Method Article

Application of a Refined Nursing Model in Children with Mycoplasma Pneumonia

DOI:

10.3791/68945

March 3rd, 2026

In This Article

Summary

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This study presents a meticulous care plan for children with mycoplasma pneumonia, covering five core modules: psychological care, respiratory tract management, dietary guidance, fever care and health education. The plan elaborates on the specific implementation steps of each nursing measure and aims to provide a systematic and operational nursing process to assist clinical nurses in standardizing their implementation, enhancing the quality of nursing and the rehabilitation experience of children patients.

Abstract

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This research aims to demonstrate and explain a meticulous care plan applicable to Mycoplasma pneumonia (MP) in children. This plan integrates multi-dimensional measures such as psychological care, respiratory tract management, dietary guidance, fever care and health education, forming a structured care path. A total of 122 children with MP admitted from May to September 2023 were selected for the study. They were divided into the experimental group and the control group by random number table method, with 61 cases in each group. The control group received routine care, while the experimental group received meticulous care on the basis of routine care. The plan mainly describes the story-telling communication skills in psychological care, the standard operation of nebulization inhalation parameters and back tapping in respiratory care, the hierarchical monitoring and treatment of fever, as well as the modular health education content for caregivers. The results show that meticulous care can promote symptom relief in children, reduce inflammatory indicators, enhance disease awareness and nursing satisfaction, verifying the feasibility and positive role of this nursing plan in clinical practice. This study provides a replicable and scalable operational framework for the systematic care of MP in children.

Introduction

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Mycoplasma pneumoniae (MP), a genus of Mycoplasma within the Tenericutes1, is one of the main agents of acute respiratory infections and a common cause of community-acquired pneumonia (CAP) in children2,3. Mycoplasma pneumoniae pneumonia (MPP) accounts for 10%--40% of CAP in children4,5, with the incidence gradually increasing in recent years6. The clinical course can be prolonged, and children, due to psychological immaturity and limited self-control, often experience anxiety and poor cooperation during treatment, which complicates care and may compromise outcomes7,8. Effective nursing is therefore crucial alongside antimicrobial therapy. However, traditional nursing models are often fragmented, focusing primarily on reactive symptom management9. They typically lack standardized, integrated approaches to address key challenges such as systematic psychological support for distressed children, structured respiratory secretion clearance, and comprehensive caregiver education. These gaps can lead to inconsistent care quality, delayed recovery, and increased risk of complications10,11.

To address these limitations, this protocol details the development and application of a structured, refined nursing model for paediatric MPP. The overall goal of this method is to provide a systematic, reproducible, and patient-centred nursing framework that integrates multidimensional interventions into a cohesive care pathway. The rationale for developing this specific protocol stems from the need to move beyond fragmented care by combining evidence-based components -- psychological intervention, sequential airway management, fever care, dietary guidance, and structured health education -- into a standardized operational plan.

This refined nursing protocol offers procedural advantages over alternative or conventional nursing approaches. First, unlike standalone psychological strategies12,13, it embeds age-appropriate, story-based psychological interventions directly into medical procedures (e.g., injections, nebulisation) to proactively reduce fear and improve compliance. Second, compared to non-standardized respiratory care, it specifies a sequential airway management strategy (nebulisation with defined medication doses and flow rates, standardized back percussion with precise frequency and technique, assisted cough training) to promote effective expectoration14,15,16,17. Third, it replaces generic advice with a modular health education system covering disease cognition, prevention, medication, nursing, and rehabilitation, transforming caregivers into informed collaborators, a approach shown to enhance knowledge and satisfaction18,19. These components are integrated into a unified protocol, ensuring consistency and comprehensiveness often absent in conventional models9,20.

This approach is suitable for clinical settings and can be used to manage hospitalized children aged 4-12 years with mild to moderate MPP who require systemic support care. This approach is particularly useful when the goals are to standardize care interventions, increase caregiver engagement, and implement replicable care structures. The protocol requires caregivers to undergo training on its specific components, but it is designed with clear and quantifiable steps that can be adopted by people of varying experience levels, ensuring the protocol is reproducible. It provides a workable reference for healthcare professionals seeking a structured, holistic care framework that addresses the multifaceted needs of children with MPP beyond conventional medication.

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Protocol

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The survey was conducted in compliance with the latest version of the Declaration of Helsinki and was approved by the Ethics Committee of Hai'an Traditional Chinese Medicine Hospital in Jiangsu Province. The guardians of the patients all signed the informed consent form.

  1. Screening of eligibility subjects
    1. Inclusion criteria: Meet the diagnostic criteria for MP infection, with interstitial pneumonia and capillary bronchitis-like changes shown on chest X-ray, age group between 4-12 years, and no use of glucocorticoid in the past two weeks.
    2. Exclusion criteria: Complicated with severe cardiopulmonary insufficiency, concurrent hepatic or renal insufficiency, or respiratory dysfunction, diagnosed with severe MPP, and poor treatment adherence.
  2. Basic treatment regimen
    1. Administer intravenous azithromycin at a dose of 15 mg·kg-1 once daily after admission.
    2. Switch to oral azithromycin tablets at a dose of 25 mg·kg-1 once daily after the child's body temperature returns to normal.
    3. The treatment course lasts 7-14 days. Determine the timing of drug withdrawal based on clinical symptoms, imaging findings, and inflammatory indicators.
      NOTE: Do not use complete absorption of lung consolidation or negative antibody/MP-DNA results alone as the withdrawal criteria21.
  3. Basic routine nursing
    1. Maintain appropriate temperature and humidity in the ward and ensure air circulation.
    2. Disinfect the ward daily to keep the environment clean.
  4. Refined nursing procedures (core steps)
    1. Psychological nursing
      1. Strengthen communication with the child and relieve negative emotions through storytelling and playing games.
      2. Before medical procedures, explain the purpose of the operation to the child using age-appropriate story templates.
        ​NOTE: For example, describe an injection as "the little warrior defeating the virus monster," where the syringe is a "magical energy stick," the virus is the "little monster," and the medicine is "super energy". Name the stethoscope as "an animal heart sound detector" and the thermometer as "a magic temperature stick."
      3. Explain disease-related knowledge to the child's guardians and answer their questions patiently.
    2. Respiratory nursing
      1. Nebulization inhalation care
        1. Before nebulization, ensure indoor air circulation, with a temperature of 18°C - 22°C and humidity of 50% - 60%, and eliminate dust and irritating odors.
        2. Check the nebulization equipment to ensure the nebulization cup, mask, and other components are clean, dry, and used exclusively by the same child.
        3. Wipe the child's nasal cavity with a saline cotton swab to remove nasal and oral secretions and maintain airway patency.
        4. Advise the child to avoid eating 30 minutes before nebulization.
        5. Prepare the nebulization solution: 0.5 mg budesonide + 2.5 mg ambroxol hydrochloride + 2-3 ml normal saline.
        6. Adjust the nebulization equipment flow rate to 6 L·min-1, and perform nebulization twice a day for 10 minutes each time.
          NOTE: Use a nebulization inhalation device (specific model see Table of Materials); infants and young children can be held by their guardians to keep calm.
        7. During nebulization, let the child take a sitting or lateral position according to their condition.
        8. After nebulization, give the child a small amount of drinking water or mild cool liquid to dilute drug residues.
        9. Clean the child's face with warm water or normal saline to remove drug residues on the skin surface.
        10. Encourage the child to drink water to keep the respiratory tract moist.
      2. Dilution of respiratory secretions and sputum excretion care
        1. Regularly assist the child in changing positions and perform back percussion.
        2. Before back percussion, adjust the room temperature to 22°C-26°C and humidity to 50%-60%, and avoid cold air or smoke stimulation.
        3. Assist the child to take a prone or lateral position, and raise the buttocks by 15-30 degrees with a pillow so that the head is lower than the chest.
          Note: Infants and young children can lie across their guardians' laps with their heads tilted to avoid slipping; the child's clothing should be thin and soft, and the back can be exposed if necessary, with a thin cloth to protect the skin.
        4. Adopt a posture with fingers together and palm cupped, relax the wrist joint, and tap the child's back with force from the wrist joint.
        5. Perform percussion in the direction from bottom to top (buttocks to shoulders) along the lung lobes, and from the outer to the inner back along the intercostal spaces.
          NOTE: Avoid direct percussion on the spine, shoulder blades, kidneys, and bone protrusions.
        6. Control the percussion intensity at 100-200 times per minute and maintain a uniform rhythm.
          NOTE: The skin may redden slightly after percussion but should not cause pain; if the sputum is thick, the frequency or duration can be appropriately increased.
        7. Choose the percussion time: 1 h before or 2 h after meals, 2-4 times a day for 5-15 minutes each time.
          NOTE: When there is a lot of sputum, the frequency can be increased to 4-6 times a day, and the child's tolerance should be closely observed.
      3. Assisted cough training
        1. For children over 3 years old, guide them to take a deep breath, hold it for 1-2 seconds, close the vocal cords, forcefully contract the abdominal muscles, and suddenly open the vocal cords to expel sputum.
        2. Enhance abdominal muscle strength through practicing the pronunciation of "K" or blowing (such as blowing a tissue).
      4. Abdominal push method
        1. Assist the child to take a sitting or semi-reclined position, and the guardian places both hands on the child's abdomen.
        2. When the child takes a deep breath, the guardian gently pushes inward and upward to help increase abdominal pressure and promote expectoration.
      5. Combined postural drainage
        1. Adjust the child's position according to the lesion location (e.g., place children with right lower lobe pneumonia in the left lateral position).
        2. Combine postural drainage with back percussion and cough techniques to enhance sputum excretion effect.
      6. Dietary guidance
        1. Instruct guardians to feed the child in small, frequent meals.
        2. Advise guardians to feed the child slowly to prevent choking.
        3. Inform guardians to increase the child's daily water intake to moisten the respiratory mucosa.
    3. Fever nursing
      1. Temperature monitoring
        1. When the body temperature rises rapidly (accompanied by chills or flushed skin), measure the temperature every 15-30 minutes.
        2. When the temperature is below 38.5°C and there is no obvious discomfort, measure the temperature every 4-6 h.
        3. When the temperature is 39°C or higher, measure the temperature every hour and implement cooling measures.
      2. Cooling measures
        1. When the child's body temperature is below 38.5°C, use physical cooling methods: sponge bathing, applying 4°C ice packs for 10 minutes, and removing excess clothing.
          NOTE: Ice packs can be reapplied after 1 h if the fever persists.
        2. When the body temperature is above 38.5°C, administer intramuscular or oral antipyretic drugs as prescribed by the doctor.
      3. Skin and oral care
        1. Maintain the child's oral hygiene to prevent infection and feeding difficulties.
        2. Change the child's clothing in a timely manner after sweating to keep the skin dry and clean.
        3. When chills occur, add clothing or bedding to keep the child warm.
    4. Health education (for child guardians)
      1. Disease cognition education
        1. Explain the etiology, susceptible population, transmission route, incubation period, and disease course of MPP to the guardians.
          Note: Clarify that MPP is a respiratory disease caused by MP infection, for which penicillins and cephalosporins are ineffective, and targeted treatment with macrolide antibiotics such as azithromycin is required; the susceptible population is mainly preschool and school-aged children, while infants under 3 years old may also be infected due to immature immune systems; MPP is mainly transmitted through droplets or contact, with an incubation period and disease course of 1-3 weeks each.
          The core symptoms include persistent dry cough (worsening at night) and moderate to high fever (38°C-39°C), and it is prone to misdiagnosis in the early stage due to normal lung auscultation results.
          ​Improper treatment may lead to complications such as atelectasis and myocarditis.
      2. Prevention measures education
        1. Guide guardians to implement respiratory isolation for the child.
        2. Advise guardians to open windows for ventilation 2-3 times a day (30 minutes each time) and maintain indoor humidity at 50%-60%.
        3. Suggest that the child avoid crowded places during the epidemic period.
        4. Inform guardians to enhance the child's protective capacity through a balanced diet (supplementing protein, vitamin C, and zinc), ensuring 10-13 h of sleep for preschool children, moderate outdoor activities, and vaccination against influenza and pneumococcal diseases.
      3. Medical consultation and medication guidance
        1. Clearly inform guardians of the indications for medical consultation: cough lasting more than 1 week, unrelieved moderate to high fever, respiratory rate > 40 times per minute, and lethargy.
        2. Emphasize that emergency medical attention is required if symptoms such as dyspnea or cyanosis of the lips occur.
        3. Prohibit guardians from self-administering penicillins to the child and instruct them to follow the doctor's prescription for the full course of medication.
      4. Treatment and nursing guidance
        1. Explain to guardians that the course of macrolide antibiotics is 10-14 days, and premature discontinuation is not allowed.
        2. Guide guardians on the use of physical cooling or antipyretic drugs (ibuprofen, acetaminophen) for fever.
        3. Inform guardians that severe cough may require nebulization therapy.
        4. Advise guardians to provide the child with a light and easily digestible diet in small, frequent meals and encourage adequate water intake.
        5. Suggest guardians alleviate the child's anxiety through games and other appropriate means.
      5. Rehabilitation and recurrence prevention guidance
        1. Instruct guardians to monitor the child for 1-2 weeks during the rehabilitation period and avoid strenuous exercise.
        2. Advise guardians to arrange for the child to undergo reexaminations as prescribed by the doctor.
        3. Guide guardians to avoid the child's contact with individuals with respiratory infections to prevent recurrence.
        4. Inform guardians to ensure the child's adequate nutrition (including vitamin D and calcium supplementation).
        5. Advise guardians to implement timely isolation of family members with respiratory symptoms to prevent cross-infection.
  5. Data collection
    1. Collect general data, response rate, symptom relief index, serological index, complications, awareness of diseases and nursing satisfaction of the patients.
      NOTE: The general data includes: gender, age, BMI, severity at admission, and temperature at admission.
      Judgment of response rate22: Markedly effective: body temperature returned to normal, clinical symptoms and lung rales disappeared in both groups after nursing.
      Effective: body temperature is normal, symptoms and signs are relieved.
      Ineffective: no change or aggravation of symptoms and signs.
      ​Overall response rate = markedly response rate + response rate.
    2. Compare the symptoms and signs such as fever, lung rales, heart rate recovery time and length of stay between the two groups.
    3. Also, compare the incidence of adverse reactions between the two groups.
      ​NOTE: Judgment of severity: MP in children is divided into mild pneumonia and severe pneumonia according to the severity. In mild pneumonia, there may be no fever symptoms, cough is not obvious. Just check for the lesion on the chest X-ray, and even did not hear the rales. In severe pneumonia, there will be lung consolidation, pleural reaction, pleural effusion, and even heart disease and encephalitis23,24.
      Symptom relief time include the time of defervescence, the time of lung rale disappearance, the time of lung shadow disappearance, the time of heart rate recovery and the length of stay.
      ​Serological indicators include the changes of IL-6, IL-8 and TNF-α levels at 1, 3, and 7 days after treatment25,26.
    4. Make a self-made disease awareness questionnaire with reference to relevant literature, including 10 questions related to MP, with a total score of 10 points for each question 20.
    5. Test the reliability of the scale.
      NOTE: The results showed that the overall Cronbach's α coefficient of the questionnaire was 0.970, and the Guttman split-half coefficient was above 0.9.
    6. Design the Newcastle Satisfaction with Nursing Scales (NSNS) to investigate patients' nursing satisfaction.
      ​NOTE: NSNS investigates patients' satisfaction with nursing from 19 items, including nurses' working ability, communication attitude, psychological counseling, nursing support and safety management.
      It was scored on a 1-5 point scale from 19 to 95 points, with ≥ 77 being very satisfied, 58-76 being satisfied, 39-57 being generally satisfied and ≤38 being dissatisfied21. Satisfaction rate = (very satisfied + satisfied + generally satisfied) ÷ total patients.
    7. Collect the general data at the time of treatment, collect the effective rate data at 48 h after treatment, collect the symptom relief data throughout the hospitalization period, collect the serological indicators before treatment and on days 1,3 and 7 after treatment, and collect the disease awareness and nursing satisfaction data at discharge.
  6. Statistical analysis
    1. Process all the data statistically using SPSS 26.0 statistical software.
    2. Use K-S method for normality testing.
    3. Express normally distributed measurement data as mean ± standard deviation (x ± s).
    4. Use independent samples t-tests for comparisons of means between the two independent groups, and use repeated measures analysis of variance (ANOVA) for repeated measurement of the data.
    5. Expressed the count data as frequency (n) or rate (%), and performed comparisons between groups using the χ2 test. Set the test level at α = 0.05.

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Results

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A total of 61 patients were included in the experimental group (28 boys, 33 girls; mean age 8.56 ± 3.57 years) and 61 in the control group (32 boys, 29 girls; mean age 9.42 ± 3.13 years). No statistically significant differences were observed in gender, age, BMI, severity at admission, or admission temperature between the two groups (P > 0.05) (Table 1).

In the experimental group, 45 cases were markedly effective, 12 were effective, and 4 were ineffective, for a to...

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Discussion

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The refined nursing protocol for children with MP is defined by three interconnected critical steps, each addressing core limitations of conventional nursing. First, embedding psychological interventions into clinical procedures -- via age-appropriate storytelling and game-based framing of medical equipment -- addresses pediatric treatment resistance, a key barrier to care efficacy. This integration aligns with children's cognitive development, reducing anxiety during interventions more effectively than standalone ps...

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Disclosures

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The authors have nothing to disclose.

Acknowledgements

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
German Bairui BRM-077 III  PARI GmbH——Nebulisation Device
IBM SPSS Statistics 26.0IBMSPSS  26.0Statistical Software  

References

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Tags

Mycoplasma PneumoniaPediatric NursingMeticulous CarePsychological CareRespiratory ManagementFever CareHealth EducationDietary GuidanceSymptom ReliefNursing Satisfaction

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