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1. PAEDIATRIC HEALTH NURSING
Unit 1
PERSPECTIVE OF PAEDIATRIC NURSING
By
Marwan khan
Lecturer KMU , IHS SWAT

2. PAEDIATRIC HEALTH
NURSING

3. OBJECTIVES
At the end of this lecture student will be able to :
Define pediatric nursing.
Discuss the evolution in pediatric nursing.
Explain the role of pediatric nurse.
Discuss the pediatric nursing in Pakistani culture.
Summarize and debate the rights of a child.
Discuss Commonly occurring ethical issues in pediatric setting of
Pakistan.

4. Pediatric nursing
Pediatric nursing is the branch of nursing that involves caring for children
from infancy through adolescence by addressing their physical, emotional,
and developmental health needs. Pediatric nurses provide care in hospitals,
clinics, schools, and home settings, working alongside families to promote
healthy growth and recovery from illness.
Key aspects of pediatric nursing include:
• Monitoring growth and development
• Administering medications and vaccinations
• Educating families about health and wellness
• Supporting children with chronic conditions or serious illnesses
• Offering emotional support to both children and their families

5. Informed Consent in Pediatric Nursing
Definition:
Informed consent is a legal and ethical process through which a patient (or their
legal guardian, in the case of a child) agrees to a medical procedure or treatment
after being informed of all the relevant details, including risks, benefits,
alternatives, and consequences of refusal.
Key Components of Informed Consent:
• Disclosure: The healthcare provider must explain the diagnosis, the purpose of
treatment or procedure, possible risks and complications, expected outcomes,
and available alternatives.
• Comprehension: The guardian must understand the information provided.
Nurses often assist in simplifying medical jargon.
• Voluntariness: Consent must be given freely, without coercion or pressure.
• Competence: The person giving consent (usually a parent or guardian in
pediatrics) must be legally and mentally capable.

6. Special Consideration in Pediatrics:
• Minors cannot legally provide consent (except in specific cases like mature
minors or for confidential reproductive health services in some regions).
• Assent should also be obtained from older children and adolescents. Assent
means the child understands the proposed treatment to the best of their ability
and agrees to proceed.
• Example:
• If a child needs surgery for appendicitis:
• The doctor explains the procedure and possible complications to the parent.
• The nurse supports by answering questions and ensuring the parent
understood.
• The parent signs the consent form.
• The child (if old enough) is told in age-appropriate language what will happen
and asked for their cooperation.

7. Confidentiality in Pediatric Nursing
• Definition:
Confidentiality is the ethical and legal obligation to keep a patient's personal and medical
information private. It means not disclosing information to others without proper
authorization.
• Importance in Pediatrics:
• Maintains trust between nurse and patient/family.
• Encourages open communication, especially in sensitive issues (e.g., abuse, sexual health).
• Respects the dignity and rights of the child and family.
• Special Issues in Pediatric Settings:
• Parents or guardians are often involved, so full confidentiality may not be possible.
• Nurses must balance between keeping adolescent concerns private and involving the
guardian when necessary.
• If a child is at risk of harm (e.g., abuse, suicidal thoughts), confidentiality may be ethically
and legally breached to protect them.
• Example:
• If a 15-year-old girl confides in a nurse about being depressed and possibly self-harming:
• The nurse respects the girl's confidentiality and supports her emotionally.
• If there is a risk to her safety, the nurse has a duty to inform appropriate authorities or
guardians for her protection, while still maintaining the girl's trust and dignity.

8. When a Minor can Receive
Confidential Care
• Contraception, treatment of
STD
• Drug and alcohol treatment
• Mental health care
• HIV testing
DEPENDS
ON
STATE
LAWS
AND
REGULATIONS

9. Consent for Donation of Tissues or Organs
• If a child is too young, the parent or legal guardian may
consent for the child
• Three requirement for the minor to be a donor:
1.The parent who is consenting must be aware of the risks
and benefits
2.The child primary caregiver must be able to provide
emotional support for the child
3.There must be a close relationship between the donor
and the recipient

10. Consent for Genetic Testing
• Dilemma created by new technology
• The benefits and the risks should be discussed with a child if appropriate
• Parents or guardian can consent for the testing
• Genetic testing should not be performed on a child unless the results of
the test will serve the best interests of the child

11. Consent for Medical
Experimentation on Children
• All research facilities that receive federal funds must
comply with federal regulations that require review of all
experimental protocols by an Institutional Review Board
(IRB)
• Federal regulations require the consent of one or both
parents and the assent of the child, depending on the
amount of the potential risk and benefit associated with
the treatment or procedure.

12. Malpractice and Negligence in Pediatric
Nursing
• 1. Malpractice in Pediatrics
• Definition:
Malpractice refers to professional misconduct or failure by a healthcare
provider to meet the standard of care, resulting in harm to the patient.
• Key Features:
• Involves professional error or intentional wrongdoing.
• Can occur due to wrong medication, improper procedures, failure to
monitor, or ignoring protocols.
• Requires proof of duty, breach, damage, and causation.
• Example in Pediatrics:
• A nurse administers adult dosage of a drug to an infant without double-
checking the order or weight-based calculation. The child suffers severe
complications.
This is malpractice, as the nurse failed to follow established pediatric
protocols.

13. • 2. Negligence in Pediatrics
• Definition:
Negligence is a failure to take proper care in doing something, whether
through ignorance, omission, or carelessness, which leads to harm.
• Key Features:
• Not always intentional.
• Often occurs due to lack of attention or failing to act when necessary.
• Still leads to harm, even without ill intent.
• Example in Pediatrics:
• A nurse forgets to reposition a bedridden child at regular intervals, causing
pressure ulcers.
This is negligence, as basic care was omitted.

14. Difference Between Malpractice and Negligence
Aspect Malpractice Negligence
Intent
May be intentional or
reckless
Usually unintentional
Nature
Professional misconduct or
deviation
Failure to act or careless
omission
Examples
Giving wrong injection,
ignoring allergic history
Not checking vital signs,
skipping routine care
Legal Consequence
Often leads to lawsuits or
disciplinary action
Can also lead to legal
action, but seen as error or
oversight

15. Prevention Strategies:
• Double-check medication dosages using body weight and age.
• Maintain accurate and timely documentation.
• Follow proper communication protocols with parents and physicians.
• Stay updated with evidence-based practices and clinical guidelines.
• Always report errors or near-misses through proper channels to prevent
future harm.

16. Evolution of Pediatric Nursing
Pediatric nursing has undergone significant transformation over the years, adapting to
changes in healthcare systems, medical advancements, and societal attitudes toward
children and their care.
1. Early Beginnings
• In the early 19th century, children were often treated as "small adults" in medical care,
with little regard for their unique physical and emotional needs. Pediatric care was
minimal, and child mortality rates were high due to infectious diseases, poor hygiene,
and lack of immunization.
• 2. Emergence as a Specialty (Late 19th – Early 20th Century)
• The development of pediatrics as a medical specialty helped highlight the importance of
age-appropriate care. Pediatric nursing started to gain recognition as a distinct
discipline:
• Children’s hospitals were established (e.g., Children’s Hospital of Philadelphia in 1855).
• Nurses began receiving formal training in child care and development.

17. Cont…
3. Mid-20th Century Advancements
• Introduction of vaccination programs (e.g., polio vaccine) significantly reduced child
mortality.
• Emphasis on growth and development milestones led to more specialized care.
• Nurses played a vital role in preventive care and health education.
• The rise of family-centered care shifted focus to including families in decision-making.
4. Late 20th to Early 21st Century Innovations
• Technology integration (like neonatal intensive care units and electronic health
records) improved outcomes.
• Evidence-based practice began guiding clinical decisions.
• Increased awareness of mental health and developmental disorders in children
expanded the pediatric nurse’s role.
5. Current Trends and Future Directions
• Focus on holistic and culturally competent care.
• Expansion of community-based and school health nursing roles.
• Emphasis on managing chronic illnesses (like diabetes and asthma) in children.
• Use of telehealth and digital tools for remote monitoring and education.
• Ongoing professional development to address emerging pediatric health concerns
like childhood obesity, substance use, and mental health.

18. Role of a Pediatric Nurse
• A pediatric nurse is a healthcare professional who specializes in providing
medical care to infants, children, and adolescents. Their role is vital in promoting
health, preventing illness, and supporting the physical and emotional well-being
of young patients.
Key Roles Include:
1) Providing Direct Patient Care
Pediatric nurses perform assessments, give medications, assist in procedures,
and monitor vital signs. They care for children with both short-term illnesses
and long-term conditions like asthma or diabetes.
2) Supporting Growth and Development
They understand normal growth and development stages, helping to identify
any delays or abnormalities and ensuring care is appropriate for the child’s age.
3) Family Education and Support
Pediatric nurses educate parents and caregivers about managing health
conditions, medication use, nutrition, and preventive care. They also offer
emotional support to families during stressful times.

19. Cont.…
iv. Emotional and Psychological Support
Using child-friendly communication and play, they help reduce anxiety and
build trust with young patients, creating a comforting environment.
v. Health Promotion and Disease Prevention
They administer vaccines, conduct screenings, and educate families about
healthy lifestyles to prevent illness and support long-term well-being.
vi. Advocacy
Pediatric nurses advocate for the needs and rights of children in healthcare
settings, ensuring that care is safe, ethical, and child-centered.
vii. Collaborating with Healthcare Teams
They work with pediatricians, therapists, social workers, and other
professionals to deliver comprehensive care.

20. Pediatric Nursing in Pakistani Culture
• Pediatric nursing in Pakistan is deeply influenced by the country’s cultural, social, and
religious norms. The nurse’s role extends beyond clinical care to include respecting family
values, traditional beliefs, and religious practices, which are crucial in gaining trust and
ensuring effective child healthcare.
• 1. Family-Centered Care in a Joint Family System
• In Pakistani culture, many families live in joint systems, where decision-making about a
child's health often involves multiple elders, especially grandparents. Pediatric nurses must
communicate effectively not just with the mother or father, but often with extended family
members. In line with Essentials of Pediatric Nursing, this emphasizes family-centered care,
where the nurse supports and educates the entire family to ensure the child’s well-being.
• 2. Gender Sensitivity and Modesty
• Cultural norms in Pakistan often demand modesty, especially in interactions involving
female patients or caregivers. Female nurses are generally preferred for child care,
particularly when dealing with female children. Pediatric nurses must be culturally
competent and sensitive to gender roles and privacy norms.
• 3. Belief in Traditional Remedies
• Many families in Pakistan rely on traditional remedies, herbal treatments, or spiritual
healing before seeking formal medical care. Pediatric nurses must approach these beliefs
with respect, while gently educating families about scientific medical practices and ensuring
that traditional methods do not interfere with treatment outcomes.

21. Cont.…
4. Religious Practices and Spiritual Needs
• Religion plays a central role in Pakistani culture. Nurses must be respectful of
Islamic practices such as prayer times, dietary laws (halal food), and fasting
periods like Ramadan. For hospitalized children and families, providing space
and time for prayer contributes to emotional and spiritual comfort, which is also
part of holistic care as described in the textbook.
5. Challenges in Healthcare Access
• In rural areas of Pakistan, pediatric nursing faces challenges such as limited
resources, lack of specialized training, and cultural resistance to hospital births
or vaccinations. Nurses working in these settings often take on expanded roles
as educators and community advocates, promoting immunization, hygiene, and
nutrition.
6. Language and Communication
• Pakistan is a multilingual country, and nurses must often communicate in Urdu
or regional languages like Punjabi, Pashto, or Sindhi. Pediatric nurses must use
simple, compassionate language when explaining health conditions or
procedures, adapting their communication according to the family's literacy
level.

22. What is the UNCRC?
• The UN Convention on the Rights of the Child (UNCRC) is an important,
legally binding agreement signed by 196 countries (as of 12 July 2022) which
outlines the fundamental rights of every child, regardless of their race, religion
or abilities.
• The UNCRC is the basis of all of our work. It is the most complete statement of
children’s rights ever produced and is the most widely-ratified international
human rights treaty in history.
• The Convention has 54 articles that cover all aspects of a child’s life and set
out the civil, political, economic, social and cultural rights. The convention is
universal—these rights apply to every child and the convention entitles every
child to claim them. It also explains how adults and governments must work
together to make sure all children can enjoy all their rights.

23. Convention on the Rights of the Child: The children's version
1. Definition of a child
• A child is any person under the age of 18.
2. No discrimination
• All children have all these rights, no matter who they are, where they live, what language they speak,
what their religion is, what they think, what they look like, if they are a boy or girl, if they have a
disability, if they are rich or poor, and no matter who their parents or families are or what their parents
or families believe or do. No child should be treated unfairly for any reason.
3. Best interests of the child
• When adults make decisions, they should think about how their decisions will affect children. All
adults should do what is best for children. Governments should make sure children are protected and
looked after by their parents, or by other people when this is needed. Governments should make sure
that people and places responsible for looking after children are doing a good job.
4. Making rights real
• Governments must do all they can to make sure that every child in their countries can enjoy all the
rights in this Convention.
• 5. Family guidance as children develop
• Governments should let families and communities guide their children so that, as they grow up, they
learn to use their rights in the best way. The more children grow, the less guidance they will need.
• 6. Life survival and development
• Every child has the right to be alive. Governments must make sure that children survive and develop in
the best possible way.

24. Cont..
7. Name and nationality
• Children must be registered when they are born and given a name which is officially recognized by the
government. Children must have a nationality (belong to a country). Whenever possible, children
should know their parents and be looked after by them.
8. Identity
• Children have the right to their own identity – an official record of who they are which includes their
name, nationality and family relations. No one should take this away from them, but if this happens,
governments must help children to quickly get their identity back.
9. Keeping families together
• Children should not be separated from their parents unless they are not being properly looked after –
for example, if a parent hurts or does not take care of a child. Children whose parents don’t live
together should stay in contact with both parents unless this might harm the child.
10. Contact with parents across countries
• If a child lives in a different country than their parents, governments must let the child and parents
travel so that they can stay in contact and be together.
11. Protection from kidnapping
• Governments must stop children being taken out of the country when this is against the law – for
example, being kidnapped by someone or held abroad by a parent when the other parent does not
agree.
12. Respect for children's views
• Children have the right to give their opinions freely on issues that affect them. Adults should listen and
take children seriously.

25. Cont..
13. Sharing thoughts freely
• Children have the right to share freely with others what they learn, think and feel, by talking, drawing,
writing or in any other way unless it harms other people.
14. Freedom of thought and religion
• Children can choose their own thoughts, opinions and religion, but this should not stop other people from
enjoying their rights. Parents can guide children so that as they grow up, they learn to properly use this
right.
15. Setting up or joining groups
• Children can join or set up groups or organizations, and they can meet with others, as long as this does not
harm other people.
16. Protection of privacy
• Every child has the right to privacy. The law must protect children’s privacy, family, home, communications
and reputation (or good name) from any attack.
17. Access to information
• Children have the right to get information from the Internet, radio, television, newspapers, books and other
sources. Adults should make sure the information they are getting is not harmful. Governments should
encourage the media to share information from lots of different sources, in languages that all children can
understand.
18. Responsibility of parents
• Parents are the main people responsible for bringing up a child. When the child does not have any parents,
another adult will have this responsibility and they are called a “guardian”. Parents and guardians should
always consider what is best for that child. Governments should help them. Where a child has both parents,
both of them should be responsible for bringing up the child.

26. Cont.…
19. Protection from violence
• Governments must protect children from violence, abuse and being neglected by anyone who looks
after them.
20. Children without families
• Every child who cannot be looked after by their own family has the right to be looked after properly by
people who respect the child’s religion, culture, language and other aspects of their life.
21. Children who are adopted
• When children are adopted, the most important thing is to do what is best for them. If a child cannot
be properly looked after in their own country – for example by living with another family – then they
might be adopted in another country.
22. Refugee children
• Children who move from their home country to another country as refugees (because it was not safe
for them to stay there) should get help and protection and have the same rights as children born in
that country.
23. Children with disabilities
• Every child with a disability should enjoy the best possible life in society. Governments should remove
all obstacles for children with disabilities to become independent and to participate actively in the
community.
24. Health, water, food, environment
• Children have the right to the best healthcare possible, clean water to drink, healthy food and a clean
and safe environment to live in. All adults and children should have information about how to stay safe
and healthy.

27. Cont.…
25. Review of a child's placement
• Every child who has been placed somewhere away from home - for their care, protection or health
– should have their situation checked regularly to see if everything is going well and if this is still
the best place for the child to be.
26. Social and economic help
• Governments should provide money or other support to help children from poor families.
27. Food, clothing, a safe home
• Children have the right to food, clothing and a safe place to live so they can develop in the best
possible way. The government should help families and children who cannot afford this.
28. Access to education
• Every child has the right to an education. Primary education should be free. Secondary and higher
education should be available to every child. Children should be encouraged to go to school to the
highest level possible. Discipline in schools should respect children’s rights and never use violence.
29. Aims of education
• Children’s education should help them fully develop their personalities, talents and abilities. It
should teach them to understand their own rights, and to respect other people’s rights, cultures
and differences. It should help them to live peacefully and protect the environment.
30. Minority culture, language and religion
• Children have the right to use their own language, culture and religion - even if these are not
shared by most people in the country where they live.
31. Rest, play, culture, arts
• Every child has the right to rest, relax, play and to take part in cultural and creative activities.

28. Cont..
32. Protection from harmful work
• Children have the right to be protected from doing work that is dangerous or bad for their
education, health or development. If children work, they have the right to be safe and paid fairly.
33. Protection from harmful drugs
• Governments must protect children from taking, making, carrying or selling harmful drugs.
34. Protection from sexual abuse
• The government should protect children from sexual exploitation (being taken advantage of)
and sexual abuse, including by people forcing children to have sex for money, or making sexual
pictures or films of them.
35. Prevention of sale and trafficking
• Governments must make sure that children are not kidnapped or sold, or taken to other
countries or places to be exploited (taken advantage of).
36. Protection from exploitation
• Children have the right to be protected from all other kinds of exploitation (being taken
advantage of), even if these are not specifically mentioned in this Convention.
37. Children in detention
• Children who are accused of breaking the law should not be killed, tortured, treated cruelly, put
in prison forever, or put in prison with adults. Prison should always be the last choice and only
for the shortest possible time. Children in prison should have legal help and be able to stay in
contact with their family.

29. Cont..
38. Protection in war
• Children have the right to be protected during war. No child under 15 can join the army or take part
in war.
39. Recovery and reintegration
• Children have the right to get help if they have been hurt, neglected, treated badly or affected by
war, so they can get back their health and dignity.
40. Children who break the law
• Children accused of breaking the law have the right to legal help and fair treatment. There should
be lots of solutions to help these children become good members of their communities. Prison
should only be the last choice.
41. Best law for children applies
• If the laws of a country protect children’s rights better than this Convention, then those laws should
be used.
42. Everyone must know children's rights
• Governments should actively tell children and adults about this Convention so that everyone knows
about children’s rights.
43 to 54. How the Convention works
• These articles explain how governments, the United Nations – including the Committee on the
Rights of the Child and UNICEF - and other organisations work to make sure all children enjoy all
their rights.

30. Debate: Rights of a Child
In Favor of Child Rights:
• Foundation for Health and Well-being: Upholding child rights promotes early
health intervention, nutrition, and education—all critical for a child’s
development.
• Legal Protection: These rights offer a legal framework that protects children
from violence, child labor, trafficking, and discrimination.
• Ethical Responsibility: As pediatric nurses and healthcare providers, ensuring
a child's right to informed care and a safe environment is both a professional
and moral obligation.
• Empowerment and Voice: Respecting children's voices builds their confidence
and emotional intelligence, making them responsible citizens in the future.

31. Challenges and Criticisms:
• Cultural Resistance: In some societies, including parts of Pakistan, traditional
views may limit child autonomy or prioritize obedience over self-expression.
• Implementation Gap: Even though laws exist, enforcement is often weak due
to poverty, illiteracy, or lack of awareness among caregivers.
• Parental Authority vs. Child Rights: In some debates, there is tension
between upholding a child's rights and respecting parental authority—
especially in decisions like medical treatment or education.

32. Commonly Occurring Ethical Issues in Pediatric Settings of Pakistan
Ethical issues in pediatric nursing arise when there is a conflict between what is
considered right for the child and the decisions made by caregivers, families, or
healthcare professionals. In Pakistan, these issues are influenced by cultural beliefs,
social norms, economic conditions, and healthcare limitations.
• 1. Informed Consent and Assent
• In pediatric care, children cannot legally give consent for treatment, so it is obtained
from parents or guardians. However, ethical issues arise when:
• Parents refuse life-saving treatment due to religious or cultural beliefs.
• Children’s voices are ignored, especially adolescents who may have the capacity to
understand and express their wishes (assent). According to Sethi & Awasthi (2022),
nurses must advocate for the child while respecting the family's authority.
• 2. End-of-Life Decisions
• Palliative care and decisions about withdrawing treatment for terminally ill children
are ethically sensitive. In Pakistan, this is further complicated by:
• Religious beliefs about prolonging life at all costs.
• Lack of palliative care services, leaving families and healthcare staff with difficult
choices without adequate support.

33. Cont.…
3. Female Child Neglect
In some areas, gender bias may lead to delays in seeking medical care for female children. Ethically,
nurses must treat every child equally and raise concerns when neglect is observed, even if it
contradicts family values.
4. Confidentiality in Adolescents
Adolescents may seek care for issues like mental health, sexual health, or substance use. Ethically,
respecting confidentiality is crucial, but:
Parental involvement is often mandatory, especially in public hospitals.
This may lead to breach of trust between the nurse and the adolescent.
5. Child Abuse and Reporting
Cases of physical, emotional, or sexual abuse are often underreported in Pakistan due to stigma,
fear, and family honor. Nurses are ethically obligated to protect the child, report abuse, and
coordinate with authorities—but fear of retaliation or lack of legal clarity often becomes a barrier.
6. Resource Allocation and Equity
Due to limited hospital beds, vaccines, or medications, ethical dilemmas arise about:
Who gets treated first?
Should expensive treatments be given to children with low chances of survival?
7. Use of Traditional or Harmful Practices
Some families rely on spiritual healers or traditional remedies, delaying appropriate care. Ethically,
nurses must educate without offending cultural beliefs, ensuring safety and dignity.

34. Refrences
• Hockenberry, M. J., & Wilson, D. (2019). Wong’s Nursing Care of Infants and
Children (11th ed.). Elsevier.
•Ball, J. W., Bindler, R. C., Cowen, K. J., & Shaw, M. (2021). Principles of pediatric
nursing: Caring for children (8th ed.). Pearson.
•Hockenberry, M. J., & Wilson, D. (2019). Wong’s nursing care of infants and
children (11th ed.). Elsevier.
•Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and
their families (3rd ed.). Cengage Learning.
•https://www.unicef.org/child-rights-convention/convention-text-childrens-version
•Sethi, N., & Awasthi, S. (2022). Essentials of Pediatric Nursing (4th ed.). Lotus
Publishers.