Introduction to the nursing care of children Part 1: Child’s Health in Changing Society By...

Introduction to the nursing care of childrenIntroduction to the nursing care of children

Part 1:Part 1: Child’s Health in Child’s Health in Changing SocietyChanging Society

By Nataliya Haliyash By Nataliya Haliyash

MD, BSNMD, BSN

Lecture ObjectivesLecture Objectives Healthy People 2010 Healthy People 2010 sets forth national health goals sets forth national health goals

and objectives for adults and children, and focuses on and objectives for adults and children, and focuses on disease prevention and health promotion.disease prevention and health promotion.

The aggregate health status of infants, children, and The aggregate health status of infants, children, and adolescents is determined statistically by keeping adolescents is determined statistically by keeping records of indicators such as infant mortality rate, low records of indicators such as infant mortality rate, low birth rate, and immunization rate. birth rate, and immunization rate.

Current societal trends affecting children, their health, Current societal trends affecting children, their health, and their families include immigration, poverty, and their families include immigration, poverty, homelessness, migrant farm work, and violence.homelessness, migrant farm work, and violence.

Intentional and unintentional iIntentional and unintentional injuries, causes and prevention.

Standards of Care and Standards of Professional Standards of Care and Standards of Professional PerformancePerformance

Current Status of Children’s Health Current Status of Children’s Health

Healthy People 2010: National Health Healthy People 2010: National Health Promotion and Disease Prevention Objectives Promotion and Disease Prevention Objectives (US Department of Health and Human (US Department of Health and Human Services – DHHS):Services – DHHS):

28 focus areas28 focus areas

467 objectives467 objectives

Healthy People 2010 GHealthy People 2010 Goalsoals::

TTo increase the qualito increase the qualityy and years of healthy and years of healthy lifelife

To To eliminate health disparitieseliminate health disparities between ethnic between ethnic groupsgroups

10 leading health indicators10 leading health indicators Physical activityPhysical activity Overweight and obesityOverweight and obesity Tobacco useTobacco use Substance abuseSubstance abuse Responsible sexual behaviorResponsible sexual behavior Mental healthMental health Injury and violenceInjury and violence Environmental qualityEnvironmental quality ImmunizationsImmunizations Access to health careAccess to health care

The main indicators of health statusThe main indicators of health status

infant mortality rate (IMR),infant mortality rate (IMR), child mortality,child mortality, immunization rates.immunization rates.

Infant MortalityInfant Mortality

IMR (Infant Mortality Rate) is the number of IMR (Infant Mortality Rate) is the number of infant death during the first year of life per infant death during the first year of life per 1,000 live births1,000 live births

Racial disparities Racial disparities The IMR target goal for the year 2010 is 4.5 The IMR target goal for the year 2010 is 4.5

death per 1,000 live birthsdeath per 1,000 live births

Racial DifferencesRacial Differences

HHigh rateigh rate of low birth weight of low birth weight (L (LBBW) infantsW) infantsborn to minority mothersborn to minority mothers

DDecrease in theecrease in the overall health status or health care overall health status or health care access of access of minorityminority women women

IMRs were also higher for infants whose mothers IMRs were also higher for infants whose mothers werewere teenagers or 40 years of age or older,teenagers or 40 years of age or older, did not did not complete highcomplete high school, were unmarried, began school, were unmarried, began prenatal care after the firstprenatal care after the first trimester of pregnancy or trimester of pregnancy or smoked during pregnancysmoked during pregnancy

Low Birth WeightLow Birth Weight

One reason for the racial disparity in IMRs and thOne reason for the racial disparity in IMRs and theeranking of ranking of thethe United States is t United States is thehe high rate of L high rate of LBBW W (weight less than 2,500(weight less than 2,500 gra gramsms, or 5 pounds 8 ounces, or 5 pounds 8 ounces))

The rate of LThe rate of LBBW was 7.6% in 1998, up from 7.5%W was 7.6% in 1998, up from 7.5% in in 1997.1997.

Infants Infants with a Lwith a LBBW have a six times higher risk of death W have a six times higher risk of death duriduring ng first first yyear of life.ear of life.

Those weighing less than 1,500 graThose weighing less than 1,500 grams have ms have an 89 times an 89 times higher risk of death than do babies havinhigher risk of death than do babies havinggnormalnormal birth weight. birth weight.

Low Birth Weight: Health Risk?Low Birth Weight: Health Risk?

LBW babies are LBW babies are at risk for impaired health, at risk for impaired health, developdevelopmental delay, mental delay, neurosensorneurosensoryy deficits, deficits, cognitive delacognitive delayys, ands, and school and behavioral school and behavioral difficultiesdifficulties..

The most common majorThe most common major neurologic neurologic abnormalityabnormality seen in these infants is cerebral seen in these infants is cerebral palsy, which inpalsy, which increases with decreasing birth creases with decreasing birth weight.weight.

Reflective thinkingReflective thinking

The Cost of Keeping LBW Infants AliveThe Cost of Keeping LBW Infants Alive Hospitals and health care delivery systems haveHospitals and health care delivery systems have

poured substantial amounts of money into neonatalpoured substantial amounts of money into neonatal iintensive care units to care for LBW infants. Thesentensive care units to care for LBW infants. These bbabies are usually technology dependent and oftenabies are usually technology dependent and often require exrequire exppensive medical equipment and nursingensive medical equipment and nursing care in their homes. care in their homes.

How do you feel about thisHow do you feel about this emphasis on high-tech emphasis on high-tech solutions versus allocatingsolutions versus allocating some resources to some resources to preventive services?preventive services?

Immunization RatesImmunization Rates

The reduction in incidence of vaccine-preventable The reduction in incidence of vaccine-preventable diseases isdiseases is one of the most significant public health one of the most significant public health achievements of tachievements of the he 20th centur20th centuryy..

The global eradication of smallpox in 1977 is anThe global eradication of smallpox in 1977 is anillustration of this success (DHHS, 1999). illustration of this success (DHHS, 1999).

Not onlNot onlyy are are immunized individuals themselves immunized individuals themselves protected from developing a potentially serious protected from developing a potentially serious illness, but, alsoillness, but, also if enough of theif enough of the population is population is immunized, transmission of the disease in aimmunized, transmission of the disease in acommunitcommunityy may be interrupted may be interrupted..


In 1999, the highest rates of childhood In 1999, the highest rates of childhood immunizationimmunization were achieved. were achieved.

Three vaccinesThree vaccines – – polio,polio, measles, and measles, and Haemophilus influenzaHaemophilus influenza type b (Hib)—had a type b (Hib)—had acoverage rate atcoverage rate at//or above 90%or above 90%

USAUSA UKRAINEUKRAINE

BirthBirth

1 month1 month

2 month2 month

3 month3 month

4 month4 month

5 month5 month

6 month6 month

12-15 month12-15 month

18 month18 month

3 years3 years

4-6 years4-6 years

7 years7 years

11-12 years11-12 years

14 years14 years

15 years15 years

16 years16 years

18 years18 years

Hepatitis BHepatitis B


IPV, DTaP, HibIPV, DTaP, Hib

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IPV, DTaP, HibIPV, DTaP, Hib

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Hepatitis B,IPV, DTaP, HibHepatitis B,IPV, DTaP, Hib

Hib, MMRHib, MMR

DTaP, Varicella zosterDTaP, Varicella zoster

--------------------------------------------------------

IPV, DTaP, MMRIPV, DTaP, MMR

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MMR(if not administered at 4-6 MMR(if not administered at 4-6 years)years)

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TdTd

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tuberculosistuberculosis

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Hepatitis B, IPV, DTaPHepatitis B, IPV, DTaP

IPV, DTaPIPV, DTaP

Hepatitis B, IPV, DTaPHepatitis B, IPV, DTaP

--------------------------------------------------------

MMRMMR

IPV, DTaPIPV, DTaP

OPVOPV

DTaP, OPV, MMRDTaP, OPV, MMR

TuberculosisTuberculosis

DTaP, OPV, tuberculosisDTaP, OPV, tuberculosis

RubellaRubella

--------------------------------------------------------

TdTd


Rates are for 19-35-month-old children who Rates are for 19-35-month-old children who have received athave received at least four doses of DTP least four doses of DTP (dip(diphhtheria, tetanus, pertussis), threetheria, tetanus, pertussis), three polio, one polio, one MMR (measles, mumps, rubella), three Hib, MMR (measles, mumps, rubella), three Hib, andand three hepatitis B.three hepatitis B.

The Healthy People 2010 target is 90%The Healthy People 2010 target is 90%coverage for all recommended vaccines in all coverage for all recommended vaccines in all populations.populations.

Immunization requirementsImmunization requirements

All 50 states have immunization requirements All 50 states have immunization requirements for entrance into school; however, some for entrance into school; however, some groups are seeking changes in these state laws. groups are seeking changes in these state laws.

Exceptions are allowed from immunization Exceptions are allowed from immunization requirements for medical reasons in all states requirements for medical reasons in all states and for religious reasons in 48 states, and 15 and for religious reasons in 48 states, and 15 states allow exemptions for philosophical states allow exemptions for philosophical reasonsreasons

Child Mortality Child Mortality

In 1900, the death rate for children 1-4 :In 1900, the death rate for children 1-4 : of age of age was about 2,000 per 100,000was about 2,000 per 100,000 population, 460 population, 460 forfor y year-olds, 300 forear-olds, 300 for children 10-14 years old, children 10-14 years old, and 50and 500 for 10 for 15-19-year-olds. 5-19-year-olds.

InjuryInjury

InjuryInjury is defined as damage or harm to an is defined as damage or harm to an indivindividual idual resulting in destruction of health, resulting in destruction of health, disability, or deathdisability, or death

Intentional and unintentionalIntentional and unintentional

Intentional injuriesIntentional injuries

HomicideHomicide SuicideSuicide RapeRape Assault and batteryAssault and battery Domestic violenceDomestic violence Child abuse and neglectChild abuse and neglect Any other injury caused on purposeAny other injury caused on purpose

Unintentional InjuriesUnintentional Injuries

Injuries due to motor Injuries due to motor vehiclesvehicles

Bicycle injuriesBicycle injuries Boating injuriesBoating injuries Choking and suffocationChoking and suffocation FallsFalls DrowningDrowning Near-drowningNear-drowning Fires and burnsFires and burns

PoisoningPoisoning Firearm injuryFirearm injury Occupational injuriesOccupational injuries Farm injuriesFarm injuries Sports injuriesSports injuries Injuries due to toys and Injuries due to toys and

recreational equipmentrecreational equipment Any other injury that was Any other injury that was

not intended to harm the not intended to harm the victimvictim


Among children aged 1-19, unintentional Among children aged 1-19, unintentional injuries areinjuries are res responsible for more deaths each ponsible for more deaths each vear than homicide, suivear than homicide, suicide, ccide, congenital ongenital anomalies, cancer, heart disease,respiratoranomalies, cancer, heart disease,respiratoryyillnessillness, and HIV combined, and HIV combined

Unintentional injuries are the leading cause of Unintentional injuries are the leading cause of death for all children over 1 year of age death for all children over 1 year of age


OOne-halne-halff o off a ann unintentional injury-related unintentional injury-related deatdeathshs occur in occur in the 15-19-the 15-19-yyear-old groupear-old group due due to motor vehicle-relatedto motor vehicle-related injuries.injuries.

Common subcategories ot motor vehicle Common subcategories ot motor vehicle injuriesinjuries include include (1) occupant (drivers and passengers), (1) occupant (drivers and passengers), ((2) bic2) bicyycle-related, cle-related, (3) motorcycle, and (3) motorcycle, and (4) pedestrian injuries.(4) pedestrian injuries.

Unintentional InjuriesUnintentional Injuries for children for children under 1 years of ageunder 1 years of age

SSuffocation is the leading cause of uffocation is the leading cause of unintentional injury-related death, unintentional injury-related death, followed bfollowed byy motor vehicle motor vehicle occupant injury, choking, occupant injury, choking, drowning, and fires or burns. drowning, and fires or burns.

SomeSome suffocation deaths in infants suffocation deaths in infants are due to entrapment of theare due to entrapment of the head head and neck in cribs.and neck in cribs.

Another cause is choking on food Another cause is choking on food oror an object, leading to aan object, leading to airirwav wav obstructionobstruction

Unintentional InjuriesUnintentional Injuries for children for children aged 1-4 yearsaged 1-4 years

Drowning is the leading cause of injury death, Drowning is the leading cause of injury death, followed bfollowed byy motor vehicle occupant injury, motor vehicle occupant injury, fires or burns, andfires or burns, and airway obstruction.airway obstruction.

Infants often drown in bathtubs, usuallyInfants often drown in bathtubs, usually as a as a result of poor supervision or neglectresult of poor supervision or neglect

ToddlersToddlers and and yyoung children fall into a body oung children fall into a body of water such as a swimming pool, lake, or of water such as a swimming pool, lake, or river, usually while unsupervised. river, usually while unsupervised.


motor vehicle occupant-related injury ismotor vehicle occupant-related injury isthe leading cause of death, followed bthe leading cause of death, followed byy drowning, pedestriandrowning, pedestrian injury (i.e., motor injury (i.e., motor vehicle collisions with the child), bicyclevehicle collisions with the child), bicycle injury, and fires or burns injury, and fires or burns


MotorMotor ve vehicle occupant injuries are the hicle occupant injuries are the primary cause of injuryprimary cause of injury--related deathsrelated deaths

DriDriverver inexperience and alcohol use are ke inexperience and alcohol use are key y contributors to the high rate of fatal crashes contributors to the high rate of fatal crashes in adolescentsin adolescents

What are the key approach to What are the key approach to reduce reduce Unintentional InjuriesUnintentional Injuries??

Prevention!Prevention! EducationEducation CChanges in the environment hanges in the environment

and inand in productsproducts LLegislationegislation or regulation or regulation (35 (35

states – no bicycle helmet law)states – no bicycle helmet law) Role of pediatric nursesRole of pediatric nurses

Access to Health CareAccess to Health Care

Lack of health insuranceLack of health insurance

The number ofThe number of uninuninsured children hassured children has been been growing at an alarming rate.growing at an alarming rate.

InIn 1999 1999 11.9 million children (one in seven) 11.9 million children (one in seven) under the age ofunder the age of 19 lacked health insurance 19 lacked health insurance

EEthnic minority children are overreprethnic minority children are overrepresented sented among tamong the uninsured.he uninsured.

Access to Health CareAccess to Health Care Those from higherThose from higher--income familiesincome families are more likely are more likely to have to have

private health insurance (90%) thanprivate health insurance (90%) than f from lowerrom lower--income income families (40%) families (40%)

Uninsured children in lowUninsured children in low-income families-income families experience experience substantial difficulties in accesssubstantial difficulties in accessing health careing health care

TheTheyy tend to lack (1) the usual sources of tend to lack (1) the usual sources of routine and routine and sick sick care, (2) a primary care provider, and (3)care, (2) a primary care provider, and (3)recent visitsrecent visits to health care providers. to health care providers.

Uninsured children areUninsured children are more likely to be underi more likely to be underimmunized and mmunized and to go without neededto go without needed medical services due to the costs of care medical services due to the costs of care

Access to Health Care: the Role of Access to Health Care: the Role of Welfare ReformWelfare Reform

Between 1995 andBetween 1995 and 1997, 1.25 1997, 1.25 million million individuals lost Medicaid coverage due toindividuals lost Medicaid coverage due to welfare-to-work welfare-to-work initiatives initiatives

MMany adult members ofany adult members of famfamilies were noilies were no longer eligible for Medicaid due to reforms,longer eligible for Medicaid due to reforms, most of the most of the children in these families were and children in these families were and are still eligiare still eligible for its ble for its benefitbenefitss

SCHIPSCHIP SState Children's Health Insurancetate Children's Health Insurance

Program (Program (SCHIP) as part of the SCHIP) as part of the Balanced Budget Act ofBalanced Budget Act of 1997. 1997.

The purpose of SCHIP is to provide The purpose of SCHIP is to provide healthhealth insurance insurance for children for children through 18 through 18 yyears of age whoears of age who are are uninsured or ineligible for uninsured or ineligible for Medicaid.Medicaid.

More More than 40 billion than 40 billion in federal in federal grants will be allocated to states grants will be allocated to states oveover a 10-year periodr a 10-year period

More than 3 million children are More than 3 million children are enrolled in SCHIPenrolled in SCHIP

Role of nurses Role of nurses

Perspectives on Pediatric NursingPerspectives on Pediatric Nursing

Family-centered careFamily-centered care Atraumatic careAtraumatic care

a philosophy of providing care that minimizes or a philosophy of providing care that minimizes or eliminates physical and psychological distress for eliminates physical and psychological distress for children and their families in the health care children and their families in the health care environment. environment.

Three principles provide the basis for atraumatic care:Three principles provide the basis for atraumatic care: identifying stressors, identifying stressors, minimizing separation of child from caregivers, minimizing separation of child from caregivers, minimizing or preventing the painminimizing or preventing the pain

Family-centered careFamily-centered care The focus of pediatric nursing must be on the The focus of pediatric nursing must be on the

child as well as the family.child as well as the family. The term The term family-centered carefamily-centered care describes a describes a

philosophy of care that recognizes the centrality of the philosophy of care that recognizes the centrality of the family in the child's life and inclusion of the family's family in the child's life and inclusion of the family's contribution and involvement in the plan for care and contribution and involvement in the plan for care and its delivery. its delivery.

It is a health care delivery model that seeks to fully It is a health care delivery model that seeks to fully involve families in the care of children. involve families in the care of children.

Family-centered care evolved in response to the Family-centered care evolved in response to the critical need to maintain the relationship between critical need to maintain the relationship between hospitalized children and their families. Previously hospitalized children and their families. Previously this relationship had been neglected or disrupted this relationship had been neglected or disrupted because of forced separation by the health care because of forced separation by the health care system.system.

Family-centered careFamily-centered care In 1987, a revolutionary document that In 1987, a revolutionary document that

defined the elements of family-centered defined the elements of family-centered care was published by the Association for care was published by the Association for the Care of Children's Health (ACCH). the Care of Children's Health (ACCH).

Family-centered care was defined as Family-centered care was defined as including including eight equally important elementseight equally important elements. .

When families are incorporated into the When families are incorporated into the care of their children, the physical and care of their children, the physical and psychosocial health of the child improves psychosocial health of the child improves and accelerated rates of progress have and accelerated rates of progress have been seen. Additionally, these families have been seen. Additionally, these families have demonstrated enhanced learning, less demonstrated enhanced learning, less stress, and more satisfaction with care.stress, and more satisfaction with care.

Family-centered careFamily-centered care1. Incorporating into policy and practice the recognition that the family is the

constant in a child's life, whereas the service systems and support personnel fluctuate.

2. Facilitating family/professional collaboration at all levels of hospital, home, and community care: care of an individual child; program development, implementation, and evaluation; and policy formation.

3. Exchanging complete and unbiased information between families and professionals in a supportive manner at all times.

4. Incorporating into policy and practice the recognition and honoring of cultural diversity, strengths, and individuality within and across all families, including ethnic, racial, spiritual, social, economic, educational, and geographic diversity.

5. Recognizing and respecting different methods of family coping and implementing comprehensive policies and programs that provide developmental, educational, emotional, environmental, and financial supports to meet the diverse needs of families.

6. Encouraging and facilitating family-to-family support and networking.7. Ensuring that hospital, home, and community services and support systems for

children needing specialized health and developmental care and their families are flexible, accessible, and comprehensive in responding to diverse family-identified needs.

8. Appreciating families as families and children as children, recognizing that they possess a wide range of strengths, concerns, emotions, and aspirations beyond their need for specialized health and developmental services and support.

INFORMED CONSENT AND INFORMED CONSENT AND ASSENT FOR HEALTH CAREASSENT FOR HEALTH CARE

Informed consent is the Informed consent is the dutyduty of a health care provider of a health care provider to discuss the risks and benefits of a treatment or to discuss the risks and benefits of a treatment or procedure with a client prior to giving care. procedure with a client prior to giving care.

Informed consent must include the following: Informed consent must include the following: the the nature of the procedure, nature of the procedure, the risks and hazards of the the risks and hazards of the procedure, procedure, the alternatives to the procedure, and the alternatives to the procedure, and the benefits of the procedure. the benefits of the procedure.

After receiving informed consent, the client has the After receiving informed consent, the client has the right to accept or refuse any health care.right to accept or refuse any health care.


AssentAssent means the pediatric client has been means the pediatric client has been informed about what will happen during the informed about what will happen during the treatment or procedure, and is willing to permit a treatment or procedure, and is willing to permit a health care provider to perform it.health care provider to perform it.

While assent is not legally required, it is always While assent is not legally required, it is always better to have the cooperation of the child prior better to have the cooperation of the child prior to giving care (Pieranunzi & Freitas, 1992). to giving care (Pieranunzi & Freitas, 1992). Assent from the child may maximize success of Assent from the child may maximize success of the procedure and minimize trauma to the child.the procedure and minimize trauma to the child.


For example, For example, a 10-year-old boy comes into the office to have a 10-year-old boy comes into the office to have

stitches placed in his right hand. The health care stitches placed in his right hand. The health care provider asks the child's parent for informed provider asks the child's parent for informed consent after the parent has been provided consent after the parent has been provided information about the risks and benefits of local information about the risks and benefits of local anesthesia and the placement of sutures. anesthesia and the placement of sutures. Alternatives to suturing and the risks of leaving the Alternatives to suturing and the risks of leaving the wound open are discussed. Once the parent wound open are discussed. Once the parent provides informed consent, the boy is asked to provides informed consent, the boy is asked to assent to the procedure. The boy is told that a tiny assent to the procedure. The boy is told that a tiny needle will be used to put a little numbing needle will be used to put a little numbing medication in the skin. When the skin is numb, the medication in the skin. When the skin is numb, the health care provider will place some stitches to health care provider will place some stitches to close the cut. If the child agrees to having stitches, close the cut. If the child agrees to having stitches, he has given assent to the procedure.he has given assent to the procedure.


Children are considered minors and, except under Children are considered minors and, except under special circumstances, special circumstances, the parentthe parent or the person or the person designated as designated as legal guardianlegal guardian for the child is required for the child is required to give informed consent before medical treatment or to give informed consent before medical treatment or any procedureany procedure

Separate permission is also required for the next:Separate permission is also required for the next: Major surgeryMajor surgery Minor surgery (cutdown, biopsy, suturing a laceration etc)Minor surgery (cutdown, biopsy, suturing a laceration etc) Diagnostic tests with high risk: bronchoscopy, angiographyDiagnostic tests with high risk: bronchoscopy, angiography Medical treatments with an element of risk: blood Medical treatments with an element of risk: blood

transfusion, radiation therapy, paracentesis transfusion, radiation therapy, paracentesis

When Informed Consent Is Not When Informed Consent Is Not RequiredRequired

In an emergency situation if health care providers cannot obtain In an emergency situation if health care providers cannot obtain prior informed consent. The care given under these circumstances prior informed consent. The care given under these circumstances is usually an emergency lifesaving procedure. is usually an emergency lifesaving procedure.

Health care providers may provide emergency care to a child if Health care providers may provide emergency care to a child if they have made a reasonable attempt to contact the child's parent or they have made a reasonable attempt to contact the child's parent or legal guardian. legal guardian.

When that person cannot be located, especially in the case of an When that person cannot be located, especially in the case of an adolescent, it is prudent to obtain informed consent from the child adolescent, it is prudent to obtain informed consent from the child (Abbott, 1996). (Abbott, 1996).

Many states allow the evaluation and treatment of a child for Many states allow the evaluation and treatment of a child for suspected physical or sexual abuse without the informed consent of suspected physical or sexual abuse without the informed consent of a parent or guardian. In Utah, physicians can take photographs or X a parent or guardian. In Utah, physicians can take photographs or X rays of a child without parental consent if they suspect child abuse rays of a child without parental consent if they suspect child abuse

When a Minor Can Consent for CareWhen a Minor Can Consent for Care A minor is a person under the age of 18. In A minor is a person under the age of 18. In

Alabama, Nebraska, and Wyoming, the age of Alabama, Nebraska, and Wyoming, the age of majority is 19.majority is 19.

In most states, care involving pregnancy, In most states, care involving pregnancy, contraception, or treatment of sexually contraception, or treatment of sexually transmitted diseases does not require either transmitted diseases does not require either consent from or notification of parents. Children consent from or notification of parents. Children may also seek drug and alcohol treatment without may also seek drug and alcohol treatment without the consent of a caregiver. The purpose of these the consent of a caregiver. The purpose of these laws is to encourage children to seek help in laws is to encourage children to seek help in situations in which they might avoid care if they situations in which they might avoid care if they were required to inform their caregiverswere required to inform their caregivers

When a Minor Can Consent for CareWhen a Minor Can Consent for Care EmancipationEmancipation is the legal recognition that a minor is the legal recognition that a minor

lives independently and is legally responsible for lives independently and is legally responsible for his or her own support and decision making. his or her own support and decision making.

Emancipation can occur through an official court Emancipation can occur through an official court proceeding in cases when:proceeding in cases when: the minor is living on his or her own and no longer the minor is living on his or her own and no longer

requires the financial support of parents. requires the financial support of parents. he or she is married, he or she is married, joining the military, or joining the military, or becoming a parent before the age of majority becoming a parent before the age of majority

Roles of Pediatric NurseRoles of Pediatric Nurse

Primary RolesPrimary Roles CaregiverCaregiver AdvocateAdvocate EducatorEducator ResearcherResearcher Manager/LeaderManager/LeaderSecondary RolesSecondary Roles CoordinatorCoordinator

CollaboratorCollaboratorCommunicatorCommunicatorConsultantConsultant

Roles of Pediatric NurseRoles of Pediatric Nurse

Differentiated Practice RolesDifferentiated Practice Roles Clinical Care CoordinatorClinical Care Coordinator

Care ManagerCare ManagerClinical NurseClinical Nurse

Advanced Practice RolesAdvanced Practice Roles Nurse PractitionerNurse Practitioner(PNP)(PNP) Clinical Nurse SpecialistClinical Nurse Specialist (CNS) (CNS) Case ManagerCase Manager

CaregiverCaregiver

HelpingHelping patientpatient d diagnosing/monitoringiagnosing/monitoring adadministeringministering// moni monitoring therapeutic toring therapeutic

interventions/regimensinterventions/regimens monitmonitooringring/ensuring the quality of health care /ensuring the quality of health care

practicepracticess organizational and work role competenciesorganizational and work role competencies effectiveeffectively ly managing rapidly changing situations. managing rapidly changing situations.

AdvocateAdvocate InformInforming ing clients and families of their rights and options as clients and families of their rights and options as

well as thewell as the consequences of those options.consequences of those options.

Pediatric nurse advocatesPediatric nurse advocates function by allowing clients/families function by allowing clients/families to make their ownto make their own informed decisions and then supporting informed decisions and then supporting those decisions.those decisions.

Even though advocates do not need to approve the decision,Even though advocates do not need to approve the decision, thetheyy do need to respect that decision and the right to make do need to respect that decision and the right to make that that decision. In fact, decision. In fact, advocates shouldn't make decisions foradvocates shouldn't make decisions for their their clients, but rather should facilitate decision making.clients, but rather should facilitate decision making.

EducatorEducator

the nurse must have knowledge of cognitive the nurse must have knowledge of cognitive developmentdevelopment

Different ages – different approaches Different ages – different approaches (imitation, repetition, association, trial and (imitation, repetition, association, trial and error, conditioning, and the development of error, conditioning, and the development of concepts)concepts)

Using of three domains of learning (cognitive, Using of three domains of learning (cognitive, affective and psychomotor) affective and psychomotor)

ResearcherResearcher

Identification of a problemIdentification of a problem Different investigative functions for nurses Different investigative functions for nurses

according to ANAaccording to ANA Evidence-based researchEvidence-based research

Manager/LeaderManager/Leader

Prioritizing, planning, and organizing Prioritizing, planning, and organizing comprehensive and accountable nursing care comprehensive and accountable nursing care for a group of patientsfor a group of patients

Differentiation between the care that is Differentiation between the care that is important from care that is urgent important from care that is urgent

Delegating aspects of careDelegating aspects of care Representing of institutionRepresenting of institution

Standards of Care and Standards of Standards of Care and Standards of Professional PerformanceProfessional Performance

The standards of care is the accepted action expected The standards of care is the accepted action expected of an individual of a certain skill or knowledge levelof an individual of a certain skill or knowledge level

It is considered the minimal level of functioning and It is considered the minimal level of functioning and what a reasonable and prudent person would do in a what a reasonable and prudent person would do in a similar situation.similar situation.

Standards is a tool to determine if the care provider Standards is a tool to determine if the care provider was adequate or negligentwas adequate or negligent

Standards are derived from regulatory agencies, Standards are derived from regulatory agencies, nursing practice act, professional nursing nursing practice act, professional nursing organizations, and state or federal lawsorganizations, and state or federal laws

Test: True or FalseTest: True or False

1.1. Child health care has changed from a disease Child health care has changed from a disease prevention and health promotion model toprevention and health promotion model to strictly a strictly a curative approach.curative approach.

2.2. The fastest growing segment of the homeless The fastest growing segment of the homeless population consists of families with children.population consists of families with children.

3.3. Suicide is the leading cause of death for black males Suicide is the leading cause of death for black males 15-24 years of age.15-24 years of age.

4.4. Because Healthy People 2010 emphasizes health Because Healthy People 2010 emphasizes health promotion and prevention, almost all ofpromotion and prevention, almost all of it pertains to it pertains to nursing.nursing.

Test: True or FalseTest: True or False

5.5. The reduction in incidence of vaccine-preventable disease is The reduction in incidence of vaccine-preventable disease is one of the most significantone of the most significant public health achievements of the public health achievements of the 20th century.20th century.

6.6. It is more likely that a child will suffer complications from It is more likely that a child will suffer complications from the immunization than fromthe immunization than from the disease.the disease.

7.7. Among children under one year of age, suffocation is the Among children under one year of age, suffocation is the leading cause of unintentionalleading cause of unintentionalinjury-related death.injury-related death.

8.8. The focus of pediatric nursing is on the family as well as the The focus of pediatric nursing is on the family as well as the child.child.

9.9. Welfare reform is one of the predominant factors that has Welfare reform is one of the predominant factors that has contributed to the growingcontributed to the growing number of uninsured children.number of uninsured children.

ImmigrationImmigration Currently 1 in 5 children under age of 18 (14 million) is an Currently 1 in 5 children under age of 18 (14 million) is an

immigrant or a member of an immigrant familyimmigrant or a member of an immigrant family State with a large number of immigrants (California, State with a large number of immigrants (California,

Florida and Texas)Florida and Texas) Different policies regarding immigrants (removing Different policies regarding immigrants (removing

eligibility for the most of services) eligibility for the most of services) Illegal status of any family member - fear of an Illegal status of any family member - fear of an

investigationinvestigation Issues of health status of immigrant children: intestinal Issues of health status of immigrant children: intestinal

parasites, poor diets, dental problems, tuberculosis, parasites, poor diets, dental problems, tuberculosis, hepatitis A hepatitis A

Continuing stresses during an immigration process – Continuing stresses during an immigration process – impact to the healthimpact to the health

Poverty: why the risk to be in Poverty: why the risk to be in poverty higher for single woman poverty higher for single woman

householdhousehold Low wages for womenLow wages for women Low educationLow education Low levels of child support from fathersLow levels of child support from fathers

Health effects experienced by Health effects experienced by homeless childrenhomeless children

UUpper respiratory, ear,pper respiratory, ear, and skin infections, and skin infections, gastrointestinal disorders (diarrhea), andgastrointestinal disorders (diarrhea), and infestations (scabies, lice) infestations (scabies, lice)

Compared withCompared with housed children, homeless housed children, homeless youth have a higher incidence ofyouth have a higher incidence of chronic chronic health problems such as asthma, anemia, health problems such as asthma, anemia, visual andvisual andneurological deficits, eczema, and trauma-neurological deficits, eczema, and trauma-related injuries. related injuries.

Multiple ChoiceMultiple Choice

1. In caring for a three-year-old child who has fallen and 1. In caring for a three-year-old child who has fallen and requires sutures on his or her face,requires sutures on his or her face, the nurse the nurse includes which of the following interventions in the includes which of the following interventions in the provision of atraumaticprovision of atraumatic care?care?

a.a. Control pain by administering analgesics freely.Control pain by administering analgesics freely.b.b. Prepare the child prior to every procedure using age-Prepare the child prior to every procedure using age-

appropriate explanations.appropriate explanations.c.c. Use EMLAUse EMLA (Euteric Mixture of Local Anesthetics) (Euteric Mixture of Local Anesthetics) cream cream

at least 10 minutes prior to blood draws, insertion of IV at least 10 minutes prior to blood draws, insertion of IV needles, andneedles, and injections.injections.

d.d. Allow caregivers to be involved and physically present as Allow caregivers to be involved and physically present as much as possible.much as possible.


2. 2. When teaching adolescents, the nurse utilizes knowledge of When teaching adolescents, the nurse utilizes knowledge of cognitive developmentcognitive development appropriate to this age group. Which appropriate to this age group. Which of the following is the best technique for the nurseof the following is the best technique for the nurseto incorporate in the health education of adolescents?to incorporate in the health education of adolescents?a.a. Adolescents learn best when they see an immediate Adolescents learn best when they see an immediate

personal benefit.personal benefit.b.b. They have short attention spans and learn best in brief They have short attention spans and learn best in brief

stages.stages.c.c. Allow the adolescent to explore the environment and Allow the adolescent to explore the environment and

handle equipment.handle equipment.d.d. Adolescents like to imitate others, so imitation would be Adolescents like to imitate others, so imitation would be

an appropriate method ofan appropriate method of teaching this age group.teaching this age group.


3. 3. All of the following statements about standards of All of the following statements about standards of care and standards of professionalcare and standards of professional practice are true practice are true except:except:a.a. Standards of care are the accepted action expected of an Standards of care are the accepted action expected of an

individual of a certain skill orindividual of a certain skill or knowledge level.knowledge level.b.b. They are considered the maximal level of functioning and They are considered the maximal level of functioning and

what a reasonable andwhat a reasonable and prudent person would do in a prudent person would do in a similar situation.similar situation.

c.c. Standards are a tool for determining if the care provided Standards are a tool for determining if the care provided was adequate or negligent.was adequate or negligent.

d.d. ProffProffesessional standards are derived from regulatory sional standards are derived from regulatory agencies, nursing practice acts,agencies, nursing practice acts, proproffesionalffesional nursing nursing organizations, and state or federal laws.organizations, and state or federal laws.

Q&A?Q&A?

Introduction to the nursing care of children Part 1: Child’s Health in Changing Society By...

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