The Nurse's Role in a Changing Child Health Care Environment Chapter 1

The Development of Pediatrics Arthur Jacobi Recognized as the father of pediatrics Helped found the American Pediatric Society in 1888 Joseph Brennaman Suggested that the infants suffered from a lack of stimulation Ren Spitz Coined the terms “hospitalism” and “anaclitic depression”

The Development of Pediatrics (cont.) John Bowlby Explored the subject of maternal deprivation Revealed the negative results of the separation of child and mother due to hospitalization Marshall Klaus and John Kennell Carried out studies on the effect of the separation of newborns and parents Established that early separation may have long- term effects on family relationships

Current Trends in Child Health Care Regionalized care Involves the centralization and regionalization of maternity and pediatric services Often takes the patient and family far from home, emphasizing the importance of family- centered care

Advantages of Family-Centered Care Pays attention to each child’s unique emotional development and social, scholastic, and physical needs Helps family members alleviate fears and anxiety Helps family members function normally Facilitates understanding of the child’s condition and the role of family in the healing process

Demographic Trends Influencing the Delivery of Child Health Care Shift in focus from the needs of women and children to those of the elderly Growing percentage of minority populations Poverty Cost containment

Cost Containment Strategies Prospective payment systems Managed care Capitation Cost sharing Cost shifting Alternative delivery systems

Cost Containment Strategies Implemented by Nurses Health promotion Case management Critical care paths

Types of Payment for Health Services Private insurance Federally funded sources Medicaid State Child Health Insurance Program Specialized services

Child Health Today Infant health status Child and adolescent health status

Addressing Child Health Status National Commission to Prevent Infant Mortality Healthy People 2010

The Nurse’s Changing Role in Child Health Care Primary thrust of health care is toward prevention Nurses at all levels are legally accountable for their actions Advance practice nurses have taken a significant place in caring for childbearing and child-rearing families Health teaching is an important aspect of promoting wellness

Critical Thinking Use of clinical judgment and purposeful thought and reasoning Nurses become more proficient and effective at meeting the needs of the patient Based on a systemic process and used as the nurse follows the nursing process

Steps of the Nursing Process Assessment Nursing diagnosis Outcome identification and planning Implementation Evaluation Documentation

Types of Nursing Diagnoses Actual nursing diagnoses Identify existing health problems Risk nursing diagnoses Identify health problems to which the patient is especially vulnerable Wellness nursing diagnoses Identify the potential of a person, family, or community to move from one level of wellness to a higher level

Types of Nursing Actions Independent nursing actions Actions that may be performed based on the nurse’s own clinical judgment Dependent nursing actions Actions that the nurse performs as a result of a physician’s order Interdependent nursing actions Actions that the nurse must accomplish in conjunction with other health team members