UNIT 1. INTRODUCTION TO PEDIATRIC NURSING.
USEFUL TERMINOLOGIES.
PEDIATRIC.
It is a Greek word in which Pedia means child, Itrike means treatment and Ics means a branch of science.
Thus pediatrics is a branch of medical science. Pediatrics is the branch of medical science that provides preventive, promotive, curative and rehabilitative care for children from conception to adolescence age in health or illness.
PEDIATRIC NURSING.
Pediatric nursing is a branch of nursing. Which provides holistic nursing care to children from CONCEPTION to Adolescence age. The main goal of which is the proper growth and development of children and physical, mental and social well-being development of the child. In pediatric nursing, preventive, promotive, curative and rehabilitative nursing care is given to every child in this group.
CONCEPTION.
Conception means fusion of ovum and sperm. After this fusion, a new cell is formed, which is called a zygote. Intra-uterine life begins from here.
ANTENATAL PERIOD.
The period from conception to birth is called antenatal period. Generally the period 9 months and 1 week after conception or 36 to 42 weeks after conception is called the antenatal period.
NEW BORN.
When a child is born, it is known as a newborn. The period till the baby is 28 days old is known as neonate.
CHILD.
Generally, the word child is used for a child. Child means below the age of legal maturity. Generally the age of maturity is considered to be 18 years hence the word CHILD is used for below 18 years.
INFANT.
The term infant is used for a child between 28 days to one year. Hence the term infant is used for a young child from the age of one year.
INFANTICIDE.
The act of killing an infant is known as infanticide. There was an early wrong concept in pediatric nursing, particularly female child-killing.
MORTALITY.
The act of dying is known as mortality. Mortality means death.
MORBIDITY.
The act of getting sick or any disease is called morbidity. Morbidity means disease condition.
FAMILY CENTERED CARE.
This is a modern concept of pediatric nursing. Family-centered care is where family members provide care and support in the sick child’s family environment under the supervision of a member of the health team and parents during the child’s illness.
APPETITIES.
That is, the desire to eat or drink anything is called appetite.
HOLISTIC CARE.
Comprehensive and total care is provided from every aspect of child care i.e. physical, mental, social, spiritual is called holistic care.
COLOSTRUM.
After the birth of the baby, the breast milk secreted from the mother’s breast for the first two to three days is called colostrum. This breast milk is pale yellow in color. It is high in protein and calories and is full of antibodies. It is necessary to give this milk specially to the child.
POSTPARTUM.
The period after the birth of the child is called the post partum period. Usually it is counted up to 45 days after the birth of the child. It is also called the postnatal period.
BELCHING.
The act of expelling gas or air from the stomach through the mouth or nose is called belching.
Excess air in the stomach is removed by this process after breast feeding the baby normally.
COLIC.
Spasmodic pain usually seen in the hollow structure of the intestine is called colic. Pain is seen due to peristalsis movement. It is also called colicky abdominal pain.
INVOLUTION.
This terminology is usually used after delivery to refer to the involution or reduction in size of the reproductive organs. In which the size of the uterus has increased during delivery. During the postnatal period, it gradually decreases in size and becomes a normal structure, which is called involution of uterus. These are retrogressive changes. In which the organ of the reproductive track returns to its original structure after delivery.
EPIDEMIOLOGY.
The scientific study of the causes, frequency, patterns, etc. of diseases is called epidemiology. In it, the interrelationship of all the factors related to the disease is studied.
ENDEMIC.
If a disease occurs frequently in the people of a particular geographical area, it is called endemic.
ATTENUATE.
The word attenuate is used for a substance that is weakened and has less harmful effect.
This terminology is commonly used for vaccines.
INTRODUCTION OF PEDIATRIC NURSING.
Nowadays it is necessary to give a lot of importance to children because the child of today is the citizen of tomorrow. The care given to children today is very important for that child to be helpful to the society going forward.
The pediatric group has the highest population among individuals of each age group in the world and this group is the highest risk group. Any disease condition or injury is irreversible. So it is necessary to take special care of this group.
Due to poor health status and many health problems in developing countries, mortality and morbidity rates are high in this group. Mortality rate in this group due to preventable causes is increasing every year which is an area of attention in the main health care system. So it is necessary to lay special emphasis on the causes related to preventable health problems in this group. A special approach to providing care to children is necessary so that mortality and morbidity rates can be reduced in this group of children.
HISTORY.
HIPPOCRATES.
He is known as the father of modern medicine. He made important contribution in the treatment of child and child diseases.
GALEN.
He wrote specially for children in Greek language for the care of infants and children.
KASHYAPA AND JEEVAKA.
He was the first Indian paediatrician, who did a lot of work on diseases and their care in children.
SORENEUS.
He gave finger nail test for purity of milk.
ABRAHAM JACOB.
German physician Abraham Jakob is known as the Father of Paediatrics. He did very important work in paediatrics between 1830 and 1919.
RHAZES.
He was an Arab physician who wrote the first book on children’s diseases.
FACTORS AFFECTING CHILD HEALTH.
The pediatric population is a very high-risk population with many factors affecting its health. These factors are as follows.
MATERNAL HEALTH.
This is a very important factor for the birth of a healthy child. If the mother is well cared for during the antenatal period, the baby will be healthy and at a good birth weight. If the mother has any problem during this period or the mother is malnourished then the health of the child is at risk and it directly affects the child. Hence maintaining proper maternal health is essential for a healthy baby.
FAMILY ENVIRONMENT.
Family members and their culture, traditions and mutual relations between each family member have a very important impact on the health of the child. After birth, a child learns everything from family members and its environment. Family environment affects a child’s physical health as well as his mental health.
SOCIOECONOMIC FACTORS.
Social factors like family member’s economic condition, living style, housing, residential, job, income etc. affect the health of the child. The food and nutrition given to the child also affects its health. Poverty and illiteracy are also major influencing factors. All these factors affect the child’s physical and mental health both positively and negatively.
ENVIRONMENT.
A child’s environment has a great impact on its growth and development. In this environment hygiene, epidemiological condition, water supply, sanitation, accident, infection etc. factors affect the health of the child.
HEALTH SERVICES.
A very influencing factor is the surrounding health services in the environment in which the child lives. All the available health services, preventive services, health programs, health care facilities, physical setup, knowledge of the health care team members, available resources etc. factors have a very important impact on the health of the child.
All the above things affect the child’s health physically, socially, mentally and spiritually. All the above factors affect the growth and development of the child, the diseases seen in children and the mortality and morbidity seen in children.
MODERN CONCEPT OF CHILD CARE. or
CONCEPT OF CHILD HEALTH CARE.
Due to high mortality and morbidity rate in children, the importance of health care services is very important in this group. Of the many causes of diseases and illnesses found in this group, the majority of causes are preventable.
The current concept of child health care emphasizes preventive services.
In earlier times, there were many wrong and old concepts in pediatric services. Which has now been replaced by the Modern Pediatric Concept. Due to which the mortality and morbidity rate can be reduced. Following are the points of modern pediatric concept.
Child care is focused on both aspects of when the child is sick and when the child is healthy.
In child care, the child’s family members and parents are treated as a unit and family centered care is provided.
Many health programs have been launched for proper growth and development of children.
The female child is given special importance because this female child is the mother of the future.
Comprehensive health services are provided to all children from conception to adolescence.
A holistic approach is taken to the child’s care.
A child is given love and warmth during his care.
Along with all kinds of care, nutrition, play, recreation etc. services are also provided to the child.
Evidence based practice is given more importance.
Eligible couples are provided guidance and counseling regarding maternal health prior to conception.
Comprehensive care is provided through the use of scientific principles during the care of the child. Emphasis is placed on the child’s all over wellbeing so that he can develop optimal function.
GOALS OF PEDIATRIC NURSING.
To provide comprehensive care according to the child’s needs during periods of child’s illness and when the child is healthy.
To promote the growth and development of the child so that every function of the child can reach its optimum state and develop all its capacities.
Informing the child’s parents and his family members about all the basic needs of the child and understanding how to take proper care of the child.
Prevention of diseases by strengthening preventive services in children.
And to explain the issues of promoting his health.
Early identification of the child’s illness and providing proper care.
QUALITIES OF PEDIATRIC NURSE.
Children are very sensitive, they feel a lot of stress when they are sick due to illness and hospital admission. To work with these children, the pediatric nurse must have the qualities to understand them and help them adjust to the hospital environment. The following qualities in a pediatric nurse make it suitable for working with children.
She should have a loving personality. He should have special affection for children. She should have patience, she should be able to understand the behavior of the child.
His disposition should always be of a happy mood.
She should be able to adjust well with children and should be able to maintain their safety and security.
She should have honest, gentle and friendly behavior.
He should have good observation power and judgment and communication ability should be very good based on his knowledge and experience.
She should know all things with children and should be skillful and responsible.
They should have professional knowledge and use scientific principles during care.
In earlier times adults and children were given the same treatment. But nowadays due to higher mortality and morbidity in the pediatric age group, more importance has been given to children and child care.
Apart from this, due to the development in the medical and surgical branches, the focus is on the special area of child health.
The following trends and practices are being observed in pediatric child health care.
Currently pediatric care is provided by pediatricians and trained registered nurses.
A scientific treatment approach is maintained in care from infancy to adolescence period.
Special vaccines are administered for disease prevention.
Regular assessment of the child’s growth and development is done.
Emphasis is placed on preventive services and health promotion rather than curative care.
Advancements in technology and science are seen in the medical field. So that high quality care can be provided.
Evidence-based practice of children’s karma is observed.
Institutional care is more emphasized than home care for any type of care for children. This institute i.e. hospital which has been developed through modernization with child friendly changes.
Family-centered care is provided through the support of parents and family members under the supervision of health care members at each care of the child. A child is not separated from his parents and family members even during illness.
Rooming-in means keeping the child with its mother at most and moving forward with the mother in every care is implemented.
Visiting hours have been increased and flexible hours have been kept during hospitalization of children.
There are support groups for parents, which help reduce the anxiety of parents. And the play and recreational needs of children are taken into consideration.
In the care of children, subspecialties of pediatric services such as pediatric neurology, cardiology, nephrology etc. have developed.
ROLE OF PEDIATRIC NURSE.
Due to changes in the field of medicine and technical advancements, there have been many changes in the role of pediatric nurses to meet new demands in child health care.
The role of the pediatric nurse has become specialized in every aspect of care. All care is provided through a comprehensive approach by nurses at every stage of the child whether healthy or sick.
The role of a nurse changes in different institutes, but its basic responsibilities and roles are the same everywhere.
A pediatric nurse has specialized training in pediatrics. Its detailed roles are classified as follows.
CARE GIVER.
Preventive, promotive, curative and rehabilitative care is given to the child in every set up by the pediatric nurse. This care is planned based on the needs of the child. It includes all needs related to therapeutic needs, comfort, safety and personal hygiene.
HEALTH EDUCATOR.
Pediatric nurses provide incidental and planned health teaching to the child’s parents and family members on all matters related to child care. So that the child can be given proper care.
ADVOCATIVE ROLE.
A pediatric nurse strives to ensure that children receive quality care using scientific principles of child health care. Works to give the child maximum benefit of its karma.
MANAGER.
A nurse acts as a manager of a pediatric care unit to fill every care of a child and helps to organize every care properly.
TEAM LEADER.
A pediatric nurse acts as a team leader in her unit and leads to provide better care by maintaining proper communication among all staff and subordinates. Distributes responsibility among everyone.
NURSE AS A RECREATIONIST.
Plan different types of recreational activities to modify the child’s stress during hospital adjustment procedures and hospitalization and help modify the child’s behavior.
NURSE AS A COUNSELOR.
Counseling and providing guidance to the child during critical care decisions and any problem solving approach to the parents.
SOCIAL WORKER.
For social problems and adjustment related to the child and his family members, it works with special welfare agencies and to provide necessary social support.
NURSE AS A RESEARCHER.
The nurse conducts different types of research during her clinical practice in the pediatric unit and tries to come up with new concepts. Finds new ways to deal with health problems. Nursing plays a role as continuous research to provide better health care facilities.
Due to new trends in pediatric nursing and changing concept of child health care, pediatric nurses have to face many challenges. A nurse working in a pediatric unit has to face the following challenges.
DEVELOPMENT OF NEW MEDICAL SPECIALTY AND SUPER SPECIALTY.
Nowadays, due to the development of specialty and sub-specialty of pediatric nurse medicine, different special units like NICU, PICU, etc. have been formed. It is challenging to get special training to work in each of these special departments and to handle special equipment. .
CHILDREN WITH SPECIAL PROBLEMS.
Some children are born with special conditions such as a child born to a mother with HIV infection or a child born to a diabetic mother etc.
A specialized skill-full approach is required by the pediatric nurse to cope with this type of special problem.
PSYCHOLOGICAL PROBLEMS.
Nowadays, different types of psychological problems are seen in children. Due to which problems many behavioral changes are seen in the child. Understanding the pattern of each and giving special attention and special management to the child and family member in its treatment is also a challenging task.
POVERTY AND ILLITRACY.
Due to poverty and low level of education in the society, it is very difficult to convince and counsel children for proper care, because due to poverty they cannot spend on health care and due to lack of education they are not able to change certain stereotypes. So these major challenges are seen in terms of child health care.
ACUTE AND CHRONIC CASES AND VARIOUS EMERGENCIES.
While working in the pediatric unit one has to handle different types of emergencies and different cases of acute and chronic illness. In which the nurse has to pay special attention to acute and emergency conditions and manage immediate conditions and in some chronic conditions developing self-resilience and adjusting to the situation is an important task. Thus different challenges have to be faced during the management of different cases.
LEGAL AND ETHICAL CONDITIONS.
Ethical decision making is required in pediatric care when certain ethical decisions such as continuing someone’s life support dish, refusing treatment etc.
Apart from this, one has to face many legal challenges under negligence, mal practice and consumer protection act while working in clinical set up.
PRINCIPLES OF PEDIATRIC NURSING.
The nurse should accept the child’s behavior as it is and inform the parents if there are changes in his behavior.
The nurse should help the child adjust to the hospital and acclimate to the hospital environment.
The nurse should explain the rights of the parents in any kind of problem of the child and the nurse should know about it and help the parents to make decisions for that problem.
The nurse should ask the child and his parents questions related to any single idea and explain anything so that he does not get confused about anything. Anxiety can develop from explaining too many topics at once.
The nurse should protect the child from any kind of injury and illness and establish a working relationship with his parents.
Comprehensive nursing care should be provided to the child both during his illness and when he is well and healthy.
During the care of the child, the nurse should use her fundamental knowledge in nursing care and solve her problems by using scientific principles.
The nurse should maintain a calm and empathetic demeanor and help the child and his parents express negative and positive behaviors and emotions.
While providing nursing care, time should be spent with the child and his family members.
There should be unity among the pediatric health care team and priority attention should be given to the needs of the child to promote the child’s health and care plans should be made on every aspect of the child.
The pediatric population is a high-risk group. Many health problems are seen in them. Majority of the health problems in this group are found especially in developing countries. These major health problems are as follows.
LOW BIRTH WEIGHT.
Low birth weight means a baby weighing less than 2.5 kilograms at birth. Many maternal factors and other factors are responsible for this. This is a major health problem in developing countries.
NUTRITIONAL DEFICIENCIES.
Due to low birth weight, low socio-economic background, poverty, illiteracy, etc., children do not get enough nutritious food for their physical growth, which leads to mal-nutrition and many nutritional deficiency disorders such as kwasiorkor, marasmus, etc.
VARIOUS INFECTIONS.
Children are at high risk for many infections. Due to their low immunity, infections like respiratory tract infection, diarrheal disease, parasitic infection etc. are commonly seen.
ACCIDENTS AND POISONING.
Many types of accidents and poisoning are especially common in children, including falls, spot injuries, drowning, burns and eating or drinking any poisonous substance.
BEHAVIORAL PROBLEMS.
In pediatrics, behavioral problems are seen in children due to many family and social factors during the growth and development of children. So there is alteration in its development. Due to these behavioral problems, there is a significant impact on the child’s development.
Thus, due to the above health problems, mortality and morbidity rates are high in children. The majority of these problems are preventable. So these problems can be reduced by taking proper care and measures.
RIGHTS OF THE CHILD.
The rights of children were declared by the United Nations on 20 November 1959. The purpose of which was to meet the special needs of the children.
In India too, these rights have been implemented for the all-over development of the child. These rights of children are as follows.
Right to Name and Nationality
Right to free education
Right to grow in an atmosphere of love and affection
Right to be protected against any form of neglect, exploitation, trafficking, etc
Right to get basic benefits like nutrition, housing, medical care etc
Right to opportunities for play and recreation
Right to Special Treatment, Special Education and Appropriate Care for Handicapped Children
Right to first protection and relief during times of disaster
The right to be brought up in an environment of freedom and dignity and the right to live as a useful member of society
Right to be brought up in a society with a sense of mutual brotherhood and peace
Every child has the right to enjoy all the above rights without any discrimination of color, sex, religion or caste.