A 12-year-old client with idiopathic scoliosis has been fitted with a Boston brace and will wear it for 18-20 hours daily. Which nursing intervention is most important to include in the client's care plan?

The prescription of 18-20 hours of daily brace wear is the single most critical factor in preventing curve progression. Landmark research demonstrates a dose-response relationship: greater wear time directly correlates with higher treatment success rates. Any interruption to this schedule, even for sleep or physical education, compromises the biomechanical goal of halting progression during peak skeletal growth. The nurse must frame all care plan interventions around protecting this prescribed schedule.

Skin breakdown is the most common reason for non-adherence. The brace creates a warm, moist environment under constant pressure, predisposing the skin to maceration, friction blisters, and pressure ulcers. A proactive skin care regimen is non-negotiable.

• Daily Inspection: Teach the client and family to inspect all skin surfaces under the brace twice daily using a mirror. Focus on bony prominences (iliac crests, spinous processes, ribs) and any areas of redness that do not blanch.
• Hygiene: Bathe daily with a mild, pH-balanced soap. Ensure the skin is completely dry before donning the brace. Pat dry; do not rub.
• Undergarment: A seamless, moisture-wicking cotton or synthetic liner must be worn between the skin and the brace at all times. This layer absorbs sweat and reduces friction. It should be changed if it becomes damp.
• Lotions and Powders: Avoid using lotions, creams, or powders under the brace unless specifically approved by the orthotist. These can macerate the skin or cake up and cause additional friction.
• Managing Redness: Any area of persistent redness that does not resolve within 30 minutes of brace removal requires immediate notification of the orthotist or provider for a brace fit adjustment. Do not apply padding without consultation, as this can alter corrective pressures.

The brace is prescribed for all activities except bathing and specific, brief skin care periods. Physical education and sports participation require a collaborative decision. While contact sports and swimming are generally restricted, the orthotist and surgeon may clear specific activities with the brace on. The nurse should advocate for a written activity plan and educate the family that unauthorized removal for sports directly sabotages treatment goals. Sleep must occur with the brace in place; this accounts for a significant portion of the daily wear hours.

Adolescence is a critical period for body image development. The nurse must address the psychosocial impact of wearing a visible orthosis. Encourage the client to choose loose-fitting, stylish clothing that accommodates the brace, rather than tight garments that can cause skin issues and draw attention. Facilitate peer support connections and normalize the experience by emphasizing the temporary nature of the treatment and its role in preventing future surgery. Assess for signs of depression, social withdrawal, or non-adherence stemming from embarrassment.

Coordinate regular follow-up visits with the orthopedic surgeon and orthotist for curve monitoring (radiographs) and brace adjustments. The nurse's role includes reinforcing the schedule, assessing the skin at each encounter, and troubleshooting barriers to adherence. Any reports of pain, rapid growth spurts, or brace discomfort warrant immediate re-evaluation, as a poorly fitting brace is both ineffective and dangerous.