current principles, practices and trends in pediatric

CURRENT PRINCIPLES, PRACTICES AND TRENDS IN PEDIATRIC NURSIG

MISS GNANA JYOTHIMSC (N) II YEAR

PEDIATRICS“Pediatrics is the speciality of medical science concerned with physical, mental and social health of children from

birth to young adulthood”

Pediatrics – derived from Greek word pais / paisons -childiatreia -cureics -subject of science

Pediatric nursing

“ Pediatric nursing is the practice of nursing involved in the health care of children from infancy through adolescence”.

-Terrikyle & Susan

EVOLUTION OF PEDIATIRCS

Ancient and medieval medical writings

• Hippocrates wrote a small treatise onOn “dentition” on the subject of teeth & noted how children differ from adults in various ways inhis “Aphorisms”

Soranus of Ephesus• detailed history of childhood diseases• explanations include feed, Bathe, swaddle an

infant• described finger nail test for breast milk

quality

• Galen (200 A.D) wrote of ear discharge, pneumonia, and intestinal prolapse and described a disorder that corresponds to rickets.

787 AD, Arch Bishop Dathers --one of th first foundling asylums at Milan

Avicenna (990 AD)–Arabian physician discussed tetanus, worms, convulsions,

meningitis & umbilical abscess.

Rhazes (Baghdad) –wrote an entire treatise on children.

RENAISSANCE MEDICAL WRITINGSFirst medical book –printed Pediatric treatise by italian Paolo Bagellardo

Thomas Phaer (1594) – first english language work on pediatrics called – “the book of children”

-dentition, teething, crying, fever, cramps, palsies

-advocated washing the child in camomolie

Hieronymus ( 1583) wrote- “de morbus pusorium “

Thomas sydenham (1624-1689)-english hippocrates wrote on

-scarlet fever-measles-small pox-epilepsy-rickets-teething fever-scorbutus(scurvy)-chorea(st.vitus dance)

Edward Jenner (1749-1823)-Invented small pox vaccine

Dr . Eli Ives (1813-1852) – gave lectures to medical students at Yale – about diseases in children.

British physician – William buchan noted that one half of the human race dies in

infancy

Theophile Rouseel (1816-1903) –French physician and politician

set laws that protected infants , abused and abandoned children.

Two of the first text books in pediatrics were published in 1825.

“Treatise on the physical & medical treatment”-Dr, William Potts

Dewees“Practical observations on diseases of children”

-Dr.George Logan

First pediatric hospital – 1802 “Hospital de enfants malades” ( French) called “Hospital for sick children”• Opened in Paris

Dr. Elizabeth Blackwell –first woman To graduate –US medical school

America’s first children hospital-“Children’s Hospital Of

Philadelphia” (1854)

Louis Pasteur (1862) –Pasteurization

New York Medical College starts a regular professorship for the diseases of children in 1860.

Dr. Abraham Jacobi – Starts “American Journal Of Obstetrics And Diseases”

Dr.Mary Putnam Jacobi –first women member of the “Academy Of Medicine”

The first issue of the “Archives Of Pediatrics” was published in 1884

American Pediatric Society (1888) –Dr.Job Lewis Smith With Dr.Abraham Jacobi

Dr. Thomas Morgan Rotch –Americas first professor of pediatrics at Harvard Medical School in 1893

Dr. Dorothy Reed Mendenhall –first to recognize Hodgkins disease was a blood cell disorder and

not a form of tuberculosis

Sir Alexander Flemming - PencillinJonas Salk (1914-1995) & Albert Sabin(1906 -1993) -Polio

Sir Edward Mellanby –Discovers Cod Liver Oil Can Treat Rickets

Dr. Emily Patridge Bacon – first pediatric specialist in Philadelphia.-introduced “well baby clinics”

Dr. J.P.Crozier – publishes “The Diseases of Infants& Children”which later became

“The Nelson’s Pediatric’s Text book”

June 23, 1930 –American Academy of Pediatrics was formed at Detroit (Michigan)

Dr. Charles Bradley – described the use of benzedrine in children with behavioral problems(1937)

Dr.Dorothy Hansine Anderson (1938)- first to recognize Cystic Fibrosis

Hattie Elizabeth Alexander , M.D- developed a treatment for Hib Meningitis.

Dr. William E.Ladd & Robert E.Gross (1941)published pediatric surgery textbook “Abdominal Surgery Of Infancy & Childhood”

Dr.Norman M.Gregg(1941) reports on congenital rubella

Dr. Helen Taussig And Dr. Alfred Blalock (1943)developed a palliative surgical treatments for babies with Tetrology Of Fallot

Dr.R.L. Jackson & Mrs. H.G. Kelly (1994)published growth charts

First military pediatrics residency program –Boston’s Chelsa Naval Base (1946)

First issue of pediatrics :“JOURNAL OF AMERICAN ACADEMY OF PEDIATRICS” (1948)

PEDIATRICS IN INDIA

Ayurveda – description of maternal and child health.

Sushrutha – “Sushrutha Samhita” Atharva Veda – Childrens DiseasesKashyapa &Jeevaka :Pediatricians –Ancient

IndiaCharaka – Case Management Of New BornKaumarabritya & Panchatantra- Prenatal Care

The history can be studied as : Academics Pediatric – Indian Pioneers Indian Academy Of Pediatrics Change Of Spectrum Of Illness Demographic Trends National Programs

Evolution Of Pediatric Nursing In Relationship To Child Health

Past centuries – • health was poorer• Crowded living conditions• Inadequate unsanitary food• Harsh working conditions• Increased mortality & morbidity rates

Over the years……• Focused attention on the health of the children• 1900s- Lilian Wald (NY)-public health nursing• Pediatric nursing-teachers college of columbia

university• Improved nutrition, sanitation, medicine• Changes in the health care delivery system• 1980-division of maternal-child health (N) practice

HISTORICAL BACKGROUND ON THE CARE OF CHILD

Child in primitive societies -NOMADS

Child in ancient civilizationsEGYPT• Settled in the valley of Nile • Dressed infants in loose clothes• Breast feeding

Greece & RomePhysical Beauty –GreeceStrong Sons (Good Warriors)- Rome

• Ancient jews- hygienic measures• Hebrews –cleanliness & circumcision

- large family – a sign of Gods blessing

Impact of Christianity on child care:• Value of child as a son and daughter• Protection of the weak by the strong and care

of the ill by the well.

The Child In Europe• Great epidemics• Young men died in war• Women married early- large families• Maternal death rate was high• Orphaned children• Infants- boarding homes or baby

farms• Asylums -787 AD• No Principles of sanitation, housing,

nutrition• Accidents were common

The child in the United States• Early 20th century – children lived

on farms• Lack of medical care• 19th century - large slums (NY)• Over –crowded, unsanitary

conditions• Accidents were common• Contaminated milk- intestinal

disorders• Dairies, stores- not inspected• Milk from tuberculous cows• Mortality & morbidity rates –

increased

The child in developing countriesInternational activities • WHO• UNICEF

WHO (1948):Geneva, switzerlandObjectives:• Directs & co-ordinates health work• Collaboration with governments• Evaluates a country’s health problems• Eradicate diseases & prevent injuries• Promotes nutrition, housing,

sanitation, env. Hygiene• MCH welfare• Promotes mental health

UNICEF (1946):• Meet the emergency needs of

children• is financed by voluntary

contributions from govts, groups, & individuals

• In USA, children volunteer – by“halloween”

• Sales of calenders, christmas cards,fund medicines & food

FACTORS INFLUENCING THE CARE OF CHILD

It includes : Societal factors Professional factors

Societal factors

• Attitude towards children• Poor & deprived families• Consumerism• The women’s movement• Health care : changes & advances

Attitude towards children:

Infanticide, neglect, abuse -persist

Poor & deprived families:Insufficient financial resourcesMisconception – govt provides –minority

groups- metrosBread winner unemployed

Consumerism ;Consumers are vocalAssertive in making decisions

Women’s movement:Mother’s work on a part-time basis or full time Mother’s take the responsibilityFamily – centered care

Health care : changes& advances:• Concept of health & illness –changing• Holistic view of health• High – level wellness• Self care movement• Advances and changes in medical care

Professional factors• The process of professionalization• Expansion of the nurses role• Nurse practice acts• Professional organizations

Principles Of Pediatrics

1.Respect the child’s need to regress & help him to accept dependence on others if he resists this

2.Have an awareness of the child’s need for help in reconquering the negative counterpart of the core problem in the stages of development to which he has regressed.

3.Protect the child-family inter -relationships

4.Awareness of the feelings of others and readiness to respond to them so as to strengthen their resources to cope up with stress is the major principle underlying effective emotional support

5.Children can tolerate discomfort if they are prepared for it, comprehend its real purpose and are adequately prepared.

6.To child, play is not time out from daily living, but rather an essential part of it that enables him grow & mature through the various stages of the development.

HEALTH CARE DELIVERY SETTINGS

It includesClinics & officesHome careParish nursingOther setting

CLINICS

• Well organized out patient facilities• Information is distributed & education is

offered on childhood immunizations• Specialty clinics• School based health centers

HOME CARE

• Lower cost & patient satisfaction• IV therapy , phototherapy

PARISH NURSING

• Health promotion• Health maintenance• Illness prevention• Community services• Support groups

OTHER SETTING

Local and national groupscamps

CURRENT PRACTICE

It involvesEducational requirementsResearch and rolesCritical thinking & nursing processDocumentationConfidentiality & informed consent

Educational requirements• Update the knowledge• Accountability – important• Responsibility to community

Research & rolesResearch– Evidence – based practice

Roles– Health promotion & anticipatory guidance– Advocating– Holistic attitude– Ethical decision making

Critical Thinking & Nursing ProcessCritical thinking – systemic, expanded way of

thinkingNursing process –

Documentation • Data collection• Assessment findings• Patient care needs • Interventions• Specific time ( legally important)• Discharge needs• Law- “ if something was not charted – not

done”

Confidentiality & Informed Consent• HIPAA ( Health Insurance Portability &

Accountability Act) regulations• Should not share information• Patient records – carefully monitored• Should not give private information –

telephone callers

TRENDS IN PEDIATRIC NURSING

It includes

• Family centered care• High technology care• EBP• Primary nursing• Case management• Child oriented environment• Atraumatic care• Cost- containment• Nursing process application• Ethics• Rights of children• others

Family centered care• Positive environment for family members • Guide in unknown new experiences• Enhance the strength & competence• Basic components

-enabling ( opportunities)-empowerment ( interaction)

• Incorporate into policies & practice- cultural div.• Recognize & respect diff. methods of coping• Family- family networking

High technology care• Advancement in medical field• Diagnostic technology

High technology includes• Controversial fetal surgeries• Fetal blood transfusions• MTP• Cloning• IVF• Female feticide

Emerging technologies1. Genetics & genomicsDiseases could be treated by genetic

element

• 2.less invasive & more accurate tools for diag.Home phototherapy

Influenza A&B detecting device

Wart cryotweezers

Shot blocker

Cerumen remover

Sensicardiac

Da vinci robotic surgery

3D printing

Others -robotics-biometrics-EHR

Evidence based practice

• CPG’S & patient centered multidmensional multidisciplinary plans of care

Primary nursing• 24 hour responsibility & accountability-one

nurse• When primary nurse is not working, an

associate nurse will maintain

Case management

• Extension of primary nursing

• Out – patient setting• A case manager – a

patient or a group of patients

Child oriented environment

• Child- friendly env. – hospital• Hospitalization – disrupts routines• Skilled staff• Liberal visiting hours• Families – receive information

Atraumatic care

• Provision of therapeutic care- minimize physical & psychological distress

• Therapeutic care-PREVENTION-DIAGNOSIS-TREATMENT -PALLIATION

SUGGESTED INTERVENTIONS• Parent –child relationship

(hosp.)• Prepare the child before any

procedure• Control pain• Child privacy• Play• Minimize loss of control• Respect cultural & religious

differences

Cost containment

• It is a management technique utilized to reduce the cost of hospitalization

• Multi- disciplinary approach• Enabling & empowerment

Nursing Process Application

Ethics In Pediatric Nursing

• In nursing practiceNon-maleficence-do no harmBeneficence – do goodJustice Respect for autonomyTruth telling

• Related to research1.Informed consentLegal age -18 yrs2.Conceptual issues e.g., reusing life saving care for religious

practices3.Beneficience 4.Truth telling5.Confidentiality6.Conflicts of interest

Children’s rights• History of children’s human rightsNatural rightsFOUNDLING HOSP (1741)LONDON – education

& maintenance of exposed & deserted young children

THOMAS SPENCE (Political radical) – rights of children -1796

Social reformIndustrial revolution – children worked in factories, coal

minesCharles Dickens (Oliver Twist)- wrote of the terrible

conditionsFactories act -19th century (< 9yrs not allowed)Mary carpenter - neglected children

USA -----children rights movement ---orphan train

National child labor committee---abolition of child labor

National child labor law(1924)----- congress constitutional amendment

Franklin D Roosevelt (1938)---signed Fair Lbor standards.

Janusz korczak (polish educationalist): ----”How to love a child”---- later entitled---THE CHILD’S RIGHTS TO RESPECT.

DECLARATION OF THE RIGHTS OF THE CHILD.

1959---United Nations General Assembly adopted an expanded version as…whose provisions are,

• Protection rights• Provision rights• Participation rights


• Protection rights: against maltreatment neglect & all forms of exploitation.


• Provision rights: right to food, health care, education and benefit from social security.


• Participation rights: right to act in certain circumstances and the right to be involved in decision making.

INDIAN CONSTITUTION

• Article 24---prohibits employment of children in factories under age 14.

• Article 39---prevents abuse of children of tender age.

• Article 45---provides for free and compulsory education ---till they complete age 14 yrs.

UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD

• Right to develop in an atmosphere of affection and security, and wherever possible, in the care and under the responsibility of his/her parents.


• Right to enjoy the benefits of social security, including nutrition, housing and medical care.


• Right to free education


• Right to full opportunity for play and recreation.


• Right to a name and nationality.


• Right to special care, if handicapped.


• Right to be among the first to service protection and relief in times of disaster.


• Right to learn to be a useful member of society and to develop in a healthy and normal manner and in conditions of freedom and dignity.


• Right to be brought up in spirit of understanding, tolerance, friendship among the people, peace and universal brotherhood.


• Right to enjoy these rights, regardless of race, colour, sex, religion, national or social origin.

Other trends

• KMC• Rooming- in concept• Child – to –child

program•

1.Kangaroo mother care

• First presented by Rey & Martinez in Bogota, Columbia.

• Care of preterm infants carried skin-to-skin with the mother.

• Promote health and well-being of infants born preterm as well as full term.

Kangaroo mother care

Key features:• Early, continuous and prolonged skin-to-skin

contact• Exclusive breast feeding• initiated in hospital and continued at home

2.Rooming-in-concept• Placing of the newborn in the same room as

the mother - early post-partum period, to foster maternal-fetal bonding and facilitate breast feeding.

2.Rooming-in-concept

Benefits of rooming-in:• Cry less and remain calm• Mothers get rest• Ability to respond to baby’s feeding cues

3.Child-to-Child Program

• David Morley & Dr. Hugh Hawes ----conceived the idea ----children working with other children to bring change(1978).

• First major child-to-child project---”Little Teacher Program” ---Botswana.

EVOLUTION OF CHILD HEALTH

• Government programs• Change in mortality and morbidity.• Insurance• Health promotion• Emergency preparedness• Current practice• Cultural and religious considerations• Complementary and alternative medicine.