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Pediatric Nursing and Family Centered Care

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Tami Bland

on 21 January 2014

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Transcript of Pediatric Nursing and Family Centered Care

Tami Bland DNP, CPNP
Pediatric Nursing
(Ball, Bindler, & Cowen, 2010)
Mutually beneficial relationship between patient’s family and health care provider
The family is the child’s primary source of strength and support
The child’s and family’s perspectives and information are important in clinical decision making
Family Centered Care
(Ball, Bindler, & Cowen, 2010)
Family Life Cycle
Framework to categorize family’s progression over time according to defined stages in family life and in response to internal and external (societal) stressors and pressure
Family Development Theory
New Couples
Childbearing
(oldest is 30 mo)
Preschool
Children
School-age
Children
Teenagers
Young
Adult
Launching
Middle-aged
Parents
Retirement
and Old Age
(Ball, Bindler, Children’s Defense Fund, 2012)
Lack of immunizations
Common infectious diseases
Sleep deficits
Vision and hearing deficits
Nutritional deficits
Dental care problems
Injuries
Adolescent pregnancy and sexually transmitted diseases
Mental illness
Educational deficits
Consequences for Children in Poverty
Physical activity
Overweight and obesity
Tobacco and substance use
Sexual behavior
Mental health
Injury and violence
Environmental quality
Immunizations
Access to health care
Terrorism
Health Decisions
Increase in health screens
Oral health
Parenting Skills
Preschool Readiness
Healthy People 2020 Child Health Concerns
In 1998, school enrollment was:
65.1% non-Hispanic white
15.5% Black
13.2% Hispanic
4.6% Asian and Pacific Islander
4.9% of enrollees were foreign-born
In 2008, school enrollment was:
59% non-Hispanic white
18% Hispanic
15% Black
5% Asian
7% of enrollees were foreign-born
The Changing Ethnicity of America’s Children

“The protection, promotion, and optimization of
health and abilities
for children of newborn age through young adulthood. Utilizing a
family-centered care approach
, pediatric nursing includes the
prevention
of illness and injury, the
alleviation
of suffering through the
diagnosis
and
treatment
of the child’s response, and
advocacy
in the care of children and families.”
(American Nurses Association, National Association of Pediatric Nurse Practitioners, and Society of Pediatric Nurses, Pediatric Nursing, 2008, p. xi)
Competencies of Pediatric Nursing
Differences among pediatric population
Family based care
Sensitivity to cultural issues
Effective communication
Safety assurance and injury prevention
Promotion of children’s health
Assessment of needs of children who have chronic conditions
Episodic injuries or illnesses
Economic, social, and political influences an impact on children’s health
Ethical, moral, and legal dilemmas
(American Nurses Association, National Association of Pediatric Nurse
Practitioners, and Society of Pediatric Nurses, Pediatric Nursing, 2008)
(Ball, Bindler, & Cowen, 2010)
The theory supports the idea that health care providers interact with the family in the belief that the child and the parent are equal members in the system.
The family is viewed as its own system functioning based on collaboration in effort to reach a common goal
Family Systems Theory
Family
Sibling
Parent
Child (patient)
Extended Family
Grand-parent
(Ball, Bindler, & Cowen, 2010)
Cultural Influences on Parenting
“The provision of therapeutic care … and the use of interventions that eliminates or minimizes the psychologic and physical distress experienced by patients and their families in the health care system (Wong, n.d.)”
Atraumatic Care
Atraumatic Care
Explanation of reason for procedure, procedure process, and expected pain
No explanation until everything ready for procedure, then brief explanation in simple terms.
Snuggling with comfort object
We may not always be able to reduce the amount of pain our patients experience, but we may be able to alter their perception of the amount of pain they experience.
Communication
All families go through stress
Unexpected stress and poor coping mechanisms lead to family crisis

Stress
Family Stress Theory
“An illness or injury that limits activity, requires medical attention or hospitalization, or results in a chronic condition”
Child Morbidity
Mortality
In 1998, school enrollment was:
65.1% non-Hispanic white
15.5% Black
13.2% Hispanic
4.6% Asian and Pacific Islander
4.9% of enrollees were foreign-born
In 2008, school enrollment was:
59% non-Hispanic white
18% Hispanic
15% Black
5% Asian
7% of enrollees were foreign-born
The Changing Ethnicity of America’s Children
By 2019, the majority of children in the U.S. will be children of color.
More medically fragile kids
More chronic disease
More complex home health functions
More day surgery
More hospice and palliative care
Most pediatric care does (and should) take place in the community, not the hospital.
Health is Not the absence of disease
Dynamic
Positive
Health
Potential
Don’t stop listening!!
Don’t talk too much!
If you ask a question –
WAIT
for the answer!
Interpret parent’s comments – they may be trying to keep child from understanding something.
Avoid analogies and metaphors.
Avoid “scary words”
Never be negative!
No false reassurance!
Never take sides!
Watch for information overload.
No personal or anecdotal advice/answers!
Pitfalls of Communication
Straightforward explanations
Encourage participation by initiating topic unrelated to health
Patience and acceptance of unwillingness to talk
Avoid signs of disapproval or surprise
Confidentiality laws and limits
Provide for private conversation without parents present
Explain everything.
Speak directly to child
Honesty
Encourage expression of thoughts and feelings
Third-person conversations helpful
Parents in infant’s view if possible
Parent’s hold if possible
Higher pitched, soft tone
Eye contact important (if baby turns away, then rest period needed)
Avoid leaning over face, forceful tones
Touch important: Swaddling, rubbing, patting, cuddling, rocking
Use play (i.e. peek-a-boo)
Stranger anxiety around 6-12 months
Acknowledge child
Speak to parent first
Eye level
Simple language
Honesty
Avoid discussing frightening issues in front of child
Toddlers and parallel play
Preschoolers and dramatic and associative play
Opportunity for questions
More time for child to express herself
Choices when possible
Toddler/Preschool
School-aged
Adolescent
Infant
Play -- The Work of Children
Child Life Specialist
The key role of all nursing but especially pediatric nursing is health promotion.Children are FULL of positive health potential!!!
Pediatric Nursing
Change in the family environment
Coping
Strategies
Stress
Resilient families can manage change and stress and may even grow in the process.
Appropriate for 6 year old?
What age child?
Who needs this?
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