Pediatric health Nursing

unit I
BSN year III, semester V
By
Hidayatullah khan
BSN, DPN & MSN
KMU- INS
 Objectives

•Perspectives of Pediatric Nursing

•Define the pediatric nursing.
•List the roles of pediatric nurse.
•Explain United Nations Convention
on the Rights of the Child (UNCRC)
•Understand ethical and legal issues
face by paediatric nurses in Pakistan
 Perspectives of Pediatric Nursing

Definition of Pediatric Nursing

Nursing is the caring for
prevention of illness, the alleviation of
suffering, and the protection, promotion,
and restoration of health in the care of
individuals, families, groups,
communities, and population.
 Definition of pediatric nursing cot…

• It is the art and science of giving

nursing care to children from birth
through adolescent with emphasis
on the physical growth, mental,
emotional and psycho-social
development.
 Role of Pediatric Nurse

The goals of nursing care of children, are:

• Promote the healthy maturation of the child as a
physical, intellectual and emotional being within the
context of his family and community (primary level)
• Provide health care for the child who requires
treatment from disease(s) (secondary level)
• Dealing with the Child's disabilities (tertiary level) or
rehabilitation which means maximizing the child's
potential level of his body function.
The role of the pediatric nurse includes:-
In primary level
• Through health education to the child and his
parents and providing child's basic needs and
immunization.
• The nurse can:
Maintain child's health.
Help the child to achieve his optimal growth and
development.
Prevent diseases and their complications.
 secondary level:

• The nurse has to provide care to sick children and

their families by:
o Assessing their needs.
o Planning for their care .
o Implementing the nursing care plan.
o Evaluating children's condition and the plan of care

o Providing health teaching to children and their parents

 In tertiary level

• The nurse should assist children to

return to their maximal level of
functioning following illness and or
disabilities.
 Family-Centered Care

The Family-Centered Care approach is:

recognizes the family as the one constant in a
child’s life, through Three key component
(Respect, Collaboration & Support).
 Parent education

• Growth and development needs

• Child's health promotion and maintenance as
nutritional need and hygienic care.
• Preventive aspects such as (accident
prevention, immunization, periodic examination).
• Child's illness (nature of illness and care needed).

• Plan for child's discharge such as child's medication,

follow up, nutrition…..etc.
 Family-Centered Care

The Family-Centered Care approach is:

The philosophy of family-centered care
recognizes the family as the one constant in a
child’s life, through Three key component
(Respect, Collaboration & Support).
 The role of pediatric nurse
•Therapeutic relationship.
•Family advocacy/caring.
•Disease prevention and health
promotion.
•Health teaching.
•Support/Counseling.
 The role of pediatric nurse
•Restorative role.
•Coordination/Collaboration.
•Research: to apply research
findings to their practice.
•Health care planning on political
or legislative level.
•Ethical decision making.
 The role of pediatric nurse

Ethical decision making:

 Autonomy…….. The patient’s right to be self-
governing.
Nonmaleficence….. The obligation to minimize or
prevent harm.
 Beneficence……. The obligation to promote the
patient’s well being.
 Justice……..The concept of fairness.
The Rights of the child
United Nations Convention
on the Rights of the Child (UNCRC)
The United Nations Convention on the Rights of
the Child (UNCRC)

• The UNCRC is an international agreement

across the world which sets out rights of children
between the age of 0 and 18.

• adoption by the UN General Committee in 1989 and it is

the most widely adopted of all international agreements.
• As of November 2009, 194 countries have ratified it , including
every member of the United Nations.

• The UNCRC itself consists of 54 articles.

What is a right?

• Human rights are the basic things that all human

beings are entitled to in order to survive and to
develop. Every single person regardless of their
age has human rights, and the Government has
a responsibility to make sure that people’s rights
can be accessed, are respected can be enjoyed.

• Children and young people need special rights because they are
relatively more vulnerable compared to adults. The UNCRC brings
together children’s human rights into one international convention.

• The Government has a responsibility to ensure that all people

understand and respect Children’s Rights - this includes children
and young people, parents, families & teachers etc.
Definition of the child: The Convention defines a
'child ' as a person below the age of 18.

Non-discrimination: The Convention applies to all

children; whatever their race, religion, language,
boys or girl, rich or poor. No child should be
treated unfairly on any basis.

Best interests of the child: The best interests of

children must be the primary concern in making
decisions that may affect them. This particularly
applies to budget, policy and law makers.
Protection of rights: Governments have a
responsibility to take all available measures to make
sure children’s rights are respected, protected and
fulfilled.  
Parental guidance: Governments should respect the
rights and responsibilities of families to direct and
guide their children so that, as they grow, they learn
to use their rights properly.

Survival and development: Children have the right to

live. Governments should ensure that children survive
and develop healthily.
Registration, name, nationality, care: Registration,
name, nationality, care All children have the right to
a legally registered name, officially recognized by the
government. Children have the right to a nationality
(to belong to a country). Children also have the right
to know and, as far as possible, to be cared for by
their parents.

Preservation of identity: Children have the right to

an identity – an official record of who they are.
Governments should respect children’s right to a
name, a nationality and family ties.
Separation from parents: Children have the right to
live with their parent(s), unless it is bad for them.
Children whose parents do not live together have the
right to stay in contact with both parents, unless this
might hurt the child.

Family reunification: Families whose members live in

different countries should be allowed to move
between those countries so that parents and children
can stay in contact, or get back together as a family.

Kidnapping: Governments should take steps to stop

children being taken out of their own country illegally.
Respect for the views of the child: When adults
are making decisions that affect children, children
have the right to say what they think should
happen and have their opinions taken into account.

Freedom of expression : Children have the right to

get and share information, as long as the
information is not damaging to them or others. 
Freedom of thought, and religion : Children have
the right to think and believe what they want and
to practice their religion, as long as they are not
stopping other people from enjoying their rights.
 Freedom of association : Children have the
right to meet together and to join groups and
organizations, as long as it does not stop other
people from enjoying their rights.

Right to privacy: Children have a right to

privacy. The law should protect them from
attacks against their way of life, their good
name, their families and their homes.
Access to information; mass media : Children
have the right to get information that is
important to their health and well-being.
Governments should encourage mass media –
radio, television, newspapers and Internet
content sources – to provide information that
children can understand and to not promote
materials that could harm children.
Parental responsibilities; state assistance : Both parents
share responsibility for bringing up their children, and
should always consider what is best for each child.
governments to provide support services to parents,
especially if both parents work outside the home.
Protection from all forms of violence : Children have
the right to be protected from being hurt and
mistreated, physically or mentally.  
Children deprived of family environment : Children who
cannot be looked after by their own family have a right
to special care and must be looked after properly, by
people who respect their ethnic group, religion, culture
and language. 
Adoption : Children have the right to care and
protection if they are adopted .The same rules should
apply whether they are adopted in the country where
they were born, or if they are taken to live in another
country.
Refugee children : Children have the right to special
protection and help if they are refugees (if they have
been forced to leave their home and live in another
country) .
Children with disabilities : Children who have any kind
of disability have the right to special care and support,
so that they can live full and independent lives.
Health and health services : Children have the right
to good quality health care – the best health care
possible – to safe drinking water, nutritious food, a
clean and safe environment, and information to
help them stay healthy. Rich countries should help
poorer countries achieve this.
 
Review of treatment in care : Children who are
looked after by their local authorities, rather than
their parents. Their care and treatment should
always be based on “the best interests of the child”.
Social security: Children – either through their
guardians or directly – have the right to help
from the government if they are poor or in need.

Adequate standard of living : Children have the

right to a standard of living that is good enough
to meet their physical and mental needs.
Governments should help families and guardians
who cannot afford to provide this, particularly
with regard to food, clothing and housing.
Right to education : All children have the right to a
primary education, which should be free.
Goals of education: Children’s education should
develop each child’s personality, talents and abilities
to the fullest. It should encourage children to respect
others, human rights and their own and other
cultures.

Children of minorities/indigenous groups : Minority

or indigenous children have the right to learn about
and practice their own culture, language and religion.
Leisure, play and culture : Children have the right
to relax and play, and to join in a wide range of
cultural, artistic and other recreational activities.
 
Child labour : The government should protect
children from work that is dangerous or might harm
their health or their education.
 
 Drug abuse: Governments should use all means
possible to protect children from the use of harmful
drugs and from being used in the drug trade.
Sexual exploitation : Governments should protect
children from all forms of sexual exploitation and
abuse.
 
Abduction, sale and trafficking : The government
should take all measures possible to make sure that
children are not abducted, sold or trafficked.

Other forms of exploitation : Children should be

protected from any activity that takes advantage of
them or could harm their welfare and development.
Detention and punishment : No one is allowed to
punish children in a cruel or harmful way. Children
who break the law should not be treated cruelly.
They should not be put in prison with adults, should
be able to keep in contact with their families, and
should not be sentenced to death or life
imprisonment without possibility of release.
War and armed conflicts : Governments must do
everything they can to protect and care for children
affected by war. Children under 15 should not be
forced or recruited to take part in a war or join the
armed forces.
Rehabilitation of child victims : Children who
have been neglected, abused or exploited
should receive special help to physically and
psychologically recover and reintegrate into
society. Particular attention should be paid to
restoring the health, self-respect and dignity
of the child.
Juvenile justice : Children who are accused of
breaking the law have the right to legal help
and fair treatment in a justice system that
respects their rights. Governments are
required to set a minimum age below which
children cannot be held criminally responsible
and to provide minimum guarantees for the
fairness and quick resolution of judicial or
alternative proceedings.
Respect for superior national standards : If the laws of
a country provide better protection of children’s rights
than the articles in this Convention, those laws should
apply.
 
Knowledge of rights - Implementation and monitoring
: Governments should make the Convention known to
adults and children. Adults should help children learn
about their rights, too. To ensure implementation,
States shall establish “a Committee on the Rights of the
Child … [to which UNICEF] and other [UN] organs [may]
provide expert advice.
Legal and Ethical Issues in Pediatrics,
 Malpractice in the Pediatric Settings

• Negligence is defined as an occasion when a

person owes a duty to another and, through
failure to fulfill that duty, causes harm
• Malpractice is professional negligence
For a court to recognize a claim of malpractice o
negligence, four legal elements must be present

1. There must be a duty owed to the client

by nurse
2. The nurse must breach the duty
3. The breach of duty must be the cause of
the damage
4. There must be actual damage to the client
Breach of Duty: 5 R Rule
 State Statutes
• State Nursing Practice Act and PNC Rules &
Regulations
– Define the scope and limitations of professional
nursing practice
– Vary from state to state but have common
elements
– Penalties for violations
• Formal reprimand
• Period of probation
• Fines
• Limiting, suspending, or revoking license
 Informed consent
• Informed Consent (IC) is the duty of a health
care provider to discuss the risks and benefits
of a treatment or procedure with a client
prior to giving care
 IC must include the following:
1.The nature of the procedure
2.The risks and hazards of the procedure
3.The alternatives to the procedure
4.The benefits of the procedure
 When IC is Not Required
• In case of emergency situation
• in case if health care providers have made a
reasonable attempt to contact the child parent
• evaluation and treatment of a child for suspected
physical or sexual abuse.
• In case of forensic examination (do not force or
restrain the child to perform genital or rectal
examination)
 When a minor can consent for care?
• Care involving pregnancy, contraception, or
treatment of STD
• Drug and alcohol treatment
• In some states – emancipated children can
make their health care decisions by
themselves
 When a minor can consent for care?
• “a minor can consent to care as long as the
individual demonstrates the maturity to
understand the risks and benefits of the
treatment”
 Parental Consent after Divorce
• After divorce, the ability to consent for
medical care rests with the parent who has
been granted legal custody by the divorce
decree ( the legal document approved by the
court that grant divorce, divides marital
property, and specifies child custody)
• Legal custody v. physical custody
Refusal of Medical Care by Parent
or Child
• Religious beliefs - state can make legal
decision for the child
• PARENS PATRIE
 Refusal of Medical Care by Parent or
Child
• Some states use child abuse statutes that
make medical neglect a form of abuse as legal
justification to take custody of a child who
needs medical care.
• The religious exemption clause only prevent
the parents from being prosecuted for medical
neglect.
 Obtaining IC under Special
Circumstances
• Consent for donation of tissues or organs
• Consent for genetic testing
• Consent for medical experimentation with
children
 Consent for Donation of Tissues or Organs
• If a child is too young, the parent or legal guardian
may consent for the child
• Three requirement for the minor to be a donor:
1. The parent who is consenting must be aware of the
risks and benefits
2. The child primary caregiver must be able to provide
emotional support for the child
3. There must be a close relationship between the
donor and the recipient
 Consent for Genetic Testing
• Dilemma created by new technology
• The benefits and the risks should be discussed
with a child if appropriate
• Parents or guardian can consent for the
testing
• Genetic testing should not be performed on a
child unless the results of the test will serve
the best interests of the child
 Consent for Medical
•
Experimentation on Children
All research facilities that receive federal funds must
comply with federal regulations that require review
of all experimental protocols by an Institutional
Review Board (IRB)
• Federal regulations require the consent of one or
both parents and the assent of the child, depending
on the amount of the potential risk and benefit
associated with the treatment or procedure.
 Confidentiality
• The right to confidential health care is
protected by PNC the ethical codes of
conduct.
• Confidentiality is an essential part of the
relationship between client and health care
provider
• Nurse has a duty of confidentiality (disciplined
by both employer and PNC)
 When a Minor can Receive
Confidential Care
• Contraception, treatment of
STD DEPENDS
• Drug and alcohol treatment ON
• Mental health care STATE
• HIV testing LAWS
AND
REGULATIONS
 When a Health Care Provider Can
Breach
There are 4 exceptions:
Confidentiality
1. Mandatory reporting laws for child abuse
2. Mandatory injury reporting laws that apply to all
clients who are injured by a weapon or criminal act
3. Public health law that require reporting infectious
diseases to the local health department
4. A duty to warn third parties