
through other senses);
8.
Developmental aspects are all inter-related, so one must
remember to evaluate the child as a whole.
42
B.
In
planning
NURSING MANAGEMENT
art
work
for
children,
then,
one
must
consider the need to do the following:
1.
Support the child by using his own resources of energy,
intelligence, and coordination;
2.
Encourage
parents
and teachers to
participate
in the
overall planning of activities;
3.
In
evaluating
children's
art,
it
is
essential
to
separate the elements that characterize the mental age from
those
that
express
more
enduring
evaluating the child's art work.
individual
while
His work might tell us
about his personality in terms of rhythm,
etc.
traits
balance,
color,
On the other hand, it might lack the element of space
placement in accordance with the child's age or developmental
level);
4.
It
is
the
job
of
the
adult
supervising
performance to help increase the vitality,
the
art
originality and
coherence as best as the child can achieve, while supervising
the art performance.
Viktor
Lowenfeld
has
eloquently
described
the
interdependence between the vitality and evocative power of
children's
art.
strengthening
the
He
skillfully
sense
of
used
identity,
art
as
a
specially
means
among
of
the
handicapped children. He helped children to feel and know who
43
they were, what is their maximum capacity and best ability.
5.
Consider
preoccupation
chronic
approaches
of
ones),
the
and
that
child
make
with
them
can
his
more
help
acute
reduce
conflicts
receptive
to
the
(or
outside
stimuli.
Emphasis
on
minimizing
psychological
recognized by nurses as far
stress
has
been
back as Florence Nightingale.
The following statement depicts her compassion and interest
in the well-being of the patient as a whole person:
Apprehension, uncertainty, waiting, expectation,
fear of surprise, do a patient more harm than any
expectation.
Remember he is face to face with his
enemy all the time, internally wrestling with him,
having long imaginary conversation with him.
You
are thinking of something else.
Rid him of his
adversary quickly, is the first rule of the sick.l
6.
Reassure
the
This
patient.
is
sometimes
difficult
because what is reassuring to one person might not be to
another.
Confidence that hissituation is under control is
often helpful, for some, that is all that is necessary.
7.
Show respect to the child because basic to care of any
individual is the respect for him as a person.
This respect
One basic method is to make
is demonstrated in many ways:
him feel that he is a partner in his care.
Needless to say,
this courtesy should be extended to the patient's family and
friends.
They do have the right to be concerned about the
patient and his/her welfare.
They also need to play a role
lFlorence Nightingale,
London, 1859, p.22.
Notes
44
on
Nursing,
Harrison,
in hisjher recovery.
8.
Anticipate the need for proper physical care because the
contribution
of
physical
care
to
the
satisfaction
psychological needs has long been recognized.
have
established
theories
before the higher needs.
on
satisfying
of
Psychologists
the
lower
needs
There will be more mention of this
later on in this paper.
9.
Establish a purposeful conversation is one skill that is
often neglected, so when a problem is known or suspected, the
objectives should be based on validity and sincerity, on the
desire
to
assist
the
patient rather
than to
identify the
problem for the sake of knowing what the problem is.
This
area can be important when dealing with the abused child or
those who are on drugs.
It is essential to remember that the conversation is a
dialogue.
This can mean that the attention of the listener
is concentrated on what the speaker is saying,
saying it.
The
how he is
But above all, what is it that he is not saying?
listener
needs
to
develop
the
ability
to
tolerate
silence.
10.
Provide an atomosphere which is calm when carrying a
conversation
with
the
seriously
ill
patient
to
conserve
hisjher energy. In some cases all that is necessary is to sit
next to the patient quietly; or allow a family member to have
the opportunity to contribute to the welfare of the patient
by sitting quietly next to him, perhaps holding his/her hand,
45
if the situation allows.
11.
Practice silence when necessary, and this is usually a
neglected area.
The reference in here is to a friendly
silence that tells the patient:
to be with you."
"I am here ... and I am glad
There is so much emphasis on socializing
and togetherness while caring for someone.
Sometimes there
is need for an opportunity to be quiet, to contemplate.
is an area that cannot be overlooked.
Poets and writers have
often expressed our need for peace and quiet.
time; time to be quiet;
This
"Here there is
time to work without pressure; time
to think; •.. time even not to talk."2
12.
Consider
individual's
the
cultural
behavior
stems
interactions with his culture.
differences
from
his
because
reactions
each
and
His biological inheritance
and structure are also a significant element in his behavior,
for they determine his possibilities for development, as well
as his limitations.
More often than not, our self-concept is
derived from the value placed by the culture.
our culture
puts the emphasis on the young, the strong, and the healthy
and doesn't that emphasis leave out a large number of people.
It certainly makes sick children andjor handicapped feel left
out, along with their fellow humans of the sick or disabled
adult population.
the
children
The effect, however, is more dramatic for
since
it
might
hinder
or
slow
their
most
2Ann Morrow Lindberg, Gift from the Sea, Pantheon, New
York, 1955, p. 116.
46
important task as the children which is growing up.
It might
thwart their opportunity to reach the maximum of what they
can be.
13 .
Observe
materials.
safety measures
The
subject matter,
author,
taken
realizing
regarding
the
usage
importance
of art
of
especially when dealing with children,
devoted a portion of this paper to cover this subject.
47
this
has
C.
THE NURSE'S ROLE IN PLANNING ART ACTIVITIES
The pediatric nurse's role in planning art activities
for
children
planning,
is
similar to other nursing roles that need
management
situation.
of
time,
and
proper
study
of
the
It is similar to the role of planning play or
recreational
activities.
This
is
because
the
child
associates fun activities with play and art activities are
intended to be "fun activities."
The nurses need to remember that:
1.
Activity
planning
for
sick
children
who
are
in
the
hospital or at home is important because
2.
a.
It keeps the child from being bored.
b.
It helps the child in coping with stress.
c.
It can help in teaching him about his illness.
When
planning
an
activity
for
a
child,
consider the
following:
3.
a.
Age
b.
Developmental level
c.
Interests
d.
Diagnosis
e.
Limitations caused by stress and illness
f.
Safety
Encourage
the
parents
to
48
bring
in
toys
and
other
materials
from home
if
the
hospital
is short on supplies
appropriate for meeting the child's needs.
4.
Arrange the time for activities
with the child and let
himjher know when the period ends.
5.
Arrange for peers and siblings to share in activities
whenever possible.
6.
Facilitate variety of form of art activities that will
help facilitate expressions of feelings and creativity, e.g.
art
media
such
as
fingerpaints,
clay,
play dough,
music,
puppets.
7.
Provide
activities
aggressive feelings:
8.
Observe,
that
help
the
child
get
rid
of
e.g. pounding boards, bean bags.
record,
and
report
the
child's
response,
attitude and productivity level.
9.
Provide as much privacy to the child as possible.
10.
Allow
the
child
to
choose the material by providing
himjher with the possible selection.
11.
Observe the safety measures.
12.
Initiate referrals to other health professionals, e.g.
play
or
art-therapists
mutilation
fears
that
if
the
cannot
child
be
expresses
relieved
by
death
and
the
art
activities and play activities provided by the nurses.
49
D.
The.
ACCEPTED NURSING DIAGNOSIS
following
list
is
an
adapted
list
of
nurses
diagnosis that can be used in planning art activities for
children.
Congress
The
list
(1982).
was
prepared
at
the
Fifth
Evans has listed the complete list from
which this abbreviated version was selected.
Activity intolerance
Anxiety
Communication, impaired verbal
Coping, ineffective individual
Coping, ineffective family:
Family:
National
compromised coping.
potential for growth
Diversional activity deficit
Family processes, alterations in
Fear (specify)
Grieving
Health maintenance, alterations in
Knowledge deficit
Maintenance and management impaired
Mobility, impaired physical
Noncompliance (specify)
Parenting, alterations in
Powerlessness
50
Self-care
deficit;
Total;
feeding;
bathing/hygiene
dressing/grooming; toileting
Self-concept, disturbance in
Sensory perceptual alterations
Sleep pattern disturbance
Social isolation
Spiritual distress
Violence, potential for3
3Marilyn Evans, Beverly Hansen, A Clinical Guide to
Pediatric Nursing, Norwalk, CT: Appleton Century Crofts,
1985, p.
357.
51
V.
A.
THE CHILD AND ILLNESS
EFFECTS OF ILLNESS AND HOSPITALIZATION ON THE CHILD
AND HIS FAMILY
Infants, children, adolescents and their families react
to
illness
and
hospitalization
Generally speaking,
child
or
the
preparation
emergency
the
can be
fear
and
anxiety.
the responses to hospitalization by the
parents
to
with
are
influenced
hospitalization.
more
dramatic
by
the
Hence,
than
the
level
of
response
to
elective type of
hospitalization.
1.
General Considerations
a.
Beginning with toddlerhood,
are affected by fears of:
hospitalized children
separation, loss of control,
and bodily injury and pain.
b.
Behavioral
regression
is
most
pronounced
in
the
toddler period, although it may occur in any age group.
c.
Illness and hospitalization may be interpreted as a
punishment as early as toddlerhood but might be present
through adolescence.
d.
The
infant
from
birth
to
three
months tolerates
hospitalization well if his needs are met consistently.
e.
The
older
infant
is
adversely
affected
mother is not available to care for him.
52
if
his
The response
to this ".stranger anxiety" reaches a peak around the age
of eight months, and if hospitalization lasts more than
three weeks it may cause serious disturbance.
f.
Separation from the parents is the most traumatic
aspect of hospitalization for the toddler.
g.
The toddler's response to hospitalization includes
the following phases:
Protest: crying, screaming, etc. may last for
a few hours to several days.
Despair:
withdrawn, depressed behavior and
refusal to relate to others may gradually
replace protest.
Denial:
Indiscriminate,
superficial
relationships with adults,
and lack of
response to parents may occur during prolonged
hospitalization.4
h.
The despair stage might be misinterpreted-that the
child has adjusted to hospitalization.
i.
The
preschooler's
response
also
reflects
anxiety and fear of abandonment by parents.
his
Hejshe has
trouble understanding how and why illness has started.
A reaction
to
his
fears
might
be
depicted
by
such
During
this
responses as nausea and pain.
j
0
The
period,
school
child
(midchildhood):
the child may have a very difficult time with
separation from parents during hospitalization.
Hejshe
has little knowledge of how hisjher body functions and
why and how the illness started.
The most stressful
4Marilyn Evans, Beverly Hansen, A Clinical Guide to
Pediatric Nursing, 2nd ed., Appleton Century-Crofts, Prentice
Hall, Inc., 1985, pp. 10-11.
53
part of hospitalization for this age group, however, is
immobilization.
k.
The school aged child also believes that illness
and hospitalization
is
a
"punishment,"
and
the
"germ
theory" as the cause of illness but his comprehension of
mechanism of infection and illness is often distorted."
k.
The adolescent may find illness and hospitalization
very
stressful.
The
enforced
dependency
of
illness
threatens his struggle for independence and infringes on
his rights for privacy and contact with peers.
2.
Nursing Management
a.
Help
the
toddler
during
the
protest
phase
by
allowing him to cry and staying with him when possible.
Help him through the despair phase by talking with him
about hisjher family; by trying to follow home routine,
and,
by
providing
aggression.
him
And finally,
with
outlets
for
his/her
help the toddler during the
denial phase by consistency of assignment, one nurse per
shift
with
a
designated
relief
person
and
by
facilitating frequent visits by parents.
b.
Help the preschool child by explaining to him/her
that he/she did not cause the illness, and by explaining
to
him/her
terminology
for
symptoms
and
by
telling
him/her what can be done to relieve them.
c.
th~
Help the school child by explaining to the parents
need for their physical presence,
54
and try to help
the child with immobilization.
d.
Help the adolescent by assigning him a room with
another teenager, if possible.
Support his independence
by allowing him to make as many decisions about his care
as possible.
letters
or
Also encourage peer contact via visits,
telephone.
Try
to
provide
himjher
with
suitable sensory stimulation.
e.
Meet the needs of parents by sharing information on
the child's progress and by encouraging them to participate
but not to be responsible for child's care.
support health team members as needed.
55
Also arrange for
p '
B.
1.
EFFECT OF ILLNESS ON BODY IMAGE
The Child's Concept of Hisjher Body Image
The body image is the "person's concept of hisjher own
body."S
from
It is formed from internal development, as well as
environmental
experiences,including
those
social
and
cultural influences.
The child's sense of body is critical in his/her early
stages of development.
of
a
part
of
the
The removal, disappearance or change
child's
body
influences
the
child
differently according to his/her stage of development.
a.
For the toddler, "autonomy is the goal as the child
strives for body control."6
his
body
and
its
The child becomes aware of
totality.
Any change
in his
body
threatens the child's existence.
b.
For
the
preschool
child
who
begins
to
see
him/herself in relation to the rest of the world, the
child
views
the
world
in
relation
to
the
familiar
things, just like a balloon with a hole in it, the child
with a simple cut on the finger insists on covering it
so the cut will be sealed and nothing will leak out.
The child at this age takes everything said literally.
5 cindy Smith Greenberg, Ed. Nursing Care Planning Guide
for Children.
Baltimore, Maryland, Williams and Wilkins,
1988, p. 30.
6rbid., p. 30.
56
c.
The school-age child,
rational,
on the other hand,
but since peers play a
is more
significant part in
hisjher life, any change in body is compared to same sex
peer group.
d.
The adolescent is very much body conscious;
changes
are
magnified,
especially since
the
body
child is
already trying to cope with the normal body changes that
are happening during this period.
Illness, then, can
cause a disturbance of body image.
This condition can
be triggered by an alteration in structure, function, or
appearance of one part or more of the body, or of the
body as a whole unit.
Inability to adapt to this change
needs to be dealt with very carefully.
2.
Nursing Management
For helping the child who is faced with a body change,
be it a minor or a major change, the following steps may be
followed:
a.
Help the child understand what he is experiencing;
consider
the
body
concern
according
to
age
group;
explain to the child that his/her body parts will be
"fixed"
not
"removed"
(unless that may be the case).
Also allow the child to touch body parts involved when
he is ready.
b.
Describe what he
is
experiencing
in relation to
previous procedures.
c.
Demonstrate respect and acceptance for the child,
57
e.g. protect from undue exposure.
d.
Help parents to cope with the child's body-image
changes; encourage them to verbalize their expectations
on how the child looks; and provide accurate information
about appearance.
Explain how a positive approach by
the parents will help the child.
Also encourage the
parents to visit the child since abandonment and pity
can be interpreted as rejection. Also, provide parents
with
information
needed
to
help
them
support
their
child.
e.
Maintain the child's positive body image by making
the
hospital
experience
as
pleasant
as
possible
by
trying to follow home routine
(as much as possible) ,
encouraging
intervention.
desired,
encourage
peer
let the
the
visits
and
child wear his
child
to
do
his
own clothes.
school
work.
If
so
Also,
Most
importantly, encourage the child to express his feelings
and concerns by providing a diversion ... an art project
perhaps.
58
C.
ANXIETY OF THE CHILD AND PARENTS DUE TO ILLNESS
Anxiety is generally explained as a "reaction to real or
anticipated danger."?
1.
Anxiety of the child:
Sources of anxiety in the sick child are due to:
2.
a.
Separation from parents
b.
Separation from familiar environment and routine
c.
Intrusive procedures such as injections
d.
Loss of control
e.
Dependency
f.
Absence from school
g.
Lack of knowledge about illness
h.
Change in body
i.
Fear from death
j.
Fear from mutilation. 8
Manifestation of anxiety in children:
Anxiety in the sick child can be noted by the following
behavior patterns:
a.
Aggression
b.
Crying
c.
Fearful facial expressions
d.
Frequent questioning
7M. Evans, Ibid., p. 24.
8 Ibid., pp. 24-25.
59
3.
e.
No questioning
f.
Clinging
g.
Sleep disturbance
h.
Refusal to eat
i.
Inability to play
j.
Hyperactivity
Nursing management:
a.
Observe behavior that may identify the source of
anxiety.
b.
Provide consistency in care-givers' assignments.
c.
Try to follow horne routines.
d.
Explain
the
honesty
(e.g.,
procedures
if
the
to
the
child
procedure
with
will
total
hurt
the
child, he needs to be told that it will).
e.
Allow the child to make choices whenever possible.
f.
Allow the child to participate in his care whenever
possible.
g.
Encourage
parents
to
bring
homework,
to
make
arrangements for homebound teachers, and establish
a quiet time for study.
h.
Provide
the
child
with
information
about
his
illness using audio-visual material, if possible.
i.
Help the child cope with body-image changes.
j.
Allow the child to express his feeling about fears
of
death
verbalization
or
or
mutilation
indirectly
60
directly
through
through
drawings
or
other art experiences.
k.
Be
specific
might
in describing the
occur.
Encourage
body changes that
questions
and
help
illustrate through an art project or on a doll.
4.
Parental anxiety:
Sources of parental anxiety include:
a.
Uncertainty
about
diagnosis,
treatment,
and
prognosis.
b.
Unfamiliar hospital environment.
c.
Loss of parental role and responsibility for the
child care.
5.
d.
Guilt for "allowing the child to become ill."
e.
Concern for siblings.
f.
Financial concerns.9
Nursing management:
a.
Anticipate
anxiety,
some
lack
of
communication
and write information clearly.
due
to
Use lay
terms and avoid using medical terms, if possible,
and answer questions calmly and honestly.
b.
Orient the parents to hospital routines.
c.
Encourage the parents to participate in the child's
care.
d.
Give simplified and honest explanations on how the
illness will affect the child.
e.
Encourage parents to voice their concerns.
9M. Evans, Ibid., transc., p. 24.
61
f.
Allow and help parents to make the right decision
about the child's care.
g.
Identify
and
support
the
positive
aspects
of
parental child care, and teach alternative methods
for poor aspects tactfully.
h.
Discuss the care of other siblings and encourage
parents to call the hospital when they are home.
i.
Make
approximate
referrals
to
social
services,
disabled children or other community services where
applicable.
62
VI.
SELECTING ART PROJECTS ACCORDING TO
ILLNESSES AND SPECIAL PROBLEMS
AFFECTING CHILDREN
A.
INTRODUCTION
The reader is provided with the selection of topics as
listed in medical and nursing books.
complete
possibilities.
The
It
one.
first
is
only
a
The list is in no way a
guide
for
the
most
common
A choice of broad problems will be itemized.
item
on
the
list
being
neurological,
and
neurosurgical problems is provided in more details because of
its vast variety and because it relates to disabilities.
A
further list will be provided in an alphabetical arrangement
to
select
from
while
planning
the
care of the particular
patient.
B.
CATEGORIES OF PEDIATRIC DISORDERS
Neurological and neurosurgical disorders
Respiratory tract disorders
Cardiovascular disorders
Digestive disorders
Kidney, urinary tract and reproductive disorders
Skin disorders
Metabolic disturbances
Eye, ear, nose and throat conditions
Connective tissue diseases
Mental retardation
63
Orthopedic conditions
Neoplastic disorders
Dependency problems
Special pediatric problems:
poisoning
Miscellaneous current topics:
organ transplant,
pain,
AIDS and other S.T.D.
C. NEUROLOGICAL DISORDERS (SUBDIVIDED)
Diseases of the muscle and neuromuscular junction
Diseases of the peripheral nervous system
Developmental
Degenerative and hereditary diseases
Mechanical and traumatic disorders
Neoplast disorders (brain tumors, etc.)
Metabolic and nutritional
Demyelinating diseases
(e.g.
multiple sclerosis,
optic
neuritis, encephalomyelitis)
Infections
Cerbero-vascular diseases
Headache
Epilepsy
Disorders of sleep
Another way of approaching categories is the following
alphabetically arranged list of:
D.
PEDIATRIC TOPICS;
Abused children
Accidents
Admissions to hospital
Aggression
AIDS
Alcoholism
Allergy
Amblyopia
Amputation
Anemia
64
(ANOTHER APPROACH)
Anorexia Nervosa
Anxiety
Arthritis -
juvenile rheumatoid, septic
Asthma
Autism
Behavior problems
Birth defects
Blindness
Brain, minimal dysfunction, tumor
Bulimia
Burns
Cast
Cerebral palsy
Cerebrovascular disease
Chemotherapy
Chronic illness
Congenital disorders
Congenital heart disease
Congestive heart failure
Convulsions/seizures
Crisis intervention
Cultural aspects
Day-care center - special concerns
Deafness
Death to family member or friend
Demyelinating disease
Dermatitis
Developmental anomalies
Diabetes mellitus
Dialysis
Discharge from hospital
Discipline - problems in
Divorce/single parent
Downs' Syndrome
Drug abuse
65
Dying child
Emotionally disturbed child
Encephalitis
Epilepsy
Ethnic group - cultural aspects of health
Ewing's syndrome: malignancy of long bones
Exceptional child
Fatal illness
Fears
Feeding problems
Fever
Gait disturbance
Genetic - inborn errors of metabolism
Grief/dying
Growing pains - chronic intermittent limb pain
Gout
Handicapped child
Headache
Head injury
Hearing problems
Heart failure
Hemophilia
Hepatitis
Hereditary and degenerative disorders
Hodgkins disease
Home management (of sick child)
Hospitalization
Immobilized child
Infections diseases
Isolated child
Kirschner's wires - traction
Language deficiency
Latch key child
Lead poisoning
Leukemia
66
Life-threatening illness
Mechanical and traumatic disorders
Mentally retarded child
Metabolic and nutritional disorders
Minimal brain dysfunction
Nephrotic syndrome
Neurological disorders
Obesity
Osteosarcoma/Ewing's Syndrome
Pain
Peripheral nervous system diseases
Plegia: para, quadri, and hemi
Poor self-image
Post-operative care
Preparation for surgery
Preschooler
Psoriasis
Radiation therapy
Regression
Rheumatic fever
School age
Seizures/epilepsy
Sexual abuse
Shyness
Sleep disorders
Suicide
Toddler
Well child care/preventative
E.
SELECTION OF PROJECT ACCORDING TO PATIENTS NEEDS
(USING A SIMPLIFIED APPROACH)
In order to utilize the preceding list of illnesses and
problems that affect the children, the author has improvised
yet another
list of
categories
67
that subdivide each topic.
The approach in here is designed so that what the illness is,
will not be the concern in the plan, it is the outcome of the
illness that matters.
This is what one needs to deal with in
caring for any patient.
The nurse is asked to select one or more numbers and
list
them
next
to
the
selected
topic.
These
numbers
represent the category of the overall effect of the illness.
In some cases,
the
illness might include many categories.
And still in other cases, the categories are represented only
in some point of the course of the illness.
1.
The Author's Approach
The categories that were selected are the following:
a.
Chronic
illness:
developmental
skills
An
and
illness
the
daily
affecting
life
the
routines.
Examples of this category are diabetes, chronic kidney
disease
leading
to
dialysis,
mental
retardation,
congestive heart failure.
b.
Acute illness:
An illness affecting the child for
a period of time, but can develop into chronic stages.
Examples of this category are accidents,
acute kidney
failure, surgery, and accidents such as burns.
c.
Handicaps:
A
condition
unfortunate
congenital
or
Examples
these
congenital
of
are
resulting
acquired
physical
absence
of
from
an
problem.
a
limb,
hemophilia, blindness.
d.
Psycho-social,
emotional
68
and
communicative
I
problems:
This category concerns itself with a variety
of situations affecting the child in different manners.
Examples
of
these
deprived children,
are
abused
children,
autistic children,
culturally
and children who
suffer from psychiatric illnesses.
e.
Terminally ill:
This category concerns itself with
the child who is terminally ill or he who has one family
member who is terminally ill.
Some examples of these
include cancer patients and patients with A.I.D.S.
f.
with
Special abilities:
gifted
children
abilities.
This category concerns itself
who
Although
have
this
one
is
or
not
more
an
special
ailment,
nevertheless these children need special attention.
2.
Steps to Follow
In order to use the list of topics and categories, the
following steps need to be followed:
Find the topic of illness that applies to the patient.
Select the categories "a" to "f" that can be used as the
guideline for the plan.
Select nursing diagnosis (Chapter IV).
Write the plan as derived from the above.
Select the projectjs that meets the patient's needs for
short-term plan and for long-term plan.
If the topic that applies to the patient's condition is
not on the list,
then write the topic and select from
list "a" to "f" that applies and proceed as the above.
69
'
3.
Example:
The
topic
retardation,
of
then
selection
the
for
categories
example
that will
is
mental
apply to this
example will be:
a.
Since mental retardation is a chronic problem and
it affects the activities of daily life.
b.
Since mental retardation can produce psycho-social,
emotional and communicative problems.
c.
Since
mental
retardation
can
affect
the
motor-
skills and the physical and mental development.
To proceed,
the
following
nursing diagnosis might be
considered in this situation:
Activity
ineffective
intolerance;
coping;
deficit
impaired
of
communication;
diversional
activity;
knowledge deficit; alternative in health maintenance, deficit
self-care.
As
the
list
is
selected,
the
patient-nurse or patient-parent team.
70
choice
is made by the
VII.
A.
1.
ART MATERIALS
SUITABLE ART MATERIAL FOR CHILDREN ACCORDING TO AGE
Art Materials for Children 2 to 4 Years Old:
a.
Crayons of assorted colors and sizes.
b.
Paper,
white,
manila,
newsprint,
colored
construction paper.
c.
Flat and round brushes - nylon 1/4 11 to 1/2 11 •
d.
Poster paint (water base opaque).
e.
Chalk, chalkboard or paper.
f.
Modeling
materials,
play
dough,
modeli~g
clay,
water base clays.
g.
Collected
materials
(natural,
discarded,
and
inexpensive non-art material.
2.
Art Materials For Children 4 to 8 Years Old:
a.
Liquid tempera or powder paints (mixed by an adult
to a thick, creamy consistency.
b.
Brushes, large and small, sponges.
c.
Crayons of assorted colors and sizes.
d.
Colored paper of assorted colors and sizes.
e.
Clay, ceramic, or other modeling materials.
f.
Colored chalks and oil pastels.
g.
Scrap material for collage and material pictures.
h.
Newsprint, manila, white drawing paper to 24 x 18" ·~
71
i.
Glue, scissors and paste.
j.
Felt
pens,
pencils,
ballpoint
pens,
tempera,
waterbase markers.
3.
k.
Paper mache.
l.
Print-making materials.
Art Materials for Children 8 to 12 Years Old:
a.
Watercolor
paints,
tempera
paint,
brushes
of
various sizes, sponges.
b.
Charcoal, pens, pencils, oil pastels, wax crayons,
felt
tip pens,
colored chalk,
manila and colored
papers.
c.
Clay, ceramics material, paper mache, play dough.
d.
Printing
material,
gadget prints,
potato_ prints,
cardboard prints, linoleum and silk-screen prints.
e.
Collage material:
textures,
cloth of
different
papers of various sorts,
kinds and
old magazines,
strings, ribbons, yarn, scissors, glue.
f.
For construction and three-dimension:
cardboard,
tagboard,
construction
toothpicks,
paper,
wire,
wood, soap bars.
g.
Weaving
and
stitchery
material:
yarn,
cloth,
string, needles, burlap, felt, hoop.
h.
Knitting,
needles,
crochet
and
sewing
variety of thread,
needles, scissors.
72
material,
yarn,
crochet and knitting
4.
Materials Used for the Adolescents:
The children after the age of 12 years can basically use
art materials available for adults.
However,
need to be observed as for any age group.
73
safety rules
B.
HAZARDS OF ART MATERIALS
AND HOW TO WORK SAFELY WITH THESE MATERIALS
1.
Introduction
This
particular area has been a
major concern to the
author as a professional nurse who is also in contact with
the professional artists and students who are artists-to-be.
This concern is also for children,
in schools or hospitals,
who
inolved
may
be
unaware
of
the
risks
in
handling
the
An awareness of teachers, nurses and parents of
materials.
the hazards
of
art material
will
help reduce the risk on
chilldren's health while using these materials or while being
exposed to them by other means.
2.
Special Problems of Children
Children
adults.
are
Before
more
vulnerable
exposing
to
children
art
to
materials
arts
and
than
crafts
materials, one should:
Be aware of the special problems involved due to
their age
and state of body development.
Consideration of these factors should determine
what art materials children ... can safely use. 1
Physiological factors determine the level of the risk on
the children because children, until their teens,
growing.
are still
They are more likely to absorb toxic material that
1 Michael Mccann, PH.D, Artists Beware:
The Hazards and
Precautions in Working with Art and Craft Materials, New
York: Watson Guptill Publications, 1979, p. 347.
74
can cause damage to their bodies.
This is because their
tissues metabolize faster than those of adults.
The
younger
the
children
brain
and
are
the
higher
their
risk
factors because:
a.
Their
developing
which
nervous
makes
systems
them
a
are
target
still
to
toxic
material; an example of this is lead poisoning.
b.
Infants'
slowly.
lungs are immature at birth and develop
Their air passages
are small,
and their
defenses are poor. They also inhale more air than
adults
in
Consequently
relation
to
they
at
are
their
a
body
risk
of
weight.
inhalation
hazards.
c.
Children
absorb
intestines
than
susceptible
to
more
do
material
adults,
through
so
they
gastrointestinal
their
are
poisoning
more
by
ingestion.
d.
Their body weight is smaller than adults, and the
smaller the body weight, the greater the effect of
a
given
smaller
amount
and
of
toxic
younger
the
material.
child,
the
Hence,
the
greater
the
which
art
risk. 2
The
developmental
factors
also
determine
materials to be safe to use for children of different groups.
2rbid., pp 347-348.
75
Children under five,
toddlers and preschool children,
are likely to put things in their mouth; the "pica-syndrome."
Hence,
in
this
age
group,
children
should
not
be
using
materials that are harmful if swallowed whether in a single
dose
or
in
a
series
of
doses.
They also
should not be
exposed to materials that are hazardous by skin contact or
inhalation.
For the school age group, the possibility of digestion
of toxic material
labeling.
is usually accidental due to neglect in
The children should not use any materials that are
hazardous by skin contact or inhalation.
By adolescence, children can use art materials that are
safe for adults except highly toxic materials such as lead,
cadmium, mercury, and uranium.
Other sources of exposure to art material include:
Practicing artists who should be aware that home studios and
workshops can expose children to hazardous art materials that
are used by adults.
It is crucial to take very careful precautions
against contamination of the home by hazardous
materials if children are around ... In fact,
children should not be permitted in your studio
while you are working.3
It is essential to notice that even materials labeled
"nontoxic" according to the Federal Hazardous Substances Act
are not necessarily safe.
"Toxic" applies to "any substance (other than a
radioactive substance) which has the capacity to
3 Ibid., p. 348.
76
produce personal injury or illness to man through
ingestion, inhalation, or absorption through any
body surface.n4
However, the Act does not specify testing for long-term
effects
such
specific
as
for
chronic
acute
or
irritation, ingestion.
poisoning
or
cancer;
immediate
toxicity
it
is
only
as
eye
such
According to Michael McCann, the word
"non-toxic" on some art supplies produced by small companies
can be misleading because they do not have the resources to
do the toxicological testing.
On the other hand, children's
art materials that carry the CP (Certified Products)
or AP
(Approved Products) Seal of the Crayon, Watercolor and Craft
Institute, have been praised by medical authorities. McCann
warns that even these certified products have not been tested
on animals for "long-term" effect.
3.
Toxic Art Materials
The author refers the reader to two Bulletins produced
by the State of California on art materials:
The
from
first
Los
Bulletin is No.
Angeles
Unified
65,
School
dated January 13,
District,
Office
1986
of
the
Associate Superintendent, Instruction.
a.
Subject:
Disposal of Toxic of Hazardous Chemicals
The bulletin covers the following subjects of concern:
Purposes,
background,
subject fields,
list
of
chemicals
for
disposal
by
and procedures for disposal and persons to
contact for additional assistance.
4 Ibid., p. 349.
77
The Act was approved by
Joseph
P.
Linscom,
Associate
Superintendent,
Instruction
Office of the Deputy Superintendent.
b.
Subject:
Toxic
Art
Supplies
Legislation.
#CIL
86/7-12, dated June 5, 1987
The
bulletin
superintendents,
is
addressed
elementary
to
and
county
secondary
and
district
principals
in
public schools, and governing authorities in private schools.
The
Bulletin
is
prepared
by
James
R.
Smith,
Deputy
Superintendent.
It is a very inclusive report that can be
used as
in using safe art materials and for safe
a
guide
techniques used for disposing of hazardous or toxic ones.
4.
List of Hazardous Materials:
The following is a
list of highly hazardous materials
and safe substitutes that can be used:
Avoid
Substitute
-Clay in dry form
-Clay in wet form
-Prints, glazes that
-Water-based products
contain lead or other
metal pigments
-Avoid organic solvents
-Water-based paints, glues,
etc.
e.g. turpentine, benzene,
rubber cement, oil based
paints
-Cold water dyes
-Vegetable dyes
-Permanent markers
-Water-based markers
that contain toluene
78
Avoid
Substitute
or toxic solvents
-Instant paper-mache
-Paper mache made from black
(may contain asbestos
and white newspaper and
from colored inks)
library or white paste
-Aerosol sprays
-Brushes and water-based
paints in splatter techniques
-Powdered tempera paints
-Liquid tempera paints or
pre-mix it for the children
-Pastels that create dust
-crayons or era-pas
-All photographic chemicals
-Use blueprint paper to
make sun-prints
-Lead solder and stained
-Colored cellophane and
glass
black paper to simulate
lead
-Epoxy instant glues
-Water-based glues or library
or other solvent glues
paste
-Solvent-based silk screen
-Paper stencils and water-
and other printing inks
based inks
-Olivine sand5
-Silica sands for molds
In conclusion, the author believes that the public needs
to be more aware of the hazards of art materials and that
publications
should
be
available
as
references
for
every
adult dealing with art and teaching materials for children,
5James R. Smith,
681 7-12, Sacramento,
1987, pp 6-7
Toxic Art Supplies Legislation, #CIL
CA:
State Department of Education,
79
and for own protection.
The public needs to be encouraged to
read labels and to interpret the limitations of the safety
assurance included in those labels.
5.
Presenting Materials Effectively
The choice of materials and the way in which they are
offered to children is of central importance at any age.
Children
seem
to
learn
best
challenging but not frustrating.
when
materials
are
Variety is essential, but
there should be opportunities to use the same material many
times over to gain mastery.
added
as
the
child
More difficult materials can be
continues
to
develop competence.
The
child needs an appropriate learning enironment in which he
can function with minimum direction andjor
the
Adults
adult.
should
remember
that
interrupt~on
their
role
from
in a
child's art experience is a supportive one.
In order to have children use the materials competently
and expressively, it is essential to arrange for a functional
setting
for
condition
art
materials.
arranged
on
open
Materials
shelves
that
"invite
are
in
frequent
good
and
constructive use because they reflect the adult value of both
the child's work and the materials he is using."
Young children learn a great deal more if they are also
involved in preparing and cleaning up activities. 6
6.
Organizing the Physical Setting
6Hilda Present Lewis, ed. The Art for the Preprimary
The National Art Education
Child, Washington,
D.C.:
Association, 1972, pp. 93-94.
80
a.
Try to use the outdoors as well as indoors.
Even
in a hospital set-up, outdoors can bring more fun
for the activity if the weather and the patient's
condition
trays,
allows.
A table
large-size
paper
and
tacked
some
to
a
cafeteria
fence
or a
little garden with flowers and dropped leaves or
the like, along with a box or two with art supplies
can bring hours of fun to children in the outdoors.
Whether outdoors or indoors,
in
a
playroom
or
in
the physical setting
patient's
room
should
be
relaxing and comfortable.
b.
Store materials on open shelves, in good condition,
labeled clearly, and always in the same place.
c.
Place individual materials in separate boxes, e.g.
crayons in one box, chalk in another, etc.
d.
If more than one kind of material is needed, then
it should be all arranged on one tray.
7.
Variety of Material
There
should
be
dimensional-materials
a
selection
available
dimensional material includes:
paint
sticks,
chalk,
oil,
at
of
all
two
and
times.
three-
Basic two-
pencils, crayons, felt pens,
pastels,
finger
paint
material, paper, construction paper, brushes, sponges.
Basic
three-dimensional materials include:
clay,
play dough,
scissors,
strong
wood scraps,
paper
for
paints,
modeling clay, potters
cardboard boxes,
paper sculpture,
81
styrofoam,
found objects
such as shells, rocks.
And finally, the adult role is, then, to facilitate the
material to the child and as Thelma Harris,
Lewis,
quoted by H.
defines the adult role as providing experiences for
children as follows:
A supportive adult gives technical help but does
not suggest subject matter.
A responsible adult
has quanti ties of materials on hand and in good
condition.
An intelligent adult reduces the
frustrations and limitations of the environment by
planning.
A sensitive adult watches and waits to
see what the child is working toward and then helps
him to reach the goal he has set for himself. 7
7rbid., p. 96.
82
VII.
SUGGESTIONS FOR THE MANUAL
A.
INTRODUCTION
It is a good idea to assemble materials in an organized
manner.
The
author suggests having some of the
set-ups to be available for the children:
set-up,
with
For a
hospital
a closet that can be organized in the play room or
other
organized
select
following
supplies
to
be
in
supply
brought
materials.
storage facilities,
to
rooms
or
patients'
home,
a
rooms
While
at
the
but a
designated closet,
cart
can
be
from which to
choices
depend
on
or sh_el ves in
the garage can be used for storage.
The supplies can be from recycled material, or some can
be bought for the purpose.
However,
many of the supplies
that were selected are readily available in most homes or in
hospitals.
B.
1.
In
jars -
SUGGESTED KITS
preferably plastic-covered,
and labeled and
filled with:
Flour,
beads,
dried
buttons,
beans,
sugar,
paper clips,
salt,
sand,
craft buttons
pebbles,
(different
shapes, some with moving objects, flowers, butterflies,
etc.), glitter, beads, pasta in variety of shapes, paper
cut
in
variety
of
small
83
shapes,
tongue
depressors,
variety of needles, ribbons.
2.
In boxes with partitions (shoe boxes taped together):
Soap
bars,
paper
plates,
straws,
paper
cups,
gloves, socks, sponges, styrofoam of different shapes,
lunch bags,
scraps of leather, scraps of cloth, tape,
variety, clay, play dough.
3.
Paper:
A variety of paper:
Newsprint,
construction,
color
pads,
water
block
cards, magazines,
shelf
paper,
black
notebooks,
brown
tissue,
paper,
white
newspaper,
nothing books,
cardboard,
wrapping
and
drawing
paper,
grocery
shopping
bags, bulletin board, scraps of wood, and wire, variety
of yarn, flowers, twigs, disposable tomato or
s~rawberry
baskets.
4.
Tools:
Scissors,
hammer,
paring knives,
pasta
cookie cutters,
machine,
potato peelers,
staplers,
staple
guns,
nails, ruler, measuring tape, hole punching kits, studs
machines,
sewing machines
(at
home)
and an
iron and
water
colors,
coloring
ironing board.
5.
Paint and drawing materials:
Tempera
pencils,
paint
pencils,
in
jars,
charcoal/pastel pencils,
marking pen
(water base) crayons, and food colors.
6.
Miscellaneous supplies:
Glue (water soluable), brushes (variety of sizes,
84
quality
and
material),
plastic
jars
and
covers,
egg
cartons and trays.
C.
PLAN OF THE EXPERIENCE
A plan will need to be followed and filled out each time
the
patient
works
on
a
project.
The
author
including the following material in an outline.
suggests
The format
will depend on the setup:
Name
of
project,
description,
age
level,
reason
for
activity (objective), time needed, number of times to repeat
experience,
materials
needed,
procedure,
step-by-step
explanation, evaluation and child's comments.
D.
~
SUGGESTED HOSPITAL FORMS FOR ART ACTIVITIES
Activity Rating Form
The author suggests dividing the form into two sections:
one side describes the activity and the other side gives the
rating on the scale of 1-5 (one being the easiest and five
being the most difficult.)
~
Suggested List of Categories
Name of Activity
Rating:
a.
Rate of difficulty
b.
Manual skill necessary.
c.
Mental acuity necessary.
d.
Level of energy necessary to
to perform.
e.
Hazards of material.
f.
Experience necessary to teach
85
1 2 3 4 5
or help the child with the
activity.
Name of Activity
Rating: 1 2 3 4 5
g.
Rate of success (average).
h.
Rate of expense of materials.
i.
Rate of difficulty finding materials.
j .
Rate of pre-preparation necessary.
k.
Rate of amount of cleaning up needed.
1.
Activity can be prepared at home.
m.
Activity is performed with a group.
n.
Activity should be restricted from
the very sick child.
o.
Activity can be performed with one
child.
p.
~
Activity needs a long attention span.
Suggested Nursing Charting Form:
The
author
suggests
that
a
form
will
include
the
following information:
a.
Activities the patient is allowed or restricted.
b.
Nursing diagnosis.
c.
Time.
d.
Nursing action--art procedure.
e.
Evaluation.
f.
suggestion of next activity name and date.
The
author
filled
out
by
also
suggests that the form which will be
nurses -on
discharge
86
of
patient
will
also
include information on who will help the child at home, and a
suggestion of some activities will be provided to the family
to take along with other forms that the patient takes home on
hisjher discharge.
E.
1.
SUGGESTED OUTLINE FOR MANUAL
Things to do sculpture with:
clay,
play dough,
mache, soap bases, wood scraps.
2.
Things to do with crayons.
3.
Things to do with wood.
4.
Things to do with paper (detailed outline follows).
5.
Things to do with yarn.
6.
Puppets.
7.
Dried flowers.
8.
Stitchery and weaving.
9.
Drawing.
10.
Painting, different media.
11.
Color.
12.
Simple jewelery made with miscellaneous materials.
13.
Basketry.
14.
Collage.
15.
Mobiles.
16.
Mosaics.
17.
Leather crafts.
18.
Mosaics.
19.
Scraps art.
20.
Wire art.
87
paper
21.
Dried flower arrangements.
22.
Boutiquing.
F.
DETAILED OUTLINE OF THINGS TO DO WITH PAPER:
1.
Paper folding:
planes, kites, and boats.
2.
Doll houses, playhouses, furniture and villages.
3.
Lanterns, lampshades and window pictures.
4.
Papier mache.
5.
Costumes and masks.
6.
Boxes, baskets and gift wrapping.
7.
Dolls, animals, birds and fish.
8.
Expansion.
9.
Origami.
10.
Place mats, desk accessories.
11.
Greeting cards, bookmarks and fans.
12.
Pictures, collages, and decorations.
13.
Tissue paper collages.
14.
Quilting.
88
IX.
SUMMARY AND CONCLUSION
Writing a paper that deals with a nursing-care plan for
any
patient
is
never
an
easy
task
because
of
individuality and uniqueness of each and every person.
when dealing with the same
from,
the
challenge
growing
challenge
is
probably
children.
parenting:
It
always
wondering if the
the
can
particular
Even
illness that two people suffer
be
more
is
the
completely
complicated
very
trying
similar
to
do
different.
when
to
our
the
best
This
dealing
with
challenge of
and
forever
"best" is really what the child needed at
time.
It
gets
even more complicated when
dealing with children who are trying to have a chance for
survival
despite the difficult struggle between growing up
and dealing with an
illness
or
a
disability ... a
challenge
that is getting more and more complicated with our changing
society
in
all
aspects
that
affects
the
people
of
the
future ... our children.
The author hopes that this guide will be helpful for the
nurses
and
struggle
to
families
pave
the
of
sick
children
children's
path
in
their
to health,
continuous
hope
and
happiness, and better future.
The author also hopes that in moments when everything
seems impossible for the child to handle,
89
and the pressure
builds up so high, then maybe a little time spent with the
joy of doing art will spark a moment of happiness or a smile
on the child's face.
That smile is always contagious to
those around him/her:
Those people whose love is helping to
reduce the pain and suffering of a child who at times is too
young to know whys of what is happening to him/her, a smile
as equally effective is that of a disabled child who has just
learned the task of lacing his shoes,
struggle and perseverance.
through a continuous
This usually simple-to-do work
for an average child is a big achievement for another.
That
smile he/she gives is also contagious.
A final quotation:
If we removed all the art in the lives of -our
children, there is no way that adding math,
increasing more reading, requiring more science,
mandating foreign language, or scheduling more
computer courses could replace what they have lost. 1
lNational
Reston, VA.
Art
Education
90
Association
Press
Release,
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A Clinical Nursing
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Appleton Century
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Children's Drawings.
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Basic Books, Inc.,
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95
Pringle, S.M. and Ramsey , B • E .
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Robinson, Jean Ed.
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C.
BULLETINS
Lincomb, Joseph P. Disposal of Toxic or Hazardous Chemicals.
L.A. Office of the Associate Superintendent, Instruction.
Bulletin No. 65, January 13, 1986.
Phone:
{ 213) 742-7371
{for assistance).
Smith, James R. Toxic Art Supplies Legislation.
Program
Advisory.
Sacramento CA:
California State Department of
Education # CIL 86/7-12.
June 5, 1987.
Phone:
( 916) 3230887 (for assistance).
96
D.
SUGGESTED EXTRA READING FOR MANUAL
Birren, Faber, Color and Human Responses.
Nostrand Reinhold Company. 1978.
Commel, Jane.
New York:
Van
The Art of Gift Wrapping.
Fiarotta, Phyllis and Fiarotta, Noel.
Ships and Snails and
Walnut Wales:
Nature craft for Children, New York:
Workman
Publishing Company, 1975.
Fiarotta, Phyllis and Fiarotta, Noel.
Sticks and Stones and
Ice Cream Cones: The Craft Book for Children.
Frank, Margorie.
I Can Make a Rainbow: Things to Create and
Do for Children and Their Groownup Friends. Nashville, TN:
Incentive Publications. 1975.
Gault, Elizabeth and Sykes, susan.
Crafts for The Disabled:
A New Kind of Craft Book for People with Special Needs.
Johnson, Mary Grace.
Paper Sculpture. Davis:
Johnson, Pauline.
Creating
Washington Press. 1967.
with
Jones, Sarah, Ed. Easy-to-Make Toys.
Ltd. 1985.
Kenny, Carla and John B.,
Chilton, 1968.
Karla.
1952.
Paper.
University
London:
Cavendish Co.,
of
The Art of Paper Mache.
Munson, Don and Allianora, Rosse. Things to Make with Paper:
187 Fun Projects. Charles Scribbners' Sons: 1970.
Raekley,
Dea,
Louise,
Caraco
California Contemporary Craftsmen.
and Schaeffer,
Phillip.
Vol. II.
Dea Rackley.
Riles,
Wilson Visual and Performing Arts Framework.
California State Department of Education.
Sacramento: 1982.
Schuman, Jo Miles.
Art From Many Hands:
Multicultural Art
Projects. Worcester, MA:
Davis Publication, Inc.
1981.
Shoemaker , Kathryn E . _,.C""'r'"""e=a=t=l.,_·v-=-=e-~C'""'l,_,a~s"'"'s~r=-=o_,o""m~,'----"A~-'c:::<.r"'--""a""'f"""t:....____.B""'o""o~k~.
Minneapolis, MN: Winston Press.
1980.
Towner, Nancy and Broad, Peabody.
St. Martin's Press. 1980.
97
Kits for Kids.
New York:
Wankelman, Willard F. and Wigg, Phillip.
A Handbook of Arts
and Crafts:
For Elementary Teachers and Junior High School
Teachers. Fifth Ed. Dubuque, IA: William c. Brown Co. 196
Western Publishing Co •
""'H'""'a"'"n..,.d"'--'C,...r""""""a-=f_,t:........oF.....,u.,..n~:_
Children Can Make. McMillan.
E.
_,5~0.t.__C~o~m'.l:'p'-"'l,_,e,_,t,_,e'"--T~h=ic.!.;n~g~s
SUGGESTED PERIODICALS FOR SUBSCRIPTION
Art and Activities.
The Nation's Leading Art Education
Magazine, 591 Camino de La Reina, Suite 200, San Diego, CA
92108. Tel:
( 619) 297-5352.
Art Education.
The Journal of the National Art Education
Association.
Ed.
Hilda Present Lewis.
National Art
Education Association, 1916 Association Drive, Reston, VA
22091. Tel:
( 703) 860-8000.
School Arts.
Education Magazine for the Teacher,
Arts, 50 Portland Street, Worcester, MA 01608.
98
School