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PERSPECTIVES OF

PEDIATRIC NURSING
OBJECTIVES
 State the major cause of death for (a) infants and (b) children 1 to
18.
 Identify factors that make a child susceptible to health problems.
 Discuss the relevance of cultural sensitivity to the implementation
of comprehensive pediatric nursing care.
 Discuss the impact that socioeconomic influence can have on health
and child development.
 Discuss the importance of family centered care.
 Give an example of atraumatic care
 Describe the roles of the pediatric nurse in today’s health care
system.
EARLY REFORMERS
 Study of Pediatrics began in mid-1800s
Abraham Jacobi, Father of Pediatrics
 Isabel Hampton Robb (1893) wrote about
the challenges of pediatric nursing:
 “the habit of observation on the part of the nurse is of the
highest degree of importance…we have to depend on signs
to tell us where the trouble is located, and we may be able
to gather facts of much importance from what are
apparently quite trivial symptoms.”

 Lillian Wald (1893) established Henry


Street → home nursing visits, school
nursing, ‘founder of public health nsg’
 Lina Rogers – 1st full time school nurse
CHALLENGES OF PEDIATRIC NURSING
 Communication – must be creative
 Developmental, cognitive, physical
differences
 Health problems specific to pediatrics

 Among the most vulnerable and


disadvantaged in society; 1 in 5 live in
poverty (current statistics)
 Diverse family systems

 Cultural diversity – must be culturally


sensitive
ATRAUMATIC CARE

 Providing therapeutic
care that eliminates
or minimizes the
psychologic and physical distress
experienced by children & families in the
health care system
 Goal: First, do no harm
 Prevent or minimize child’s separation from
their family
 Promote a sense of control
 Prevent or minimize bodily injury and pain
FAMILY –CENTERED
CARE
 Recognizes family as the
constant in child’s life
 Needs of all
family members are addressed
 Acknowledges diversity among family
structures and backgrounds
 Empowerment – helping families
maintain or acquire a sense of control and
competence by fostering their strengths
and abilities, and by treating them with
respect and acknowledging their expertise
in caring for their child.
PARENT-PROFESSIONAL PARTNERSHIP
 Implies the belief that partners are capable
individuals who become more capable by sharing
knowledge, skills and resources
 Nurse can help families identify their strengths,
build on them, and assume a comfortable level of
participation
 Our role is to strengthen their ability to nurture
CULTURAL INFLUENCES
 Culture: pattern of assumptions, beliefs,
& practices that unconsciously frames or
guides the outlook & decisions of a group
 Race: traits that are transmissible by
descent &are sufficient to characterize
those as a distinct human type
 Ethnicity: people sharing a unique
cultural, social, and linguistic heritage
 Ethnocentrism: attitude that one’s own
ethnic group is superior to others
NEW PERSPECTIVE ON CULTURE
CULTURAL INFLUENCES ON
HEALTH CARE (CHAPTER 2)
 May view illness in a child differently
 Gender of child may be a factor

 Time orientation differs among cultures

 Authority figure in family

 Interactions: verbal & nonverbal

 Food customs

 Health beliefs & Practices


OTHER FACTORS
 Heredity – innate susceptibility acquired
through generations of evolutionary
changes within a certain population
 Cystic Fibrosis: almost
nonexistent in Asians & African-
Americans
 Lactase deficiency: African-
Americans, Asians, Arabs, Native
Americans
 Sickle cell disease: Blacks
PHYSICAL CHARACTERISTICS
 Different skin tones require modification of
assessment techniques to √ for cyanosis or
jaundice – Hockenberry, p. 152 (9th ed.), p. 124 (10th ed.)
 Mongolian spots on babies

 Stature and body build


RELIGIOUS INFLUENCES
 Religion influences lifestyles of many cultures
 Meeting family’s spiritual needs can give them
strength, esp. during stressful times
 Certain rites/beliefs surrounding birth and death

 Diet and food practices

 Medical practices
CONCLUSION
 Goal is to adapt ethnic practices to the family’s
health needs rather than try to change their
beliefs
 Practices that do no harm should be respected

 Remember: No cultural group is homogeneous;


there is always great diversity within groups
FAMILIES
CHAPTER 2

 Relationships between dependent children


and one or more protective adults
 Basically it is what an individual
considers it to be
 Must understand family’s strengths &
stressors & how they function
 Assess how this impacts the child &
his/her health
FAMILY SYSTEMS THEORY
 Derives from general systems theory
 The family is a system that continually interacts
with its members and the environment
 Emphasis on “interaction”

 Problems do not lie in any one member but in the


type of interactions used by the family
FAMILY STRESS THEORY
 Families encounter stressors, both predictable
and unpredictable. When family experiences too
many stressors for it to cope adequately, a crisis
ensues. Adaptation requires a change in family
structure and/or interaction. Resiliency to stress
through adjustment and adaptation emphasizes
that stress doesn’t have to be pathological

 Developmental Theory: addresses family change


over time, using family life-cycle stages
 Duvall Stages of the Family (Box 2-1)
FAMILIES–
 Various types of family structures:
2 parents, 1 parent, grandparent(s),
relative, non-relative, stepparent,
foster parents, adoptive, blended families,
divorced, extended, gay-lesbian,
polygamous, communal, etc.
SOCIOECONOMIC INFLUENCES
 Poverty: not a social class but a condition
 Visible: lack of money or material
resources
 Invisible: social & cultural
deprivation; inferior employment &
education opportunities; lack or
inferior medical services
 Most overwhelming influence on
health
CHILDREN & POVERTY
 In US, nearly twice as likely to be
poor as citizens >65 yrs old
 1 in 5 children live in poverty
(current statistics)
 Much higher rate in US than in
other comparable countries
 60% live in suburbs or rural areas
 ↑ in chronically poor vs episodically
poor
EFFECTS OF POVERTY
 High correlation between poverty and
prevalence of illness
 Uninsured or underinsured so limited
access to health services
 High infant mortality

 Substandard housing; crowded living

 Unbalanced meals and/or insufficient food

 Miss more school due to illness


HOMELESSNESS
 Fastest growing homeless: families
 Most common – single moms w/2-3 kids
 Children = more than 1/3 of homeless
 Some are “runaway” adolescents
 Many have been victims of or witnessed
forms of abuse
 Physical and mental disorders are greater
in this population
IMPORTANCE OF SAFETY IN PEDIATRICS &
ANTICIPATORY GUIDANCE

 It is critical for the nurse to assess the


safety needs of all children in the hospitalized
setting:
 side rails up, dangerous objects out of reach, belts on high
chairs and infant seats, no plastic bags nearby
 It is also as imperative for the nurse to assess the
home environment for safe practices
 Consistent use of car seats
 Locked cabinets for all dangerous chemicals, drugs, etc.

 Anticipatory Guidance focuses on preventative


teaching for caregivers based on the
developmental needs of the child.
INFORMED CONSENT
 Definition:
 Refers to the Legal and Ethical requirements
that patients must completely understand
proposed treatment, including the RISKS &
BENEFITS as well as alternative procedures.
 Should be done by the primary physician, but
the nurse is often involved in confirming that
the patient understands the information and
has the patient sign the consent for treatment
forms.
 This is a big issue in Pediatrics.
3 THINGS NEEDED FOR INFORMED
CONSENT (HOCKENBERRY, PP. 999-1000,
9TH ED. PP. 883-885 10TH ED.))
 Person must be “capable” of giving
consent ( have adequate mental
capacities), & be over the age of 18 years.
 Person must receive enough information
necessary to make an intelligent decision.
 Person must act voluntarily when
exercising freedom of choice without
fraud, force, deceit, duress, or other forms
of constraint or coercion.
ASSENT
 An ethical requirement that a child be informed
about a proposed treatment or plan of care and
agree or concur with the decisions made by the
person(s) giving Informed Consent.
 Age where “assent” begins is ~7 years.
 Demonstrates respect for child’s right to know at
this level of intellectual development.
WHO CAN GIVE INFORMED CONSENT
FOR CHILDREN?

 Parent or Legal Guardian—


 need to be careful when dealing with divorced
families as to who has legal guardianship.

 Evidence of Consent/ Oral Consent


 e.g. via telephone with 2 persons listening and
witnessing.
WHO CAN GIVE INFORMED CONSENT
FOR CHILDREN? (CONT’D)

 Mature & Emancipated Minor


 Mature Minor’s doctrine: permits minors to
give consent who are >14 years of age, who can
understand all elements of informed consent,
as long as they understand consequences
 Emancipated Minor: Person under 18 yrs who
is recognized as having legal capacity of an
adult under these circumstances:
 Pregnancy
 Marriage

 High school graduation

 Living independently

 Military service
WHO CAN GIVE INFORMED CONSENT
FOR CHILDREN? (CONT’D)
 In IL, if < 18 yrs, can give consent if: PG,
married, or is a parent
 Mature minor doctrine

 In IL, do not NEED consent for:

• Contraceptives (includes EC) or


Pregnancy testing
• STI tx, includes HIV testing & tx (>12 yrs)
• Abortion (this changes)
• Sexual Assault tx
• Emergency care – consent implied by law
• Substance abuse care (> 12)
• Mental health services if >12 – 5 session limit
WHO CAN GIVE INFORMED CONSENT
FOR CHILDREN? (CONT’D)

 Treatment without parental consent—


 Times of emergency which include a “danger/threat
to life or possibility of permanent injury”
 In this instance, no consent is needed.
WHO CAN GIVE INFORMED CONSENT
FOR CHILDREN? (CONT’D)

 Parental Negligence—
 In cases of neglect or abuse by parent/legal
guardian, most states have statutory procedures by
which custody of the child is transferred to a
governmental or private agency (like DCFS) and
consent for treatment can then be obtained.
 The State does interfere with a parent’s rights in
the interest of protection of the child
 Blood Transfusion for a child of Jehovah’s Witness parents
 Medical tx for children of Christian Scientists
WHO CAN GIVE INFORMED CONSENT
FOR CHILDREN?

 Summary:
 As an RN, work within the law.
 Respect the patient and family wishes
as appropriate.
 Give full, informed consent after the
primary caregiver has reviewed it
with the appropriate parties, being
sure that the benefits AND the risks of
the procedure(s) have been discussed in
terms the consumer/family can
understand.
ROLE OF THE PEDIATRIC NURSE

 Therapeuticrelationships
 Family Advocacy/Caring
 Health Promotion/Disease Prevention
 Anticipatory Guidance
 Support/Counseling
 Restorative Role
 Coordination/Collaboration
 Ethical Decision Making
 Research – evidence based practice
 Health Care Planning – family & consumer
advocates
UNITED NATIONS’ DECLARATION OF THE
RIGHTS OF THE CHILD

 All Children Need:


 To be free from discrimination
 To develop physically & mentally in freedom and
dignity
 To have a name and nationality
 To have adequate nutrition, housing, recreation, and
medical services
 To receive special treatment if handicapped
 To receive love, understanding, & maternal security
 To receive an education and develop their abilities
 To be the first to receive protection in disaster
 To be protected from neglect, cruelty, & exploitation
 To be brought up in a spirit of friendship among people
YOU’VE GOT THE BASICS!
 Enjoy the wonderful world of Pediatric Nursing!
It’s one of the most rewarding things you will
ever do!!