Family Centered care (legal/ethical variations assessment of the family maltreatment )

What are 3 basic components of pediatric nursing?

Providung care by:

- Focus on family centered care

- Provide atraumatic care

- Use evidence based practice

The child receives the highest quality care when healthcare providers work with the______ and _____.

parents and family

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* Must respect parents views

* Address concerns

* Regard parents as important participants in child's health

*Always take parents concerns seriously

The family into which a child is born greatly influences his/her development and health. What are different considerations?

- Child and parent temperament

- Family Structure (structure ex: nuclear; special family situations

- Lifestyle choices (inactivity, ETOH/drugs)

- Socioeconomic status (poverty greatly increases risk of poorer child health)

- Nutrition

- Environmental exposure (air pollution, smoke, water contaminants)

- Access to healthcare (insurance, transportation, location, sociocultural barriers etc..)

- Culture

- Community connections/support

- Spirituality

What are the 4 different types of parental roles/styles?

- Authoritarian

- Authoritative

- Permissive

- Uninvolved

What is authoritarian parenting?

- Expects obedience and discourages child questioning family rules

- Low support- high control

- Child has little to no decision making

- "my way or the high way"

What is authoritative parenting?

- Expects child to adhere to rules

- Respects for child's opinions

- Promotes individualization

- "open, democratic"

What is permissive parenting?

- Little control over child's behavior

- Inconsistent, unclear rules

- Little discipline

- "laid back parenting"

What is uninvolved parenting?

Basic needs are not met

Family center care includes assessing for discipline and how parents punish their children. What is discipline and punishment?

Discipline- increasing desirable behaviors and decreasing undesirable:

- Positive reinforcement... "time- in"

- Extinction ... "time-out," ignoring

Punishment- negative or unpleasant experience

- Verbal- scolding, disapproving statements

- Nonverbal- spanking

What are recommendations for discipline?

- Clear, consistent expectations

- Avoid spanking (not effective)

- Role model desired behavior

- GIVE ATTENTION and praise desired behavior

- Provide consequence of (positive or negative) behavior immediately

Pediatric nursing legal/ethical considerations includes rules of consent. What does this include?

Generally consent gained from individuals over the age of majority (over 18)

What criteria does a patient need to meet to give informed consent?

- Legal age and competent

- Voluntary

- Fully understood

If a patient under the age of 18 is emancipated, then they are able to give consent. What are some examples of this?

- In armed service

- Married

- Court appointed

- Financially independent and lives without parents support

- College attendance

- Pregnancy

- Mother younger than 18

- Runaway

What is mature minor doctrine?

If a child has sufficient maturity to understand the nature, purpose and risks of a medical procedure, parental consent might not be necessary (or is not necessary)

-

Health care providers ultimately decides

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Mature minor can receive confidential/consent to services related to:

- Pregnancy

- Prenatal care

- Contraceptives

- STI treatment

- Substance abuse

- Mental illness

What is assent/dissent?

Child's participation in decision making related to research and treatment

-

Child's opinion should be listened to and used in plan of care

-

age depends on child's maturity, developmental level

Family centered care includes assessing for maltreatment. What kind of violence do you assess for?

Assess for violence in and around home:

- Suicide

- Violence in community

- School violence (frequent absence; headaches, stomach aches)

- Violence in home

What are questions you can ask the child and parents to assess for violence?

Children questions:

- "Do you feel afraid in your home?"

- "What happens to you when you get in trouble?"

Parent:

- "Do you feel afraid in your home?"

- "How do you discipline your children?"

What are different forms of maltreatment?

- Physical

- Sexual (ANY sexual behavior toward a minor)

- Emotional

- Neglect (Physical and emotional, Most common type of abuse)

What are warning signs of maltreatment?

- Physical evidence - bruises

- *History incompatible with injury*

- Vague explanations

- Multiple fracture in different stages of healing and/or other injuries

- Delay in seeking care

- Caregiver reports

What are parental characteristics that are associated with maltreatment of children?

- Young, single, isolated parents

- Low income and lack of education

- Low self esteem

- Substance abuse

- History of being abused

What are characteristics of children that tend to be maltreatment?

- Infants, especially premature or requiring special care

- Unwanted children

- Hyperactive children

What are environmental characteristics that tend to be associated with maltreatment of children?

Chronic stress

-

Divorce, low support, addiction, poverty, inadequate housing/food

What are common assessment findings associated with maltreatment?

Physical neglect:

- FTT; lack of hygiene; frequent injuries; dull affect; self stimulating

Physical abuse:

- Bruises, welts, fractures in different stages of healing; aggression, lack of emotion

Emotional neglect/abuse:

- FTT, enuresis, sleep disturbances, self stimulating, delayed development

Sexual:

- Lacerations around mouth, genital area, anus

STI; UTI

Regressive behaviors; Personality changes

What are maltreatment assessment findings particular to infants?

- Bruising

- Fractures

- Shaken baby syndrome/shaken impact syndrome

* Vomiting, poor feeding, bulging fontanel, retinal hemorrhages, seizures, apnea, bradycardia

What are ways to diagnose maltreatment?

Diagnostic procedures:

* X-ray

* CT/MRI

* Ophthalmology consult

What does nursing care include for a maltreated pediatric patient?

- Identify and report abuse early

- Priority is to keep child safe

- Document clearly and objectively

- Photograph injuries

- Provide support for child and family

What is Munchausen Syndrome by Proxy? What are the signs and symptoms?

Type of abuse

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Parent (often healthcare provider) creates symptoms of illness

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Adult meeting his/her psychological need by having ill child

-

S/S:

- 1 or more illness that doesn't respond to treatment

- Symptoms that don't make sense or disappear when parent not present (separation test)

- Physical/lab findings that do not correlate with history

- Repeated hospitalization