PRINCIPLES OF PAEDIATRIC NURSING

PRINCIPLES OF PAEDIATRIC NURSING

INTRODUCTION

pediatrics nursing deals with individuals who are going through a period of growth .in the case of adults ,his body will change little during the remainder of his life .whereas in the case of a child he has to accommodates to more than a 3fold increase in length and an approximate 20 fold increase in weight between birth and adolescence so also ,in his muscular and intellectual skills and his emotional controls progress from the rudimentary state of the complex highly integrated level of adults .

The newborn undergoes various changes from helpless state of earliest infancy to adolescence where physical and emotional maturity occures.in order to provide expert care to children of different age group, the pediatric nurse must equip herself­­­ himself with the principles of child care

1Respect the child’s need regress and help him to accept dependence on other if he resists this.

Child is like an adult .he is different from adult in various ways and respects. For e.g. an adult coming with abdominal pain will ask for injection to get relief from pain but a child resist injection and is not ready to tolerate the pain of injection under the circumstances the nurse should show sympathy and common sense in her approach to the child .

Illness produces regression since child cannot concentrate on self-control .he will go back to the previous stages of development .in such situations the nurse should understand that it is a need of the child to regress in the new situation. she should respect the need of the child

2 have an awareness of the child’s need for help in reconquering the negative counter part of the core problem in the stage of development to which he has regressed.

In the psychological development of a child ,there are core problems with which the child struggles at the various stages of development in life .in each core problem or crises has a negative as well as positive counter part of core problem. During early year only family members influences but in the later years the society influences to reach a high level of maturity.

3 protect the child family interpersonal relationship

In order to protect the child’s growth potentials to the fullest, she should take account the situation of the child s parents because they are the most important people concerning the child .the family relationship influences the child’s personality development to a great extent.

4 awareness of the feeling of others and readiness to respond to them so as to strengthen their resources to cope up with stress is the major principle underlining effective emotional support.

Emotional support becomes paramount when illness occurs; it is also paramount when a child or adult faces a major change in him or in life situation. For e.g. when a girl first menstruates, she needs lot of support from an elderly female whom the girl can depend .continuity of relationship is essential when the child should be one that helps him to know that the nurse is friendly ,honest and understanding

5 children can tolerate discomfort if they are prepared for it, comprehend its real purpose and are adequately prepared.

Some of the child’s fears can be alleviated if preparation precedes experience. If you are preparing before a painful treatment, it can provide a basis for the maintains of trust. Without preparation, the child will deeply be resentful towards all persons. Concerned to an older child each step of the procedure can be explained, and the nurse should explained and the nurse should explain why it is done.

6 to child, play is note time out from daily living, but rather an essential part of it that enables him grow and mature through the various stages of the development.

To an adult ,play is recreation ,talking time out of daily routine of life is for enjoyment .however ,for a child ,play helps the child to regain his independence graduallz.as adults talk out the problem

Current practice in child health nursing

Introduction

Care of child rearing families is a major focus of nursing practice.to have healthy children ,it is important to promote the health of the family from the time before children are born until they reach adulthood.as children grow the family needs continued health supervision and support.

As children reach maturity, a new cycle beings and new support becomes necessary the nurses’ role in all these phases focuses on promoting health and in illness.

Goals and philosophies of child health nursing

The primary goals of child health nursing care can be stated simply as the promotion and maintained of optimal family health to ensure cycle of optimal child rearing. The goals of child health nursing care are necessary broad because the scope of practice is so broad .the range of practice include.

Care of children during the perinatal period

Care of children from infancy through adolescence.

Care in setting as varied as ambulatory clinics,pediatric intensive care units and the home.

In all setting and types of care, keeping the family at the center of care delivery is an essential goal. Child health nursing is always family centered. Which means the family is considered the primary unit of care. The level of family functioning impacts the health states of individuals.

If the family’s level of functioning is low the emotional,phzsical and social health and potential of the Individuals  in the family can adversely affected.

Philosophy of child health nursing

Child health nursing is family centered.

Child health nursing is community centered.

Child health nursing is research oriented

Nursing theory provides a foundation for nursing care.

A child health nurse serves as an advocate to protect the rights of all family members

Child health nursing uses a high degree of independent nursing functions because teaching and counseling are so frequently required

Promoting health is an important nursing role because this protect the health of the next generation

Childhood  illness can be stressful.they can alter family life.

Personal ,cultural and religious attitudes and belifs influence the meaning of illness and its impact on the family.

Child health nursing is a challenging role for the nurse and is a major factor in promoting high level wellness in families.

Standards of child health nursing practice

The importance of society places on caring can be measured by the concern it places on its most vulnerable members or its elderly, disadvantages and young citizens .comprehensive pediatric nursing care focuses on helping children and their families and communities achieve their optimum health potentials.

The peadiatric nurse systematically evaluates the quality and effectiveness of pediatric nursing practice.

Standards of professional performance

Standard1;quality of care

The pediatric nurse evaluates the quality of effectiveness of pediatric nursing practice.

Standard 2;performance appraisal

The pediatric nurse evaluates his or her own nursing practice in relation to professional practice standards and relevant status and regulations.

Standard3;education

The pediatric nurse acquires and maintained current knowledge in pediatric nursing practice.

Standared4;collegiality

The pediatric nurse contributes to the professional development of peers, colleagues and others.

Standerd5;ethics

The peadric nurses decision and actions on behalf of children and their families are determined in an ethical manner.

Standerd 6;collaboration

The pediatric nurse collaborates with the child ,family, and health care provider in providing client care.

Standared7;reaserch

The pediatric nures uses research finding in pediatric.

Standered 8;resource utilization.

The pediatric nurse considers factores related to safety,effectiveness and cost in planning and delivery care.

Special legal concerns.

Accountability;

Nursing accountability involves knowledge of current laws. Accountability in pediatric nursing requires special consideration because the nurse must be accountable to the family as well as to child.

Accountability also involve competency if a nurse is not competent to perform a particularly nursing task. The nurse must immediately communicate this fact to the nursing supervisor ,physician.

Negligence and malpractice.

Negligence is failure to perform the way a reasonable, prudent person of similar background would act in a similar situation .negligence may consist of doing something that should not be done or failing to do something that should be done.

Malpractice is a negligence by professionals such as nurses or physicians in the performance of their duties .nures may be accused of malpractice if they do not perform  according to established standareds of care and in the manner of reasonable.

Informed consent

Informed consent is a ethical concept that has been enacted into law.clints and families have right to decide whatever to accept or reject treatment opions as part of function autonomously.to make wise decisions thay need ful information about treatment offered .

Without proper informed constant assult and battery charges can result some times parents or childrens decline treatment offered by health care workers .parents may refuse treatment when they belive that the benefits of treatments do not out weigh the burden of the treatment or the qulity of life .the nurse document on the chart refused explanation given to the parent and notification of the physician.

Documentation

Documentation is especially important when there is a question of liability because it is the best evidence that a standard of care has been maintained .all information recorded about a child should reflect that standard of care.

The information include nurse s notes,flowchart and any other data recorded in the chart.although documentation isbnot listed as a step in the nursing process it is integrated part of the process it is especially important that documentation be specific and complete in pediatric nursing

Current trends in paediatricnursing

Child health nursing is undergoing tremendous advancements just like paediatric medicineand surgery.the current trends in the practice are based on researches that have taken place in the field of paedric nursing.the child population constantly changing along with changes in social structure variation in family life style increase health costs, improvement in medical technology and changing pattern of illness .the common trends are

Managed care

Family centered care

Enabling

Empowerment

High techonolgy care

Evidence baced practice

Atraumatic care

Cost containment

Prevention and health promotion

Family centered care

It is based on the philosophy that quality care be provided in an environment that support family and promote psychology and physiology halth of the family it assumes that if the family gain adequate information and support it is capable of making healthcare decision parents know best about their child s need,more aware about their childs behavior and habits inovelement of the parents in  the  care

of their childrens facilitiesbetter coping in parents and reduce trauma to children that aid speedy recovery.

Two basic concepts of family centered care are enabling and empowerment .in the process of enabling all the family members are helped by the professionals to create opportunites and means to utilize their present abilities competence of acquired new skills that are neccary to provide to their children .enpowering helps to foster the strengths of family members to cope up and with stand stress related to sickness of their children.

High technology care.

Advancement in the medical field has created the care of children too technologically versatile the nurse also needs to be technologicaly competent enough to meet the nursing care needs of children the advancement in the diagnostic technology has made detection of many disorders even in the foetal period.

Advanced technology and computer skills in working places challenge nurses for continuing nursing education.

Evidence based practice

In evidence based practice ,nurses need to make desion on the best available evidences EBP in nursing provides a systematic approach to ensure nurses to effectively the best solution related to nursing practice.EBPcan be applied to any problem that seeks solution.the problem seeking solution needs to be framed as a questions .a problem may have many sub problem .allneed to be framed as question .after framing the questions the nurse need to search for evidence in literature.then appraise by the evidence in terms of validity and relibilityby finding out the generalizability after appraising the evidence make deciosionto use or not to use.

Child oriented environment

A child friendly environment should be provided to a child who is admitted to hospital .child should be admitted in childrens ward the outlay of the ward should be one of child friendly with adequate safty precaution.education and facilities for play should be provided .removing the child from the familiar environment to strange ward is frightinig to the child .

Staff should be sensititve to the families individual needs according to the social educational ,culture and relogius back ground.childrens ward should be occupied with skilled staff.

Librral visiting hours and permating parents to be with children when hospitalization also promotes child oriented environment in a hospital

Atraumatic care

It is provision of therapeutic care in settings by personel with intervention that eliminates or minimize the psychology and physical distress experienced by children and their families in the health care system.therapeutic care includes the prevention diagnosis treatment or palliation of chronic or acute codition and setting refers to whatever places that care is provided.

The concept of  atraumatic care is intended to reduce mental and physical harm and to provide an environment with minimum physical mental trauma.there are three principles to be followed in the provision of atramatic care

Prevent or minimize the childs separation from family

Promote sense of comfort

Prevent or minimize bodly injuryand pain

A child who recevice therapeutic intervention needs to be treated with tender ,loving care.suggested nursing interventions are as following.

Foster parent

Prepare the child before any procedure.

Control pain.

Provide child privacy.

Provide play for expression,fear and aggression.

Minimize loss of control

Respect culture and religious difference

Cost containment

Cost containment is a management technique utilized to reduce the cost of hospitialisation.it is achieved in many ways in hospital and either by cutting nursing positions or by improving the process of care and tightening non labour resourses.

By reducing mortality rates , length of the stay , costs and by increasing family satisfaction and readiness and ability.

To function upon discharge , nurses make significant contribution to both the quality of hospital services and the containment of hospital costs.

                    MANAGED  CARE:-

It is the system of health delivery that focuses on reducing the cost of health care through closely monitoring the cost of personnel the use and brands of supplies , length of hospital stay , no. of procedure carried out and no. of  referals required.

Before managed care health care insurance paid separately for each procedure or piece of equipments.

Managed care has had dramatic affects on health care. Most noticeable limiting the no. of hospital days and distribution of personnel. Before managed care for eg. Childrens stayed in the hospital for approximately 7 days for abdominal surgery.

Today they may stay only 3 – 4 days. Some surgical procedures such as tonsillectomy . once done as in patient are now being done on an out patient days.

   ALTERNATIVE SETTINGS AND STYLE FOR HEALTH CARE:-

Health care settings for children are changing. The home community centres , out patient clinics, well baby clinics, schools and group form are some settings where comprehensive health care may be administered.

In this settings the nurse provide immunization , screening , health and safety education , counseling , crisis intervention , parenting clasess and care of ill child and family.

 

 STRENGTHENINIG THE AMBULATORY CARE SYSTEM:

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The ambulatory care system has broaden its base so more and more people who might been have admitted to a hospital are now been care for in ambulatory clinics or at home.

This option has provided a specially important in the care of sick children.

           SHORTENING OF HOSPITAL STAYS:-

Many hospitals perform children surgery such as tonsillectomy or umbilical or inguinal hernia repairs without requiring a over night stay. Short term hospitalization requires intensive health teaching by the nursing staff and followed by home care nurses.

A child parents must be tought to watch for dander signs in the child without being frightened.

    INCREASE IN THE NO. OF INTENSIVE CARE UNIT:-

Over the past 20% care of infants and children has become more intensive. It is generally assumed that new borns with a term birth weight will thrive at birth. A no. of infants are born each year,however with birth weight low birth 2500 gm or who are ill at and not thrive.such infants are regularly transferred to a neonatal intensive care units.