Chapter 1 (Pgs. 13-15, 17-55), Chapter 2 (pgs. 62-83)
Family-Centered Care
Collaborative partnership, mutual trust, sensitivity to clients’ beliefs among the individual, family, and caregivers to
determine goals, share information, offer support, and formulate plans for health care.
Recognize the family as constant
clients and their families are considered integral components of the health care decision-making and delivery
processes.
This involves listening to the family’s needs and a shift of the nurse’s authoritarian role to the family to empower
them to make their own decisions within the context of a supportive environment.
Informed consent/Assent- Nurses Role and Responsibilities Table 1.7 (Pg. 47), pg 46 Box 1.5 Situations When considerations to
consent
Informed consent: must be obtained for test, treatments, and procedures
Assent: agreeing to something; child’s participation in decision making process about health care
o The age of assent depends on the child’s developmental level, maturity, and psychological state
o First help the child understand their condition, inform the child of treatment and what to expect, make sure
child is not influenced to decide, lastly ascertain the child’s willingness to participate in treatment or research
Procedures that require consent: surgery, invasive procedures-amniocentesis, internal fetal monitor, LP’s, bone
marrow aspiration, chemotherapy and radiation, research, application of restraints, and photography
People who can provide consent: 18 years of age, parent/ legal guardian
Decision makes must be of legal age and competent
Present information that is simple, concise and appropriate to the level of education and language
Decision making must be voluntary
Have a witness
Children not living with biological/adoptive parent- legal appointed guardian must provide consent
Parent consent after divorce- consent comes from parent with legal custody however, in emergency physical custody can
consent
Organ donation- for a minor, parents must be aware of risk, benefit and provided emotional support; minor must agree
without coercion
Medical Experimentation- requirement include consent from parent, assent of child and perceived benefit to child… comply
with federal regulations if funds are received
*Never assume the adult accompanying the child is the parent or legal guardian always clarify
Nurse’s role with informed consent:
Ensure the child, parent, guardian understand what they are signing by asking question
Ensure the consent form is completed with signatures from client or parent/guardian
Serve as a witness to the signature process
Cultural Considerations
Nurses need to avoid stereotyping, which can lead to misconceptions. Stereotyping or labeling can result from
ethnocentrism, a belief that one’s own ethnic group is superior to other ethnic groups. This attitude can lead to a
slanted view of the world, and it may hinder the nurse’s ability to provide culturally competent care.
“Most cultures have remedies that people may use or consider before they seek professional health care
Social and Environmental Influences
Social media
Social roles: specific patterns of behaviors
Violence
Poverty
Socioeconomic status: family’s economic, occupational, and educational levels.
-Low socioeconomic status typically has an adverse influence on an individual’s health.
Homelessness
Figure 1.3 Causes of Hospitalization pg. 14
Top causes of hospitalization is reproductive system, digestive system, Nervous system, mental disease and disorders,
musculoskeletal/ connective issues
Childhood mortality
the number of deaths in children 1-14
ages 1-4 leading cause of death: unintentional
injuries and congenital malformation
ages 5-14 leading cause of death: unintentional
injuries and cancer
Childhood morbidity
Key issues the endanger health:
Obesity, environmental toxins, allergies, drug
abuse, child abuse and neglect, and mental health
problems
Factors that may increase morbidity include
homelessness, poverty, low birth weight, chronic
health disorders, foreign-born adoption,
attendance at day care centers, and barriers to
health care.
African Americans and Hispanics are particularly
at increased risk for illness.
The most important aspect of morbidity is the
degree of disability it produces, which is identified
in
Atraumatic Care
Care the minimizes or eliminates the
psychological or physical distress experienced by
children and their families
Preventing and eliminating separation of the child
from the family
Promoting self-control
Communication
Effective communication is crucial to quality
nursing care
Trust, respect and empathy are factors needed to
foster effective communication
children as the number of days missed from
school or confined to bed.
Client Rights
Ensuring the clients rights are upheld is key for
the pregnant women two clients must be
considered the mother and baby
Bill of right of children- have basic needs met, to
make choices whenever possible, have parent or
other important person with child, respected as a
person, respect the child’s confidentiality
Confidentiality- apply to a given clinical situations
Clients’ confidentiality and privacy must be in the
same manner as it is maintained when using
computerized documentation
Security of personal login information
Do not leave clients information visible when
unattended
Exception exists with physical, sexual abuse and
injuries
Verbal Communication
Use open-ended questions
Demonstrate active listening by using the child’s
and family’s own words
Acknowledge emotions
Nonverbal Communication
Maintain eye contact
Maintain open posture- arms uncrossed
Nod your head to demonstrate interest
Work with an interpreter when communicating
across cultures, and with deaf and hearing
impaired
Box 1.4 Assessing for Violence
Questions for the Parent
• Do you ever feel afraid in your home?
• Do arguments ever become physical (hitting, kicking,
pushing, throwing, or punching/breaking objects)?
• Have you ever been threatened with a weapon (gun,
knife, other)?
• Have you ever felt trapped or like a prisoner in your own
home? Does your partner ever lock you in/out of the house
or take your car keys?
• Have your children ever seen or heard violence in the
home?
• Have the police ever been involved due to violence in
your home?
Questions for the Child
• What happens when Mommy and Daddy (or appropriate
partner names) argue/fight? Is there any hitting, pushing,
and so forth?
• How do you feel when Mommy and Daddy (or
appropriate partner names) fight?
• What happens to you when you get in trouble?
Page 17) Table1.2 Types of Families
Nuclear Family: husband, wife, and children living
in the same household
Binuclear family: child who is member of two
families due to joint custody
Single-parent family: one parent responsible for
care of children
Blended family: adults with children from
previous marriages or a new marriage
Extended family: nuclear family and grandparents,
cousins, aunts, and uncles
Adverse Childhood Experiences (ACE’s)- examples of, what are the outcomes of exposure to ACE’s
ACES study explored risk factors for disease and social well-being across the lifespan
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Abuse: emotional, physical, sexual
Neglect: emotional and physical
Household dysfunction: mother treated violently, household substance abuse, mental illness, separation/ Divorce,
incarceration of a household member
Other: poverty, racism, community violence, police brutality, sexism
+ affects: promoting health growth and development
- affects: increase health risk
TEDx Talk from Nadine Burke-Harris – mentions several interventions that can be done to addresses trauma in managing kids
Hormonal, brain, and immune development causes that can happen to you as a child
Interventions: Having a multidisciplinary team- home visits, care coordination, holistic care, medication as the last
resort, educating parents
It’s not what’s wrong it’s what happened to you
Health Literacy – nurses’ role and responsibilities as it relates to health teaching
Health literacy is the ability to read, understand, and use health care information to make appropriate health care decisions
and successfully navigate the health care system
All health care providers should use universal literacy precautions and focus on providing easy to understand information
during every patient encounter.
The elderly, the poor, members of minority groups, medically underserved, and people who speak English as a second
language are at a higher risk
Difficulty filling out registration forms, questionnaires, and consent forms; forms are incomplete, incorrect, or
inaccurate.
Frequently missed appointments
Noncompliance and lack of follow-up with treatment regimens
History of medication errors
Responses such as, “I forgot my glasses” or “I’ll read this when I get home”
Inability to answer common questions about their treatment or medicines
Avoiding asking questions for fear of looking “stupid”
Nurses need to provide understandable and accessible information to all clients, regardless of their literacy or education
levels.
avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a
visit to three key points or tasks, and assessing for comprehension.
In addition, printed information should be written at or below a 5th to 6th grade reading level with plenty of visual
aids or pictures