Judith A. Vessey, PhD, DPNP, RN, FAAN Boston College and Children’s Hospital, Boston.

Judith A. Vessey, PhD, DPNP, RN, FAANBoston College and Children’s Hospital, Boston

Objectives

Describe the evolution of pediatric nursing as a specialty practice discipline

Discuss historic events and policy and practice issues that have impacted the development of pediatrics as a nursing specialty

Given national pediatric nursing education survey results, develop strategies to strengthen competencies in pediatric nursing practice

THE EVOLUTION OF PEDIATRIC NURSING AS A SPECIALTY PRACTICE DISCIPLINE

1850▼

•Specialized care for children was developed in response to profound societal needs

•Prior to the 19th c, children needed for agrarian lifestyle•Little to no understanding of disease and illness•High childhood mortality

•Mid 19th c.: the industrial revolution and major social upheaval•Populations of major cities grew exponentially

•by 1840, 30% under the age of ten•Public health was extremely poor•Working conditions were abysmal•Children would go to work as young as six or seven•Housing was substandard

Great Ormond Street Hospital

1852▼

Goals: Providing inpatient medical treatment to ill children and

advice to mothers of sick children who were not admitted Promoting the advancement of medical science Employing (the hospital) as a school for the education and

training of women in the special duties of children's nursing

“The instruction of young women in the care and management of sick children sets the pattern of development in sick children’s nursing for the next 100 years.”

C. West1854

▼

• “Sick children require special nursing“• “Sick children's nurses require special training"• She insisted that her nurses keep the child: "well amused by occupations and interest”

Miss Woods,Superintendent

“Whatever you do, do not have children’s wards in a general hospital, but mix them up with the adults for where adults are mixed with them, the woman in the next bed, if the patients are judiciously distributed, often becomes the child’s best protector and nurse.”

F. Nightingale1859

▼

1855: Children's Hospital of Philadelphia1869: Children’s Hospital, Boston1880: Children's Hospital in San Francisco1894: Floating Hospital for Children

By the end of the 19th century, virtually every major city had a children’s hospital

1855▼

Children’s Hospitals in the US

1869▼

1880▼

1894▼

Henry Street Settlement

1893▼

1902▼

•Children also were a major emphasis of public health nursing •Public health nursing was initiated by Lillian Wald in 1883-- the Henry Street Settlement House

•Other community activists complemented nursing’s contributions•Lina Rogers: stared school nursing in 1902

• Public health efforts had little involvement with organized pediatric nursing

•1878: first school of pediatric nursing opened in Boston

•1895: second school was the CHOP Ingersoll Training School

•These and similar schools taught little that wasn't acute care

•1886: pediatric nursing began appearing in nursing texts

•1917: Standard Curriculum for Schools of Nursing stated content to be included in pediatric nursing classes

•1923: The Committee for the Study of Nursing Education, commissioned by the Rockefeller Foundation, published their recommendations in Nursing and Nursing Education in the United States (the Goldmark Report)

•Harsh criticism for the state of nursing

Training Schools

Federal MCH Initiatives

•White Conference on Children•Children’s Health Bureau•Sheppard-Towner Maternity and Infancy Act

•Social Security Act—Title V•Maternal-Child Services

•Crippled Children’s Services •Title XIX: Social Security Act of 1965•First comprehensive federal entitlement for children’s health

1921▼

1929▼

‘12▼

1935▼

1909▼

1965▼

Loretta Ford & Henry Silver and the birth of the

Pediatric Nurse Practitioner Movement

1964▼

Federal Activities Helping to Shape Child Welfare & Healthcare

•1965: Head Start•1972: Special Supplemental Food Program for Women, Infants, & Children (WIC)•1973: EPSDT enacted•1975: SSI for Children with Disabilities•1981: Maternal-Child Block Grants•1984: Emergency Medical Services for Children•1994: Healthy Start Program•1996: Temporary Assistance for Needy Families (TANF)•1997: State Children’s Health Insurance Program (S-CHIP)

1965▼

1997▼

Pediatric Nursing Professional Organizations

•Interdisciplinary Groups:•1965: Association for the Care of Children’s Health

•Independent Specialty Pediatric Nursing groups:•1971: Association of Child & Adolescent Psychiatric Nurses•1973: NAPNAP•1973: APON•1969-79: NASN•1984: NANN

•Independent General Pediatric Nursing group:•1990:Society for Pediatric Nurses

•Subspecialty groups within other pediatric nursing organizations1965

▼1990

▼

Pediatric Certification and Licensure

•PNP certification

•Change to NCLEX

•General pediatric nursing certification

1977▼

1989▼

78▼

THE IMPACT OF HISTORICAL EVENTS ON THE DEVELOPMENT OF PEDIATRIC NURSING

Strengths

•Family-centered care & care coordination, medical homes•Symptom assessment•Managing prematurity•School health•Pediatric nurse practitioners

•Lack of a central professional identity•Lack of integrated partnerships

•Children’s hospitals free-standing•Change in focus of MSN programs•Cost of pediatric nursing

Threats

•NCLEX •Aging population•Many areas of practice were, but are not now, the strict purview of pediatric nursing are

Opportunities•Academic-practice partnerships

•Endowed chairs•CTSA grants

•Embrace the changes in occurring in children’s hospitals

•Magnet status•Clinical inquiry •Nurse residencies•Integrated health systems

•Patient Protection & Affordable Care Act

STRATEGIES TO STRENGTHEN PEDIATRIC COMPETENCIES