A nurse is caring for a 10-year-old child with mild intellectual disability who is being admitted to the pediatric unit for elective surgery. Which nursing intervention is most appropriate to help the child cope with hospitalization?
1Provide detailed written instructions about all hospital policies and procedures
2Use complex medical terminology to ensure accurate information is conveyed
3Limit family involvement to reduce overstimulation during the hospital stay
4Use simple language and visual aids to explain procedures at the child's developmental level✓ 정답
해설
Children with intellectual disability require communication tailored to their developmental level; using simple language and visual aids reduces anxiety and promotes cooperation. Other options (detailed written instructions, complex terminology, limiting family) are inappropriate as they overwhelm or isolate the child.
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
Communication Strategies for a Child with Intellectual Disability
Assess Baseline: Determine the child's specific cognitive level, communication style, and any sensory sensitivities by collaborating with the family before initiating interactions.
Simplify Language: Use short, concrete sentences. Avoid abstract concepts, idioms, and medical jargon. For example, say "The doctor will fix your tummy" instead of "You are having an appendectomy."
Utilize Visual Supports: Employ picture schedules, social stories, or a tour of the unit to demonstrate procedures step-by-step. A doll or stuffed animal can be used to model IV insertion or anesthesia mask placement.
Verify Understanding: Ask the child to demonstrate or repeat information in their own words rather than asking "Do you understand?" which may elicit a reflexive "yes."
Family-Centered Coping Interventions
Preserve the Parental Role: Actively involve parents or primary caregivers in care routines, such as bathing or distraction during procedures, to maintain the child's sense of security.
Encourage Rooming-In: Facilitate continuous family presence to prevent separation anxiety, which can be more intense for children with developmental delays.
Coach the Family: Teach caregivers simple distraction techniques (e.g., blowing bubbles, using a tablet, singing) and comfort positioning to empower them as active participants in pain and anxiety management.
Preoperative Preparation and Environmental Modifications
Minimize Sensory Overload: Provide a quiet, private room away from high-traffic areas. Dim lights and reduce unnecessary alarms to prevent overstimulation and agitation.
Maintain Routine: As much as medically possible, preserve the child's home schedule for meals, sleep, and play to provide predictability in an unfamiliar environment.
Offer Choices: Provide simple, controlled choices to give the child a sense of autonomy (e.g., "Do you want to wear the red or blue hospital pajamas?" or "Should we count to three before the blood pressure cuff squeezes?").
Intellectual Disability — A neurodevelopmental disorder characterized by limitations in intellectual functioning and adaptive behavior, affecting conceptual, social, and practical skills.
Developmentally Appropriate Communication — Tailoring language, explanations, and teaching methods to match a child's cognitive and emotional maturity level to ensure understanding.
Visual Aids — Tools such as pictures, diagrams, models, or videos used to make abstract concepts concrete, especially helpful for individuals with cognitive impairments.
Situational Vulnerability — A state where an individual's ability to cope is compromised by the specific context or environment, such as the stress of a hospital admission.
Anticipatory Care — A proactive nursing approach that prepares a patient for upcoming events, procedures, or sensations to reduce fear of the unknown and promote coping.