The use of therapeutic play in pediatric settings: barriers and strategies identified by Brazilian nurses

Abstract

Therapeutic play, despite being an advanced care technology supported by robust evidence of its effectiveness, remains insufficiently implemented in clinical practice, highlighting the need to examine barriers to its implementation and to develop strategies for its integration into routine care. Purpose To identify the barriers and strategies reported by nurses for the systematic implementation of therapeutic play as a pediatric nursing intervention. Methods This quantitative cross-sectional study was conducted in two phases. First, a data collection instrument was developed based on the literature and the authors' expertise and subsequently validated by 12 expert reviewers. In the second phase, 52 nurses working in pediatric settings, each with at least three months of experience, completed the online instrument. Results The barriers with the highest levels of agreement were the absence of institutional training programs for therapeutic play (100%), lack of specific professional certifications (98.1%), and the absence of a clinical management model prioritizing therapeutic play (98%). Among the strategies, the most strongly endorsed were the inclusion of the topic in professional curricula (100%), training for nurses and managers (100%), provision of material resources and therapeutic play kits (96.2% and 98.1%, respectively), and the creation of child-friendly, playful environments in care settings (100%). Conclusion The identified barriers reveal important gaps in professional education, knowledge, and institutional organization that hinder the implementation of therapeutic play as a nursing care practice. In contrast, the strategies emphasize educational efforts and institutional commitment as key drivers for advancing this intervention. Practice implications These findings highlight opportunities for system-level improvements, guided by the proposed strategies, which underscore the need for sustained investment in training, capacity building, and institutional infrastructure to support the effective and routine use of therapeutic play in pediatric nursing