21st century pediatric nursing

Goal of pediatric nursing
To improve quality of healthcare for all children

WHO six leading causes of disease, disability and death
Tobacco use
Injury and violence
Alcohol and substance abuse
Dietary and hygiene practices
Sedentary lifestyle
Sexual behavior
> Asthma, autism, ADHD, childhood obesity—primary concerns in Peds today

Childhood Health Problems
Dental Care (dental caries are the most common chronic disease of childhood)
Obesity (most common nutritional problem among American children) and type 2 diabetes
Childhood injuries (most common cause of death and disability to children in the US/MVAs are the most common cause of death in children over 1 year)
Substance abuse
Mental health problems

Incidence or number of deaths in a specific period

Infant mortality
Number of deaths per 1000 live births during first year of life

Neonatal mortality
<28 days of life

Postnatal mortality
28 days to 11 months

Birth weight
Major determinant of neonatal death

<2500 g (5.5 lbs)

Risk factors mortality/LBW
Black race
Male gender
Short or long gestation
Maternal age (younger or older)
Maternal education
Congenital anomalies in children <1 yr of age

Lowest death rate
Age 5-14

Sharp increase of death rate occurs in
MVAs, gun/violence related death/injury

Specific groups of children have increased morbidity (illness)
Living in poverty
Chronic illness
Foreign born/adopted children
Children in day care centers

Measures the prevalence of specific illnesses in the population at a particular time

Philosophy of care
Attention to full range of human experiences
Integration of objective data
Application of scientific knowledge
Provision of caring relationships

Family centered care
Recognizes family as constant in child’s life
Systems must support, respect, encourage, and enhance strength and competence of family
Needs of all family members must be addressed
Concepts of enabling and empowering

Atraumatic care
Where, who, why, and how of a procedure performed on a child for the purpose of preventing or minimizing psychologic and physical stress

Therapeutic care
Encompasses the prevention, diagnosis, treatment, or palliation of acute or chronic conditions

Refers to the place in which the care is given-home, hospital, any health care setting

Include anyone directly involved in providing therapeutic care

Range from psychologic approaches, such as preparing children for procedures, to physical interventions, such as providing space for a parent to room in with a child

Psychologic distress

Physical distress
Disturbances from sensory stimuli: pain, temperature extremes, loud noises, bright lights, or darkness

Overriding goal in providing atraumatic care
First, do no harm
(1) prevent/minimize child’s separation from the family
(2) promote a sense of control
(3) prevent or minimize bodily injury and pain

Therapeutic relationship
Meaningful relationship with children and their families
Yet, remain separate enough to distinguish their own feelings and needs
Caring, well defined boundaries-positive and professional and promote family’s control over the child’s healthcare
Nurse and family empowered
Maintain open communication

Family advocacy and caring
Involves ensuring that families were aware of all available health care services , adequately informed of treatments and procedures, involved in the child’s care, and encouraged to change or support existing health care practices
Aspects if caring embody the concept of atraumatic care and the development of a therapeutic relationship with patients

Disease prevention and health promotion
Care plan must include a thorough assessment of all aspects of a child’s growth and development
Problems identified- nurse intervenes directly or refers family
Best approach- education and anticipatory guidance
Appreciation of hazards or conflicts of each developmental period
Promote mental well being

Health teaching
Direct- parenting classes
Indirect- edu on diagnosis/literature
Involves transmitting information at the child’s level of understanding and desire for information
Appropriate teaching with generous feedback and evaluation to promote learning

Injury prevention
Injuries kill /disable more children >1 year than all childhood diseases combined
Developmental approach to safety counseling
Part of routine patient care

Support and counseling
Virtue of the individualized approach
Offer support by listening, touching, and being physically present
Touch-good with children- facilitates nonverbal communication
Counseling- resolve a crisis
Family attain higher level of functioning , greater self esteem, closer relationships
Student/nurses- help patient cope with immediate crisis and refer families for additional professional assistance

Coordination and collaboration
C/C nursing care with other professionals
Holistic care-unified, interdisciplinary, aware of individual contributions and limitations
Failure to recognize- destructive

Ethical decision making
Nurse must determine the most beneficial or least harmful action within the framework of societal mores, professional practice standards, the law, institutional rules, the families value system, and the nurses personal values
Must be educated on mechanism for dispute resolution…
Code of ethics- self regulation; focuses on nurses accountability and responsibility to the patient; nurses role as an independent professional and upholds its own legal liability

Research and EBP
Questioning why something is effective and whether a better approach exists
Analyzing and translating published clinical research into the everyday practice of nursing
Nurses Measures the prevalence of specific illnesses in the population at a particular time to validate their contributions
Assessment establishes important clinical questions SNF completes a critical review of existing knowledge
Behind with identification of a problem
Nurses must have access to recent resources
Issue of time allocation
Available evidence increases, so does our need to critically evaluate the evidence

Clinical reasoning
A cognitive process that uses formal and informal thinking to analyze patient data
Evaluates the significant information and considers actions
Based upon the scientific method
Combined with the nursing process, a holistic approach to problem solving

All children need
To be free from discrimination
To develop physically and mentally in freedom and dignity
To have a name and nationality
To have adequate nutrition, housing, recreation, and medical services
To receive special treatment if handicapped

All children need ctd
To receive love, understanding, and material security
To receive an education and develop his or her abilities
To be first to receive protection in disaster
To be protected from neglect, cruelty,
and exploitation
To be brought up in spirit of friendship among people

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