4.8 Spotlight Application

The following spotlight application provides an example of applying the nursing process to assessing and providing care to a pediatric client and their family.

A nurse is caring for a client who is eight years old with abdominal pain. The mother is present and mentions the parents are going through a divorce. The nurse plans to apply principles of family dynamics when caring for this child and her family.

1. What assessment data should the nurse collect?

• Pain assessment, including onset, location, duration, character, aggravating and relieving factors, and treatment 
• Family members (Who are they and how do they interact?)
• Living situation (Who is in the household? Where does the child stay?)
• Family dynamics of respect, communication, nurturing, and protection. Are the child’s needs for physical care, love and security, belonging met?
• How does the child feel about the family and divorce? Is the child feeling responsible? 
• What are family strengths and stressors?
• What kind of support does the family have? 

2. Based on the assessment data, what family-related nursing diagnosis applies?

Dysfunctional Family Processes

3. What is an appropriate goal for this family?

The family works cooperatively to provide support for the child.

4. What is an appropriate SMART outcome criteria?

By the end of the teaching session, the parent will describe three ways to mitigate the effects of divorce for the child.

5. What nursing interventions could the nurse implement?

• Teach mom and child to realize the divorce is not the child’s fault.
• Model acceptance of the situation.
• Recommend community resources for families experiencing divorce.
• Encourage the child to verbalize feelings.

6. How will the nurse evaluate if the interventions were effective?

• Assess if the abdominal pain was relieved.
• Assess if the child verbalizes understanding of divorce and future living arrangements.
• Assess for the child’s expression of feelings.
• Assess if the mother and father report ability to support the emotional health of the child.

7. If the child is appropriately progressing toward the goal, what should the nurse do next?

• Document that the child is progressing toward the overall goal and if the SMART outcome was met, partially met, or not met.
• Set a future time to reevaluate progress.