The nurse is caring for a 14-year-old adolescent after a serious injury. A twice-daily dressing change has been ordered by the child’s primary health-care provider. When planning care with the patient, which of the following statements would be best for the nurse to make?

Adolescents are in Erikson’s stage of identity vs. role confusion and have a strong need for independence, autonomy, and control over their environment.

Rationale for correct answer:

B. “When do you think will be the best times for me to change your dressing?” Allowing the adolescent to help determine the schedule supports their developmental need for control, fosters cooperation, and builds trust in the nurse–patient relationship.

Rationale for incorrect answers:

A. “I’ll be in to change your dressing twice today.” This is authoritative and gives the adolescent no control or input, which may increase resistance and frustration.

C. “I’m going to have you help me when I change your dressing.” While involving the adolescent is good, this statement does not address their need to have a say in planning their care. It is directive, not collaborative.

D. “Can you help me to figure out how best to change your dressing?” This may be overwhelming and unrealistic. The adolescent is not expected to know how best to perform the procedure; that’s the nurse’s responsibility.

Take home points

• Adolescents value independence and participation in their care.
• Nurses should encourage shared decision-making (e.g., timing, comfort measures) while maintaining professional responsibility for safe care.
• Involving adolescents in planning care improves compliance, trust, and self-esteem.
• Effective communication balances nurse expertise with adolescent autonomy.

A tympanostomy tube placement is a minor outpatient procedure typically done in children with recurrent otitis media. Freestanding outpatient surgery centers, also known as ambulatory surgical centers (ASCs), are independent medical facilities designed specifically for same-day surgical procedures that don’t require an overnight hospital stay.

Rationale for correct answer:

C. Freestanding centers do not have the capacity for inpatient admissions. This is the major disadvantage compared to hospital-based surgery centers, as unplanned transfers delay continuity of care and increase risks in case of complications.

Rationale for incorrect answers:

A. Outpatient centers actually have lower infection risks compared to hospitals due to shorter stays and reduced exposure to hospital-acquired infections.

B. Care at outpatient centers is usually less expensive, making this an advantage rather than a disadvantage.

D. Outpatient centers allow same-day discharge, which reduces family disruption, making this incorrect.

Take-Home Points

• Main disadvantage of freestanding surgery centers: inability to provide overnight care, requiring transfer if complications arise.
• Outpatient centers are generally safe, cost-effective, and less disruptive for families.
• Nurses should educate parents about possible transfer needs and what to expect in the rare event of complications.
• Preoperative and postoperative planning should always consider the setting’s limitations.