Unit I
Pediatric Nursing
Perspective of Pediatric nursing.
PRESENTED BY
AKHLAQUE AHMED QADRI
QADRI COLLEGE OF HEALTH SCIENCES KARACHI
Objectives:
• Evolution in Pediatric Nursing.
• Role of pediatric nurse.
• Paediatric Nursing in Pakistani culture.
• Convention on the rights of the child.
• Commonly occurring ethical issues in pediatric setting
of Pakistan.
PEADIATRIC NURSING
• Pediatric nursing/child health nursing is the specialty nursing care of
infants, children and adolescents.
• Goal of pediatric nursing is to improve the quality of health care for
children and their parents.
•
Evolution in Pediatric Nursing
Few centuries children consider as manure adult
And hold the responsibilities as adult as soon as grow
Later on infant and child mortality rate is high
Epidemic diseases were common, with no control or treatment for
smallpox, diphtheria, measles, dysentery, mumps, chickenpox, yellow
fever, cholera, or whooping cough.
Evolution in Pediatric Nursing
• 1860: Dr. Abraham Jacobi, a New York physician referred to as the
“father of pediatrics,” first lectured to medical students on the special
diseases and health problems of children.
• At “milk stations,” infants were weighed and mothers were taught
how to prepare milk before giving it to their babies.
• Late 1800s: Increasing concern developed for the social welfare of
children, especially those who were homeless or employed as factory
laborers.
Evolution in Pediatric Nursing
• In 1880, Jacobi and a few other interested physicians founded the
American Medical Association’s section on the diseases of children.
• In 1888, they formed a new organization, the American Pediatric
Society, which helped to solidify pediatrics as a distinct branch of
medicine.
• Jacobi served as the first president of both groups.
Evolution in Pediatric Nursing
• As the hospital began to admit sicker patients, hospital trustees and
physicians understood that trained nurses were essential for children
to benefit from the burgeoning diagnostic and therapeutic modalities.
• The ongoing need for more and better-trained nurses resulted in the
long anticipated inauguration of a nurse training school at the hospital
in 1895, an advance that the Board noted answered "a want, long
felt" (CHOP, 1895).
Evolution in Pediatric Nursing
• Lillian Wald: founder of public health or community nursing,
• A New York City nurse, Lillian Wald, pioneered the new nursing
specialty of public health nursing, an important engine of child-saving.
• In 1893, she and a colleague merged the concepts underlying district
nursing and settlement houses by creating the nurse-managed Henry
Street Settlement.
• One of Wald’s most significant accomplishments for children was her
idea for school nurses. In 1902, Wald convinced the Board of
Education to hire a Henry Street nurse to work in the school system.
Evolution in Pediatric Nursing
• Early 1900s: Children with contagious diseases were isolated from
adult patients; parents were prohibited form visiting.
• 1940s: Famous works of Spite and Robertson on institutionalized
children; the effects of isolation and maternal deprivation were
recognized.
• 1909: White House Conference on Children focused on issues of child
labor, dependent children, and infant care.
• 1912: U.S Children’s Bureau was established.
Evolution in Pediatric Nursing
• 1919: First funded program for mothers and children
• 1929: Depression caused conditions for children to decline, once
again
• 1987: National Commission on Children formed; served as a forum on
behalf of the children of the nation
• Children are the focus of many reform initiatives in the twenty-first
century, and solutions will emphasize collaboration among various
disciplines.
Cont..
• Though the first pediatric nursing textbook was not published until
1923, articles addressing the needs of children appeared in nursing
journals much earlier. (Farrar, 1906; Pierce, Cutler, & Bancroft, 1923).
• Florence Nightingale herself emphasized children's nursing care
needs in her seminal 1859 book.
Evolution in Pediatric Nursing
• Nursing of infants and children is consistent with the revised
definition of nursing proposed by the Social Policy Task Force of the
American Nurses Association (ANA) in 2003.
• This definition incorporates the four essential features of nursing
practice: Attention to the full range of human experiences and
responses to health and illness without restriction to a problem-
focused orientation Integration of objective data with knowledge
gained from an understanding of the patient or group’s subjective
experience
Evolution in Pediatric Nursing
• The American Nurses Association (ANA) (2003) stated that
• “an essential feature of professional nursing is the provision of a
caring relationship that facilitates health and healing”.
• Knowledge and communication are required elements in the practice
of all health professionals.
Cont.….
• Today, an essential site for children’s health care delivery is the
school-based health clinic, where school nurses and pediatric nurse
practitioners address epidemics of child obesity, asthma, and mental
health and behavioral problems (Halfon, 2007).
Role of pediatric nurse/ basic role of
a nurse
• Primary care giver
• Coordinator and Collaborator
• Advocate
• Health Educator
• Consultant
• Counselor
• Case Manager
• Recreationist
• Social Worker
• Researcher
Roles of the Pediatric Nurses
• Pediatric nurses plays an essential role in:
• • Establishing therapeutic relationship
• • Family Advocacy/Caring
• • Disease Prevention/Health Promotion
• • Health Teaching
• • Support /Counseling
• • Restorative Role
• • Coordination/ Collaboration
• • Research
• • Ethical decision Making
• • Health Care Planning
Role of pediatric nurse
• Pediatric nursing is different from other clinical specialties in nursing.
• Pediatric nursing is family-centered nursing in its truest sense.
• The pediatric nurse must have keen observation skills, especially
when caring for infants and toddlers or children who are critically or
cannot communicate in the traditional sense.
• Supporting a children through difficult procedures or illnesses is an
activity in which a pediatric nurse commonly becomes involved.
Role of pediatric nurse
• Nurses also need to be aware of the indirect teaching that occurs
through example.
• A pediatric nurse also functions as a child and family advocate,
whether those activities involve an ethical decision or the quality of
care given. Being able to communicate effectively with a child is
essential.
• Three key components of family-centered care are respect, collaboration, and
support.
• Two basic concepts in family-centered care are enabling and empowerment.
• The parent-professional partnership is a powerful mechanism for enabling
and empowering family.
Family centered care
• Partnerships imply the belief that partners are capable individuals
who become more competent by sharing knowledge, skills, and
resources in a manner that benefits all participants. -often illness and
hospitalization are the first crises children must face:
• Stress represents a change from the usual state of health and environment
routine
• Children have a limited number of coping mechanisms to resolve stressors.
Pediatric Nursing Partnerships
with Parents
• Parental involvement in their children’s care has evolved from their
role to institutions to today’s role of planners, in addition to recipients
of services, parents are treated as equals and have a rightful role in
deciding what is important for themselves and their family. Parents of
special needs children often become experts on their child’s
condition.
Pediatric Nursing in Pakistan
• Pediatric Nursing in Pakistan is a specialized area in health care setup.
• One year specialization course available for pediatric Nurse.
• Tertiary care hospital consist on separate department for Children
under 12 years of age.
Convention on the rights of
child (CRC) U.N.
• All children born with equal basic human rights without any
discrimination, our religion has also said that human rights are the
freedom and standards we must have in our lives to live in dignity and
with respect.
• U.N Convention on the rights of child (CRC) 1989
Why we need Child Rights?
• Implementation of Child rights gives strong social, physical, mental,
and spiritual support to a child. They protect children from unsafe
behaviors, increase self esteem and make a child decisive and
empathetic
U.N Convention on the rights of child (CRC)
1989
few important rights
• The Right to Life
• The Right to Liberty and Security of the Person
• The Right to Equality and to be free from all forms of discrimination
• The Right to Privacy
• The Right to Freedom of Thought
• The Right to Information and Education
• The Right to Health Care and Health Protection
• The Right to participation
• The Right to Freedom of Assembly and Political Participation
• The Right to Free from Torture and ill Treatment
• The Right to education
• The Right to decide:
Child Health in Pakistan: Current Issues and
Challenges
• Pakistan, a developing country, has the 2nd highest child mortality
rates in South Asia
101 deaths per 1000 live births (Bhutta, Hyder, & Ali, 2007)
• Common causes of high child mortality in Pakistan includes sepsis,
prematurity, respiratory infections, low birth weights, and
malnutrition (Hirani & Kenner, 2011; Kenner & Hirani, 2008)
Ethical issues in pediatric setting of Pakistan:
• Ethics conflicts, such as professional-personal boundary conflicts,
end-of-life decision-making, and maintaining patient privacy and
confidentiality, are a few of a broad spectrum of ethics challenges
occurring in today’s rural health care settings.
• Rural health care professionals respond to the ethics challenges that
occur in their clinics or in critical access hospitals based on their
personal beliefs and experiences, community values, organizational
policy, and/or understanding of ethical guidelines.
General ethical principles
• Respect of the individual's autonomy. ...
• Respect of the individual's competence. ...
• Respect beneficence. ...
• Respect of the truth. ...
• Respect of patient confidentiality. ...
• Avoidance of paternalism and bias. ...
• Avoidance of all conflicts of interest. ...
• Respect the limitations of medical care
Ethical issue at pediatric setting
• • Deciding for DNR or no code status of patients
• • Telling the exact diagnosis to the child
• • Withholding the treatment
• • Withdrawing the treatment
• • Limited options of medical treatment (due to financial constrains)
Future challenges of Pediatric
Nursing
• The present shift from treatment of disease to promotion of health is
likely to further expand nurses’ roles in ambulatory care, with
prevention and health teaching receiving a major emphasis.
• Technological advances will influence the pediatric nurse to increase
technical skills related to patient care.
• Nurses will need to keep along side of developments in adolescent
medicine and continually adapt their care to the cultural environment
in which they practice.
• https://www.nursing.upenn.edu/nhhc/home-care/late-nineteenth-an
d-early-century-pediatrics
/
• https://www.ohchr.org/en/professionalinterest/pages/crc.aspx
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232508/
• (Reading et al., 2009; U.N. Convention on the Rights of the Child,
1989)
Amjad Ali + Tanseer Ahmed 31
