ch 1-4

historical nursing care

- preventing spread of disease

- no parents allowed

- no emotional or psychological care

- CHOP: founded in 1855, 1st childrens hospital, pnps were 1st nps

healthy people 2030

• Decrease infant mortality

• Increase breastfeeding, vaccinations <2yo, sufficient sleep, medical home model care, trauma informed care

social determinants of health

- access to hc and education

- financial resources

- discrimination

- physical environment

- increase in bi/multi racial kids

- 50% white, 25% hispanic, 13% black

- children of color=poor outcomes

fx that affect health outcomes

- homeless children: insecurity and lack of safety, lack of nutrition leads to altered growth and dev

- racial effect: cultural background have risks for certain illnesses and chronic diseases

models of care

- family centered care

- relationship based care: building relationship w child and family, open communication

- pediatric medical home: model of care, all disciplines come together, comprehensive care

role of peds nurse

- developmentally appropriate and culturally sensitive care

- physiologic differences from adults

- recognize integral role of family

certification/training

- nrp: neonatal resucitation program

- pals

- stable: how to stabilize infants and newborns

- sane: sexual abuse nurse examiner

issues in peds nursing

- ethical research: not ethical to do research on children

- chronically ill: increases due to medical advantages, continuity of care, safety, education

- increased dx of many conditions: autism, mental health, adult diseases

ana code of ethics

- values and moral standards that guide nursing practice

- foundation and source of guidance and empowerment

- professional boundaries must be respected but can be difficult to define

what are therapeutic relationships guided by

- care

- compassion

- competence

- communication

- courage

- commitment

- mutual respect and trust

- empathy

- advocacy

- pt vulnerability

what is family centered care

- promotes partnership between pt, family and hcp

- involvement of family crucial to good outcomes

- decreases stress

- improves sleep and nutrition

- decreased medical error

what is a family life specialist

- key in family centered care

- promote effective coping

- promote ongoing dev

- provide normalization for children and families

- art and music therapy

developmentally appropriate care

- not small adults

- still developing

- education must be accurate, useful, and tailored to child

- assess understanding and retention

- active learners: touch and do, vidoes, dolls, pics

- provide privacy and confidentiality: get away from parent

- limitations and legal exceptions

- best interest of the child

- involve child and family in decision making process

- consent, assent, and permisison

consent, assent, permission differences

- consent: provides willingness to participate in something

- assent: not competent but willing to participate in research study, kid has to agree >7

- permission: allowing something to happen

safety in peds setting

- med errors

- hospital acquired infections

- wrong site or wrong surgery

- skin breakdown

- child abduction

national pt safety goals

- 2 pt identifiers

- fall reduction

culturally sensitive care

obligated to attempt to understand pt beliefs and customs:

- culture of origin

- culture of poverty

- religious

- gender and sexual pref

- age

- interests

key features with communication

- influenced by culture

- effective listening

- empathy

- children are very aware of anxiety and fear in their caregiver

- verbal and non verbal

- introduce yourself

- clear and concise

- do not make promises you cant keep

- get eye level

- communicate slowly

- avoid medical jargon

barriers to communication

- physical and cognitive

- environmental noise

- cultural differences

- language barrier/no interpreter

- closed end questions

- bias/predjudice

- fears

- lack of respect

- not including parents

- not using culturally appropriate interactions (eye contact, shaking hands, silence)

reaction to a childs illness

- range of emotional rxns ( disbelief, frustration, guilt, worry, anger, denial, helplessness)

- siblings feel isolated, afraid, feel responsible, ambiguity, jealousy

- communicate openly, encourage parents care for child and sibling visits, begin d/c at admission, dev trust w child and family

parenting styles

- authoritarian: dicatorial, absolute rules, children have little decision making

- permissive: child makes decisions, few rules, child controls environment

- authoritative: rules that allow freedom, learn action/consequences, children become self reliant

communicating w the family

- do not exclude child or family

- active communication and listening

- understand growth and dev

- observe non verbal gestures

- incorporate play

- use visual forms of communication

- be aware of ur verbal and non verbal communication

communicating w infant (birth-12mo)

- communicate w caregivers

- use gentle touch

- allow sucking on pacifier

- talk to infant or make sounds

- sing song approach

- use wide eyed and high pitched

- incorporate consistency

communicating w toddlers and preschoolers (1-5yo)

- egocentric, can throw tantrums

- fearful, literal, concrete

- use simple terminology

- get in same position as child

- tx room for painful procedures

- have toys and parents available

- allow choices when available

communicating with school age (6-12yo)

- concrete and curious

- learn by hands on

- allow child to assist w care

- explain why and how in simple terms

- encourage questions and concerns

- allow time to play and ask questions

communicating w adolescents (13-18yo)

- use open ended questions

- encourage sharing feelings

- provide privacy

- do not confuse mature body for emotional maturity

- explain limits of confidentiality

altered family unit

- substance use, coercive family process

- physical, emotional, or sexual abuse

- chronic physical or mental illness

- hospitalization

- death of a family member

how to provide culturally competent care

- consider culture, spiritual beliefs, values, traditions, and environment

- be aware of any person bias you have

- recognize disparities and inequalities

- be aware of social determinants

- allow cultural foods

- educate staff

- learn ab diverse cultures

- know who makes decisions for pt

- ask pt/family which language they prefer to use

- use certified interpreter

- provide undivided attention and do not interrupt

- be aware of body language and touch acceptance

- avoid hand gestures

what to do when using and interpreter

- document name and number of interpreter

- use for teaching and consent

- speak directly to pt not to interpreter

characteristics and behaviors determined by culture

- personal space

- eye contact

- diet

- time

- touch

- use of alternative medicine