Nursing diagnosis: Anxiety/Fear; ineffective Coping related to situational and maturational crises; interpersonal transmission or contagion; threat to, or change in, health status; natural or innate origin—pain, loss of physical support; separation from support system in potentially stressful situation—hospitalization, hospital procedures; learned response—conditioning, modeling from or identification with others
Possibly evidenced by
Excessive psychomotor activity, restlessness, crying, lack of eye contact, withdrawal, sleep disturbances, nightmares
Avoidance or attack behaviors, reports of being scared, expressed concerns about changes
Social inhibition, shy, withdrawn demeanor
Desired Outcomes/Evaluation Criteria—Child Will
Appear relaxed and report or demonstrate relief from somatic manifestations of anxiety.
Demonstrate a decrease in somatic complaints and physical symptoms when faced with stressful situations such as impending separation from SO.
Engage in age-appropriate activities in absence of parent or primary caregiver without fear or distress noted.
Nursing intervention with rationale:
1. Establish an atmosphere of calmness, trust, and genuine positive regard.
Rationale: Trust and unconditional acceptance are necessary for satisfactory therapeutic relationship. Calmness is important because anxiety is easily transmitted from one person to another, and children are often adept at sensing changes in the moods of adults around them.
2. Prepare child for activites and procedures. Provide explanations in language appropriate for age. Use terms familiar to child, such as for care activities—“walk” instead of “ambulate”—or procedures—“take a picture” instead of “fluoroscope.” Provide opportunity for client to ask questions, observe or touch equipment as appropriate.
Rationale: Accurate and age-appropriate communication promotes trust and creates an atmosphere where child feels free to ask questions. Based on child’s developmental level, tour of facility or surgical suite and observation of “machinery” in action may help reduce concerns regarding the unknown. Note: Children may become frightened of things they cannot articulate.
3. Ensure child of his or her safety and security—listen to child, identify needs, and be available for support.
Rationale: Strange people and surroundings, changes in routine, and loss of control in situation create anxiety and can be very frightening. Children may believe that situation is punishment for some wrongdoing—imagined or real—on their part. Providing information and being available can be reassuring.
4. Be honest with child and parents by saying, “Yes, this will hurt and I will help you manage it.”
Rationale: Promotes trust and belief that child will not be left alone to deal with situation.
5. Refrain from conversations unrelated to child in his or her presence or failing to include child in conversations regarding him or her.
Rationale: Ignoring the child or talking about, instead of to, the child or allowing child to overhear partial or unrelated conversations may be very stressful and result in child imagining things that are incorrect.
6. Maintain home routines whenever possible. Encourage child and parents to bring transitional object from home, such as familiar toys, handheld computer games or digital music player, special pillow or blanket, some favorite pictures, or posters, if hospitalized.
Rationale: Use of age-appropriate object enhances sense of security when child or adolescent is hospitalized or in treatment setting.
7. Provide consistency of caregivers.
Rationale: Becoming acquainted with caregiver enhances sense of security, facilitates communication, and lessens anxiety.
8. Promote child and family contact and interaction. Encourage parents to participate in care planning and care provision.
Rationale: Family involvement in activities promotes continuity of family unit, provides opportunity to learn and practice new skills, and enhances coping skills.
9. Emphasize importance of staff and family giving verbal prompts in anticipation of absences. Provide honest information about leaving and returning.
Rationale: Avoidance of these issues increases the likelihood of anxiety responses when separation occurs.
10. Schedule ample time for play and age-appropriate diversions. Use play materials, such as puppets, doll house, doctor/nurse kits, fairy tale stories, clay, coloring book, and so on.
Rationale: Promotes normalcy and helps divert attention from situation. Play therapy enables child to explore conflicts, express fears, and release tension.