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Artykuły / Referaty


Teaching English to children treated in hospitals - Barbara Boniecka

A hospital school is a special institution as it deals with sick children requiring a particularly individual process of teaching. There are so many students who cannot continue their education in regular schools because their medical problems make it impossible. When teaching those children, it is crucial to understand the character of the disease, the children’s current health state as well as their psyche. Children’s psyche changes considerably when they find themselves in completely new circumstances, are isolated from their families, friends and have to cope with the illness which usually means pain and bad mood. That is why the role of a teacher does not amount only to educating students but primarily to helping small patients to recover. It can be done by the use of different types of therapies: therapy of presence, relaxing therapy and activating one.

As far as English is concerned, it is a subject that brings a wide range of opportunities where the therapeutic methods can be used. Most of activities, so characteristic of teaching young learners, are of a great value. All kinds of games, songs, pictures and storytelling can be easily adapted to teaching children who are treated in hospitals. The only condition is that their choice must be strictly subordinated to students’ current health state and the kind of disease.

The psyche of children in hospital

Children afflicted with an illness are in an extremely difficult situation. All of a sudden, they are placed in completely new circumstances and face numerous negative experiences. Thou, their psyche state and at the same time their needs differ considerably from those of healthy children.

First of all, children have to face parting from home, family and close friends. They experience fear, longing, anxiety, they feel insecure and lost. In addition, there often arises revolt and jealousy of their healthy peers who can be at their homes, can go to schools. Moreover, children in hospitals are deprived of the normal life conditions, different forms of activities, which are available to healthy children. As a result of those limited experiences, hospitalization has a negative influence on the development of cognitive processes (translation mine, Ślenzak, 1984). However, the severest thing for small patients, especially those who are bedridden, is the lack of free movement and the lack of varied and activating games (translation mine, Doroszewska, 1963). What is more, all patients are deprived of privacy and independence. One can no longer choose when and what to eat, when to read, when to play. All these aspects of a person individual lifestyle are taken over by the hospital regime (Pitts, Philips 1998).

Secondly, a child has to cope with the illness. It is overburdened with the fight against the illness and that is why it is much more susceptible to tiredness and weariness. It is manifested in sleepiness, an aversion to any effort, distracted attention, forgetting. Children become impatient, disobedient, capricious, and sometimes even aggressive. Furthermore, pain is an inseparable part of the illness. It causes lots of negative feelings and is deepened when has to be endured among strangers (translation mine, Doroszewska, 1963).

Children’s needs in hospitals are difficult to characterize as they depend on many factors: the age, the kind of disease, its seriousness, its course and the child’s resistance on difficult inner conditions. However, for everybody a stay in hospital makes normal development impossible and it results in bad mood and often frustration. R. S. Mendelson (1971) says about a destructive influence of hospitalization on children. Some patients, as a result of even short-term hospitalization, have symptoms of neurosis and psyche problems (translation mine, Ślenzak, 1984). All those characteristics are the basis of teacher’s work in hospital. A teacher should be able to answer the needs by his/her presence, personality and all positive aspects he/she can bring into a child’s life.

The role of a teacher in hospital school

What is the role of a teacher? The first answer that comes to one’s mind is of course to teach. According to the Cambridge International Dictionary of English, “teaching” means “to give (someone) knowledge or to instruct or train (someone)”, whereas the Longman Dictionary of Contemporary English suggest that it means to “show somebody how to do something” or to “change somebody’s ideas”. (Harmer, 2001). Harmer also mentions eight roles of a teacher in the classroom. A teacher can be perceived as a controller, an organiser, an assessor, a prompter, a participant, a resource, a tutor and an observer. This all also is true about a hospital school teacher. However, here those roles are broadened to the therapeutic ones. In hospital school a teacher works with children whose needs differ from those from normal schools, with children for whom a teacher means much more than just a person who passes the knowledge to them.

First of all, for ill children a teacher is a symbol of a normal life and health, which they in fact head for. A symbol of a normal life where rhythm is determined by a school. For all students, young and older, this is a school that dictates most of the actions, sets hours of lessons, terms connected with assigned homework. A teacher conducting lessons in hospital brings this order and rhythm of a normal life into the life of hospitalised children. He/she gives them hope that this life they had before illness has not gone away so far and it will come back (translation mine, Doroszewska 1963).

Furthermore, the presence of a teacher makes children feel that it is not so bad if a teacher appears and ensures that although they cannot learn now they will return to their schools, maybe even as better students, because there is somebody who tends them and supervises their work. It is important especially for older students not to lose out a year in school. It is extreme relief for them and often prevents from not only psychical break but also physical one (translation mine, Janeczko 1991).A teacher has a great power to shorten the hours of boredom and idleness in different ways. Unfortunately, there are also children whose health state is so serious that they cannot perform even the easiest and the most pleasant tasks. Then, the place by a bed should be for a teacher equally important as a place in a classroom of healthy children. His/her presence, warm and friendly smile are often enough (translation mine, Doroszewska 1963).

Teaching as the therapy

A hospital school differs considerably from other regular schools. The teaching aim is subordinated here to the therapeutic one and teaching should help in the children’s treatment. Recent studies prove that noticing children’s needs and satisfying them is as important as the very treatment (translation mine, Janeczko 1991). If children do not have any opportunities to develop themselves, it will result in their bad mood and frustration. Certainly, such state does not create an appropriate background for doctor’s work. That is why the major aim of teaching is to create such conditions in which children will be given a chance to have their needs satisfied. It can be done by using different types of therapeutic methods. Three main types of therapy can be distinguished.

The first one concerns very sick children and is called the therapy of presence. It is the basis of other types of therapy as the presence of a friendly teacher, his/her support and a warm attitude to a child is most important of all.

The aim of the next type, the relaxing therapy, is to create such conditions in which a student’s effort put into a given task would be the smallest and in which a student could rest. By the participation in the following forms of the relaxing therapy, a student can get over stresses and tension connected with the illness and hospitalisation: calm conversations; listening to the texts read by a teacher; listening to the music; looking at pictures, albums, illustrations (not complicated, colourful, pleasant); simple plays and physical exercises; drawing, painting; cutting out; doing jigsaw puzzles (translation mine, Doroszewska 1989).

The aim of the third one, the activating therapy, in contrast to the relaxing therapy, is to activate a sick child. Here, stress and tension are reduced by the following forms: plays and games; active participation in dramas; group work; singing songs; manual activities; participation in different kinds of events (translation mine, Doroszewska 1989).

A teacher is obliged to use all those therapeutic methods, its different kinds and when a child’s state allows, base them on a syllabus (translation mine, Doroszewska 1963).

Grading the students

The overriding aim of hospital school is a therapeutic aim. Every teaching activity should be then conformed to a child’s health abilities and recommendations of a leading doctor. The foregoing assumption also refers to grading the students. Therefore, a grade in a hospital school has got a therapeutic character (translation mine, Lipkowski 1981).

In the work with a very sick child, one should remember to create him/her such conditions so that he/she could success to the best of its abilities. A grade should aid in the treatment, motivate to work and emphasis even minor achievements as they are often the crowning of a child’s enormous effort (translation mine, Lipkowski 1981). It is also worth remembering to avoid an excessive rivalry between students. It is better for a child to compare its own achievements. What is more, a child should not be afraid of a grade and it must realise that it has a right to make mistakes (translation mine, Doroszewska 1963).

When grading a sick child, one should take into consideration a health state of a child, a kind of a current treatment and its influence, a student’s engagement and an child’s effort. What is more, in the process of teaching, the emphasis is placed on a personal development of a child, on what is happening in its mind, its heart and on its relation with itself, the closest family and peers, not on the possessed knowledge (translation mine, Lipkowski 1981).

Learner centeredness

Since teaching in hospital schools requires teacher’s great awareness of his/her students, the concept of learner centeredness seems to be here of a great value.

It is based on two main principles: one is that learners are the main reference point for decision making, regarding both the content and the form of teaching. Language teaching is much more effective if teaching structures are related to the needs, characteristics and expectations of learners and if they are encouraged to play an active role in their language study. The other principle is that this may be achieved by means of consultation and negotiation between a teacher and learners. (Tudor 1996) A teacher via observations, discussions with students has some notion about their needs.

Language learners differ on a number of ways which include their subjective needs arising out of a variety of psychological and cognitive factors, the purpose for which the language is being learned (Tudor 1996). Other factors making a student unique are: cultural background, previous learning experience, age, emotional and social needs. It never happens that a teacher has all the students sharing the same characteristics.

Thou, teaching should be flexible in effort to accommodate to the interests, needs and abilities of individual learner (Tudor 1996). All those factors must be taken into consideration and when one knows the characteristics of the students and knows how to teach them, some rules and tips concerning the process of teaching can be established.

Children as the learners of the foreign language

Keeping in mind all the aspects connected with hospitalisation, now we should also consider children as the learners of the foreign language.

Scott and Ytreberg (1990) indicate some general characteristics of young learners. Children of ten are relatively mature children with an adult side and a childish side. They have already formed the basic concepts and views of the world. They are also able to: tell the difference between fact and fiction, to make some decisions about their own learning, to work with others and learn from others. What is more, children at that age rely on the spoken word as well as the physical world to convey and understand the meaning, and have a developed sense of fairness about what happens in the classroom and begins to question the teacher’s decisions.


Children have greater need to be motivated by a teacher and the materials than any other group of learners. In order to teach them efficiently, a teacher should offer them a wide variety of interesting activities. Most of those activities should appeal to the senses, activate them in speech or movement. Worth remembering is also the fact that children, even when healthy, have a very short concentration span and it should be taken into consideration while designing a lesson for them. It is more beneficial when activities are not only enjoyable but also varied. A change of pace and approach within a teaching sequence is vital. Otherwise, children can be easily discouraged. If new language is introduced always in the same way, then it is becoming gradually less and less challenging for students. Boring and monotonous activities can easily demotivate them to learn (Ur 1996).

Furthermore, young learners motivation is very susceptible to surrounding. Children respond well to surroundings which are pleasant and familiar (Scott Ytreberg 1990). The physical condition of the classroom as well as atmosphere the language is learnt in have a great effect on student’s learning (Harmer 1991). Unfortunately, with reference to hospitals, it usually brings a number of problems. There is often no special classroom designed for students. Lesson conducted in halls, where children also sleep, is not surely pleasant and familiar Nevertheless, teachers should try to create secure atmosphere and make children feel comfortable. If possible a teacher should always gather students in a common room as the place does not bring such negative associations as other rooms in hospital (translation mine, Doroszewska 1963).

Techniques that work best

English is a subject in which all mentioned forms of therapy can be easily adopted. Techniques characteristic of teaching young learners, when used in an appropriate way and situation, can be significant in children’s recovery. Viewing students as individuals as well as flexibility in teaching methods and adapting them is crucial. The following techniques seems to be the most valuable ones:


Play appears to have implications for all areas of a child’s psychological life and it is a mistake to see it even in older children as a trivial, time wasting activity. On the other hand, it is a mistake to lose sight of the fact that the purpose of play from the child’s point of view is simple enjoyment. A child does not consciously engage in play in order to find out how things work. A child plays because it is fun, and the learning that arises out of play is to him or her quite incidental. For psychologist, everything that contributes toward the psychological health of the individual is of importance, and in this respect pleasure-oriented activities may at times be of greater value than those related to work (Fontana 1996) “We should not forget that one of the shortest but perhaps most satisfactory definitions of psychological health is that the healthy individual is one who can work and play and love” (Fontana 1996; Allport 1961). There is no doubt that children learn through play. Children learn well when they are active and when action is challenged into an enjoyable game they are often willing to invest considerable time and effort in playing. If games are designed in the way they are productive of language learning they become an excellent, even essential part of language learning (Ur, 1996).


“Songs create their own world of feeling and emotion, and as we participate in the song, we participate in the world it creates. Mark Booth states: The song embodies myth and we step into it ”(Griffee 1992, 4). Songs are a powerful, non-threatening, they reassure in the moments of trouble. They can be used to relax students and provide an enjoyable classroom atmosphere, and what is more they encourage harmony within oneself and within a group, thanks to them students can feel more secure (Murphey1992). A teacher can use songs as the tool in a change of pace and the support to carry on with the task (Griffee 1992). It is amazing how quick students are at learning songs and that is why they can be easily used for instance when introducing vocabulary as they provide a meaningful context, can be the basis of conversation tasks. Furthermore, “songs and music, with their tones, rhythm and stress, can provide a suitable way to teach pronunciation (…) They also can be used for pattern practice and memory retention, they give pleasurable repetition with no boredom and provide active participation in the language ”(Griffee 1992, 6). However, we must be careful not to kill the material by doing too much of serious work. We should remember that having fun is probably the most important thing when using music and songs in classes (Murphey1992).


“Young children also love having stories told to them. In contrast to pictures and even games are pure language”(Ur, 1996). Telling a story in the foreign language is one of the simplest and kindest sources of foreign language input to young learners.

Listening to stories should be part of growing up for every child. Educationalists and psychologists have shown that stories have a vital role to play in the child’s development, and in the development of language. Listening to stories allows children to form their own inner pictures. They can be told by a teacher, the story can be then adapted to all levels, a teacher can go back repeat use gestures and facial expressions. Stories can be also read aloud from a book and then a story should not be changed as children like to have their favourite stories repeated word by word. Another form of story telling is to create stories with the children, so that a teacher can tell their story (Scott, W. Ytreberg, L. 1990). The most effective combination in teaching is picture and stories combined together.


Another important source of interest are pictures. The more visible and colourful pictures the better. Professionally drawn pictures or photographs in textbooks, coloured posters, pictures cut from magazines, teacher’s own quick sketches, however unprofessional and untidy, children’s own drawings. The visual stimulus is a very dominant channel of input. If young learners are not supplied with something to look at that is relevant to the learning task in hand they will find and probably be distracted by something else (Ur, 1996). The illustrations in a book for young learners matter almost as much as the words themselves (Scott, W. Ytreberg, L. 1990.) Pictures are a great basis of different activities types: sharing information, creative writing, introducing new vocabulary or revision of the language, warm ups, listening skills.

The best summary of the whole sense in teaching children in hospitals is made by J. Doroszewska (translation mine, 1963): “What nursery school pupils expect from the adults the most is happiness and care. When ill, all children, smaller and bigger, even the adolescents need this from us. However, it is not possible to talk about happiness in the face of such child’s disasters as a complete break with the way they have been living so far, an isolation from home, a constant bad mood, pain that must be endured among strangers. What can be offered to children is then a light and bright attitude to the world and a good mood. It is not so hard to do that as children have so enormous possibilities of regeneration inside and it is so easy to make them smile, to divert their attention from pain and fear.”


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