1. 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.

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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)

14. 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