Current principles, practices and trends in pediatric

Evolution of pediatrics, Pediatrics in India, Evolution of Pediatric Nursing in relationship to Child health, Historical background on the care of the child, Factors influencing the care of the child.........

1. CURRENT PRINCIPLES, PRACTICES AND TRENDS IN PEDIATRIC NURSIG MISS GNANA JYOTHI MSC (N) II YEAR

2. PEDIATRICS “ Pediatrics is the speciality of medical science concerned with physical, mental and social health of children from birth to young adulthood”

3. Pediatrics – derived from Greek word p ais / paisons -child i atreia -cure i cs -subject of science

4. Pediatric nursing “ Pediatric nursing is the practice of nursing involved in the health care of children from infancy through adolescence”. - Terrikyle & Susan

5. EVOLUTION OF PEDIATIRCS

6. Ancient and medieval medical writings Hippocrates wrote a small treatise on On “dentition” on the subject of t eeth & noted how children d iffer from adults in various ways in h is “Aphorisms”

7. Soranus of Ephesus detailed history of childhood diseases e xplanations include feed, Bathe, swaddle an infant d escribed finger nail test for breast milk quality

8. Galen (200 A.D) wrote of ear discharge, pneumonia, and intestinal prolapse and described a disorder that corresponds to rickets.

9. 787 AD, Arch Bishop Dathers --one of th first foundling asylums at Milan

10. Avicenna (990 AD)– Arabian physician discussed tetanus, worms, convulsions, meningitis & umbilical abscess.

11. Rhazes (Baghdad) –wrote an entire treatise on children.

12. RENAISSANCE MEDICAL WRITINGS First medical book –printed Pediatric treatise by italian Paolo Bagellardo

13. Thomas Phaer (1594 ) – first english language work on pediatrics called – “the book of children” -dentition, teething, crying, fever, cramps, palsies -advocated washing the child in camomolie

14. Hieronymus ( 1583) wrote- “de morbus pusorium “

15. Thomas sydenham (1624-1689)- english hippocrates wrote on -scarlet fever -measles -small pox -epilepsy -rickets -teething fever - scorbutus (scurvy) -chorea( st.vitus dance)

16. Edward Jenner (1749-1823)- Invented small pox vaccine

17. Dr . Eli Ives (1813-1852) – gave lectures to medical students at Yale – about diseases in children.

18. British physician – William buchan noted that one half of the human race dies in infancy

19. Theophile Rouseel (1816-1903) –French physician and politician set laws that protected infants , abused and abandoned children.

20. Two of the first text books in pediatrics were published in 1825. “Treatise on the physical & medical treatment ” -Dr, William Potts Dewees “ Practical observations on diseases of children” - Dr.George Logan

21. First pediatric hospital – 1802 “Hospital de enfants malades ” ( French) called “Hospital for sick children” Opened in Paris

22. Dr. Elizabeth Blackwell –first woman To graduate –US medical school

23. America’s first children hospital- “Children’s Hospital Of Philadelphia” (1854)

24. Louis Pasteur (1862) –Pasteurization

25. New York Medical College starts a regular professorship for the diseases of children in 1860.

26. Dr. Abraham Jacobi – Starts “American Journal Of Obstetrics And Diseases”

27. Dr.Mary Putnam Jacobi –first women member of the “ Academy Of Medicine”

28. The first issue of the “ Archives Of Pediatrics” was published in 1884

29. American Pediatric Society (1888) – Dr.Job Lewis Smith With Dr.Abraham Jacobi

30. Dr. Thomas Morgan Rotch –Americas first professor of pediatrics at Harvard Medical School in 1893

31. Dr. Dorothy Reed Mendenhall –first to recognize Hodgkins disease was a blood cell disorder and not a form of tuberculosis

32. Sir Alexander Flemming - Pencillin Jonas Salk (1914-1995) & Albert Sabin(1906 -1993) -Polio

33. Sir Edward Mellanby –Discovers Cod Liver Oil Can Treat Rickets

34. Dr. Emily Patridge Bacon – first pediatric specialist in Philadelphia. -introduced “well baby clinics”

35. Dr. J.P.Crozier – publishes “The Diseases of Infants& Children” which later became “The Nelson’s Pediatric’s Text book”

36. June 23, 1930 – American Academy of Pediatrics was formed at Detroit (Michigan)

37. Dr. Charles Bradley – described the use of benzedrine in children with behavioral problems(1937)

38. Dr.Dorothy Hansine Anderson (1938)- first to recognize Cystic Fibrosis

39. Hattie Elizabeth Alexander , M.D- developed a treatment for Hib Meningitis.

40. Dr. William E.Ladd & Robert E.Gross (1941) published pediatric surgery textbook “ Abdominal Surgery Of Infancy & Childhood ”

41. Dr.Norman M.Gregg (1941 ) reports on congenital rubella

42. Dr. Helen Taussig And Dr. Alfred Blalock (1943) developed a palliative surgical treatments for babies with Tetrology Of Fallot

43. Dr.R.L . Jackson & Mrs. H.G. Kelly (1994) published growth charts

44. First military pediatrics residency program – Boston’s Chelsa Naval Base (1946)

45. First issue of pediatrics : “JOURNAL OF AMERICAN ACADEMY OF PEDIATRICS” (1948)

46. PEDIATRICS IN INDIA

47. Ayurveda – description of maternal and child health.

48. Sushrutha – “ Sushrutha Samhita ” Atharva Veda – Childrens Diseases Kashyapa & Jeevaka :Pediatricians –Ancient India Charaka – Case Management Of New Born Kaumarabritya & Panchatantra - Prenatal Care

49. The history can be studied as : Academics Pediatric – Indian Pioneers Indian Academy Of Pediatrics Change Of Spectrum Of Illness Demographic Trends National Programs

50. Evolution Of Pediatric Nursing In Relationship To Child Health

51. Past centuries – health was poorer Crowded living conditions Inadequate unsanitary food Harsh working conditions Increased mortality & morbidity rates

52. Over the years…… Focused attention on the health of the children 1900s- Lilian Wald (NY)-public health nursing Pediatric nursing-teachers college of columbia university Improved nutrition, sanitation, medicine Changes in the health care delivery system 1980-division of maternal-child health (N) practice

53. HISTORICAL BACKGROUND ON THE CARE OF CHILD

54. Child in primitive societies - NOMADS

55. Child in ancient civilizations EGYPT Settled in the valley of Nile Dressed infants in loose clothes Breast feeding

56. Greece & Rome Physical Beauty –Greece Strong Sons (Good Warriors)- Rome

57. Ancient jews - hygienic measures Hebrews –cleanliness & circumcision - large family – a sign of Gods blessing

58. Impact of Christianity on child care: Value of child as a son and daughter Protection of the weak by the strong and care of the ill by the well.

59. The Child In Europe Great epidemics Young men died in war Women married early- large families Maternal death rate was high Orphaned children Infants- boarding homes or baby farms Asylums -787 AD No Principles of sanitation, housing, nutrition Accidents were common

60. The child in the United States Early 20 th century – children lived on farms Lack of medical care 19 th century - large slums (NY) Over –crowded, unsanitary conditions Accidents were common Contaminated milk- intestinal disorders Dairies, stores- not inspected Milk from tuberculous cows Mortality & morbidity rates – increased

61. The child in developing countries International activities WHO UNICEF

62. WHO (1948): Geneva, switzerland Objectives: Directs & co-ordinates health work Collaboration with governments Evaluates a country’s health problems Eradicate diseases & prevent injuries Promotes nutrition, housing, sanitation, env . Hygiene MCH welfare Promotes mental health

63. UNICEF (1946): Meet the emergency needs of children is financed by voluntary contributions from govts , groups, & individuals In USA, children volunteer – by“halloween ” Sales of calenders , christmas cards,fund medicines & food

64. FACTORS INFLUENCING THE CARE OF CHILD

65. It includes : Societal factors Professional factors

66. Societal factors Attitude towards children Poor & deprived families Consumerism The women’s movement Health care : changes & advances

67. Attitude towards children: Infanticide, neglect, abuse -persist

68. Poor & deprived families: Insufficient financial resources Misconception – govt provides –minority groups- metros Bread winner unemployed

69. Consumerism ; Consumers are vocal Assertive in making decisions

70. Women’s movement: Mother’s work on a part-time basis or full time Mother’s take the responsibility Family – centered care

71. Health care : changes& advances: Concept of health & illness –changing Holistic view of health High – level wellness Self care movement Advances and changes in medical care

72. Professional factors The process of professionalization Expansion of the nurses role Nurse practice acts Professional organizations

73. Principles Of Pediatrics

74. 1.Respect the child’s need to regress & help him to accept dependence on others if he resists this

75. 2.Have an awareness of the child’s need for help in reconquering the negative counterpart of the core problem in the stages of development to which he has regressed.

76. 3.Protect the child-family inter -relationships

77. 4.Awareness of the feelings of others and readiness to respond to them so as to strengthen their resources to cope up with stress is the major principle underlying effective emotional support

78. 5.Children can tolerate discomfort if they are prepared for it, comprehend its real purpose and are adequately prepared.

79. 6.To child, play is not time out from daily living, but rather an essential part of it that enables him grow & mature through the various stages of the development.

80. HEALTH CARE DELIVERY SETTINGS

81. It includes Clinics & offices Home care Parish nursing Other setting

82. CLINICS Well organized out patient facilities Information is distributed & education is offered on childhood immunizations Specialty clinics School based health centers

83. HOME CARE Lower cost & patient satisfaction IV therapy , phototherapy

84. PARISH NURSING Health promotion Health maintenance Illness prevention Community services Support groups

85. OTHER SETTING Local and national groups camps

86. CURRENT PRACTICE

87. It involves Educational requirements Research and roles Critical thinking & nursing process Documentation Confidentiality & informed consent

88. Educational requirements Update the knowledge Accountability – important Responsibility to community

89. Research & roles Research Evidence – based practice Roles Health promotion & anticipatory guidance Advocating Holistic attitude Ethical decision making

90. Critical Thinking & Nursing Process Critical thinking – systemic, expanded way of thinking Nursing process –

91. Documentation Data collection Assessment findings Patient care needs Interventions Specific time ( legally important) Discharge needs Law- “ if something was not charted – not done”

92. Confidentiality & Informed Consent HIPAA ( Health Insurance Portability & Accountability Act) regulations Should not share information Patient records – carefully monitored Should not give private information – telephone callers

93. TRENDS IN PEDIATRIC NURSING

94. It includes Family centered care High technology care EBP Primary nursing Case management Child oriented environment Atraumatic care Cost- containment Nursing process application Ethics Rights of children others

95. Family centered care Positive environment for family members Guide in unknown new experiences Enhance the strength & competence Basic components -enabling ( opportunities) -empowerment ( interaction) Incorporate into policies & practice- cultural div. Recognize & respect diff. methods of coping Family- family networking

96. High technology care Advancement in medical field Diagnostic technology

97. High technology includes Controversial fetal surgeries Fetal blood transfusions MTP Cloning IVF Female feticide

98. Emerging technologies 1 . Genetics & genomics Diseases could be treated by genetic element

99. 2.less invasive & more accurate tools for diag. Home phototherapy

100. Influenza A&B detecting device

101. Wart cryotweezers

102. Shot blocker

103. Cerumen remover

104. Sensicardiac

105. Da vinci robotic surgery

106. 3D printing

107. Others -robotics -biometrics -EHR

108. Evidence based practice CPG’S & patient centered multidmensional multidisciplinary plans of care

109. Primary nursing 24 hour responsibility & accountability-one nurse When primary nurse is not working, an associate nurse will maintain

110. Case management Extension of primary nursing Out – patient setting A case manager – a patient or a group of patients

111. Child oriented environment Child- friendly env . – hospital Hospitalization – disrupts routines Skilled staff Liberal visiting hours Families – receive information

112. Atraumatic care Provision of therapeutic care- minimize physical & psychological distress Therapeutic care -PREVENTION -DIAGNOSIS -TREATMENT -PALLIATION

113. SUGGESTED INTERVENTIONS Parent –child relationship (hosp.) Prepare the child before any procedure Control pain Child privacy Play Minimize loss of control Respect cultural & religious differences

114. Cost containment It is a management technique utilized to reduce the cost of hospitalization Multi- disciplinary approach Enabling & empowerment

115. Nursing Process Application

116. Ethics In Pediatric Nursing In nursing practice Non- maleficence -do no harm Beneficence – do good Justice Respect for autonomy Truth telling

117. Related to research 1.Informed consent Legal age -18 yrs 2.Conceptual issues e.g., reusing life saving care for religious practices 3.Beneficience 4.Truth telling 5.Confidentiality 6.Conflicts of interest

118. Children’s rights History of children’s human rights Natural rights FOUNDLING HOSP (1741)LONDON – education & maintenance of exposed & deserted young children THOMAS SPENCE (Political radical) – rights of children -1796

119. Social reform Industrial revolution – children worked in factories, coal mines Charles Dickens ( Oliver Twist) - wrote of the terrible conditions Factories act -19 th century (< 9yrs not allowed) Mary carpenter - neglected children

120. USA ----- children rights movement --- orphan train National child labor committee--- abolition of child labor National child labor law (1924 )----- congress constitutional amendment Franklin D Roosevelt (1938)--- signed Fair Lbor standards.

121. Janusz korczak (polish educationalist): ---- ”How to love a child” ---- later entitled--- THE CHILD’S RIGHTS TO RESPECT.

122. DECLARATION OF THE RIGHTS OF THE CHILD. 1959---United Nations General Assembly adopted an expanded versio n as…whose provisions are, Protection rights Provision rights Participation rights

123. DECLARATION OF THE RIGHTS OF THE CHILD. Protection rights: against maltreatment neg lect & all forms of exploitation.

124. DECLARATION OF THE RIGHTS OF THE CHILD. Provision rights: right to food, health care, education and benefit from social security.

125. DECLARATION OF THE RIGHTS OF THE CHILD. Participation rights: right to act in certain circumstances and the right to be involved in decision making.

126. INDIAN CONSTITUTION Article 24 ---prohibits employment of children in factories under age 14 . Article 39- --prevents abuse of children of tender age. Article 45- --provides for free and compulsory education ---till they complete age 14 yrs.

127. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to develop in an atmosphere of affection and security, and wherever possible, in the care and under the responsibility of his/her parents.

128. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to enjoy the benefits of social security, including nutrition, housing and medical care.

129. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to free education

130. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to full opportunity for play and recreation.

131. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to a name and nationality.

132. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to special care, if handicapped.

133. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to special care, if handicapped.

134. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to be among the first to service protection and relief in times of disaster.

135. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to learn to be a useful member of society and to develop in a healthy and normal manner and in conditions of freedom and dignity.

136. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to be brought up in spirit of understanding, tolerance, friendship among the people, peace and universal brotherhood.

137. UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD Right to enjoy these rights, regardless of race, colour, sex, religion, national or social origin.

138. Other trends KMC Rooming- in concept Child – to –child program

139. 1.Kangaroo mother care First presented by Rey & Martinez in Bogota, C olumbia. Care of preterm infants carried skin-to-skin with the mother. Promote health and well-being of infants born preterm as well as full term.

140. Kangaroo mother care Key features: Early, continuous and prolonged skin-to-skin contact Exclusive breast feeding initiated in hospital and continued at home

141. 2.Rooming-in-concept Placing of the newborn in the same room as the mother - early post-partum period, to foster maternal-fetal bonding and facilitate breast feeding.

142. 2.Rooming-in-concept Benefits of rooming-in: Cry less and remain calm Mothers get rest Ability to respond to baby’s feeding cues

143. 3.Child-to-Child Program David Morley & Dr. Hugh Hawes ----conceived the idea ----children working with other children to bring change(1978). First major child-to-child project- --”Little Teacher Program” --- Botswana.

144. EVOLUTION OF CHILD HEALTH Government programs Change in mortality and morbidity. Insurance Health promotion Emergency preparedness Current practice Cultural and religious considerations Complementary and alternative medicine.