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63-277

63-277. NURSING CARE OF CHILDREN & YOUTH WITH EPISODIC AND LONG-TERM HEALTH NEEDS. Introduction to 63 277. Review of course outline Review of competency performance assessments Policies Texts & Resources- DVD Clickers – class participation Clinical component 63 274.

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63-277

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  1. 63-277 NURSING CARE OF CHILDREN & YOUTH WITH EPISODIC AND LONG-TERM HEALTH NEEDS

  2. Introduction to 63 277 • Review of course outline • Review of competency performance assessments • Policies • Texts & Resources- DVD • Clickers – class participation • Clinical component 63 274 63-277 Winter 2006

  3. What Is Pediatrics ? • Who are the clients ? • What is the setting ? • What is nursing’s role ? 63-277 Winter 2006

  4. Pediatric Nursing is : • Practice of nursing involving the health care of children from infancy to adulthood • Overall goal is to promote & assist the child in maintaining optimal levels of health while recognizing the influence of the family on the child’s well being 63-277 Winter 2006

  5. PHILOSOPHY of Pediatric Nursing Care • Focus on family- “family centered care” • Advocacy • Atraumatic therapeutic care • Anticipatory guidance • Evidence-based practice 63-277 Winter 2006

  6. Wellness the goal Build on strengths Everyday a new opportunity Nature + Nurture Child has rights Diversity expected Prevent injury/illness Integrate Gr.& Dev. Evidence-based care adapts to needs Family is constant Family as partners Wholistic presence Philosophy & Principles 63-277 Winter 2006

  7. Pediatric Nursing As Specialty • Complex – multiple ages & stages • Anatomy & physiology different from adult • Growth & developmental stages • Full of change • Emphasis on anticipatory guidance, risk reduction, injury prevention 63-277 Winter 2006

  8. Changing Pediatric Scene • Partnership with families • Changing demographics • Smaller families • Ethnic diversity •   demands for adolescent care • Movement of care into home/community • Health care cost containment 63-277 Winter 2006

  9. Changes in the Pediatric Population  technology & procedures • More serious and complex problems • Fragile newborns - Survivors of premature births • Children with severe injuries • Children with disabilities who have survived • More frequent and lengthy stays in hospital 63-277 Winter 2006

  10. Role of Pediatric Nurse Therapeutic relationship Family Advocacy Caring Disease Prevention Health Promotion Health Teaching 63-277 Winter 2006

  11. Role of Pediatric Nurse • Support/counseling • Restorative role • Coordination/collaboration • Ethical Decision making • Research • Health care planning 63-277 Winter 2006

  12. Ethical-Legal Issues • Atraumatic care • Bill of rights • Consent for treatment • Age of assent (age 7) • Advanced directives • Maintaining nursing records • Confidentiality • Research with children 63-277 Winter 2006

  13. Nursing Care with Children & Families • Orient to “care by family” approach • Increase family involvement • Learn interpersonal skills • Physical care • Emotional care • Self-awareness • Critical thinking - purposeful, organized, goal-directed 63-277 Winter 2006

  14. FAMILY-CENTERED CAREAmerican Academy of Pediatrics 2003 • Respect for child & family • Recognition of effects of cultural, racial, ethnic & socioeconomic diversity on the family’s health care experience • Identification of and expansion of the family’s strengths • Support of the family’s choices related to health care 63-277 Winter 2006

  15. Family-centered care cont’d • Maintenance of flexibility • Provision of honest, unbiased information in an affirming & useful approach • Assistance with emotional & other support the child & family require • Collaboration with families • Empowerment of families 63-277 Winter 2006

  16. Significance of Family Centered Care Family is constant in child’s life Family supported in care giving & decision making Expertise in own family dynamics recognized Family strengths built on Needs of whole family considered Diversity among families honored & respected Professionals enable & empower client families Parent-professional partnership

  17. Advocacy • Intervene to prevent developmental & health problems • Work with families to identify needs, strengths, goals, and plans • Educate about available services • Promote children’s well-being through teaching, counseling, holistic care, collaboration 63-277 Winter 2006

  18. Therapeutic Relationship • Caring yet defined boundaries – not overinvolved • Empower families • Promote family’s control over child’s health care • Teach “how to” rather than “do for” • Decrease family dependence on health care providers • Separate families’ needs from own needs • Open communication • Effective advocacy • See [p 15 – Guidelines…] 63-277 Winter 2006

  19. UN Bill of Rights (1959) & Convention of Rights (1989) • Definition of a ChildA child is recognized as a person under 18, unless national laws recognize the age of majority earlier 63-277 Winter 2006

  20. Children’s Rights • Freedom from discrimination • Conditions of freedom & dignity • Name & nationality • Adequate nutrition, housing, recreation and medical services • Care of parents – moral, material security • Protection from neglect, exploitation • Education • First to receive protection and relief • Be brought up in a spirit of understanding, tolerance, friendship among peoples, peace & universal brotherhood 63-277 Winter 2006

  21. BILL OF RIGHTS for CHILDREN’S HEALTH CAREUniversity Children’s Hospital - University of California-Irvine 2006 • To be called by name • To receive compassionate care in a careful, prompt& courteous manner • To know names of all providers caring for the child • To have basic needs met and usual schedules or routines honoured • To be kept without food or water when necessary for the shortest time possible 63-277 Winter 2006

  22. To be unrestrained if able • To have parents or other important persons with the child • To have an interpreter for the child & family when needed • To object noisily if desired • To be educated honestly about the child’s health care • To be respected as a person (not being talked about unless child knows what is happening) • To have confidentiality respected at all times 63-277 Winter 2006

  23. Atraumatic Care Prevent or minimize child’s separation from family Promote a sense of control Prevent or minimize bodily injury and pain Prepare child for procedure or treatment Control pain Provide privacy Encourage play for expression of fear or aggression Provide choices 4. Respect cultural differences

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  25. Preventing or Minimizing Separation ☺Parents present at all times ☺Accommodations provided for comfort ☺Positive attitude of collaboration by staff ☺Family encouraged to participate according to comfort levels ☺Reminder to consider parent stress level, need for sleep, nutrition & relaxation ☺Nurses must augment & complement parent role 63-277 Winter 2006

  26. EPISODIC CARE • Occasional interaction of nurse with child and family.. • Education part of each interaction. • Concerns may be developmental, growth, illness, care management or parenting needs. • Therapeutic relationship required • Best if consistent team in child-centred setting. • Important to plan for ATRAUMATIC CARE. 63-277 Winter 2006

  27. Special Needs Children Long Term Care Populations ♦Cognitive Impairment ♦ Sensory Impairment ♦ Communication Impairment ♦ Chronic Illness ♦ Congenital disability ♦ Developmental delay ♦ Disability ♦ Handicap ♦ Impairment ♦ Technology-dependent child 63-277 Winter 2006

  28. Trends in Care for Child with Chronic Illness or Disability • Developmental Focus • Family development • Family Centered Care • Normalization • Home care • Mainstreaming • Early Intervention • Managed care 63-277 Winter 2006

  29. ANTICIPATORY GUIDANCE • Prevention - Deal with an issue before it becomes a problem • Traditional • Information on normal growth & development • Nurturing childrearing practices • Injury prevention 63-277 Winter 2006

  30. Anticipatory Guidance • Role of Nurse • Base interventions on needs identified by family • View family as having ability to be competent • Provide opportunities for family to achieve competence 63-277 Winter 2006

  31. 63-277 Winter 2006

  32. Community Health Concepts • Community • group of individuals with shared characteristics or interests who interact with each other • Populations • groups of people who live in a community • Target population • more narrowly defined groups • Demography • study of population characteristics • Demographic characteristics include age, gender, race ,ethnicity, socioeconomic status & education • Risk • probability of developing a disease, illness or injury 63-277 Winter 2006

  33. Nursing Activities for the Community • Needs assessment – community priorities • Public Health • Health assessment, disease surveillance, policy development • Health promotion • Perinatal care, screening clinics, parenting skills education, education on health/injury risks • Injury Prevention • Develop and implement prevention strategies 63-277 Winter 2006

  34. Community Assessment • Demographics • Population • Culture, ethnicity • Social class • Family size, types 63-277 Winter 2006

  35. Community Systems • Health & social services • Communication • Recreation • Physical environment • Education • Safety & transportation • Politics & government • Economics 63-277 Winter 2006

  36. Mortality and Morbidity • See selected statistical document for Essex/Chatham/-Kent/Lambton 63-277 Winter 2006

  37. Vital Statistics • Epidemiology –science of population health applied to detection of morbidity & mortality in a population • Mortality: number of deaths in a specific period (rate/100,000 population) • Infant Mortality Rate: number of deaths during 1st year of life (rate/1000 births) • Morbidity: prevalence of a specific illness (rate/1000) • New Morbidity: pediatric social illnesses e.g. poverty, abuse, violence, school failure, divorce 63-277 Winter 2006

  38. Perinatal inheritance Optimal weight Nutrition Injury/violence Environmental risks (pollution) Access to health care Substance use/abuse Exposure to tobacco, alcohol Sexual behaviour Mental health Gender Dominant ethnic group Family income Home location Education Leading Health Indicators for Children 63-277 Winter 2006

  39. Leading Causes of Infant Mortality • Congenital anomalies • Prematurity • Low birth weight • Sudden infant death syndrome (SIDS) • Maternal complications in pregnancy • Newborn birth complications • Respiratory distress syndrome (RDS) • Infections – bacterial sepsis • Birth asphyxia • Intrauterine hypoxia 63-277 Winter 2006

  40. Leading Causes of Childhood Mortality After 1 year of age • Injuries/accidents are leading cause of death • Adolescence: higher risk for – • Injury • Homicide • Suicide • Cancer • Heart disease 63-277 Winter 2006

  41. Sex Temperament Stress Alcohol/drug use History of previous injury Developmental characteristics Cognitive characteristics Anatomic characteristics Injuries – Risk Factors 63-277 Winter 2006

  42. Injury Prevention • Passive strategies • Seat belts • Helmets • Active strategies • Anticipatory guidance • Self protection behaviours 63-277 Winter 2006

  43. Levels of Prevention • Primary • Health promotion, disease & injury prevention • Secondary • Screening & early diagnosis • Tertiary • Disease management, optimizing rehabilitation 63-277 Winter 2006

  44. Levels of Prevention • Primary- focuses on health promotion & prevention of disease or injury • Well child clinics • Immunization programs • Safety programs-prevention of injuries • Nutrition programs • Environmental efforts • Sanitation • Community parenting classes 63-277 Winter 2006

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  46. Levels of Prevention • Secondary prevention- focuses on screening & early diagnosis • TB screening • Lead screening • Mental health counseling for stressful events ie divorce, death, disasters Screening –purpose to detect & treat disease early in the period of pathogenesis in order to prevent the spread & progression of disease 63-277 Winter 2006

  47. Levels of Prevention • Tertiary focuses on optimizing function for children with disability or chronic diseases • Rehabilitation • Disease management programs for asthma, cancer, etc • Special education programs 63-277 Winter 2006

  48. Best Practice • Evidence-based practice & research • Optimize care & standards • Share & disseminate findings • Future • Collaborative management, ambulatory care, home care, health promotion • RNAO Best Practice Guidelines 63-277 Winter 2006

  49. EVIDENCE-BASED PRACTICE • EBP is the collection, interpretation & integration of valid, important & applicable patient-reported, nurse-observed & research derived information • Combines knowledge with clinical experience & intuition 63-277 Winter 2006

  50. EBP • Begins with identification of the problem • Clinical questions are asked to allow for clear answers • Clinically relevant research is evaluated • Findings from the history & physical are analyzed • Specific pathophysiology is reviewed 63-277 Winter 2006

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