Ammar Hyder

Perspective of Pediatric nursing

PEDIATRIC NURSING:
 Pediatric is a word derived from the Greek word pais, meaning “child.”
 Pediatric: branch of medicine that deal specifically with children, their development,
childhood diseases and their treatment.
 Pediatric nursing: the art and science of giving nursing care to children from birth through
adolescence with a holistic family centered approach, including emphasis on their physical
growth, mental, emotional, psychosocial and spiritual development
EVOLUTION IN PEDIATRIC NURSING:
The historical evolution of pediatric nursing can be traced back to the early 20th century, when
advancements in medical knowledge and a growing recognition of the unique healthcare needs
of children led to the development of specialized pediatric care. Here are some key milestones in
the historical evolution of pediatric nursing:
 Early Beginnings: In the late 19th and early 20th centuries, pediatric care was primarily
provided by general nurses with limited knowledge of child health. However, influential
figures such as Lina Rogers, who established the first pediatric nursing school in the United
States in 1889, recognized the need for specialized training in caring for children.
 Founding of Pediatric Hospitals: The establishment of dedicated pediatric hospitals in the
early 20th century played a significant role in the evolution of pediatric nursing. Hospitals
such as the Children's Hospital of Philadelphia (1855) and the Boston Floating Hospital for
Children (1894) provided specialized care for children and created opportunities for nurses to
specialize in pediatric nursing.
 Development of Pediatric Nursing Education: As the demand for specialized pediatric care
increased, nursing schools began incorporating pediatric nursing into their curriculum. This
led to the development of pediatric nursing education programs, focusing on child growth
and development, pediatric diseases, and age-specific care.
 Professional Organizations: The formation of professional organizations dedicated to
pediatric nursing also contributed to its evolution. In 1932, the Society of Pediatric Nurses
(now known as the National Association of Pediatric Nurse Practitioners) was founded,
providing a platform for nurses to share knowledge, advocate for pediatric health, and
promote the specialty.
 Role Expansion: Over time, the role of pediatric nurses expanded beyond bedside care. In
the mid-20th century, pediatric nurses began taking on leadership roles, engaging in research,
and advocating for improved child health outcomes. They became involved in policy
development, public health initiatives, and community education to promote child well-
being.
 Technological Advancements: The evolution of medical technology has had a significant
impact on pediatric nursing. Advancements in medical equipment, diagnostic tools, and
treatment modalities have improved the quality of care provided to children. Pediatric nurses

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had to adapt to new technologies and incorporate them into their practice to ensure optimal
care for their patients.
 Family-Centered Care: The concept of family-centered care gained prominence in the latter
half of the 20th century. Pediatric nurses recognized the importance of involving families in
their child's care, considering their preferences and cultural beliefs, and promoting parental
involvement. This shift in focus contributed to improved health outcomes and a more holistic
approach to pediatric nursing.
 Advanced Practice Roles: In recent decades, advanced practice roles in pediatric nursing,
such as pediatric nurse practitioners (PNPs) and pediatric clinical nurse specialists (PCNS),
have emerged. These roles allow nurses to provide comprehensive care, diagnose and treat
common childhood illnesses, and collaborate with other healthcare providers to deliver
specialized care to children.
ROLE OF PEDIATRIC NURSE:
The pediatric nurse is responsible for promoting the health and well-being of the child and
family.
a) Therapeutic Relationship: Pediatric nurses need to have meaningful relationships with
children and their families and yet remain separate enough to distinguish their own feelings
and needs.
b) Family caring: The nurse must work with family members, identify their goals and needs,
and plan interventions that best address the defined problems.
c) Family advocacy: Advocacy involves ensuring that families are aware of all available health
services, adequately informed of treatments and procedures, involved in the child's care, and
encouraged to change or support existing health care practices.
d) Disease Prevention and Health Promotion: The best approach to prevention is education
and anticipatory guidance. An appreciation of the hazards or conflicts of each developmental
period enables the nurse to guide parents regarding childrearing practices aimed at preventing
potential problems. One significant example is safety.
e) Health Teaching: helping parents and children understand a diagnosis or medical treatment,
encouraging children to ask questions about their bodies, referring families to health-related
professional or lay groups, supplying patients with appropriate literature, and providing
anticipatory guidance.
f) Injury Prevention: The nurse plays an important role in preventing injuries by using a
developmental approach to safety counseling for parents of children of all ages.
g) Support and Counseling: It involves support, teaching, techniques to foster the expression
of feelings or thoughts, and approaches to help the family cope with stress.
h) Coordination and Collaboration: The nurse, as a member of the health care team,
collaborates and coordinates nursing care with the care activities of other professionals.
i) Ethical Decision Making: Nurses must prepare themselves systematically for collaborative
ethical decision making. They can accomplish this through formal course work, continuing
education, contemporary literature, and work to establish an environment conducive to
ethical discourse.

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PEDIATRIC NURSING IN PAKISTANI CULTURE:

Pediatric nursing in Pakistani culture is influenced by various factors, including societal norms,
cultural beliefs, and healthcare practices specific to the region. Here are some key points about
pediatric nursing in Pakistani culture:
 Importance of Family: In Pakistani culture, family plays a central role in a child's life and
healthcare decisions. Pediatric nurses often interact closely with parents, extended family
members, and caregivers, as they are involved in the child's care and decision-making
processes.
 Respect for Elders and Authority: Pakistani culture places significant importance on
respecting elders and authority figures. Pediatric nurses often encounter families who defer to
healthcare professionals' expertise and decisions regarding their child's care. Nurses are
expected to demonstrate respect, empathy, and professionalism when interacting with parents
and extended family members.
 Cultural Sensitivity: Pakistan is a diverse country with various cultural, ethnic, and
religious groups. Pediatric nurses need to be culturally sensitive and aware of the diverse
beliefs and practices that may influence healthcare decisions.
 Traditional Healing Practices: Traditional healing practices are still prevalent in Pakistani
culture, alongside modern healthcare approaches. Some families may seek traditional
remedies or alternative therapies alongside medical treatments. Pediatric nurses need to
understand and address these beliefs respectfully while providing evidence-based care.
 Gender Roles: Gender roles and expectations exist in Pakistani culture, and they can
influence the dynamics of pediatric nursing. In some cases, female nurses may be preferred
for caring for female children due to cultural sensitivities. However, there is an increasing
recognition and acceptance of male nurses in the field of pediatric nursing in Pakistan.
 Health Education and Communication: Health literacy may vary among different
populations in Pakistan. Pediatric nurses play a crucial role in educating parents and
caregivers about child health, nutrition, immunizations, and hygiene practices according to
culturally appropriate language, and visual aids to ensure understanding and compliance.
 Role of Religion: Religion, particularly Islam, has a significant influence on healthcare
practices and decision-making in Pakistani culture. Pediatric nurses may encounter families
who seek guidance from religious leaders or incorporate religious practices into their child's
care.
 Limited Resources: Pakistan faces challenges in terms of healthcare infrastructure and
resources, particularly in rural areas. Pediatric nurses often work in resource-limited settings,
which can impact the availability of equipment, medications, and healthcare facilities. Nurses
may need to be creative, adaptable, and innovative in providing care within the available
resources.

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CONVENTION ON THE RIGHTS OF THE CHILD:

The Convention on the Rights of the Child (CRC) is an international human rights treaty adopted
by the United Nations General Assembly in 1989. It outlines the fundamental rights that should
be universally guaranteed to all children, defined as individuals below the age of 18, regardless
of their nationality, ethnicity, gender, religion, or social status. Here is a brief summary of the
Convention on the Rights of the Child:
1. Non-Discrimination: The CRC emphasizes that all children are entitled to enjoy their rights
without any form of discrimination. Children should be treated equally and protected from all
forms of prejudice and discrimination.
2. Best Interests of the Child: The best interests of the child must be a primary consideration
in all actions concerning children. Governments, legal authorities, and caregivers are
responsible for ensuring that children's well-being and needs are prioritized.
3. Right to Life, Survival, and Development: Children have the right to life, survival, and
optimal development. Governments are obliged to ensure children's access to healthcare,
nutrition, education, and safe environments that support their physical, mental, and social
development.
4. Right to Identity: Every child has the right to an identity, including a name and nationality,
and the right to preserve their family relationships. Governments are responsible for
preventing arbitrary separation from parents and facilitating family reunification when
separated.
5. Parental Guidance and Responsibilities: The CRC acknowledges that parents and legal
guardians have the primary responsibility for the upbringing and development of the child.
Governments should support parents in fulfilling their responsibilities and protect children
from abuse, neglect, or exploitation within the family context.
6. Respect for the Views of the Child: Children have the right to express their opinions and
have them taken into account in matters that affect them. Their views should be heard and
given due weight according to their age and maturity.
7. Protection from Violence, Abuse, and Exploitation: The CRC guarantees children's
protection from all forms of physical or mental violence, abuse, neglect, exploitation, and
harmful practices. Governments are responsible for preventing and responding to such
violations and providing support to child victims.
8. Right to Education: Every child has the right to free and compulsory primary education.
Governments should ensure access to quality education that promotes the child's full
potential and prepares them for responsible citizenship.
9. Freedom of Expression and Access to Information: Children have the right to freedom of
thought, expression, and access to information. They should be provided with opportunities
to participate in cultural, artistic, recreational, and media activities that foster their creativity
and understanding of the world.

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10. Protection of Refugee and Migrant Children: Refugee and migrant children are entitled to
special protection and assistance. Governments should ensure their access to healthcare,
education, and social services, regardless of their legal status.
COMMONLY OCCURRING ETHICAL ISSUES IN PEDIATRIC SETTING OF
PAKISTAN:
In the pediatric setting of Pakistan, healthcare professionals may encounter various ethical issues
while providing care to children:
1. Limited Resources: The healthcare system in Pakistan, especially in rural areas, often faces
resource constraints, including a shortage of healthcare facilities, medical equipment, and
essential medications. Healthcare professionals may face ethical dilemmas when deciding
how to allocate scarce resources and provide equitable care to all children.
2. Consent and Decision-Making: Informed consent for medical procedures and treatments
can be challenging in certain cultural contexts. Healthcare professionals may face ethical
dilemmas in obtaining valid consent while respecting cultural values and ensuring the child's
best interests.
3. Cultural and Religious Beliefs: Pakistani culture is diverse, and religious beliefs strongly
influence healthcare decisions. Healthcare professionals may encounter ethical challenges
when cultural or religious beliefs conflict with evidence-based medical practices.
4. Child Protection: Child abuse and neglect are significant concerns in Pakistan. Healthcare
professionals may face ethical dilemmas when identifying and reporting suspected cases of
child abuse or neglect.
5. Gender and Social Inequities: Gender and social inequities can impact access to healthcare
and the quality of care provided to children. Healthcare professionals may face ethical
challenges related to gender bias, discrimination, and unequal distribution of resources.
6. End-of-Life Decisions: End-of-life decisions and palliative care in pediatric patients can be
ethically complex. Cultural beliefs, religious practices, and limited access to specialized
pediatric palliative care services may contribute to ethical dilemmas for healthcare
professionals in making decisions about withholding or withdrawing life-sustaining
treatments.
7. Confidentiality and Privacy: Protecting the confidentiality and privacy of pediatric patients
can be challenging in a cultural context where family involvement in healthcare decisions is
highly valued. Healthcare professionals may face ethical dilemmas when balancing the
child's right to privacy with the need to involve family members decision-making processes.
8. Access to Healthcare: Access to healthcare services can be limited, particularly in rural and
underserved areas. Healthcare professionals may encounter ethical issues related to
disparities in access to healthcare, including inequitable distribution of resources and
challenges in providing timely and appropriate care to all children.

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