N2130 - Family Centered Care (Lecture 1)

Children in Canada

Of approximately 36 million Canadians, over 6 million are children aged 14 years and younger.

COVID-19 effects on children

The pandemic contributed to record rises in child poverty, setbacks in routine vaccination progress, and disruption to education.

Canada’s child/youth health ranking

Among 38 countries, Canada ranked 30th overall in the lecture’s reported comparison.

Canada’s mental health and happiness ranking

Canada ranked 31st among 38 countries for child/youth mental health and happiness.

Canada’s physical health and survival ranking

Canada ranked 30th among 38 countries for physical health and survival.

Children’s life satisfaction

1 in 4 Canadian children has low life satisfaction.

Adolescent suicide rate cited

Canada has a high adolescent suicide rate: 9 per 100,000 people aged 15–19 years.

Measles immunization coverage cited

87% of children were immunized against measles, below the 95% threshold cited for protection.

Child overweight/obesity

1 in 3 Canadian children is overweight or obese.

Education and skills ranking

Canada ranked 18th for education and skills development.

Reading and math skills

1 in 3 young people do not have basic reading and math skills by age 15.

Friendship difficulties

26% of young people have difficulty making friends.

Supportive relationships ranking

Canada ranked 27th for supportive relationships.

Family support

26% of children say they have low support from their families.

Bullying frequency cited in country comparison

20% of young people are frequently bullied.

Child poverty ranking

Canada ranked 26th for child poverty.

Child poverty by population

1 in 5 Canadian children lives in poverty; cited rates were 1 in 3 Black children and 1 in 2 First Nations children.

Air and water quality rankings

Canada has better air and water quality than most countries; the lecture cited ranks of 4th and 18th, respectively.

Areas where Canada made the most progress

Reducing child poverty and reducing the number of young people excluded from education, employment, and training; disparities remain.

Areas with little/no progress

Child mortality, obesity, and bullying.

Areas where Canada is falling backward

Children’s sense of well-being and the quality of their close relationships.

Canada’s investment in child/youth health

Canada invests approximately 1.7% of GDP in child/youth health investments.

Comparison of investment in other countries

France, the UK, and Sweden invest approximately 3.7% of GDP in child/youth health investments.

Canada’s childhood conditions and outcomes

Despite better economic, environmental, and social conditions than most countries, Canada ranked 23rd for conditions for good childhoods and 30th for children’s outcomes.

Proposed solution for child health systems

Provide accessible, equitable, connected healthcare designed for children, youth, and families.

Funding and research recommendation

Provide dedicated, protected funding for children’s health systems across the continuum of care, including child health research.

Child health data recommendation

Make child health data publicly accessible and capture it under national health data strategies.

Pediatric workforce recommendation

Make the highly specialized workforce caring for children/youth an intentional focus of national health workforce planning.

Why children need tailored care

Children are not small adults; they need tailored physical and mental healthcare across the continuum.

Primary health care review prompts in lecture

The slides ask students to recall PHC principles, metaparadigm concepts, social determinants of health, and PHC services; the slides do not list the answers.

Framework for child well-being

Child well-being is not simply caused by individual characteristics (e.g., resilience, effort) or family characteristics (e.g., marital status, employment).

Broader influences on child well-being

Public policy and economic, environmental, and social conditions profoundly influence child well-being.

Healthy childhood environments

Children and youth thrive in environments that are safe, nurturing, predictable, and structured.

Changing threats and anticipatory guidance

Threats to healthy childhood change with internal and external factors; anticipatory guidance is needed to help prevent them.

Childhood mortality trend

Canada’s mortality rate for children who die before age 15 has decreased over the past 50 years.

Canada’s relative mortality ranking

Canada’s relative ranking compared with other countries has fallen because other countries achieved greater reductions in infant mortality.

Infant death risk factors

Risk factors cited include low maternal education, inadequate housing, lack of healthcare access, food insecurity, poverty, and unemployment.

Prenatal contribution to infant deaths

Many leading causes of death during infancy involve issues that occur during the prenatal period.

Morbidity statistics definition

Morbidity statistics measure the prevalence of specific illnesses in a population at a particular time.

How morbidity is presented

Morbidity statistics are generally presented as rates per 1,000.

What morbidity may describe

Morbidity may refer to acute illness, chronic disease, or disability.

Groups of children with increased morbidity

Children who are homeless, immigrants, in care, adopted, low-birth-weight, or chronically ill.

Pediatric health challenges on the rise

Obesity, type II diabetes, injuries, violence, vaping, and substance use.

Top 10 threat: unintentional preventable injuries

Unintentional injuries remain the leading cause of death among children aged 1–14 years.

Top 10 threat: poor mental health

The lecture reports that 40–50% of Canadian youth aged 12–18 experience anxiety or depression.

Top 10 threat: violence and maltreatment

Nearly two-thirds (60%) of Canadians report experiencing some form of maltreatment before age 15, including sexual abuse in schools and sexual luring online.

Sexual abuse risk and intellectual disability

Children with intellectual disabilities have 3.5 times the risk of experiencing sexual abuse.

Top 10 threat: vaccine-preventable illness

Vaccination coverage for all vaccinations among children aged 2, 7, and 14 is below the 95% threshold cited to prevent outbreaks.

Top 10 threat: systemic racism and discrimination

Racist and discriminatory actions can have lifelong impacts on children and affect future generations.

Racism reported against Asian children

Reports cited a nearly 300% increase in racist and discriminatory actions against Asian children from 2020–2021.

Top 10 threat: poverty

Over 1.1 million children across Canada live in low-income households.

Food insecurity figure

In 2022, 1.8 million children under age 18 were affected by food insecurity.

Top 10 threat: infant mortality

Canada’s infant mortality rate is approximately 3.9 deaths per 1,000 live births; the lecture ranked Canada 28th, in the bottom third of wealthy countries for child mortality.

Top 10 threat: bullying

Approximately 7 in 10 (70%) of youth aged 15–17 experience bullying.

Groups with high bullying rates

Adolescents from low socioeconomic status backgrounds and sexually/gender-diverse youth often experience high rates of bullying.

Top 10 threat: limited physical activity and play

Less than 3% of Canadian youth meet the 24-hour movement guidelines.

Top 10 threat: climate change

Nearly half (48%) of Canadian youth aged 16–25 report high anxiety about air pollution and climate change.

Premature deaths from air pollution

The lecture cites 15,300 premature deaths each year due to exposure to air pollution.

How threats to children interconnect

The top 10 threats are not standalone; they influence and can intensify one another.

Poverty and infant mortality connection

Lower socioeconomic status is associated with preterm birth; preterm birth can cause serious negative health outcomes and is a leading cause of infant mortality.

Physical inactivity and poverty connection

Family financial challenges may prevent children from accessing physical activities and sports.

Injury and discrimination connection

Gender discrimination can increase stress and affect mental health; this may contribute to risky behaviours such as substance use and unintentional self-harm.

Climate change, food insecurity, and discrimination connection

Environmental exposures can contaminate food and water; this risk is especially prevalent in some populations, including Indigenous populations.

Roots of health inequities

Systemic discrimination in Canada is rooted in inequality, poverty, Indigenous identity, ethnicity, gender, immigration status, disability, and other social, cultural, and economic factors.

Barriers linked to homelessness and poverty

Discrimination, language barriers, historical trauma, and colonization are linked to homelessness and poverty.

Nursing response to child health inequities

Nurses can advocate for social policies that reduce poverty and refer children and families to needed services.

Indigenous children: hospitalization and fatalities

Hospitalization rates are higher among Indigenous children/youth. They represent 3.3% of Canada’s pediatric population but nearly 31% of child fatalities, according to the lecture.

Indigenous youth and abuse

15% of First Nations, Métis, and Inuit youth report physical and/or sexual abuse before age 15—more than double the rate among non-Indigenous youth.

Indigenous children and child welfare

Children from Indigenous communities are concerningly and pervasively overrepresented in the child welfare system.

Indigenous children and low income

Over 130,000 First Nations, Métis, and/or Inuit children, on and off reserve, were living in low-income households.

Limitation of Indigenous low-income count

The number may be higher because census data were collected during COVID-19 relief efforts and over 60 First Nations reserves were missed due to forest fires and isolation protocols.

Indigenous infant mortality and bullying

Infant mortality rates are higher among Indigenous infants, and Indigenous youth often experience higher rates of bullying.

Source noted for threats data

The lecture references the Raising Canada 2023 Report.

Major goal of pediatric nursing

Improve the quality of healthcare for children.

How pediatric nursing improves child health

Understand threats to healthy childhood and work to prevent them, within the context of the family.

Therapeutic relationship in pediatric nursing

Develop a trusting and collaborative relationship with the child and family.

Canadian Pediatric Nursing Standards: purpose

Five practice domains guide pediatric nursing and support equitable access to high-quality care for all children and families regardless of circumstances.

Where pediatric nursing standards apply

They are integrated into the practice of nurses working with children, youth, and families in all settings and through key transitions.

Foundational scope and regulation

The standards assume nurses have a foundational scope of practice and meet requirements of their provincial/territorial regulatory body.

Standard 1: name

Supporting and Partnering with the Child, Youth, and their Family.

Standard 1: therapeutic relationship

Establish an equitable and inclusive therapeutic relationship with the child/youth and family.

Standard 1: goals, decisions, and consent

Respect and support the child/youth and family in goal setting, decision-making, and consent.

Standard 1: family context

Collect and use information about the family context to inform care.

Standard 1: communication and partnership

Communicate with the child/youth and/or family as partners in care.

Standard 1: resources and caregivers

Advocate for optimal resources; recognize and foster the caregiver role in supporting child/youth well-being.

Standard 1: definition of family

Respect the child/youth’s own definition of family.

Standard 2: name

Advocating for Equitable Access and the Rights of Children, Youth, and their Family.

Standard 2: assessment and SDOH

Complete a comprehensive assessment through an advocacy lens, considering social determinants of health (SDOH) and child/youth well-being.

Standard 2: privacy and confidentiality

Provide an appropriate environment for assessment and intervention that considers privacy and confidentiality.

Standard 2: self-advocacy

Build the capacity of children/youth and their families to advocate for themselves.

Standard 2: current resources

Maintain active knowledge of current resources by engaging in pediatric communities of practice.

Standard 2: navigating the system

Support children/youth and families in navigating the healthcare system.

Standard 3: name

Delivering Developmentally Appropriate Care.

Standard 3: development knowledge

Know typical and atypical development.

Standard 3: developmental safety

Know safety risks and perform safety assessments appropriate to the child’s developmental stage.

Standard 3: screening

Use validated screening tools to identify high-risk activities or behaviours.

Standard 3: pronouns

Identify and use appropriate pronouns when addressing the child/youth and family.

Standard 3: anticipatory guidance

Provide anticipatory guidance and coaching about typical development and safety for the developmental stage.

Standard 3: play

Incorporate developmentally appropriate play and/or recreational activities into care.

Standard 3: biopsychosocial assessment

Perform age- and developmentally appropriate biopsychosocial assessments.