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Chapter 1
Introduction to Child Health and
Pediatric Nursing

Copyright © 2021 Wolters Kluwer • All Rights Reserved
Learning Objectives
Upon completion of the chapter, student will be able to:
1. discuss different methods of measuring child health.
2. Discus the philosophy of pediatric nursing care.
3. Identify the major roles and functions of pediatric nursing, including
the scope of practice and the professional standards for pediatric nurses.
4. Explain the components of the nursing process as they relate to
nursing practice for children and their families.
5. Identify ethical concepts related to providing nursing care to children
and their families.
6. Describe legal issues related to caring for children and their families.

Definitions of Health
Health definition
o In the past, defined as (Absence of disease)
o Health was measured by monitoring mortality and morbidity of a group.
Current definition
o Health has shifted in focus to
 Disease prevention
 Health promotion
 Wellness

World Health Organization Definition of Health (2018)
“A state of complete physical, mental, and social well-being, and not
merely the absence of disease or infirmity.”

History of Child Health and Child Health Care #1
Prior to the late 18th Century
o Children were viewed as commodities or property
o Their role was to increase population and help with workload
o High rates of child mortality were common because of inadequate and unsanitary
food, lack of childhood immunizations and harsh working conditions

End of 19th century
o They gained a better understanding of cause of illnesses
o New public health efforts
 Campaign for safe milk (Milk pasteurization)
 Compulsory vaccination programs
o Public schools were established
o Court viewed children as minors (not property!)

19th and early 20th centuries
o Urban public health improvements
 Improved sanitation, treated regional drinking water, and hygiene awareness
o Growth of public health initiatives
o Growing knowledge
 Nutrition, sanitation, bacteriology, pharmacology, and psychology

End of 20th century
o New antibiotics and vaccines
o Increased survival rates
o Increase in chronic versus acute illness
o Biotechnology and genetic research

Focus of National and International Organizations to
Protect Child Rights
Violence and abuse
Child labor and soldiering
Juvenile justice
Child immigrants and orphaned children
Abandoned or homeless children

Key Milestones in Federal Programs in Support of
Children’s Health
1909—First White House Conference on Care of Dependent Children
1935—The Social Security Act
1946—National School Lunch Program
1965—Medicaid Program (Title XIX)
1966—Women, Infants, Children (WIC) Program
1993—Family & Medical Leave Act (FMLA)
1995—Early Head Start Program
1997—Children’s Health Insurance Program (CHIP)
 Adapted from Yarrow, A. L. (2011). A history of federal child antipoverty and health policy in the United States
since 1900. Child Development Perspectives, 5(1), 66–72.

Question #1
 Is the following statement true or false?
 In 2018, the World Health Organization defined health solely as “an
absence of disease or infirmity.”

Answer to Question #1
False.
Rationale: In 2018, the World Health Organization defined health as
“a state of complete physical, mental, and social well-being, and not
merely the absence of disease or infirmity.”

Evolution of Pediatric Nursing
1870: First pediatric professorship awarded to Abraham Jacobim MD
1900: Henry Street Settlement House established by Lillian Wald RN
(first public health nurse)
1902: Lina Rogers, RN, appointed as first full-time public school nurse
(salary paid by the Henry Street Settlement)
1960s: Pediatric nurse practitioner role developed (first NPs)
1980s: Maternal and child health standards developed by ANA

Measurement of Health Status
1979 U.S. Surgeon General’s Report, Healthy People
o Provided agenda that identified most significant preventable threats to health
o Set national objectives and metrics for monitoring progress toward goals
o Revised every 10 years
Healthy People 2030
o Comprehensive health promotion and disease prevention agenda working to
improve quantity and quality of life for Americans

Overall Goals of Healthy People 2030
Eliminate preventable disease, disability, and injury and premature
death
Achieve health equity
Eliminate disparities and attain health literacy to improve the health
of all groups
Create physical, economic, and social environments that promote
good health
Promote healthy development and behaviors across every stage of
life (specific goals for each stage)
Engage leadership, the public and key constituents to take action and
develop policies that will improve the health of all

Mortality
o Number of individuals who have died over a specific period (can be overall
or from specific cause)
o Presented in rates per unit of population (usually 1,000 or more)
o Infant mortality often used as indirect measure of the general health of a
population
Key Concepts in Health Reporting: Mortality Versus
Morbidity #1

Morbidity
o Measure of prevalence of disease or degree of disability in a population at
a particular time (e.g., days lost from school due to a particular problem)
o Presented as a rate per unit of population
Key Concepts in Health Reporting: Mortality Versus
Morbidity #2

Question #2
Is the following statement true or false?
The nurse researcher would measure the number of cases of asthma in
children in an inner-city population to determine mortality.

Answer to Question #2
 False.
The nurse researcher would measure the number of cases of asthma in
children in an inner-city population to determine morbidity.
Rationale: Researching the number of deaths due to a specific cause
over a specific period would assess mortality.

Infant and neonatal mortality from 1960 to 2016
Adapted from Xu, J., Murphy, S. L., Kochanek, K. D., Bastian, B., & Arias, E. (Eds.). (2018).
Deaths: Final data for 2016. National Vital Statistics Reports, 67(5), 1–76. Hyattsville, MD:
National Center for Health Statistics. Retrieved October 1, 2018, from
https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf

Top major diagnostic categories for hospitalization in
children 1 to 17 years of age, 2012
Witt, W. P., Weiss, A. J., & Elixhauser, A. (2014). Overview of Hospital Stays for Children in the
United States, 2012. HCUP Statistical Brief #187. Rockville, MD, Agency for Healthcare Research
and Quality. Retrieved October 13, 2018, from
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb187-Hospital-Stays-Children-2012.pdf. Note:
This figure includes all hospital stays but excludes newborns and other neonates with conditions
originating in perinatal period, for which there were 3.9 million total hospital stays.

Causes of Death in Children by Age Group
Age 0 to 1 years
 Developmental, genetic conditions present at birth
 Premature birth
 SIDS
Age 1 to 4 years
 Accidents (unintentional injuries)
 Developmental, genetic conditions present at birth
 Homicide
Age 5 to 14 years
 Accidents (unintentional injuries)
 Cancer
 Suicide
From Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (2017). Child
Health. Retrieved on October 15, 2019 from https://www.cdc.gov/nchs/fastats/child-health.htm

Philosophy of Pediatric Nursing
To promote and assist the child in maintaining optimal levels of health
by:
Focusing on the family
o Providing family centered, culturally competent care
Providing atraumatic therapeutic care
o Minimizing physical and psychological stress for children and their parents
Using evidence-based practices
o Using research findings to establish a plan of care

Characteristics of Pediatric Care
Continuous
Comprehensive
Coordinated
Family centered
Compassionate
Culturally competent

Roles of the Pediatric Nurse
Providing direct nursing care to children and their families
Promote optimum growth and development of the child through health
education
Being an advocate, educator, and manager
Serving as a collaborator, care coordinator, and consultant

Role of the Nurse in Relationship to Morbidity and
Mortality in Children
Educating families and communities about:
o Developmentally appropriate child safety and preventative measures
o Utility of vaccinations in preventing childhood illnesses/morbidity and benefits of
preventative care
o Symptoms requiring health care visits
Goal
o Raise awareness of and provide guidance and counseling to prevent unnecessary
deaths/illnesses in children

Pediatric Nursing: Scope and Standards of Nursing
Practice #1
Defines guiding principles in pediatric nursing practice
Position statement about standards of practice and professional
performance of pediatric nurses
Jointly adopted upon by National Association of Pediatric Nurse
Practitioners (NAPNAP), Society of Pediatric Nurses, American Nurse’s
Association (ANA) Scope, and Standards of Pediatric Nursing Practice

Practice #2
Standards of Practice: Nursing Process
 Assessment
 Nursing diagnosis
 Planning and expected outcomes
 Implementation
 Evaluation

Practice #3
Standards of Professional Practice
Quality of practice
Professional practice evaluation
Education
Collegiality, communication and collaboration
Ethics, research, evidenced-based practice, and clinical scholarship
Resource utilization, environmental health, advocacy,
and leadership

Core Ethical Principles
Autonomy—freedom to choose and make decisions
Beneficence—actions that will benefit others
Nonmaleficence—avoiding causing harm (intentionally or
unintentionally)
Justice—acting fairly to all
Veracity—telling the truth
Fidelity—keeping promises, maintaining confidentiality

Balancing Ethical Components for Families of Different
Cultures and Religions
Identify the problem within the family’s cultural context
Gather information about the problem and the culture
Weigh risks against benefits
Choose solution based upon culturally competent care
Implement solution based within family values
Evaluate outcome of implementation

Key Elements of Informed Consent
The decision maker (person who consents) must be of legal age in
that state, with full civil rights and be competent
Information in the consent form must be simple, concise,
appropriate to the level of education and language of the decision
maker
Decision to participate must be voluntary, without coercion, force,
or influence of duress
Have a witness to the process of obtaining informed consent
Have that witness sign the consent form

Nurse’s Responsibility Related to Informed Consent
Determine whether parent/legal guardian understands what they are
signing
Ask specific questions to assess parent/legal guardian’s knowledge
related to the consent
Clarify and resolve knowledge deficits
Ensure the consent form is completed with signatures for parents or legal
guardians
Serve as a witness to the consent process
Children over the age of 8 may be asked to sign an assent form

Special Considerations Related to Informed Consent
Child not living with parent (biologic or adoptive)
Mature or emancipated minors
Parental consent after divorce
Consent for organ donation
Consent for medical experimentation
Psychiatric and reproductive health services (may be a different age of
consent than for other health care services)

Pediatric Assent
Affirms child’s participation in the decision-making process about health
care (child does not make final decision)
Helps the child to understand his or her health condition as developmentally
appropriate for the child
Informs the child of the treatment planned and discuss what he or she
should expect
Make sure he or she is not being unduly influenced to make a decision one
way or another
Ascertains the child’s willingness to participate in the treatment or
research

Advance Directives
Patient Self-Determination Act of 1990 established the concept
Determine and communicate the child’s and family’s wishes should life-
sustaining care become necessary
Parents are generally the surrogate decision makers for children; need
to take into consideration the views of the child when possible
Health care providers assist families in developing and implementing
advance directives
Related acronyms are: AND (Allow Natural Death) and DNAR (Do Not
Attempt Resuscitation)

HIPAA Regulations/Maintaining Confidentiality With
Electronic Records
Be aware of HIPAA regulations
Always maintain security of personal log-in information
Always log-off when leaving computer
Do not leave child’s information visible on computer
Use safeguards when using alternate communication
Know the exceptions to confidentiality (e.g., suspicion of child abuse; reporting
infections to health agencies; child threatens harm to self or others)
HIPAA is a federal law that protects the privacy and security of health information
in the US

References
 Kyle, T., & Carman, S. (2019). Essentials of Pediatric Nursing (4th ed.). Wolters Kluwer Health

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