Unit I Foundations in Maternal Family and Child

Unit I Foundations in Maternal, Family and Child Care Chapter 1

Chapter 1 – Introduction to Child Health and Pediatric Nursing • "Greatest Love Of All“ • http: //www. youtube. com/watch? v=IYzl. VDl E 72 w • I believe the children are our future Teach them well and let them lead the way Show them all the beauty they possess inside Give them a sense of pride to make it easier Let the children's laughter remind us how we used to be

Caring for Children • They are NOT little adults – Anatomical and physiological differences – Growth & Development milestones • Part of a family unit • Require the nurse to strengthen skills: communication, assessment, interventions, teaching • Use the knowledge and skills you have

Historical Perspectives 21 st Century: • Growth of Ethnopluralism – population more diverse. Each culture comes with own beliefs, values and practices. • Change from Ethnocentrism(medical model) – health care systems driven by Euro-Caucasian, male • How does this affect Nursing? – Approach of engaging transpersonal care = shared decision-making with the family, teaching, health promotion and advocating for child/family,

Evolution of Pediatric Nursing – an Historical Perspective • Later 1800’s, European immigrants settled in eastern US cities. Children were a commodity – Infectious diseases – Unsanitary food – Harsh working conditions (child labor)

Historical Events • Over time, health and wellbeing of children considered • Public schools established, courts viewed children as minors • 1870 – 1 st pediatric professorship to Dr. Abraham Jacobi, father of pediatrics – 1889: Milk distribution centers with pasteurized milk helped decrease infant mortality

• Early 1900’s, Lillian Wald established the Henry Street Settlement House in NYC – start of public health nursing • 1902 Lina Rogers appointed full-time public school nurse in NYC • Pediatric nursing course started at Teacher’s College of Columbia University

20 th Century Advances • • • Nutrition Sanitation Bacteriology Pharmacology Medications – Penicillin, corticosteroids, vaccines • Psychology • Mechanical ventilation and other technology

• 1960’s led to development of nurse practitioner role • 1970’s brought costcontrol systems due to rising health care costs • 1980’s emphasis on quality outcomes and cost containment – Division of Maternal. Child Health Nursing Practice of the American Nurses Association developed standards of care

History (cont. ) • 1990’s brought federal legislation and funding: Family & Medical Leave Act (1993), Early Heads Start Program (1995) and Children’s Health Insurance. • 2000 -2010: – Decrease incidence of vaccine-preventable diseases and new vaccines – Prevention and control of infectious diseases – Increase motor vehicle safety – Occupational safety – decrease youth farm injuries – Decrease in childhood lead poisoning, 23 states have laws – Public health preparedness for natural/manmade disasters, flu pandemics • http: //www. cdc. gov/mmwr/preview/mmwrhtml/mm 6019 a 5. htm’s

Healthy People 2020 Initiated in 1979 by the US Surgeon General and updated every 10 years. Identifies most significant preventable threats to the nation’s health. • From U. S Department of Health and Human Services (2010)

Universal Roles of the Pediatric Nurse • Communicates with child and family based on the child’s age and developmental level • Provide direct nursing care as an advocate, educator and manager • Serves as collaborator, care coordinator and consultant

Roles of the Pediatric Nurse (cont. ) • Participates in Research • Provides care: – Cultural Diversity across the Care Settings: home, community, school, clinics, – – – acute care, rehab and long-term care Across the Health-Illness continuum Family-centered Preventative Continuum of care, Community focus Child and Family teaching Using the Nursing Process

• Contemporary Nursing Care – Family – centered care – Evidence- based Practice – Quality Improvement – Cost of Health Care • The Caring Art and Science of Nursing – Characteristics of Caring: trust, enhancing child/family coping, spirituality, therapeutic presence – Theories of Caring • Florence Nightengale – Holistic nursing care • Jean Watson – human caring • Madeleine Leininger – transcultural nursing – Caring as: • Provider of Care: – Incorporate caring behaviors when addressing physical, psychosocial, emotional, and spiritual needs of child and family – Staying current and competent (EBP) – Safe!

• Caring: – Critical Thinker – Effective Communicator • Listening just as Important! – Teacher – Collaborator – Advocate • Legal and Ethical • Patient Bill of Rights • Vulnerable populations

Philosophy of Pediatric Nursing • Family – Centered Care – Family is child’s primary source of support and strength – Involves families and caregivers working collaboratively, as partners – Leads to better outcomes and satisfaction

Key Elements of Family-Centered Care Academy of Pediatrics 2003) • Respect for child and family • Recognize effects of cultural, etnic, racial and socioeconomic diversity • Identify and support family strengths • Support family’s health care choices for child (American

Key Elements (cont. ) • Maintain flexibility • Provide honest, unbiased information with a positive approach • Provide emotional support • Collaborate with families • Empower families

Use of Nursing Process in Caring for Children and Their Families • Knowledge of the definition and trends in health is essential to understanding the causes of death and illness • This information can then be used to provide appropriate anticipatory guidance: – Health counseling – Teaching for children and families – Identifying high-risk groups

Atraumatic Care • Providing therapeutic care through interventions that minimize physical and psychological distress for children and their families • Specific interventions to provide atraumatic care

Principles and Concepts of Atraumatic Care • “Defined as therapeutic care that minimizes or eliminates psychological and physical distress experienced by children and their families in the health care system. ”(Ricci, Kyle and Carman p. 1038) • Prevent or minimize – Stressors: pain, discomfort, immobility, sleep deprivation, withholding food or fluids – Avoid intrusive or painful procedures; noise, cold/shivering, restraints

Atraumatic Care (cont. ) • Parent-Child separation – Treat the family as the “patient” – Family-centered care • Promote a Sense of Control – Assess child/family’s knowledge about health issues; promote partnerships; empower family – Reduce fear through knowledge and education – Allow parents to participate with care, normalize schedule

Child Life Specialist • A specially trained member of the interprofessional health team • Services provided include: – – – – Preparation and support for medical procedures Therapeutic play Activities to promote growth & development Sibling support Advocate for child and family Provide tours and information Outpatient consultation

Minimizing Physical Stress During Procedures • Before the procedure, prepare child based on age. Family included, given option to assist. • Invasive/painful procedures often done in a separate treatment room • During the procedure: – Therapeutic hugging – Distraction methods • After the Procedure: • • • Hold, cuddle and comfort child. Parent s good at this! Allow child to cry, express feelings Praise child, small rewards can help

Evidence-Based Practice • Using research findings to support the plan of care • Problem-solving approach to make nursing decisions

Sudden Infant Death Syndrome: SIDS, Crib Death http: //www. nlm. nih. gov/medlineplus/suddeninfantdeathsyndrome. html • Placing babies on their backs to sleep, even for short naps - "tummy time" is for when babies are awake and someone is watching • Using a firm sleep surface, such as a crib mattress covered with a fitted sheet • Keeping soft objects and loose bedding away from sleep area • Making sure babies don't get too hot - keep the room at a comfortable temperature for an adult

Case Management Care • • • Collaborative process involving an interdisciplinary plan of care Includes advocacy, communication and resource management Comprehensive, patientfocused care across a continuum Coordinate care with the Interdisciplinary team http: //www. guideline. gov/sear ch/searchresults. aspx? Type= 3&txt. Search=children&num=2 0

Quality Improvement • Emphasis on improving the quality of care provided by the nation’s hospitals has increased significantly and continues to gain momentum. • Nurses are integral to hospitalized patients’ care • Nurses also are pivotal in hospital efforts to improve quality. • What QI initiatives are happening on your pedi unit/hospital?

Childrens Hospital Association 2016 Quality and Safety in Children's Health Conference on March 8, 2016 in New Orleans. Here's a look at the winners and the practices that successfully improved patient care, transformed care delivery and reduced costs. https: //www. childrenshospitals. org/newsroom/childrens-hospitals-today/articles/2016/03/5 award-winning-pediatric-quality-improvement-ideas Overall winner and clinical care category winner • Sustained Reduction in LOS for Neonates with Neonatal Abstinence Syndrome Yale-New Haven Children's Hospital Outcomes over five years: 70 percent reduction in length of stay; $1. 2 million reduction in costs. Category winners Delivery system transformation: Developing Future Improvement Leaders: Experiental QI Training in Residency Levine Children's Hospital at Carolinas Health. Care System Outcomes over three years: 600 children impacted each month; 82 percent residents identified as QI leaders.

QI (cont. ) • Patient safety and reduction of harm: Reducing Radiation Exposure: Pediatric Modified Barium Swallow Studies Doernbecher Children's Hospital at OHSU Outcomes over three years: 50 percent reduction in radiation exposure; 2, 000 minutes of staff exposure prevented. • Waste reduction/improved efficiency Decreasing Hospital LOS for Post-Operative Adolescent Spinal Fusion Patients Children's of Alabama Outcomes: $800, 000 ROI in 10 months; 50 percent reduction in length of stay. • New: Distinctive achievement award, recognizing a high-quality project that is easily implementable and demonstrates unique efforts: Using Quality Improvement to Reduce Necrotizing Enterocolitis Across Hospital Systems Cincinnati Children's Hospital Medical Center Outcomes over five years: 49 cases prevented; $5. 7 million reduction in cost.

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