Providing Developmentally Based Care for School-Aged and Adolescent Patients

Abstract

AUGUST 2009, VOL 90, NO 2 • AORN JOURNAL • 261 chool-aged and adolescent patients are at the age when one may think that because of their increased cognitive ability and vocabulary, developmental care is not as important. Regardless of the patient’s age, however, a developmentally based approach to care is essential to ease the stress and fears of the perioperative experience. Pediatric patients at any age are not small adults; rather, each child is a unique individual who is actively engaged in gaining control over and learning about his or her world. Similarities in children do exist based on developmental levels, however. The theories of Sigmund Freud, Jean Piaget, and Erik Erikson provide a theoretical foundation for understanding children at each psychosocial and cognitive level (Table 1) and offer guide lines in the best approach for providing holistic, familycentered care. All humans have the potential to developmentally regress when under stress. If a school-aged child or adolescent regresses, the developmental interventions that are appropriate for the previous stage should be considered. Hallmarks of the school-age period are • the transition from the home to the school environment as a major social influence, • the resolution of separation anxiety with a shift to peers as important relationships, and • shedding of deciduous teeth along with eruption of permanent teeth. The school-aged stage from a chronological perspective is from the sixth birthday until about age 12. Adolescence begins at the onset of puberty (ie, between 11 and 12 years of age) and ends when the child assumes the responsibilities and sexual and physical characteristics of an adult (ie, usually between 18 and 20 years of age). Adolescence has three subgroups: • early (ie, ages 11 to 14 years); • middle (ie, ages 15 to 17 years); and • late (ie, ages 18 to 20 years). The hallmark of adolescence is puberty, which includes profound changes in body mass, sexual characteristics, and psychosocial status that accompany the transition from child to adult. The major fear of the school-aged child revolves around loss of control, whereas the adolescent fears disfigurement. If at any point during the perioperative process there is a possibility that the school-aged child might lose control of body functions (eg, cry, soil the bed, pass gas), the nurse needs to ensure that the child’s peers are not present to witness the event. The same applies to the adolescent’s peer group being allowed to see the patient when the patient may not think he or she is looking good enough for visitors. The information presented in this column is designed to provide a developmental theory foundation to augment the psychosocial competency as outlined in the Age-Specific Care Competency Assessment Module from the Competency & Credentialing Institute. School-aged and adolescent patients have specific physiological needs based on their size and the maturity of their body systems that are also addressed in the module. The major fear of