Chapter 1

Foundation of Pediatric Nursing:

- Children are the future of our society
- Nursing roles in caring for children and their families include direct care, education,
advocacy, and case management.
- GOALS:
o Overall health increase
o Illness to some degree decreases
- Nursing care for a wide range of problems:
o Healthy child
o Acutely ill
o Injured
o Chronically ill
o Client and family
Continuum of Pediatric Health Care for Children and their Families:

Important nursing implication = HEALTH promotion (to all levels of the continuum)
o Every encounter should be a teaching moment

Standards of pediatric nursing:

- Society of Pediatric Nurses (SPN) = developed the scope and standards of pediatric
nursing
- National Association of Pediatric Nurse practitioners:
o
clinical practice guidelines: evidence based statements about care used to
make decisions about care or a child with a certain diagnosis

Responsibilities of Pediatric Nurses:

- Society of Pediatric Nurses Competencies
- Professional Practice Standards Standards of Performance
- Professional Practice Standards Standards of Care
Competencies:
- Understanding anatomy and physiology and developmental differences in children
o Family and cultural sensitivity
o Communication
o PROMOTE health
o Understand social/ political / legal/ moral issues when caring for children
Standards of Performance:
- Enhance quality of care
- Evaluate practice in relation to:
o Standard
o Statues and regulations
o Apply ethical principles in care
o PATIENT ADVOCACY
Standards of Care:
- Assessment
- Diagnosis
- Identify outcomes and develop a plan of care
- ADPIE
o Assessment, Diagnosis, Planning, Implementation/Intervention, and Evaluation
Areas of Pediatrics:
- Bedside = direct patient care
o Specialized treatment improves outcomes
o Ex: ICU, trauma, NICU, education, advocacy
- ADVOCACY
o knowing what resources are available for your patient and using to advocate
with insurance and politics
- Research
o Consent issues
o Not a big population: Children from birth to 19 years of age accounted for
approximately 25-27% of the total population.
Advanced Practice Nurses:
- Masters level: More responsible for care of client and outcomes
- Clinical specialist, NP, PNP, ARNP, APRN, MSM
o Advanced practiced nurses can diagnose and prescribe medicine
Autonomy
Leadership
- Doctors level: more research related responsibilities
o DNP clinical doctorate
o PhD- research doctorate
What is the difference between DNP and PhD?
- DNP takes what PhD discover and apply it to the clinic setting.

History of child healthcare:

- Flood of immigrants from Europe
o Leading to crowded and unsanitary conditions
o Lack of immunizations
o Harsh working conditions (child labor)
- Resulted in of immigration/ unsanitary conditions
o Infectious diseases = TB, typhoid fever, smallpox, scarlet fever
Founder of Public Health Nursing:
- Lilian Wald pioneered:
o Home visits
o School nursing
o Public health nursing
- Opened first child/family clinic and Henry Street Settlement which is still open and
operated by nurses today
o Provided nursing care for immigrant families
o Henry Street opened to children, families, and the poor
Focused on health promotion and disease prevention:
- Infectious disease
o causes: inadequate/unsanitary foods, lack of immunizations, harsh working
conditions
Advances Contributing to Child Healthcare:
- Antibiotics, Immunizations are the two most important things that truly influenced
the healthcare of the child.
Philosophy of Pediatric Nursing:

Atraumatic care: Provide therapeutic care through interventions that minimize

physical and psychological distress.
o Always try to avoid patient pain
o Although all anti-pain measure is typically done, sometimes its unavoidable
o Ex atraumatic care: J tip, is used to numb the area before inserting an I.V
Evidence based care: want to perform practice that has science behind it.

Family centered care: the most important thing to a child is the family because it is a
constant.
o In most institutions, there are no visitor hours for children because families
are not considered visitors rather theyre the centered care focuses around
the patient and always allowed in the patient room
o Family is always included in the patients care plan/updates

Family Centered Care:

- Family is considered a constant and is incorporated in everything dealing with patient
- Participation from parents is vital and essential for care
- Respect and dignity are basic concepts needed
Pediatric Health Statistics:
- Leading cause of death: pre-maturity
- Neonatal deaths = within the first 29 days of life
o Leading cause of death in neonatal = short gestation and low birth weights
o 47 nations that have a lower infant mortality rate than the United States
- Infant mortality = before 1st birthday (29 days to 1 year)
o SIDS
- US has one of the worst infant mortality rates in the world
o Related to extreme pre-term births
- Infant Mortality Rate = 6.1 per 1,000 live births in 2011
o Stats havent changed much
Leading cause of hospitalizations: respiratory problems
- 80% of illness attribute to infections, with respiratory infections
Unintentional injury by age: Ages 1 to 19 years mortality typically due to unintentional
injury (potentially preventable)
- Age 0-1: Suffocating
- Age 1-4: Drowning (you only need enough water to cover nose and mouth to down)
- Age 5-19: Motor vehicle/traffic accidents
Education: about causes of injury and death (injury prevention)
- education is based on level of development, not age
o level of development = partially determine the type of injury most likely to occur
Anticipatory guidance for parents and caregivers
- Infants: sleep on back, no pillows, blankets, stuffed animals, not in bed with parents
- Toddler/School age: Drowning precautions, never bathing alone, lifeguards, helmets,
seatbelt use
- Adolescents: driving safety, alcohol, drug use, safe sex, texting while driving, social
media
Plan strategies to include pediatric patient safety in the healthcare setting:
- children cannot voice their pain/symptoms, and system errors overall make child
mortality 3x more likely that adult medical deaths
Medical error prevention:
- Quiet zone
- Dosage calculation sheets
- Double verification

Injury prevention:
- Teaching moments with parents/ injury prevention:
o Climbing furniture, swimming/drowning, sunscreen
- Clear and appropriate communication
Healthy people 2020
- National effort to identify priorities for health improvement
o Obesity is a new issue for peds
- Federal funding typically available for program designed to reduce deaths in high risk
groups
- Education/injury prevention = active nursing role
o Nursing implication: awareness of resources and funding for children (patient
advocacy)
Patient Safety in Children
- Children are at greater risk for medical error
- Med errors are 3X more likely than adults = because dosing medication is done by
weight
o immature physiology-affects how they metabolize and excrete medications,
communication errors
o The nurse needs two forms of identification and/or identification of child by
parent.
Legal and ethical considerations:
- Issues related to consent who can legally consent for the child?
o Does the parent/child understand the disclosed information; consent must be
voluntary.
Informed Consent:
- Signer must be of legal age in state and competent to make decision
- Parent or guardian has decision for minors (minors are <18 yoa)
- Minors can give consent if: emancipated or parent of child receiving care
- Healthcare provider must obtain consent
- EXCEPTION
o Consent may be delayed in emergency situations
o Minor is a parent or pregnant
o Mature minors (14-18) able to understand tx risks may give independent
consent
Nursing implications in obtaining informed consent:
- Develop therapeutic relationship
- Review rights of minor
- Assess and document consent process
- Verify prior consent
- Serve as witness
Ethical Guidelines:
- Nurses use four ethical principles:
1. Beneficence - make decisions that benefit the patient.
2. Non-maleficence - reduce the risk of harm - use interventions that promotes most
benefits.
3. Autonomy - right for self determination
4. Justice - Treat all with fairness and respect.
Organizational ethics committees resolve conflicts and make recommendations

Identify unique pediatric legal and ethical issues in pediatric nursing practice.
- Issues in pediatric nursing practice:
- End of life sustaining treatment
- Genetic testing of children
- Organ transplant
- Research on children