Ch1 – NUR320 – Pediatric Health Nursing – EXAM 1 CONTENT

accommodation
The process of changing an individual’s cognitive structures to include data from recent experiences.

adherence
The extent to which a patient or parent acts consistently with regard to recommended care.

advance directives
A patient’s living will or appointed durable power of attorney for healthcare decisions.

Advocacy
Acting to safeguard and advance the interests of another.

Assent
Voluntary agreement to participate in a research project or to accept treatment.

autonomy
Right for self-determination in decision making or to protect the informed choices of patients who are capable of decision making.

Beneficence
An obligation to act or make a decision to benefit the patient.

Case management
A process of coordinating the delivery of healthcare services in a manner that focuses on both quality and cost outcomes.

Clinical pathways (critical pathways)
Structured care plans for a specific patient problem that outline patient goals and essential steps in the management of a child by multiple healthcare professionals within a healthcare facility.

Clinical practice guidelines
Specific medical and nursing assessments and interventions that occur during specific time intervals for a specific condition; often adopted by an institution for all healthcare providers to follow so that quality of care is increased and costs of care are minimized.

competence
An ability to be involved in healthcare decisions requiring a certain degree of intellect, an ability to communicate, and an ability to remember.

Confidentiality
An agreement between a patient and a provider that information discussed during the healthcare encounter will not be shared without the permission of the patient.

continuity of care
An interdisciplinary process of facilitating a patient’s transition between and among settings based on changing needs and available resources.

Critical thinking
An individualized, creative thinking or reasoning process that the nurse uses to solve problems.

emancipated minors
Self-supporting adolescents under 18 years of age not subject to parental control.

Ethics
The philosophic study of morality, and the analysis of moral problems and moral judgments.

Evidence-based practice
Integration of the best research evidence with an individual’s clinical expertise and the patient’s values or preferences.

Family-centered care
A partnership between families, the nurse, and other health professionals in which the priorities and needs of the family are addressed when the family seeks health care; a dynamic, deliberate approach to building collaborative relationships between health professionals and families that are respectful of diversity and beliefs about the nature of the child’s condition and ways to manage it.

Health literacy
The degree to which individuals have the capacity to obtain and understand basic health information needed to make appropriate health decisions.

healthcare home
A continuous, comprehensive, family-centered, and compassionate source of health care. Also known as a medical home.

Informed consent
A formal preauthorization for an invasive procedure or participation in research.

Justice
Fairness in the use of resources.

Managed care
A health delivery system that combines financing and delivery of specified healthcare services with the following elements in place: clinicians are contracted to provide services for a preset fee, clinicians are selected according to specific standards, formal programs of quality assurance and utilization review are in place, and members of the health program have incentives to use selected clinicians.

Mature minors
Adolescents of 14 and 15 years of age who are able to understand treatment risks and who, in some states, can consent to or refuse treatment.

Medical futility
The treatment of an irreversibly dying patient that provides no physiologic benefit to the patient.

medical home
A continuous, comprehensive, family-centered, and compassionate source of health care. Also known as a healthcare home.

moral dilemma
A conflict of social values and ethical principles that support different courses of action.

morbidity
An illness or injury that limits activity, requites medical attention or hospitalization, or results in a chronic condition.

Nonmaleficence
To prevent harm.

partnership
A relationship in which participants join together to ensure healthcare delivery in a way that recognizes the critical role and contribution of each partner in promoting health, preventing illness, and managing healthcare conditions.

privacy
Ability of an individual to relate information in a protected manner.

Quality improvement
The continuous study and improvement of the processes and outcomes of providing healthcare services to meet the needs of patients by examining the system and processes of care and service delivery.

Risk management
A process established by a healthcare institution to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors, and thereby reduce the institution’s liability.

BOX 1-1 Expected Competencies of the Pediatric Nurse
The Society of Pediatric Nurses has described the competencies for pediatric prelicensure and early professional development for the generalist pediatric nurse.
■ An understanding of the unique anatomical, physiological, and developmental differences among neonates, infants, children, and adolescents, as well as the needs unique to the growth and development of children who have chronic conditions and their families;
■ The ability to care for children and promote their health in the context of their families;
■ The ability to communicate effectively with children, families, and other healthcare providers, demonstrating sensitivity to cultural issues, especially those related to how the family and healthcare providers tend to children’s healthcare needs;
■ The provision of safety assurance and injury prevention to children and their families;
■ The ability to provide for the exceptional needs of children with episodic injuries or illnesses;
■ The ability to assess the unique growth and development needs of children who have chronic conditions and of their families;
■ An understanding of the economic, social, and political influences outside the family that have an impact on children’s health and development and family functioning; and
■ An understanding of the ethical, moral, and legal dilemmas involving children, families, and healthcare professionals.

Source: Reprinted with permission from American Nurses Association, National Association of Pediatric Nurse Practitioners, and Society of Pediatric Nurses, Pediatric Nursing: Scope and Standards of Practice, © 2008 Nursesbooks.org, Silver Spring, MD.

BOX 1-2 Significant Federal Legislation Affecting Child Health
■ 1920—Sheppard-Towner Act supported services to mothers and infants.
■ 1935—Social Security Act included two important programs for children: Aid to Families with Dependent Children (AFDC), now called Temporary Assistance to Needy Families (TANF), and Title V of this act, which initiated programs to improve the health of mothers and children.
■ 1946—National School Lunch Act created the modern school lunch program.
■ 1965—Medicaid, under Title XIX of the Social Security Act, enabled indigent pregnant women and children to have access to health care.
■ 1966—Child Nutrition Act initiated the school breakfast program.
■ 1970—Poisoning Prevention Packaging Act required that dangerous medications were to have childproof caps.
■ 1972—Women, Infants, and Children (WIC) program began providing supplemental food for low-income pregnant women, infants, and children.
■ 1973—Rehabilitation Act required that accommodations be made for children with disabilities to have access to schools and other public programs.
■ 1974—Child Abuse Prevention and Treatment Act provided funding for recognition of child abuse and development of child protection teams. This law also specified that every baby, regardless of disabilities, should receive nutrition, hydration, and medication.
■ 1975—Education for All Handicapped Children Act mandated that children with disabilities receive a free and appropriate education in the least restrictive environment. This act was reauthorized as the Individuals with Disabilities Education Act (IDEA) in 1 997 and 2004, and children with disabilities were provided with educational opportunities and benefits equivalent to their nondisabled peers.
■ 1984—Emergency Medical Services for Children program was created to improve the quality of and access to emergency care for children with acute illnesses and injuries.
■ 1997—State Children’s Health Insurance Program (SCHIP) legislation expanded health coverage to children through 19 years of age in families with an income too high to qualify for Medicaid.

Nurses Provide Care for a Wide Range of Problems
Care of the healthy child
Care of the acutely ill
Care of the injured
Care of the chronically ill
Care of the client and family

Nurses Provide Care in a Wide Range of Settings
Hospitals
Healthcare provider offices and clinics
Home of the child
Rehabilitation centers
Schools, childcare centers
Community

Nurses May Specialize in Pediatrics
Standards of pediatric nursing developed
The Society of Pediatric Nurses (SPN) (www.pedsnurses.org) developed the scope and standards of pediatric nursing practice

National Association of Pediatric Nurse Practitioners (NAPNAP) (www.napnap.org)

Nurses May Work in Many Different Areas of Pediatrics
Direct patient care
Education
Advocacy
Case management
Research

General Pediatric Nurses Follow the Nursing Model
Assess care needs
Use nursing diagnosis
Plan, implement, and provide care based on nursing diagnosis with collaboration of healthcare team members
Evaluate care

Barnard’s Child Health Asssessment Interaction Model
Every child has a family
That child and family are intertwined with their environment: one cannot separate a child from his/her family and/or environment

Advanced Practice Nurse (APN)
Graduate-level education in nursing (MSN or DNP)
Clinical nurse specialist (CNS)
Pediatric nurse practitioner (NP, PNP, ARNP)
More responsibility for care of client and client outcomes

Supervising Unlicensed Persons
Medical assistants (MA)
Certified nursing assistants (CNA)
Licensed practical nurse (LPN)/Licensed vocational nurse (LVN)

First Child/Family Clinic
Established in 1890s by Lillian Wald

First National Legislation
The 1920 Sheppard-Towner Act
Supported services to mothers and infants

Social Security Act
Aid to Families with Dependent Children (AFCD) in 1935
Title V
Various legislative acts support child health

Advances Contributing to Child Healthcare
Immunizations: Primary Interventions
Antibiotics: Secondary or Tertiary Interventions
Technology

Infant Mortality: Age 1 to 27 days
Leading cause of death: prematurity

Figure 1-6 Leading causes of death in the United States in the neonatal period (in infants up to 28 days of age) in 1993 and 2004. Why do you think the neonatal mortality rate associated with short gestation and low birth weight was higher in 2004 than in 1993? What could account for the dramatic reduction in mortality due to respiratory distress syndrome? Consider the impact of advances in healthcare technology on the changes in mortality rates during the decade illustrated. The neonatal intensive care nurseries have collaborated in multicenter research trials to identify the medical interventions associated with the best outcomes for low-birth-weight infants and those with respiratory distress syndrome. New technology and new knowledge have improved survival of infants with respiratory distress syndrome, but there are increasing numbers of very-low-birth-weight infants alive at birth who die in the first days of life. Source: Data from National Center for Health Statistics. (1996). Vital statistics of the United States, vol. 2: Mortality. Part A. Washington, DC: Public Health Service; Hyattsville, MD: Public Health Service; Heron, M. (2007). Death: Leading Causes for 2004. National Vital Statistics Reports, 56(5), 80-83.

Infant Mortality: Age 28 days to 1 year
Leading cause of death: SIDS

Figure 1-7 Leading causes of death in the United States in the postneonatal period, 1993 and 2004 (in infants between 28 days and 1 year old). In 1993, the mortality rate for sudden infant death syndrome was 109.5 per 100,000 live births in contrast to 2004 when the mortality rate was 49.5 per 100,000 live births. The change in recommended sleep position for newborns and infants from the stomach to the back has been credited with much of this decreased rate of SIDS. See Chapter 24 for more information. Source: Data from National Center for Health Statistics. (1996). Vital statistics of the United States, vol. 2: Mortality. Part A. Washington, DC: Public Health Service; Heron, M. (2007). Death: Leading Causes for 2004. National Vital Statistics Reports, 56(5), 83-86.

Infant Mortality
Death rate per 1,000 live births

Figure 1-8 Ranking the nations with the lowest infant mortality rates in the world in 2005. Note the 36 nations that have a lower infant mortality rate than the United States. What could account for the United States’ poorer ranking? Source: Data from World Health Organization. (2007). WHO Statistical Information System, Core health indicators. Retrieved July 28, 2007, from http://www.who.int/whosis/database/core/core_select_process.cfm

2: Iceland, Signapore
3: Czech Republic, Finland, Japan, Monaco, Norway, San Marino, Slovenia, Sweden
4: Austria, Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Israel, Italy, Netherlands, Portugal, Spain, Switzerland
5: Australia, Canada, Cuba, Malta, New Zealand, United Kingdom
6: Andorra, Croatia, Estonia, Hungary, Poland, Republic of Korea
7: United States

Child Mortality: Age 1-4 years
Leading cause of death: unintentional injury

Figure 1-9 Age-specific death rate per 100,000 children in the United States in 1992 and 2004 for children 1 to 4 years of age. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webappa.cdc.gov/sasweb/ncipc/leadcause10.html

Child Mortality: Age 5-9 years
Leading cause of death: unintentional injury

Figure 1-10 Age-specific death rate per 100,000 children in the United States in 1992 and 2004 for children 5 to 9 years of age. Throughout the decade the leading cause of death in children between the ages of 5 and 9 years was unintentional injury. Why do you think that is? Do you think these data still apply today? Which type of injury has the highest rate of death? Drowning? Fires and burns? Motor vehicle crashes? See Table 1-1 for the answer. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webappa.cdc.gov/sasweb/ncipc/leadcause10.html

Child Mortality: Age 10-14 years
Leading cause of death: unintentional injury

Figure 1-11 Age-specific death rate per 100,000 children in the United States in 1992 and 2004 for children 10 to 14 years of age. Which injuries are leading causes of death in this age group? Which ones are unintentional and which are intentional? See Table 1-1 for the answer. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webapppa.cdc.gov/sasweb/ncipc/leadcause10.html

Child Mortality: Age 15-19 years
Leading cause of death: unintentional injury

Figure 1-12 Death rates per 100,000 adolescents 15 to 19 years in the United States in 1992 and 2004. Unintentional and intentional injuries are the leading causes of death in this age group. Why do you think this is happening? See Chapters 18 and 34for information on violence and suicide. Source: Data from National Center for Health Statistics. (1995). Age-specific death rates for children, 1992. National Vital Statistics System, unpublished data; National Center for Health Statistics. (2007). Injury deaths and rates for children and teenagers by age, external cause, and intent, 2004, National Vital Statistics System. Retrieved July 21, 2007, from http://webappa.cdc.gov/sasweb/ncipc/leadcause10.html

Nursing Role in Injury Prevention
Education about causes of injury and death
Anticipatory guidance for parents and caregivers

Healthy People 2010
National objective to decrease mortality rates for high-risk categories
Education in injury prevention is active nursing role
Seek funding from federal agencies for education of clients and community

Informed Consent
Healthcare provider must obtain
Must be obtained for invasive procedures and some medical treatments
May be delayed in emergency situations

Nurse’s role in obtaining informed consent
Assess and document
Review rights of minors
Develop therapeutic relationship
Verify prior consent
Serve as witness

Minor Defined by Individual State Laws
Until the person reaches age of adult based on state law, parent or guardian must provide informed consent.
Parent or guardians have ultimate decision, with some exceptions.

Minors May Give Informed Consent in Certain Circumstances
Emancipated minor
Minor is parent of a child receiving treatment

Children Should Be Given Age-Appropriate Information
Assent and preference by child should be obtained

Advances in Medical Treatment
Ability to save lives of severely impaired infants
Genetic testing
Gene therapy

Ethical Guidelines
Define
Evaluate
Identify
Apply principles
Make decisions

Increase in Ethical Issues and Decisions
Nurses use four ethical principles
– Beneficence
– Nonmaleficence
– Autonomy
– Justice

Healthcare Institutions and Ethics Committees
Ethics committees resolve conflicts and make recommendations

BOX 1-11: Legal & Ethical Considerations: Informed Consent
Information that must be provided to obtain informed consent includes an explanation of the condition, a detailed description of the treatment (such as surgical procedures, blood products, sedation, anesthesia, and certain diagnostic procedures), possible benefits and significant risks associated with the proposed treatments, possible alternative treatments, answers to questions, and notification of a parent’s or guardian’s right to refuse treatment on behalf of the child.

Current Issues Causing Increasing Conflict for Nurses and Families
End of life-sustaining treatment
Genetic testing of children
Organ transplant
Research on children

■ Roles of nurses in caring for children include providing direct care (health promotion, health maintenance, and nursing care for health conditions), patient education, patient advocacy, and case management, and minimizing the psychological and physical distress experienced by children and their families.

■ Nurses care for children in many different settings: various units within the hospital and outpatient clinics, schools, childcare centers, physician offices, community health centers, rehabilitation centers, and the home.

■ Family-centered care is a method designed to meet the emotional, social, and developmental needs of children and families needing health care.

■ Nurses must identify culturally relevant facts about their patients to provide appropriate and competent care to an increasingly diverse population.

■ Unintentional injury is the leading cause of death for children between 1 and 1 9 years of age.

■ Efforts to increase the number of children with access to health care include the State Children’s Health Insurance Program (SCHIP) currently being implemented nationwide.

■ Documentation of nursing care is essential for risk management and quality improvement. Documentation must include the patient assessment, the nursing care plan, the child’s responses to medical therapies and nursing care, and the regular evaluation of the child’s progress toward nursing goals.

■ Informed consent is the formal preauthorization for an invasive procedure or participation in research. Parents typically give informed consent for children under 1 8 years of age unless the child is an emancipated minor, a self-supporting adolescent not subject to parental control.

■ Children need to become more actively involved in decisions about their care as their decision-making abilities develop. Even though they cannot provide informed consent, federal guidelines mandate that children as young as 7 years of age receive information about treatment procedures and research project participation and give their assent.

■ Because adolescents fear disclosure of confidential information, they may avoid seeking health care. When adolescents have a reportable disease, it is important to inform them that confidentiality cannot be maintained, as a report must be made to a public health agency.

■ Adolescents at a higher risk of death due to a serious acute or chronic condition should be encouraged to talk with their parents and jointly prepare advance directives.

■ Federal regulations require a formalized ethical decision-making process to assist healthcare providers and families in making important decisions about withholding, withdrawing, or limiting a child’s therapy.

Which role would the nurse be serving when helping parents understand and respond to the needs of an ill child’s siblings?

A) Educator
B) Case manager
C) Advocate
D) Researcher

C) Advocate

Rationale: The nurse acts to safeguard the child’s interests by educating and supporting his parents; therefore, advocate is correct. A team effort is not being coordinated as it relates to the child’s needs, so case manager is incorrect. The nurse is, in fact, educating the child’s parents. The education is focused specifically on advocacy in relation to the child’s needs, so educator also is incorrect. Though the nurse would certainly want to provide evidence-based care to the family, the role in this instance is that of an advocate for the child, not a researcher.

In planning care for a student with a seizure disorder, the school nurse considers that this child’s educational rights are protected by which most recent federal legislation?

A) Sheppard-Towner Act
B) The Individual with Disabilities Education Act
C) Healthy Start
D) Title V

B) The Individual with Disabilities Education Act

Rationale: The Individual with Disabilities Education Act was designed to ensure that all children have access to appropriate education in the least restrictive environment. The other choices are not the most recent. Review IDEA 1997.

Prior to identifying a nursing diagnosis for a 3-year-old child with seizure disorder, it is important that the nurse:

A) Use both objective and subjective measures to assess progress in meeting goals for the child.
B) Synthesize data to make a judgment about the child’s problems.
C) Carry out interventions specified in the nursing care plan for him.
D) Define nursing intervention classifications (NICs) relevant to his care.

B) Synthesize data to make a judgment about the child’s problems.

Rationale: It is important to assess prior to making decisions; therefore, synthesizing data to make a judgment about the child’s problems is the best answer. Carrying out interventions specified in the nursing care plan for him would be premature; remember that the nurse should assess before any intervention. Defining nursing intervention classifications (NICs) relevant to his care would not be done yet; after assessing, the nurse would examine the NIC database. Using both objective and subjective measures to assess progress in meeting goals for the child also is incorrect. First the nurse would have to define those goals, following a comprehensive assessment.

The nurse assigned to care for a 3-year-old child with seizure disorder is unsure of protocols for nursing management of children with seizure disorders. To identify the best evidence to use to provide care, the nurse should consult:

A) Research studies.
B) Internet search engines.
C) Critical pathways for 3-year-old children.
D) Clinical practice guidelines.

D) Clinical practice guidelines.

Rationale: Clinical practice guidelines are most valuable in promoting uniformity and excellence in care. The wealth of both credible and incorrect information on the Internet precludes the use of Internet search engines for best care. A synthesis of the best research is provided in clinical practice guidelines. Individual articles are not sufficient as guides to practice. Because the child is 3 years old, the nurse would need to consult only critical pathways that have as their focus protocols for managing seizures in children. These are found in clinical practice guidelines.

The nurse is planning educational interventions to reduce the incidence of the number one cause of mortality in children ages 1 to 4. Recognizing the developmental needs of this age group, the nurse would focus the session on which topic?

A) Unintentional injury awareness
B) Child abuse prevention
C) Seizure disorder management
D) Sudden infant death syndrome (SIDS) recognition

A) Unintentional injury awareness

Rationale: Unintentional injury awareness includes motor vehicle accidents, so teaching should include prevention factors. Although all the other choices are a significant cause of mortality, they are not the number one problem for children ages 1 to 4.

The nurse recognizes the need to update knowledge related to the most common cause of hospitalization in children. On which body system should continuing education focus?

A) Respiratory
B) Musculoskeletal
C) Gastrointestinal
D) Cardiac

A) Respiratory

Rationale: Respiratory diseases are the most common admission to hospitals in children from 1 to 14 years old. They account for 33% of hospital discharges in the 1- to 14-year-old age group.

The nurse is caring for a pediatric patient not covered by insurance. Which statement to the child’s parents regarding the State Child Health Insurance Program is accurate?

A) Families are only eligible if the parents are unemployed.
B) Eligibility for coverage is determined based on household income and the number of children.
C) Early application is recommended due to the large number of applications received annually.
D) Eligibility for the program is determined based on the child’s medical diagnosis.

B) Eligibility for coverage is determined based on household income and the number of children.

Rationale: The State Child Health Insurance Program is designed to provide the patient with health insurance comparable to federal/state employee benefit programs. This program is undersubscribed, with lack of knowledge of its eligibility requirements being one of the barriers to subscription.

A 15-year-old is hospitalized following her second relapse of acute myelogenous leukemia and is scheduled for a bone marrow transplant. She tells the nurse that she doesn’t want to go through with it and that she would rather die. The nurse should:

A) Inform the patient’s teacher.
B) Inform the physician and nursing supervisor.
C) Ensure that her parents sign the informed consent form.
D) Cancel the procedure.

B) Inform the physician and nursing supervisor.

Rationale: The child is of an age where issues of consent need to be considered seriously; therefore, informing the physician and nursing supervisor is the best answer. Telling her teacher of her decision violates patient confidentiality. Canceling the procedure is not under the nursing scope of practice. Ensuring that her parents sign the informed consent form does not address the moral conflict in this situation.

An adolescent client states that he would rather die than undergo a prescribed treatment. Which of the following ethical principles should direct the nurse in planning care for this client? (Select all that apply.)

A) Compassion
B) Autonomy
C) Beneficence
D) Nonmaleficence
E) Justice

B) Autonomy
C) Beneficence
D) Nonmaleficence

Rationale: Autonomy, the right to self-determination, and involvement in decision making should be respected in all individuals to the extent of their capacities. Adolescents are able to think abstractly and should have this right respected. Often it is compromised. Beneficence – an obligation to act or to make a decision to benefit the client, promoting the child’s well-being in addition to working with parents and other family members – and nonmaleficence, preventing harm, also are appropriate. Justice, or fairness in the use of scarce resources, is another ethical principle important to consider in decision making but is not central to this situation. Compassion is considered a virtue, not an ethical principle.

In order to administer a medication safely to a pediatric client, what drug information must the nurse be aware of that is not always essential when administering a medication to an adult client?

A) Recommended dose per kilogram of body weight
B) Commonly expected side effects
C) Incompatibilities with other medications
D) Indicators of drug toxicity

A) Recommended dose per kilogram of body weight

Rationale: Children require medication doses based on weight or body surface area. Consequently, nurses must determine the appropriateness of the ordered dose and be able to calculate its preparation. Drug calculations are very complex and consequently pose a greater risk for error.

How would you design the content of a smoking prevention patient education brochure for an immigrant population of parents written at the fifth- to sixth-grade level designed to help them counsel their school-aged children? Ensure that the brochure is both linguistically and culturally appropriate.
The brochure should be written in short words of no more than two syllables when possible with words familiar to the target audience (e.g., urinate might be better referred to as pass water). Medical terms should be expressed with simple language (e.g., pulmonary function might be changed to ease of breathing). The brochure should use short sentences as well with active rather than passive verbs. The words used should be well understood by the audience. Including graphics is a great idea. Make sure that they are correct and clearly labeled.

Now design the content of a smoking prevention patient education brochure for a population of 12-year-old students written at the fifth- to sixth-grade level. The brochure should be written in a way that attends to what is important to the children. Ensure that the writing is both developmentally and culturally appropriate.
The brochure should be written in short words of no more than two syllables when possible with words familiar to the target audience (e.g., urinate might be better referred to as pee with a school-aged population). Medical terms should be expressed with simple language (e.g., pulmonary function might be changed to the way you breathe). The brochure should use short sentences as well with active rather than passive verbs. The words used should be well understood by the audience (e.g., until adolescence, children have difficulty understanding abstract concepts). Including graphics is a great idea. Make sure that they are correct, attractive, and clearly labeled.

Review the policies and actual practices in one healthcare setting regarding the role of families in their child’s care. Consider such issues as visiting rules, presence during procedures, participation in care conferences about their child, and other activities that flow from family-centered care, such as participation in client rounds, joint decision making about care for the child, and whether a family advisory committee exists. Interview a nurse manager, a pediatrician, and a member of an allied health profession about their feelings regarding family-centered care.

What do the policies and practices identified reflect in terms of the value of families as critical partners in the care of children? Briefly describe how each one does or does not promote family-centered care.

Answers should reveal reflective thinking about what is and what should be, given theories that promote the value of family-centered care. Families play vital roles in meeting the emotional, social, and developmental needs of children and in ensuring their health and well-being.

Review the policies and actual practices in one healthcare setting regarding the role of families in their child’s care. Consider such issues as visiting rules, presence during procedures, participation in care conferences about their child, and other activities that flow from family-centered care, such as participation in client rounds, joint decision making about care for the child, and whether a family advisory committee exists. Interview a nurse manager, a pediatrician, and a member of an allied health profession about their feelings regarding family-centered care.

From the interview material gathered, discuss the likelihood that the healthcare center studied will adopt a partnership model as it relates to family-centered care. If the center already has, examine the outcomes of such an approach in terms of child and parent satisfaction.

Answers should use the interview data to determine the degree to which a family-centered care model is valued. Be careful to provide the data from which to evaluate care values, not your interpretation of the data.

A 10-year-old client sustained a deep laceration on her leg from falling on a rusty can. She had lost a significant amount of blood by the time she arrived at the hospital with her parents. Neither the child nor her parents agree to an emergency blood transfusion ordered by the physician.

Think about all the reasons why the parents and child might want to select a different treatment than that proposed by the physician (e.g., cultural, religious, protection of child, etc.), and suggest a course of action that respects the family’s autonomy while protecting the child from hypovolemia.

Your answer might include their fear of the transmission of disease through blood products; their past experiences with such treatment; their religious orientation, which might forbid transfusions, believing them to be morally and spiritually sinful; and cultural prohibitions from using blood.

Ethical issues arise from a moral dilemma, a conflict of social values and ethical principles that support different courses of action that could be correct, depending on the individual’s values and beliefs. Whereas adults are permitted to refuse blood products (even when death can occur), most healthcare institutions have policies that address the care of children in need of blood products.

A 10-year-old client sustained a deep laceration on her leg from falling on a rusty can. She had lost a significant amount of blood by the time she arrived at the hospital with her parents. Neither the child nor her parents agree to an emergency blood transfusion ordered by the physician.

Now consider the point of view of health professionals, and suggest strategies to respect both the physician’s and family’s points of view.

Physicians educated in North America tend to practice from a biomedical (scientific) rather than a holistic perspective. Ordering a treatment for a child reflects the ethical principles of beneficence, an obligation to make decisions to benefit the patient, and nonmaleficence, the intent to prevent harm. Given the emergency nature of many situations involving moral conflicts around blood products, many practitioners use plasma expanders whenever possible to prevent the need to transfuse blood. However, judicial decisions to use blood products for children sometimes are sought, and the blood is transfused against the judgment of the parents.

A 10-year-old client sustained a deep laceration on her leg from falling on a rusty can. She had lost a significant amount of blood by the time she arrived at the hospital with her parents. Neither the child nor her parents agree to an emergency blood transfusion ordered by the physician.

Think about your response as the nurse providing care to the child and family. How would you participate in the decision-making process?

The answer should include such steps in ethical problem solving as collecting as much information as possible; identifying if surrogate decision makers exist; seeking consultation on all possible courses of action; identifying strengths and benefits of all courses of action; ensuring that the family is an active participant in any decision made; and collaborating with the physician and associated health professionals working with the family.

Review the History of Child Health Care, starting on page 7 in the textbook, detailing changes in infant mortality rates over the past 150 years. Consider the history of child health services over that period for infants and school-aged children, and note the roles nursing held in the newly formed child healthcare services.

What factors or evidence led to changes in public health practice that reduced the infant mortality rates in the early 1900s?

By 1915, the infant mortality rate had decreased from 200 per 1,000 (the rate from 1850 to 1880) to 100 per 1,000 live births. Causes of death included communicable disease, poor nutrition, and epidemics of “summer diarrhea.” Improvements in infant health stemmed from a national legislative focus on prenatal care and infant health services. Funding allowed the development of initiatives to promote the health of neonates. Regulations were enacted to improve the sanitation of milk, and artificial infant formulas were developed. All of these developments had an impact on mortality rates.

Review the History of Child Health Care, starting on page 7 in the textbook, detailing changes in infant mortality rates over the past 150 years. Consider the history of child health services over that period for infants and school-aged children, and note the roles nursing held in the newly formed child healthcare services.

What evidence led to the initiation of school health nursing?

Many children in the early 20th century were absent or sent home from school because of illness. In the Northeast corridor of the United States, physicians inspected schools and examined students to identify infectious disease.

Review the History of Child Health Care, starting on page 7 in the textbook, detailing changes in infant mortality rates over the past 150 years. Consider the history of child health services over that period for infants and school-aged children, and note the roles nursing held in the newly formed child healthcare services.

What were the roles of nurses in these historical beginnings of child healthcare services?

In the 1890s, Lillian Wald, RN, recognized the need for health promotion and disease prevention among New York’s immigrant population, and in her center, The Henry Street Settlement, nurses actively sought improvements in social conditions affecting health.

In 1902, Wald assigned a nurse to a school as a pilot project that was successful in reducing absenteeism. This school nursing model soon spread to other cities in the United States and Canada. The nurses monitored for illness, educated about personal hygiene and disease prevention, and were successful in their goal to improve the health of children.

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