S E C T I O N
Introduction to the Family and
S E C T I O N O U T L I N E
Chapter 1 Perspectives on the Nurse’s Role in Child Care
Chapter 2 The Nurse’s Role in the Care of Children
Chapter 3 The Family
Chapter 4 The Nursing Process in the Care of Children
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C H A P T E R O U T L I N E
Historical Background on the Care of Children
Delivery of Care to Children: Factors Influencing the
HISTORICAL BACKGROUND ON THE
CARE OF CHILDREN
An understanding of child care since it began is essential for the
nurse to gain an appreciation of the trends leading to the present
concepts and practices specific to children. Some of today’s
philosophical beliefs can be attributed to evolving civilizations.
THE CHILD IN PRIMITIVE SOCIETIES
Little is known about life in prehistoric times, but child care is
believed to have been similar to that among cultural groups
living today in areas hardly touched by civilization. In such
groups, children usually are not valued for themselves but as
future adults. For this reason, social development according to
the customs of the groups is revealing.
Early primitive people were nomads, moving constantly in
groups in their search for adequate food and for safety from
wild animals and hazardous weather conditions. Groups looked
favourably on members who were strong and destroyed those
who were sick or weak. When such a society ruled that a
malformed or sickly infant would drain the resources of the
group, the infant was killed or left behind to die. Sometimes
infants were killed simply because they were females who could
not contribute as much productive labour to the group as males
could. This practice is termed infanticide. Probably some
infants survived because their mothers protected them. Then as
now, societies were composed of individuals not all of whom
necessarily lived by the rules of the group.
In addition, some primitive peoples believed in superior
beings who ruled not only them but also nature and the
universe as they knew it. They reasoned that the forces of a
storm or a period of prolonged drought was an act of a supe-
rior being who was displeased. Perhaps the birth of a
deformed infant was also punishment for previous trans-
gressions of the parents. Such thinking did not cease with
The child, even in primitive tribes, had to receive at least a
minimum of physical care in order to live. Whether the child
received love and affection depended on the cultural group and
on the mother.
THE CHILD IN ANCIENT CIVILIZATIONS
The concept of the importance of the child to society gradually
emerged as each group settled on an area of fertile land. Instead
of being a liability, the child slowly became an asset to society.
L E A R N I N G O B J E C T I V E S
Trace the historical perspectives influencing the role of the nurse in child care.
Describe the influence of the family, culture, and the health care delivery system on the children.
Discuss the societal factors influencing the role of the nurse.
Identify the influences on the nurse’s role of the professionalizing process.
C H A P T E R
Perspectives on the Nurse’s Role in
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SECTION I | INTRODUCTION TO THE FAMILY AND CHILD CARE
Egypt. The early peoples who settled in the valley of the Nile
River cared for their children, dressing even their infants in
loose clothes and encouraging breast feeding. They encouraged
children to learn, as well as to participate in outdoor activity. As
early as 1500 BC, treatment different from that given to adults
was prescribed for the diseases of childhood.
Greece and Rome. Physical beauty was considered important
by the early inhabitants of Greece; thus children were reared so
that they would have well-formed bodies. The importance of the
family was stressed in Rome because its function was to raise
strong sons to become good warriors who could serve the state.
Hippocrates (460–370 BC) referred frequently in his writ-
ings to the peculiarities of disease in children. Specific treat-
ment for the illnesses of children as opposed to that given to
adults was also recommended by Celsus, who lived in the first
Israel. Among the ancient Jews the hygienic measures
prescribed in the Mosaic Law had a great influence on maternal
and child care. The Hebrew people recognized the importance
of cleanliness and nutrition. They also recognized communi-
cable diseases and made efforts to control them. They believed
that the religious ceremony of circumcision practised on male
infants served as a health measure as well.
Parenthood was honoured among the Hebrews, and a large
family was considered a sign of God’s blessing upon the parents.
The greatest disappointment a woman could have was to be
IMPACT OF CHRISTIANITY ON CHILD CARE
Christianity, among other emerging religions, helped promote
the philosophy of the sanctity of human life. Christianity taught
the value of the child as an individual, not merely as a son or
daughter who would cherish the parents in their old age and
give them grandchildren so that the family might extend for
generations to come. Furthermore, since Christianity also
taught the protection of the weak by the strong and the care of
the ill by the well, the helpless child and the infirm became
objects of special consideration. Orphan asylums for dependent
children and hospitals for the care of the sick were founded
early in the history of the Christian Church.
THE CHILD IN DEVELOPING COUNTRIES
The speed of modern transport and the exploding world popu-
lation are bringing the people of the world closer together than
ever before. Health problems that were once the concern of only
a small segment of the population now potentially threaten the
whole world. Through the international activities of the World
Health Organization (WHO), the United Nations Children’s
Fund (UNICEF), and the other groups, assistance is being
provided to developing countries in their efforts to improve
their level of child care (Table 1-1).
THE CHILD IN INDIAN SCENARIO
The health of the children is of vital importance in all societies
as the children are future citizens. The concept of health and
illness are ever changing. Health is said to exist when an indi-
vidual can meet the physical, physiological, intellectual, psycho-
logical, and social requirements appropriate for his age, sex, and
level of growth and development. WHO defines health as a state
of complete mental, physical, and social well-being, the holistic
view of health is being widely accepted and practised. It implies
a philosophy, believing in an integration and harmonious
balance of body, mind, and spirit. Any disturbance in the equi-
librium results in disease, or illness, or disability. Illness of child
Table 1-1 Milestones in child care in India and the health care
1946 The United Nations International Children’s Emergency
Fund (UNICEF) created by the United Nations
1948 The World Health Organization (WHO) created by the
1959 The 14th General Assembly of the United Nations
approved the Declaration of the Rights of the Child
‘Mankind owes the child the best it has to give.
The right to affection, love, and understanding.
The right to adequate nutrition and medical care.
The right to free education.
The right to full opportunity for play and recreation.
The right to a name and nationality.
The right to special care, if handicapped.
The right to be among the ﬁrst to receive relief in times of
The right to learn to be a useful member of society and to
develop individual abilities.
The right to be brought up in a spirit of peace and brotherhood.
The right to enjoy these rights, regardless of race, colour, sex,
religion, national or social origin.
All children, without any exception whatsoever, shall be entitled
to these rights, without distinction or discrimination.’
1961 Midday Meal Scheme for children was launched by
Government of India
1962 Control of iodine deﬁciency disorder programme
1969–74 Prophylaxis against nutritional anaemia
1975 Integrated Child Development Scheme launched
1978 Expanded programme on immunization launched
1985 Universal Immunization Programme launched
1986–87 Oral rehydration therapy programme launched
1990 Acute respiratory disease control programme launched
1992 Concept of baby friendly hospital was initiated
1995 Pulse Polio programme launched
1997–2002 Reproductive and Child Health Programme Phase I
2005 Reproductive and Child Health Programme Phase II and
Integration of IMNCI
2005 Launch of National Rural Health Mission
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PERSPECTIVES ON THE NURSE’S ROLE IN CHILD CARE
affects the family as a unit as child is an important part of the
family and also since the child is dependent on the adults, as the
child needs help for meeting his physical, physiological, and
care needs from the family members. Thus the illness of the
child affects the whole family. In India family system is very
significant, most of the people in rural areas are still living in
the joint family system, however increasing urbanization is
giving rise to nuclear families in the cities. Approximately one
fourth of the total population of our country is represented by
the children, thus their health issues are a cause of concern for
the health care professionals.
Emphasis on the concepts of child care gradually developed
in the countries of the world. Hippocrates of Greece (460–370
BC), the father of modern medicine, devoted a great part of his
treatise to children and made many observations on the
diseases found among children. In India Sushruta Samhita, the
classical encyclopaedia of ayurvedic medicine, bears a record of
children anywhere in the world. The colossal work written by
Sushruta (The Indian Hippocrates) contains many aspects of
child rearing such as infant feeding, paediatric diseases includ-
ing fever, liver diseases, etc. Charaka, the court physician in
Peshawar, wrote in detail on the care and management of
newborn in the fourth century. The siddha system of medicine
in South India describes that service to the child starts from the
moment of conception itself.
Presently health of the children is given vital importance by
the international agencies such as WHO, UNICEF, etc. These
agencies provide assistance to the developing countries of the
world for improvement of the health care of children.
World Health Organization. WHO, established as a special-
ized agency of the United Nations in 1948, was the first world-
wide health organization. Its headquarters are in Geneva,
Switzerland. Its objective is to assist in the attainment of the
highest possible level of health. To do this, it acts as director and
coordinating authority of the international health work; estab-
lishes and maintains effective collaboration with governments
and other interested groups; provides health information and
technical, educational, and other services; evaluates a country’s
health problems when requested; stimulates and advances work
to eradicate diseases and prevent injuries; promotes improve-
ment of nutrition, housing, sanitation, and other aspects of
environmental hygiene; promotes maternal and child health
and welfare; and promotes mental health, among its many other
The present main objectives of the WHO are to control
communicable diseases on an international scale, such as
malaria, tuberculosis, leprosy, yaws, and the sexually transmit-
ted diseases; to build up public health organizations in coun-
tries that have underdeveloped programmes; and to educate
and train medical and auxiliary personnel in the health fields.
The activities of WHO prove that nations can work together
for an important cause: the improvement of human health.
United Nations Children’s Fund. UNICEF was created in
1946 to meet the emergency needs of children, as in times of
war or other disasters. Aid to a country is given only when
requested and on the basis of need, irrespective of race, creed,
or political beliefs. UNICEF is financed by voluntary contribu-
tions from governments, groups, and individuals. In the United
States, children volunteer to collect money for its work by
participating in the Halloween ‘trick or treat’ effort. The sale of
calendars, Christmas cards, and other greeting cards has
provided funds to send medicines and food to many ill and
impoverished children worldwide.
Today’s society is complex and ever changing. As children
grow, they must learn not only to cope with current demands
but also to prepare for the many unexpected events they will
face in their future. Changes brought by new techniques and
technologies will continue to have an impact on society as a
Children are expected to grow and learn to their fullest
potential. Adults serve as advocates for children in order to
meet the needs of all children for access to education and the
health care process. Knowledge of the political system is a
must if adults and children are going to influence society and
ensure quality programmes to assist in meeting future chal-
Children of Varying Family Types and Cultures
Typical of our society is the uprooting and movement of family
groups. Migration occurs as the result of families moving from
one place to other: farm labour families moving as they follow
seasonal crops, rural families seeking opportunities in large
cities, middle class families moving into the suburbs, and the
increase in the numbers of urban families in the lower-income
Partly because of these migrations, the extended family of a
century ago, which included several generations of relatives
living in close geographic proximity, has become fragmented
into small nuclear families composed of parents, children, and
perhaps a grandparent. While the extended family was tradi-
tion-bound and secure—its members being interdependent,
today’s small family is largely adrift in a sea of strangers. Even
the established nuclear family consisting of two parents, includ-
ing a working father and one or more children, is changing. For
various reasons, the decision may be made that the mother
support the family and the father stay home to care for the chil-
dren. Or, both parents may need to work outside the home, and
the child or children may be placed in day care centres or with
another service. When parents are unmarried, separated, or
divorced, or when one parent has died, producing a single-
parent family, further adjustments are necessary for child care.
Attempting to prevent complete disintegration of such small
family groups is the responsibility of society’s agencies and soci-
ety as a whole.
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SECTION I | INTRODUCTION TO THE FAMILY AND CHILD CARE
In view of these social forces, the nursing profession has a
responsibility with other disciplines to create a setting in which
all children, in health and in illness, will receive optimal care in
a secure environment.
DELIVERY OF CARE TO CHILDREN:
FACTORS INFLUENCING THE NURSE’S
It is important for the nurse to recognize the great improve-
ments in child care in the community. Such an understanding
is essential not only for the nurse as a professional caregiver but
also as a parent or potential parent and a community member.
Part of the support that young parents formerly gained from
an extended kinship family is now being supplied by the
government agencies and privately supported programmes. As
noted earlier, the union, state, and local governments have
committed themselves to providing improved care for mothers
and children. This is especially true for those at high risk or
those at the low-income or poverty level. Funds have been allo-
cated for the care of mothers and well children through
improved nutrition, immunization programmes, well-child
conferences, and other services. Funds have also been allocated
for the extension of screening and detection programmes for
hereditary disorders, for the support of various clinics and
health-related services for ill children, and for research.
Among the most important movements in the provision of
comprehensive health care has been the widespread development
through various government programmes for welfare of mother
and child. Government-sponsored programmes have attempted
to lower the incidence of complications associated with preg-
nancy and to provide services to high-risk infants in the form of
early treatment to prevent or minimize defects. Various National
Health Programmes of India with specific reference to various
vector-borne diseases, such as national antimalaria, filaria, and
kala-azar control programme, also attempt to lower the incidence
of these diseases. Another programme initiated by the Indian
(EPI). The main objective of this programme is reduction of
morbidity and mortality among children by preventing various
known as six killer diseases of childhood such as poliomyelitis,
immunization programme was started in India in 1985; two vital
components of this programme are immunization of expectant
mothers against tetanus and immunization of children in the first
year of birth. In addition to this Pulse Polio Programme was
launched in India in the year 1995, with an aim to eradicate polio.
Since the Indian population has a low life expectancy, its most
pressing health problems are those that affect infants and chil-
dren: principally accidents, gastrointestinal diseases, tuberculo-
sis, respiratory diseases, and communicable diseases. The prob-
lem of infant and child health results from the high incidence and
severity of infectious disease, delay in obtaining treatment result-
ing in secondary complications, and the difficulty in providing
preventive medical services. Malnutrition, anaemia, and poor
general environment contribute to the incidence and severity of
Children of migrant farm families are often deprived cultur-
ally as well as physically, intellectually, and socially. Because of
repeated migrations, these children have complex needs that
can be met only through programmes of education, social
welfare, and medical services. The initial need of migrant farm
families is for day care centres where parents can leave their
children while they work on the farms. The health services
provided at these centres depend on the local need, interest, and
availability of professional suppliers, and facilities. The common
health care needs of these children are for immunizations,
improved feeding habits, physical examinations, testing if the
children are ill, and correction of problems resulting from igno-
rance and poverty.
The trend towards regionalization of health care—a coopera-
tive effort among institutions in a geographic area allowing for
an orderly distribution of services to all patients who need
them—has accelerated in recent years. Three levels of care are
provided: primary care for patients having relatively normal or
uncomplicated problems; secondary care for normal- and high-
risk patients; and tertiary care not only for normal- and high-
risk patients but also for those having the most complicated
Primary care is the usual point of entry into the health care
system. It is generalized patient care, emphasizing the promo-
tion and maintenance of health and the prevention of disease
and serving the simpler and more common illnesses of chil-
dren. Primary care is usually given outside a hospital environ-
ment, in a private physician’s or practitioner’s office, local clinic,
or health maintenance organization.
Secondary care is for more acute illness and is usually
provided in a paediatric unit of a general or community hospi-
tal. Acute care is generally intense, of short duration, and of a
nonchronic nature. Children may enter this level directly or
Tertiary care is highly specialized, complex care dependent
on sophisticated technological and support facilities, such as
are found in a hospital devoted to the care of children.
Children are referred to tertiary care from the primary or
secondary levels. Tertiary care is based on diagnostic and
therapeutic advances that have come from basic and clinical
research. In a tertiary care facility, standards are set for study-
ing, treating, and managing routine paediatric problems,
which can then be used by secondary facilities. Also, such a
facility centralizes the most serious disorders of children
where medical, nursing, and technological capabilities are
available to care for them.
Regionalization became necessary because of problems of
economics and community demands for quality health care.
Costly physical facilities and medical and nursing personnel
can no longer be duplicated in agencies near each other. Small
paediatric units in general hospitals are closing because a
surplus of paediatric beds has led to underutilization of depart-
ments that are uneconomical.
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PERSPECTIVES ON THE NURSE’S ROLE IN CHILD CARE
The specialized strengths of a medical centre for children as
a regional resource are dramatically illustrated by neonatal
intensive care units (NICU). An emergency transport system
can immediately bring its services to infants in distress over a
wide geographic area and speed the patients back to the inten-
sive care unit. Many infants who formerly would have died now
have an improved chance for survival.
The need for day care for children whose parents cannot care
for them during the day is well documented. Without an orga-
nized facility, such children are cared for by older brothers or
sisters, grandparents or friends, or are permitted to stay by
themselves. A small number of children are cared for by a
parent at work.
School health programmes vary, depending on the locale and
size of the school. The school nurse or nurse practitioner may
function alone or may be a member of a health care team
consisting also of a physician, child psychologist, guidance
counsellor, and social worker. The nurse’s functions may
include being responsible for providing first aid care for chil-
dren during school hours, assisting with physical examinations
and conducting hearing, vision, and tuberculosis screening
tests, checking on immunizations, caring for children who have
problems such as diabetes or epilepsy, carrying out sex educa-
tion programmes for children and sometimes for parents as
well, and being a health counsellor for the families and children
in school. The school nurse may be a public health nurse who
spends only a brief time in the school or may be a full-time
nurse whose total responsibility is the care of the children
enrolled in a particular school.
Home health care has been growing in importance as a
component of the health care delivery system, since many chil-
dren who have conditions that required hospitalization a few
years ago are now being cared for in the home. This develop-
ment has increased the need for nurses who are able not only to
give direct care to children but also to teach such care effectively
to responsible adults.
Another responsibility that nurses assume with other
members of the health care team is to implement the concept of
preventive paediatrics. This includes the maintenance of Family
Health Clinics, immunization against preventable communi-
cable diseases, education for the prevention of accidents and
poisonings, and case finding of children showing early
emotional disturbances or physical illness. Referrals are made
to facilitate treatment.
Nurses are involved in implementation of these referral
programmes; they can function as patient advocates and as
integral members of the interdisciplinary team. They can be
instrumental in providing counselling for pregnant adoles-
cents, as well as for children who are victims of learning and
developmental disabilities, child abuse, emotional illness,
addiction, and suicidal thinking. In established health care
facilities, in free clinics, or wherever children and youth are
found, nurses can play a pivotal role in providing family
health care and health teaching, and in coordinating multiple
The nurse has an important role in the nurturing of children.
To understand how that role is fulfilled, the nurse must consider
the impact of societal forces upon the nursing of children. The
following elements are discussed not in order of importance but
as a constellation of factors influencing the nurse and impacting
on the nursing role in society.
ATTITUDES TOWARDS CHILDREN
The changing (and unchanging) attitudes towards the younger
members of our society influence the nurse who cares for
children. Whether the birth rate decreases or increases has an
impact on the need for maternity and paediatric units in
hospitals and other institutions, schools, and businesses
devoted to the production and marketing of childcare prod-
Topics related to child behaviour and health are abundant in
consumer media. Consumers nowadays are more vocal and
better able to express feelings about any perceived or real inad-
equacies in the health care system. They are becoming more
assertive in making decisions concerning their own and their
To understand what the consumer is telling the nursing
profession about health care and its delivery, each nurse must
listen, read what the consumer is reading, see what the
consumer is seeing, and anticipate the results of these messages.
If nurses are not aware of what is happening, the public will
meet its own needs in ways that may be harmful to all.
THE WOMEN’S MOVEMENT
Changes continue in the definition of femininity and masculin-
ity today. The idea that all human beings achieve happiness and
self-acceptance when free to fulfil their own potential has
become more widely accepted. Individuals should be free to
discover who they are and what their abilities are and to strive
towards their goals.
As a result of the women’s movement, changes have evolved
in the role of both mothers and fathers. Mothers can now
work outside or within the home on a part-time or full-time
basis. Instead of the father being wholly responsible for
providing financial support to the family, he may now take
over responsibility for the children while the mother works. In
many families, both parents share the responsibility for child
care. With today’s changing role of women, the nurse will find
that they are more assertive and expect to participate more in
the health care of their children. The nurse must be supportive
of family-centred care and be an advocate for women as deci-
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SECTION I | INTRODUCTION TO THE FAMILY AND CHILD CARE
HEALTH CARE: CHANGES AND ADVANCES
Concepts of Health and Illness
The concepts of health and illness are changing. One formerly
accepted definition of health stated that it is a state of being in
the absence of illness, implying organic illness. This statement
might be amplified to say that health exists when persons can
meet the minimal physical, physiological, intellectual, psycho-
logical, and social requirements to function appropriately for
their age, sex, and level of growth and development. Illness,
then, becomes a situation in which individuals experience a
disturbance in any of these areas that prevents functioning at
the appropriate level. Attention is directed to the psychosocial
as well as the physiological characteristics of health and illness.
Holistic View of Health
The holistic view of health, which is widely accepted today, sees
a human life as a total system. The word health is etymologically
related to the word wholeness. Holistic health implies that all
aspects of the total system of the individual are in balance with
The human system is not closed. It is open to the environ-
ment through the neuroendocrine system with its extensions—
the sensory apparatus. Openness to the environment helps
meet the needs of the system. This also leaves the system open
to disturbances by disharmonious influences. Poisonous influ-
ences, such as smog in the environment, can disturb the physi-
cal system. Mental, emotional, and spiritual ‘poisons’, such as
noise pollution or ‘brainwashing’, can disturb the nonphysical
Holistic health care is a philosophy that believes in an inte-
gration and harmonious balance of body, mind, and spirit to
maintain or regain health. The patient in this framework is
looked at as a whole person, physically, emotionally, intellectu-
ally, and spiritually, in terms of total lifestyle functioning. Life
goals, their relationship and their values, are important consid-
erations. With holistic care, for example, the infant is seen not
only in terms of an upper respiratory infection but also as a
frightened person who is crying out for help because of diffi-
culty in breathing. The adolescent girl who has been diagnosed
as having severe scoliosis cannot be given holistic care unless
her dream of becoming a ballet dancer is considered. The
parents, who usually are in a bruised emotional state when their
child becomes ill, need support and guidance to be able to
supply their child with the love and compassion needed.
Nursing assessments take into consideration all aspects of the
patient’s pattern of living to provide a base for the giving of
The holistic movement is life affirming in that individuals
are encouraged to make choices that have a direct bearing on
health. They assume more responsibility for their own well-
being. This concept leads directly to the areas of high-level
wellness and of self-care.
Wellness means more than the absence of disease. It is a positive
approach to well-being. High-level wellness for the individual
child or adult is defined by Dunn as an integrated method of
functioning which is oriented towards maximizing the poten-
tial of what the individual is capable of, within the environment
where he is functioning (Dunn, 1977).
Therefore, in order to achieve high-level wellness, the indi-
vidual continually progresses as a whole being, physically,
emotionally, mentally, and spiritually, towards a higher level of
functioning in order to achieve a fuller potential (Fig. 1-1). This
progression occurs in a constantly changing environment. Five
important areas of wellness behaviour are (1) physical fitness,
(2) optimal nutrition, (3) appropriate management of stress, (4)
awareness of environmental influences on the individual, and
(5) responsibility for oneself.
Children learn wellness or illness behaviour during their
years of growth and development, principally from parents.
Parents have always been the primary guardians of the health of
their children. They orient children early in life within the
home setting to attitudes and habits of positive personal health
maintenance. Other family members, peers, health care profes-
sionals, and persons in the mass media also have an influence
on children. The value that these significant others, especially
the parents, place on wellness influences children’s attitudes
towards health and behaviour leading to wellness. Parents who
Disability Symptoms Signs
Figure 1-1 Illness–wellness continuum.
(Reprinted with permission from the Wellness Workbook for Health by the Wellness Resource Center, Mill Valley, CA 94941)
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PERSPECTIVES ON THE NURSE’S ROLE IN CHILD CARE
have provided examples of good health care practices through
their own behaviour, who have communicated to their children
the reasons for such practices, and who have helped them solve
problems in other areas of living can expect the children to
assume responsibility for dealing with their own health.
If parents are not aware of or do not recognize the state of
wellness as having high priority in their own home and culture,
their children will not value it either. In such a situation, influ-
ences outside the home, such as in school, may change the
beliefs of the children. They may learn in spite of earlier inad-
equate parental example to deal actively with their own lives
and to seek the highest level of wellness of which they are
In summary, children learn to value wellness as they grow
from infancy through adolescence to adulthood. For this to
happen, they must be aware of the meaning of wellness behav-
iour as it is practised by significant others in their environment.
They also learn from information given to them in a manner
appropriate to their developmental level. Furthermore, children
need to be motivated to participate actively in making the kinds
of behavioural choices that will lead to wellness and to have
such behaviour reinforced.
The self-care movement can be adapted to all levels of the
health–illness continuum. Its purpose is to assist patients to
meet their health needs. These needs may be focused on health
maintenance or health restoration in illness or on health
promotion and prevention of illness. Health education is an
essential component of self-care.
The patient must be knowledgeable, motivated, and compe-
tent to implement a plan of action. School children are usually
able to make decisions and can become involved in self-care. If
their parents do not support their efforts, the school nurse and
teachers may become their support system.
A number of support groups are also used by those involved
in self-care. Examples specific to children and adolescents
include groups geared to chronic illness such as diabetes, cystic
fibrosis, and cancer; ostomy clubs; alcoholics; anonymous
groups including young people’s groups; and narcotics anony-
Advances and Changes in Medical Care
The care of children has changed dramatically for both physi-
cians and nurses during recent decades of advances in medical
knowledge and understanding of the emotional responses of
children, such as the discovery of various immunizations, anti-
biotics, and other drugs that have curative value in many
illnesses; computed tomographic (CT) scans and ultrasound
techniques that make early diagnosis possible; and public
health measures and public education that can prevent or
shorten periods of hospitalization. Children who require hospi-
talization are less often isolated for prolonged periods for infec-
tious diseases, have opportunities for early ambulation, and
have shorter convalescences than in the past. Today, some
children may still require long hospitalization for complicated
diagnostic or therapeutic measures, some of which have been
discovered only during recent years.
The present emphasis on health education in disease preven-
tion, self-care, and self-help groups should result in reduced
morbidity for all. Increased control of environmental factors
that lead to disease, advanced technology in the areas of self-
monitoring, and computers in the home will be among the key
influences on health care in the future.
Advances in the understanding of human development and
the stages of personality development throughout the life cycle
have led to a better understanding of the needs of all family
members. Since the child and the family are interdependent,
health care team members must be aware that the anxieties of
the parents as well as those of the child need to be considered if
a constructive response and adjustment to the experience of
illness are to be made. Such understanding has led to prepara-
tion for hospitalization for parents and child, extended visiting
hours during the child’s hospital stay, parental care of the hospi-
talized child, inclusion of children at the birth of a sibling, etc.,
are the new concepts in child care.
Nurses can now understand from the foregoing discussion
that they have an important role in organized community
action by collaborating with other members of the health care
team and coordinating services of the nursing team. In addi-
tion, nurses have the responsibility of providing nursing inter-
vention in the hospital, clinic, school, home, or the community
where children or parents have health or counselling needs. The
abilities of nurses who care for children as health educators,
teachers, counsellors, researchers, case finders, and compas-
sionate, skilled care providers are urgently needed by today’s
The role of the nurse has evolved into that of caregiver, patient
advocate, counsellor, teacher, collaborator, coordinator, change
agent, and consultant. Many factors have influenced the role of
the nurse; some considered most significant are reviewed here.
THE PROCESS OF PROFESSIONALIZATION
Nursing has always been recognized for nurturing and caring
for those in need. As a result of recognition by its early support-
ers, nursing became a part of the educational process. Today
nursing continues in its pursuit towards recognition as a profes-
sion. By broadening its initial services to include health main-
tenance and illness prevention, health promotion, and health
restoration, nursing continues to keep abreast of the health care
needs of the consumer. Nursing is presently based on a body of
knowledge encompassing the arts and sciences. With ongoing
research and theory development, it continues to broaden its
scope. By incorporating the new technologies into already
existing skills, nursing continues to provide expert care to the
patients it serves. The nursing process incorporates assessing,
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SECTION I | INTRODUCTION TO THE FAMILY AND CHILD CARE
planning, implementing, and evaluating nursing care. The
nursing diagnosis movement is an example of networking and
the use of nursing research to standardize identification of
EXPANSION OF THE NURSING ROLE
Caring is an essential ingredient in the role of a paediatric nurse.
It is a way of relating to others that develops through reciprocal
trust and honesty. It involves great commitment on the part of the
nurse. The circle of care should include the concerned child, the
parents, and other family members. Guidance and encourage-
ment should be provided to cope up with illness. The nurse
should make efforts to allay the anxiety and divert the parent’s
anger towards the illness into constructive outlets. This would
enable them to take better care of their child.
A paediatric nurse must have special skills to look after the
special needs of young patients. The paediatric nurse needs to
be gentle to touch and performance as she is working with
young and delicate individuals. A child responds best to a quiet
and confident voice. The child unlike adults is not able to recog-
nize his problem and report his illness state verbally. He cannot
express the area of concern, the only expression he can exhibit
is crying. Nurse must be sensitive to changes in moods and
temperament of the child. The sickness of the child can be
assessed due to behaviour change in the form of restlessness,
refusal to eat, clinging to mother. The changes in children take
place very quickly and often without warning. The paediatric
nurse must be over alert. She needs not only to be alert to symp-
toms but to be able to anticipate wants of the child. She needs to
develop skills in identification of physical and emotional
distress in children. She needs to be skilled in providing physi-
cal care to the child. Children should be told in advance as per
their age and level of understanding about the procedure to be
done so that they are not scared during the procedure.
Communication is very important component of nursing
care of children. It is essential in developing a trusting relation-
ship with them. Although most of the verbal communication is
done with the parent, the child should also be involved as per
the condition. Play is a universal language of children. It is an
effective and important technique in communicating with chil-
dren. While giving direction to children or seeking cooperation
from a child, the nurse should speak clearly, be specific, and use
as few words as possible, as simple language is easily under-
stood. Nurse should be able to guide the parents in handling the
child to prevent complications, prevent illness, and promote
health. The nurse should be honest in dealing with the children
and make no promises that are impossible to carry out. To
assure that an injection will not hurt or will not cause pain is
Because of the increased complexity of medical and nursing
care, a need for highly specialized practitioners has developed.
Graduate programmes evolved to meet these needs and have
resulted in the creation of the nurse practitioner and the nurse
Although the implementation of these specialties may vary
from institution to institution, they focus on providing quality
patient care to children in primary, secondary, and tertiary care
settings. These nurses serve as role models, provide care, teach
the nursing staff, collaborate with all members of the health
care team, and serve as an advocate for children and their fami-
lies. In addition, they initiate and direct nursing research, the
purpose of which is to improve the quality of care.
Specialization provides further opportunities for nurses in
the expanded role. Subspecialty areas include neonatal nursing,
nursing of pregnant adolescents, oncology nursing, and school
nursing, to name a few. The subject of paediatric nursing has
been included in the undergraduate programme of nursing by
the Indian Nursing Council. It prepares the nurses having
knowledge and skill related to child care who should be capable
of providing nursing care to sick children. Master’s in nursing
programme has also been started in the speciality of child
health nursing; the curriculum of this programme has also been
designed and approved by Indian nursing council.
As may be expected, services for children are costlier than
they are for adults with comparable health problems. Since cost
containment is a current concern of nurses as well as consum-
ers, it is essential to develop such innovations that utilize all
available resources in providing quality nursing care for chil-
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