A nurse is caring for a 10-year-old child with autism spectrum disorder (ASD) who is being admitted to the pediatric unit for a scheduled surgical procedure. The child exhibits repetitive behaviors, has difficulty with verbal communication, and becomes agitated with changes in routine. What is the most appropriate nursing intervention to help reduce the child's anxiety and promote cooperation during the hospitalization?

The child in this scenario has autism spectrum disorder (ASD), a neurodevelopmental condition characterized by challenges with social communication and interaction, alongside restricted, repetitive patterns of behavior, interests, or activities. A key feature often seen in hospitalized children with ASD is sensory defensiveness and a strong preference for predictability, which makes changes in routine a significant trigger for anxiety and agitation ^[2]. The unfamiliar environment of a pediatric unit, filled with new sights, sounds, and people, can be profoundly distressing.

The primary goal of the nursing intervention is not to teach new social skills or foster independence during an acute, stressful admission, but to mitigate this anxiety by creating a safe, predictable environment. The systematic review of the literature identifies that health care providers find behaviors such as non-compliance and hyperactivity challenging, and that partnering with parents is a crucial strategy for reducing these behaviors ^[2]. This underscores that the child's ability to cooperate is directly linked to their emotional state and sense of security.

Option 4: Maintain consistent routines and assign the same nurses to provide care whenever possible.
This intervention directly addresses the core pathophysiology of anxiety in ASD. Consistency minimizes the unpredictable sensory and social input that can overwhelm the child. By assigning the same nurses, the child can begin to recognize and build trust with a few specific caregivers, transforming an unfamiliar threat into a predictable element of the environment. This reduces the cognitive load and sensory defensiveness that lead to agitation, thereby promoting cooperation. The emphasis on individualized, consistent approaches is supported by research exploring therapeutic interventions for children with ASD, which highlights the importance of structured, predictable methods to effectively reduce anxiety ^[1].

Option 1: Encourage the child to interact with other children in the playroom to improve social skills.
This is contraindicated in the acute phase of hospitalization. A core deficit in ASD is social communication, and forcing interaction in a novel, high-stimulation environment like a playroom will dramatically increase the child's anxiety and risk of agitation. The hospitalization is for a surgical procedure; the priority is reducing stress, not conducting social skills training.

Option 2: Limit the parents' presence to help the child adapt to the hospital environment independently.
This action would be detrimental. For a child with ASD, parents are the primary source of safety, communication, and routine. Separating the child from their parents removes their most effective coping mechanism and interpreter of the environment. The literature explicitly identifies partnering with parents as a key strategy to reduce challenging behaviors ^[2]. Limiting their presence would sever this critical therapeutic alliance and escalate the child's distress.

Option 3: Use multiple staff members to provide care to expose the child to different people.
This approach directly contradicts the need for predictability and routine. Introducing multiple new faces is a form of uncontrolled social sensory input that will heighten the child's hypervigilance and sensory defensiveness, making cooperation far less likely. The goal is to reduce unpredictability, not increase it.