Hockenberry: Wongs Nursing Care of Infants and Children, 10th Edition

Chapter 01: Perspectives of Pediatric Nursing

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Healthy People 2020 broadens the health care objectives achieved in the 1990s and focuses
on prevention as the method for achieving its goals. Healthy People 2010s goals include
increasing the quality and length of healthy life and eliminating health disparities.
The Healthy People 2020 Leading Health Indicators provide a framework for identifying
essential components for child health promotion programs designed to prevent future health
problems in our nations children. These Leading Health Indicators include physical activity,
overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental
health, injury and violence, environmental quality, immunization, and access to health care.
Many of tomorrows leading causes of death, disease, and disability, such as cardiovascular
disease, cancer, chronic lung disease, depression, violence, substance abuse, injuries,
nutritional deficiencies, and human immunodeficiency virus/acquired immunodeficiency
syndrome, can be significantly reduced in children and adolescents by preventing the
following six categories of behavior: tobacco use, behavior that results in injury and
violence, alcohol and substance use, dietary and hygienic practices that cause disease,
sedentary lifestyle, and sexual behavior that causes unintended pregnancy and disease.
The two public health interventions that have had the greatest impact on world health are
clean drinking water and childhood vaccination programs. However, immunization rates
continue to differ depending on childrens race and ethnicity, family income, the state in
which they live, types of vaccinations, and their age.
Childhood obesity is the most common nutritional problem among American children, is
increasing in epidemic proportions, and is associated with type 2 diabetes. Overweight youth,
especially children of Hispanic, African-American, and Native American descent, have
increased risk for developing hypercholesterolemia, insulin resistance, diabetes,
hypertension, and heart disease. Nursing interventions focused on prevention strategies to
reduce the incidence of overweight children in this county are essential.
The infant mortality rate is the number of deaths during the first year of life per 1000 live
births. It may be further divided into neonatal mortality (<28 days of life) and postneonatal
mortality (28 days to 11 months). Although the infant mortality rate in the United States has
declined dramatically over the last few decades, the United States lags significantly behind
most other major countries, such as Canada.
Many of the leading causes of death during infancy continue to occur during the perinatal
period. The following four causes of death account for about half of all deaths of infants
younger than 1 year of age: congenital anomalies, disorders relating to short gestation and
unspecified low birth weight, sudden infant death syndrome, and newborns affected by
maternal complications of pregnancy.
Injuries are the leading cause of death in children older than age 1 year, with the majority
being motor vehicle injuries. As children grow older, the percentage of deaths from injuries
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increases. Motor vehicle accidents continue to be the most common cause of death in
children older than 1 year of age. Other common types of unintentional injuries include
drowning, burns, and firearm accidents.
Developmental stage and environment are important determinants in the prevalence of
injuries at a given age and thus help to direct preventive measures. Risk-taking behaviors,
particularly in boys and men, tend to begin in the first decade of life and continue into
adolescence with drinking alcohol while driving, speeding, carrying a weapon, or using illicit
drugs.
Morbidity statistics are measurements of the prevalence of a specific illness in the
population at a particular time. Childhood morbidity statistics encompass acute illness,
chronic disease, and disability. Recent concern has focused on groups of children who have
increased morbidity, such as homeless children, children living in poverty, low-birth-weight
children, children with chronic illnesses, foreign-born adopted children, and children in
daycare centers.
The term new morbidity refers to behavioral, social, and educational problems that can
significantly alter a childs health.
Eighty percent of childhood illnesses are attributable to infections, with respiratory tract
infections occurring two or three times more often than all other illnesses combined.
Todays best approach to illness prevention is education and anticipatory guidance.
The definition of nursingthe diagnosis and treatment of human responses to actual or
potential health problemsis consistent with contemporary nursing care of infants,
children, and adolescents.
The philosophy of family-centered care recognizes that the family is the constant in a
childs life and that service systems and personnel must support, respect, and enhance the
familys strength and competence.
Two basic concepts in family-centered care are enabling and empowerment. Professionals
enable families by creating opportunities and means for all family members to display their
current abilities and competencies and to acquire new ones to meet the needs of the child and
family. Empowerment describes the interaction of professionals with families in such a way
that families maintain or acquire a sense of control over their family lives and acknowledge
positive changes that result from helping behaviors that foster their own strengths, abilities,
and actions.
Atraumatic care is the provision of therapeutic care in settings, by personnel, and through
the use of interventions that eliminate or minimize the psychologic and physical distress
experienced by children and their families in the health care system. The overriding goal in
providing atraumatic care is first, do no harm. Three principles provide the framework for
achieving this goal: (1) prevent or minimize the childs separation from the family, (2)
promote a sense of control, and (3) prevent or minimize bodily injury and pain.
Pediatric nurses are involved in every aspect of a childs and familys growth and
development. The pediatric nurses roles include a therapeutic relationship, family advocacy,
disease prevention and health promotion, health teaching, support and counseling,
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coordination and collaboration, ethical decision making, research, and health care planning.
The nurse, as a member of the health care team, collaborates and coordinates nursing services
with the activities of other professionals. Working in isolation does not serve the childs best
interests. The concept of holistic care can be realized only through a unified, interdisciplinary
approach.
Ethical dilemmas arise when parents, nurses, physicians, and other health care team
members reach different but morally defensible decisions by assigning different weights to
competing moral values. These competing moral values may include autonomy, the patients
right to be self-governing; nonmaleficence, the obligation to minimize or prevent harm;
beneficence, the obligation to promote the patients well-being; and justice, the concept of
fairness. Nurses must determine the most beneficial or least harmful action within the
framework of societal mores, professional practice standards, the law, institutional rules, the
familys value system, religious traditions, and the nurses personal values.
Evidence-based practice is the collection, interpretation, and integration of valid, important,
and applicable patient-reported, nurse-observed, and research-derived information. Evidencebased nursing practice combines knowledge with clinical experience and intuition. It
provides a rational approach to decision making that facilitates best practice.
A systematic thought process is essential to a profession. It assists professionals in meeting
the patients needs. Critical thinking is purposeful, goal-directed thinking that assists
individuals in making judgments based on evidence rather than guesswork.
The process of nursing children and families includes accurate and comprehensive
assessment, analysis, and synthesis of assessment data to arrive at a nursing diagnosis, plan
of care, implementation of the plan, and evaluation of interventions.
The nursing process is a method of problem identification and problem solving that
describes what the nurse actually does. The accepted, five-step model for the nursing process
includes assessment, diagnosis (problem identification), planning (with outcome
development), implementation, and evaluation.
Quality of care refers to the degree to which health care for patients and families increases
the likelihood of desired health outcomes that are consistent with current professional
knowledge. Because nurses are the principal caregivers within health care institutions, highquality nursing outcomes are used as an indicator of the ability to provide excellence in
patient care.
Quality outcome evaluation criteria establish a framework for measuring nursing care
performance.

Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.