# A 5-year-old kindergartener is hospitalized for asthma exacerbation. The child has been crying inconsolably for the past 2 hours since the parents left. Which nursing intervention should be the priority to promote the child's emotional well-being and cooperation with treatment?

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> subject: Growth & Development

## 문제

A 5-year-old kindergartener is hospitalized for asthma exacerbation. The child has been crying inconsolably for the past 2 hours since the parents left. Which nursing intervention should be the priority to promote the child's emotional well-being and cooperation with treatment?

## 보기

1. Offer the child a favorite toy or comfort object from home
2. Provide distraction with age-appropriate hospital toys and activities
3. Maintain a consistent routine similar to the child's home schedule
4. Assign the same nurse to care for the child throughout the hospitalization **✔ 정답**

**정답: 4**

## 해설

Assigning the same nurse (primary nursing) is the priority to build trust and reduce separation anxiety, promoting emotional well-being and cooperation. Other interventions (comfort objects, distraction, routine) are supportive but secondary to consistent caregiving.

## 심화 해설

Understanding the Priority: Separation Anxiety in the Hospitalized Preschooler

A 5-year-old child is in the preoperational stage of cognitive development, characterized by magical thinking, egocentrism, and limited ability to understand time or the temporary nature of separation. When a child of this age is hospitalized for an acute condition such as an asthma exacerbation and the parents leave, the inconsolable crying is not simply misbehavior—it is a manifestation of separation anxiety, which is the central developmental stressor for this age group. The unfamiliar hospital environment significantly increases psychological distress in children, particularly those of younger age [1]. The child’s emotional dysregulation from prolonged crying can directly worsen the clinical picture by increasing oxygen consumption and triggering or sustaining bronchospasm, making cooperation with nebulizer treatments or inhaler therapy nearly impossible.

Analyzing the Intervention Options

To determine the priority nursing intervention, it is essential to evaluate which action directly addresses the root cause of the distress—the disruption of a secure, trusting relationship with a primary caregiver—rather than merely distracting from it.

- Option 1: Offer a favorite toy or comfort object. A transitional object from home can provide a tangible link to the family and a sense of security. However, for a child in the throes of acute, intense separation anxiety, an inanimate object is often insufficient to replace the felt safety provided by a consistent human presence, especially when the child has already been crying for 2 hours.

- Option 2: Provide distraction with hospital toys. Distraction techniques, such as play interventions, have documented benefits in relieving anxiety and fear in hospitalized children [1]. However, distraction is a coping strategy most effective for mild to moderate anxiety or procedural pain. In a state of high emotional arousal and established mistrust of the unfamiliar setting, a child is unlikely to engage meaningfully with a new toy offered by a rotating stranger. The intervention addresses the symptom (crying) but not the underlying cause (loss of the parental bond).

- Option 3: Maintain a consistent routine. Structuring the day to mirror the home schedule is a valuable strategy for promoting a sense of predictability and control, which reduces overall stress. Yet, routines are a secondary layer of security; a child cannot benefit from a predictable schedule if their fundamental need for a primary, trusting relationship is unmet. This is a supportive, not a priority, intervention in the acute phase of separation crisis.

- Option 4: Assign the same nurse consistently. This is the priority intervention. Consistency of care by assigning the same nurse directly mitigates the core threat of separation by fostering a surrogate, trusting relationship. For a preschooler, the nurse becomes a predictable, safe "anchor" in the parent's absence. A nurse-led, relationship-based approach is foundational because it builds the trust necessary for the child to eventually accept other therapeutic interventions, such as distraction or play. A study on nurse-led mindfulness interventions for hospitalized school-aged children demonstrated that a structured, consistent therapeutic relationship significantly reduces psychological distress and improves emotional well-being . While the child in this scenario is slightly younger, the principle that a stable, nurse-facilitated relational context is the primary vehicle for reducing distress applies directly. Without this foundational trust, all other interventions—including distraction and routine—are built on unstable ground. Once a bond with a consistent nurse is formed, the child’s cooperation with asthma treatment, which is critical for physiological stability, becomes achievable.References (research sources)

- [1]Nurse-led play intervention on hospitalization anxiety, fear among children admitted to a tertiary care hospital.Research articleBenazeera, Aranha PR. (2025) · DOI: 10.4103/jehp.jehp_57_25

## 임상 시나리오

Primary Nursing for the Hospitalized PreschoolerBuilding Trust to Mitigate Separation Anxiety
For a 5-year-old child, separation anxiety is the major developmental stressor. Inconsolable crying after parents leave is a direct manifestation of this. The priority intervention is to re-establish a secure, trusting relationship with a consistent caregiver.

Implement primary nursing by assigning the same nurse to the child for the entire hospitalization. This provides a predictable and safe "home base" in the unfamiliar environment, directly addressing the root cause of the child's distress rather than simply distracting from it.

CautionProlonged crying can worsen respiratory distress in asthma by increasing oxygen consumption and triggering bronchospasm. A transitional object (e.g., favorite toy) is a helpful adjunct but is not a substitute for a consistent human relationship when anxiety is acute.

## 핵심 개념

- **Separation Anxiety** — A developmental stage common in toddlers and preschoolers characterized by intense distress when separated from primary caregivers, peaking around 18 months to 3 years but still significant at age 5.
- **Primary Nursing** — A care delivery model where one nurse assumes 24-hour responsibility for planning and evaluating care for a specific patient, promoting continuity and a therapeutic relationship.
- **Therapeutic Relationship** — A purposeful, goal-directed connection between nurse and patient built on trust, respect, and empathy to facilitate healing and cooperation with treatment.

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