PAEDIATRICS AND PAEDIATRIC NURSING

By Benkele R. G.

BScN., PaedN., RN., EN.

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1. HISTORICAL DEVELOPMENT OF PAEDIATRIC NURSING

By Benkele R. G.

BScN., PaedN., RN., EN.

2

Introduction

• Colonial America children were born into a world with many hazards to their heath and survival.

• Physicians were few; midwives were untrained

• Books that provided information on childcare and feeding were scarce

• Only available to a minority of literate parents.

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Introduction, cont….

• Native American children were treated for diseases according tradition of each tribe - mixture of medicine, magic and religion.

• Epidemic diseases included smallpox, measles, mumps, chickenpox, Influenza diphtheria, TB, yellow fever, cholera, whooping cough and dysentery.

• Dysentery surpassed all others as causes of childhood death.

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Introduction, cont….

• Consequences of childhood illness, injury and effects of child labor, poverty and neglect – widely recognized during the industrial revolution in the 19th Century.

• The end of 19th Century is often regarded as the ‘Dark’ Ages Of Pediatrics.

• The 1st half of the 20th Century is regarded as the ‘Dawn’ Of Improved Healthcare For Children (Cone, 1976).

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Study of Paediatrics

• Began in the last half of 1800s under the influence of Prussian born physician - Abraham Jacobi (1830-1919) referred as The Father of Paediatrics

• With other physicians, he pioneered in the scientific and clinical investigation of childhood diseases.

• One outstanding achievement was the establishment of “milk stations”

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Study of Paediatrics, cont…..

• Mothers could bring sick children for treatment and learn the importance of pure milk and its proper preparation.

• The crusade for pure milk helped bring the dairy industry under legal control.

• The decline in infant mortality since 1900 was achieved through prevention and health promotion measures – improved sanitation and pasteurization of milk.

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Study of Paediatrics, cont…..

• Before these regulations; unsanitary milk supply was a chief source of infantile diarrhea and bovine tuberculosis.

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Social Welfare of Children

• Lillian Wald (1867-1940) a social reformer founded the Henry – street settlement in New York City - The ‘Founder’ of Public Health or Community Nursing.

• Nursing services, social work and an organized programs of social, cultural and educational activities were being provided.

• As causes of diseases were identified, emphasis on isolation and asepsis occurred.

• In 1900s children with contagious diseases were isolated from adult patients.

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Social Welfare of Children, cont……

• Parents were prohibited from visiting because they might transmit diseases to and from home

• Even toys and personal articles of clothing were kept from the child.

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Isolation and Asepsis

• Spits and Roberson in (1940) identified the effects of isolation and maternal deprivation

• This brought a surge of interest in psychological health of children

• Resulted in changes for hospitalized children, such as rooming in, sibling visitation, child life (play) programs such as pre-hospitalization preparation, parent education and hospital schooling.

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Improvement of children’s living conditions

• In 1909 President Roosevelt called the 1st White House conference on children.

• The conference addressed the deplorable working condition of youngsters under care of dependant children in 1912.

• The US Children Bureau was established as a result of this conference.

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Improvement of children’s living conditions, cont.....

• Studies of economics and social factors i.e infant mortality, maternal death and maternal and infant care stimulated the creation of better standards of care for mothers and children and led to the 1st maternity and infants Act.

• The Act provided grants to states to develop a division of maternal department and influenced creation of the American Academy of Pediatrics (AAP).

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Landmarks in development of child health nursing (Paediatric Nursing)

• 1771- New York hospital, one of the 1st Teaching Hospitals in USA provided classroom presentations designed for nurses.

• 1851-The Hospitals for sick children was founded in London.

• 1855- One of the earliest known Paediatric Textbook “How to Nurse Sick Children” was published.

• 1855 – The Children’s Hospital of Philadelphia, USA, was founded

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Landmarks in development of child health nursing (Paediatric Nursing), cont……

• 1860 – Florence Nightingale opened her first school of nursing connected with St. Thomas Hospital in London.

• 1880 – Children Hospital Training School in San Francisco offered formal classes to educate nurses in the care of ill-children.

• During this period the role of the nurse was that of a childcare taker.

• Nurses were responsible for maintaining nutrition, hygiene and hydration.

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Landmarks in development of child health nursing (Paediatric Nursing), cont……

• They played a major role in controlling the spread of communicable disease by observing sanitary measures.

• Nursing care like the medical practice it supported, was curative rather than preventive.

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Social influences on nursing

• 1886 – Nurses practiced in home without direct physician supervision.

• 1893 – Lilian Wald opened the Henry Street settlement house, which provided medical social, cultural and education services to the poor.

• 1896 – Nurses’ Association Alumni of the United States and Canada was founded; later it became the American Nurses’ Association

• 1903-Recognition of nurses was initiated.04/08/23 17

Social influences on nursing, cont…….

• 1912 – Us Children Bureau which oversees children’s health and environment was established.

• 1970’s – Health became a more comprehensive concept than suggested by the traditional definition, which indicated merely the absence of diseases.

• Nurses began to view children holistically-i.e. in relation to their biophysical, cognitive, affective and social needs.

• Nursing process cleave was developed.04/08/23 18

Social influences on nursing, cont…….

• Nurses developed their roles as child advocates ensuring the highest quality of health care for children.

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QUESTIONS?

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Evolution of Child Health Nursing in Zambia

• The vision to have a specialized course for nurses caring for sick children has began

• There are handful of nurses who have been trained outside the country

• Their registration in Zambia costs K1,000,000 currently

• The impact of these nurses on the care of sick children has been negligible

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Evolution of Child Health Nursing in Zambia, Cont…………………………

• They are not very sure about its history in Zambia – no available documents

• Efforts have started to write the Evolution of Child Health Nursing in Zambia

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QUESTIONS?

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Current barriers to health care services that remain:

• Financial barriers- e.g. Inability to pay for services.

• Systems barriers- e.g. Having to travel great distances for healthcare.

• Knowledge barriers- e.g. Lack of use and understanding of the need for parental or child health supervision.

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Future Trends

• Shift in focus from treatment of disease to promotion of health will expand the nurses role in ambulatory care, with prevention and health teaching receiving a major emphasis.

• Technologic advances related to patient care as well as knowledge in computer in the work setting.

• Changing demographics and their impact to paediatric nursing

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Qualities of a good Paediatric Nurse

• 1.   Good observer.

• 2.    Honest and truthful.

• 3.    Sympathetic, kind, patient and cheerful.

• 4.    Love to work with children.

• 5.    Interested in family care.

• 6.    Able to provide teaching to children and their families.

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Roles of a Paediatric Nurse

1. Therapeutic Relationship- to relate meaningfully to the children and their families and yet separate enough to distinguish their own feelings and needs.

2. Family Advocacy - the nurse must work with family members, identify their goals and needs and plan interventions that best meet the defined problems - assists to make informed choices

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Roles of a Paediatric Nurse, cont........

3. Health Teaching - involves transmitting information at the child’s and family’s level of understanding and desire for information - appropriate health teaching with generous feedback and evaluation to promote learning.

4. Support /Counselling

support -by listening, touching, physical presence- most helpful with children because they facilitate non-verbal communication

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Roles of a Paediatric Nurse, cont........

counselling- mutual exchange of ideas and opinions that provide the basis for mutual problem solving. Also enables the family to attain higher level of functioning, greater self esteem and closer relationships.

5. Restorative Role - most basic of the nurse’s role. Meeting the physical and emotional needs of the patients, continual assessment and evaluation of physical status. The nurse must be aware of normal findings in order to intelligently identify and document deviations

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Roles of a Paediatric Nurse, cont........

6. Coordination and Collaboration - as a member of the health care team, the nurse coordinates and collaborates nursing services with the activities of other professionals - multi-disciplinary team (MDT) approach

7. Ethical Decision Making - ethical dilemmas arise when competing moral considerations underline various alternatives.

may include; autonomy, nonmaleficence, beneficence and justice.

The nurse’s role as a member of the health care team is to participate in ethical decision making.

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Roles of a Paediatric Nurse, cont........

8. Research - Current emphasis on measurable outcomes to determine the efficacy of interventions – Evidence Based Practice (EBP). Nurses must constantly question why something is effective or not.

9. Health Care Planning - Nurses must incorporate a political component into their professional role identity and must also affect the decision-making body of government.

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Roles of a Paediatric Nurse, cont........

Knowledge and awareness of community needs, an interest in government formulation bills, support of politicians to ensure passage of (or rejection) of significant legislation and active involvement in groups dedicated to the welfare of children

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QUESTIONS?

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REFERENCES

• Wong D. L., Hockenberry, M. J., Wilson, D., Winklstein, M. L. and Kline, N. E. (2003). Wong’s nursing care of infants and children, (7th ed.), St Louis: Mosby.

• Hockenberry M. J., Wilson D., & Winkelstein M. L. (2005). Wong’s essentials of pediatric nursing, (7th ed.), St Louis: Mosby.

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