# Situation: A nurse at a Rural Health Unit (RHU) runs a well-child clinic for children aged 3 to 6 years before they enter school. A 4-year-old girl will receive an injection in 5 minutes. How should the nurse prepare her?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse at a Rural Health Unit (RHU) runs a well-child clinic for children aged 3 to 6 years before they enter school.

A 4-year-old girl will receive an injection in 5 minutes. How should the nurse prepare her?

## 보기

1. Explain how the medicine travels in her blood to protect her from illness
2. Let her give a pretend injection to a doll with a needleless syringe **✔ 정답**
3. Keep the syringe out of sight and tell her it will not hurt
4. Promise her a toy if she stays still and does not cry

**정답: 2**

## 해설

Preschoolers understand best through play and simple, concrete explanations given shortly before a procedure. Therapeutic play with a doll and real equipment lets her see and handle what will happen. Honest words, not promises that it will not hurt, build trust.

## 심화 해설

Therapeutic play before an injection in a preschooler

A 4-year-old child is in the preoperational stage of cognitive development. At this age, abstract explanations about medicine traveling through blood vessels are not meaningful, and a child cannot reliably distinguish between a promise and a prediction about pain. The most developmentally appropriate preparation is to let the child handle safe, real equipment through therapeutic play.

Preschoolers process unfamiliar medical events best through concrete, hands-on experience rather than verbal reasoning. Giving the child a needleless syringe and a doll allows her to act out the procedure on a safe object. This converts an unpredictable, frightening event into something she can see, touch, and control. The play session should occur shortly before the injection, because young children have a limited sense of time and prolonged anticipation can increase anxiety.

The Cochrane review on psychological interventions for needle-related pain and distress supports this approach. It found that cognitive-behavioral strategies, including preparation and rehearsal, are effective for reducing needle-related distress in children and adolescents [1]. Therapeutic play functions as a form of behavioral rehearsal: the child practices the coping sequence in a low-threat context before encountering the real stimulus.

A related Cochrane review on non-pharmacological management of procedural pain in infants and young children emphasizes that pre-procedural preparation and distraction-based strategies are core components of developmentally sensitive pain management [2]. Although that review focuses on infants and young children, the principle extends to preschoolers: preparation must match the child's developmental capacity, and play is the natural medium for this age group.

A meta-analysis of Child Life Services (CLS) further confirms that structured, play-based preparation delivered by trained professionals reduces procedural pain in pediatric patients [3]. The doll-and-syringe technique described in the question is a classic CLS intervention. The evidence indicates that allowing the child to manipulate medical equipment in a safe, supervised setting reduces perceived threat and improves cooperation during the actual procedure [3].

| Option | Why it is incorrect or less appropriate |
| --- | --- |
| 1. Explain how medicine travels in blood | Too abstract for a 4-year-old. Preschoolers cannot follow circulatory physiology, and this explanation does not reduce fear of the needle itself. |
| 3. Hide the syringe and say it will not hurt | Dishonest and counterproductive. If the injection does hurt, the child loses trust in the nurse. Hiding equipment also prevents the child from developing a realistic expectation of the procedure. |
| 4. Promise a toy for staying still | Bribery focuses on the outcome rather than coping. It does not teach the child how to manage fear, and it can create a pattern of expecting rewards for every medical encounter. |

Watch out! Do not tell a child an injection will not hurt. Pain perception is individual, and a false reassurance damages the therapeutic relationship. Instead, use honest but simple language such as "You may feel a small pinch, and then it will be done."

Key point! The correct preparation for a preschooler is concrete, play-based, and honest. Let the child handle a needleless syringe and a doll, explain what will happen in simple words immediately before the procedure, and avoid abstract physiology, false promises, and reward-based bargaining [1][2][3].References (research sources)

- [1]Psychological interventions for needle-related procedural pain and distress in children and adolescents.Research articleBirnie KA, Noel M, Chambers CT, Uman LS, Parker JA (2018) · DOI: 10.1002/14651858.CD005179.pub4

- [2]Non-pharmacological management of infant and young child procedural pain.Research articlePillai Riddell RR, Bucsea O, Shiff I, Chow C, Gennis HG, Badovinac S, DiLorenzo-Klas M, Racine NM, Ahola Kohut S, Lisi D, Turcotte K, Stevens B, Uman LS. (2023) · DOI: 10.1002/14651858.cd006275.pub4

- [3]The Effectiveness of Child Life Services in Reducing Pediatric Procedural Pain: A Systematic Review and Three-Level Meta-Analysis.Meta-analysis/systematic reviewZhu L, Wang Z, Zhou Z, Ma Z, Dang Q, Fu C, Duan W. (2026) · DOI: 10.2147/jpr.s588505

## 임상 시나리오

Preparing a Preschooler for InjectionTherapeutic play with real equipment reduces needle distress
A 4-year-old is in the preoperational stage and cannot process abstract explanations about medicine traveling in blood. Preparation should be concrete and occur shortly before the procedure because young children have a limited sense of time.

Let the child give a pretend injection to a doll using a needleless syringe. This therapeutic play converts a frightening event into something she can see, touch, and control, functioning as behavioral rehearsal.

CautionDo not hide the syringe or promise it will not hurt. Honest, simple words build trust; false reassurance can damage the nurse-child relationship.

## 핵심 개념

- **Therapeutic play** — Use of play with real or safe medical equipment to help a child understand and cope with a procedure through hands-on rehearsal.
- **Preoperational stage** — Piaget's cognitive stage from about 2 to 7 years, characterized by concrete thinking and limited ability to understand abstract explanations.
- **Behavioral rehearsal** — Practicing a coping sequence in a low-threat context before encountering the real stimulus, reducing distress.
- **Needle-related distress** — Anxiety, fear, or pain response associated with needle procedures, which can be reduced by cognitive-behavioral preparation.
- **Concrete preparation** — Giving a young child simple, honest, hands-on information about what will happen, appropriate to their developmental level.

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