Concept of Pediatric

Dian Susmarini, MN
Nursing Program
Medical Faculty, University of Brawijaya
General Objective
By the end of this lecture, the student will be
able to discuss perspectives in the nursing
care of children.
Specific Objectives:
At the end of this part, the student will be able to:
Define what pediatric nursing means.
Mention the historical background of pediatric nursing
and its development.
Enumerate scopes of pediatric nurses practices.
List the qualities characterizing a good pediatric nurse.
Identify the role of pediatric nurse.
Mention the family center care approach.
Mention the health education necessary to parents.

Health During Childhood
Health is a state of complete physical, mental,
and social well-being and not merely the
ABSENCE of DISEASE.
The World Health
Organization

Definition of Pediatric Nursing:
It is the art and science of giving nursing care
to children from birth through adolescent with
emphasis on the physical growth, mental,
emotional and psycho-social development .
Scope of Pediatric Nursing Practices:
The responsibility in providing nursing
interventions either in ambulatory or
institutional settings. Ambulatory setting: such
as home, schools and or physicians clinic
where children and their parents have health or
counseling needs. While, institutional settings
are mainly hospitals (general or specialized
hospitals) where care is provided to sick
children and their parents.
Qualities of Good Pediatric Nurse:
The good pediatric nurse must be:
Good observer.
Honest and truthful.
Sympathetic, kind, patient and cheerful.
Love to work with children.
Interested in family care.
Able to provide teaching to children and their
families.
Role of Pediatric Nurse:

The pediatric nurses role is unique because of
developmental immaturity and vulnerability of children.
The goals of nursing care of children, based on primary
health care are:
Promote the healthy maturation of the child as a
physical, intellectual and emotional being within the
context of his family and communities (primary level).
Provide health care for the child who requires
treatment from disease(s) (secondary level).
Dealing with the childs disabilities (tertiary level).
Therefore, the role of the pediatric nurse includes:
In Primary Level:
Through health education to child and his parents
and providing childs basic needs and
immunization, the nurse can:
Maintain childs health.
Help the child achieves his optimal growth and
development.
Prevent diseases and their complications.
In Secondary Level:
The nurse has to provide care to sick children and
their families by:
Assessing their needs.
Planning for their care.
Implementing the plan.
Evaluating childrens condition.
Providing heath teaching to children and their
parents.
In Tertiary Level:
The nurse should assist children to return to
their maximal level of functioning following
illness and /or disabilities.
Role of the pediatric nurse
Therapeutic relationship
Family advocacy
Disease prevention/health promotion
Health teaching
Support/counseling
Collaboration
Ethical decision making
Research
Health care planning

Future Trends
What issues do you think become
trends within the next few years
Nursing Care of the Child and Family
During Stress and Illness
. The sense I have that Im a lousy mother
whatever I do here, you lose your control over
your child here, you are no longer the childs
best carer but that is someone else
. Nurses took a rather cautious attitude and said
its up to you what I want to do, but I want that
kind of support because I was pretty exhausted
in that situation
. I was kind of timidly asking that I can do this, I
didnt know whether I supposed to brush my
childs teeth and grease his bottom

. The first time I gave an injection to my child
was awful, I wanted to cry and he was
screaming, but then this lovely nurse said it
went well
.... We were told that it is us who know the child
better than anyone, in that sense we are the
experts of child care
Stressors and reactions related to developmental
stage
Separation anxiety
Loss of control
Bodily injury and pain
Effects of hospitalization on the child
Stressors
of Hospitalization
Separation anxiety
Protest phase
Cry and scream, cling to parent
Despair phase
Crying stops; evidence of depression
Detachment phase
Denial; resignation and not contentment
May seriously affect attachment to parent after separation
Loss of Control: Infants Needs
Trust
Consistent, loving caregivers
Daily routines
Loss of Control:
Toddlers Needs
Autonomy
Daily routines and rituals
Loss of control may contribute to:
Regression of behavior
Negativity
Temper tantrums
Loss of Control: Preschoolers
Egocentric and magical thinking typical of age
May view illness or hospitalization as
punishment for misdeeds
Loss of Control: School Age
Striving for independence and productivity
Fears of death, abandonment, permanent injury
Boredom
Loss of Control: Adolescents
Struggle for independence and liberation
Separation from peer group
May respond with anger, frustration
Need for information about their condition
Fears of Bodily Injury and Pain
Common fears among children
May persist into adulthood and result in
avoidance of needed care
Effects of Hospitalization
on the Child
Effects may be seen before admission, during
hospitalization or after discharge
Stressors and reactions of the family of the
child who is hospitalized
Parental reactions
Sibling reactions
Altered family roles
Parental Responses to Stressors of
Hospitalization
Disbelief, anger, guilt
Especially if sudden illness
Fear, anxiety
R/T childs pain, seriousness of illness
Frustration
Especially r/t need for information
Depression
Sibling Reactions
Loneliness, fear, worry
Anger, resentment, jealousy
Guilt
Altered Family Roles
Anger and jealousy between siblings and ill child
Ill child obligated to play sick role
Parents continue pattern of overprotection and
indulgent attention
Nursing care of the child who is hospitalized and
the family
Preventing or minimizing separation
Minimizing loss of control
Preventing or minimizing bodily injury
Providing developmentally appropriate activities
Using play/expressive activities to minimize stress
Maximizing potential benefits of hospitalization
Supporting family members
Nursing care of the child who is hospitalized and
the family
Preventing or minimizing separation
Parent participation and rooming-in
Strategies to minimize the effects of separation

Preventing or Minimizing Separation
Primary nursing goal
Especially for children <5 yrs
Family-centered care
Parents are not visitors
Familiar items from home
Family-Centered Care
Recognizes the family as the constant in a
childs life
Systems must support, respect, encourage, and
enhance the strength and competence of the
family
Needs of all family members must be addressed

Family-Centered Care (contd)
Concept of ENABLING
Concept of EMPOWERMENT
Normalizing the Hospital Environment
Maintain childs routine, if possible
Time structuring
Self-care (age appropriate)
School work
Friends and visitors
Nursing care of the child who is hospitalized and
the family
Minimizing loss of control
Promoting freedom of movement
Maintaining childs routine
Encouraging independence
Promoting understanding
(Hopia, Tomlison, Paavilainen & Kurki, 2003)
39
Factors that influence siblings responses to illness/hospitalization of
the child (p. 1041)
Fear of contracting the illness
Younger age
Close relationship to sick sibling
Out-of-home residence during period of hospitalization
Minimal explanation of the sick childs illness
Perceived changes in parenting, such as increased
parental anger
40
Nursing care of the siblings of the child who is ill/hospitalization of the
child (p. 1040)
Keep siblings informed of the childs illness & progress
Allow siblings to visit the hospitalized child
Encourage siblings to provide pictures, make cards, &
call
Allow older siblings to assist with the care of the ill
child if they seem comfortable doing so
Care of the Child and
Family in Special Hospital Situations
Ambulatory/Outpatient
Benefits
Preparation of child can be challenging
The stress of waiting
Explicit discharge and follow-up instructions
Isolation
Added stressor of hospitalization
Child may have limited understanding
Dealing with childs fears
Potential for sensory deprivation
Emergency Admission
Essentials of admission counseling
Postventioncounseling subsequent to the
event
Participation of child and family as appropriate
to situation
Intensive Care Unit
Increased stress for child and parents
Emotional needs of the family
Parents need for information
Perception of security from constant monitoring
and individualized care
Wassalam