A nurse is caring for a 10-year-old child with mild intellectual disability who is being prepared for a surgical procedure. Which nursing intervention is most appropriate to help the child understand and cope with the upcoming surgery?
1Use simple, concrete language and visual aids to explain the procedure step by step✓ 정답
2Provide detailed medical explanations to ensure complete understanding
3Avoid discussing the surgery to prevent increased anxiety
4Have the parents explain everything since they know the child best
해설
Children with intellectual disabilities require communication tailored to their developmental level. Using simple, concrete language with visual aids helps them understand procedures step-by-step, reducing anxiety and promoting cooperation. Other options either overwhelm, avoid discussion, or delegate inappropriately.
Understanding the Child’s Needs
A 10-year-old child with a mild intellectual disability processes information best when it is presented in a concrete, literal manner. Abstract medical concepts or lengthy verbal explanations can be overwhelming and increase anxiety. The systematic review by Suna et al. highlights the critical importance of tailoring healthcare communication to the developmental and cognitive needs of the child, emphasizing that effective pediatric interventions must reflect the specific needs and preferences of patients and families [1]. For a child with an intellectual disability, this means breaking down the surgical experience into manageable, tangible steps.
Why Option 1 is Correct
Using simple, concrete language and visual aids directly aligns with the principles of developmentally appropriate communication. This approach translates the abstract and potentially frightening concept of "surgery" into a sequence of understandable events (e.g., "You will wear special pajamas," "You will breathe sleepy air through a mask," "You will wake up with a bandage"). The scoping review by MacKay et al. identifies informational support as a key domain of psychosocial care for hospitalized children, noting that it must be adapted to the child’s cognitive level to be effective [2]. Visual aids like picture books, dolls, or simple diagrams serve as concrete references, reducing fear of the unknown and fostering a sense of predictability and control, which is essential for coping.
Analysis of Incorrect Options
- Option 2: Providing detailed medical explanations is counterproductive. Abstract terminology and complex pathophysiological details exceed the cognitive processing capacity of a child with an intellectual disability. This approach can lead to confusion, misinterpretation, and heightened anxiety, contradicting the evidence that informational support must be tailored to the recipient's ability to understand [2].
- Option 3:Avoiding discussion of the surgery is a nontherapeutic communication technique. Children are highly perceptive and will sense the tension and secrecy. Lack of information creates a void that is often filled with fear and catastrophic fantasies, which can be more damaging than a simple, honest explanation. This directly opposes the principle of providing appropriate emotional and informational support to mitigate the stress of hospitalization [2].
- Option 4: Delegating the entire explanation to the parents is an abdication of the nurse’s professional responsibility. While parents are vital partners in care, as underscored by the emphasis on parental engagement in co-design [1], the nurse possesses the clinical knowledge to frame the surgical process accurately and the therapeutic communication skills to deliver it effectively. The appropriate intervention is a collaborative one, where the nurse leads the explanation with developmentally appropriate methods and reinforces the parents' supportive role.
Integrating the Evidence into Practice
The most effective nursing intervention synthesizes the core findings from the provided evidence. It involves a co-design mindset by partnering with the parent to understand the child’s specific communication style and preferences [1], while the nurse actively delivers structured, multimodal psychosocial support. The nurse provides the informational support through concrete, step-by-step teaching with visual aids and simultaneously offers emotional support by creating a safe, honest, and predictable environment [2]. This combination directly addresses the child’s cognitive needs and reduces the psychological distress associated with an unfamiliar and invasive hospital experience.
References (research sources)
[1]
Evaluating co-design approaches with parents in paediatric healthcare: a systematic review.Meta-analysis/systematic reviewSuna J, Tanti D, Merlo G, Bryant P, McMullan B, Hall L, HOMEFREE Study Group. (2025) · DOI: 10.1186/s12913-025-13495-x
[2]
Supporting Children With a Chronic Disease and Their Parents When Admitted to Hospital: A Scoping Review of Psychosocial Supports.Research articleMacKay LJ, Lagrisolal N, Chang U, Christoffersen M, Hayden KA, Birnie K, Dewan T. (2026) · DOI: 10.1111/apa.70492
Clinical Practice Guide: Preoperative Preparation for a Child with Intellectual Disability
Assessment
Determine the child's specific cognitive level and communication style (verbal, non-verbal).
Ask parents/caregivers about the child's preferred words for body parts, pain, and emotions.
Identify any previous medical experiences and specific fears or triggers.
Assess the child's attention span and optimal time of day for teaching.
Intervention: Step-by-Step Teaching
Use simple, concrete sentences: "The doctor will fix your tummy. You will have a special sleep."
Break the surgical timeline into 3-4 key steps (e.g., pre-op room, mask for sleep, waking up with a bandage).
Incorporate visual aids: a picture book, a doll with a hospital gown, or a simple diagram of the operating room.
Allow the child to handle safe medical equipment (e.g., a mask without the circuit) to desensitize and build familiarity.
Use a consistent, calm tone and repeat key information in short sessions.
Family-Centered Collaboration
Partner with parents as co-educators; have them practice the language you will use at home.
Encourage parents to bring a comfort item (toy, blanket) that can accompany the child to the operating room if policy allows.
Validate the child's feelings by naming them: "It is okay to feel scared. Your mom and I will be right here."
Evaluation & Follow-Up
Ask the child to point to or show you what will happen first using the visual aid.
Observe for non-verbal signs of reduced anxiety (relaxed posture, willingness to engage).
Document the effective communication strategies in the care plan for the perioperative team.
Intellectual Disability — A neurodevelopmental disorder characterized by deficits in intellectual and adaptive functioning, requiring concrete and simplified communication.
Concrete Language — Use of specific, literal words and short sentences to describe objects and events that can be directly perceived, avoiding abstract concepts.
Visual Aids — Tools such as picture books, dolls, or diagrams used to provide a tangible reference and enhance understanding of a procedure.
Preoperative Anxiety — Fear and distress experienced before a surgical procedure, often heightened in children by the unknown and lack of control.
Developmentally Appropriate Care — Tailoring healthcare interventions and communication to match the cognitive, emotional, and social developmental stage of the child.