Changing paediatric trends in nursing

This is regarding philosophy & changing trends of nursing in paediatric. if you like kindly give your comment and follow my account.

1. Philosophy Of Pediatric Care & Changing Trends In Pediatric Nursing By, Mr. Abhijit Bhoyar Child Health Nursing

2. Introduction Children need accessible ,continuous , comprehensive, coordinated and family centered care that focuses on their changing physical and emotional needs. Pediatric nurses provide this care by focusing on the family , providing atrumatic care , evidence based practices , High technology care , cost containment and child oriented environment.

3. Components of philosophy of pediatric nursing care- Family- Centered Care A traumatic Care Evidence-based practice High technology care Cost Containment Child oriented environment

4. 1) Family- Centered Care :- Family –centered care involves families and caregivers working in a collaborative partnership to determine goals and plans for health care. It works well in all areas of health care, from preventive care of the healthy child to long term care of the chronically or terminally ill child .

5. Continued- Family –centered care enhances parents and caregivers confidence in their own skills and also prepares children and young adults for assuming responsibility for their own health care needs.

6. Elements of Family-Centered Care Demonstrating interpersonal sensitivity Providing general health information Communicating specific health information Treating people with respect.

7. Respect for the child and family Recognition of the effects of cultural, racial, ethnic, and socioeconomic diversity on the family’s health care experience. Identification of and expansion of the family’s health care experience. Support of the family’s choices related to the child’s health care According to the American Academy of pediatrics, family-centered care focuses on several core principles

8. Continued- Provision of honest , unbiased information in an affirming and useful approach. Assistance with the emotional and other support the child and family require Collaboration with families Empowerment of families

9. Outcomes Of Family-Centered care : Anxiety is decreased Children are calmer and pain management is enhanced. Recovery times are shortened Families confidence and problem solving skills are improved Communication between the health care team and the family is also improved.

10. Advantages of family centered care:- Practicing true family centered care may Empower the family , Strengthen family resources , & Help the child feel more secure throughout the process.

11. 2) A traumatic Care This is a philosophy of providing therapeutic care through interventions that minimize physical and psychological distress for children and their families. Therapeutic care includes prevention, diagnosis, treatment of chronic or acute condition.

12. The concept of a traumatic care is intended to reduce mental and physical harm & provide an environment with minimum physical and mental trauma.

13. Components of A traumatic care:­ Atrumatic care :-is the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminate or minimize the psychological & physical distress experienced by children and their families in the health care system. Therapeutic care :- It includes prevention, diagnosis & treatment of chronic or acute condition.

14. Components of A traumatic care:­ Setting : - It refers to whatever place that care is given at the home , the hospital , or any other health care setting. Personnel :- It includes anyone directly involved in providing therapeutic care

15. continued- Interventions : - Interventions range from psychological approaches, such as preparing children for procedures, to physical interventions , such as providing space for a parent to room in with a child. Psychological distress :- It may include anxiety , fear, anger, Disappointment , sadness, shame, or guilt.

16. continued- Physical distress :- may range from sleeplessness and immobilization to the experience of disturbing sensory stimuli such as pain, temperature, extremes, loud noises, bright lights or darkness.

17. Principles Of Atraumatic Care: Prevent or minimize physical stressor, including pain, discomfort, immobility, sleep deprivation, inability to eat or drink, and changes in elimination 1

18. Interventions are… Avoid or reduce painful procedure, such as injections, multiple punctures ,urethral catheterization. Avoid or reduce other kinds of physical distress, such as noise, smells, shivering, restraints, skin trauma . Control pain via frequent assessments and use of pharmacologic and non pharmacologic interventions.

19. Prevent or minimize parent child separation . Interventions are… Promote family centered care, treating the family as the patient. Use core primary nursing. Consider research findings related to preferences of parents and children and whether or not to be together . 2

20. Promote a sense of control. Interventions are… Elicit the family’s knowledge about the child and his or her health condition, promoting partnerships, empowerment. Reduce fear of the unknown through educations, familiar articles, and decreasing the threat of the environment. Provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions 2

21. Suggestion For Nursing Care:- 1 ) Prevent or minimize physical stressor :- During painful or invasive procedures, avoid traditional restraint or holding down of the child, allow the privacy, providing play activities for expansion of fear. If the above mentioned positions are not an option, have the parent stand near the child’s head to provide comfort. Minimize intramuscular or subcutaneous injection.  

22. 2) Prevent or minimize parent child separation : Promote family centered care In the hospital, provide comfortable accommodations for the patient Allow the family the choice about whether to stay for an invasive procedure and support them in their decision.

23. 3) Promote a sense of control:- Maintain child’s home routine related to activities of daily living In the hospital, use primary nursing Provide security of the child Provide a education for the child & parent Make the environment more inviting & less intimidating

24. 3)Evidence-based practice:- Evidence based practice in nursing provides a systematic approach to enable nurses to effectively use the best solution related to nursing practice. Hence nurses need to search the literature to analyze evidences using biostatics rules to identify generalisability of findings .

25. Continued - Evidenced based practice involves the ability to access, summarized and apply information from literature to day – to- day clinical problems. Nursing focus is on the illness aspects of care the human response during disease and therapy. Nurses should find data necessary to identify and support their contribution to patient outcomes .

26. Continued- Quality improvement measures and throwing outdated management tools are essential to improve nursing practice .This is possible to use of evidence based practices. Clinical practice guidelines and patient centered multidisciplinary multidimensional plans of care ,will help nursing team move towards evidence based practice and improve the process of care delivered .

27. Clinical practice guideline help- Encourage practitioner accountability Encourage highly coordinated care Decrease unnecessary variations in practice pattern Increase high quality cost effective services Provide a mechanism to systematically evaluate the quality and effectiveness of nursing

28. Process of using evidence based practice in nursing – Frame questions Search for evidences Asses /appraise Make a decision Evaluate performance

29. 4) High technology care The advancement in the diagnostic technology has made detection of many disorder event in the fetal period. Laboratory methods –to assess fetal maturity and health of the fetus. Ultrasonography - for diagnostic purpose.

30. Continued- Fetal surgeries Fetal blood transfusions Medical termination of pregnancy In vitro fertilization Female feticide

31. 5) Cost Containment Cost containment is a management technique utilize to reduced the cost of hospitalization. It is achieved by improving the process of care.

32. 5 Component Cost Containment By reducing mortality rate By reducing Length of stay By reducing Cost By reducing Complications By increasing family satisfaction And ability to function upon discharge

33. 6) Child oriented environment A child friendly environment should be provided to a child who is admitted to hospitals Adequate safety precautions Education and facility for play should be provided Staff should be sensitive to the families individual needs according to the social ,educational, cultural, and religious background. Children’s ward should be equipped with skilled staff

34. Continued- There should be “named nurse” responsible for planning and coordinating the care by other nurses. Ensures that families receive all information they need. Liberal visiting hours Permitting parents to be with children when hospitalized also promotes child- oriented environment in a hospital.

35. Changing Trends In Pediatric Nursing:- INTRODUCTION The increasing complexity of medical & Nursing techniques has created a need for special area of the child care. In earlier days, present medical & nursing techniques has created a need for special area of child same. Now the child care has prime importance, as a mortality & morbidity are higher in this group .

36. The services provided for people :- Institutional Care Family centered care Regionalized Care Other Innovative Child Health Care Programs  

37. Pediatrics is new medical specialty developed in mid 1800. Children were cared as adults in these hospitals. Following the deaths & diseases, these children were kept isolated from other children to prevent from contact of diseases . Institutional Care

38. Institutional Care :- Children were ambulated as soon possible & made to visit play rooms, where they can be with other children . The nurses were trained to raise their level & provided daily care for children. Institutional Care

39. Family centered nursing care was recent trend in developed countries where the children were not treated as patients . But the attention was given to their medical problem. Family Centered Care

40. Regionalization of pediatric services were in progress from last several decades . Providing high quality medical care in pediatrics was important for best resources in diagnosis & treatment . Some of the branches were pediatric, medicine & surgery, pediatric neurology, pediatric allergy specialist, pediatric cardiology, pediatric nephrology, pediatric urology . Regionalized Care

41. Many pediatric hospitals have home care program for child illness like leukemia, hemophilia etc. By hospitalization, child’s condition is monitored at home for continuing care. Pediatric nurse practioner is prepared for specialized care to provide basic & primary health care to family & children . They provide consultant services & offer day today assessment & care.   Other Innovative Child Health Care Programs

42. CHANGING TRENDS IN HOSPITAL CARE Introduction The hospital are necessary places for providing the care of ill children . Previously, the care of ill child used to be completed at their birth places or at their homes.

43. CHANGING TRENDS IN HOSPITAL CARE Introduction Now a days, the hospitals have become a necessary organ of health chain, where all types of health professionals can easily be made available. This is based on preventive, promotive , curative, aspect of child health

44. 1.VISITING HOUR In earlier days parents with permitted to visit their hospitalization child fore only 1 hour once a month. Children were deprived from parental love. Today , many hospital permits visiting from 2 to 8 p.m. There are modern trends/modern concept of hospitalization child which are as follows:

45. 1.VISITING If parents are unable to visit the child frequently, grand parents, aunts uncles or Baby sitters may visit instead. Some hospital permits visiting by siblings between 2 and 12 years of age during certain hours of the day. A parent must accompany a younger sibling during visit . There are modern trends/modern concept of hospitalization child which are as follows:

46. Continued:- If child’s room is restricted, some hospital have provide television or telephone video system that allows two- way visit between the child and visitors of all ages. If parents , family , members of friends are not able to visit the hospital because of difficulty in travelling or any other reason , tape recording can be made & played to the child to maintain some contact with home, thus reducing separation anxiety. Topics such as favorite story or song , a talking letter from the family or just conversation with the child are appropriate for recording.

47. 2 . Rooming-in Parents should never be required to stay at a child’s bed side, but they are not prohibited from doing so if they desire. The parents who stay during the day time in the pediatric unit, some hospital provide a comfortable waiting room where they can relax. waiting room

48. 2 . Rooming-in In some institution, meals can be served to parents in the child’s room so they can eat with their child or they may eat in the hospital cafeteria or coffee shop. Food may be brought from home for the child if there are no dietary restrictions and if the policy of the institution permits.

49. 2 . Rooming-in Parents , usually mother as of seriously ill children may be encouraged to stay in the hospital all nights if they desire to do so and if facilities are available for their comforts. Some hospitals have room such as a play room in the pediatric unit where the parents may sleep .  

50. 3.Care by parents Unit Some hospital have care by parent unit or a family participation unit with the child. This method of core has its roots in the orient, where the whole family becomes involved with the care of the sick. In this system, the child gets attention when it is needed each day from a familiar person, under the supervision of the nurse. When the parents are near, parents are also prepared naturally and effectively for the care of their child which will need at home .

51. 4. Parent Support Groups:- Many support groups for parents meet outside the hospital, some hospital started with In the hospital for parents of hospitalized children. Such group may be conducted by nurses, by play therapist or by child life program staff. In these groups, a non- threatening atmosphere is provided, where parents may feel comfortable enough to move away from the hospital routine and ventilate their feelings and concerns to relieve their anxiety and stress.

52. 5 . Self Care By the self-care framework nurses have the responsibility of assessing the abilities of the hospitalized child and then helping the child to learn self-care skills. The time and methods used in teaching these skills depend on the child’s cognitive abilities, emotional state, and readiness to learn .

53. 6 . Neighborhood Health Centre of clinic :- The neighborhood or clinics are primarily concerned with the care of children and the guidance of their parents. If sickness occurs, the child may be cared at the clinic for a mild temporary illness or referred to another facility in further treatment .

54. 7. Emergency facilities :- Facilities where emergency care is given, may be located in hospital emergency department or in community based emergency centers. They have been designed primarily to fulfill a need for convenient, accessible, low-cost medical services.

55. 8.Hospital Based and free Standing Facilities for minor Surgical Care The advantage of care given in an ambulatory setting is that the child does not have to remain away from home for more than a few hours, resulting in less trauma and family disturbance and less chance of infection from seriously ill children in the inpatient hospital setting. Parents must assume responsibility for the pre-operative routine preparation usually carried out by nurses in the hospital including post-operative .

56. 9. Pediatric Unit:- Hospitalized children are usually segregated by care requirement or by age or by both, children need are- adequate provision for care, protection from physical danger e.g. infection and accidents, and protection from a psychologically threatening environment. In the pediatric unit the surrounding should be home like and cheerful .

57. 10 . Pediatric Newborn and Pediatric Intensive Care Unit (PICU ) New born and pediatric intensive care unit for the critically ill are found in many pediatric hospitals and the large pediatric departments in general hospital in some states. New born infants who are critically ill are transferred from local hospital to these centers for care, these units based on electrical instrument related to vital signs and other physiology of new born and pediatric.

58. 11 . intermediate care Unit :- Here children who have been in the intensive care unit can be moved if their conditions have improved. These children may still be too ill for care in a standard pediatric unit.

59. 12. The pediatric research centre:- Some children’s hospital have pediatric research centers where little understood diseases are under investigation. These centers give nurses an opportunities to provide comprehensive care to children.

60. 13 . Outpatient department’s of hospitals :- During the 19 th century, hospitals in America began to provide services for out patients. Increasing number of private physicians use the outpatient department for children with problems requiring careful diagnosis and treatment, such as complex medical or surgical problems or psychological difficulties .

61. 13 . Outpatient department’s of hospitals :- Because of awareness of the need to avoid the possible trauma of hospitalization and the possibility of cross infection, more children with pneumonia, abscesses, or urinary or other infections can be treated on an outpatient basis if there is a responsible adult in the home to provide care. One of the newer functions of the staff in outpatient department is to provide genetic-counseling.

62. 13 . Outpatient department’s of hospitals :- One of the functions of nurses is to provide health teaching for parents. The nurse needs to be approachable- one who listens, teaches and cares-in order to make such communications learning situations for the parent & child.

63. Other Trends- According to UNICEF, assistance for meeting the needs of children should no longer be restricted to only one aspect like nutrition, but it should be broad based and geared to their long term personal development ensuring holistic health care of children.

64. Modern approach of child health care:- Modern approach of child health care emphasizes on preventive care rather than curative care. At present, in child health care more emphasis given on preventive approach rather than curative care only. Primary health care concept with team approach and multidisciplinary collaboration are adopted for child care.

65. Modern approach of child health care:- Increased public awareness, participation in child care are newer trends. Family health a new concept is accepted for the care of children in their families and families in society.

66. Recent trend is Growth of sub- specialties for the super-specialized care of children. The sub areas are neonatology, perinatology , pediatric surgery, pediatric cardiology, pediatric neurology, preventive pediatrics, child psychology, child psychiatry, pediatric intensive care unit, neonatal intensive care unit etc.

67. Growth of specialization There is need for specialized well trained pediatric nurses with continuous re-orientation about the advancement of technical aspect of child care. Pediatric nurses are performing specialized care in neonatal intensive care unit, pediatric intensive care unit, and in any care system of child care.

68. Continued- Because of growth and maturation of the nursing profession, nurse may become an independent practitioner who can fulfill an autonomous position as a member of an interdisciplinary health team. Areas of independent practices of community services for improvement in child care.

69. continued The large number of child population with various health problems required more numbers of health care providers along with specially trained nurses so special importance are given in basic nursing curriculum to prepare the nurses with specialized knowledge and skill on child health.

70. New trends- Ethical decision making Legal safeguards Quality assurance Consideration of ethical , moral & legal dilemmas in child care create problems & nurse may need to decide to perform nursing activities based on professional & personal judgment . Ethical decision – making , legal safeguard & quality assurance are the recent trend .