Role of MSc Pediatrics & Child Health nurse according to the Ethiopian context.

1. College of Health Sciences & Medicine, School of Health
Sciences, Department of Pediatrics & Child Health
Nursing
Course Title: Advanced Management of Common
Acute Pediatrics Problems
• Course code: PNurs5053
• Credit value: 3CHRs (6EtCTS)
• Placement: First year
By Aklilu Endalamaw
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2. Course description
This course is designed to further build the learner’s skills in
advanced pediatric health assessment and to integrate
appropriate management plans for children presenting with
urgent or emergent health issues in a hospital setting.
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3. Course Objectives
Develop basic knowledge on the epidemiology of illness.
Demonstrate advanced skill in triaging and presenting findings.
Integrate path physiology, epidemiology, developmental stage, and age in the
development of a differential diagnosis based on a presenting symptom.
Manage cases during an emergency situation.
Apply strategies used to enhance, maintain and restore health.
Demonstrate increasing ability to communication to other health care providers and
patients and families.
Use consultation and referral approach to other health care providers when necessary
Review using electronic/Internet-based sources of information about evidence-based
health care for children and adolescents.
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4. Unit- I:
Role of the advanced pediatrics Nurse in Acute Care
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5. Objectives
At the end of this session, learners will able to:
߷ Demonstrate the role of pediatrics and Child Health Nurse
specialist (MSc level)
߷ Practice family centered care & therapeutic communication
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6. Cont…
According to EFMHCAAA. scope of practice for health professionals
in Ethiopia. 2014
In addition to the tasks of Nurse Professional, the Pediatrics and
Child Health Nurse Specialist may perform:
 Obtain comprehensive history, perform physical examination,
order investigations, and diagnose paediatric cases including
chronic and acute conditions;
 Formulate a holistic, culturally sensitive, family-centred plan of
care in collaboration with the child and family as active
participants;
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7. Cont…
 Provide comprehensive health plans by teaching, counselling,
and advising children and their families about growth and
development, health promotion, health status, illnesses, illness
management plans, as well as providing anticipatory guidance;
 Treat childhood illnesses, chronic and acute conditions, or any
other condition (childhood emergencies and administering
immunizations) that is within the skill, expertise, and
knowledge of the profession;
 Prescribe/order appropriate pharmacological and non-
pharmacological interventions11/21/2020 Aklilu Endalamaw 7

8. Cont…
 Provide appropriate child and family education
regarding purpose, regimens, side effects, possible
interactions of medications and/or treatments, cost,
and alternative treatments or procedures;
 Monitor child and family response to treatments
 Participate in Continuous Quality Improvement
processes to assure provision of quality health care
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9. Cont…
 Synthesize and use the results of evaluation to make or
recommend changes including policy, procedure, or
protocol documentation
 Conduct researches to improve the health of pediatrics
population
 Take leadership and managerial role in health care settings
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10. Patient- and family-centered care
• Patient- and family-centered care is an approach to the
planning, delivery, and evaluation of health care that is
grounded in a mutually beneficial partnership among
patients, families, and health care professionals
(Dudley N. et al, 2015).
• In pediatrics, patient-and family-centered care is based
on the understanding that the family is the child’s
primary source of strength and support.11/21/2020 Aklilu Endalamaw 10

11. Cont….
• This approach to care recognizes that the
perspectives and information provided by families,
children, and young adults are essential components
of high-quality clinical decision-making.
• Patients and family are integral partners with the
health care team.
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12. Cont…
Patient- and family-centered care embraces the following
concepts(American Academy of Pediatrics, 2014):
(1) care is provided for a person, not a condition;
(2) the patient is best understood in the context of his or her
family, culture, values, and goals; and
(3) honoring this context will result in better health care, safety,
and patient satisfaction.
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13. The core principles of patient- and family
centered care
• Patient- and family-centered care is grounded in collaboration
among patients, families, physicians, nurses, and other
professionals in clinical care as well as for the planning,
delivery, and evaluation of health care, and in the education
of health care professionals and in research, as well.
• These collaborative relationships are guided by the following
principles:
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14. Principles Cont…
፩. Listening to and respecting each child and his or her family.
Honoring racial, ethnic, cultural, and socioeconomic background
and patient and family experiences and incorporating them in
accordance with patient and family preference into the planning
and delivery of health care.
፪. Ensuring flexibility in organizational policies, procedures, and
provider practices so services can be tailored to the needs, beliefs,
and cultural values of each child and family and facilitating choice
for the child and family about approaches to care (Tarini BA et al,
2007).
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15. Principles cont…
፫. Sharing complete, honest, and unbiased information with patients and
their families on an ongoing basis and in ways they find useful and
affirming, so that they may effectively participate in care and decision-
making to the level they Health information for children and families
should be available in the range of cultural and linguistic diversity in the
community and take into account health literacy.
In hospitals, conducting physician rounds in the patients’ rooms with
nursing staff and family present can enhance the exchange of information
and encourage the involvement of the family in decision-making (Landry
MA et al, 2007; Muething SE et al, 2007; Simmons JM, 2006; Rosen P et al,
2009).
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16. Principles cont…
፬. Providing and/or ensuring formal and informal support (eg, peer
to-peer support) for the child and family during each phase of the
child’s life. Such support is provided so that Health Insurance
Portability and Accountability Act and other relevant ethical and
legal guidelines are followed.
፭. Collaborating with patients and families at all levels of health
care: in the delivery of care to the individual child; in professional
education, policy-making, program development, implementation,
and evaluation; and in health care facility design.
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17. Principles cont...
• As part of this collaboration, patients and families can serve as
members of child or family advisory councils, committees, and task
forces dealing, for example, with operational issues in health care
facilities; as collaborators in improving patient safety; as
participants in quality-improvement initiatives; and as leaders or co-
leaders of peer-support programs (Conway J et al, 2010; Johnson B
et al, 2008).
• In the area of medical research, patients and families should have
voices at all levels in shaping the research agenda, in determining
how children and families participate in research, and in deciding
how research findings will be shared with children and families
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18. Principles cont…
፮. Recognizing and building on the strengths of individual children
and families and empowering them to discover their own
strengths, build confidence, and participate in making choices and
decisions about their health care.
A self-assessment tool is available for families to evaluate whether
the care they are receiving fits into the realm of family-centered
care and also can be used by pediatrics and child health nurse to
evaluate the care they deliver .
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19. Benefits to be expected when engaging in patient- and
family-centered pediatric practice
Patient- and family-centered care can improve
ሀ. Patient and family outcomes,
ለ. Improve the patient’s and family’s experience,
ሐ. Increase patient and family satisfaction,
መ. Build on child and family strengths,
ሠ. Increase professional satisfaction,
ረ. Decrease health care costs, and lead to more effective use of
health care resources
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20. Patient and family outcomes
• High-quality, patient- and family centered primary care is
associated with a significant reduction in non-urgent emergency
department visits in children .
• Family presence during health care procedures decreases anxiety
for the child and the parents.
• Children whose mothers were involved in their care recovered
faster and were discharged earlier .
• Children who had undergone medical procedure cried less, could
be less restless, and required less medication when their parents
were present and assisted in pain assessment and management .
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21. Cont..
• Parents of infants who received more patient-and family-
centered care and in discharge planning could more satisfied
with the care they received, demonstrated increased
competence and confidence in infant caregiving, and were
more willing to seek help from health care providers.
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22. Staff Satisfaction
• Those who participate in education programs with families as
teachers believe that these experiences are highly valuable.
• When patient-and family-centered care is the cornerstone of
culture, staff members have more positive feelings about their
work that does emphasize emotional support.
• This may lead to improved job performance, less staff
turnover, and a decrease in costs .
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23. BENEFITS OF PATIENT- AND FAMILY-CENTERED CARE
FOR Pediatrics & Child Health Nurse professionals
• Those who practice patient- and family-centered care may
experience the following benefits:
1. A stronger alliance with the family in promoting each child’s
health and development .
2. Improved clinical decision-making based on better
information and collaborative processes.
3. Improved follow-through when the plan of care is developed
collaboratively with families.
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24. Cont…
4. Greater understanding of the family’s strengths and caregiving
capacities.
5. More efficient and effective use of professional time,
including the use of patient- and family-centered rounds.
6. More efficient use of health care resources (eg, more care
managed at home, decrease in unnecessary hospitalizations and
emergency department visits, more effective use of preventive
care).
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25. Cont…
7. Improved communication among members of the health care
team.
8. A more competitive position in the health care marketplace.
9. An enhanced learning environment for future pediatricians
and other professionals in training
10. A practice environment that enhances professional
satisfaction in both inpatient and outpatient practice.
11. Greater child and family satisfaction with their health care.
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26. Cont…
12. Improved patient safety from collaboration with
informed and engaged patients and families
13. An opportunity to learn from families how care
systems really work and not just how they are intended
to work.
14. A possible decrease in the number of legal claims,
claim severity, and legal expenses.
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27. Conclusions
1. Patient- and family-centered care are incorporated into all
aspects of their professional practice.
2. You should unequivocally convey respect for families’ unique
insights into and understanding of their child’s behavior and
needs, should actively seek out their observations, and should
appropriately incorporate family preferences into the care plan.
3. In hospitals, conducting attending PCHN rounds (ie, patient
presentations and discussions) in the patients’ rooms with
nursing staff and the family present should be standard practice.
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28. Cont…
4. Parents or guardians should be offered the option to be present with
their child during medical procedures and offered support before, during,
and after the procedure
5. Families should be strongly encouraged to be present during
hospitalization of their child, and PCHN should advocate for improved
employer recognition of the importance of family presence during a
child’s illness.
6. Patients and families should have a voice in shaping the research
agenda, and they should be invited to collaborate in pediatric research
programs. This should include determining how children and families
participate in research and deciding how research findings will be shared
with children and families.
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29. Cont…
7. PCHN should share information with and promote the active
participation of all children, including children with disabilities, if
capable, in the management and direction of their own health care.
The adolescent’s and young adult’s capacity for independent
decision-making and right to privacy should be respected.
8. In collaboration with patients, families, and other health care
professionals, PCHN should modify systems of care, processes of
care, and patient flow as needed to improve the patient’s and
family’s experience of care.
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30. Cont…
9. PCHN should share medical information with children and families in
ways that are useful and affirming. This information should be complete,
honest, and unbiased.
10. PCHN should encourage and facilitate peer-to-peer support and
networking, particularly with children and families of similar cultural and
linguistic backgrounds or with the same type of medical condition.
11. PCHN should collaborate with patients and families and other health
care providers to ensure a transition to good-quality, developmentally
appropriate, patient- and family-centered adult health care services.
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31. Cont…
12. In developing job descriptions, hiring staff, and designing
performance appraisal processes, PCHN should make explicit the
expectation of collaboration with patients and families and other
patient- and family-centered behaviors.
13. PCHN should create a variety of ways for children and
families to serve as advisors for and leaders of office, clinic,
hospital, institutional, and community organizations involved
with pediatric health care.
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32. Cont…
14. The design of health care facilities should promote the
philosophy of patient- and family-centered care, such as
including single room care, family sleeping areas, and availability
of kitchen and laundry areas and other areas supportive of
families. PCHN should advocate for children and families to
participate in design planning of health care facilities.
15. Education and training in patient and family-centered care
should be provided to all trainees, students, and residents as well
as staff members
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33. Cont…
16. PCHN should advocate for and participate in research on
outcomes and implementation of patient- and family-centered
care in all venues of care.
17. Incorporating the patient- and family-centered care concepts
described in this statement into patient encounters requires
additional face-to-face and coordination time by pediatricians.
This time has value and is an investment in improved care, leading
to better outcomes and prevention of unnecessary costs in the
future. Payment for time spent with the family should be
appropriate and paid without undue administrative complexities.11/21/2020 Aklilu Endalamaw 33

34. Take an institutional assignment
• Will you integrate patient- and family-centered care in
hospitals, clinics, and community settings, and in broader
systems of care?
• How can you integrate patient- and family-centered care in
hospitals, clinics, and community settings, and in broader
systems of care?
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35. References
• American Academy of Pediatrics, Council on Children With Disabilities, Medical Home
Implementation Project Advisory Committee. Patient- and family-centered care coordination: a
framework for integrating care for children and youth across multiple systems. Pediatrics.
2014;133(5):e1451–60. Available at: http://pediatrics. aappublications.org/content/133/5/e1451.
full.html. Accessed November 6, 201
• Tarini BA, Christakis DA, Lozano P. Toward family-centered inpatient medical care: the role of
parents as participants in medical decisions. J Pediatr. 2007;151(6):690–695, e1
• Landry MA, Lafrenaye S, Roy MC, Cyr C. A randomized, controlled trial of bedside versus
conference-room case presentation in a pediatric intensive care unit. Pediatrics. 2007;120(2):275–
280 4.
• Muething SE, Kotagal UR, Schoettker PJ, Gonzalez del Rey J, DeWitt TG. Familycentered bedside
rounds: a new approach to patient care and teaching. Pediatrics. 2007;119(4):829–832 5.
• Simmons JM. A fundamental shift: familycentered rounds in an academic medical center.
Hospitalist. 2006;10:45–46 6.
• Rosen P, Stenger E, Bochkoris M, Hannon MJ, Kwoh CK. Family-centered multidisciplinary rounds
enhance the team approach in pediatrics. Pediatrics. 2009;123(4). Available at:
www.pediatrics.org/cgi/content/ full/123/4/e603
• Conway J, Johnson BH, Edgman-Levitan S, et al. Partnering with patients and families to design a
patient- and family-centered health care system: a roadmap for the future—a work in progress.
Bethesda, MD: Institute for Family-Centered Care and Institute for Healthcare Improvement; 2006.
Available at: http://www.ipfcc.org/pdf/ Roadmap.pdf. Accessed July 19, 2010 8.
• Johnson B, Abraham M, Conway J, et al. Partnering With Patients and Families to Design a Patient-
and Family-Centered Health Care System: Recommendations and Promising Practices. Bethesda,
MD: Institute for Family-Centered Care; 2008
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