■ An understanding of the unique anatomical, physiological, and developmental differences among neonates, infants, children, and adolescents, as well as the needs unique to the growth and development of children who have chronic conditions and their families;
■ The ability to care for children and promote their health in the context of their families;
■ The ability to communicate effectively with children, families, and other healthcare providers, demonstrating sensitivity to cultural issues, especially those related to how the family and healthcare providers tend to children’s healthcare needs;
■ The provision of safety assurance and injury prevention to children and their families;
■ The ability to provide for the exceptional needs of children with episodic injuries or illnesses;
■ The ability to assess the unique growth and development needs of children who have chronic conditions and of their families;
■ An understanding of the economic, social, and political influences outside the family that have an impact on children’s health and development and family functioning; and
■ An understanding of the ethical, moral, and legal dilemmas involving children, families, and healthcare professionals.
Source: Reprinted with permission from American Nurses Association, National Association of Pediatric Nurse Practitioners, and Society of Pediatric Nurses, Pediatric Nursing: Scope and Standards of Practice, © 2008 Nursesbooks.org, Silver Spring, MD.
■ 1935—Social Security Act included two important programs for children: Aid to Families with Dependent Children (AFDC), now called Temporary Assistance to Needy Families (TANF), and Title V of this act, which initiated programs to improve the health of mothers and children.
■ 1946—National School Lunch Act created the modern school lunch program.
■ 1965—Medicaid, under Title XIX of the Social Security Act, enabled indigent pregnant women and children to have access to health care.
■ 1966—Child Nutrition Act initiated the school breakfast program.
■ 1970—Poisoning Prevention Packaging Act required that dangerous medications were to have childproof caps.
■ 1972—Women, Infants, and Children (WIC) program began providing supplemental food for low-income pregnant women, infants, and children.
■ 1973—Rehabilitation Act required that accommodations be made for children with disabilities to have access to schools and other public programs.
■ 1974—Child Abuse Prevention and Treatment Act provided funding for recognition of child abuse and development of child protection teams. This law also specified that every baby, regardless of disabilities, should receive nutrition, hydration, and medication.
■ 1975—Education for All Handicapped Children Act mandated that children with disabilities receive a free and appropriate education in the least restrictive environment. This act was reauthorized as the Individuals with Disabilities Education Act (IDEA) in 1 997 and 2004, and children with disabilities were provided with educational opportunities and benefits equivalent to their nondisabled peers.
■ 1984—Emergency Medical Services for Children program was created to improve the quality of and access to emergency care for children with acute illnesses and injuries.
■ 1997—State Children’s Health Insurance Program (SCHIP) legislation expanded health coverage to children through 19 years of age in families with an income too high to qualify for Medicaid.
Care of the acutely ill
Care of the injured
Care of the chronically ill
Care of the client and family
Healthcare provider offices and clinics
Home of the child
Schools, childcare centers
The Society of Pediatric Nurses (SPN) (www.pedsnurses.org) developed the scope and standards of pediatric nursing practice
National Association of Pediatric Nurse Practitioners (NAPNAP) (www.napnap.org)
Use nursing diagnosis
Plan, implement, and provide care based on nursing diagnosis with collaboration of healthcare team members
That child and family are intertwined with their environment: one cannot separate a child from his/her family and/or environment
Clinical nurse specialist (CNS)
Pediatric nurse practitioner (NP, PNP, ARNP)
More responsibility for care of client and client outcomes
Certified nursing assistants (CNA)
Licensed practical nurse (LPN)/Licensed vocational nurse (LVN)
Supported services to mothers and infants
Various legislative acts support child health
Antibiotics: Secondary or Tertiary Interventions
Figure 1-6 Leading causes of death in the United States in the neonatal period (in infants up to 28 days of age) in 1993 and 2004. Why do you think the neonatal mortality rate associated with short gestation and low birth weight was higher in 2004 than in 1993? What could account for the dramatic reduction in mortality due to respiratory distress syndrome? Consider the impact of advances in healthcare technology on the changes in mortality rates during the decade illustrated. The neonatal intensive care nurseries have collaborated in multicenter research trials to identify the medical interventions associated with the best outcomes for low-birth-weight infants and those with respiratory distress syndrome. New technology and new knowledge have improved survival of infants with respiratory distress syndrome, but there are increasing numbers of very-low-birth-weight infants alive at birth who die in the first days of life. Source: Data from National Center for Health Statistics. (1996). Vital statistics of the United States, vol. 2: Mortality. Part A. Washington, DC: Public Health Service; Hyattsville, MD: Public Health Service; Heron, M. (2007). Death: Leading Causes for 2004. National Vital Statistics Reports, 56(5), 80-83.
Figure 1-7 Leading causes of death in the United States in the postneonatal period, 1993 and 2004 (in infants between 28 days and 1 year old). In 1993, the mortality rate for sudden infant death syndrome was 109.5 per 100,000 live births in contrast to 2004 when the mortality rate was 49.5 per 100,000 live births. The change in recommended sleep position for newborns and infants from the stomach to the back has been credited with much of this decreased rate of SIDS. See Chapter 24 for more information. Source: Data from National Center for Health Statistics. (1996). Vital statistics of the United States, vol. 2: Mortality. Part A. Washington, DC: Public Health Service; Heron, M. (2007). Death: Leading Causes for 2004. National Vital Statistics Reports, 56(5), 83-86.
Figure 1-8 Ranking the nations with the lowest infant mortality rates in the world in 2005. Note the 36 nations that have a lower infant mortality rate than the United States. What could account for the United States’ poorer ranking?Source: Data from World Health Organization. (2007). WHO Statistical Information System, Core health indicators. Retrieved July 28, 2007, from http://www.who.int/whosis/database/core/core_select_process.cfm
2: Iceland, Signapore
3: Czech Republic, Finland, Japan, Monaco, Norway, San Marino, Slovenia, Sweden
4: Austria, Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Israel, Italy, Netherlands, Portugal, Spain, Switzerland
5: Australia, Canada, Cuba, Malta, New Zealand, United Kingdom
6: Andorra, Croatia, Estonia, Hungary, Poland, Republic of Korea
7: United States
Figure 1-9 Age-specific death rate per 100,000 children in the United States in 1992 and 2004 for children 1 to 4 years of age. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webappa.cdc.gov/sasweb/ncipc/leadcause10.html
Figure 1-10 Age-specific death rate per 100,000 children in the United States in 1992 and 2004 for children 5 to 9 years of age. Throughout the decade the leading cause of death in children between the ages of 5 and 9 years wasunintentional injury. Why do you think that is? Do you think these data still apply today? Which type of injury has the highest rate of death? Drowning? Fires and burns? Motor vehicle crashes? See Table 1-1 for the answer. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webappa.cdc.gov/sasweb/ncipc/leadcause10.html
Figure 1-11 Age-specific death rate per 100,000 children in the United States in 1992 and 2004 for children 10 to 14 years of age. Which injuries are leading causes of death in this age group? Which ones are unintentional and which are intentional? See Table 1-1 for the answer. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webapppa.cdc.gov/sasweb/ncipc/leadcause10.html
Figure 1-12 Death rates per 100,000 adolescents 15 to 19 years in the United States in 1992 and 2004. Unintentional and intentional injuries are the leading causes of death in this age group. Why do you think this is happening? See Chapters 18 and 34for information on violence and suicide. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webappa.cdc.gov/sasweb/ncipc/leadcause10.html
Anticipatory guidance for parents and caregivers
Education in injury prevention is active nursing role
Seek funding from federal agencies for education of clients and community
Must be obtained for invasive procedures and some medical treatments
May be delayed in emergency situations
Review rights of minors
Develop therapeutic relationship
Verify prior consent
Serve as witness
Parent or guardians have ultimate decision, with some exceptions.
Minor is parent of a child receiving treatment
Genetic testing of children
Research on children
B) Case manager
Rationale: The nurse acts to safeguard the child’s interests by educating and supporting his parents; therefore, advocate is correct. A team effort is not being coordinated as it relates to the child’s needs, so case manager is incorrect. The nurse is, in fact, educating the child’s parents. The education is focused specifically on advocacy in relation to the child’s needs, so educator also is incorrect. Though the nurse would certainly want to provide evidence-based care to the family, the role in this instance is that of an advocate for the child, not a researcher.
A) Sheppard-Towner Act
B) The Individual with Disabilities Education Act
C) Healthy Start
D) Title V
Rationale: The Individual with Disabilities Education Act was designed to ensure that all children have access to appropriate education in the least restrictive environment. The other choices are not the most recent. Review IDEA 1997.
A) Use both objective and subjective measures to assess progress in meeting goals for the child.
B) Synthesize data to make a judgment about the child’s problems.
C) Carry out interventions specified in the nursing care plan for him.
D) Define nursing intervention classifications (NICs) relevant to his care.
Rationale: It is important to assess prior to making decisions; therefore, synthesizing data to make a judgment about the child’s problems is the best answer. Carrying out interventions specified in the nursing care plan for him would be premature; remember that the nurse should assess before any intervention. Defining nursing intervention classifications (NICs) relevant to his care would not be done yet; after assessing, the nurse would examine the NIC database. Using both objective and subjective measures to assess progress in meeting goals for the child also is incorrect. First the nurse would have to define those goals, following a comprehensive assessment.
A) Research studies.
B) Internet search engines.
C) Critical pathways for 3-year-old children.
D) Clinical practice guidelines.
Rationale: Clinical practice guidelines are most valuable in promoting uniformity and excellence in care. The wealth of both credible and incorrect information on the Internet precludes the use of Internet search engines for best care. A synthesis of the best research is provided in clinical practice guidelines. Individual articles are not sufficient as guides to practice. Because the child is 3 years old, the nurse would need to consult only critical pathways that have as their focus protocols for managing seizures in children. These are found in clinical practice guidelines.
A) Unintentional injury awareness
B) Child abuse prevention
C) Seizure disorder management
D) Sudden infant death syndrome (SIDS) recognition
Rationale: Unintentional injury awareness includes motor vehicle accidents, so teaching should include prevention factors. Although all the other choices are a significant cause of mortality, they are not the number one problem for children ages 1 to 4.
Rationale: Respiratory diseases are the most common admission to hospitals in children from 1 to 14 years old. They account for 33% of hospital discharges in the 1- to 14-year-old age group.
A) Families are only eligible if the parents are unemployed.
B) Eligibility for coverage is determined based on household income and the number of children.
C) Early application is recommended due to the large number of applications received annually.
D) Eligibility for the program is determined based on the child’s medical diagnosis.
Rationale: The State Child Health Insurance Program is designed to provide the patient with health insurance comparable to federal/state employee benefit programs. This program is undersubscribed, with lack of knowledge of its eligibility requirements being one of the barriers to subscription.
A) Inform the patient’s teacher.
B) Inform the physician and nursing supervisor.
C) Ensure that her parents sign the informed consent form.
D) Cancel the procedure.
Rationale: The child is of an age where issues of consent need to be considered seriously; therefore, informing the physician and nursing supervisor is the best answer. Telling her teacher of her decision violates patient confidentiality. Canceling the procedure is not under the nursing scope of practice. Ensuring that her parents sign the informed consent form does not address the moral conflict in this situation.
Rationale: Autonomy, the right to self-determination, and involvement in decision making should be respected in all individuals to the extent of their capacities. Adolescents are able to think abstractly and should have this right respected. Often it is compromised. Beneficence – an obligation to act or to make a decision to benefit the client, promoting the child’s well-being in addition to working with parents and other family members – and nonmaleficence, preventing harm, also are appropriate. Justice, or fairness in the use of scarce resources, is another ethical principle important to consider in decision making but is not central to this situation. Compassion is considered a virtue, not an ethical principle.
A) Recommended dose per kilogram of body weight
B) Commonly expected side effects
C) Incompatibilities with other medications
D) Indicators of drug toxicity
Rationale: Children require medication doses based on weight or body surface area. Consequently, nurses must determine the appropriateness of the ordered dose and be able to calculate its preparation. Drug calculations are very complex and consequently pose a greater risk for error.
What do the policies and practices identified reflect in terms of the value of families as critical partners in the care of children? Briefly describe how each one does or does not promote family-centered care.
From the interview material gathered, discuss the likelihood that the healthcare center studied will adopt a partnership model as it relates to family-centered care. If the center already has, examine the outcomes of such an approach in terms of child and parent satisfaction.
Think about all the reasons why the parents and child might want to select a different treatment than that proposed by the physician (e.g., cultural, religious, protection of child, etc.), and suggest a course of action that respects the family’s autonomy while protecting the child from hypovolemia.
Ethical issues arise from a moral dilemma, a conflict of social values and ethical principles that support different courses of action that could be correct, depending on the individual’s values and beliefs. Whereas adults are permitted to refuse blood products (even when death can occur), most healthcare institutions have policies that address the care of children in need of blood products.
Now consider the point of view of health professionals, and suggest strategies to respect both the physician’s and family’s points of view.
Think about your response as the nurse providing care to the child and family. How would you participate in the decision-making process?
What factors or evidence led to changes in public health practice that reduced the infant mortality rates in the early 1900s?
What evidence led to the initiation of school health nursing?
What were the roles of nurses in these historical beginnings of child healthcare services?
In 1902, Wald assigned a nurse to a school as a pilot project that was successful in reducing absenteeism. This school nursing model soon spread to other cities in the United States and Canada. The nurses monitored for illness, educated about personal hygiene and disease prevention, and were successful in their goal to improve the health of children.