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1. Pediatric health Nursing unit I BSN year III, semester V By Hidayatullah khan BSN, DPN & MSN KMU- INS

2. Objectives Perspectives of Pediatric Nursing Define the pediatric nursing. List the roles of pediatric nurse. Explain United Nations Convention on the Rights of the Child (UNCRC) Understand ethical and legal issues face by paediatric nurses in Pakistan

3. Perspectives of Pediatric Nursing Definition of Pediatric Nursing Nursing is the caring for prevention of illness, the alleviation of suffering, and the protection, promotion , and restoration of health in the care of individuals, families, groups, communities, and population.

4. Definition of pediatric nursing cot… It is the art and science of giving nursing care to children from birth through adolescent with emphasis on the physical growth, mental, emotional and psycho-social development.

5. Role of Pediatric Nurse The goals of nursing care of children, are: Promote the healthy maturation of the child as a physical, intellectual and emotional being within the context of his family and community (primary level) Provide health care for the child who requires treatment from disease(s) (secondary level) Dealing with the Child's disabilities (tertiary level) or rehabilitation which means maximizing the child's potential level of his body function.

6. The role of the pediatric nurse includes:- In primary level Through health education to the child and his parents and providing child's basic needs and immunization. The nurse can: Maintain child's health. Help the child to achieve his optimal growth and development. Prevent diseases and their complications.

7. secondary level: The nurse has to provide care to sick children and their families by: Assessing their needs. Planning for their care . Implementing the nursing care plan. Evaluating children's condition and the plan of care Providing health teaching to children and their parents

8. In tertiary level The nurse should assist children to return to their maximal level of functioning following illness and or disabilities.

9. Family-Centered Care The Family-Centered Care approach is: recognizes the family as the one constant in a child’s life, through Three key component ( Respect, Collaboration & Support).

10. Parent education Growth and development needs Child's health promotion and maintenance as nutritional need and hygienic care. Preventive aspects such as (accident prevention, immunization, periodic examination). Child's illness (nature of illness and care needed). Plan for child's discharge such as child's medication, follow up, nutrition…..etc.

11. Family-Centered Care The Family-Centered Care approach is: The philosophy of family-centered care recognizes the family as the one constant in a child’s life, through Three key component ( Respect, Collaboration & Support).

12. The role of pediatric nurse Therapeutic relationship. Family advocacy/caring. Disease prevention and health promotion. Health teaching. Support/Counseling.

13. The role of pediatric nurse Restorative role. Coordination/Collaboration. Research: to apply research findings to their practice. Health care planning on political or legislative level. Ethical decision making.

14. The role of pediatric nurse Ethical decision making: Autonomy…….. The patient’s right to be self- governing. Nonmaleficence….. The obligation to minimize or prevent harm. Beneficence……. The obligation to promote the patient’s well being. Justice…….. The concept of fairness.

15. The Rights of the child

16. United Nations Convention on the Rights of the Child (UNCRC)

17. The United Nations Convention on the Rights of the Child (UNCRC) • The UNCRC is an international agreement across the world which sets out rights of children between the age of 0 and 18. adoption by the UN General Committee in 1989 and it is the most widely adopted of all international agreements. As of November 2009, 194 countries have ratified it , including every member of the United Nations. The UNCRC itself consists of 54 articles .

18. What is a right? • Human rights are the basic things that all human beings are entitled to in order to survive and to develop. Every single person regardless of their age has human rights, and the Government has a responsibility to make sure that people’s rights can be accessed, are respected can be enjoyed. • Children and young people need special rights because they are relatively more vulnerable compared to adults. The UNCRC brings together children’s human rights into one international convention. • The Government has a responsibility to ensure that all people understand and respect Children’s Rights - this includes children and young people, parents, families & teachers etc.

19. Definition of the child: The Convention defines a 'child ' as a person below the age of 18. Non-discrimination: The Convention applies to all children; whatever their race, religion, language, boys or girl, rich or poor. No child should be treated unfairly on any basis. Best interests of the child: The best interests of children must be the primary concern in making decisions that may affect them. This particularly applies to budget, policy and law makers.

20. Protection of rights: Governments have a responsibility to take all available measures to make sure children’s rights are respected, protected and fulfilled.   Parental guidance: Governments should respect the rights and responsibilities of families to direct and guide their children so that, as they grow, they learn to use their rights properly. Survival and development: Children have the right to live. Governments should ensure that children survive and develop healthily.

21. Registration, name, nationality, care: Registration, name, nationality, care All children have the right to a legally registered name, officially recognized by the government. Children have the right to a nationality (to belong to a country). Children also have the right to know and, as far as possible, to be cared for by their parents. Preservation of identity: Children have the right to an identity – an official record of who they are. Governments should respect children’s right to a name, a nationality and family ties.

22. Separation from parents: Children have the right to live with their parent(s), unless it is bad for them. Children whose parents do not live together have the right to stay in contact with both parents, unless this might hurt the child. Family reunification: Families whose members live in different countries should be allowed to move between those countries so that parents and children can stay in contact, or get back together as a family. Kidnapping: Governments should take steps to stop children being taken out of their own country illegally.

23. Respect for the views of the child: When adults are making decisions that affect children, children have the right to say what they think should happen and have their opinions taken into account. Freedom of expression : Children have the right to get and share information, as long as the information is not damaging to them or others.  Freedom of thought, and religion : Children have the right to think and believe what they want and to practice their religion, as long as they are not stopping other people from enjoying their rights.

24. Freedom of association : Children have the right to meet together and to join groups and organizations, as long as it does not stop other people from enjoying their rights. Right to privacy: Children have a right to privacy. The law should protect them from attacks against their way of life, their good name, their families and their homes.

25. Access to information; mass media : Children have the right to get information that is important to their health and well-being. Governments should encourage mass media – radio, television, newspapers and Internet content sources – to provide information that children can understand and to not promote materials that could harm children.

26. Parental responsibilities; state assistance : Both parents share responsibility for bringing up their children, and should always consider what is best for each child. governments to provide support services to parents, especially if both parents work outside the home. Protection from all forms of violence : Children have the right to be protected from being hurt and mistreated, physically or mentally.   Children deprived of family environment : Children who cannot be looked after by their own family have a right to special care and must be looked after properly, by people who respect their ethnic group, religion, culture and language. 

27. Adoption : Children have the right to care and protection if they are adopted .The same rules should apply whether they are adopted in the country where they were born, or if they are taken to live in another country. Refugee children : Children have the right to special protection and help if they are refugees (if they have been forced to leave their home and live in another country) . Children with disabilities : Children who have any kind of disability have the right to special care and support, so that they can live full and independent lives.

28. Health and health services : Children have the right to good quality health care – the best health care possible – to safe drinking water, nutritious food, a clean and safe environment, and information to help them stay healthy. Rich countries should help poorer countries achieve this.   Review of treatment in care : Children who are looked after by their local authorities, rather than their parents. Their care and treatment should always be based on “the best interests of the child”.

29. Social security: Children – either through their guardians or directly – have the right to help from the government if they are poor or in need. Adequate standard of living : Children have the right to a standard of living that is good enough to meet their physical and mental needs. Governments should help families and guardians who cannot afford to provide this, particularly with regard to food, clothing and housing.

30. Right to education : All children have the right to a primary education, which should be free. Goals of education: Children’s education should develop each child’s personality, talents and abilities to the fullest. It should encourage children to respect others, human rights and their own and other cultures. Children of minorities/indigenous groups : Minority or indigenous children have the right to learn about and practice their own culture, language and religion.

31. Leisure, play and culture : Children have the right to relax and play, and to join in a wide range of cultural, artistic and other recreational activities.   Child labour : The government should protect children from work that is dangerous or might harm their health or their education.   Drug abuse: Governments should use all means possible to protect children from the use of harmful drugs and from being used in the drug trade.

32. Sexual exploitation : Governments should protect children from all forms of sexual exploitation and abuse.   Abduction, sale and trafficking : The government should take all measures possible to make sure that children are not abducted, sold or trafficked. Other forms of exploitation : Children should be protected from any activity that takes advantage of them or could harm their welfare and development.

33. Detention and punishment : No one is allowed to punish children in a cruel or harmful way. Children who break the law should not be treated cruelly. They should not be put in prison with adults, should be able to keep in contact with their families, and should not be sentenced to death or life imprisonment without possibility of release. War and armed conflicts : Governments must do everything they can to protect and care for children affected by war. Children under 15 should not be forced or recruited to take part in a war or join the armed forces.

34. Rehabilitation of child victims : Children who have been neglected, abused or exploited should receive special help to physically and psychologically recover and reintegrate into society. Particular attention should be paid to restoring the health, self-respect and dignity of the child.

35. Juvenile justice : Children who are accused of breaking the law have the right to legal help and fair treatment in a justice system that respects their rights. Governments are required to set a minimum age below which children cannot be held criminally responsible and to provide minimum guarantees for the fairness and quick resolution of judicial or alternative proceedings.

36. Respect for superior national standards : If the laws of a country provide better protection of children’s rights than the articles in this Convention, those laws should apply.   Knowledge of rights - Implementation and monitoring : Governments should make the Convention known to adults and children. Adults should help children learn about their rights, too. To ensure implementation, States shall establish “a Committee on the Rights of the Child … [to which UNICEF] and other [UN] organs [may] provide expert advice.

37. Legal and Ethical Issues in Pediatrics,

38. Malpractice in the Pediatric Settings Negligence is defined as an occasion when a person owes a duty to another and, through failure to fulfill that duty, causes harm Malpractice is professional negligence

39. For a court to recognize a claim of malpractice or negligence, four legal elements must be present: There must be a duty owed to the client by nurse The nurse must breach the duty The breach of duty must be the cause of the damage There must be actual damage to the client

40. Breach of Duty: 5 R Rule

41. State Statutes State Nursing Practice Act and PNC Rules & Regulations Define the scope and limitations of professional nursing practice Vary from state to state but have common elements Penalties for violations Formal reprimand Period of probation Fines Limiting, suspending, or revoking license

42. Informed consent Informed Consent (IC) is the duty of a health care provider to discuss the risks and benefits of a treatment or procedure with a client prior to giving care

43. IC must include the following: The nature of the procedure The risks and hazards of the procedure The alternatives to the procedure The benefits of the procedure

44. When IC is Not Required In case of emergency situation in case if health care providers have made a reasonable attempt to contact the child parent evaluation and treatment of a child for suspected physical or sexual abuse. In case of forensic examination (do not force or restrain the child to perform genital or rectal examination)

45. When a minor can consent for care? Care involving pregnancy, contraception, or treatment of STD Drug and alcohol treatment In some states – emancipated children can make their health care decisions by themselves

46. When a minor can consent for care? “ a minor can consent to care as long as the individual demonstrates the maturity to understand the risks and benefits of the treatment”

47. Parental Consent after Divorce After divorce, the ability to consent for medical care rests with the parent who has been granted legal custody by the divorce decree ( the legal document approved by the court that grant divorce, divides marital property, and specifies child custody) Legal custody v. physical custody

48. Refusal of Medical Care by Parent or Child Religious beliefs - state can make legal decision for the child PARENS PATRIE

49. Refusal of Medical Care by Parent or Child Some states use child abuse statutes that make medical neglect a form of abuse as legal justification to take custody of a child who needs medical care. The religious exemption clause only prevent the parents from being prosecuted for medical neglect.

50. Obtaining IC under Special Circumstances Consent for donation of tissues or organs Consent for genetic testing Consent for medical experimentation with children

51. Consent for Donation of Tissues or Organs If a child is too young, the parent or legal guardian may consent for the child Three requirement for the minor to be a donor: The parent who is consenting must be aware of the risks and benefits The child primary caregiver must be able to provide emotional support for the child There must be a close relationship between the donor and the recipient

52. Consent for Genetic Testing Dilemma created by new technology The benefits and the risks should be discussed with a child if appropriate Parents or guardian can consent for the testing Genetic testing should not be performed on a child unless the results of the test will serve the best interests of the child

53. Consent for Medical Experimentation on Children All research facilities that receive federal funds must comply with federal regulations that require review of all experimental protocols by an Institutional Review Board (IRB) Federal regulations require the consent of one or both parents and the assent of the child, depending on the amount of the potential risk and benefit associated with the treatment or procedure.

54. Confidentiality The right to confidential health care is protected by PNC the ethical codes of conduct. Confidentiality is an essential part of the relationship between client and health care provider Nurse has a duty of confidentiality (disciplined by both employer and PNC)

55. When a Minor can Receive Confidential Care Contraception, treatment of STD Drug and alcohol treatment Mental health care HIV testing DEPENDS ON STATE LAWS AND REGULATIONS

56. When a Health Care Provider Can Breach Confidentiality There are 4 exceptions: Mandatory reporting laws for child abuse Mandatory injury reporting laws that apply to all clients who are injured by a weapon or criminal act Public health law that require reporting infectious diseases to the local health department A duty to warn third parties