The nurse is developing the plan of care for a school-aged boy with a chronic disability. The child frequently cries about being different from his siblings and wants others to do things for him that he is capable of doing for himself. To assist the family in coping with this child's chronic illness, which intervention is most important for the nurse to implement?

• A. Recommend the use of consistent discipline and reward for acceptable behavior.
• B. Encourage the parents to role model ways to act when one is disappointed.
• C. Suggest that all the children are included in family decision making.
• D. Evaluate the proper use of equipment that is provided to improve the child's lifestyle.

Answer: (A)

Promoting independence through clear expectations and positive reinforcement is the most effective approach for a school-aged child with a chronic disability who feels different and looks to others to do tasks he can do himself. By setting consistent rules about what the child is expected to accomplish and following through with fair consequences when those expectations aren’t met, the child learns autonomy and self-efficacy. Rewarding acceptable behavior reinforces voluntary effort and participation in self-care, which helps the child cope with the chronic illness and reduces reliance on others. This also gives the family a stable, predictable framework for responding to the child’s needs, lessening conflicts that arise from mixed messages or inconsistent responses. While involving all children in family decisions and ensuring equipment is used properly are helpful in their own right, they don’t directly address the behavioral pattern of dependency this child displays. Modeling disappointment may touch on emotion but is less effective at fostering concrete self-care skills and independence, making consistent discipline with positive reinforcement the strongest approach.