Implementing play-based interventions to reduce pain among hospitalized children with chronic pain: A quality improvement project in a tertiary Hospital in Rwanda

BACKGROUND: Chronic pain is common among hospitalized children and is often inadequately managed in low-resource settings. Therapeutic play is an effective non-pharmacological strategy but is rarely integrated into routine care. LOCAL PROBLEM: In a pediatric oncology ward in Kigali, Rwanda, therapeutic play was underutilized because of limited training, inadequate resources, and lack of a structured implementation process. METHODS: A 12-week quality improvement project using three Plan-Do-Study-Act cycles included 54 children aged 3-15 years. Pain was assessed using validated age-appropriate tools. Process measures included play adherence and nurse knowledge, while outcome measures included pain scores and analgesic use. Adherence was monitored daily, pain outcomes were evaluated at baseline and over the first 72 h following intervention initiation. INTERVENTIONS: Structured play activities like music, games, drawing, and painting were integrated into routine nursing care through staff training, nurse champions, caregiver involvement, and bedside play resources. RESULTS: Play adherence increased from 35.4% to 100% (p = .004). Pain scores decreased in 96.3% of children within 72 h (F[3159] = 122.32, p < .001), and nurse knowledge improved significantly (p = .008). Significant reductions were observed across all measured time points, accompanied by decreased opioid utilization. Qualitative findings showed improved emotional well-being, enhanced family engagement, and reduced nursing workload. CONCLUSION: Structured therapeutic play was associated with reduced pain and improved implementation of multimodal pediatric pain management in a resource-limited setting. IMPLICATIONS FOR PRACTICE: Therapeutic play is a feasible, low-cost strategy that can be integrated into routine pediatric care to improve pain management.