Nursing Diagnosis in Pediatric Care: A Comprehensive Guide for Hospitalized Children

Hospitalization, whether for a short observation, planned surgery, or ongoing treatment for a chronic condition, represents a significant disruption for children and their families. For a child, the hospital environment can evoke feelings of fear, anxiety, and loss of control. Common reactions are centered around separation from loved ones, fear of bodily injury and pain, and a general sense of unease in an unfamiliar setting.

The ease with which a child adjusts to hospitalization is greatly influenced by the preparation they receive beforehand and how effectively their emotional and physical needs are addressed during their stay. A crucial aspect of care is providing robust support to the family, keeping them informed, and actively involving them in the child’s care. This collaborative approach significantly contributes to the well-being of everyone involved and facilitates a smoother adjustment to the hospital experience.

Nursing Care Plans and Management

The primary goals of nursing care for a hospitalized child are multifaceted. They include maximizing the child’s ability to engage in self-care activities to the best of their ability, nurturing their emotional well-being during a stressful time, reinforcing the family’s vital role in decision-making processes related to their child’s health, and ensuring the child’s safety throughout their hospital stay.

Prioritized Nursing Problems

When caring for a child in the hospital, nurses must prioritize the following:

Effective assessment and management of pain and discomfort.
Maintaining a safe environment and preventing falls and injuries.
Continuous monitoring of vital signs and vigilant observation for any changes in the child’s condition.
Delivering comprehensive emotional support and fostering a child-friendly atmosphere.
Promoting clear and effective communication and teamwork among the child’s family and the interdisciplinary healthcare team.
Assisting with age-appropriate activities of daily living (ADLs) and encouraging self-care practices.
Providing thorough education to both the child and their family about the child’s diagnosis, treatment plan, and discharge instructions.
Supporting adequate nutritional intake and hydration.
Facilitating play and developmentally appropriate activities to support ongoing normal development.

Comprehensive Nursing Assessment

A thorough nursing assessment is critical and should include gathering both subjective and objective data. Key assessment areas include:

Chief Complaint: The primary reason for the child’s admission (e.g., fever, abdominal pain, breathing difficulties).
Symptom Description: Detailed information about symptoms, such as pain characteristics, levels of discomfort, and any changes in appetite or sleep patterns.
Allergies and Medical History: Documentation of any known allergies or pre-existing medical conditions.
Past Medical and Surgical History: Information on previous illnesses, hospitalizations, and surgical procedures.
Current Medications and Treatments: A complete list of all medications and treatments the child is currently receiving.
Family Medical and Social History: Relevant family medical history and social factors that may impact the child’s health.
Vital Signs: Regular monitoring of vital signs, including temperature, heart rate, respiratory rate, and blood pressure.
Physical Examination Findings: Detailed physical examination findings, noting general appearance, skin condition, and assessments of specific organ systems.
Laboratory and Diagnostic Results: Review of laboratory results such as blood tests, imaging studies, and microbiological cultures.
Medication Administration and Response: Accurate records of medications administered and the child’s response to these medications.
Fluid Balance Monitoring: Intake and output measurements to monitor fluid balance.
Pain Assessment: Assessment of pain level using a validated, age-appropriate pain scale.
Procedure Documentation: Detailed documentation of all procedures performed and their outcomes.
Changes in Condition: Documentation of any changes in the child’s condition or their response to treatment interventions.

Nursing Diagnosis Formulation

Following a comprehensive assessment, a nursing diagnosis is formulated to precisely address the unique challenges presented by the hospitalized child. This diagnosis is based on the nurse’s expert clinical judgment and a deep understanding of the child’s specific health circumstances. While nursing diagnoses provide a valuable framework for structuring care, their direct application can vary across different clinical scenarios. In real-world practice, while diagnostic labels may be less overtly emphasized, the principles of nursing diagnosis remain fundamental. Ultimately, it is the nurse’s clinical expertise and thoughtful judgment that truly shape the individualized care plan, ensuring it effectively meets each child’s distinct needs and prioritizes their most pressing health concerns.

Establishing Nursing Goals

Clearly defined goals and expected outcomes are essential for guiding nursing care. For a hospitalized child, these may include:

Achieving maximum possible self-care ability, potentially with the aid of assistive devices.
Engaging in age-appropriate activities to the fullest extent permitted by their medical condition.
Experiencing a reduction in anxiety levels for both the child and their family.
Developing an enhanced sense of control over their hospital experience.
Participating in suitable play activities without sustaining injury.
Parents will be able to verbalize key safety considerations related to toys and play within the hospital environment.

Nursing Interventions and Actions

Therapeutic nursing interventions for hospitalized children are varied and aim to address their holistic needs. Key areas include:

1. Facilitating Self-Care in Children

Supporting self-care in a hospitalized child means offering age-sensitive assistance and guidance to help them maintain personal hygiene. This includes support with bathing, grooming, and dressing. Encouraging the child to actively participate in their care is vital, fostering independence whenever feasible. The nurse should create a supportive and nurturing atmosphere that respects the child’s privacy and maintains their dignity throughout their hospital stay.

Assess the child’s physical capacity and tolerance for performing ADLs, as well as permitted play activities and any restrictions imposed by their illness or medical protocols.
This assessment provides essential information about the child’s energy levels and how their illness impacts their ability to engage in activities.

Provide direct personal care for infants and younger children. For older children, offer assistance and adapt care schedules and methods to align with their home routines.
This approach ensures that younger children receive the necessary care while older children benefit from familiar routines that offer comfort and normalcy.

Proactively anticipate the child’s needs for toileting, feeding, oral hygiene, bathing, and other personal care tasks, especially if they are unable to manage independently. Encourage the child to do as much as they are capable of.
This prevents potential embarrassment related to toileting accidents and maintains the child’s comfort and sense of personal hygiene and appearance.

Offer praise and positive reinforcement for the child’s participation in their own care, tailored to their age, developmental stage, and energy level.
Positive reinforcement boosts self-esteem and fosters a sense of independence and accomplishment in the child.

Balance activity with necessary rest periods. Ensure that essential items and the call light are easily accessible to the child, if appropriate for their age and condition.
This strategy helps prevent fatigue by promoting energy conservation and ensuring adequate rest, while also empowering the child to call for assistance when needed.

Provide assistive devices or aids as needed to facilitate ADLs, and whenever possible, allow the child to make choices in their care.
Assistive aids enhance the child’s ability to perform self-care tasks, and offering choices provides a sense of control and involvement.

Encourage rest and quiet periods throughout the day.
Adequate rest is crucial for recovery and helps to prevent fatigue, supporting the child’s overall well-being.

Instruct parents on how to interpret their child’s needs, particularly if the child is too young to communicate verbally.
This education empowers parents to provide anticipatory care and effectively advocate for their child’s needs within the hospital setting.

Provide clear instructions to parents and older children on hospital-specific procedures for bathing, hygiene, toileting, feeding, and dressing, highlighting any differences from home routines and adapting methods as needed.
This instruction promotes the maintenance of ADL skills the child already possesses, adapting them to the hospital environment.

Encourage parents to actively assist their child with ADLs but to also allow the child as much independence as their condition safely permits. Inform parents that accommodations are available to support their own needs, enabling them to remain with their child.
This approach balances parental involvement with the child’s need for independence and control, while also supporting the parents’ ability to stay comfortably with their child.

2. Implementing Diversional Activities for Children in Hospitals

Providing diverse and engaging activities for a hospitalized child is crucial for their emotional health and ongoing development. These activities might include age-appropriate play, creative arts and crafts, reading, movies, and therapeutic play programs. These diversions are essential to distract the child from the hospital environment, lessen anxiety, and foster a sense of normalcy and enjoyment during their stay. Activities should be adapted to suit the child’s abilities, preferences, and any medical restrictions, always ensuring safety and adherence to infection control protocols.

Assess the types of activities that are appropriate and appealing to the child, considering the level of physical exertion required. Review the medical orders for any activity restrictions, such as bed rest limitations imposed by the child’s condition.
This assessment provides essential information for suggesting suitable play and activities that align with the child’s medical status and preferences.

Schedule nursing care and treatments to allow ample time for play activities.
Prioritizing play by scheduling care around it ensures that the child has dedicated opportunities for diversion and enjoyment.

If possible, place the child in a room with another child of a similar age.
Room sharing can encourage social interaction and provide mutual diversion for hospitalized children.

Introduce the child and their family to the playroom and to other children and families facing similar health challenges.
A playroom provides a familiar and normalized environment, and introductions can foster a sense of community and shared experience.

Actively encourage family members to engage in play and interaction with the child.
Family involvement in play promotes diversion and strengthens family bonds during a stressful time.

Advise parents to bring the child’s favorite toys and comfort items from home.
Familiar toys and items from home serve as effective diversions and offer emotional comfort and security.

Offer a variety of age-appropriate play activities tailored to the child’s energy levels and permitted activity levels. Include quiet play options such as games, television, reading, soft toys, and cherished personal toys.
Providing a range of activities prevents fatigue while still catering to the child’s need for rest and quiet during illness.

For school-aged children, incorporate activities that address their educational needs. If appropriate, arrange for schoolwork to be brought from home.
Integrating educational activities helps maintain a sense of normalcy and supports the child’s continued learning and development.

Educate parents and the child about the importance of balancing activity and rest, while still allowing for play and social interaction.
This education helps prevent fatigue during the acute phase of illness while ensuring the child still benefits from play and social engagement.

Refer to a play therapist as needed for specialized assistance in designing therapeutic activities and assessing the child’s specific play needs.
Play therapists offer expertise in using play as a therapeutic tool and can provide tailored interventions to meet the child’s emotional and developmental needs.

3. Strategies for Reducing Anxiety in Hospitalized Children

Anxiety is a common emotional response in hospitalized children. Empowering them through various strategies can significantly reduce their fears and enhance their sense of control. This can be achieved by providing age-appropriate information about their condition and treatments, actively involving them in decision-making when appropriate, and offering opportunities for self-expression and autonomy within their capabilities.

Assess the anxiety levels of both the child and their parents. Evaluate the child’s developmental stage, their understanding of their illness, the reason for hospitalization, and their reactions to current and past hospital experiences upon admission.
This thorough assessment provides crucial insights into the sources and levels of anxiety related to illness and hospitalization. Anxiety triggers and responses vary with age and can include separation anxiety, fear of pain or bodily harm, loss of control, enforced dependence, fear of the unknown, fear of medical equipment, unfamiliar surroundings and routines, feelings of guilt, and concern for recovery.

Evaluate the child and family’s social and emotional history to identify strengths and effective coping mechanisms they have used in the past.
Understanding past coping strategies and strengths helps healthcare providers build upon these resources to support the child and family during hospitalization.

Recognize and acknowledge regressive behavior as a normal response to illness and hospitalization. Support the child in managing the dependency associated with being hospitalized.
Acknowledging regressive behavior as a normal response helps normalize the child’s experience and provides reassurance and support.

Encourage both the child and parents to verbalize their feelings and concerns about the child’s condition and medical procedures. Actively listen to both the child and parents individually.
Providing a safe space for verbalizing feelings and fears can significantly lessen anxiety and promote better adjustment to the hospital experience.

Allow the child to express their feelings through play. Accept all feelings and responses the child expresses without judgment.
Play allows children to communicate their emotions in a non-threatening way, and unconditional acceptance of these expressions is crucial for emotional processing.

Ensure consistency in staffing by assigning the same personnel to care for the child whenever possible and by adhering to written care plans. Schedule regular personal interaction with the child throughout the workday.
Consistency in care promotes a sense of stability and helps build a trusting relationship between the child, family, and healthcare team.

Provide a thorough orientation to the hospital environment, including their room, daily routines, meal and playtime schedules, introductions to staff members, explanations of necessary forms, and hospital policies.
Familiarizing the child and family with the hospital environment enhances their sense of security and reduces fear of the unknown.

Interact with the child in a positive and approachable manner. Use the child’s correct name and avoid any verbal or nonverbal communication that conveys rejection, judgment, or negativity.
Positive interactions build rapport and trust, and using the child’s name respectfully affirms their identity.

Create a calm and accepting environment. Avoid rushing interactions and care procedures.
A calm environment and unrushed interactions help build trust and promote emotional stability for both the child and family.

Maintain a quiet environment and manage visitors and interactions to minimize overstimulation.
Reducing excessive stimuli helps decrease anxiety and promotes a more restful and therapeutic environment.

Actively involve the child and parents in planning care and interventions. Allow parents to stay with the child, and encourage physical closeness such as holding and cuddling.
Parental involvement and physical affection are crucial for reducing anxiety and promoting a sense of security and connection.

Whenever possible, incorporate home routines into the hospital stay. Encourage parents to bring familiar items from home, such as toys, tapes, photographs, and favorite foods.
Familiar routines and items from home provide comfort and security, reducing anxiety associated with new experiences.

Provide consistent support to the child during all procedures and any distressing aspects of care, including invasive procedures, exposure of body parts, and the need for both personal privacy and the privacy of others.
Providing support and respecting privacy helps minimize anxiety and fear related to potential bodily harm and loss of dignity.

Utilize therapeutic play to explain procedures and prepare the child for what to expect. Repeat teaching as often as needed to reinforce understanding.
Therapeutic play helps children understand medical procedures in an age-appropriate way, reducing fear and increasing cooperation.

Reassure parents and the child that anxiety and fear are normal and expected responses to hospitalization.
Normalizing these feelings helps alleviate guilt or shame and validates their emotional experience.

Provide clear and simple explanations of all procedures and care plans to both the child and parents, using language appropriate to their intellectual level and age. Pace the information delivery to match their needs and ability to process information.
Clear and understandable information reduces anxiety by addressing the unknown and fostering a sense of predictability.

If surgery is planned, provide detailed information about the surgical procedure, its purpose, the expected duration of hospitalization, and both preoperative and postoperative care.
Thorough preparation for surgery minimizes anxiety by providing a clear picture of what to expect before, during, and after the procedure.

Encourage parents and the child to express their feelings in a supportive and accepting environment.
Allowing open expression of feelings helps manage frustration and the sense of loss of control associated with hospitalization.

Facilitate parental participation in the child’s care to the extent they desire and ensure they can visit or stay with the child consistently.
Parental involvement offers crucial support to the child and gives the family a degree of control over the situation.

Offer encouragement and express appreciation to the child and parents for their active participation. Positively reinforce the expression of their genuine feelings.
Positive feedback and validation of feelings builds confidence and reduces fear of judgment from the healthcare team.

Actively seek suggestions and input from the child and parents when formulating care goals, care plans, and activity schedules. Integrate their input into daily routines as much as possible.
Involving the child and family in care planning maximizes their sense of control and collaboration.

Allow the child to perform simple tasks within the hospital unit and in their self-care, such as pouring water and recording intake amounts at the bedside.
Giving children simple responsibilities promotes independence and a sense of control over their environment.

Clearly communicate to parents and the child which tasks they can actively participate in as part of the care plan.
Clear communication ensures that the child and family are aware of their roles and opportunities for involvement, further supporting their sense of control.

4. Promoting Safety and Preventing Trauma in Pediatric Hospitalization

Hospitalization can be a stressful and potentially traumatic experience for children, particularly when they undergo painful or invasive procedures, face serious medical conditions, or endure prolonged hospital stays. These experiences can have lasting impacts on a child’s emotional and psychological well-being, influencing their future perceptions of healthcare and medical environments.

Assess the child’s age and the reason for selecting specific types of play and play materials, as well as the intended therapeutic purpose of play.
This assessment is crucial for selecting age-appropriate and developmentally beneficial play activities. For example, infants respond to grasping toys, young children engage in pretend play, and older children enjoy games, hobbies, and sports. Play serves as a fun diversion, a learning tool, and a way for children to process their hospital experience.

Encourage play and allow parents to bring favorite toys, games, or other play materials from home.
Familiar play items promote learning, skill development, and provide a healthy outlet for emotional expression.

Involve the child in communicating their preferred types of toys and in helping to choose toys and play activities.
This involvement fosters independence and control in play situations, empowering the child within the hospital setting.

Select safe toys that are appropriate for the child’s age and the level of activity permitted, aligning with the child’s skills and interests.
Choosing appropriate toys ensures safe and engaging play, whether it’s quiet, restful play or more active engagement.

Plan and implement age-appropriate play activities to prepare the child for invasive procedures, observe the child’s behavior, or allow the child to express fears and concerns, either independently or with support.
Therapeutic play is invaluable for preparing children emotionally and cognitively for medical procedures. Using dolls, puppets, toy medical supplies, and art materials allows children to express emotions and develop coping strategies.

Eliminate any dangerous, sharp, or broken toys, as well as toys with small parts that could be swallowed, and toys that are not age-appropriate.
Removing hazardous toys prevents potential trauma or injury to the child.

Educate parents on selecting safe toys, play equipment, and supplies that are appropriate for their child’s age group. Emphasize the importance of non-toxic, flame-resistant materials with clear instructions for use, durability, smooth edges, and no small detachable parts. Also, advise them to avoid toys that are broken, rusted, or weakened.
Parent education is key to ensuring safe play practices within the hospital and at home.

Educate parents about separating play materials intended for older children from those for younger children to create a safe play environment. Advise them to regularly discard or repair any broken toys.
Proper organization and maintenance of toys prevents accidents and ensures a safe play space.

Educate parents on choosing play activities that match the child’s energy and tolerance levels during illness. Also, guide them in assessing the safety and suitability of toys given as gifts to the child.
This education ensures that play activities are beneficial and safe, tailored to the child’s current health condition and energy levels.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
This handbook is valued for its evidence-based approach to nursing interventions. It employs a user-friendly, three-step system to guide users through client assessment, nursing diagnosis, and care planning. It includes step-by-step instructions on implementing care and evaluating outcomes, helping to build essential skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
This resource features over two hundred care plans reflecting the most current evidence-based guidelines. This edition includes new ICNP diagnoses, care plans addressing LGBTQ health issues, and information on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
This quick reference tool is essential for identifying accurate diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions, with an alphabetized listing of nursing diagnoses covering over 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
This manual helps identify interventions to plan, personalize, and document care for more than 800 diseases and disorders. Unique to this manual are subjective and objective findings for each diagnosis, sample clinical applications, prioritized actions/interventions with rationales, documentation sections, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
This comprehensive e-book includes over 100 care plans spanning medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health nursing. Interprofessional “patient problems” focus to familiarize users with patient-centered communication.