2. Beads of Courage in Ward 2, RHSC

3. What is it?
A system whereby children are given beads representing each medical procedure they have encountered, to strengthen resilience and alleviate suffering

5. Timescale
Ward 2 were introduced to the system in July by trainers from USA, who also visited Addenbrookes, Great Ormond Street and QMC Nottingham
All staff received beads to recognise and honour their work with children
Later the same afternoon, all children on the ward had beads
Children diagnosed previously have also been enrolled onto the system

6. Other bead programmes Also available in these areas Cardiac patients
Neonatal ICU
Siblings
Bereavement
Burns
Chronic illness
Clinician retreats

7. A few facts
Founded in 2004 by Jean Baruch, an oncology nurse in Arizona
Funded by charitable donations
Beads donated by glass artists and bead bags by sewing groups

8. Where is it used? Used with 10,000 children in USA
Used in 26 hospitals in UK, and also in Japan and New Zealand
Established with oncology/haematology patients but programme is extending to other diagnoses, and to siblings

9. How it works Children are given beads, representing milestones such as
overnight stays, chemo, MRIs,
hair loss, radiotherapy, port access etc
Certain beads have specific meanings
Some are mass-produced for ‘ordinary’ experiences
More unusual, unique ones are given for more significant procedures
A purple heart is given for completion

10. Types of beads Every child starts with letter beads
on a string to spell their name
Many beads are for common procedures
Individually packaged beads are for more significant events, such as bone marrow transplant or a particular act of courage (eg learning to self-catheterise). A card explains what each bead is for
There are ‘booster’ beads to encourage children who seem to be struggling

18. Daily bead journal
Every family is given a daily bead journal on which they record which procedures the child has been through that day.
This allows a record to be kept even if staff are too busy at that moment to hand out beads

20. Bead trolley
Beads are kept in a wheel-able trolley on the ward for easy access
The play specialist supervises bead distribution, but all staff members are familiar with the system and can give them out
Supplies are ordered from the charity bechildcanceraware in Birmingham, who in turn imports them from USA

22. Where are they put? The child collects the beads on a string
The first beads threaded onto the string make the child’s name
Some children end up with beads many feet long, depending on the treatment protocol
They can be worn as necklaces, or hung on toys, or kept safe in a bag
Children wear them to clinic and bring them into the ward

24. Why beads? Beads are significant in many cultures
They can signify strength and courage
They have everyday uses – weights, prayer tools, decoration
They carry value, and have been used to trade for many centuries
Some cultures believe they carry protective and healing powers
They signify status and prestige in some cultures
Children love to thread beads

25. Introducing beads to Ghana twinning programme
Ward 2 is twinned with a paediatric hospital in Accra
Beads so successful in ward 2 that there are
plans to introduce a simplified version of them
at the next teaching session in Ghana

26. African beads

27. Aims of collecting beads
Each bead tells a story
Help the child to discuss their journey
Mark milestones
Help memories
Signify courage and resilience
Reward
Increase positive coping strategies
Help with perspective of time

29. Patient stories

30. Funding The programme is funded in this country by bechildcanceraware
Cost is £3250 per hospital for one year’s supply
They hope for donations
Some hospitals are funded for a period in memory of children, or from other charitable donations

31. Potential problems
Even teenagers and boys love beads - somewhat to our surprise !
Infection control – all beads are glass or plastic and washable. The string is plastic.
Staff time – it took a lot of time to get all existing children on the programme, but it is now manageable

32. Survey results 10 families surveyed
Overwhelmingly positive ratings on every question
‘The beads of courage have been such a good thing. I know my son gets excited about getting them and it has also been a way of my son talking about his illness.’

33. References
Baruch J. (2010) ‘The beads of courage program for children coping with cancer’ Doctoral dissertation

34. Presentation by
Helen Veitch, Play Specialist
Jenny Tomes, Clinical Psychologist
Oncology/Haematology Service, RHSC, Edinburgh