NUR 231 Pediatric Nursing Laura Salisbury RN, MSN/Ed. Ch 1&2 Perspectives of Pediatric Nursing & Community Based Nursing care of the child and family NUR 231 Pediatric Nursing Laura Salisbury RN, MSN/Ed.

Chapter 1 Perspectives of Pediatric Nursing Healthy People 2010 is a project that focuses on health problems and how to solve them Many of the Healthy People 2010 goals focus on children

Problems in the pediatric population Dental caries are the single most common chronic disease of childhood Obesity in children is a rapidly increasing problem due to lack of physical activity, video games, television watching, and poor nutrition Lack of education and prenatal care increases the risk for a child to have chronic health complications Exposure to Second hand smoke Increases the risk for a child to have chronic respiratory and other health complications

Children at high risk for health problems Children at highest risk for health problems are: Those living in poverty Immigrant children low-birth-weight children children with chronic illnesses foreign-born adopted children children in daycare There are major barriers to receiving healthcare for children in poverty Beyond physical illness children face social, education, and behavior problems

Leading causes of death for children In children less than one year congenital anomalies are leading cause of death In children older than one year accidents are the leading cause of death Automobile accidents are leading cause Other deaths are caused by drowning, burns, firearm accidents Prevention strategies have been decreasing deaths in children US exceeds other countries in violent deaths Homicide is second leading cause of death in US children ages 15-19

Family-centered care Family-centered care recognizes that the family is the constant in the child’s life Families need to be enabled and empowered Nurses need to collaborate with families when caring for children Atraumatic care: interventions for children are designed to minimize the stress on the child and family The overriding goal of atraumatic care is first, do no harm Prevent or minimize separation from family Provide a sense of control Prevent or minimize bodily injury/pain

Therapeutic relationships Pediatric nurses need to have a therapeutic relationship with children and families Therapeutic relationships have effective, well- maintained boundaries Non-therapeutic relationships have boundaries that are blurred: many of the nurse’s actions serve personal needs rather than family needs Becoming over-involved with certain children/families Spending excessive time with particular children and families Attempting to influence family decisions Becoming under-involved Focusing on technical care Excluding families Competing w/parents for child’s affections Non-therapeutic relationships happen when a nurse becomes overinvolved with certain children/families, may spend excessive time with particular children and families, try to influence family decisions; OR may become underinvolved and focus on technical care, exclude families; OR may start to compete w/parents for child’s affections (p. 12, Nursing Care Guidelines)

Nursing Process for Pediatrics The Nursing Process in pediatric care is the same as you have learned for adult care and includes Assessment Diagnosis Planning Implementation Evaluation Only other considerations are to focus the nursing process to the pediatric client which includes the family

Chapter 2 Community Based Pediatric Nursing A “community” is a group of individuals with shared characteristics and interests who interact with each other Community health nurses promote and maintain health of individuals, families, and groups in a community setting

Epidemiology Epidemiology identifies distribution and causes of disease and death in a population and is important for identifying health needs of a community Morbidity rates measure disease and injury Incidence: occurrence of new events in a population during a time period Prevalence: existing events in a population during a time period Mortality rates refer to rates of death from a disease or other factor

Epidemiological Triangle Three factors that can alter the risk of acquiring a disease or condition Host is the individual or group with the disease or condition Agent is what causes disease or problem Environmental factors are factors outside the host and agent Host is the individual or group with the disease or condition: factors affecting the host include genetics and lifestyle choices (exercise, nutrition, etc), immunizations, medications, etc. Agent is what causes disease or problem; could be infectious agent, physical agent (fire), chemical agent (lead in paint) Environmental factors are factors outside the host and agent; can include climate, factors related to home/neighborhood/school, cleanliness of water/food, etc.

Levels of Prevention Classify at what point disease and other problems are prevented by community health programs Primary prevention is done BEFORE disease or injury Secondary prevention is early diagnosis and screening Tertiary prevention focuses on optimizing function after disease or problem—includes rehabilitation and disease management Primary Secondary Tertiary Primary prevention is done BEFORE disease or injury: seat belt use, immunizations, nutrition programs, etc. Secondary prevention is early diagnosis and screening; done for those who ALREADY HAVE disease or other problem: TB screening, lead screening, mental health counseling right after a disaster, blood glucose screening Tertiary prevention focuses on optimizing function after disease or problem—includes rehabilitation and disease management: helping asthmatic children with meds, special education for children with cognitive problem, rehabilitation after injury

Community Assessment/Diagnosis Done by community nurses to determine the strengths and the needs of a community Nurses examine such things as Health and social services Communication Recreation Physical environment Education Safety and transportation Politics and government Economics The community nurse draws on the strengths of a community in order to solve problems Done by community nurses to determine the strengths of a community as well as the needs of a community; nurses examine such things as health and social services, communication, recreation, physical environment, education, safety and transportation, politics and government, economics (p 24-25) The community nurse draws on the strengths of a community in order to solve problems (p 25)

Community Planning, Implementation & Evaluation Community planning takes place in collaboration with community leaders: health programs are established with specific goals Community implementation and evaluation carried out by the nurse along with other key community members and leaders Communication is essential and program evaluation is ongoing