Pediatric Nursing Diagnosis: Crafting Effective Care Plans for Hospitalized Children

Hospitalization, whether for a short observation, a planned surgery, or ongoing management of a chronic condition, represents a significant disruption in a child’s life and family dynamics. For pediatric patients, the hospital environment can evoke feelings of fear, anxiety, and loss of control, stemming from separation from loved ones, unfamiliar surroundings, potential for injury, and the experience of pain. Understanding these unique vulnerabilities is paramount in pediatric nursing, where care extends beyond the physical ailment to encompass the child’s emotional and developmental needs.

The transition from home to hospital hinges on meticulous preparation and a holistic approach to care. Nurses play a pivotal role in easing this transition by providing comprehensive support to both the child and their family. This includes clear communication, age-appropriate information, and active involvement of the family in the child’s care plan. By addressing the multifaceted needs of hospitalized children, nurses contribute significantly to their adjustment, well-being, and positive health outcomes. This guide delves into the essential aspects of nursing care plans for hospitalized children, emphasizing accurate nursing diagnoses and evidence-based interventions to promote healing and comfort.

Nursing Care Plans and Management

Effective nursing care for hospitalized children centers on several key objectives. Primarily, the aim is to maximize the child’s ability to engage in self-care activities to the best of their capability. Concurrently, fostering the child’s emotional well-being is crucial, creating a supportive and child-friendly environment that minimizes anxiety and fear. Furthermore, recognizing and empowering the family’s role in decision-making and care promotes a sense of partnership and strengthens the child’s support system during hospitalization. Finally, a cornerstone of pediatric nursing care is ensuring patient safety and preventing any hospital-acquired injuries.

Nursing Problem Priorities

In the care of a hospitalized child, nurses prioritize the following critical areas:

• Pain and Discomfort Management: Promptly assess, manage, and alleviate pain and discomfort using age-appropriate pain scales and interventions.
• Safety and Injury Prevention: Maintain a safe environment to prevent falls and injuries, considering the child’s developmental stage and mobility.
• Vital Signs Monitoring and Condition Observation: Regularly monitor vital signs and vigilantly observe for any changes in the child’s physical or emotional condition, reporting deviations promptly.
• Emotional Support and Child-Friendly Environment: Provide consistent emotional support, create a nurturing and child-friendly atmosphere to reduce anxiety and promote a sense of security.
• Communication and Collaboration: Facilitate open and effective communication and collaboration among the child, family, and interdisciplinary healthcare team to ensure coordinated and family-centered care.
• Activities of Daily Living (ADLs) and Self-Care Assistance: Assist with ADLs as needed, encouraging self-care and independence appropriate to the child’s age and condition, promoting dignity and self-esteem.
• Education and Information Sharing: Educate the child and family about the child’s condition, treatment plan, and discharge instructions in an accessible and understandable manner, empowering informed participation in care.
• Nutrition and Hydration: Ensure adequate nutrition and hydration, considering the child’s dietary needs and preferences, and addressing any feeding challenges.
• Play and Developmentally Appropriate Activities: Facilitate play and age-appropriate activities to support normal development, provide distraction, and reduce stress associated with hospitalization.

Nursing Assessment

A comprehensive nursing assessment is the foundation of effective pediatric care planning. This involves gathering both subjective and objective data to understand the child’s current health status and needs.

Key Assessment Areas Include:

• Chief Complaint and Admission Reason: Document the primary reason for hospitalization, such as fever, abdominal pain, or respiratory distress.
• Symptom Description: Obtain a detailed description of symptoms, including pain characteristics (location, intensity, duration), discomfort, and any changes in appetite or sleep patterns.
• Allergies and Medical History: Thoroughly document any known allergies (medications, food, environmental factors) and previous medical conditions, including chronic illnesses.
• Past Surgical History: Record any prior surgeries or hospitalizations, noting dates and reasons.
• Current Medications and Treatments: List all medications (prescription, over-the-counter, herbal supplements) and treatments the child is currently receiving, including dosages and frequency.
• Family Medical and Social History: Gather relevant family medical history and social factors that may impact the child’s health and hospitalization experience.
• Vital Signs: Accurately measure and record vital signs, including temperature, heart rate, respiratory rate, and blood pressure, noting any deviations from age-appropriate norms.
• Physical Examination Findings: Conduct a systematic physical examination, documenting general appearance, skin condition (color, temperature, turgor, lesions), and detailed assessments of each body system.
• Laboratory and Diagnostic Results: Review and document relevant laboratory results (blood tests, urine analysis), imaging studies (X-rays, CT scans), and microbiological cultures.
• Medication Administration and Response: Record all medications administered during hospitalization and the child’s response to these medications, including therapeutic effects and any adverse reactions.
• Intake and Output: Monitor and document fluid intake (oral, intravenous) and output (urine, stool, emesis, drainage) to assess fluid balance, particularly important in pediatric patients.
• Pain Assessment: Assess pain level using a validated, age-appropriate pain scale (e.g., FACES, numeric scale), documenting pain intensity, location, and characteristics.
• Procedure Documentation and Outcomes: Document all nursing procedures performed (e.g., dressing changes, IV insertion) and their outcomes, including patient tolerance and any complications.
• Changes in Condition and Treatment Response: Continuously monitor for any changes in the child’s condition or response to treatment, documenting observations and interventions promptly.

Child being comforted by a nurse in a hospital bed

Nursing Diagnosis

Following a comprehensive assessment, formulating an accurate nursing diagnosis is essential for creating a targeted pediatric care plan. A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems or life processes. In pediatric nursing, these diagnoses address the unique challenges and vulnerabilities of hospitalized children. It is crucial to remember that while standardized nursing diagnoses provide a valuable framework, the application in pediatrics requires nuanced clinical judgment and adaptation to each child’s specific situation.

While nursing diagnosis labels are helpful for organization and communication, the practical application in clinical settings prioritizes the nurse’s expertise and clinical reasoning. The care plan is ultimately shaped by the nurse’s in-depth understanding of the child’s health condition, developmental stage, and individual needs, focusing on the most pressing health concerns and priorities. For pediatric patients, common nursing diagnoses may include, but are not limited to:

• Anxiety related to separation from family, unfamiliar environment, and anticipated procedures.
• Fear related to hospitalization, medical procedures, and potential pain.
• Risk for Injury related to unfamiliar environment, altered mobility, and invasive procedures.
• Acute Pain related to illness, injury, or medical procedures.
• Self-Care Deficit related to illness, developmental stage, or imposed restrictions.
• Disturbed Sleep Pattern related to hospital environment, pain, and anxiety.
• Imbalanced Nutrition: Less Than Body Requirements related to illness, decreased appetite, or feeding difficulties.
• Deficient Diversional Activity related to restricted environment and illness.
• Interrupted Family Processes related to child’s hospitalization and family stress.
• Knowledge Deficit (family or child) related to condition, treatment, or home care.

Nursing Goals

Well-defined goals and expected outcomes provide direction for nursing interventions and a framework for evaluating the effectiveness of the care plan. For hospitalized children, goals are individualized and patient-centered, focusing on achievable and measurable outcomes. Examples of nursing goals for pediatric patients may include:

• The child will achieve maximum self-care abilities appropriate to their developmental level and health condition, with or without assistive devices.
• The child will actively participate in age-appropriate activities and play within the limitations imposed by their illness or medical protocol.
• The child and family will demonstrate reduced anxiety and improved coping mechanisms related to hospitalization and treatment.
• The child will express a sense of control and understanding of their hospital experience, appropriate to their age and cognitive level.
• The child will engage in safe and developmentally appropriate play activities without experiencing injury or complications.
• Parents/caregivers will verbalize understanding of safety considerations related to play, activities, and the hospital environment.
• The child will maintain adequate nutritional intake and hydration to support healing and recovery.
• The child will experience minimal pain and discomfort, as evidenced by pain assessment scores and behavioral cues.
• The child will maintain a safe hospital environment, free from preventable injuries or accidents.
• The child and family will demonstrate effective communication and collaboration with the healthcare team.

Nursing Interventions and Actions

Nursing interventions are the specific actions that nurses implement to achieve the established goals and address the identified nursing diagnoses. For hospitalized children, these interventions are tailored to their age, developmental stage, medical condition, and individual needs.

1. Assisting in Self-Care

Supporting self-care in hospitalized children is crucial for promoting independence, maintaining dignity, and fostering a sense of normalcy within the hospital setting. Interventions focus on providing age-appropriate assistance and encouragement with personal hygiene and activities of daily living.

Nursing Actions:

• Assess Physical Abilities and Restrictions: Evaluate the child’s physical tolerance, abilities to perform ADLs, and any restrictions imposed by their illness or medical treatments. This assessment informs the level of support and modifications needed.
• Provide Age-Appropriate Personal Care: Offer personal care tailored to the child’s age and developmental stage. For infants and younger children, provide complete care, while encouraging older children to participate actively in their care. Adapt routines to align with the child’s home practices whenever feasible to provide comfort and familiarity.
• Anticipate Needs and Offer Assistance: Proactively anticipate the child’s needs for toileting, feeding, oral hygiene, bathing, and other personal care activities. Offer assistance before it is requested, especially if the child is unable to communicate their needs effectively. Allow the child to perform as much of the task independently as possible to foster self-esteem and autonomy.
• Praise Participation and Effort: Provide positive reinforcement and praise for the child’s participation in self-care activities. Acknowledge their efforts and accomplishments, regardless of how small, to build self-esteem and encourage continued participation.
• Balance Activity and Rest: Plan care activities to balance periods of activity with sufficient rest. Ensure that essential items, including the call light, are within the child’s reach to promote independence and prevent fatigue.
• Utilize Assistive Aids and Offer Choices: Provide assistive devices or adaptive equipment as needed to facilitate self-care. Offer choices whenever possible in aspects of care, such as bath time, clothing, or meal selections, to enhance the child’s sense of control.
• Promote Rest and Quiet Periods: Encourage rest and quiet periods to conserve energy and prevent fatigue, which is especially important during illness and recovery.
• Educate Parents on Interpreting Child’s Needs: Instruct parents on how to interpret their child’s cues and needs, especially if the child is preverbal or has communication difficulties. This empowers parents to actively participate in their child’s care.
• Provide Instructions on Hospital Hygiene Practices: Educate parents and older children about hospital-specific hygiene practices, such as handwashing and infection control measures, and how these may differ from home routines.
• Encourage Parental Involvement and Independence: Encourage parents to assist with their child’s ADLs while allowing the child to be as independent as their condition permits. Provide a comfortable space for parents to remain with their child, fostering family-centered care.

Alt text: A nurse gently guides a young child in brushing their teeth in a hospital setting, illustrating assistance with daily hygiene as part of pediatric nursing care.

2. Providing Diversional Activities

Diversional activities are vital for hospitalized children to reduce anxiety, promote emotional well-being, and support normal development. Play and age-appropriate activities offer distraction from the hospital environment and therapeutic outlets for emotions.

Nursing Actions:

• Assess Activity Preferences and Limitations: Determine the types of activities the child enjoys and is permitted to engage in, considering any medical restrictions such as bed rest or limitations due to illness.
• Schedule Playtime: Plan nursing care and treatments to allow dedicated time for play and diversional activities. Protect these times from interruptions whenever possible.
• Facilitate Peer Interaction: If appropriate and feasible, place the child in a room with another child of a similar age to encourage social interaction and peer support.
• Introduce Playroom and Social Opportunities: Introduce the child and family to the hospital playroom or designated play areas, and facilitate introductions to other children and families, fostering a sense of community.
• Encourage Family Play and Interaction: Encourage family members to actively engage in play and interaction with the child. Provide suggestions for age-appropriate games and activities that families can do together in the hospital room.
• Promote Familiar Comforts: Instruct parents to bring familiar and favorite toys, books, or comfort items from home to create a more comforting and personalized environment.
• Offer Age-Appropriate Play Options: Provide a variety of age-appropriate play activities, considering the child’s energy level and any activity restrictions. Offer quiet play options like books, puzzles, and soft toys, as well as more active options if permitted.
• Integrate Educational Play: For school-aged children, incorporate educational activities and schoolwork into playtime to maintain academic engagement and a sense of normalcy.
• Educate on Balancing Activity and Rest: Teach parents and older children about the importance of balancing play and activity with adequate rest, especially during illness and recovery.
• Refer to Play Therapy Specialists: Consult with a play therapist for specialized assistance in designing therapeutic play activities and assessing the child’s specific play needs, particularly for children with significant emotional or developmental challenges.

3. Reducing Anxiety

Reducing anxiety in hospitalized children is paramount. Creating a sense of security and control is crucial in mitigating the stress associated with hospitalization.

Nursing Actions:

• Assess Anxiety Levels and Sources: Assess both the child’s and parents’ anxiety levels, considering the child’s developmental stage, understanding of their illness, reason for hospitalization, and past experiences with healthcare settings. Identify specific sources of anxiety, such as separation, pain, or fear of the unknown.
• Evaluate Coping Mechanisms and Support Systems: Assess the child and family’s social and emotional history, identifying existing strengths and effective coping strategies that can be utilized during hospitalization.
• Acknowledge and Address Regression: Recognize that regressive behaviors are a common response to the stress of hospitalization. Provide support and understanding, and help the child and family manage dependency needs associated with illness and hospitalization.
• Facilitate Verbalization of Feelings: Encourage the child and parents to verbalize their feelings, concerns, and fears about the child’s condition and medical procedures. Actively listen and provide a safe and non-judgmental space for emotional expression.
• Utilize Therapeutic Play for Emotional Expression: Encourage the child to use play to express their feelings. Accept and validate all expressed emotions without judgment or punishment.
• Ensure Consistent Staffing and Care: Strive for consistency in nursing staff assigned to the child’s care to promote the development of a trusting relationship. Maintain consistent communication and care practices.
• Orient to Hospital Environment and Routines: Provide a thorough orientation to the hospital environment, including the child’s room, daily routines (meal times, play times), staff introductions, hospital policies, and any necessary paperwork. Familiarize the child and family with the unfamiliar setting to reduce anxiety related to the unknown.
• Maintain Positive and Respectful Interactions: Interact with the child in a positive, respectful, and age-appropriate manner. Use the child’s preferred name and avoid any verbal or nonverbal communication that conveys rejection, judgment, or negativity.
• Create a Calm and Accepting Environment: Maintain a calm, quiet, and accepting environment. Avoid rushing through interactions and care activities, allowing time for the child to adjust and feel comfortable.
• Minimize Environmental Stimuli: Control environmental stimuli, such as noise and excessive visitors, to create a calming atmosphere and reduce anxiety.
• Promote Family Involvement and Presence: Encourage the active involvement of the child and parents in care planning and decision-making. Allow parents to remain with the child as much as possible, providing comfort and security. Encourage physical closeness, such as holding and cuddling, as appropriate.
• Incorporate Home Routines and Familiar Items: Encourage the child and family to incorporate familiar home routines into the hospital day as much as possible. Allow them to bring comfort items from home, such as toys, blankets, photographs, and favorite snacks (if medically appropriate).
• Provide Support During Procedures: Offer consistent emotional support during medical procedures or any distressing aspects of care. Address concerns related to intrusive procedures, exposure of body parts, and the need for personal privacy.
• Utilize Therapeutic Play for Preparation and Explanation: Use therapeutic play to explain medical procedures and prepare the child for what to expect. Repeat teaching and explanations as needed, using age-appropriate language and methods.
• Normalize Anxiety and Fear Responses: Reassure parents and the child that anxiety and fear are normal and expected responses to hospitalization. Validate their feelings and avoid making them feel inadequate or ashamed for experiencing these emotions.
• Provide Clear and Simple Explanations: Explain all procedures and care plans in simple, understandable language tailored to the child’s and parents’ intellectual level and age. Pace the information delivery to meet their individual needs and processing abilities.
• Prepare for Surgery (If Applicable): If surgery is planned, provide detailed information about the surgical procedure, its purpose, expected duration of hospitalization, and pre- and postoperative care. Address any questions and concerns to minimize anxiety related to surgery.
• Encourage Venting of Feelings: Create an accepting environment where the child and parents feel comfortable venting their feelings of frustration, loss of control, and fear.
• Facilitate Parental Participation in Care: Allow parents to participate in their child’s care to the extent they desire and are comfortable with. Encourage consistent visitation and parental presence at the bedside.
• Offer Positive Reinforcement and Appreciation: Provide encouragement and appreciation to both the child and parents for their participation in care and their efforts to cope with hospitalization. Positively reinforce their strengths and coping behaviors.
• Incorporate Input into Care Planning: Actively solicit suggestions and input from the child and parents when formulating care goals, care plans, and activity schedules. Integrate their preferences and input into daily routines as much as possible to enhance their sense of control and partnership.
• Delegate Simple Tasks for Control: Allow the child to perform simple, age-appropriate tasks within the hospital unit and for self-care, such as pouring water or marking intake amounts on a chart. These small acts of independence can promote a sense of control over their environment.
• Communicate Achievable Tasks: Clearly communicate to parents and the child the tasks they can actively participate in within the care plan. This transparency helps to accommodate the child’s need for control and involvement.

4. Promoting Safety and Preventing Trauma

Ensuring a safe environment and minimizing potential trauma are critical aspects of pediatric nursing care during hospitalization. Children are particularly vulnerable to accidents and psychological distress in the unfamiliar hospital setting.

Nursing Actions:

• Assess Age and Play Preferences for Safety: Assess the child’s age, developmental stage, and play preferences when selecting toys and activities. Consider the intended purpose of play (e.g., diversion, therapeutic expression, learning). Age-appropriate toys and activities minimize safety risks and maximize developmental benefits.
• Encourage Therapeutic and Familiar Play: Encourage play and allow parents to bring familiar toys, games, or play materials from home. Play is a vital tool for learning, skill development, and emotional expression, especially in the context of hospitalization.
• Promote Child Choice and Involvement in Play: Encourage the child to communicate their preferred types of toys and activities and involve them in the selection process. This fosters independence and control within the play environment.
• Select Safe and Age-Appropriate Toys: Choose toys that are safe, age-appropriate, and match the child’s developmental skills and interests. Consider activity levels allowed and select toys suitable for quiet play or more active play as permitted.
• Utilize Play for Procedure Preparation and Emotional Expression: Plan and implement age-appropriate play activities to prepare the child for invasive procedures. Observe the child’s behavior during play for cues about their fears and concerns. Utilize therapeutic play techniques, such as medical play with dolls and hospital equipment replicas, to allow for emotional expression and coping strategy development.
• Eliminate Hazardous Toys and Materials: Remove any dangerous, sharp, or broken toys, toys with small parts that could be swallowed, and toys that are inappropriate for the child’s age or developmental level.
• Educate Parents on Safe Toy Selection: Educate parents about selecting safe toys, play equipment, and materials. Emphasize the importance of choosing items that are non-toxic, flame-resistant, durable, without sharp edges or small detachable parts, and appropriate for their child’s age group.
• Educate on Toy Organization and Maintenance: Educate parents on the importance of separating toys intended for older children from those for younger children. Encourage them to maintain a safe play area, promptly discard or repair broken toys, and store toys safely when not in use.
• Educate on Activity Level and Toy Appropriateness During Illness: Educate parents on choosing play activities and toys that are appropriate for the child’s current energy and tolerance levels during illness. Advise them to assess the safety and suitability of toys brought as gifts to ensure they meet safety guidelines and are appropriate for the child’s condition.

Recommended Resources

To further enhance your understanding and practice of pediatric nursing diagnoses and care planning, consider these valuable resources:

• Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care: This handbook offers an evidence-based approach to nursing interventions, guiding you through assessment, diagnosis, and care planning with a three-step system. It provides step-by-step instructions for implementing care and evaluating outcomes, building diagnostic reasoning and critical thinking skills.
• Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition): This comprehensive resource includes over 200 care plans reflecting current evidence-based guidelines. This edition features ICNP diagnoses, care plans addressing LGBTQ health issues, and content on electrolytes and acid-base balance.
• Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales: A quick-reference tool for identifying accurate diagnoses and planning efficient patient care. The latest edition includes updated nursing diagnoses and interventions, with an alphabetized listing covering over 400 disorders.
• Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care: This manual assists in planning, individualizing, and documenting care for over 800 diseases and disorders. It provides subjectively and objectively defined diagnoses, sample clinical applications, prioritized interventions with rationales, and documentation guidelines for each diagnosis.
• All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health: This resource includes over 100 care plans spanning medical-surgical, maternity, pediatric, and psychiatric-mental health nursing. It utilizes an interprofessional “patient problems” focus to enhance communication and collaboration.

See also

Explore these related resources for further learning on pediatric nursing care:

• [Nursing Care Plans for Children with Asthma](link to asthma care plans on nurseslabs if available)
• [Nursing Care Plans for Children with Diabetes Mellitus](link to diabetes care plans on nurseslabs if available)
• [Nursing Care Plans for Children with Seizures](link to seizure care plans on nurseslabs if available)
• [Pain Management in Pediatric Patients: Nursing Guide](link to pain management in pediatrics on nurseslabs if available)
• [Anxiety Management in Children: Nursing Interventions](link to anxiety management in children on nurseslabs if available)