Chapter 1: Perspectives of Pediatric Nursing
Health Care for Children
Healthy People 2020
o Framework for identifying essential components for child health promotion programs
o Designed to prevent future health problems in children
o Goal to increase quality and length of healthy life and eliminate health disparities
Substance abuse
Dental caries---single most common chronic disease of childhood
o Begins practicing dental hygiene beginning w/ the first tooth eruption; drinking fluoridated water, including bottled
water; and instituting early dental preventive care
Violence
Mental health disorders
Child Health Promotion
Provides opportunities to reduce differences in current health status among members of different groups and ensure equal
opportunities and resources to enable all children to achieve their fullest health potential
“Bright Futures”---book on kind of what to expect in the upcoming months or years –also provides family support, physical
activity, healthy weight, dental carries
o Really hits hard on safety!
Case Study
A group of nursing students have been asked to participate in a pediatric health fair. They will talk to participants about
health care for children. The nursing students know that the health fair will include both parents and children of all ages.
Leading Health Indicators (Healthy People 2020)
1) Physical inactivity
2) Overweight and obesity (#1 nutritional problem in children)
o Greater than the 95th percentile---child is considered obese
3) Tobacco use
4) Substance abuse
5) Responsible sexual behavior
6) Mental health
7) Injury and violence
8) Environmental quality
9) Immunization
10) Access to health care
Development
Developmental processes are unique to each stage of development:
o Infant
o Toddler
o Early Childhood
o Adolescence
Continuous screening and assessment are essential for early intervention when problems are found.
Nutrition in Infancy
Breast-feeding is BEST
o Human milk is the preferred form of nutrition for all infants
o Provides
Micronutrients
Immunologic properties
Enzymes that enhance digestion and absorption
Nutrition in Childhood
Lifelong eating habits established by age 3
Parent teaching
Eating preferences and attitudes related to food are established by:
o Family influences
o Culture
Homelessness and low income associated with lack of resources to provide children with adequate, nutritious meals.
Case Study (Cont.)
1
, When talking to parents about childhood obesity and type 2 diabetes, which topics should the nursing students discuss with
the parents? Select all that apply.
a) Obesity in children and adolescents is defined as a body mass index at or greater than the 95th percentile for
youth of the same age and gender.
b) Easy access to television and video games has increased the incidence of obesity.
c) Lack of physical exercise contributes to obesity.
d) The importance of allowing children to choose their favorite foods every day, including sweets such as dessert.
e) The importance of maintaining a normal body weight.
f) Overweight youth have increased risk for not only type 2 diabetes, but also high blood pressure and
dyslipidemia.
Dental Care
Dental caries are preventable
o Dental hygiene beginning with first tooth eruption
o Role of fluoridated water
o Early dental preventive care
o Parent and child teaching
Case Study (Cont.)
The single most common chronic disease of childhood is?
a) Arthritis
Cancer
b) Dental caries
c) Diabetes
Immunizations: Role of Nurse
Review individual immunization records at every clinic visit
Avoid missing opportunities to vaccinate
Encourage parents to keep immunizations current (U.S. Department of Health and Human Services, 2009)
Keep up with changes in immunization schedules, recommendations, and research related to childhood vaccines
www.cdc.gov/vaccines
HPV--- usually given at 11 yrs of age
o Girls pass out from HPV vaccine—less likely to happen if given at a younger age (9yrs)
Childhood Health Problems
Obesity and Type 2 Diabetes, p. 3
Childhood Injuries, p. 3
Violence, p. 6
Mental Health Problems, p. 6
Case Study (Cont.)
When talking to parents about pedestrian accidents, the nursing students know that the top reasons involving children are
related to motor vehicle–related deaths. Most of these accidents will occur in which areas? Select all that apply.
a) Driveways
b) Freeways
c) Intersections
d) Midblock
e) Parking lots
Mortality statistics refer to the number of individuals who have died over a specific period
Infant Mortality
o Death in first year of life per 1000 live births***
o 6 lives per 1000 live births (in 2011)
neonatal mortality (<28 days of life)
low birth weight (less than 2500g---5lbsish)
postneonatal mortality (28 days to 11 months)
o the lower the birth weight, the higher the mortality
o First 4 causes ( accounted for about half of all deaths of infants under 1 year of age)
1) Congenital anomalies
2) Disorders r/t short gestation and unspecified LBW
3) SIDS
4) Newborn affected by maternal complications of pregnancy
2
, Childhood Mortality
o Usually presented per 100,000 population
o Ages 5-14 –have the lowest rate of death
Usually do to accidental injuries
o Sharp rise is really seen after the age of 14----driving, adolescence, think they are invincible
Morbidity statistics show the prevalence of specific illness in the population at a particular time
Prevalence of a specific illness in a population
Childhood morbidity
Statistics generally rates per 1000 population
Difficult to define
o May denote acute illness, chronic disease, or disability
Resp. infections
Diarrhea
Common cold--- chief illness of childhood****
Childhood Morbidity
Acute illness: symptoms severe enough to limit activity or require medical attention
Respiratory illness = approximately 50% of all acute conditions
Infections and parasitic disease = 11%
Injuries = 15%
Leading cause of death from unintentional injuries in children= motor vehicle injuries
o Leading cause of death in children older than 1 year of age
Drowning and burns are among the top 3 causes of death for boys and girls throughout childhood
Intentional poisoning, associated w/ drug and alcohol abuse and suicide attempt, is the second leading cause of death in
adolescent females and the 3rd leading cause in adolescent males
The “New Morbidity”
AKA Pediatric Social Illness
o Behavior, social, and educational problems
o Psychosocial factors
Poverty, violence, aggression, noncompliance, school failure, and adjustment to parental separation and
divorce
o Mental health issues
Philosophy of Care (from American Nurses Association, 2010):
Protection, promotion, and optimization of health and abilities
Prevention of illness and injury
Alleviation of suffering through the diagnosis and treatment of human response
Advocacy in the care of individuals, families, and populations
Family-Centered Care: Two Basic Concepts
Enabling
o Current abilities and competencies
o Acquire new abilities and competencies as needed
o Means we are giving the parents the tools they need to take care of their child
Ex: baby admitted d/t FTT---give the parents the skills they need in order to be successful in taking care of
that child
Empowerment
o Interaction that allows the family to maintain or acquire a sense of control
o Behaviors that foster family’s strengths, abilities, and actions
o Giving the family the voice that they need---allow the parent to let their voice be heard. Empower the care givers
so they are able to recognize & pay attention to own gut instincts and act on them
Case Study (Cont.)
The nurse makes sure that the family maintains a sense of control over their lives while their child is in the hospital when
the nurse provides family-centered care and positively acknowledges their strength and helping behaviors. What concept
would this nurse’s actions demonstrate?
a) Nonmaleficenceobligation to minimize or prevent harm
b) Empowerment
c) Atraumatic care eliminate or minimize distress (psychological/ physical)
d) Enabling
3
, Atraumatic Care
Eliminate or minimize distress
o Psychologic
Anxiety, fear, anger, disappointment, sadness, shame, or guilt
o Physical
Sleeplessness and immobilization to disturbances from sensory stimuli such as pain, temperature
extremes, loud noises, bright lights, or darkness
Goals of Atraumatic Care
Prevent or minimize separation from the family
Promote sense of control
Prevent or minimize bodily injury and pain
Examples
o Foster the parent-child relationship
o Prepare child before any treatment or procedure
o Control pain
o Allow privacy
o Provide play activities for expression of fear and aggression
o Providing choices to children
o Respecting cultural differences
Role of the Pediatric Nurse
Therapeutic Relationship
Family Advocacy and Caring
Disease Prevention and Health Promotion
Health Teaching
Injury Prevention injuries kill or disable more children over 1 year old than all childhood diseases combined
Support and Counseling
Coordination and Collaboration
Ethical Decision Making
Ethical Decision Making
Ethical dilemmas = competing moral considerations
Competing moral values may include
o Autonomy patients right to be self-governing
o Nonmaleficence minimize or prevent harm (do no harm)
o Beneficence promote the patients well-being (do
good)
o Justice concept of fairness
Determine the most beneficial or least harmful action within
the framework of
o Societal mores
o Professional practice standards
o The law
o Institutional rules
o Family’s value system and religious traditions
o Nurse’s personal values
Evidence-Based Practice
Based on valid, important, and applicable patient-reported,
nurse-observed, and research-derived information
Combines knowledge with clinical experience and intuition
Provides a rational approach to decision making that
facilitates best practice
GRADE Criteria for EBP
Evaluates the quality of research articles used to develop
practice guidelines
Rates the quality of the evidence
4
Health Care for Children
Healthy People 2020
o Framework for identifying essential components for child health promotion programs
o Designed to prevent future health problems in children
o Goal to increase quality and length of healthy life and eliminate health disparities
Substance abuse
Dental caries---single most common chronic disease of childhood
o Begins practicing dental hygiene beginning w/ the first tooth eruption; drinking fluoridated water, including bottled
water; and instituting early dental preventive care
Violence
Mental health disorders
Child Health Promotion
Provides opportunities to reduce differences in current health status among members of different groups and ensure equal
opportunities and resources to enable all children to achieve their fullest health potential
“Bright Futures”---book on kind of what to expect in the upcoming months or years –also provides family support, physical
activity, healthy weight, dental carries
o Really hits hard on safety!
Case Study
A group of nursing students have been asked to participate in a pediatric health fair. They will talk to participants about
health care for children. The nursing students know that the health fair will include both parents and children of all ages.
Leading Health Indicators (Healthy People 2020)
1) Physical inactivity
2) Overweight and obesity (#1 nutritional problem in children)
o Greater than the 95th percentile---child is considered obese
3) Tobacco use
4) Substance abuse
5) Responsible sexual behavior
6) Mental health
7) Injury and violence
8) Environmental quality
9) Immunization
10) Access to health care
Development
Developmental processes are unique to each stage of development:
o Infant
o Toddler
o Early Childhood
o Adolescence
Continuous screening and assessment are essential for early intervention when problems are found.
Nutrition in Infancy
Breast-feeding is BEST
o Human milk is the preferred form of nutrition for all infants
o Provides
Micronutrients
Immunologic properties
Enzymes that enhance digestion and absorption
Nutrition in Childhood
Lifelong eating habits established by age 3
Parent teaching
Eating preferences and attitudes related to food are established by:
o Family influences
o Culture
Homelessness and low income associated with lack of resources to provide children with adequate, nutritious meals.
Case Study (Cont.)
1
, When talking to parents about childhood obesity and type 2 diabetes, which topics should the nursing students discuss with
the parents? Select all that apply.
a) Obesity in children and adolescents is defined as a body mass index at or greater than the 95th percentile for
youth of the same age and gender.
b) Easy access to television and video games has increased the incidence of obesity.
c) Lack of physical exercise contributes to obesity.
d) The importance of allowing children to choose their favorite foods every day, including sweets such as dessert.
e) The importance of maintaining a normal body weight.
f) Overweight youth have increased risk for not only type 2 diabetes, but also high blood pressure and
dyslipidemia.
Dental Care
Dental caries are preventable
o Dental hygiene beginning with first tooth eruption
o Role of fluoridated water
o Early dental preventive care
o Parent and child teaching
Case Study (Cont.)
The single most common chronic disease of childhood is?
a) Arthritis
Cancer
b) Dental caries
c) Diabetes
Immunizations: Role of Nurse
Review individual immunization records at every clinic visit
Avoid missing opportunities to vaccinate
Encourage parents to keep immunizations current (U.S. Department of Health and Human Services, 2009)
Keep up with changes in immunization schedules, recommendations, and research related to childhood vaccines
www.cdc.gov/vaccines
HPV--- usually given at 11 yrs of age
o Girls pass out from HPV vaccine—less likely to happen if given at a younger age (9yrs)
Childhood Health Problems
Obesity and Type 2 Diabetes, p. 3
Childhood Injuries, p. 3
Violence, p. 6
Mental Health Problems, p. 6
Case Study (Cont.)
When talking to parents about pedestrian accidents, the nursing students know that the top reasons involving children are
related to motor vehicle–related deaths. Most of these accidents will occur in which areas? Select all that apply.
a) Driveways
b) Freeways
c) Intersections
d) Midblock
e) Parking lots
Mortality statistics refer to the number of individuals who have died over a specific period
Infant Mortality
o Death in first year of life per 1000 live births***
o 6 lives per 1000 live births (in 2011)
neonatal mortality (<28 days of life)
low birth weight (less than 2500g---5lbsish)
postneonatal mortality (28 days to 11 months)
o the lower the birth weight, the higher the mortality
o First 4 causes ( accounted for about half of all deaths of infants under 1 year of age)
1) Congenital anomalies
2) Disorders r/t short gestation and unspecified LBW
3) SIDS
4) Newborn affected by maternal complications of pregnancy
2
, Childhood Mortality
o Usually presented per 100,000 population
o Ages 5-14 –have the lowest rate of death
Usually do to accidental injuries
o Sharp rise is really seen after the age of 14----driving, adolescence, think they are invincible
Morbidity statistics show the prevalence of specific illness in the population at a particular time
Prevalence of a specific illness in a population
Childhood morbidity
Statistics generally rates per 1000 population
Difficult to define
o May denote acute illness, chronic disease, or disability
Resp. infections
Diarrhea
Common cold--- chief illness of childhood****
Childhood Morbidity
Acute illness: symptoms severe enough to limit activity or require medical attention
Respiratory illness = approximately 50% of all acute conditions
Infections and parasitic disease = 11%
Injuries = 15%
Leading cause of death from unintentional injuries in children= motor vehicle injuries
o Leading cause of death in children older than 1 year of age
Drowning and burns are among the top 3 causes of death for boys and girls throughout childhood
Intentional poisoning, associated w/ drug and alcohol abuse and suicide attempt, is the second leading cause of death in
adolescent females and the 3rd leading cause in adolescent males
The “New Morbidity”
AKA Pediatric Social Illness
o Behavior, social, and educational problems
o Psychosocial factors
Poverty, violence, aggression, noncompliance, school failure, and adjustment to parental separation and
divorce
o Mental health issues
Philosophy of Care (from American Nurses Association, 2010):
Protection, promotion, and optimization of health and abilities
Prevention of illness and injury
Alleviation of suffering through the diagnosis and treatment of human response
Advocacy in the care of individuals, families, and populations
Family-Centered Care: Two Basic Concepts
Enabling
o Current abilities and competencies
o Acquire new abilities and competencies as needed
o Means we are giving the parents the tools they need to take care of their child
Ex: baby admitted d/t FTT---give the parents the skills they need in order to be successful in taking care of
that child
Empowerment
o Interaction that allows the family to maintain or acquire a sense of control
o Behaviors that foster family’s strengths, abilities, and actions
o Giving the family the voice that they need---allow the parent to let their voice be heard. Empower the care givers
so they are able to recognize & pay attention to own gut instincts and act on them
Case Study (Cont.)
The nurse makes sure that the family maintains a sense of control over their lives while their child is in the hospital when
the nurse provides family-centered care and positively acknowledges their strength and helping behaviors. What concept
would this nurse’s actions demonstrate?
a) Nonmaleficenceobligation to minimize or prevent harm
b) Empowerment
c) Atraumatic care eliminate or minimize distress (psychological/ physical)
d) Enabling
3
, Atraumatic Care
Eliminate or minimize distress
o Psychologic
Anxiety, fear, anger, disappointment, sadness, shame, or guilt
o Physical
Sleeplessness and immobilization to disturbances from sensory stimuli such as pain, temperature
extremes, loud noises, bright lights, or darkness
Goals of Atraumatic Care
Prevent or minimize separation from the family
Promote sense of control
Prevent or minimize bodily injury and pain
Examples
o Foster the parent-child relationship
o Prepare child before any treatment or procedure
o Control pain
o Allow privacy
o Provide play activities for expression of fear and aggression
o Providing choices to children
o Respecting cultural differences
Role of the Pediatric Nurse
Therapeutic Relationship
Family Advocacy and Caring
Disease Prevention and Health Promotion
Health Teaching
Injury Prevention injuries kill or disable more children over 1 year old than all childhood diseases combined
Support and Counseling
Coordination and Collaboration
Ethical Decision Making
Ethical Decision Making
Ethical dilemmas = competing moral considerations
Competing moral values may include
o Autonomy patients right to be self-governing
o Nonmaleficence minimize or prevent harm (do no harm)
o Beneficence promote the patients well-being (do
good)
o Justice concept of fairness
Determine the most beneficial or least harmful action within
the framework of
o Societal mores
o Professional practice standards
o The law
o Institutional rules
o Family’s value system and religious traditions
o Nurse’s personal values
Evidence-Based Practice
Based on valid, important, and applicable patient-reported,
nurse-observed, and research-derived information
Combines knowledge with clinical experience and intuition
Provides a rational approach to decision making that
facilitates best practice
GRADE Criteria for EBP
Evaluates the quality of research articles used to develop
practice guidelines
Rates the quality of the evidence
4
