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S E C T I O N

IIntroduction to the Family and

Child Care

S E C T I O N O U T L I N E

Chapter 1 Perspectives on the Nurse’s Role in Child Care

Chapter 2 The Nurse’s Role in the Care of Children

Chapter 3 The Family

Chapter 4 The Nursing Process in the Care of Children

Chapter-01.indd 1Chapter-01.indd 1 7/3/2013 11:28:07 AM7/3/2013 11:28:07 AM

C H A P T E R O U T L I N E

� Historical Background on the Care of Children � Delivery of Care to Children: Factors Influencing the Nurse’s Role

� Societal Factors � Professional Factors

HISTORICAL BACKGROUND ON THE CARE OF CHILDREN

An understanding of child care since it began is essential for the nurse to gain an appreciation of the trends leading to the present concepts and practices specific to children. Some of today’s philosophical beliefs can be attributed to evolving civilizations.

THE CHILD IN PRIMITIVE SOCIETIES

Little is known about life in prehistoric times, but child care is believed to have been similar to that among cultural groups living today in areas hardly touched by civilization. In such groups, children usually are not valued for themselves but as future adults. For this reason, social development according to the customs of the groups is revealing.

Early primitive people were nomads, moving constantly in groups in their search for adequate food and for safety from

wild animals and hazardous weather conditions. Groups looked favourably on members who were strong and destroyed those who were sick or weak. When such a society ruled that a malformed or sickly infant would drain the resources of the group, the infant was killed or left behind to die. Sometimes infants were killed simply because they were females who could not contribute as much productive labour to the group as males could. This practice is termed infanticide. Probably some infants survived because their mothers protected them. Then as now, societies were composed of individuals not all of whom necessarily lived by the rules of the group.

In addition, some primitive peoples believed in superior beings who ruled not only them but also nature and the universe as they knew it. They reasoned that the forces of a storm or a period of prolonged drought was an act of a supe-rior being who was displeased. Perhaps the birth of a deformed infant was also punishment for previous trans-gressions of the parents. Such thinking did not cease with civilization.

The child, even in primitive tribes, had to receive at least a minimum of physical care in order to live. Whether the child received love and affection depended on the cultural group and on the mother.

THE CHILD IN ANCIENT CIVILIZATIONS

The concept of the importance of the child to society gradually emerged as each group settled on an area of fertile land. Instead of being a liability, the child slowly became an asset to society.

L E A R N I N G O B J E C T I V E S

� Trace the historical perspectives influencing the role of the nurse in child care. � Describe the influence of the family, culture, and the health care delivery system on the children. � Discuss the societal factors influencing the role of the nurse. � Identify the influences on the nurse’s role of the professionalizing process.

C H A P T E R

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Perspectives on the Nurse’s Role in Child Care


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SECTION I | INTRODUCTION TO THE FAMILY AND CHILD CARE

Egypt. The early peoples who settled in the valley of the Nile River cared for their children, dressing even their infants in loose clothes and encouraging breast feeding. They encouraged children to learn, as well as to participate in outdoor activity. As early as 1500 BC, treatment different from that given to adults was prescribed for the diseases of childhood.Greece and Rome. Physical beauty was considered important by the early inhabitants of Greece; thus children were reared so that they would have well-formed bodies. The importance of the family was stressed in Rome because its function was to raise strong sons to become good warriors who could serve the state.

Hippocrates (460–370 BC) referred frequently in his writ-ings to the peculiarities of disease in children. Specific treat-ment for the illnesses of children as opposed to that given to adults was also recommended by Celsus, who lived in the first Christian century.Israel. Among the ancient Jews the hygienic measures prescribed in the Mosaic Law had a great influence on maternal and child care. The Hebrew people recognized the importance of cleanliness and nutrition. They also recognized communi-cable diseases and made efforts to control them. They believed that the religious ceremony of circumcision practised on male infants served as a health measure as well.

Parenthood was honoured among the Hebrews, and a large family was considered a sign of God’s blessing upon the parents. The greatest disappointment a woman could have was to be childless.

IMPACT OF CHRISTIANITY ON CHILD CARE

Christianity, among other emerging religions, helped promote the philosophy of the sanctity of human life. Christianity taught the value of the child as an individual, not merely as a son or daughter who would cherish the parents in their old age and give them grandchildren so that the family might extend for generations to come. Furthermore, since Christianity also taught the protection of the weak by the strong and the care of the ill by the well, the helpless child and the infirm became objects of special consideration. Orphan asylums for dependent children and hospitals for the care of the sick were founded early in the history of the Christian Church.

THE CHILD IN DEVELOPING COUNTRIES

The speed of modern transport and the exploding world popu-lation are bringing the people of the world closer together than ever before. Health problems that were once the concern of only a small segment of the population now potentially threaten the whole world. Through the international activities of the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the other groups, assistance is being provided to developing countries in their efforts to improve their level of child care (Table 1-1).

THE CHILD IN INDIAN SCENARIO

The health of the children is of vital importance in all societies as the children are future citizens. The concept of health and illness are ever changing. Health is said to exist when an indi-vidual can meet the physical, physiological, intellectual, psycho-logical, and social requirements appropriate for his age, sex, and level of growth and development. WHO defines health as a state of complete mental, physical, and social well-being, the holistic view of health is being widely accepted and practised. It implies a philosophy, believing in an integration and harmonious balance of body, mind, and spirit. Any disturbance in the equi-librium results in disease, or illness, or disability. Illness of child

Table 1-1 Milestones in child care in India and the health care programmes

1946 The United Nations International Children’s Emergency Fund (UNICEF) created by the United Nations

1948 The World Health Organization (WHO) created by the United Nations

1959 The 14th General Assembly of the United Nations approved the Declaration of the Rights of the Child

‘Mankind owes the child the best it has to give.The right to affection, love, and understanding.The right to adequate nutrition and medical care.The right to free education.The right to full opportunity for play and recreation.The right to a name and nationality.The right to special care, if handicapped.The right to be among the fi rst to receive relief in times of disaster.The right to learn to be a useful member of society and to develop individual abilities.The right to be brought up in a spirit of peace and brotherhood.The right to enjoy these rights, regardless of race, colour, sex, religion, national or social origin.All children, without any exception whatsoever, shall be entitled to these rights, without distinction or discrimination.’

1961 Midday Meal Scheme for children was launched by Government of India

1962 Control of iodine defi ciency disorder programme

1969–74 Prophylaxis against nutritional anaemia

1975 Integrated Child Development Scheme launched

1978 Expanded programme on immunization launched

1985 Universal Immunization Programme launched

1986–87 Oral rehydration therapy programme launched

1990 Acute respiratory disease control programme launched

1992 Concept of baby friendly hospital was initiated

1995 Pulse Polio programme launched

1997–2002 Reproductive and Child Health Programme Phase I

2005 Reproductive and Child Health Programme Phase II and Integration of IMNCI

2005 Launch of National Rural Health Mission


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PERSPECTIVES ON THE NURSE’S ROLE IN CHILD CARE

affects the family as a unit as child is an important part of the family and also since the child is dependent on the adults, as the child needs help for meeting his physical, physiological, and care needs from the family members. Thus the illness of the child affects the whole family. In India family system is very significant, most of the people in rural areas are still living in the joint family system, however increasing urbanization is giving rise to nuclear families in the cities. Approximately one fourth of the total population of our country is represented by the children, thus their health issues are a cause of concern for the health care professionals.

Emphasis on the concepts of child care gradually developed in the countries of the world. Hippocrates of Greece (460–370 BC), the father of modern medicine, devoted a great part of his treatise to children and made many observations on the diseases found among children. In India Sushruta Samhita, the classical encyclopaedia of ayurvedic medicine, bears a record of children anywhere in the world. The colossal work written by Sushruta (The Indian Hippocrates) contains many aspects of child rearing such as infant feeding, paediatric diseases includ-ing fever, liver diseases, etc. Charaka, the court physician in Peshawar, wrote in detail on the care and management of newborn in the fourth century. The siddha system of medicine in South India describes that service to the child starts from the moment of conception itself.

Presently health of the children is given vital importance by the international agencies such as WHO, UNICEF, etc. These agencies provide assistance to the developing countries of the world for improvement of the health care of children.

World Health Organization. WHO, established as a special-ized agency of the United Nations in 1948, was the first world-wide health organization. Its headquarters are in Geneva, Switzerland. Its objective is to assist in the attainment of the highest possible level of health. To do this, it acts as director and coordinating authority of the international health work; estab-lishes and maintains effective collaboration with governments and other interested groups; provides health information and technical, educational, and other services; evaluates a country’s health problems when requested; stimulates and advances work to eradicate diseases and prevent injuries; promotes improve-ment of nutrition, housing, sanitation, and other aspects of environmental hygiene; promotes maternal and child health and welfare; and promotes mental health, among its many other functions.

The present main objectives of the WHO are to control communicable diseases on an international scale, such as malaria, tuberculosis, leprosy, yaws, and the sexually transmit-ted diseases; to build up public health organizations in coun-tries that have underdeveloped programmes; and to educate and train medical and auxiliary personnel in the health fields.

The activities of WHO prove that nations can work together for an important cause: the improvement of human health.

United Nations Children’s Fund. UNICEF was created in 1946 to meet the emergency needs of children, as in times of war or other disasters. Aid to a country is given only when requested and on the basis of need, irrespective of race, creed, or political beliefs. UNICEF is financed by voluntary contribu-tions from governments, groups, and individuals. In the United States, children volunteer to collect money for its work by participating in the Halloween ‘trick or treat’ effort. The sale of calendars, Christmas cards, and other greeting cards has provided funds to send medicines and food to many ill and impoverished children worldwide.

Today’s society is complex and ever changing. As children grow, they must learn not only to cope with current demands but also to prepare for the many unexpected events they will face in their future. Changes brought by new techniques and technologies will continue to have an impact on society as a whole.

Children are expected to grow and learn to their fullest potential. Adults serve as advocates for children in order to meet the needs of all children for access to education and the health care process. Knowledge of the political system is a must if adults and children are going to influence society and ensure quality programmes to assist in meeting future chal-lenges.

Children of Varying Family Types and Cultures

Typical of our society is the uprooting and movement of family groups. Migration occurs as the result of families moving from one place to other: farm labour families moving as they follow seasonal crops, rural families seeking opportunities in large cities, middle class families moving into the suburbs, and the increase in the numbers of urban families in the lower-income groups.

Partly because of these migrations, the extended family of a century ago, which included several generations of relatives living in close geographic proximity, has become fragmented into small nuclear families composed of parents, children, and perhaps a grandparent. While the extended family was tradi-tion-bound and secure—its members being interdependent, today’s small family is largely adrift in a sea of strangers. Even the established nuclear family consisting of two parents, includ-ing a working father and one or more children, is changing. For various reasons, the decision may be made that the mother support the family and the father stay home to care for the chil-dren. Or, both parents may need to work outside the home, and the child or children may be placed in day care centres or with another service. When parents are unmarried, separated, or divorced, or when one parent has died, producing a single-parent family, further adjustments are necessary for child care. Attempting to prevent complete disintegration of such small family groups is the responsibility of society’s agencies and soci-ety as a whole.


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In view of these social forces, the nursing profession has a responsibility with other disciplines to create a setting in which all children, in health and in illness, will receive optimal care in a secure environment.

DELIVERY OF CARE TO CHILDREN: FACTORS INFLUENCING THE NURSE’S

ROLE

It is important for the nurse to recognize the great improve-ments in child care in the community. Such an understanding is essential not only for the nurse as a professional caregiver but also as a parent or potential parent and a community member.

Part of the support that young parents formerly gained from an extended kinship family is now being supplied by the government agencies and privately supported programmes. As noted earlier, the union, state, and local governments have committed themselves to providing improved care for mothers and children. This is especially true for those at high risk or those at the low-income or poverty level. Funds have been allo-cated for the care of mothers and well children through improved nutrition, immunization programmes, well-child conferences, and other services. Funds have also been allocated for the extension of screening and detection programmes for hereditary disorders, for the support of various clinics and health-related services for ill children, and for research.

Among the most important movements in the provision of comprehensive health care has been the widespread development through various government programmes for welfare of mother and child. Government-sponsored programmes have attempted to lower the incidence of complications associated with preg-nancy and to provide services to high-risk infants in the form of early treatment to prevent or minimize defects. Various National Health Programmes of India with specific reference to various vector-borne diseases, such as national antimalaria, filaria, and kala-azar control programme, also attempt to lower the incidence of these diseases. Another programme initiated by the Indian government in 1978 was Expanded Programme on Immunization (EPI). The main objective of this programme is reduction of morbidity and mortality among children by preventing various communicable diseases. Six EPI target diseases are also commonly known as six killer diseases of childhood such as poliomyelitis, diphtheria, pertussis, tetanus, measles, and tuberculosis. Universal immunization programme was started in India in 1985; two vital components of this programme are immunization of expectant mothers against tetanus and immunization of children in the first year of birth. In addition to this Pulse Polio Programme was launched in India in the year 1995, with an aim to eradicate polio. Since the Indian population has a low life expectancy, its most pressing health problems are those that affect infants and chil-dren: principally accidents, gastrointestinal diseases, tuberculo-sis, respiratory diseases, and communicable diseases. The prob-lem of infant and child health results from the high incidence and severity of infectious disease, delay in obtaining treatment result-ing in secondary complications, and the difficulty in providing

preventive medical services. Malnutrition, anaemia, and poor general environment contribute to the incidence and severity of disease.

Children of migrant farm families are often deprived cultur-ally as well as physically, intellectually, and socially. Because of repeated migrations, these children have complex needs that can be met only through programmes of education, social welfare, and medical services. The initial need of migrant farm families is for day care centres where parents can leave their children while they work on the farms. The health services provided at these centres depend on the local need, interest, and availability of professional suppliers, and facilities. The common health care needs of these children are for immunizations, improved feeding habits, physical examinations, testing if the children are ill, and correction of problems resulting from igno-rance and poverty.

The trend towards regionalization of health care—a coopera-tive effort among institutions in a geographic area allowing for an orderly distribution of services to all patients who need them—has accelerated in recent years. Three levels of care are provided: primary care for patients having relatively normal or uncomplicated problems; secondary care for normal- and high-risk patients; and tertiary care not only for normal- and high-risk patients but also for those having the most complicated conditions.

Primary care is the usual point of entry into the health care system. It is generalized patient care, emphasizing the promo-tion and maintenance of health and the prevention of disease and serving the simpler and more common illnesses of chil-dren. Primary care is usually given outside a hospital environ-ment, in a private physician’s or practitioner’s office, local clinic, or health maintenance organization.

Secondary care is for more acute illness and is usually provided in a paediatric unit of a general or community hospi-tal. Acute care is generally intense, of short duration, and of a nonchronic nature. Children may enter this level directly or through referral.

Tertiary care is highly specialized, complex care dependent on sophisticated technological and support facilities, such as are found in a hospital devoted to the care of children. Children are referred to tertiary care from the primary or secondary levels. Tertiary care is based on diagnostic and therapeutic advances that have come from basic and clinical research. In a tertiary care facility, standards are set for study-ing, treating, and managing routine paediatric problems, which can then be used by secondary facilities. Also, such a facility centralizes the most serious disorders of children where medical, nursing, and technological capabilities are available to care for them.

Regionalization became necessary because of problems of economics and community demands for quality health care. Costly physical facilities and medical and nursing personnel can no longer be duplicated in agencies near each other. Small paediatric units in general hospitals are closing because a surplus of paediatric beds has led to underutilization of depart-ments that are uneconomical.


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The specialized strengths of a medical centre for children as a regional resource are dramatically illustrated by neonatal intensive care units (NICU). An emergency transport system can immediately bring its services to infants in distress over a wide geographic area and speed the patients back to the inten-sive care unit. Many infants who formerly would have died now have an improved chance for survival.

The need for day care for children whose parents cannot care for them during the day is well documented. Without an orga-nized facility, such children are cared for by older brothers or sisters, grandparents or friends, or are permitted to stay by themselves. A small number of children are cared for by a parent at work.

School health programmes vary, depending on the locale and size of the school. The school nurse or nurse practitioner may function alone or may be a member of a health care team consisting also of a physician, child psychologist, guidance counsellor, and social worker. The nurse’s functions may include being responsible for providing first aid care for chil-dren during school hours, assisting with physical examinations and conducting hearing, vision, and tuberculosis screening tests, checking on immunizations, caring for children who have problems such as diabetes or epilepsy, carrying out sex educa-tion programmes for children and sometimes for parents as well, and being a health counsellor for the families and children in school. The school nurse may be a public health nurse who spends only a brief time in the school or may be a full-time nurse whose total responsibility is the care of the children enrolled in a particular school.

Home health care has been growing in importance as a component of the health care delivery system, since many chil-dren who have conditions that required hospitalization a few years ago are now being cared for in the home. This develop-ment has increased the need for nurses who are able not only to give direct care to children but also to teach such care effectively to responsible adults.

Another responsibility that nurses assume with other members of the health care team is to implement the concept of preventive paediatrics. This includes the maintenance of Family Health Clinics, immunization against preventable communi-cable diseases, education for the prevention of accidents and poisonings, and case finding of children showing early emotional disturbances or physical illness. Referrals are made to facilitate treatment.

Nurses are involved in implementation of these referral programmes; they can function as patient advocates and as integral members of the interdisciplinary team. They can be instrumental in providing counselling for pregnant adoles-cents, as well as for children who are victims of learning and developmental disabilities, child abuse, emotional illness, addiction, and suicidal thinking. In established health care facilities, in free clinics, or wherever children and youth are found, nurses can play a pivotal role in providing family health care and health teaching, and in coordinating multiple health resources.

SOCIETAL FACTORS

The nurse has an important role in the nurturing of children. To understand how that role is fulfilled, the nurse must consider the impact of societal forces upon the nursing of children. The following elements are discussed not in order of importance but as a constellation of factors influencing the nurse and impacting on the nursing role in society.

ATTITUDES TOWARDS CHILDREN

The changing (and unchanging) attitudes towards the younger members of our society influence the nurse who cares for children. Whether the birth rate decreases or increases has an impact on the need for maternity and paediatric units in hospitals and other institutions, schools, and businesses devoted to the production and marketing of childcare prod-ucts.

CONSUMERISM

Topics related to child behaviour and health are abundant in consumer media. Consumers nowadays are more vocal and better able to express feelings about any perceived or real inad-equacies in the health care system. They are becoming more assertive in making decisions concerning their own and their family’s care.

To understand what the consumer is telling the nursing profession about health care and its delivery, each nurse must listen, read what the consumer is reading, see what the consumer is seeing, and anticipate the results of these messages. If nurses are not aware of what is happening, the public will meet its own needs in ways that may be harmful to all.

THE WOMEN’S MOVEMENT

Changes continue in the definition of femininity and masculin-ity today. The idea that all human beings achieve happiness and self-acceptance when free to fulfil their own potential has become more widely accepted. Individuals should be free to discover who they are and what their abilities are and to strive towards their goals.

As a result of the women’s movement, changes have evolved in the role of both mothers and fathers. Mothers can now work outside or within the home on a part-time or full-time basis. Instead of the father being wholly responsible for providing financial support to the family, he may now take over responsibility for the children while the mother works. In many families, both parents share the responsibility for child care. With today’s changing role of women, the nurse will find that they are more assertive and expect to participate more in the health care of their children. The nurse must be supportive of family-centred care and be an advocate for women as deci-sion makers.


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HEALTH CARE: CHANGES AND ADVANCES

Concepts of Health and Illness

The concepts of health and illness are changing. One formerly accepted definition of health stated that it is a state of being in the absence of illness, implying organic illness. This statement might be amplified to say that health exists when persons can meet the minimal physical, physiological, intellectual, psycho-logical, and social requirements to function appropriately for their age, sex, and level of growth and development. Illness, then, becomes a situation in which individuals experience a disturbance in any of these areas that prevents functioning at the appropriate level. Attention is directed to the psychosocial as well as the physiological characteristics of health and illness.

Holistic View of Health

The holistic view of health, which is widely accepted today, sees a human life as a total system. The word health is etymologically related to the word wholeness. Holistic health implies that all aspects of the total system of the individual are in balance with each other.

The human system is not closed. It is open to the environ-ment through the neuroendocrine system with its extensions—the sensory apparatus. Openness to the environment helps meet the needs of the system. This also leaves the system open to disturbances by disharmonious influences. Poisonous influ-ences, such as smog in the environment, can disturb the physi-cal system. Mental, emotional, and spiritual ‘poisons’, such as noise pollution or ‘brainwashing’, can disturb the nonphysical system.

Holistic health care is a philosophy that believes in an inte-gration and harmonious balance of body, mind, and spirit to maintain or regain health. The patient in this framework is looked at as a whole person, physically, emotionally, intellectu-ally, and spiritually, in terms of total lifestyle functioning. Life goals, their relationship and their values, are important consid-erations. With holistic care, for example, the infant is seen not only in terms of an upper respiratory infection but also as a frightened person who is crying out for help because of diffi-culty in breathing. The adolescent girl who has been diagnosed

as having severe scoliosis cannot be given holistic care unless her dream of becoming a ballet dancer is considered. The parents, who usually are in a bruised emotional state when their child becomes ill, need support and guidance to be able to supply their child with the love and compassion needed. Nursing assessments take into consideration all aspects of the patient’s pattern of living to provide a base for the giving of holistic care.

The holistic movement is life affirming in that individuals are encouraged to make choices that have a direct bearing on health. They assume more responsibility for their own well-being. This concept leads directly to the areas of high-level wellness and of self-care.

High-Level Wellness

Wellness means more than the absence of disease. It is a positive approach to well-being. High-level wellness for the individual child or adult is defined by Dunn as an integrated method of functioning which is oriented towards maximizing the poten-tial of what the individual is capable of, within the environment where he is functioning (Dunn, 1977).

Therefore, in order to achieve high-level wellness, the indi-vidual continually progresses as a whole being, physically, emotionally, mentally, and spiritually, towards a higher level of functioning in order to achieve a fuller potential (Fig. 1-1). This progression occurs in a constantly changing environment. Five important areas of wellness behaviour are (1) physical fitness, (2) optimal nutrition, (3) appropriate management of stress, (4) awareness of environmental influences on the individual, and (5) responsibility for oneself.

Children learn wellness or illness behaviour during their years of growth and development, principally from parents. Parents have always been the primary guardians of the health of their children. They orient children early in life within the home setting to attitudes and habits of positive personal health maintenance. Other family members, peers, health care profes-sionals, and persons in the mass media also have an influence on children. The value that these significant others, especially the parents, place on wellness influences children’s attitudes towards health and behaviour leading to wellness. Parents who

Neutral point(No discernable

illness orwellness)

Wellness

Prematuredeath

Disability Symptoms Signs

High-levelwellness

Education GrowthSelf-

actualization

Traditionalmedicine

0

Figure 1-1 Illness–wellness continuum. (Reprinted with permission from the Wellness Workbook for Health by the Wellness Resource Center, Mill Valley, CA 94941)


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have provided examples of good health care practices through their own behaviour, who have communicated to their children the reasons for such practices, and who have helped them solve problems in other areas of living can expect the children to assume responsibility for dealing with their own health.

If parents are not aware of or do not recognize the state of wellness as having high priority in their own home and culture, their children will not value it either. In such a situation, influ-ences outside the home, such as in school, may change the beliefs of the children. They may learn in spite of earlier inad-equate parental example to deal actively with their own lives and to seek the highest level of wellness of which they are capable.

In summary, children learn to value wellness as they grow from infancy through adolescence to adulthood. For this to happen, they must be aware of the meaning of wellness behav-iour as it is practised by significant others in their environment. They also learn from information given to them in a manner appropriate to their developmental level. Furthermore, children need to be motivated to participate actively in making the kinds of behavioural choices that will lead to wellness and to have such behaviour reinforced.

Self-Care Movement

The self-care movement can be adapted to all levels of the health–illness continuum. Its purpose is to assist patients to meet their health needs. These needs may be focused on health maintenance or health restoration in illness or on health promotion and prevention of illness. Health education is an essential component of self-care.

The patient must be knowledgeable, motivated, and compe-tent to implement a plan of action. School children are usually able to make decisions and can become involved in self-care. If their parents do not support their efforts, the school nurse and teachers may become their support system.

A number of support groups are also used by those involved in self-care. Examples specific to children and adolescents include groups geared to chronic illness such as diabetes, cystic fibrosis, and cancer; ostomy clubs; alcoholics; anonymous groups including young people’s groups; and narcotics anony-mous.

Advances and Changes in Medical Care

The care of children has changed dramatically for both physi-cians and nurses during recent decades of advances in medical knowledge and understanding of the emotional responses of children, such as the discovery of various immunizations, anti-biotics, and other drugs that have curative value in many illnesses; computed tomographic (CT) scans and ultrasound techniques that make early diagnosis possible; and public health measures and public education that can prevent or shorten periods of hospitalization. Children who require hospi-talization are less often isolated for prolonged periods for infec-tious diseases, have opportunities for early ambulation, and have shorter convalescences than in the past. Today, some

children may still require long hospitalization for complicated diagnostic or therapeutic measures, some of which have been discovered only during recent years.

The present emphasis on health education in disease preven-tion, self-care, and self-help groups should result in reduced morbidity for all. Increased control of environmental factors that lead to disease, advanced technology in the areas of self-monitoring, and computers in the home will be among the key influences on health care in the future.

Advances in the understanding of human development and the stages of personality development throughout the life cycle have led to a better understanding of the needs of all family members. Since the child and the family are interdependent, health care team members must be aware that the anxieties of the parents as well as those of the child need to be considered if a constructive response and adjustment to the experience of illness are to be made. Such understanding has led to prepara-tion for hospitalization for parents and child, extended visiting hours during the child’s hospital stay, parental care of the hospi-talized child, inclusion of children at the birth of a sibling, etc., are the new concepts in child care.

Nurses can now understand from the foregoing discussion that they have an important role in organized community action by collaborating with other members of the health care team and coordinating services of the nursing team. In addi-tion, nurses have the responsibility of providing nursing inter-vention in the hospital, clinic, school, home, or the community where children or parents have health or counselling needs. The abilities of nurses who care for children as health educators, teachers, counsellors, researchers, case finders, and compas-sionate, skilled care providers are urgently needed by today’s society.

PROFESSIONAL FACTORS

The role of the nurse has evolved into that of caregiver, patient advocate, counsellor, teacher, collaborator, coordinator, change agent, and consultant. Many factors have influenced the role of the nurse; some considered most significant are reviewed here.

THE PROCESS OF PROFESSIONALIZATION

Nursing has always been recognized for nurturing and caring for those in need. As a result of recognition by its early support-ers, nursing became a part of the educational process. Today nursing continues in its pursuit towards recognition as a profes-sion. By broadening its initial services to include health main-tenance and illness prevention, health promotion, and health restoration, nursing continues to keep abreast of the health care needs of the consumer. Nursing is presently based on a body of knowledge encompassing the arts and sciences. With ongoing research and theory development, it continues to broaden its scope. By incorporating the new technologies into already existing skills, nursing continues to provide expert care to the patients it serves. The nursing process incorporates assessing,


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planning, implementing, and evaluating nursing care. The nursing diagnosis movement is an example of networking and the use of nursing research to standardize identification of patient’s problems.

EXPANSION OF THE NURSING ROLE

Caring is an essential ingredient in the role of a paediatric nurse. It is a way of relating to others that develops through reciprocal trust and honesty. It involves great commitment on the part of the nurse. The circle of care should include the concerned child, the parents, and other family members. Guidance and encourage-ment should be provided to cope up with illness. The nurse should make efforts to allay the anxiety and divert the parent’s anger towards the illness into constructive outlets. This would enable them to take better care of their child.

A paediatric nurse must have special skills to look after the special needs of young patients. The paediatric nurse needs to be gentle to touch and performance as she is working with young and delicate individuals. A child responds best to a quiet and confident voice. The child unlike adults is not able to recog-nize his problem and report his illness state verbally. He cannot express the area of concern, the only expression he can exhibit is crying. Nurse must be sensitive to changes in moods and temperament of the child. The sickness of the child can be assessed due to behaviour change in the form of restlessness, refusal to eat, clinging to mother. The changes in children take place very quickly and often without warning. The paediatric nurse must be over alert. She needs not only to be alert to symp-toms but to be able to anticipate wants of the child. She needs to develop skills in identification of physical and emotional distress in children. She needs to be skilled in providing physi-cal care to the child. Children should be told in advance as per their age and level of understanding about the procedure to be done so that they are not scared during the procedure.

Communication is very important component of nursing care of children. It is essential in developing a trusting relation-ship with them. Although most of the verbal communication is done with the parent, the child should also be involved as per the condition. Play is a universal language of children. It is an

effective and important technique in communicating with chil-dren. While giving direction to children or seeking cooperation from a child, the nurse should speak clearly, be specific, and use as few words as possible, as simple language is easily under-stood. Nurse should be able to guide the parents in handling the child to prevent complications, prevent illness, and promote health. The nurse should be honest in dealing with the children and make no promises that are impossible to carry out. To assure that an injection will not hurt or will not cause pain is not true.

Because of the increased complexity of medical and nursing care, a need for highly specialized practitioners has developed. Graduate programmes evolved to meet these needs and have resulted in the creation of the nurse practitioner and the nurse clinician.

Although the implementation of these specialties may vary from institution to institution, they focus on providing quality patient care to children in primary, secondary, and tertiary care settings. These nurses serve as role models, provide care, teach the nursing staff, collaborate with all members of the health care team, and serve as an advocate for children and their fami-lies. In addition, they initiate and direct nursing research, the purpose of which is to improve the quality of care.

Specialization provides further opportunities for nurses in the expanded role. Subspecialty areas include neonatal nursing, nursing of pregnant adolescents, oncology nursing, and school nursing, to name a few. The subject of paediatric nursing has been included in the undergraduate programme of nursing by the Indian Nursing Council. It prepares the nurses having knowledge and skill related to child care who should be capable of providing nursing care to sick children. Master’s in nursing programme has also been started in the speciality of child health nursing; the curriculum of this programme has also been designed and approved by Indian nursing council.

As may be expected, services for children are costlier than they are for adults with comparable health problems. Since cost containment is a current concern of nurses as well as consum-ers, it is essential to develop such innovations that utilize all available resources in providing quality nursing care for chil-dren.

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Sample Chapter Marlows Textbook of Pediatric Nursing Adaptation 1e by Marlow To Order Call Sms at...

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