# A 17-year-old adolescent is admitted to the medical-surgical unit for management of a newly diagnosed type 1 diabetes. The nurse is developing a safety plan specific to adolescent developmental needs. Which nursing intervention should be the highest priority to ensure safety for this hospitalized adolescent?

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> language: ko  
> subject: Growth & Development

## 문제

A 17-year-old adolescent is admitted to the medical-surgical unit for management of a newly diagnosed type 1 diabetes. The nurse is developing a safety plan specific to adolescent developmental needs. Which nursing intervention should be the highest priority to ensure safety for this hospitalized adolescent?

## 보기

1. Establish clear boundaries and expectations while allowing appropriate independence within the hospital setting **✔ 정답**
2. Restrict all visitors except immediate family members to prevent overstimulation and maintain a quiet environment
3. Assign the adolescent to a room with younger pediatric patients to ensure closer supervision by nursing staff
4. Implement strict bedrest protocols and limit self-care activities to prevent injury during the recovery period

**정답: 1**

## 해설

Adolescents need balance between safety and autonomy. Clear boundaries with appropriate independence support psychological development while maintaining safety. Other options are overly restrictive or inappropriate for adolescent needs.

## 심화 해설

Understanding the Adolescent with Type 1 Diabetes

The highest priority safety intervention for a hospitalized 17-year-old with newly diagnosed type 1 diabetes is to establish clear boundaries and expectations while allowing appropriate independence. This approach directly addresses the unique developmental needs of adolescence, which is characterized by a drive for autonomy, identity formation, and a heightened sensitivity to peer perception. A chronic diagnosis like type 1 diabetes during this period can threaten self-esteem and create a sense of being different from peers . A safety plan that is overly restrictive ignores these core developmental tasks and can paradoxically increase safety risks by provoking rebellion, non-adherence to the treatment plan, and psychological distress.

Why the Other Options are Incorrect

- Restricting all visitors except immediate family is counter-therapeutic. Peer interaction is a cornerstone of adolescent development. Isolating the patient from their social support system can worsen feelings of alienation and low self-esteem, which are already significant risks with a new chronic illness . A safe environment is not a socially isolated one.

- Assigning the adolescent to a room with younger pediatric patients fails to recognize the adolescent's developmental stage. This placement can be perceived as demeaning and infantilizing, damaging the therapeutic relationship and undermining the patient's self-image as a capable young adult. It does not promote the independence necessary for successful self-management.

- Implementing strict bedrest and limiting self-care activities is developmentally inappropriate and clinically unnecessary for a medically stable adolescent with a new diabetes diagnosis. The ultimate goal of care is to equip the patient with the knowledge and skills for lifelong self-management. Limiting self-care directly contradicts this goal and fosters dependence rather than the self-efficacy needed to manage blood glucose, nutrition, and insulin administration safely after discharge .

The Clinical Rationale: Balancing Safety and Autonomy

The correct intervention is rooted in the understanding that safety for an adolescent is not just physical but also psychological and developmental. The Roy Adaptation Model, when applied to an adolescent with type 1 diabetes, emphasizes nursing approaches that promote adaptation in the physiologic, self-concept, role function, and interdependence modes . A rigid, controlling environment creates a maladaptive response. Instead, the nurse must act as a collaborator. By negotiating clear, non-negotiable safety parameters—such as accurate blood glucose monitoring and reporting symptoms of hypo- or hyperglycemia—while granting autonomy in areas like scheduling self-care activities or choosing meal options within a dietary plan, the nurse supports the patient’s need for control. This collaborative, person-centered approach is a core component of effective transitional and inpatient care, fostering trust and making the adolescent more likely to engage with the treatment plan and communicate openly about their challenges . The highest priority is to create a safe space where the adolescent can begin to integrate the demands of this chronic illness into their emerging identity without feeling that their normal developmental need for independence is being pathologized.

## 임상 시나리오

Adolescent Safety & AutonomyBalancing boundaries with independence in the hospital
For a hospitalized adolescent, the highest priority is a plan that supports identity formation and autonomy. Establish clear, consistent boundaries while negotiating choices for care schedules, food options (within dietary limits), and privacy.

Overly restrictive rules can be perceived as a threat to self-control, provoking rebellion and deliberate non-adherence to the diabetes management plan. Safety is enhanced through collaboration, not rigid control.

CautionNever isolate an adolescent from their peer group. Peer interaction is critical for self-esteem and coping. Placing them with younger children is demeaning and damages the therapeutic relationship.

## 핵심 개념

- **Adolescent Autonomy** — A core developmental need during adolescence involving the drive for independence, decision-making, and control over one's own life and care.
- **Therapeutic Relationship** — A professional, trust-based alliance between the nurse and patient that is essential for effective care, easily damaged by developmentally inappropriate restrictions.
- **Non-adherence** — Failure to follow a prescribed treatment plan, which in adolescents can be a form of rebellion against overly strict or developmentally insensitive rules.

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