Current trends in pediatric nursing - Modified.pptx

trends in pediatrics

1. Presented by Richa Mishra MSc nursing 1 st year Current trends in pediatric nursing

2. Recap.... First printed book - “ Little Book in disease in Children”(Italian) First english book on children’s disease - “ Book of Children” Worlds first pediatrician were two Indians- Kashyap and Jeevaka.

3. Introduction Lot of changes have occurred in pediatric nursing due to advance technology, consumer demands, and public awareness. Modern health approach emphasis on preventive care rather than curative care. Modern concept of child health emphasis given on continuous care of “ whole child”.

4. Current trends

5. Cont….

6. Family centered care

7. It is based upon the philosophy that quality care can be provided in an environment that support family integrity and promote physiological and psychological health of the family. It assumes that if the family gain adequate support and information it will be capable of making health care decisions Family centered care

8. Two basic concepts of FCC

9. ENABLING Enabling is to make them use their competence and acquire new skills which are useful in provide care to children . Professional enables families by creating opportunities and means for all family members to display their present abilities and compete to acquire new ones that are necessary to meet the needs of child and family . EMPOWERMENT Empowerment describes the interactions of professional with families in such a way that families maintain a sense of control over their families. Acknowledge positive changes that result from helping behaviors that foster their own strengths, abilities and actions. The parent professional partnership is a powerful mechanism for enabling and empowering families.

10. Atraumatic care

11. Cont….. Atraumatic care is the provision of therapeutic care in settings, by personnel and through the use of interventions that eliminate or minimize the psychological or physical distress experienced by the child and family in the health care systems. The overriding goal in providing atraumatic care is ‘’FIRST DO NO HARM’ ’ Three principles providing the frame work of achieving this goal are   Prevent or minimize child’s separation from family Promote a sense of control Prevent or minimize bodily injury and pain.

12. Cont… . EXAMPLES OF PROVIDING ATRAUMATIC CARE includes Fostering the parent child relationship during hospitalization. Preparing the child before any unfamiliar treatment or procedure. Controlling pain Allowing the child privacy Providing play activities for expression of fear and aggression. Providing choices to children Respecting cultural differences.

13. Guidelines for atraumatic care Never put a child on open bed without padded side rails , as the child may fall off causing greater trauma. Never use needles and instruments which causes unnecessary pain and it doesn’t fit in terms of its size, always double check size of needles, vasofix . Use pre- anasthetic medication when necessary Do not use irritating chemicals on to the skin,if n’t needed eg : instead of alcohol or spirit use, saline sponge or cotton ball to wipe. Handle surgical dressing and wounds gently Try your level best to prevent cross infection to the child Try allowing parents most of the time with child to divert pain. Make sure using non invasive techniques, prefer invasive techniques only if it is a compulsion and last option Never unnecessarily restrain the child.

14. EVIDENCE BASED PRACTICE

15. Cont… . EBP in nursing provides a systematic approach to enable nurses to effective use the best solution related to nursing practice. It involves the use of research findings in establishing a plan of care and implementing it. Appropriate resources must be available for nurses to implementing evidence based practice. Resources include online research journals computers internet and online journals It provides the rational approach to decision making that facilitates best practice.

16. Key Steps in the EBP Process

17. Case management

18. CONT….. Case management   is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcome,coordinate care and control costs.

19. Cont… . Case management was developed as an approach to coordinate care and control costs.Benifits of case management such as I mproved patient and family satisfaction Decreased fragmentation of care Improves individuality focus is on individual patient not on population of patients

20. Child oriented enviroment

21. Cont…. . An environment that supports children’s feelings of wellbeing by addressing their need to feel comfortable in the environment, maintain a positive frame of mind and remain positively engaged. An environment that facilitates children’s goodness of fit by supporting individual choice, control and self-help and by minimizing unwanted distractions .

22. Desirable features of hospital Provision of play room equipped with soft toys, sand and water, a home corner, climbing frame and slide education room liberal meeting hours with friends and family TV room

23. Cost attainment

24. Cost containment is management technique utilized to reduce the cost of hospitalization by providing the child with medicine and other needed articles and requirements A goal of managed care is to reduce cost of health care and to maintain the quality of care. these efforts has shortened hospital stay of children and increases nurses’ awareness of the supplies and services. Reduce direct or indirect cost of clinical services by cost containment family feels more satisfied. prevent duplication of nursing.

25. Cost containment strategies Health care costs continue to increase at a rate out of proportion to the cost of living.some major strategies include: Prospective payment system Managed care Capitation Alternative delivery system

26. High technology care

27. Cont… Technology can be defined as items, machinery and equipment that are connected to knowledge and management to maximize efficiency. Technology is not only the equipment itself, but also the knowledge of how to use it and the ability to convert it into nursing care. For e.g. management of technical equipment, such as ventilators infusion pumps monitors dialysis in an intensive care setting .

28. NICU of the future.... The NICU of the future project goals will design incorporating the following:- Family -centered care Developmentlly appropriate care for vulnerable newborns Smart workplace Minimally invasive, state-of-the-art technology A data based” living laboratory” for translational research Telemedicine( local,national and international consultation)

29. Intensive Respiratory Care Unit... These should be two separate sections for such unit:- I.For Infectious II.For non-infectious diseases. Air pollution exacerbates the condition of people with respiratory and cardiovascular diseases and causes measurable increases in the rates of hospitalization. Cardiovascular and respiratory diseases are among the leading causes of death.

30. Cont.... * Respiratory disease classifications according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes 460--519. “In 2005, approximately one fourth of the 2.4 million hospitalizations for children aged <15 years were for respiratory diseases, the largest category of hospitalization diagnoses in this age group. Of these, 31% were for pneumonia, 25% for asthma, 25% for acute bronchitis and bronchiolitis, and 19% for other respiratory diseases, including croup and chronic disease of tonsils and adenoids.”

31. Intensive labour Care Unit(ILCU) Almost 20% pregnant women in India fall in the high risk rate of category. In Wadia hospital in Bombay, 7% of cases in the labour room have been referred as emergency admissions. Moreover, the ILCU will be very useful in reducing maternal and infant death. For example, maternal morbidity rate is 1 per 100 deliveries and 1/3rd of total death in infant occur at the time of labour or delivery. I n such a unit, close monitoring of the high risk mother can be carried out during labour and delivery and special care instituted in them. The nurses can be trained to assess, help and study such monitoring.

32. Pdiatrics Intensive Care Units... To reduce the mortality further it is important to develop ICUs specialised for particular diseases like”- Intensive cardiac care unit Pediatric genetic counselling centres Others measures can also be adopted to have a check on these diseases - “The Nurse Parent Support Tool Manual”

33. NPTS.. It was designed to measure parents perception of nursing support during their child’s hospitalization. Focus of the Instrument During the period of acute illness and hospitalization, the environment created by the nursing staff defines a large part of the reality for parents. Nurses control contact with and interaction with the sick child, provide an important channel of information, and have ongoing interactions with parents .

34. Health education

35. Cont…. Health teaching may be a direct goal of the nurse, this includes Parenting classes or may be indirect such as helping parents and children understand a diagnosis or medical treatment, Encouraging children to ask questions about their bodies Referring families to health related professional or lay groups, Supplying patients with appropriate literature and providing anticipatory guidance.

36. support and Counselling

37. Attention to emotional needs requires support and counseling. Support be offered in following ways, listning ,touching and physical presence. Touching and physical presence are most helpful for children because they facilitate non verbal communication. Counseling Involves a mutual exchange of ideas and opinions that provides the basis for mutual problem solving. It involves, teaching, techniques to foster the expression of feelings or thoughts and approaches to help the family cope with stress. Optimally counseling not only helps resolve a crisis or problem but also enables the family to attain a higher level of functioning, greater self-esteem, and closer relationships .

38. Disease prevention and promotion of health

39. Current trends in health care have focused on prevention of illness and maintenance of health rather than treatment of disease or disabilit . Regardless of the identified problem the role of the nurse is to plan care that fosters every aspect of growth and development based on thorough assessment process, DENTAL CARE, PROBLEMS RELATED TO NUTRITION ,IMMUNIZATIONS, SAFETY, MENTAL HEALTHDEVELOPMENT, SOCIALIZATION ,DISCIPLINE OR SCHOOLING often becomes obvious. Once the problem is identified the nurse acts to intervene directly or to refer the family to other health care providers or agencies

40. Coordination and collaboration

41. Cont… The nurse as a member of health care team collaborates and co-ordinates nursing services with the activities of other professionals. The concept of holistic care can be realized only through a unified inter disciplinary approach.

42. Nursing process application

43. Current statistics in Pediatric...

44. INDICATOR SRS 2014 SRS 2019 SRS 2020 Crude Birth Rate (CBR) 21.0 19.7 19.5 Total Fertility Rate 2.3 2.1 2.0 Early Neonatal Mortality Rate (ENMR) – 0- 7 days 20 16 15 Neonatal Mortality Rate (NMR) 26 22 20 Infant Mortality Rate (IMR) 39 30 28 Under 5 Mortality Rate (U5MR) 45 35 32

45. Under five Mortality Data.. Following a steady downward trend, IMR, U5MR and NMR have further declined:  Under 5 Mortality Rate (U5MR) for the country has shown significant decline of 3 points (Annual Decline Rate: 8.6%) from 2019 (32 per 1000 live births in 2020 against 35 per 1000 live births in 2019). It varies from 36 in rural areas to 21 in urban areas. U5MR for Female is higher (33) than male (31). There has been a decline of 4 points in male U5MR and 3 points in female U5MR during the corresponding period. Highest decline of U5MR is observed in the State of Uttar Pradesh (5 points) and Karnataka (5 points) 

46. Infant Mortatlity Rate .. Infant Mortality Rate (IMR) has also registered 2-point decline to 28 per 1000 live births in 2020 from 30 per 1000 live births in 2019 (Annual Decline Rate: 6.7%). The Rural-Urban difference has narrowed to 12 points (Urban 19, Rural-31). No gender differential has observed in 2020 (Male -28, Female - 28).

47. Neonatal Mortality Rate... It also declined by 2 points from 22 per 1000 live births in 2019 to 20 per 1000 live births in 2020 (Annual Decline Rate: 9.1%). It ranges from 12 in urban areas to 23 in rural areas.

48. Ethics in pediatric nursing practice: Non maleficence :obligation to minimize or prevent pain. Beneficence: obligation to promote child’s wellbeing Justices: There are three aspects as legal justice, respect for right, and fair distribution of resources even the nurses time and attention. Respect for autonomy : Respect the individual’s right to make informed and thought out decisions for themselves. Truth telling    

49. Difference between old and new trends Old trends New trends single dimension care Multi dimension care Curative approach Preventive approach No concept of primary health care Concept of primary health care adapted Community and family were not considered Community and society are considered Patient centered approach was used Family centered approach is used Simple technical skills are used Complex technical skills are used Role of nurse was limited with no specialization New roles of nurse emerging

50. OLD TRENDS NEW TRENDS Care given had a little scientific base Increase in scientific care Judgemental role of nurses was limited Increased independence in use of judgement Hospital based service Community health services Only the need of ill was served Needs of healthy as well as those of ill are served Child health care was limited to 10-12 years of children Child health care includes adolescents as well like through RCH services No special attention is given to children at risk special attention is given to children at risk No movements are made against social evils Movements against social evils well implemented Less political involvement care More political involvement

51. References: Marliyn,j , hochenberry , david , Wilson, wong’s essentials of pediatric nursing, 8 th edition. Elsevier, page 10-18. Terry kyle essentials of pediatrics,7 th edition,Lippincott Williams and wilkins perspectives of pediatric nursing page no 7-9 DuttaParul ; “Pediatric Nursing”; 2nd edition; published by Jaypee publishers. Pp2-3.

52. Thank you