Chapter 1 Perspectives of Pediatric Nursing 1 Pediatric Nursing •https://www.youtube.com/watch?v=c2iCWXyRb5g Copyright © 2022, Elsevier Inc. All rights reserved. 2 Health Care for Children •Healthy People 2030 • Framework for identifying essential components for child health promotion programs • Designed to prevent future health problems in children • Goal to increase quality and length of healthy life and eliminate health disparities https://health.gov/healthypeople/objectives-anddata/leading-health-indicators Copyright © 2022, Elsevier Inc. All rights reserved. 3 Health Promotion for Pediatric Nursing Goals •Promote development •Improve childhood nutrition •Improve oral health Copyright © 2022, Elsevier Inc. All rights reserved. 4 4 Goals of Health Promotion for Pediatric Nursing- Development •Developmental processes are unique to each stage of development: • Infant • Toddler • Early Childhood • Adolescence •Continuous screening and assessment are essential for early intervention when developmental delays are found. •Anticipatory guidance Copyright © 2022, Elsevier Inc. All rights reserved. 5 5 Goals of Health Promotion for Pediatric Nursing- Nutrition • Infancy • Human milk is the preferred form of nutrition for all infants • Provides • Micronutrients • Immunologic properties • Enzymes that enhance digestion and absorption •Childhood •Lifelong eating habits established by age 3 years. •Parent teaching •Eating preferences and attitudes related to food are established by: • Family influences • Culture •Homelessness and low income associated with lack of resources to provide children with adequate, nutritious meals. Copyright © 2022, Elsevier Inc. All rights reserved. 6 Goals of Health Promotion for Pediatric Nursing- Oral Health • Oral health is an essential component of health promotion throughout infancy, childhood, and adolescence. • Dental caries are preventable –tooth decay • Dental hygiene beginning with first tooth eruption – wipe first tooth with a cloth • Role of fluoridated water • Early dental preventive care • Parent and child teaching • Parents should help kids (8 to 10 yrs) Copyright © 2022, Elsevier Inc. All rights reserved. 7 Issues Affecting Childhood Health • Obesity and Type 2 diabetes • Childhood injuries • Violence • Mental health problems •Obesity and Type 2 Diabetes • Most common nutritional problem among American children and associated with Type 2 Diabetes • Defined as a BMI at or greater than the 95th percentile • Obesity affects more than 13.7 million children and adolescents in 2016 • Causes • Lack of physical activity and sedentary lifestyle • Increased risk for: • Cardiometabolic changes Copyright © 2022, Elsevier Inc. All rights reserved. 8 Childhood Health Problems • Childhood injuries (Table 1.1 p. 4) • Most common cause of death and disability to children in the United States. • Risk factors • Sex – males more than female • Temperament – difficult, easy going, slow to warm up • Stress • Alcohol or drug use • History of previous illness • Developmental, cognitive, & anatomic characteristics • Other factors such as poverty, family stress Copyright © 2022, Elsevier Inc. All rights reserved. 9 Childhood Health Problems •Childhood violence • Causes are not well understood • Early identification and prevention is important • Assess children and adolescents for risk factors • Families with firearms must be educated about their safe use and storage •Mental health problems • 1 out of 5 adolescents has a mental health problem • 80% of chronic mental disorders begins in childhood • Nurses should be alert of mental illness symptoms and potential suicidal ideation Copyright © 2022, Elsevier Inc. All rights reserved. 10 Infant Mortality •Definition: Number of deaths per 1000 live births during the first year of life • Neonatal period: Day 1 to day 27 of life • Postnatal period: Day 28 to 1 year of life Birth Weight • Major determinant of neonatal death in the United States • Low birth weight (LBW): Less than 2500 g (5.5 lbs.) • Lower birth weight = Higher mortality rate Copyright © 2022, Elsevier Inc. All rights reserved. 11 11 Causes of Infant Death oCongenital anomalies oDisorders related to short gestation and unspecified low birth weight oNewborn affected by maternal complications of pregnancy oSudden infant death syndrome (SIDS) oUnintentional injuries oNewborn affected by complications of placenta cord and membranes oBacterial sepsis oDiseases of the circulatory system oRespiratory distress of newborn oNeonatal hemorrhage Copyright © 2022, Elsevier Inc. All rights reserved. 12 12 Childhood Mortality •Injuries are the leading cause of death in children older than 1 year • Motor vehicle crashes • Drowning • Burns • Firearms • Poisoning Copyright © 2022, Elsevier Inc. All rights reserved. 13 13 Childhood Morbidity • Statistics generally rates per 1000 population • Acute illness: symptoms severe enough to limit activity or require medical attention • Difficult to define and measure • May denote acute illness, chronic disease, or disability • Groups with increased morbidity • Children who are homeless, poor, or chronically ill; foreign-born adopted children; and children in daycare • Respiratory illness = approximately 50% of all acute conditions • Infections and parasitic disease = 11% • Injuries = 15% Copyright © 2022, Elsevier Inc. All rights reserved. 14 Philosophy of Care • Protection, promotion, and optimization of health and abilities • Prevention of illness and injury • Alleviation of suffering through the diagnosis and treatment of human response • Advocacy in the care of individuals, families, and populations •Family-Centered Care • Recognizes the family as the constant in a child’s life • Systems must support, respect, encourage, and enhance the family’s strength and competence • Needs of all family members must be addressed Copyright © 2022, Elsevier Inc. All rights reserved. 15 Family-Centered Care: Two Basic Concepts • Enabling • Current abilities and competencies • Acquire new abilities and competencies as needed • Empowerment • Interaction that allows the family to maintain or acquire a sense of control • Behaviors that foster family’s strengths, abilities, and actions Copyright © 2022, Elsevier Inc. All rights reserved. 16 Atraumatic Care • Eliminate or minimize distress • Psychologic • Physical • Goals • Prevent or minimize separation from the family • Promote sense of control • Prevent or minimize bodily injury and pain • Examples • • • • Foster the parent-child relationship Prepare child before any treatment or procedure Control pain Provide play activities for expression of fear and aggression Copyright © 2022, Elsevier Inc. All rights reserved. 17 Pediatric Nurse’s Role • Therapeutic relationship building • Negotiating a meaningful relationship with the child and family within welldefined boundaries • Family advocacy and caring • Providing atraumatic care • Disease prevention and health promotion • Educate about health promotion and injury prevention using anticipatory guidance • Health teaching • May be the nurse’s direct goal • Providing the appropriate health teaching with feedback • Injury prevention • Utilizing developmental approach to safety counseling for parents of children of all ages to prevent injury • Support and counseling • Attention to emotional needs require support and, sometimes counseling Copyright © 2022, Elsevier Inc. All rights reserved. 18 18 Pediatric Nurse’s Role • Coordination and Collaboration • Collaborates and coordinates nursing care with the care activities of other professionals • Ethical decision making • Create an environment that embraces discussion of ethical dilemmas and employs mechanisms for dispute resolution • Competing moral values may include • Autonomy, Nonmaleficence, Beneficence, Justice Copyright © 2022, Elsevier Inc. All rights reserved. 19 Evidence-Based Practice • Based on valid, important, and applicable patientreported, nurse-observed, and research-derived information • Combines knowledge with clinical experience and intuition • Provides a rational approach to decision making that facilitates best practice Copyright © 2022, Elsevier Inc. All rights reserved. 20 Evidence-Based Nursing Practice •Ask the question •Search for evidence •Critically analyze the evidence •Apply the evidence: nursing implications Copyright © 2022, Elsevier Inc. All rights reserved. 21 21 GRADE Criteria for EBP • Evaluates the quality of research articles used to develop practice guidelines • Rates the quality of the evidence • Establishes a strong versus weak recommendation for practice change Copyright © 2022, Elsevier Inc. All rights reserved. 22 CLINICAL REASONING AND THE PROCESS OF PROVIDING NURSING CARE TO CHILDREN AND FAMILIES • Clinical Reasoning • Cognitive process that uses formal and informal thinking to gather and analyze patient data, evaluate the significance of the information, and consider alternative actions. • Nursing process • Assessment • Nursing diagnosis • Planning • Implementation • Evaluation Copyright © 2022, Elsevier Inc. All rights reserved. 23
