Introduction to pediatric nursing
Just the factsIn this chapter, you’ll learn:
the role of the pediatric nurse
the philosophy of family-centered care
standards of care for pediatric nursing
types of family structures
sociocultural influences that affect pediatric health.
Role of the pediatric nurse
Pediatric nursing involves providing care for infants, children, and adolescents on a continuum from health to illness to recuperation and, when needed, rehabilitation.
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However, providing care to the pediatric population doesn’t stop with the pediatric patient; pediatric nursing should incorporate parents and other family members into the child’s care. This philosophy is known as family-centered care.
Family-centered care
Family-centered care acknowledges the parents as the constant in the child’s life and as experts in the care of their child, whether in the hospital or at home. In family-centered care, the family’s input is the major driving force behind the development of the child’s care plan.
In addition, the needs of the child and his family are taken into account in family-centered care. Interventions are geared toward respecting, supporting, and encouraging the family’s ability to participate in the care of their child throughout illness and recovery.
Power to the people
Empowering and enabling are two important concepts in familycentered care. Empowering is allowing parents to maintain, or helping them to develop, a sense of control over their child’s care. Enabling refers to the practices that help family members to acquire the new skills necessary to meet the needs of their child.
These two concepts foster the teamwork between the family and health care professionals that serves to benefit the child, both physically and emotionally. (See Benefits of familycentered care.)
Benefits of familycentered care
Familycentered care benefits the child and family as well as the health care professional.
Benefits to families
Less stress and heightened feelings of confidence and competence in caring for their children
Less dependence on professional caregivers
Empowerment to develop new skills and expertise in the care of their children
Benefits to health care professionals
Greater job satisfaction
Empowerment to develop new skills and expertise in pediatric nursing
Standards of care
Pediatric nursing care is governed by standards. The American Nurses Association (ANA), the National Association of Pediatric Nurse Practitioners (NAPNAP), and the Society of Pediatric Nurses (SPN) have developed a document which outlines the scope and standards of pediatric nursing practice to ensure that each pediatric patient receives safe and effective care. (See Standards of pediatric nursing care and professional performance.)
Room for improvement
In 2010, there were 74.1 million children younger than 18 years old living in the United States. Children younger than 16 years of age compose 24% of the total population. Although children’s health has improved dramatically over the last century, there’s still work to be done.
Childhood morbidity and mortality rates, key indicators of the health of a population, provide the nurse with essential information about how and where to direct care for individual patients and the community at large.
Childhood morbidity
Morbidity is defined as the number of people in a population who are faced with a specific health problem at a particular point in time. Because these statistics aren’t compiled on an annual basis, it’s difficult to compare them from year to year. It is important to remember that it is during the middle childhood and early adolescent times that the children are usually healthy, but they develop habits that will influence their health later in life.
Morbidity rates for many illnesses that previously caused severe problems for children, such as poliomyelitis and measles, have been dramatically reduced through immunizations. Other conditions studied in relation to morbidity include obesity, injuries, acute illness, HIV infection, and sexually transmitted infections (STIs).
Acute isn’t cute
The most common causes of acute illness in childhood include:
respiratory illness (50%)
injuries (15%)
infections and parasitic disease (11%).
Standards of pediatric nursing care and professional performance
By adhering to these guidelines, jointly developed by the ANA, NAPNAP, and the SPN, the pediatric nurse can serve as an advocate for patients and their families. These guidelines should be upheld to ensure that professional care is provided to all patients.
Scope of practice
The scope of practice section of the document discusses the different areas of pediatric nursing practice and the different settings where pediatric nurses practice. Also discussed in this section are education and certification of pediatric nurses.
The Differentiated Areas of Pediatric Nursing Practice include:
The Pediatric Nurse: Generalist
The Advanced Practice Pediatric Nurse
Pediatric Clinical Nurse Specialist (PCNS)
Pediatric Nurse Practitioner (PNP)
Neonatal Nurse Practitioner (NNP)
The Settings for Pediatric Nursing Practice include:
Inpatient and Acute Care Settings
Perioperative and Surgical Settings
Hospice and Palliative Care Settings
Ambulatory Care Settings
Community Health and School Settings
Transport Settings
Camp Settings
Standards of care
Comprehensive pediatric nursing care focuses on helping children and their families and communities achieve their optimum health potentials. This goal is best achieved within the framework of family-centered care and the pediatric nursing process, including primary, secondary, and tertiary care coordinated across health care and community settings. The jointly published document includes 16 standards that govern the practice of the pediatric nurse.
Standard 1. Assessment
Standard 2. Diagnosis
Standard 3. Outcomes Identification
Standard 4. Planning
Standard 5. Implementation
Standard 5a. Coordination of Care and Case Management
Standard 5b. Health Teaching and Health Promotion, Restoration, and Maintenance
Standard 5c. Consultation
Standard 5d. Prescriptive Authority and Treatment
Standard 5e. Referral
Standard 6. Evaluation
Standard 7. Quality of Practice
Standard 8. Professional Practice Evaluation
Standard 9. Education
Standard 10. Collegiality
Standard 11. Collaboration
Standard 12. Ethics
Standard 13. Research, Evidence-Based Practice, and Clinical Scholarship
Standard 14. Resource Utilization
Standard 15. Leadership
Standard 16. Advocacy
American Nurses Association, National Association of Pediatric Nurse Practitioners, & Society of Pediatric Nurses. (2008). Pediatric nursing: Scope of practice. Washington, DC; American Nurses Association.
Risky business
Factors that place children at risk for increased morbidity include:
chronic illness
homelessness
low birth weight
poverty
adoption from a foreign country
time spent in day-care centers.
Childhood mortality
Mortality refers to the number of deaths from a specific cause in a given year. Accidents are the leading cause of death in all age-groups of children (older than age 1) in the United States.
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Infant mortality rates are the number of infant deaths during the first year of life per 1,000 live births. Infant mortality rates have decreased dramatically in the United States, but the nation still lags behind other developed countries that have even lower infant mortality rates.
Many of the nations with lower infant mortality rates also have national health programs in place. Researchers aim to improve these vital statistics for all populations in the United States.
National health initiatives
The current focus on health promotion and disease prevention has prompted national initiatives, such as Healthy People 2020, aimed at improving children’s health.
