Family-Centered Nursing: Structures & Care Hallmarks

• Family-centered nursing involves a collaborative partnership between patients, families, and healthcare professionals in planning, delivering, and evaluating healthcare.

Hallmarks of High-Quality Family-Centered Care

• Family presence with the patient is valued.
• Cooperation among healthcare providers and families is emphasized.
• An appropriate and supportive environment is provided.
• Allocate sufficient time for family involvement.
• Valuing the experience of the nurse is crucial.

Barriers to Effective Family-Centered Care

• Lack of communication skills can impede effective care.
• Challenges in role negotiation may arise.
• Inadequate education preparedness can hinder family involvement.
• Difficulties in developing strong relationships can affect care quality.

Family Structures

• Blended families are formed when parents bring children from previous relationships into a new family.
• Multigenerational families consist of three or more generations living together, sometimes referred to as "boomerang" families when adult children return home.
• Boomerang families involve adult children returning to live with their parents, seeking support particularly from grandparents for their children.
• LGBTQ+ families offspring may come from previous heterosexual relationships, adoption, or assisted reproductive techniques like IVF.

Characteristics of Healthy Families

• Open communication to express concerns and needs is present.
• Flexible roles within the family are maintained.
• Agreement on basic parenting principles helps minimize conflicts.
• Families are not overwhelmed by life changes.
• Assistance is offered without needing to be asked.

High-Risk Families

• Marital conflict or divorce increases risk.
• Adolescent parents may face additional challenges.
• Violence among family members constitutes a high-risk situation.
• Substance abuse within the family poses significant risks.
• A chronically ill child can strain family resources and dynamics.

Adverse Childhood Experiences (ACEs)

• Long-term consequences of living in a high-risk family can lead to toxic stress from ACEs.
• Unaddressed ACEs can contribute to later mental health issues.
• They may also lead to substance use.
• Possible runaway behavior may arise.
• Potential for violence may be a consequence.

Healthcare Delivery Settings for Pediatric Patients

• Clinics are common settings for pediatric care.
• Hospitals provide care for more acute or severe conditions.
• Schools offer healthcare services to students.
• Home healthcare allows for care in the patient's residence.

Reducing Child Anxiety During Assessments

• Involve parents as much as possible to provide comfort.
• Allow the child to play with instruments to reduce fear.

Assessing Infants (Birth to 6 Months)

• Start with quiet tasks like listening to pulses and respiratory rate.
• Progress to more active assessment as the infant becomes comfortable.
• Assessing heart, lungs, and abdomen without waking the baby, if asleep or nursing, is ideal.
• Leave uncomfortable procedures until the end.

Assessing Infants (6 to 12 Months)

• Follow the same procedure as with younger infants.
• Be aware of stranger anxiety at this age.
• Conduct as much of the exam as possible with the child in the parent's lap.
• Leave ear, oral, and uncomfortable procedures for last.

Uncomfortable Procedures for Infants

• Abduction of hips can cause discomfort.
• Speculum exam of tympanic membranes may be upsetting.
• Elicitation of Moro reflex can be startling.

Assessing Toddlers

• Toddlers are often the most challenging to examine due to limited cooperation.
• Build rapport by standing or sitting near the parent.
• Offer toys or books to provide relaxation.
• Communicate about the exam using age-appropriate words.
• Proceed from least to most invasive procedures.

Assessing Preschoolers

• Preschoolers can undress themselves but are becoming more modest.
• Perform a head-to-toe exam but leave invasive procedures for last.

Assessing School-Age Children

• Ask questions about school, activities, and friends to engage them.
• Perform a head-to-toe exam.
• Children at this age typically prefer a drape for modesty.

Assessing Adolescents

• Assess the adolescent without the parent present in most cases.
• Conduct a head-to-toe exam.

Normal Vital Signs in Infants

• Temperature (axillary): 97.7 - 99.3 F
• Pulse: 80-150 bpm
• Respiratory Rate: 25-55 breaths per minute
• Blood Pressure: systolic 65-100 mmHg; diastolic 45-65 mmHg

Normal Vital Signs in 1-3 Year Olds

• Temperature (axillary): 97.5 - 98.6 F
• Pulse: 70-110 bpm
• Respiratory Rate: 20-30 breaths per minute
• Blood Pressure: systolic 90-105 mmHg; diastolic 55-70 mmHg

Normal Vital Signs in 3-6 Year Olds

• Temperature (axillary): 97.5 - 98.6 F
• Pulse: 65-110 bpm
• Respiratory Rate: 20-25 breaths per minute
• Blood Pressure: systolic 95-110 mmHg; diastolic 60-75 mmHg

Normal Vital Signs in 6-12 Year Olds

• Temperature (oral): 97.5 - 98.6 F
• Pulse: 60-95 bpm
• Respiratory Rate: 14-22 breaths per minute
• Blood Pressure: systolic 100-120 mmHg; diastolic 60-75 mmHg

Normal Vital Signs in 12+ Year Olds

• Temperature (oral): 97.5 - 98.6 F
• Pulse: 55-85 bpm
• Respiratory Rate: 12-18 breaths per minute
• Blood Pressure: systolic 110-135 mmHg; diastolic 65-85 mmHg

Minimizing Fear During Blood Pressure Measurement

• Take a blood pressure reading on a doll, stuffed animal, or parent first.

Key Assessments During Physical Examination

• Assess the child's level of consciousness based on their developmental stage.
• Note if the child appears undressed, clean, and well-kept without body odor.
• Observe if the child makes eye contact when addressed (except for infants).
• Assess if the child can follow simple, age-appropriate commands.
• Evaluate spontaneous speech, language, and motor skills.
• Assess muscle tone, expecting erect head posture in children older than 4 months.

Evaluating a Child's Circulation

• Palpate the apical pulse.

Explore family-centered nursing, emphasizing collaboration between patients, families, and healthcare professionals. Discover hallmarks of high-quality care, including valuing family presence and cooperation among providers. Also, learn about barriers to effective care, such as communication issues and role negotiation challenges.