Changing paediatric trends in nursing

Philosophy Of Pediatric Care
&
Changing Trends In Pediatric
Nursing
By,
Mr. Abhijit Bhoyar
Child Health Nursing

Introduction
• Children need accessible ,continuous , comprehensive,
coordinated and family centered care that focuses on
their changing physical and emotional needs.
• Pediatric nurses provide this care by focusing on the
family , providing atrumatic care , evidence based
practices , High technology care , cost containment and
child oriented environment.

Components of philosophy of
pediatric nursing care-
1) Family- Centered Care
2) A traumatic Care
3) Evidence-based practice
4) High technology care
5) Cost Containment
6) Child oriented environment

1) Family- Centered Care :-
• Family –centered care involves families and caregivers
working in a collaborative partnership to determine goals and
plans for health care.
• It works well in all areas of health care, from preventive care
of the healthy child to long term care of the chronically or
terminally ill child .

Continued-
• Family –centered care enhances parents and caregivers
confidence in their own skills and also prepares children and
young adults for assuming responsibility for their own health
care needs.

Elements of Family-Centered Care
• Demonstrating interpersonal sensitivity
• Providing general health information
• Communicating specific health information
• Treating people with respect.

• Respect for the child and family
• Recognition of the effects of cultural, racial, ethnic, and
socioeconomic diversity on the family’s health care
experience.
• Identification of and expansion of the family’s health care
experience.
• Support of the family’s choices related to the child’s health
care
According to the American Academy of pediatrics,
family-centered care focuses on several core
principles

Continued-
• Provision of honest , unbiased information in an affirming
and useful approach.
• Assistance with the emotional and other support the child
and family require
• Collaboration with families
• Empowerment of families

Outcomes Of Family-Centered care :
• Anxiety is decreased
• Children are calmer and pain management is enhanced.
• Recovery times are shortened
• Families confidence and problem solving skills are
improved
• Communication between the health care team and the
family is also improved.

Advantages of family centered
care:-
Practicing true family centered care may
• Empower the family ,
• Strengthen family resources , &
• Help the child feel more secure
throughout the process.

2) A traumatic Care
• This is a philosophy of providing therapeutic care
through interventions that minimize physical and
psychological distress for children and their families.
• Therapeutic care includes prevention, diagnosis,
treatment of chronic or acute condition.

• The concept of a traumatic care is intended to reduce
mental and physical harm & provide an environment
with minimum physical and mental trauma.

Components of A traumatic care:
• Atrumatic care:-is the provision of therapeutic care
in settings, by personnel, and through the use of
interventions that eliminate or minimize the
psychological & physical distress experienced by
children and their families in the health care system.
• Therapeutic care:- It includes prevention, diagnosis
& treatment of chronic or acute condition.

Components of A traumatic care:
• Setting:- It refers to whatever place that care is
given at the home , the hospital , or any other
health care setting.
• Personnel:- It includes anyone directly involved
in providing therapeutic care

continued-
• Interventions :- Interventions range from
psychological approaches, such as preparing
children for procedures, to physical interventions
, such as providing space for a parent to room
in with a child.
• Psychological distress:- It may include anxiety
, fear, anger, Disappointment , sadness, shame,
or guilt.

continued-
• Physical distress:- may range from
sleeplessness and immobilization to the
experience of disturbing sensory stimuli such as
pain, temperature, extremes, loud noises, bright
lights or darkness.

Principles Of Atraumatic Care:
Prevent or minimize physical stressor,
including pain, discomfort,
immobility, sleep deprivation, inability
to eat or drink, and changes in
elimination
1

Interventions are…
Avoid or reduce painful procedure, such as injections,
multiple punctures ,urethral catheterization.
Avoid or reduce other kinds of physical distress, such
as noise, smells, shivering, restraints, skin trauma.
Control pain via frequent assessments and use of
pharmacologic and non pharmacologic interventions.

Prevent or minimize parent
child separation .
Promote family centered care, treating the family as
the patient.
Use core primary nursing.
Consider research findings related to preferences of
parents and children and whether or not to be
together .
2

Promote a sense of
control.
Elicit the family’s knowledge about the child and
his or her health condition, promoting partnerships,
empowerment.
Reduce fear of the unknown through educations,
familiar articles, and decreasing the threat of the
environment.
Provide opportunities for control, such as
participating in care, attempting to normalize daily
schedule, and providing direct suggestions
2

Suggestion For Nursing Care:-
1) Prevent or minimize physical stressor:-
• During painful or invasive procedures, avoid
traditional restraint or holding down of the child,
allow the privacy, providing play activities for
expansion of fear.
• If the above mentioned positions are not an option,
have the parent stand near the child’s head to provide
comfort.
• Minimize intramuscular or subcutaneous injection.

2) Prevent or minimize parent
child separation :
• Promote family centered care
• In the hospital, provide comfortable accommodations
for the patient
• Allow the family the choice about whether to stay for
an invasive procedure and support them in their
decision.

3) Promote a sense of
control:-
• Maintain child’s home routine related to activities of
daily living
• In the hospital, use primary nursing
• Provide security of the child
• Provide a education for the child & parent
• Make the environment more inviting & less
intimidating

3)Evidence-based practice:-
• Evidence based practice in nursing provides a
systematic approach to enable nurses to effectively
use the best solution related to nursing practice.
• Hence nurses need to search the literature to analyze
evidences using biostatics rules to identify
generalisability of findings.

Continued-
• Evidenced based practice involves the ability to
access, summarized and apply information from
literature to day – today clinical problems.
• Nursing focus is on the illness aspects of care the
human response during disease and therapy.
• Nurses should find data necessary to identify and
support their contribution to patient outcomes.

Continued-
• Quality improvement measures and throwing
outdated management tools are essential to improve
nursing practice .This is possible to use of evidence
based practices.
• Clinical practice guidelines and patient centered
multidisciplinary multidimensional plans of care ,will
help nursing team move towards evidence based
practice and improve the process of care delivered.

Clinical practice guideline help-
• Encourage practitioner accountability
• Encourage highly coordinated care
• Decrease unnecessary variations in practice pattern
• Increase high quality cost effective services
• Provide a mechanism to systematically evaluate the
quality and effectiveness of nursing

Process of using evidence based
practice in nursing –
• Frame questions Search for evidences
Asses /appraise
Make a decision
Evaluate performance

4) High technology care
The advancement in the diagnostic technology
has made detection of many disorder event in
the fetal period.
• Laboratory methods –to assess fetal maturity
and health of the fetus.
• Ultrasonography -for diagnostic purpose.

Continued-
• Fetal surgeries
• Fetal blood transfusions
• Medical termination of pregnancy
• In vitro fertilization
• Female feticide

5) Cost Containment
• Cost containment is a management technique
utilize to reduced the cost of hospitalization.
• It is achieved by improving the process of
care.

5 Component Cost Containment
•
• By reducing mortality rate
• By reducing Length of stay
• By reducing Cost
• By reducing Complications
• By increasing family satisfaction
• And ability to function upon discharge

6) Child oriented environment
A child friendly environment should be provided
to a child who is admitted to hospitals
• Adequate safety precautions
• Education and facility for play should be provided
• Staff should be sensitive to the families individual
needs according to the social ,educational,
cultural, and religious background.
• Children’s ward should be equipped with skilled
staff

Continued-
• There should be “named nurse” responsible for
planning and coordinating the care by other
nurses.
• Ensures that families receive all information
they need.
• Liberal visiting hours
• Permitting parents to be with children when
hospitalized also promotes child- oriented
environment in a hospital.

Changing Trends In Pediatric
Nursing:-
INTRODUCTION
• The increasing complexity of medical & Nursing
techniques has created a need for special area of the
child care.
• In earlier days, present medical & nursing techniques
has created a need for special area of child same.
• Now the child care has prime importance, as a
mortality & morbidity are higher in this group .

The services provided for people :-
• Institutional Care
• Family centered care
• Regionalized Care
• Other Innovative Child Health Care
Programs

• Pediatrics is new medical specialty developed
in mid 1800.
• Children were cared as adults in these
hospitals. Following the deaths & diseases,
these children were kept isolated from other
children to prevent from contact of diseases .
Institutional Care

Institutional Care :-
• Children were ambulated as soon possible &
made to visit play rooms, where they can be
with other children .
• The nurses were trained to raise their level &
provided daily care for children.
Institutional Care

• Family centered nursing care was recent trend
in developed countries where the children
were not treated as patients .
• But the attention was given to their medical
problem.
Family Centered Care

•Regionalization of pediatric services were in progress
from last several decades .
•Providing high quality medical care in pediatrics was
important for best resources in diagnosis & treatment .
•Some of the branches were pediatric, medicine &
surgery, pediatric neurology, pediatric allergy specialist,
pediatric cardiology, pediatric nephrology, pediatric
urology .
Regionalized Care

•Many pediatric hospitals have home care program for
child illness like leukemia, hemophilia etc.
•By hospitalization, child’s condition is monitored at
home for continuing care.
•Pediatric nurse practioner is prepared for specialized
care to provide basic & primary health care to family &
children .
•They provide consultant services & offer day today
assessment & care.
Other Innovative Child Health Care Programs

CHANGING TRENDS IN
HOSPITAL CARE
Introduction
• The hospital are necessary places for providing the care of
ill children .
• Previously, the care of ill child used to be completed at
their birth places or at their homes.

CHANGING TRENDS IN
HOSPITAL CARE
Introduction
• Now a days, the hospitals have become a necessary organ
of health chain, where all types of health professionals
can easily be made available.
• This is based on preventive, promotive, curative, aspect
of child health

1.VISITING HOUR
• In earlier days parents with permitted to visit their
hospitalization child fore only 1 hour once a month.
• Children were deprived from parental love.
• Today, many hospital permits visiting from 2 to 8 p.m.
There are modern trends/modern concept of
hospitalization child which are as follows:

1.VISITING
• If parents are unable to visit the child frequently, grand
parents, aunts uncles or Baby sitters may visit instead.
• Some hospital permits visiting by siblings between 2 and 12
years of age during certain hours of the day.
• A parent must accompany a younger sibling during visit .
There are modern trends/modern concept of
hospitalization child which are as follows:

Continued:-
• If child’s room is restricted, some hospital have provide
television or telephone video system that allows two- way
visit between the child and visitors of all ages.
• If parents , family , members of friends are not able to visit
the hospital because of difficulty in travelling or any other
reason , tape recording can be made & played to the child to
maintain some contact with home, thus reducing separation
anxiety.
• Topics such as favorite story or song , a talking letter from the
family or just conversation with the child are appropriate for
recording.

2. Rooming-in
• Parents should never be required to stay at a child’s bed side,
but they are not prohibited from doing so if they desire.
• The parents who stay during the day time in the pediatric unit,
some hospital provide a comfortable waiting room where they
can relax.
waiting room

2. Rooming-in
• In some institution, meals can be served to parents in the
child’s room so they can eat with their child or they may eat in
the hospital cafeteria or coffee shop.
• Food may be brought from home for the child if there are no
dietary restrictions and if the policy of the institution permits.

2. Rooming-in
• Parents, usually mother as of seriously ill children may be
encouraged to stay in the hospital all nights if they desire to do
so and if facilities are available for their comforts.
• Some hospitals have room such as a play room in the
pediatric unit where the parents may sleep .

3.Care by parents Unit
• Some hospital have care by parent unit or a family
participation unit with the child.
• This method of core has its roots in the orient, where the
whole family becomes involved with the care of the sick.
• In this system, the child gets attention when it is needed each
day from a familiar person, under the supervision of the nurse.
• When the parents are near, parents are also prepared naturally
and effectively for the care of their child which will need at
home.

4. Parent Support Groups:-
• Many support groups for parents meet outside the hospital,
some hospital started with In the hospital for parents of
hospitalized children.
• Such group may be conducted by nurses, by play therapist or
by child life program staff.
• In these groups, a non- threatening atmosphere is provided,
where parents may feel comfortable enough to move away
from the hospital routine and ventilate their feelings and
concerns to relieve their anxiety and stress.

5. Self Care
• By the self-care framework nurses have the
responsibility of assessing the abilities of the
hospitalized child and then helping the child to learn
self-care skills.
• The time and methods used in teaching these skills
depend on the child’s cognitive abilities, emotional
state, and readiness to learn.

6. Neighborhood Health
Centre of clinic:-
• The neighborhood or clinics are primarily concerned
with the care of children and the guidance of their
parents.
• If sickness occurs, the child may be cared at the clinic
for a mild temporary illness or referred to another
facility in further treatment.

7. Emergency facilities:-
• Facilities where emergency care is given, may be
located in hospital emergency department or in
community based emergency centers.
• They have been designed primarily to fulfill a need
for convenient, accessible, low-cost medical services.

8.Hospital Based and free
Standing Facilities for minor
Surgical Care
• The advantage of care given in an ambulatory setting is that
the child does not have to remain away from home for more
than a few hours, resulting in less trauma and family
disturbance and less chance of infection from seriously ill
children in the inpatient hospital setting.
• Parents must assume responsibility for the pre-operative
routine preparation usually carried out by nurses in the hospital
including post-operative .

9. Pediatric Unit:-
• Hospitalized children are usually segregated by care
requirement or by age or by both, children need are-
adequate provision for care, protection from physical
danger e.g. infection and accidents, and protection from a
psychologically threatening environment.
• In the pediatric unit the surrounding should be home like
and cheerful.

10. Pediatric Newborn and
Pediatric Intensive Care Unit
(PICU)
• New born and pediatric intensive care unit for the critically ill
are found in many pediatric hospitals and the large pediatric
departments in general hospital in some states.
• New born infants who are critically ill are transferred from
local hospital to these centers for care, these units based on
electrical instrument related to vital signs and other physiology
of new born and pediatric.

11. intermediate care Unit:-
• Here children who have been in the intensive care unit
can be moved if their conditions have improved.
• These children may still be too ill for care in a standard
pediatric unit.

12. The pediatric research centre:-
• Some children’s hospital have pediatric research centers
where little understood diseases are under investigation.
• These centers give nurses an opportunities to provide
comprehensive care to children.

13. Outpatient department’s of
hospitals:-
• During the 19th century, hospitals in America began
to provide services for out patients.
• Increasing number of private physicians use the
outpatient department for children with problems
requiring careful diagnosis and treatment, such as
complex medical or surgical problems or
psychological difficulties.

hospitals:-
• Because of awareness of the need to avoid the
possible trauma of hospitalization and the possibility
of cross infection, more children with pneumonia,
abscesses, or urinary or other infections can be treated
on an outpatient basis if there is a responsible adult in
the home to provide care.
• One of the newer functions of the staff in outpatient
department is to provide genetic-counseling.

hospitals:-
• One of the functions of nurses is to provide
health teaching for parents.
• The nurse needs to be approachable- one who
listens, teaches and cares-in order to make such
communications learning situations for the
parent & child.

Other Trends-
• According to UNICEF, assistance for meeting
the needs of children should no longer be
restricted to only one aspect like nutrition, but it
should be broad based and geared to their long
term personal development ensuring holistic
health care of children.

Modern approach of child health
care:-
• Modern approach of child health care emphasizes on
preventive care rather than curative care.
• At present, in child health care more emphasis given
on preventive approach rather than curative care only.
• Primary health care concept with team approach and
multidisciplinary collaboration are adopted for child
care.

Modern approach of child health
care:-
• Increased public awareness, participation in child care
are newer trends.
• Family health a new concept is accepted for the care
of children in their families and families in society.

• Recent trend is Growth of sub- specialties for
the super-specialized care of children.
• The sub areas are neonatology, perinatology,
pediatric surgery, pediatric cardiology,
pediatric neurology, preventive pediatrics,
child psychology, child psychiatry, pediatric
intensive care unit, neonatal intensive care unit
etc.

Growth of specialization
• There is need for specialized well trained
pediatric nurses with continuous re-orientation
about the advancement of technical aspect of
child care.
• Pediatric nurses are performing specialized
care in neonatal intensive care unit, pediatric
intensive care unit, and in any care system of
child care.

Continued-
• Because of growth and maturation of the
nursing profession, nurse may become an
independent practitioner who can fulfill an
autonomous position as a member of an
interdisciplinary health team.
• Areas of independent practices of community
services for improvement in child care.

continued
• The large number of child population with
various health problems required more
numbers of health care providers along with
specially trained nurses so special importance
are given in basic nursing curriculum to
prepare the nurses with specialized knowledge
and skill on child health.

New trends-
• Ethical decision making
• Legal safeguards
• Quality assurance
• Consideration of ethical , moral & legal
dilemmas in child care create problems & nurse
may need to decide to perform nursing activities
based on professional & personal judgment .
• Ethical decision – making , legal safeguard &
quality assurance are the recent trend .

Changing paediatric trends in nursing

Changing paediatric trends in nursing

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