Family Centered Care Scenario #3 (preschooler)
Amy, a 4-year-old girl has been hospitalized after a family car accident. Amy’s parents have been
taken to another facility for serious injuries. The child has arrived via ambulance and her aunt
accompanied her and is staying with her until her parent’s are discharged from the hospital. The
aunt is struggling with helping with the care of Amy as she has not spent a lot of time alone with
Amy and she doesn’t have children of her own. She states to you as the nurse that, “she is having
a hard time because she knows she has to step up for her family to help but she needs help too
because she is not very experienced with children”.
Questions:
1. Describe what the manifestations of the 3 stages of separation anxiety might look like in
a child this age?
Stages of Protest
a.
b.
c.
d.
e.
Verbally attacks strangers (ex: go away)
Physically attacks strangers (ex: kicks, bits, hits, pinches)
Attempt to escape to find parent
Attempt to physically force parent to stay
Crying
Stages of Despair
f.
g.
h.
i.
j.
Inactive
Withdraws from others
Sad
Uncommunicative
Regresses to earlier behavior (ex: thumb sucking, bedwetting, pacifier use, use of
bottle)
Stages of Development
k. Increased interest in surroundings
l. Interacts with strangers or familiar caregivers
m. Forms new but superficial relationships
n. Appears happy
2. Name at least 3-5 ways to prevent or minimize the loss of control in this child.
- Promote freedom of movement
- Maintain the childs routine
- Encourage independence
- Promote understanding
3. How will you as the nurse prevent or minimize the fear of bodily injury in the child?
● Modifying procedural techniques for children in each age group also minimizes fear of
bodily injury. For example, because toddlers and young preschoolers are traumatized by
insertion of a rectal thermometer, axillary temperatures or temperatures taken with
electronic or tympanic membrane devices can effectively be substituted.
● telling children that the bleeding will stop after the needle is removed does lile to relieve
their fears, but applying a small Band-Aid usually reassures them. The size of bandages is
also significant to children in this age group; the larger the bandage, the more importance
is attached to the wound.
4. Give an example of how you will provide educational opportunities to the aunt and what
you can educate her on to assist the family.
- Ans: Some examples that a nurse can provide educational opportunities to the aunt are
ways to communicate with the child, explain about procedures that are given to the child.
5. List some appropriate services that you can utilize within the hospital setting to assist this
family with their stay?
- Child protective services
- Play therapy
- Dog therapy
6. List 3 of each physical, environmental, psychological & social stressor for the child and
family and what you will do to help accommodate these?
- Physical stressor: injuries, nutritional deficit. Nutritional assessment and collaborating
with nutrition. Ensuring any injuries she sustained are healing.
- Psychological stressor: anxiety, depression, loneliness. Engage in activities that can
decrease anxiety such as therapy. Allow for adequate rest. Give the patient autonomy in
their care.
- Environmental stressor: lack of routine, hospital environment in general, alarm fatigue.
Make an environment that promotes peace, routine, and safety. Bundle nursing care to
decrease interruptions.
7. How will you establish trust and provide support to the child and family?
- Introduce yourself to them, introduce the patient to the environment, educate the family,
follow out on your actions
8. What are some age-appropriate activities that you can perform or arrange for Amy to take
her mind off the separation from her parents?
- Play therapy, role play/imaginative play, coloring, painting, TV, dog therapy, music
therapy, playing with dolls,