Chelsea Zielinski, MSN, RN Social & Environmental Influences Ch. 17 1 Learning Outcomes 1. Identify Major Social and Environmental Factors Influencing Health of Children and Adolescents 2. List External Influences that Influence Child and Adolescent Health 3. 4. Apply Ecologic Model and Resilience Theory to Assessment of Social and Environmental Factors Examine Effects of Substance Abuse, Physical Activity, and Lifestyle Patterns on Health 5. Plan Nursing Interventions for Child Experiencing Violance 6. Evaluate Environment for Hazards 7. Explore the Nursing Role in Prevention and Treatment of Child Abuse, Neglect, and Other Forms of Violence 8. Plan Nursing Interventions for Children Related to Social and Environmental Situations 2 Health Problems of Children in Poverty Immunizations Infectious disease Developmental Delays Vision and Hearing Nutrition Dental health Injury Pregnancy Mental illness 3 Stress Social Influences on Child Health • School • Sports • Family changes • Finances • Sleep • Violence • Homelessness • Early puberty Manifestations • Frequent respiratory or gastrointestinal illnesses • Injuries • Regressive behavior • Suicidal ideation Coping strategies, resources 4 Social Influences on Child Health • School and Childcare • Childcare use? • Effect on Development • Homeschool/Public/Private School • Access to screening programs • Health education • Early intervention programs This Photo by Unknown author is licensed under CC BY-SA-NC. 5 Social Influences on Child Health • Community • Environmental factors • Cleanliness • Crime • Lead • Culture • Influence on healthcare practices • Culture shock • Child interpreter 6 Lead Exposures • Sources of Lead Exposure Paint chips and dust from homes built before 1978 Contaminated soil Occupations and hobbies involving lead exposure Food prepared in improperly fired pottery Drinking water from lead pipes, lead-lined tanks or tea pots soldered with lead • Imported or antique toys or furniture • • • • • 7 Lifestyle Activities and Their Influence on Child Health Alcohol use • Risk factors Drug Use • Risk factors • Types • Manifestation of Maladaptive Coping • Stressors 8 Tobacco Use 9-14 yrs Risks Nursing role: • Parent/caregivers smoke • Peers • Low SES • Increased respiratory illnesses • Activity intolerance • Long-term smoker • Inform • Ask about smoking at age 9-10 • Referrals for cessation programs 9 Sexual Orientation • LGBT/Q • Adolescent self-esteem = peer comparison • Risks • Abuse (verbal, sexual, physical) • Rejection • Nursing Role • Fostering acceptance • Positive self-esteem • Resources 10 Effects of Violence • Schools and Communities • • • • Firearms Homicide Sexual violence War, terrorism, and natural disasters • Bullying • Physical, verbal abuse • Cyberbullying • Referals if suspected 11 Parental Risk Factors Child Abuse • Parents of young age • Low-income • Low self-esteem • Lack of parenting knowledge • Substance use • Abuse history • Family stressors • Inadequate support Child risk factors • Under age 1 • Mental disabilities • Premature birth 12 Types of Child Abuse • Physical •Sexual •Emotional •Neglect •Munchausen's by Proxy 13 Nevada Law • “Abuse or neglect of a child” means, except as otherwise provided: (a) Physical or mental injury of a nonaccidental nature; (b) Sexual abuse or sexual exploitation; or (c) Negligent treatment or maltreatment of a child caused or allowed by a person responsible for the welfare of the child under circumstances which indicate that the child’s health or welfare is harmed or threatened with harm. • Penalty for failure to make report: misdemeanor 14 Physical Abuse • Symptoms: • Bruises • Various stages of healing • Non-mobile child • Fractures • Different stages of healing • Locations • Burns • Fear of parents • Withdrawal 15 Physical Neglect • Symptoms: • Failure to thrive • Poor hygiene • Delay in care • Flat affect • School absence • Frequent injuries 16 Emotional Abuse Failure to thrive Eating disorders Enuresis Sleep disturbances Withdrawal Lack of social smile Delayed development Depression/suicide attempts 17 Sexual Abuse Brusies Bleeding genitalia STIs UTIs Regression Withdrawal Bloody, torn underwear Difficulty walking or standing 18 Shaken Baby Syndrome • Non-accidental head trauma • Symptoms • Vomiting, poor feeding • Bulging fontanelles • Seizures • Posturing • Altered LOC • Apnea/bradycardia • Retinal hemorrhage 19 Suspected Abuse • Mandated reporters • Acute care • Thorough assessment • Imaging • Labs • Notify Provider • Notify Social Work • Assess safety • Primary care / school • Law enforcement • Child Protective Services 20 Nursing Goals • Work with Family to: • Understand present and future risks • Change social and physical environment • To Achieve Goals: • Educate families, connecting them with resources • Plan measurable behavior changes 21
