Concept of Pediatric

8/12/2019 Concept of Pediatric

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Concept of Pediatric

Dian Susmarini, MN

Nursing ProgramMedical Faculty, University of Brawijaya


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General Objective

By the end of this lecture, the student will be

able to discuss perspectives in the nursing

care of children.


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Specific Objectives:

At the end of this part, the student will be able to:

Define what pediatric nursing means.

Mention the historical background of pediatric nursingand its development.

Enumerate scopes of pediatric nurses practices.

List the qualities characterizing a good pediatric nurse.

Identify the role of pediatric nurse. Mention the family center care approach.

Mention the health education necessary to parents.


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Health During Childhood

Health is a state of complete physical, mental,and social well-being and not merely theABSENCE of DISEASE.

The World Health

Organizat ion


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Definition of Pediatric Nursing:

It is the art and science of giving nursing care

to children from birth through adolescent with

emphasis on the physical growth, mental,emotional and psycho-social development .


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Scope of Pediatric Nursing Practices:

The responsibility in providing nursing

interventions either in ambulatory or

institutional settings. Ambulatory setting: suchas home, schools and or physicians clinic

where children and their parents have health or

counseling needs. While, institutional settings

are mainly hospitals (general or specializedhospitals) where care is provided to sick

children and their parents.


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Qualities of Good Pediatric Nurse:

The good pediatric nurse must be:

Good observer.

Honest and truthful. Sympathetic, kind, patient and cheerful.

Love to work with children.

Interested in family care. Able to provide teaching to children and theirfamilies.


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Role of Pediatric Nurse:

The pediatric nurses role is unique because of

developmental immaturity and vulnerability of children.

The goals of nursing care of children, based on primary

health care are:

Promote the healthy maturation of the child as a

physical, intellectual and emotional being within the

context of his family and communities (primary level).

Provide health care for the child who requires

treatment from disease(s) (secondary level).

Dealing with the childs disabilities (tertiary level).

Therefore, the role of the pediatric nurse includes:


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In Primary Level:

Through health education to child and his parents

and providing childs basic needs and

immunization, the nurse can: Maintain childs health.

Help the child achieves his optimal growth and

development. Prevent diseases and their complications.


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In Secondary Level:

The nurse has to provide care to sick children and

their families by:

Assessing their needs.

Planning for their care.

Implementing the plan.

Evaluating childrens condition. Providing heath teaching to children and their

parents.


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In Tertiary Level:

The nurse should assist children to return to

their maximal level of functioning following

illness and /or disabilities.


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Role of the pediatric nurse

Therapeutic relationship

Family advocacy

Disease prevention/health promotion

Health teaching Support/counseling

Collaboration

Ethical decision making Research

Health care planning


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Nursing Care of the Child and Family

During Stress and Illness


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. The sense I have that Im a lousy mother

whatever I do here, you lose your control over

your child here, you are no longer the childs

best carer but that is someone else. Nurses took a rather cautious attitude and said

its up to you what I want to do, but I want that

kind of support because I was pretty exhausted

in that situation


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. I was kind of timidly asking that I can do this, I

didnt know whether I supposed to brush my

childs teeth and grease his bottom

. The first time I gave an injection to my child

was awful, I wanted to cry and he was

screaming, but then this lovely nurse said it

went well


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.... We were told that it is us who know the child

better than anyone, in that sense we are the

experts of child care


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Stressors and reactions related to developmentalstage

Separation anxiety

Loss of control

Bodily injury and pain

Effects of hospitalization on the child


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Stressorsof Hospitalization

Separation anxiety

Protest phase

Cry and scream, cling to parent

Despair phase

Crying stops; evidence of depression

Detachment phase

Denial; resignation and not contentment

May seriously affect attachment to parent after separation


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Loss of Control: Infants Needs

Trust

Consistent, loving caregivers

Daily routines


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Loss of Control:Toddlers Needs

Autonomy

Daily routines and rituals

Loss of control may contribute to:

Regression of behavior Negativity

Temper tantrums


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Loss of Control: Preschoolers

Egocentric and magical thinking typical of age

May view illness or hospitalization aspunishment for misdeeds


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Loss of Control: School Age

Striving for independence and productivity

Fears of death, abandonment, permanent injury

Boredom


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Loss of Control: Adolescents

Struggle for independence and liberation

Separation from peer group

May respond with anger, frustration

Need for information about their condition


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Fears of Bodily Injury and Pain

Common fears among children

May persist into adulthood and result inavoidance of needed care


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Effects of Hospitalizationon the Child

Effects may be seen before admission, duringhospitalization or after discharge


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Stressors and reactions of the family of thechild who is hospitalized

Parental reactions

Sibling reactions

Altered family roles


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Parental Responses to Stressors ofHospitalization

Disbelief, anger, guilt Especially if sudden illness

Fear, anxiety

R/T childs pain, seriousness of illnessFrustration

Especially r/t need for information

Depression


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Sibling Reactions

Loneliness, fear, worry

Anger, resentment, jealousy

Guilt


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Altered Family Roles

Anger and jealousy between siblings and ill child

Ill child obligated to play sick role

Parents continue pattern of overprotection and

indulgent attention


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Nursing care of the child who is hospitalized andthe family

Preventing or minimizing separation

Minimizing loss of control

Preventing or minimizing bodily injury

Providing developmentally appropriate activities Using play/expressive activities to minimize stress

Maximizing potential benefits of hospitalization

Supporting family members


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Preventing or minimizing separation

Parent participation and rooming-in

Strategies to minimize the effects of separation


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Preventing or Minimizing Separation

Primary nursing goal

Especially for children


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Family-Centered Care

Recognizes the family as the constant in achilds life

Systems must support, respect, encourage, andenhance the strength and competence of thefamily

Needs of all family members must be addressed


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Family-Centered Care (contd)

Concept of ENABLING

Concept of EMPOWERMENT


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Normalizing the Hospital Environment

Maintain childs routine, if possible

Time structuring

Self-care (age appropriate)

School workFriends and visitors


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Minimizing loss of control

Promoting freedom of movement

Maintaining childs routine

Encouraging independence

Promoting understanding


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(Hopia, Tomlison, Paavilainen & Kurki, 2003)


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Factors that influence siblings responses to illness/hospitalization ofthe child (p. 1041)

Fear of contracting the illness

Younger age

Close relationship to sick sibling

Out-of-home residence during period of hospitalization

Minimal explanation of the sick childs illness

Perceived changes in parenting, such as increased

parental anger


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Nursing care of the siblings of the child who is ill/hospitalization of thechild (p. 1040)

Keep siblings informed of the childs illness & progress

Allow siblings to visit the hospitalized child

Encourage siblings to provide pictures, make cards, &

call

Allow older siblings to assist with the care of the ill

child if they seem comfortable doing so


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Care of the Child andFamily in Special Hospital Situations


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Ambulatory/Outpatient

Benefits

Preparation of child can be challenging

The stress of waiting

Explicit discharge and follow-up instructions


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Isolation

Added stressor of hospitalization

Child may have limited understanding

Dealing with childs fears

Potential for sensory deprivation


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Emergency Admission

Essentials of admission counseling

Postventioncounseling subsequent to theevent

Participation of child and family as appropriateto situation


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Intensive Care Unit

Increased stress for child and parents

Emotional needs of the family

Parents need for information

Perception of security from constant monitoringand individualized care


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Wassalam

Concept of Pediatric

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