A nurse is interviewing a group of 4th grade children. It would be appropriate for the nurse to diagnose the child who made which of the following statements as at “Risk for Altered Coping related to poor psychosocial development”?

According to Piaget’s cognitive development theory, children in this stage are in the concrete operational phase, meaning they understand logical sequences and real-life scenarios but may still struggle with abstract reasoning. Effective preparation helps reduce fear and anxiety, encourages cooperation, and fosters a sense of control during hospitalization.

Rationale for correct answer:

4. Taking a tour of the pediatric unit helps a school-age child form realistic expectations about the hospital experience. It allows for hands-on learning, which is appropriate for this developmental stage, and fosters a sense of security and trust by introducing the care team.

Rationale for incorrect answers:

1. Speaking with another child who was hospitalized may not be helpful or reliable. The discharged child's experience may not apply and could unintentionally increase anxiety by sharing negative or confusing stories.

2. Verbal explanation alone is too abstract for many children at this age. Without visual or tangible support, it may not effectively prepare the child or address specific fears.

3. Playing a board game about hospitals may help with general understanding, but it lacks the personalized, concrete exposure that a hospital tour provides. It may also oversimplify or misrepresent what the child will actually experience.

Take home points

• School-age children benefit from concrete, hands-on teaching methods that allow for real-life experience and logical understanding.
• Hospital tours reduce anxiety by making the unknown environment familiar.
• Relying solely on verbal instruction or peer stories may be less effective or even counterproductive.
• Nurses should aim to engage children actively and address fears using age-appropriate, experiential approaches.

Erik Erikson's psychosocial theory outlines a series of developmental stages that individuals progress through across the lifespan. For school-age children, the relevant stage is Industry vs. Inferiority. The main developmental task during this stage is to develop a sense of competence and self-worth through success in school, sports, hobbies, and peer interactions.

Rationale for correct answer:

2. Developing a sense of worth and competence directly reflects the successful resolution of the Industry vs. Inferiority stage, in which children gain confidence in their ability to be productive and valued contributors in school and social settings.

Rationale for incorrect answers:

2. When school-age children experience support and success, they develop industry, which means they feel capable, confident, and valued. This sense of competence promotes positive self-esteem and motivation, key indicators of healthy psychosocial development at this age.

Rationale for incorrect answers:

1. While repetition can support skill-building, this alone does not reflect Erikson’s psychosocial resolution. Without a sense of mastery or competence, repetition does not necessarily foster development.

3. Using fantasy and magical thinking to cope with problems is more characteristic of preschool-age children in Erikson’s Initiative vs. Guilt stage and reflects immature coping strategies, not appropriate for school-age development.

4. Developing a sense of trust belongs to the Trust vs. Mistrust stage, which occurs in infancy (birth to 1 year). It is not the relevant developmental task for a school-age child.

Take home points

• School-age children (6–12 years) are in Erikson’s Industry vs. Inferiority stage.
• Success and encouragement lead to a sense of worth and competence, the desired outcome of this stage.
• Failure without support can lead to feelings of inferiority, negatively impacting self-esteem.
• Nurses and caregivers can promote healthy development by providing praise, responsibility, and opportunities to succeed.