A 4-year-old preschooler is recovering at home for 5 days following a tonsillectomy. The child appears withdrawn, refuses to participate in play activities, and states 'I want to go outside. I don't like staying inside.' Which nursing intervention would be most appropriate to address this child's developmental needs?
1Encourage the child to call friends from school daily to maintain social connections
2Provide age-appropriate books and puzzles for independent quiet activities
3Allow the child to sleep with parents in the hospital room each night
4Involve the child in planning their daily care routine and treatment schedule✓ 정답
해설
Involving the child in care planning addresses their developmental need for control and mastery during hospitalization, reducing feelings of helplessness and regression. Other options do not directly restore their sense of autonomy.
Clinical Judgment
This question assesses the ability to identify the developmental needs of a school-age child exhibiting regression and withdrawal symptoms due to hospitalization, and to select the most appropriate nursing intervention. The core issues are "loss of control" and "restoring autonomy". A 9-year-old child is in Erikson's Industry vs. Inferiority stage, characterized by a strong desire to demonstrate competence and control their environment. A 5-day hospitalization strips away this sense of control and leads to feelings of powerlessness. Therefore, actively involving the child in the treatment plan and daily routines is the most effective strategy to give them a sense of control and choice, thereby reducing powerlessness and encouraging cooperation.
Memory Tip:
Think of the Control, Industry, Participation (CIP) principle to remember coping strategies for school-age children's hospitalization stress. If loss of Control is the problem, resolution through Participation is the answer.
KR vs US:
In Korea, family-centered care is emphasized, so parental decisions or nurse-led plans may be more common. In contrast, US nursing strongly emphasizes Patient-Centered Care and self-determination, actively encouraging developmentally appropriate child participation and communication. There is a difference in perspective, viewing the child not as a 'passive recipient of treatment' but as an 'active partner'.
Clinical Practice Guide
When using therapeutic communication and interventions with school-age children:
1. When explaining, be specific and factual, and tailor it to the child's level of understanding.
2. Create a chart that visually shows the day's schedule and plan it together.
3. Provide realistic choices within safe boundaries, such as medication times, bath times, or meal menu selections.
4. Help the child set small, achievable goals where they can experience success.
Caution:
In SATA (Select All That Apply) questions, options like "providing independent activities" or "promoting contact with parents" can be attractive distractors. While these may be partially helpful, they are not the most direct and effective interventions for addressing the core issue of loss of control and powerlessness. Always select interventions by focusing on the root cause of the specific behaviors the child is exhibiting (e.g., withdrawal, regression).
Regression (퇴행) — A defense mechanism against stress, characterized by reverting to behaviors from an earlier developmental stage. Example: A hospitalized school-age child exhibiting infantile behaviors (clinging to the mother, seeking a bottle).
Industry vs. Inferiority (근면성 대 열등감) — In Erik Erikson's psychosocial development theory, the stage for school-age children aged 6-12. They develop a sense of competence (industry) through learning new skills and achieving accomplishments, or feel a sense of inadequacy (inferiority) due to failure.
Patient-Centered Care (환자 중심 돌봄) — A nursing philosophy and practice model that respects the patient's values, preferences, and needs, and actively involves the patient in treatment decisions.
Withdrawal (위축/은둔) — Withdrawal from social interactions or activities, emotional blunting, and becoming introverted. A common response to hospitalization stress.
Therapeutic Communication (치료적 의사소통) — A deliberate and technical conversation method used by nurses to understand the patient's emotions, build a trusting relationship, and help solve problems.