Chapter 14: Developmentally Appropriate Nursing Care Across Care Settings

The approach begins with establishing therapeutic relationships through systematic health history gathering, employing developmental communication strategies and assessment mnemonics such as OLD CAT for symptom characterization and SODA for evaluating illness impact on daily functioning. Physical assessment techniques are tailored to each developmental stage, progressing from least to most invasive procedures, and include anthropometric measurements, vital sign evaluation using age-appropriate routes, and systematic organ system examination with particular attention to developmental landmarks like fontanelle closure and Tanner staging for pubertal assessment. Pain management represents a critical component, recognizing that pain expression varies significantly across developmental stages from infant behavioral cues to adolescent verbal descriptions, requiring matched assessment tools such as FLACC for nonverbal children and numeric scales for older school-age children, alongside both pharmacological and nonpharmacological interventions. The chapter emphasizes atraumatic care principles in hospital settings through family-centered approaches including rooming-in policies and therapeutic play preparation, while acknowledging that community-based care encompasses primary clinics, medical home models, school nursing programs, and specialized services that extend care beyond acute settings. Families caring for children with disabilities require targeted nursing support to address caregiver fatigue and facilitate access to community resources and respite care. Throughout all settings, nurses implement essential safety measures including medication administration protocols, proper identification systems, infection control practices, and environmental safety modifications, while maintaining holistic care delivery that attends to physical comfort, nutritional needs, and psychosocial wellbeing. The integration of family involvement, cultural sensitivity, and recognition of individual resilience factors distinguishes pediatric nursing as a specialized discipline requiring adaptation of standard nursing practices to the unique developmental, cognitive, and emotional needs of the pediatric population.