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Introduction to the nursing care of children Part 1: Child’s Health in Changing Society

Introduction to the nursing care of children Part 1: Child’s Health in Changing Society. By Nataliya Haliyash MD, BSN. Lecture Objectives. Healthy People 2010 sets forth national health goals and objectives for adults and children, and focuses on disease prevention and health promotion.

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Introduction to the nursing care of children Part 1: Child’s Health in Changing Society

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  1. Introduction to the nursing care of childrenPart 1:Child’s Health in Changing Society By Nataliya Haliyash MD, BSN

  2. Lecture Objectives • Healthy People 2010 sets forth national health goals and objectives for adults and children, and focuses on disease prevention and health promotion. • The aggregate health status of infants, children, and adolescents is determined statistically by keeping records of indicators such as infant mortality rate, low birth rate, and immunization rate. • Current societal trends affecting children, their health, and their families include immigration, poverty, homelessness, migrant farm work, and violence. • Intentional and unintentional injuries, causes and prevention. • Standards of Care and Standards of Professional Performance

  3. Current Status of Children’s Health Healthy People 2010: National Health Promotion and Disease Prevention Objectives (US Department of Health and Human Services – DHHS): 28 focus areas 467 objectives

  4. Healthy People 2010 Goals: • To increase the quality and years of healthy life • To eliminate health disparitiesbetween ethnic groups

  5. 10 leading health indicators • Physical activity • Overweight and obesity • Tobacco use • Substance abuse • Responsible sexual behavior • Mental health • Injury and violence • Environmental quality • Immunizations • Access to health care

  6. The main indicators of health status • infant mortality rate (IMR), • child mortality, • immunization rates.

  7. Infant Mortality • IMR (Infant Mortality Rate) is the number of infant death during the first year of life per 1,000 live births • Racial disparities • The IMR target goal for the year 2010 is 4.5 death per 1,000 live births

  8. Racial Differences • High rate of low birth weight (LBW) infantsborn to minority mothers • Decrease in theoverall health status or health care access of minority women • IMRs were also higher for infants whose mothers wereteenagers or 40 years of age or older,did not complete highschool, were unmarried, began prenatal care after the first trimester of pregnancy or smoked during pregnancy

  9. Low Birth Weight • One reason for the racial disparity in IMRs and theranking of the United States is the high rate of LBW (weight less than 2,500 grams, or 5 pounds 8 ounces) • The rate of LBW was 7.6% in 1998, up from 7.5% in 1997. • Infants with a LBW have a six times higher risk of death during first year of life. • Those weighing less than 1,500 grams have an 89 times higher risk of death than do babies havingnormal birth weight.

  10. Low Birth Weight: Health Risk? • LBW babies are at risk for impaired health, developmental delay, neurosensory deficits, cognitive delays, and school and behavioral difficulties. • The most common major neurologic abnormality seen in these infants is cerebral palsy, which increases with decreasing birth weight.

  11. Reflective thinking • The Cost of Keeping LBW Infants Alive • Hospitals and health care delivery systems havepoured substantial amounts of money into neonatal intensive care units to care for LBW infants. These babies are usually technology dependent and oftenrequire expensive medical equipment and nursingcare in their homes. • How do you feel about thisemphasis on high-tech solutions versus allocatingsome resources to preventive services?

  12. Immunization Rates • The reduction in incidence of vaccine-preventable diseases isone of the most significant public health achievements of the 20th century. • The global eradication of smallpox in 1977 is anillustration of this success (DHHS, 1999). • Not only areimmunized individuals themselves protected from developing a potentially serious illness, but, alsoif enough of thepopulation is immunized, transmission of the disease in acommunity may be interrupted.

  13. Immunization Rates • In 1999, the highest rates of childhood immunizationwere achieved. • Three vaccines – polio,measles, and Haemophilus influenza type b (Hib)—had acoverage rate at/or above 90%

  14. Immunization Rates • Rates are for 19-35-month-old children who have received atleast four doses of DTP (diphtheria, tetanus, pertussis), threepolio, one MMR (measles, mumps, rubella), three Hib, andthree hepatitis B. • The Healthy People 2010 target is 90%coverage for all recommended vaccines in all populations.

  15. Immunization requirements • All 50 states have immunization requirements for entrance into school; however, some groups are seeking changes in these state laws. • Exceptions are allowed from immunization requirements for medical reasons in all states and for religious reasons in 48 states, and 15 states allow exemptions for philosophical reasons

  16. Child Mortality • In 1900, the death rate for children 1-4 :of age was about 2,000 per 100,000population, 460 for year-olds, 300 forchildren 10-14 years old, and 500 for 15-19-year-olds.

  17. Injury • Injury is defined as damage or harm to an individual resulting in destruction of health, disability, or death • Intentional and unintentional

  18. Intentional injuries • Homicide • Suicide • Rape • Assault and battery • Domestic violence • Child abuse and neglect • Any other injury caused on purpose

  19. Injuries due to motor vehicles Bicycle injuries Boating injuries Choking and suffocation Falls Drowning Near-drowning Fires and burns Poisoning Firearm injury Occupational injuries Farm injuries Sports injuries Injuries due to toys and recreational equipment Any other injury that was not intended to harm the victim Unintentional Injuries

  20. Unintentional Injuries • Among children aged 1-19, unintentional injuries are responsible for more deaths each vear than homicide, suicide, congenital anomalies, cancer, heart disease,respiratoryillness, and HIV combined • Unintentional injuries are the leading cause of death for all children over 1 year of age

  21. Unintentional Injuries • One-half of an unintentional injury-related deaths occur inthe 15-19-year-old groupdue to motor vehicle-relatedinjuries. • Common subcategories ot motor vehicle injuriesinclude • (1) occupant (drivers and passengers), • (2) bicycle-related, • (3) motorcycle, and • (4) pedestrian injuries.

  22. Unintentional Injuries for children under 1 years of age • Suffocation is the leading cause of unintentional injury-related death, followed by motor vehicleoccupant injury, choking, drowning, and fires or burns. • Somesuffocation deaths in infants are due to entrapment of thehead and neck in cribs. • Another cause is choking on food oran object, leading to airwav obstruction

  23. Unintentional Injuries for children aged 1-4 years • Drowning is the leading cause of injury death, followed by motor vehicle occupant injury, fires or burns, andairway obstruction. • Infants often drown in bathtubs, usuallyas a result of poor supervision or neglect • Toddlersand young children fall into a body of water such as a swimming pool, lake, or river, usually while unsupervised.

  24. Unintentional Injuries for children aged 5-14 years • motor vehicle occupant-related injury isthe leading cause of death, followed by drowning, pedestrianinjury (i.e., motor vehicle collisions with the child), bicycleinjury, and fires or burns

  25. Unintentional Injuries for children aged 14-19 years • Motor vehicle occupant injuries are the primary cause of injury-related deaths • Driver inexperience and alcohol use are key contributors to the high rate of fatal crashes in adolescents

  26. What are the key approach to reduce Unintentional Injuries? • Prevention! • Education • Changes in the environment and inproducts • Legislationor regulation (35 states – no bicycle helmet law) • Role of pediatric nurses

  27. Access to Health Care • Lack of health insurance • The number ofuninsured children has been growing at an alarming rate. • In 1999 11.9 million children (one in seven) under the age of 19 lacked health insurance • Ethnic minority children are overrepresented among the uninsured.

  28. Access to Health Care • Those from higher-income families are more likely to have private health insurance (90%) than from lower-income families (40%) • Uninsured children in low-income families experience substantial difficulties in accessing health care • They tend to lack (1) the usual sources of routine and sick care, (2) a primary care provider, and (3)recent visits to health care providers. • Uninsured children are more likely to be underimmunized and to go without needed medical services due to the costs of care

  29. Access to Health Care: the Role of Welfare Reform • Between 1995 and 1997, 1.25 millionindividuals lost Medicaid coverage due to welfare-to-work initiatives • Many adult members offamilies were no longer eligible for Medicaid due to reforms, most of the children in these families were and are still eligible for its benefits

  30. SCHIP • State Children's Health Insurance Program (SCHIP) as part of the Balanced Budget Act of 1997. • The purpose of SCHIP is to provide health insurance for children through 18 years of age whoare uninsured or ineligible for Medicaid. • More than 40 billion in federal grants will be allocated to states over a 10-year period • More than 3 million children are enrolled in SCHIP • Role of nurses

  31. Perspectives on Pediatric Nursing • Family-centered care • Atraumatic care • a philosophy of providing care that minimizes or eliminates physical and psychological distress for children and their families in the health care environment. • Three principles provide the basis for atraumatic care: • identifying stressors, • minimizing separation of child from caregivers, • minimizing or preventing the pain

  32. Family-centered care • The focus of pediatric nursing must be on the child as well as the family. • The term family-centered care describes a philosophy of care that recognizes the centrality of the family in the child's life and inclusion of the family's contribution and involvement in the plan for care and its delivery. • It is a health care delivery model that seeks to fully involve families in the care of children. • Family-centered care evolved in response to the critical need to maintain the relationship between hospitalized children and their families. Previously this relationship had been neglected or disrupted because of forced separation by the health care system.

  33. Family-centered care • In 1987, a revolutionary document that defined the elements of family-centered care was published by the Association for the Care of Children's Health (ACCH). • Family-centered care was defined as including eight equally important elements. • When families are incorporated into the care of their children, the physical and psychosocial health of the child improves and accelerated rates of progress have been seen. Additionally, these families have demonstrated enhanced learning, less stress, and more satisfaction with care.

  34. Family-centered care 1. Incorporating into policy and practice the recognition that the family is the constant in a child's life, whereas the service systems and support personnel fluctuate. 2. Facilitating family/professional collaboration at all levels of hospital, home, and community care: care of an individual child; program development, implementation, and evaluation; and policy formation. 3. Exchanging complete and unbiased information between families and professionals in a supportive manner at all times. 4. Incorporating into policy and practice the recognition and honoring of cultural diversity, strengths, and individuality within and across all families, including ethnic, racial, spiritual, social, economic, educational, and geographic diversity. 5. Recognizing and respecting different methods of family coping and implementing comprehensive policies and programs that provide developmental, educational, emotional, environmental, and financial supports to meet the diverse needs of families. 6. Encouraging and facilitating family-to-family support and networking. 7. Ensuring that hospital, home, and community services and support systems for children needing specialized health and developmental care and their families are flexible, accessible, and comprehensive in responding to diverse family-identified needs. 8. Appreciating families as families and children as children, recognizing that they possess a wide range of strengths, concerns, emotions, and aspirations beyond their need for specialized health and developmental services and support.

  35. INFORMED CONSENT AND ASSENT FOR HEALTH CARE • Informed consent 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. • Informed consent must include the following: the nature of the procedure,  the risks and hazards of the procedure,  the alternatives to the procedure, and  the benefits of the procedure. • After receiving informed consent, the client has the right to accept or refuse any health care.

  36. INFORMED CONSENT AND ASSENT FOR HEALTH CARE • Assent means the pediatric client has been informed about what will happen during the treatment or procedure, and is willing to permit a health care provider to perform it. • While assent is not legally required, it is always better to have the cooperation of the child prior to giving care (Pieranunzi & Freitas, 1992). Assent from the child may maximize success of the procedure and minimize trauma to the child.

  37. INFORMED CONSENT AND ASSENT FOR HEALTH CARE • For example, • a 10-year-old boy comes into the office to have stitches placed in his right hand. The health care provider asks the child's parent for informed consent after the parent has been provided information about the risks and benefits of local anesthesia and the placement of sutures. Alternatives to suturing and the risks of leaving the wound open are discussed. Once the parent provides informed consent, the boy is asked to assent to the procedure. The boy is told that a tiny needle will be used to put a little numbing medication in the skin. When the skin is numb, the health care provider will place some stitches to close the cut. If the child agrees to having stitches, he has given assent to the procedure.

  38. INFORMED CONSENT AND ASSENT FOR HEALTH CARE • Children are considered minors and, except under special circumstances, the parent or the person designated as legal guardian for the child is required to give informed consent before medical treatment or any procedure • Separate permission is also required for the next: • Major surgery • Minor surgery (cutdown, biopsy, suturing a laceration etc) • Diagnostic tests with high risk: bronchoscopy, angiography • Medical treatments with an element of risk: blood transfusion, radiation therapy, paracentesis

  39. When Informed Consent Is Not Required • In an emergency situation if health care providers cannot obtain prior informed consent. The care given under these circumstances is usually an emergency lifesaving procedure. • Health care providers may provide emergency care to a child if they have made a reasonable attempt to contact the child's parent or legal guardian. • When that person cannot be located, especially in the case of an adolescent, it is prudent to obtain informed consent from the child (Abbott, 1996). • Many states allow the evaluation and treatment of a child for suspected physical or sexual abuse without the informed consent of a parent or guardian. In Utah, physicians can take photographs or X rays of a child without parental consent if they suspect child abuse

  40. When a Minor Can Consent for Care • A minor is a person under the age of 18. In Alabama, Nebraska, and Wyoming, the age of majority is 19. • In most states, care involving pregnancy, contraception, or treatment of sexually transmitted diseases does not require either consent from or notification of parents. Children may also seek drug and alcohol treatment without the consent of a caregiver. The purpose of these laws is to encourage children to seek help in situations in which they might avoid care if they were required to inform their caregivers

  41. When a Minor Can Consent for Care • Emancipation is the legal recognition that a minor lives independently and is legally responsible for his or her own support and decision making. • Emancipation can occur through an official court proceeding in cases when: • the minor is living on his or her own and no longer requires the financial support of parents. • he or she is married, • joining the military, or • becoming a parent before the age of majority

  42. Roles of Pediatric Nurse Primary Roles • Caregiver • Advocate • Educator • Researcher • Manager/Leader Secondary Roles • CoordinatorCollaboratorCommunicatorConsultant

  43. Roles of Pediatric Nurse Differentiated Practice Roles • Clinical Care CoordinatorCare ManagerClinical Nurse Advanced Practice Roles • Nurse Practitioner(PNP) • Clinical Nurse Specialist (CNS) • Case Manager

  44. Caregiver • Helping • patient diagnosing/monitoring • administering/ monitoring therapeutic interventions/regimens • monitoring/ensuring the quality of health care practices • organizational and work role competencies • effectively managing rapidly changing situations.

  45. Advocate • Informing clients and families of their rights and options as well as theconsequences of those options. • Pediatric nurse advocatesfunction by allowing clients/families to make their owninformed decisions and then supporting those decisions. • Even though advocates do not need to approve the decision,they do need to respect that decision and the right to makethat decision. In fact, advocates shouldn't make decisions fortheir clients, but rather should facilitate decision making.

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