A 16-year-old adolescent is hospitalized for management of newly diagnosed type 1 diabetes. The patient appears anxious and asks many questions about insulin therapy and lifestyle changes. Which nursing intervention is most appropriate to address the developmental needs of this hospitalized adolescent?
1Encourage the parents to stay with the patient at all times to provide comfort and support
2Limit visitors to immediate family members only to reduce overstimulation and promote rest
3Allow friends to visit and maintain contact through phone calls and social media when appropriate✓ 정답
4Provide detailed medical explanations using complex terminology to demonstrate respect for intelligence
해설
Allowing friends to visit and maintain contact addresses the adolescent's developmental need for peer relationships and social support, which reduces anxiety and promotes better cooperation during hospitalization.
Core Nursing ExplanationKey Concept Analysis: This question assesses the application of Developmental theory, specifically Erikson's stages of psychosocial development, to nursing care for a hospitalized adolescent. The adolescent stage (12-18 years) is characterized by the crisis of Identity vs. Role Confusion. A primary developmental task is forming a strong sense of self, which is heavily influenced by Key Point!peer relationships and social acceptance. Hospitalization disrupts this critical social connection, leading to feelings of isolation and anxiety, which can hinder coping and adherence to a new, demanding regimen like diabetes management.
Answer Rationale: The most appropriate intervention is to Allow friends to visit and maintain contact through phone calls and social media when appropriate. This directly supports the adolescent's developmental need for peer interaction. Maintaining these connections helps preserve their identity outside of the "sick role," reduces feelings of isolation, and can provide a powerful source of emotional support. Friends can also be allies in learning about and adapting to lifestyle changes. This approach fosters a sense of normalcy and control, which is crucial for managing a chronic illness.
Distractor Analysis:
Watch out for confusion! Option ①, encouraging parents to stay at all times, is more appropriate for younger children (e.g., toddlers in the autonomy vs. shame/doubt stage). For an adolescent, constant parental presence can be perceived as infantilizing and can hinder their struggle for independence, potentially increasing conflict and resistance.
Option ②, limiting visitors to immediate family, ignores the adolescent's primary psychosocial need for peer contact. While rest is important, complete social isolation from peers is developmentally detrimental and can exacerbate anxiety and non-compliance.
Option ④, using complex medical terminology, misunderstands the concept of respecting intelligence. While adolescents are capable of abstract thought, effective patient education requires using clear, understandable language and checking for comprehension. Bombarding an anxious patient with jargon can increase confusion and fear, not demonstrate respect.
Related Concepts: Nursing care must be tailored to the patient's developmental stage. For adolescents, principles include promoting independence within safe limits, involving them in care planning, ensuring privacy, and facilitating peer contact. Effective diabetes education for this age group should be collaborative, practical, and focus on how management fits into their social life (e.g., managing insulin around sports, parties).
Nursing Clinical Practice GuideClinical Scenario: You are the nurse assigned to Jamie, a 16-year-old high school sophomore newly diagnosed with Type 1 Diabetes Mellitus (T1DM). She is scared, asking, "Will I still be able to go to soccer practice? What will my friends think if I have to check my blood sugar at lunch?"
Nursing Intervention Strategy:
1AssessmentAssess Jamie's understanding of T1DM, her fears, her social support system (friends, team), and her usual daily routines. Use open-ended questions.
2Planning & Implementation- Collaborate with Jamie to create a visiting schedule that includes her close friends and maybe a teammate, adhering to unit policies.
- Help her practice explaining her condition to friends in her own words. Role-play scenarios.
- Integrate diabetes education into discussions about real-life situations: "Let's plan what you'll do for insulin when you have a pizza party."
- Encourage her to use her phone to text friends, join a moderated online support group for teens with diabetes, or use diabetes management apps that allow social sharing (with privacy settings).
- Provide private space for conversations with friends.
3Patient Safety and PrecautionsEnsure friends understand any unit rules (e.g., quiet hours, infection control). Monitor Jamie's emotional state—peer pressure can sometimes lead to risky behaviors like omitting insulin. Education must include safety.
Nursing Procedure & Medication Flow
When teaching insulin administration:
- Use a collaborative, hands-on approach. Say, "Let me show you once, then you try with the practice injector. You're in charge of your body."
- Link medication timing to social cues: "You'll take your rapid-acting insulin right before you eat, so if you're at a friend's house, just excuse yourself to the bathroom for a minute."
- Discuss alcohol and substance use openly and non-judgmentally, focusing on the severe, acute dangers (hypoglycemia) in a way that resonates with adolescent risk perception.
A Word from Your Senior Nurse
"Remember, a teenager isn't just a 'big child' or a 'small adult.' Their world revolves around their friends and their place in the social hierarchy. When you help a hospitalized teen stay connected to their peers, you're not just being nice—you're providing essential psychosocial support that is as vital as their medication. This connection is their lifeline to normalcy and a powerful motivator for learning self-management. On the NCLEX, always ask yourself: 'What is this patient's developmental stage, and what is the primary psychosocial task?' Let that guide your choice of intervention."
Erikson's Stages of Psychosocial Development — A theory outlining eight stages of human development, each characterized by a psychosocial crisis that must be resolved for healthy personality development. The adolescent stage is Identity vs. Role Confusion.
Identity vs. Role Confusion — Erikson's psychosocial crisis of adolescence (ages 12-18), where the primary task is to develop a coherent sense of self and personal identity. Success leads to fidelity; failure leads to confusion about one's role in life.
Type 1 Diabetes Mellitus — An autoimmune condition characterized by the destruction of insulin-producing beta cells in the pancreas, leading to an absolute deficiency of insulin. Requires lifelong exogenous insulin therapy.
Psychosocial Support — Interventions that address the emotional, social, and spiritual needs of a patient, which are integral to holistic nursing care and can significantly impact coping and health outcomes.
Patient-Centered Care — A healthcare approach that respects and responds to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions. For adolescents, this means involving them in their care plan.