paedai rtci nursing in australia principles for...

Paediatric Nursing in Australia: Principles for practice equips students with the essential skills and knowledge to become paediatric, child and youth health nurses across a variety of clinical and community settings. It prepares students for critical thinking and problem-solving within this fi eld by emphasising contemporary issues impacting on the health of children and young people and their families.

Written by a team of experienced paediatric nurses, the content is based on themes that align with Australian standards for practice and expectations of paediatric nursing: communication, family involvement and evidence-based practice. Comprehensive yet concise, the text examines the integration of theoretical and clinical components of nursing knowledge. To enhance learning each chapter features illustrative case studies, refl ection points and learning activities.

An essential resource for nursing students, this text is well grounded in current care delivery and professional issues for care of the child to prepare future nurses for evidence-based practice in paediatric settings throughout Australia.

Additional resources are available online at www.cambridge.edu.au/academic/paediatricnursing .

Paediatric Nursing in Australia

Principles for practice

www.cambridge.org© in this web service Cambridge University Press

Cambridge University Press978-1-107-68500-0 - Paediatric Nursing in Australia: Principles for PracticeJennifer Fraser, Donna Waters, Elizabeth Forster and Nicola BrownFrontmatterMore information

http://www.cambridge.org/9781107685000

http://www.cambridge.org


Principles for practice

Paediatric Nursing in

Australia

Jennifer Fraser Donna Waters

Elizabeth Forster Nicola Brown






477 Williamstown Road, Port Melbourne, VIC 3207, Australia

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Every effort has been make in preparing this book to provide accurate and up-to-date information

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This book is dedicated to our dear friend and mentor, Professor Sue Nagy, an

outstanding nurse educator, infl uential academic and passionate advocate for

children, young people and their families.






Contents Preface xiii

PART 1: THE AUSTRALIAN CONTEXT OF PAEDIATRIC NURSING 1

1 Australia’s children and young people 3 Donna Waters

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Australia’s children and young people . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 The health of Australia’s children and young people . . . . . . . . . . . . . . . . 10 Emerging health priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Applying new knowledge to practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

2 Child rights in Australia 29 Jennifer Fraser and Helen Stasa

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 International legislation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Australian legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Practice implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

3 Psychosocial development and response to illness 49 Jennifer Fraser and Robyn Rosina

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 The psychosocial development of children and young people

experiencing disruptions to health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Trust versus mistrust: Infancy (fi rst year of life) and the sick infant . . . . 51 Autonomy versus shame and doubt: Infancy (second year of life)

and the sick toddler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Initiative versus guilt: Early childhood – the preschool years

(3–5 years). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Industry versus inferiority: Middle and late childhood (infants and

primary school – 6 years to puberty) . . . . . . . . . . . . . . . . . . . . . . . . . . 60

vii






viii CONTENTS

Identity versus identity confusion: Adolescence (10–20 years) . . . . . . . 65 Intimacy versus isolation: Early adulthood (twenties and thirties)

and the sick young adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 4

4 Research in the paediatric setting 77 Donna Waters

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 What is research? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 What is evidence-based practice? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Researching with children and young people . . . . . . . . . . . . . . . . . . . . . 84 Human research and ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Core principles of research ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Research monitoring and participation . . . . . . . . . . . . . . . . . . . . . . . . . . 9 6 Applying new knowledge to practice . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Learning activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

PART 2: EVIDENCE-BASED PAEDIATRIC NURSING CARE 107

5 Recognising and responding to the sick child 109 Elizabeth Forster and Loretta Scaini

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Structured assessment of the paediatric patient . . . . . . . . . . . . . . . . . 111 Recognition of clinical deterioration using a Primary

Assessment Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Paediatric neurological assessment tools . . . . . . . . . . . . . . . . . . . . . . . 125 Responding to the sick child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Parental presence during resuscitation . . . . . . . . . . . . . . . . . . . . . . . . . 133 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Learning activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

6 End-of-life and palliative care in Australian paediatric care settings 141 Elizabeth Forster

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143






CONTENTS ix

Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Dyspnoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Gastrointestinal disturbances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Communication with children and adolescents . . . . . . . . . . . . . . . . . . 153 Communication and the family in paediatric

end-of-life care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

7 Mental health and illness in childhood and adolescence 162 Jennifer Fraser, Lindsay Smith and Julia Taylor

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Mental health problems and mental disorders . . . . . . . . . . . . . . . . . . . 163 What mental disorders affect Australian children? . . . . . . . . . . . . . . . . 165 Attention Defi cit Hyperactivity Disorder . . . . . . . . . . . . . . . . . . . . . . . . 166 Autism Spectrum Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Externalising disorders: Conduct disorders . . . . . . . . . . . . . . . . . . . . . . 171 Risk and protective factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Internalising disorders: Anxiety and depression . . . . . . . . . . . . . . . . . . 17 4 Promoting mental health in children and young people . . . . . . . . . . . . 176 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Learning activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

8 Evidence-based nursing assessments and interventions: The acutely ill child 189 Nicola Brown

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Fever in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Dehydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Gastroenteritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Intravenous therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Acute otitis media (AOM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Pain assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Acute respiratory illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207






9 Evidence-based nursing assessments and interventions: The acutely ill young person 212 Nicola Brown

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Key issues for young people during hospitalisation . . . . . . . . . . . . . . . 213 Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Abdominal pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Preoperative care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 Postoperative care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Alcohol poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

10 Evidence-based nursing assessments and interventions: The child and young person with a chronic illness 229 Donna Waters and Helen Stasa

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Chronic conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Congenital, chromosomal and genetic disorders . . . . . . . . . . . . . . . . . 241 Transition to adult care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

11 Evidence-based nursing assessments and interventions: The family 259 Ibi Patane and Elizabeth Forster

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Families in contemporary Australian society . . . . . . . . . . . . . . . . . . . . . 259 Family Partnership Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Family-centred care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Family assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4 Learning activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

12 Evidence-based care of children with complex medical needs 279 Nicola Brown

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Types of conditions associated with complex medical needs . . . . . . . 280

x CONTENTS






Families and children with complex medical needs . . . . . . . . . . . . . . . 283 Nursing assessment and interventions . . . . . . . . . . . . . . . . . . . . . . . . . 286 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 Learning activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291

Index 295

CONTENTS xi






Preface I am delighted to have the opportunity to present the fi rst edition of an

Australian paediatric nursing text, Paediatric Nursing in Australia: Principles

for practice. As its title indicates, the aim is to provide a valuable primary re-

source for paediatric nurses and students of nursing who are working in pae-

diatric settings across Australia. With its strong Australian focus, the book

integrates key elements of paediatric nursing practice, communication, family

involvement and evidence-based practice throughout each of two parts. Part 1

sets the context within which paediatric nurses and students of nursing can ex-

pect to practise in Australia. Child health, child illness and child injury within

Australian communities are presented from an epidemiological perspective.

This includes details of national health trends for children and young people

in Australia, and provides comparisons with international trends. Part 2 shifts

the focus to become more specifi c about the paediatric nurse’s role, including

nursing assessment, nursing care and nursing interventions in paediatric set-

tings. Each chapter provides at least one case study to encourage refl ection and

critical analysis of practice. Engagement of crucial concepts into paediatric

nursing practice is anticipated by using this approach.

Part 1, The Australian Context of Paediatric Nursing, comprises four chap-

ters. Chapter 1 sets the context of health and illness in Australia for children up

to age 18. Future challenges for Australia as a healthy nation – such as childhood

overweight and obesity – are analysed. Chapter 3 builds on this to examine the

basis for understanding the way in which children and young people’s rights –

including the right to be protected from all forms of violence and neglect – are

upheld in Australia, and in particular within the health-care system. In Chapter 3 ,

attention is given to the responses of children, young people and their families to

experiences of illness – both acute and chronic. Cultural practices and their poten-

tial implications for care provided to children, young people and their families are

considered. In particular, the ways in which Aboriginal and Torres Strait Islander

children experience the health-care system are explored, and extra reading in this

topic is recommended. Chapter 4 is dedicated to the conduct of research within

the paediatric setting and the implementation of evidence-based interventions.

Part 2, Evidence-based Paediatric Nursing Care, consists of eight chapters.

This part is more specifi c about the paediatric nurse’s role, including nursing

assessment, nursing care and nursing interventions in paediatric settings.

xiii






xiv PREFACE

For the cover of this book, we have chosen a beautiful work designed by

Robert Ingpen, whose body of illustrative and fi ne art work has been acknowl-

edged through the Hans Christian Andersen Award for children’s book illus-

tration in 1986 and an honorary doctorate from RMIT in 2005. He was made

a member of the Order of Australia in 2007. ‘The Games Children Play’ was

commissioned by the Royal Children’s Hospital Foundation, Melbourne as a

tribute to Dame Elisabeth Murdoch’s 75-year relationship with the hospital.

This gorgeous tapestry was woven by three Royal Children’s Hospital weavers:

Sue Batten, John Dicks and Emma Sulzer, in 2009, and can be viewed at the

Royal Children’s Hospital, where it is displayed for all to enjoy.

I am most grateful to my co-authors, Donna Waters, Elizabeth Forster and

Nikki Brown, and thank them for their hard work, vision and commitment to

making this book such a potentially valuable contribution to the fi eld. Their

wealth of practice experience in paediatric nursing settings across a range of

Australian contexts, ongoing research and leadership in teaching have com-

bined to create a relevant and creative text. We are indebted to the team of en-

thusiastic contributing authors whose specialist expertise is highly regarded.

These contributions should not be overlooked in a text such as this. We thank

Helen Stasa, Robyn Rosina, Lindsay Smith, Julia Taylor, Loretta Scaini and Ibi

Patane very much for their time and outstanding effort.

Jennifer Fraser






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