trends in pediatrics

1. Presented by
Richa Mishra
MSc nursing 1st
year
Current trends in pediatric nursing

2. Recap....
 First printed book - “ Little Book in disease in
Children”(Italian)
 First english book on children’s disease - “ Book of
Children”
 Worlds first pediatrician were two Indians- Kashyap
and Jeevaka.

3. Introduction
 Lot of changes have occurred in pediatric
nursing due to advance technology, consumer
demands, and public awareness.
 Modern health approach emphasis on
preventive care rather than curative care.
Modern concept of child health emphasis given
on continuous care of

4. Current trends
Family
Centered Care
Atraumatic
Care
Evidence
Based Practice
Case
Management

5. Child
oriented
enviroment
cost
containment
High
technology
care
Health
education

6. support and
Counseling
Disease
prevention and
health
promotion
Coordination
and
collaboration

7. Cont….
Nursing
process
implication
Ethics in
nursing

8. Family centered care

9. It is based upon the philosophy that quality care
can be provided in an environment that support
family integrity and promote physiological and
psychological health of the family. It assumes
that if the family gain adequate support and
information it will be capable of making health
care decisions
Family centered care

10. Two basic concepts of FCC
Enablin
g
Empowerment

11. ENABLING
 Enabling is to make them use their competence and acquire new
skills which are useful in provide care to children .
 Professional enables families by creating opportunities and means
for all family members to display their present abilities and
compete to acquire new ones that are necessary to meet the needs of
child and family.
EMPOWERMENT
 Empowerment describes the interactions of professional with
families in such a way that families maintain a sense of
control over their families.
 Acknowledge positive changes that result from helping
behaviors that foster their own strengths, abilities and
actions.
The parent professional partnership is a powerful
mechanism for enabling and empowering families.

12. Atraumatic care

13. Cont…..
Atraumatic care is the provision of therapeutic care in settings, by
personnel and through the use of interventions that eliminate or
minimize the psychological or physical distress experienced by the
child and family in the health care systems.
The overriding goal in providing atraumatic care is ‘’FIRST DO
NO HARM’ ’
Three principles providing the frame work of achieving this goal
are
 Prevent or minimize child’s separation from family
 Promote a sense of control
 Prevent or minimize bodily injury and pain.

14. Cont….
EXAMPLES OF PROVIDING ATRAUMATIC CARE includes
 Fostering the parent child relationship during hospitalization.
 Preparing the child before any unfamiliar treatment or procedure.
 Controlling pain
 Allowing the child privacy
 Providing play activities for expression of fear and aggression.
 Providing choices to children
 Respecting cultural differences.

15. Guidelines for atraumatic care
 Never put a child on open bed without padded side rails , as the child
may fall off causing greater trauma.
 Never use needles and instruments which causes unnecessary pain
and it doesn’t fit in terms of its size, always double check size of
needles, vasofix.
 Use pre-anasthetic medication when necessary
 Do not use irritating chemicals on to the skin,if n’t needed eg: instead
of alcohol or spirit use, saline sponge or cotton ball to wipe.
 Handle surgical dressing and wounds gently
 Try your level best to prevent cross infection to the child
 Try allowing parents most of the time with child to divert pain.
 Make sure using non invasive techniques, prefer invasive techniques
only if it is a compulsion and last option
 Never unnecessarily restrain the child.

16. EVIDENCE BASED PRACTICE

17. Cont….
 EBP in nursing provides a systematic approach to enable
nurses to effective use the best solution related to nursing
practice.
 It involves the use of research findings in establishing a plan
of care and implementing it.
Appropriate resources must be available for nurses to
implementing evidence based practice.
Resources include
 online research journals
computers
 internet and online journals
It provides the rational approach to decision making that facilitates
best practice.

18. Key Steps in the EBP Process
Implement Evidence
Assessing the Evidence
Finding the Evidence
Framing the Clinical Question

19. Case management

20. CONT…..
 Case management is a collaborative
process of assessment, planning,
facilitation, care coordination,
evaluation, and advocacy for options
and services to meet an individual's
and family's comprehensive health
needs through communication and
available resources to promote
quality, cost-effective
outcome,coordinate care and control
costs.

21. Cont….
Case management was developed as an approach
to coordinate care and control costs.Benifits of
case management such as
 Improved patient and family satisfaction
Decreased fragmentation of care
 Improves individuality focus is on individual
patient not on population of patients

22. Child oriented enviroment

23. Cont….
.
 An environment that supports children’s feelings of
wellbeing by addressing their need to feel comfortable in the
environment, maintain a positive frame of mind and remain
positively engaged.
 An environment that facilitates children’s goodness of fit by
supporting individual choice, control and self-help and by
minimizing unwanted distractions.

24. Desirable features of
hospital
 Provision of play room equipped with soft toys, sand and
water, a home corner, climbing frame and slide
 education room
 liberal meeting hours with friends and family
 TV room

25. Cost attainment

26. Cost containment is management technique utilized to reduce the
cost of hospitalization by providing the child with medicine and
other needed articles and requirements
 A goal of managed care is to reduce cost of health care
and to maintain the quality of care.
 these efforts has shortened hospital stay of children and
increases nurses’ awareness of the supplies and services.
 Reduce direct or indirect cost of clinical services by cost
containment family feels more satisfied.
 prevent duplication of nursing.

27. Cost containment strategies
Health care costs continue to increase at a rate out of
proportion to the cost of living.some major strategies
include:
 Prospective payment system
 Managed care
 Capitation
 Alternative delivery system

28. High technology care

29. Cont…
 Technology can be defined as items, machinery and
equipment that are connected to knowledge and
management to maximize efficiency. Technology is not
only the equipment itself, but also the knowledge of how
to use it and the ability to convert it into nursing care. For
e.g.
management of technical equipment, such as
 ventilators
 infusion pumps
 monitors
 dialysis in an intensive care setting.

30. NICU of the future....
 The NICU of the future project goals will
design incorporating the following:-
 Family -centered care
 Developmentlly appropriate care for
vulnerable newborns
 Smart workplace
 Minimally invasive, state-of-the-art technology
 A data based” living laboratory” for
translational research
 Telemedicine( local,national and international
consultation)

31. Intensive Respiratory Care
Unit...
These should be two separate sections for such
unit:-
 I.For Infectious
 II.For non-infectious diseases.
 Air pollution exacerbates the condition of
people with respiratory and cardiovascular
diseases and causes measurable increases in
the rates of hospitalization.
 Cardiovascular and respiratory diseases are
among the leading causes of death.

32. Cont....
 * Respiratory disease classifications
according to the International Classification of
Diseases, Ninth Revision, Clinical
Modification codes 460--519.
“In 2005, approximately one fourth of the 2.4
million hospitalizations for children aged <15
years were for respiratory diseases, the largest
category of hospitalization diagnoses in this
age group. Of these, 31% were for pneumonia,
25% for asthma, 25% for acute bronchitis and
bronchiolitis, and 19% for other respiratory
diseases, including croup and chronic disease
of tonsils and adenoids.”

34. Intensive labour Care
Unit(ILCU)
 Almost 20% pregnant women in India fall in the
high risk rate of category. In Wadia hospital in
Bombay, 7% of cases in the labour room have
been referred as emergency admissions.
Moreover, the ILCU will be very useful in reducing
maternal and infant death.
 For example, maternal morbidity rate is 1 per 100
deliveries and 1/3rd of total death in infant occur
at the time of labour or delivery. In such a unit,
close monitoring of the high risk mother can
be carried out during labour and delivery and
special care instituted in them. The nurses
can be trained to assess, help and study such
monitoring.

35. Pdiatrics Intensive Care
Units...
 To reduce the mortality further it is important to
develop ICUs specialised for particular diseases
like”-
 Intensive cardiac care unit
 Pediatric genetic counselling centres
Others measures can also be adopted to have a
check on these diseases-
“The Nurse Parent Support Tool Manual”

36. NPTS..
 It was designed to measure parents perception of
nursing support during their child’s hospitalization.
Focus of the Instrument
 During the period of acute illness and
hospitalization, the environment created by the
nursing staff defines a large part of the reality for
parents. Nurses control contact with and
interaction with the sick child, provide an
important channel of information, and have
ongoing interactions with parents.

37. Health education

38. Cont….
Health teaching may be a direct goal of the nurse,
this includes
 Parenting classes or may be indirect such as
helping parents and children understand a
diagnosis or medical treatment,
 Encouraging children to ask questions about their
bodies
 Referring families to health related professional
or lay groups,
 Supplying patients with appropriate literature and
providing anticipatory guidance.

39. support and Counselling

40. Attention to emotional needs requires support and
counseling.
 Support be offered in following ways,
 listning ,touching and physical presence.
 Touching and physical presence are most helpful for
children because they facilitate non verbal
communication.
 Counseling
 Involves a mutual exchange of ideas and opinions
that provides the basis for mutual problem solving.
 It involves, teaching, techniques to foster the
expression of feelings or thoughts and approaches to
help the family cope with stress.
Optimally counseling not only helps resolve a
crisis or problem but also enables the family to
attain a higher level of functioning, greater self-
esteem, and closer relationships.

41. Disease prevention and promotion of
health

42.  Current trends in health care have focused on prevention of
illness and maintenance of health rather than treatment of
disease or disabilit.
 Regardless of the identified problem the role of the nurse
is to plan care that fosters every aspect of growth and
development based on thorough assessment process,
DENTAL CARE, PROBLEMS RELATED TO
NUTRITION ,IMMUNIZATIONS, SAFETY, MENTAL
HEALTHDEVELOPMENT, SOCIALIZATION
,DISCIPLINE OR SCHOOLING often becomes obvious.
 Once the problem is identified the nurse acts to intervene
directly or to refer the family to other health care providers
or agencies

43. Coordination and collaboration

44. Cont…
 The nurse as a member of
health care team collaborates
and co-ordinates nursing
services with the activities of
other professionals. The
concept of holistic care can be
realized only through a
unified inter disciplinary
approach.

45. Nursing process application

46. Current statistics in Pediatric...

47. INDICATOR SRS 2014 SRS 2019 SRS 2020
Crude Birth Rate (CBR) 21.0 19.7 19.5
Total Fertility Rate 2.3 2.1 2.0
Early Neonatal Mortality Rate (ENMR)
– 0- 7 days
20 16 15
Neonatal Mortality Rate (NMR) 26 22 20
Infant Mortality Rate (IMR) 39 30 28
Under 5 Mortality Rate (U5MR) 45 35 32

49. Under five Mortality Data..
 Following a steady downward trend, IMR, U5MR and
NMR have further declined:
 Under 5 Mortality Rate (U5MR) for the country has
shown significant decline of 3 points (Annual
Decline Rate: 8.6%) from 2019 (32 per 1000 live
births in 2020 against 35 per 1000 live births in
2019). It varies from 36 in rural areas to 21 in urban
areas.
 U5MR for Female is higher (33) than male (31). There
has been a decline of 4 points in male U5MR and 3
points in female U5MR during the corresponding
period.
 Highest decline of U5MR is observed in the State of
Uttar Pradesh (5 points) and Karnataka (5 points)

51. Infant Mortatlity Rate..
 Infant Mortality Rate (IMR) has also registered
2-point decline to 28 per 1000 live births in
2020 from 30 per 1000 live births in 2019
(Annual Decline Rate: 6.7%).
 The Rural-Urban difference has narrowed to
12 points (Urban 19, Rural-31).
 No gender differential has observed in 2020
(Male -28, Female - 28).

53. Neonatal Mortality Rate...
 It also declined by 2
points from 22 per 1000
live births in 2019 to 20
per 1000 live births in
2020 (Annual Decline
Rate: 9.1%). It ranges
from 12 in urban areas
to 23 in rural areas.

54. Ethics in pediatric nursing practice:
 Non maleficence:obligation to minimize or prevent pain.
 Beneficence: obligation to promote child’s wellbeing
 Justices: There are three aspects as legal justice, respect for
right, and fair distribution of resources even the nurses time
and attention.
 Respect for autonomy: Respect the individual’s right to
make informed and thought out decisions for themselves.
 Truth telling

55. Difference between old and new trends
Old trends New trends
single dimension care Multi dimension care
Curative approach Preventive approach
No concept of primary health care Concept of primary health care
adapted
Community and family were not
considered
Community and society are
considered
Patient centered approach was
used
Family centered approach is used
Simple technical skills are used Complex technical skills are used
Role of nurse was limited with no
specialization
New roles of nurse emerging

56. OLD TRENDS NEW TRENDS
Care given had a little scientific base Increase in scientific care
Judgemental role of nurses was limited Increased independence in use of
judgement
Hospital based service Community health services
Only the need of ill was served Needs of healthy as well as those of ill are
served
Child health care was limited to 10-12
years of children
Child health care includes adolescents as
well like through RCH services
No special attention is given to children at
risk
special attention is given to children at risk
No movements are made against social
evils
Movements against social evils well
implemented
Less political involvement care More political involvement

57. References:
 Marliyn,j, hochenberry, david, Wilson, wong’s
essentials of pediatric nursing, 8th edition. Elsevier, page
10-18.
 Terry kyle essentials of pediatrics,7th edition,Lippincott
Williams and wilkins perspectives of pediatric nursing
page no 7-9
 DuttaParul; “Pediatric Nursing”; 2nd edition;
published by Jaypee publishers. Pp2-3.


58. Thank you