63-277

63-277 Winter 2004

63-27763-277

NURSING CARE OF CHILDREN NURSING CARE OF CHILDREN AND YOUTHAND YOUTH

WITH EPISODIC AND LONG-WITH EPISODIC AND LONG-TERM HEALTH NEEDSTERM HEALTH NEEDS

63-277 Winter 2004

Pediatric Nursing As SpecialtyPediatric Nursing As Specialty • Complex – multiple ages & stagesComplex – multiple ages & stages

• Anatomy & physiology different from adultAnatomy & physiology different from adult

• Growth & developmental stages Growth & developmental stages

• Full of change Full of change

• Atraumatic care Atraumatic care

• Family centred care Family centred care

• Emphasis on anticipatory guidance, risk Emphasis on anticipatory guidance, risk reduction, injury prevention reduction, injury prevention

63-277 Winter 2004

Changing Pediatric SceneChanging Pediatric Scene• Partnership with familiesPartnership with families technologytechnology

• Changing demographics Changing demographics

• Smaller familiesSmaller families

• Ethnic diversityEthnic diversity survivors of premature births survivors of premature births demands for adolescent caredemands for adolescent care

• Movement of care into home/communityMovement of care into home/community

63-277 Winter 2004

Key Elements of Family Centred CareKey Elements of Family Centred Care • partnershippartnership model model• family is the “constant”family is the “constant”• effective communication with parentseffective communication with parents• honour cultural diversity honour cultural diversity • support family strengths & resources support family strengths & resources • recognize & respect methods of coping recognize & respect methods of coping • facilitate flexible plans of care facilitate flexible plans of care

63-277 Winter 2004

Nursing Care with Children & Nursing Care with Children &

FamiliesFamilies • Orient to “care by family” approach Orient to “care by family” approach • Increase family involvement Increase family involvement • Learn interpersonal skills Learn interpersonal skills • Self-awareness Self-awareness • Critical thinking - purposeful, organized, Critical thinking - purposeful, organized,

goal-directed goal-directed

63-277 Winter 2004

BEVIS’ NURSING SYSTEMBEVIS’ NURSING SYSTEM INPUT

NEEDS PROBLEMS

GOALSDESIRES

of IndividualsFamiliesGroups

THROUGHPUTCONCEPTS – LIFE

TASKSAdaptation

(Stresses & Strains)Maturation

TOOLSProblem-Solving/Decision-

MakingCommunication

Teaching/LearningManagement/Change

Caring

OUTPUTBEHAVIOURS

ProtectiveNurturative Generative

CLIENT SYSTEMS

IntrapersonalInterpersonalCommunity

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

63-277 Winter 2004

Use of Nursing ProcessUse of Nursing Process • AssessmentAssessment

• PhysiologicalPhysiological • History, examination, diagnosticsHistory, examination, diagnostics

• DevelopmentalDevelopmental • Developmental stages & tasksDevelopmental stages & tasks• Client & familyClient & family

• Psychosocial Psychosocial • Culture, language, religionCulture, language, religion• EconomicsEconomics• Family roles, health beliefsFamily roles, health beliefs• Communication Communication

63-277 Winter 2004

Nursing ProcessNursing Process (cont’d)(cont’d)

• Diagnosis & PlanningDiagnosis & Planning• NANDANANDA• Parenting & family diagnosesParenting & family diagnoses• Family-centred care goals/beliefs & identified Family-centred care goals/beliefs & identified

health goalshealth goals • Collaboration – mutual identification of goalsCollaboration – mutual identification of goals

63-277 Winter 2004

Nursing ProcessNursing Process (cont’d)(cont’d)

• InterventionsInterventions• creative nursing creative nursing • interdependent nursing actions, collaboration interdependent nursing actions, collaboration • identify supports/resources, referrals identify supports/resources, referrals • teaching/learning teaching/learning • ensure safety, security of child ensure safety, security of child • care appropriate to age & development care appropriate to age & development • caring, compassion, comfort caring, compassion, comfort

63-277 Winter 2004

Ethical Decision-MakingEthical Decision-Making

• AutonomyAutonomy

• Non-maleficenceNon-maleficence

• BeneficienceBeneficience

• JusticeJustice

63-277 Winter 2004

Ethical-Legal IssuesEthical-Legal Issues

• Atraumatic careAtraumatic care• Consent for treatmentConsent for treatment• Maintaining nursing recordsMaintaining nursing records• ConfidentialityConfidentiality• Research with childrenResearch with children

63-277 Winter 2004

UN Bill of Rights (1959) UN Bill of Rights (1959) & Convention of Rights (1989)& Convention of Rights (1989)

• Definition of a ChildDefinition of a Child

A child is recognized as a person under 18, unless A child is recognized as a person under 18, unless

national laws recognize the age of majority earliernational laws recognize the age of majority earlier

63-277 Winter 2004

• Children’s RightsChildren’s Rights• Freedom from discriminationFreedom from discrimination• Conditions of freedom & dignityConditions of freedom & dignity• Name & nationalityName & nationality• Adequate nutrition, Adequate nutrition, housing, recreation and housing, recreation and

medical servicesmedical services • Care of parents – moral, material securityCare of parents – moral, material security• Protection from neglect, exploitationProtection from neglect, exploitation• EducationEducation• First to receive protection and reliefFirst to receive protection and relief• Be brought up in a spirit of understanding, Be brought up in a spirit of understanding,

tolerance, friendship among peoples, peace & tolerance, friendship among peoples, peace & universal brotherhood universal brotherhood

63-277 Winter 2004

AdvocacyAdvocacy

• Intervene to prevent developmental & health Intervene to prevent developmental & health problemsproblems

• Work with families to identify Work with families to identify needs, needs, strengths, goals, and plansstrengths, goals, and plans

• Educate about available servicesEducate about available services• Promote children’s well-being through Promote children’s well-being through

teaching, counseling, holistic care, teaching, counseling, holistic care, collaborationcollaboration

63-277 Winter 2004

Best Practice Best Practice

• Evidence-based practice & researchEvidence-based practice & research• Optimize care & standardsOptimize care & standards• Share & disseminate findingsShare & disseminate findings

• FutureFuture• Collaborative management, ambulatory care, Collaborative management, ambulatory care,

home care, health promotionhome care, health promotion

• RNAO Best Practice GuidelinesRNAO Best Practice Guidelines

63-277 Winter 2004

RNAO BPG: RNAO BPG:

SUPPORTING & SUPPORTING &

STRENGTHENING STRENGTHENING

FAMILIESFAMILIES

63-277 Winter 2004

Levels of PreventionLevels of Prevention• PrimaryPrimary

• Health promotion, disease & injury Health promotion, disease & injury preventionprevention

• SecondarySecondary• Screening & early diagnosisScreening & early diagnosis

• TertiaryTertiary• Disease management, optimizing Disease management, optimizing

rehabilitationrehabilitation

63-277 Winter 2004

Community AssessmentCommunity Assessment

• DemographicsDemographics• PopulationPopulation

• Culture, ethnicityCulture, ethnicity

• Social classSocial class

• Family size, typesFamily size, types

63-277 Winter 2004

• Community SystemsCommunity Systems• Health & social servicesHealth & social services• CommunicationCommunication• RecreationRecreation• Physical environmentPhysical environment• EducationEducation• Safety & transportationSafety & transportation• Politics & governmentPolitics & government• EconomicsEconomics

63-277 Winter 2004

Cultural AssessmentCultural Assessment

• Cultural diversity, subcultures, minoritiesCultural diversity, subcultures, minorities

• Class structure – upper, middle, lowerClass structure – upper, middle, lower

• ““Culture shock” – new immigrant experienceCulture shock” – new immigrant experience

• Barriers – language, habits, attitudes & Barriers – language, habits, attitudes &

beliefs, isolationbeliefs, isolation

• Stereotypes & prejudicesStereotypes & prejudices

• Cultural health practicesCultural health practices

63-277 Winter 2004

PovertyPoverty• Episodic or chronicEpisodic or chronic• Visible or invisibleVisible or invisible• Homelessness, migrant populationsHomelessness, migrant populations• Issues: Issues:

chronic illnesses, injuries, dental caries, etc.chronic illnesses, injuries, dental caries, etc.• poor nutritionpoor nutrition• lack of resourceslack of resources• delayed growth & developmentdelayed growth & development teen pregnanciesteen pregnancies

63-277 Winter 2004

Nursing Activities for the CommunityNursing Activities for the Community

• Needs assessment – community prioritiesNeeds assessment – community priorities

• Public HealthPublic Health • Health assessment, disease surveillance, Health assessment, disease surveillance,

policy developmentpolicy development

• Health promotionHealth promotion• Perinatal care, screening clinics, parenting Perinatal care, screening clinics, parenting

skills education, education on health/injury risksskills education, education on health/injury risks

• Injury PreventionInjury Prevention• Develop and implement prevention strategiesDevelop and implement prevention strategies

63-277 Winter 2004

Haddon Phase-Factor MatrixHaddon Phase-Factor MatrixUseful for planning, strategy identification, resource allocationUseful for planning, strategy identification, resource allocation

Phase

Host(Human)

Vector(Vehicle)

Physical Environment

Cultural Environment

Pre-Event

Event

Post-Event

63-277 Winter 2004

Haddon Phase-Factor MatrixHaddon Phase-Factor MatrixApplication to Playground SafetyApplication to Playground Safety

PhaseHost(Human)

Vector(Vehicle)

Physical Environment

Cultural Environment

Pre-Event

-before the fall

Teaching re: playground rules

Construct safe equipment

Playground design to minimize risk.

Foster social norms of orderly play.

Event- time of

fall/ impact

Teach how to fall to minimize injury

Reduce sharp protrusions to reduce injury in falls.

Use of resilient surfacing.

Develop comm.-unity systems to monitor playground

Post-Event-after injury

Teach children how to summon help

Playground accessible to rescue personnel

Benches placed so parents can supervise & notice injury.

Ensure funding for trained emergency personnel.

63-277 Winter 2004

Vital StatisticsVital Statistics

• Mortality: Mortality: number of deaths in a specific period number of deaths in a specific period (rate/100,000 population)(rate/100,000 population)

• Infant Mortality Rate: Infant Mortality Rate: number of deaths during number of deaths during 11stst year of life (rate/1000 births) year of life (rate/1000 births)

• Morbidity: Morbidity: prevalence of a specific illness prevalence of a specific illness (rate/1000) (rate/1000)

• New Morbidity: New Morbidity: pediatric social illnesses e.g. pediatric social illnesses e.g. poverty, abuse, violence, school failure, divorcepoverty, abuse, violence, school failure, divorce

63-277 Winter 2004

Leading Health Indicators for ChildrenLeading Health Indicators for Children

• Perinatal inheritencePerinatal inheritence• Optimal weightOptimal weight• NutritionNutrition• Injury/violenceInjury/violence• Environmental risks Environmental risks

(pollution)(pollution)• Access to health careAccess to health care• Substance use/abuseSubstance use/abuse

• Exposure to tobacco, Exposure to tobacco, alcoholalcohol

• Sexual behaviourSexual behaviour• Mental healthMental health• Gender (female)Gender (female)• Dominant ethnic groupDominant ethnic group• Family incomeFamily income• Home locationHome location• EducationEducation

63-277 Winter 2004

Leading Causes of Infant MortalityLeading Causes of Infant Mortality• Congenital anomaliesCongenital anomalies• PrematurityPrematurity• Low birth weightLow birth weight• Sudden infant death syndrome (SIDS)Sudden infant death syndrome (SIDS)• Maternal complications in pregnancyMaternal complications in pregnancy• Newborn birth complicationsNewborn birth complications• Respiratory distress syndrome (RDS)Respiratory distress syndrome (RDS)• Infections – bacterial sepsisInfections – bacterial sepsis• Birth asphyxiaBirth asphyxia• Intrauterine hypoxiaIntrauterine hypoxia

63-277 Winter 2004

Leading Causes of Childhood MortalityLeading Causes of Childhood Mortality

• After 1 year of ageAfter 1 year of age• Injuries/accidents are leading cause of deathInjuries/accidents are leading cause of death• Adolescence: higher risk for – Adolescence: higher risk for –

• InjuryInjury• HomicideHomicide• SuicideSuicide• CancerCancer• Heart diseaseHeart disease