# Situation: A 9-year-old boy in grade 4 is admitted to the pediatric ward for a planned operation on his left leg, to be followed by several days of bed rest. He worries about missing school and his basketball games. On the second day after the operation, the boy is irritable, pushes away his meal tray, and says, "Nobody lets me do anything here." His pain score is 1 out of 10, and his parents stay with him every evening. Which concern MOST likely explains his behavior?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629519  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 9-year-old boy in grade 4 is admitted to the pediatric ward for a planned operation on his left leg, to be followed by several days of bed rest. He worries about missing school and his basketball games.

On the second day after the operation, the boy is irritable, pushes away his meal tray, and says, "Nobody lets me do anything here." His pain score is 1 out of 10, and his parents stay with him every evening. Which concern MOST likely explains his behavior?

## 보기

1. Loss of control over his day **✔ 정답**
2. Fear of injury to his body
3. Separation from his parents
4. Worry about how his leg looks

**정답: 1**

## 해설

Loss of control is the main stressor of hospitalized school-age children, who are used to independence and industry. Bed rest and others making every decision for him show in his complaint that nobody lets him do anything. His pain is controlled and his parents visit daily, so pain and separation are less likely causes; the nurse gives him tasks and choices.

## 심화 해설

The school-age child, typically between 6 and 12 years, is developmentally focused on industry versus inferiority — a stage where mastery, productivity, and a sense of competence are central. A 9-year-old in grade 4 has already established routines around schoolwork, friendships, and physical activities such as basketball. Hospitalization disrupts all of these, but the most immediate psychological threat is not the illness itself; it is the sudden removal of autonomy and self-direction that the child has worked hard to build.

The boy’s statement, “Nobody lets me do anything here,” is a direct verbalization of perceived loss of control. He is not complaining about pain, and he is not asking for his parents. His irritability and refusal to eat are behavioral expressions of frustration over having his daily choices — when to eat, how to move, what to do — made for him by staff and the imposed bed rest. Key point! For a school-age child, loss of control over routines and decision-making is a more powerful stressor than physical discomfort or brief parental absence.

The clinical data support this interpretation. His pain score is 1 out of 10, indicating that postoperative pain is well controlled and unlikely to be driving his behavior. His parents visit every evening, so separation anxiety — a dominant concern for toddlers and preschoolers — is less salient here. A school-age child can tolerate predictable daily separation when he knows his parents will return. The remaining options, fear of bodily injury and worry about appearance, are more characteristic of younger children or of specific surgical contexts involving visible disfigurement; nothing in the scenario suggests these are active concerns.

The nursing implication is to restore a sense of agency. Offering structured choices and meaningful tasks within safe limits reduces the distress of hospitalization in this age group. For example, the nurse can let him decide the order of morning care, choose between two approved activities, or assign him a small responsibility such as marking his own intake chart. These interventions do not compromise the medical plan, but they directly counter the feeling that “nobody lets me do anything.”

| Developmental stage | Primary stressor during hospitalization | Typical behavioral cue | Nursing response |
| --- | --- | --- | --- |
| Toddler (1–3 years) | Separation from parents | Crying, clinging, regression | Encourage parent presence, maintain routines |
| Preschooler (3–6 years) | Fear of bodily injury or mutilation | Asks about body parts, resists procedures | Simple explanations, bandage play, reassurance |
| School-age (6–12 years) | Loss of control and independence | Irritability, refusal, verbal protest | Offer choices, assign tasks, involve in care plan |
| Adolescent (12–18 years) | Loss of privacy and peer connection | Withdrawal, anger, nonadherence | Respect privacy, facilitate peer contact |

Research on hospitalized children reinforces that loss of autonomy is a core component of the psychosocial burden of hospitalization. Instruments designed to measure children’s self-reported needs consistently include domains related to control, independence, and participation in decisions. Watch out! Do not mistake a school-age child’s irritability for pain or for separation distress. When pain is controlled and parents are present, the most likely driver of protest behavior is the child’s thwarted need for self-direction. The correct nursing action is to return appropriate control to the child through choices and tasks that fit within the treatment plan.

## 임상 시나리오

School-Age Hospitalization: Loss of ControlWhy a 9-year-old says "Nobody lets me do anything here"
For children aged 6-12 years, the dominant developmental task is industry vs. inferiority. They value mastery, productivity, and self-direction. Hospitalization threatens this by removing autonomy and imposing routines.

The boy's irritability, meal refusal, and statement "Nobody lets me do anything here" are behavioral expressions of perceived loss of control, not pain or separation. His pain score is 1/10 and parents visit daily.

CautionDo not mistake this for separation anxiety or pain. Provide choices and age-appropriate tasks to restore a sense of control and industry.

## 핵심 개념

- **Industry vs. Inferiority** — Erikson's developmental stage for ages 6-12, where children derive self-worth from mastery, productivity, and competence in tasks.
- **Loss of Control** — The primary psychosocial stressor for hospitalized school-age children, arising from imposed routines and removal of decision-making autonomy.
- **Separation Anxiety** — Distress from being apart from primary caregivers; most pronounced in toddlers and preschoolers, less salient in school-age children with predictable visitation.
- **Regression** — A coping mechanism where a child reverts to earlier developmental behaviors under stress, such as irritability or refusal to eat.

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