Introduction to the nursing care of children Part 1: Child’s Health in Changing Society

1. Introduction to the nursing care of childrenPart 1:Child’s Health in Changing Society By Nataliya Haliyash MD, BSN

2. Lecture Objectives • Healthy People 2010 sets forth national health goals and objectives for adults and children, and focuses on disease prevention and health promotion. • The aggregate health status of infants, children, and adolescents is determined statistically by keeping records of indicators such as infant mortality rate, low birth rate, and immunization rate. • Current societal trends affecting children, their health, and their families include immigration, poverty, homelessness, migrant farm work, and violence. • Intentional and unintentional injuries, causes and prevention. • Standards of Care and Standards of Professional Performance

3. Current Status of Children’s Health Healthy People 2010: National Health Promotion and Disease Prevention Objectives (US Department of Health and Human Services – DHHS): 28 focus areas 467 objectives

4. Healthy People 2010 Goals: • To increase the quality and years of healthy life • To eliminate health disparitiesbetween ethnic groups

5. 10 leading health indicators • Physical activity • Overweight and obesity • Tobacco use • Substance abuse • Responsible sexual behavior • Mental health • Injury and violence • Environmental quality • Immunizations • Access to health care

6. The main indicators of health status • infant mortality rate (IMR), • child mortality, • immunization rates.

7. Infant Mortality • IMR (Infant Mortality Rate) is the number of infant death during the first year of life per 1,000 live births • Racial disparities • The IMR target goal for the year 2010 is 4.5 death per 1,000 live births

9. Racial Differences • High rate of low birth weight (LBW) infantsborn to minority mothers • Decrease in theoverall health status or health care access of minority women • IMRs were also higher for infants whose mothers wereteenagers or 40 years of age or older,did not complete highschool, were unmarried, began prenatal care after the first trimester of pregnancy or smoked during pregnancy

10. Low Birth Weight • One reason for the racial disparity in IMRs and theranking of the United States is the high rate of LBW ( weight less than 2,500 grams, or 5 pounds 8 ounces) • The rate of LBW was 7.6% in 1998, up from 7.5% in 1997. • Infants with a LBW have a six times higher risk of death during first year of life. • Those weighing less than 1,500 grams have an 89 times higher risk of death than do babies havingnormal birth weight.

12. Low Birth Weight: Health Risk? • LBW babies are at risk for impaired health, developmental delay, neurosensory deficits, cognitive delays, and school and behavioral difficulties. • The most common major neurologic abnormality seen in these infants is cerebral palsy, which increases with decreasing birth weight.

13. Reflective thinking • The Cost of Keeping LBW Infants Alive • Hospitals and health care delivery systems havepoured substantial amounts of money into neonatal intensive care units to care for LBW infants. These babies are usually technology dependent and oftenrequire expensive medical equipment and nursingcare in their homes. • How do you feel about thisemphasis on high-tech solutions versus allocatingsome resources to preventive services?

14. Immunization Rates • The reduction in incidence of vaccine-preventable diseases isone of the most significant public health achievements of the 20th century. • The global eradication of smallpox in 1977 is anillustration of this success (DHHS, 1999). • Not only areimmunized individuals themselves protected from developing a potentially serious illness, but, alsoif enough of thepopulation is immunized, transmission of the disease in acommunity may be interrupted.

15. Immunization Rates • In 1999, the highest rates of childhood immunizationwere achieved. • Three vaccines – polio,measles, and Haemophilus influenza type b (Hib)—had acoverage rate at/or above 90%

18. Immunization Rates • Rates are for 19-35-month-old children who have received atleast four doses of DTP (diphtheria, tetanus, pertussis), threepolio, one MMR (measles, mumps, rubella), three Hib, andthree hepatitis B. • The Healthy People 2010 target is 90%coverage for all recommended vaccines in all populations.

19. Immunization requirements • All 50 states have immunization requirements for entrance into school; however, some groups are seeking changes in these state laws. • Exceptions are allowed from immunization requirements for medical reasons in all states and for religious reasons in 48 states, and 15 states allow exemptions for philosophical reasons

20. Child Mortality • In 1900, the death rate for children 1-4 :of age was about 2,000 per 100,000population, 460 for year-olds, 300 forchildren 10-14 years old, and 500 for 15-19-year-olds.

22. Injury • Injury is defined as damage or harm to an individual resulting in destruction of health, disability, or death • Intentional and unintentional

23. Intentional injuries • Homicide • Suicide • Rape • Assault and battery • Domestic violence • Child abuse and neglect • Any other injury caused on purpose

24. Unintentional Injuries • Injuries due to motor vehicles • Bicycle injuries • Boating injuries • Choking and suffocation • Falls • Drowning • Near-drowning • Fires and burns • Firearm injury • Poisoning • Occupational injuries • Farm injuries • Sports injuries • Injuries due to toys and recreational equipment • Any other injury that was not intended to harm the victim

25. Unintentional Injuries • Among children aged 1-19, unintentional injuries are responsible for more deaths each vear than homicide, suicide, congenital anomalies, cancer, heart disease,respiratoryillness, and HIV combined • Unintentional injuries are the leading cause of death for all children over 1 year of age

26. Unintentional Injuries • One-half of an unintentional injury-related deaths occur inthe 15-19-year-old groupdue to motor vehicle-relatedinjuries. • Common subcategories ot motor vehicle injuriesinclude (1) occupant (drivers and passengers), 1,2) bicycle-related, (3) motorcycle, and (4) pedestrian injuries.

27. Unintentional Injuries for children under 1 years of age • Suffocation is the leading cause of unintentional injury-related death, followed by motor vehicleoccupant injury, choking, drowning, and fires or burns. • Somesuffocation deaths in infants are due to entrapment of thehead and neck in cribs. • Another cause is choking on food oran object, leading to airwav obstruction

28. Unintentional Injuries for children aged 1-4 years • drowning is the leading cause of injury death, followed by motor vehicle occupant injury, fires or burns, andairway obstruction. • Infants often drown in bathtubs, usuallyas a result of poor supervision or neglect • toddlersand young children fall into a body of water such as a swimming pool, lake, or river, usually while unsupervised.

29. Unintentional Injuries for children aged 5-14 years • motor vehicle occupant-related injury isthe leading cause of death, followed by drowning, pedestrianinjury (i.e., motor vehicle collisions with the child), bicycleinjury, and fires or burns

30. Unintentional Injuries for children aged 14-19 years • Motor vehicle occupant injuries are the primary cause of injury-related deaths • Driver inexperience and alcohol use are key contributors to the high rate of fatal crashes in adolescents

31. What are the key approach to reduce Unintentional Injuries? • Prevention! • Education • Changes in the environment and inproducts • Legislationor regulation (35 states – no bicycle helmet law) • Role of pediatric nurses

32. Access to Health Care • Lack of health insurance • The number ofuninsured children has been growing at an alarming rate. • In 1999 11.9 million children (one in seven) under the age of 19 lacked health insurance • Ethnic minority children are overrepresented among the uninsured.

33. Access to Health Care • Those from higher-income families are more likely to have private health insurance (90%) than from lower-income families (40%) • Uninsured children in low-income families experience substantial difficulties in accessing health care • They tend to lack (1) the usual sources of routine and sick care, (2) a primary care provider, and (3)recent visits to health care providers. • Uninsured children are more likely to be underimmunized and to go without needed medical services due to the costs of care

34. Access to Health Care: the Role of Welfare Reform • Between 1995 and 1997, 1.25 millionindividuals lost Medicaid coverage due to welfare-to-work initiatives • Many adult members offamilies were no longer eligible for Medicaid due to reforms, most of the children in these families were and are still eligible for its benefits

35. SCHIP • State Children's Health Insurance Program (SCHIP) as part of the Balanced Budget Act of 1997. • The purpose of SCHIP is to provide health insurance for children through 18 years of age whoare uninsured or ineligible for Medicaid. • More than 40 billion in federal grants will be allocated to states over a 10-year period • More than 3 million children are enrolled in SCHIP • Role of nurses

36. Perspectives on Pediatric Nursing • Family-centered care • Atraumatic care (identifying stressors, minimizing separation of child from caregivers, minimizing or preventing the pain)

37. Roles of Pediatric Nurse Primary Roles • Caregiver • Advocate • Educator • Researcher • Manager/Leader Secondary Roles • CoordinatorCollaboratorCommunicatorConsultant

38. Roles of Pediatric Nurse Differentiated Practice Roles • Clinical Care CoordinatorCare ManagerClinical Nurse Advanced Practice Roles • Nurse Practitioner(PNP) • Clinical Nurse Specialist (CNS) • Case Manager

39. Caregiver • Helping • patient diagnosing/monitoring • administering/ monitoring therapeutic interventions/regimens • monitoring/ensuring the quality of health care practices • organizational and work role competencies • effectively managing rapidly changing situations.

40. Advocate • Informing clients and families of their rights and options as well as theconsequences of those options. • Pediatric nurse advocatesfunction by allowing clients/families to make their owninformed decisions and then supporting those decisions. • Even though advocates do not need to approve the decision,they do need to respect that decision and the right to makethat decision. In fact, advocates shouldn't make decisions fortheir clients, but rather should facilitate decision making.

41. Educator • the nurse must have knowledge of cognitive development • Different ages – different approaches (imitation, repetition, association, trial and error, conditioning, and the development of concepts) • Using of three domains of learning (cognitive, affective and psychomotor)

42. Researcher • Identification of a problem • Different investigative functions for nurses according to ANA • Evidence-based research

43. Manager/Leader • Prioritizing, planning, and organizing comprehensive and accountable nursing care for a group of patients • Differentiation between the care that is important from care that is urgent • Delegating aspects of care • Representing of institution

44. Standards of Care and Standards of Professional Performance • The standards of care is the accepted action expected of an individual of a certain skill or knowledge level • It is considered the minimal level of functioning and what a reasonable and prudent person would do in a similar situation. • Standards is a tool to determine if the care provider was adequate or negligent • Standards are derived from regulatory agencies, nursing practice act, professional nursing organizations, and state or federal laws

45. Test: True or False • Child health care has changed from a disease prevention and health promotion model tostrictly a curative approach. • The fastest growing segment of the homeless population consists of families with children. • Suicide is the leading cause of death for black males 15-24 years of age. • Because Healthy People 2010 emphasizes health promotion and prevention, almost all ofit pertains to nursing.

46. Test: True or False • The reduction in incidence of vaccine-preventable disease is one of the most significantpublic health achievements of the 20th century. • It is more likely that a child will suffer complications from the immunization than fromthe disease. • Among children under one year of age, suffocation is the leading cause of unintentionalinjury-related death. • The focus of pediatric nursing is on the family as well as the child. • Welfare reform is one of the predominant factors that has contributed to the growingnumber of uninsured children.

47. Test: Fill in the blank • The health status of immigrant children can be compromised due to_______ ,_______, _________,__________,_________ and other conditions originating in their country of origin. • The risk of poverty in single-parent households is high for several reasons, including__________, ____________, and ____________.

48. Immigration • Currently 1 in 5 children under age of 18 (14 million) is an immigrant or a member of an immigrant family • State with a large number of immigrants (California, Florida and Texas) • Different policies regarding immigrants (removing eligibility for the most of services) • Illegal status of any family member - fear of an investigation • Issues of health status of immigrant children: intestinal parasites, poor diets, dental problems, tuberculosis, hepatitis A • Continuing stresses during an immigration process – impact to the health

49. Poverty: why the risk to be in poverty higher for single woman household • Low wages for women • Low education • Low levels of child support from fathers

50. Test: Fill in the blank • The most common physical health problems of homeless children include:___________, ___________, ___________, and __________ • The leading health indicators of Healthy People 2010 are______,______,____, _______,______,_______,______,____,_____,_and_______. • A low birth weight infant is considered to weigh less than ____________ at birth.