Pediatrics
Pediatrics

Pediatrics

Lead Author(s): Jennifer Wheeler

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The pediatric study guide is an overview of essential concepts associated with the nursing care of children.

Pediatric Nursing: A Family-Centered Care Practice

Welcome to the Pediatric Study Guide. 

Through interactive technologies, students will learn about Family Centered Care (FCC) as it relates to the specialty nursing practice of Pediatrics. The purpose of this study guide is to facilitate student learning of the most common evidenced-based concepts in caring for children according to theories of growth and development. This resource is not intended to replace but rather augment the use of any pediatric text by highlighting current topics, summarizing information concerning the most critical elements of care, and providing self-directed techniques for the student learner such as discussion threads and quiz questions throughout each chapter. 


Fig 1.1

A Historical Review   

Learning Objectives:

  • Identify concepts associated with historical origins of pediatric nursing practice
  • Understand the role of the pediatric nurse according to Family Centered Care (FCC) concepts and regulatory institutions that guide pediatric practice.
  • Explain the Nursing Process as it relates to critical thinking and prioritization of nursing interventions in the care of children.


Fig. 1.2
"One way to create positive change for the future is by caring for the children of today."

 Historically, children were raised to fulfill supportive family roles and assume adult responsibilities at very early ages. Children were not valued in the same ways as today, which lead to abuse, neglect and early death.  Throughout the early 16th through 19th centuries, children were often considered the property of the parents' facing harsh abuses of being bought, sold or worked to the point of their demise.  Mortality rates were very high as communicable diseases were lethal and children being the most vulnerable to illness, often died in massive numbers affecting the overall status of populations.  The influx of families migrating to the United States created conditions of overcrowding of communities. Overcrowding resulted in rising mortality rates of children in urban settings as a result of unsanitary living conditions, improper ways of storing and preparing food, and a lack of regulatory work guidelines. In 1893 Lillian Wald became one of the first nursing advocates for these disparate communities in becoming the founder of the Henry Street Settlement. Henry Street Settlement was then and continues to be, a central hub for programs to support the underprivileged residents of Eastern America providing resources to social services, arts, and healthcare services.  She was an integral force for advocacy establishing the United States Children's Bureau, school nursing, and visiting nurse services for people who lived in more rural areas, eventually becoming the president of the first nationally organized public health nursing association. 

Along with social advocacy, new scientific advancements by renowned scientists such as Louis Pasteur best known for discoveries in microbiology, developed pasteurization improving the safety and quality of foods.  Joseph Lister pioneered techniques of antiseptic surgical procedures and Robert Koch,was awarded the Nobel Prize in 1905 for the discovery of modern bacteriology. These are just a few of the scientists who've contributed to the expansion of knowledge in medical science and whose discoveries have helped to decrease mortality throughout the world. Illness could now be prevented in ways that gave rise to healthier populations of people. 

Social and scientific advances continued to progress throughout the 20th-century. As knowledge of preventive measures evolved, programs supported by federal grants and healthcare regulatory agencies began to emerge. Increasingly, attention became more focused on the family unit and advocacy of children. Development of programs such as Women, Infants, and Children (WIC), and government agencies for regulation of immunizations such as the Hygenic Laboratory of the U.S. Public Health Service, that eventually became the National Institutes of Health (NIH),  and the American Academy of Pediatrics (AAP) is made up of professional teams of pediatricians who've come together to form an organization that promotes social, mental and physical, health and wellness initiatives for all children and young adults (American Academy of Pediatrics, 2017). The AAP is considered a guiding agency for practice development and regulation of safe healthcare initiatives for families and children in the United States today.  

With more social agencies supporting FCC, the realization and identification of unique forms of psychologic stress children and their families encounter when entering the hospital setting became apparent. Focused attention on the interrelations of families members brought to light that ambiguity of defined familial roles intensified when in the acute care environment. Intense parental stress and anxiety associated with ill children made it apparent that collaboration was a partnership essential for the recovery from illness and promotion of wellness among the pediatric populations of patients. Acknowledgment of the specific need for stress reduction gave rise to theoretical concepts of FCC as a holistic therapeutic approach that now serves as the standard method across the country of forming partnerships with families.

A snapshot of  Family Centered Care.....

Role of the Pediatric Nurse

Role of Pediatric Nurse

Skill in caring for children is directly related to our own cultural upbringing. Briefly, list the childcare skills you bring to this course.

Fig. 1.3

Pediatric nursing is often considered a specialty practice in many inpatient hospital settings. However, outside of the acute care environment, non-specialty nurses can be found in many diverse child care settings. 

These include but are not limited to:

  • Clinics
  • Physician's offices
  • Home health agencies
  • Schools
  • Rehabilitation centers
  • Summer Camps
  • Daycare Centers
  • Hospice
We're Better Together.....

Current primary preventative initiatives have changed the landscape of pediatric nursing care throughout the healthcare environment. As more focus is placed on wellness models when caring for children, goals of nursing care are being directed toward primary prevention of illness if and when at all possible. The United States Department of Health and Human Services (USDHHS) Healthy People 2020 pediatric initiatives address the most impactful disparities facing Early and Middle Childhood and Adolescent health in our society. These along with numerous specialty focused objectives enable the formation of a collaborative partnership that seeks to unify communities of providers across the nation in efforts to prevent future health crises on the rise. 


Healthy People 2020 Goals

Match the Healthy People 2020 Objective to its reference number

Premise
Response
1

Increase the proportion of parents who read to their young children

A

NWS-1

2

(Developmental) Increase the proportion of children aged 4-5 years diagnosed with ADHD who receive recommended behavioral treatment

B

PA-4

3

Increase the proportion of adolescents whose parents consider them to be safe at school

C

PA-8

4

Increase the proportion of 8th grade students whose mathematics skills are at or above the proficient achievement level for their grade

D

IVP-11

5

Increase the number of States with nutrition standards for foods and beverages provided to preschool-aged children in child care

E

EMC-5.1

6

Reduce the proportion of children and adolescents with untreated dental decay

F

AH-5.4.2

7

Maintain vaccination coverage levels for children in kindergarten

G

AH-8

8

Increase the proportion of the Nation’s public and private schools that require daily physical education for all students

H

OH-2

9

Increase the proportion of children and adolescents who do not exceed recommended limits for screen time

I

IID-10

10

Reduce unintentional injury deaths

J

EMC-2.3


High-Quality Ethical Care

When caring for families and children it is essential for nurses to carry forth interventions in an ethical and professional manner. Standards for these behaviors have been established by guiding nursing institutions such as the American Nurses Association (ANA) in the Code of Ethics and for the specialty of pediatric practice, the Society of Pediatric Nursing (SPN). Nursing associations such as these are designed to enhance the professional practice of individuals through regulatory guidelines, according to evidence-based research, aimed at guiding behaviors exemplary of nursing excellence.  Many regulatory institutions for practice exist within the field of nursing. Each provider must subscribe to self-development through life-long practices of seeking educational opportunities, participating in current research, and adhering to the application of safe care practices.

Using the Nursing Process to Develop Critical Thinking

A foundational theory,  universal for all nursing practice, is the application of the Nursing Process. The steps of care through assessment, diagnosis, planning, intervention, and evaluation are guiding concepts that direct nursing providers ability to critically think about their delivery systems and prioritize through reason the very best approach to their actions. Written by Jean Orlando and accepted in 1958, this timeless theory for nursing continues as the framework for practice excellence as Walton (2016) renews Benner's writing from the 1980's defining how the steps of the Nursing Process as essential building blocks for clinical reasoning continue to serve as the guide for nursing action in the clinical environment. 

The steps are defined as Assessment, Diagnosis, Planning, Intervention, and Evaluation. Critical thinking enables development of the novice nurse to obtain professional expertise through the practical application of skilled learning. Critically thinking through the nursing process as it relates to professional growth requires one to examine their assumptions according to an understanding or set of learned skills. Over time and with experience of carefully examining clinical events as a routine practice of self-assessment, the novice nurse can progress to a level of proficiency and eventually achieve expertise in advocacy. Nurses who do not practice self-examination of their thoughts in ways that review for errors of professional behavior or actions can lead to inaccuracies in clinical judgment and risks client harm.  

Prioritization of Nursing Response

When critically thinking about a plan of client care, determining the appropriate course of nursing action occur through prioritization of behaviors according to the severity and demand of the event. Many methods serve as a frame of reference for prioritizing decision-making. Maslow's Hierarchy of Needs,  Nursing Process, airway, breathing, circulation, most significant risk, acute vs. chronic, and stable vs. unstable, are just some of the methods employed by nurses to direct their clinical decisions. The framework each nurse employs is individual to their practice; however, the goals of prioritization are to employ cognitive tools that guide safe behaviors to achieve quality outcomes. The North American Nursing Diagnosis Association (NANDA) International founded by professional nurses, is an organization for the regulation of nursing practice and clinical judgment through standardized terminologies to guide the application of skilled care interventions (NANDA, 2017). Creating prioritized nursing diagnosis is dependent upon the use of evidence-based practice interventions Nursing Intervention Classification (NIC) and outcomes Nursing Outcome Classification (NOC) that address client health problems nurses are legally accountable for identifying and managing independently. Competence in assessment methods and application of best practices for prioritized care of client problems in nursing practice is the expected guideline for the behavior of every nurse. 


Family Centered Care

The nurse assigned a 5 year old child understands a component of family-centered care as

A

Recognizing and planning care according to the families strengths

B

Accepting all cultural practices and rituals

C

Guaranteeing that all of the families financial burden will be met.

D

Reinforcing all parenting practices


Pediatric Governing Organizations

Name the two governing organizations that regulate and recommend immunization policies in the United States.

A

American Medical Association and National Immunization Program

B

Minister of National Health and Welfare and National Advisory Committee on Immunization

C

Pediatric Infectious Disease Association and National Institutes of Health

D

American Academy of Pediatrics and U.S. Department of Health and Human Services


Prioritization

After receiving the shift SBAR report, the nurse planing care according to priority will see this child first.

A

16 month-old child with viral meningitis

B

3 week-old infant admitted 24-hours ago with fever, irritability and possible sepsis

C

12 month-old with tracheotomy newly admitted with Respiratory Syncytial Virus (RSV)

D

15 year-old 36 hours post-operative laparoscopic appendectomy


Prioritization
question description

A school-age girl playing during gym fell after accidentally running over a hole on the playground. She was in pain from hurting her leg and could not get up off the ground. The gym teacher was first to reach her and called for the school nurse.The nurse determined the child's level of consciousness to be intact, and that she was in in severe pain with a possible broken leg. Which of the following is the priority action the nurse should take?

A

Put her in semi-Fowler’s position for comfort.

B

Immobilize the affected limb with a splint and ask her not to move.

C

Check the pedal pulse and blanching sign in both legs.

D

Make a thorough assessment of the circumstances surrounding the accident.

Prioritization
question description

An hour after admission to the nursery, the nurse observes a newborn baby having spontaneous jerky movements of the limbs. The infant’s mother had gestational diabetes mellitus (GDM) during pregnancy. Which of the following actions should the nurse take FIRST?

A

Call the physician immediately.

B

Observe closely for other symptoms.

C

Determine the blood glucose level.

D

Give dextrose water.


Images

Figure 1.1: Image Courtesy of Pixabay CC0

Figure 1.2: Image courtesy of Pixabay CC0

Figure 1.3: Image courtesy of Pixabay CC0

Prioritization 1: Image courtesy of Pixabay CC0

Prioritization 2: Image courtesy of Pixabay CC0

Final Page Border: Image courtesy of Pixabay under CC0

References

American Academy of Pediatrics. (2017). Professional Resources. Retrieved from https://www.aap.org/en-us/professional-resources/Pages/Professional-Resources.aspx

American Nurses Association. (2017). About Code of Ethics. Retrieved from http://www.nursingworld.org/codeofethics

American Nurses Association. (2017). The Nursing Process. Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/

Briggs, J. P. (2017). Childhood Vaccinations—Vital to Our Children’s Health. NIH National Center for Complementary and Integrative Health. Retrieved from https://nccih.nih.gov/about/offices/od/Childhood-Vaccinations-2017

Jewish Women's Archive. (2018). Lilian Wald. Retrieved from https://jwa.org/womenofvalor/wald 

McKinney, E. S., James, S. R., Murray, S. S., Nelson, K. A., & Ashwill, J. W. (2018). Maternal-Child Nursing (5th ed.). St. Louis, MO: Elsevier: Publisher 

Office of Disease Prevention and Health Promotion. (2017). Adolescent Health - New. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Adolescent-Health

Office of Disease Prevention and Health Promotion. (2017). Early and Middle Childhood-New. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/early-and-middle-childhood

Office of Disease Prevention and Health Promotion. (2017). Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives

NANDA North American Nursing Diagnosis Association. (2017). NANDA Defining the Knowledge of Nursing. Retrieved from http://www.nanda.org/about-nanda-international.html

Society of Pediatric Nurses. (n.d.). About the Society of Pediatric Nurses. Retrieved from http://www.pedsnurses.org/page/about-spn

The College of Physicians of Philadelphia. (2017). The History of Vaccines. Retrieved from https://www.historyofvaccines.org/content/articles/government-regulation

United States Department of Agriculture Food and Nutrition Service. (2017). Women, Infants, and Children (WIC). Retrieved from https://www.fns.usda.gov/wic/women-infants-and-children-wic

Family Centered Care is the collaborative partnership between nurses and family members that serves as the standard approach to Pediatric Nursing practice.