Pediatric Nursing in Canada - NUR373

Welcome to NUR373! Sandra Merklinger RN, MN, PhD, NP-Paeds...

Welcome to NUR373! Sandra Merklinger RN, MN, PhD, NP-Paeds Assistant Professor, Teaching Stream https://www.pexels.com/photo/ woman-in-pink-dress-standing-beside-white-stand-6191540/ Pediatric Nursing in Canada: Standards, Philosophy of Care, Child & Family Centred Care, Communicating with Children and Families  Children’s Health in Canada 15.6% of Canadians are aged 0-14 years The health of most Canadian children has continued to improve with improvements including the development of vaccines, decreased tobacco smoking, and improved child health outcomes However, the health of Indigenous children still lags behind non-Indigenous children Negative indicators of child health and well-being currently being observed include: disparities in income; exclusion of youth from adequate education and employment; children from low income families are being left further behind; city air pollution; childhood obesity; teen mental health issues; bullying not equal acorss Canada access to HC not only in hospitals, but also includes community care with PT/OT and other out of pocket services Factors that Influence the Health of Canadian Children family income level - poverty = less access to care and mothers recieve less maternity care and don't have adequate nutrition or housing by 18 months should have so many words and consonants - if by then they don't Childhood mortality and morbidity refer to SLP and parents can self refer for SLP (long waitlist) Social determinants of health Health inequities among children Food insecurity Health promotion vaccinations are very improtant with peds Immunizations Antimicrobial resistance thus we now have reduced treatment options Childhood injuries most common cause of death among Can children however most are preventable Violence Toxic stress adverse chidlhood advance? shapes their mental health and well-being Mental health Substance use  as nurses we can help nurture parent-child relaitonships and helping them embrace their racial Challenges facing Indigenous Peoples identiy is a huge factor in shaping their self confidence and self esteem Indigenous youth make up over 50% of the Indigenous populations higher child: adult ratio than in the overall ratio of Canadian population health of Indigenous children lags behind non-Indigenous children infant mortality rates are 3x higher immunization rates are lower infectious diseases continue to contribute to chronic illness for Indigenous children rate of diabetes for adolescents is higher number of deaths related to injuries is 4x higher suicide rate is almost 4x higher than for the overall Canadian population  don't memorize Canadian Paediatric Nursing Standards BOX 30.1 – CORE DOMAINS OF PEDIATRIC NURSING STANDARDS Standard 1: Supporting and Partnering With the Child and the Family Standard 2: Advocating for Equitable Access and the Rights of Children and Their Family Standard 3: Delivering Developmentally Appropriate Pediatric Care Standard 4: Creating a Child and Family-Friendly Environment Standard 5: Enabling Successful Transitions Set by the Canadian Association of Pediatric Nurses (CAPN) in 2017 Philosophy of Pediatric Nursing Care the goal is to first understand and then maximize the strenghs of the child and Strengths-based approach foundation of ped nursing their family Child and family-centred care approach Pediatric nurses require knowledge of: psychomotor, psychosocial and cognitive growth and development health issues and needs specific to infants, children and youth Canadian Pediatric Nursing Standards Atraumatic care – aim to eliminate or minimize the psychological and physical distress that children are at risk of experiencing while receiving care Family advocacy – ensure that every child receives optimal care ensuring they're involved in child's care, provide them resources, keeping them informed even United Nations Declaration of the Rights of the Child (Box 30.4) during procedures or arrests we can keep them there but a nurse will usually be with them and parents are part of the team and the discharge teaching starts on admision explaining the procedures etc to preapre and ease anxiety What is a Family? the family is who the patient tells you they are “A group of individuals who are bound by strong emotional ties, a sense of belonging, and a passion for being involved in one another’s lives” highlights social supports and acceptance (Wright & Bell, 2009 in Shajani & Snell, 2019, p.54) as basis of it Every family: is a small social system has its own cultural values and rules when you come in and talk with the parents first children has a structure and basic functions see that and might be more comfortable with you (NUR350: RW) Family Centered Care (FCC) Recognizes the centrality of families to the well-being of hospitalized children siblings are very affected, Acknowledges that hospitalization of a child affects the whole family because now one parent might not be home as much Promotes partnership: goal of FCC is to promote the resiliancy of families and at the core of FCC is to approach it with empathy, compassion, and caring (3 pillars of the TR) Health Family Child Care Providers Family Centered Care FCC: 8 Key Elements Therapeutic Relationships 1. Recognize family as the constant in a child’s life 2. Cultivate family and health care provider collaboration 3. Provide complete & unbiased information in a supportive manner 4. Honour cultural diversity, strengths and individuality within and across families 5. Recognize and respect different methods of coping and remain non-judgmental 6. Encourage and facilitate family to family support 7. Provide flexible, accessible and comprehensive care in response to family-identified needs 8. Appreciate families as families and children as children Child and Family Centred Care child is at the core - priority family is next to the child and represents centrality the 3 elements: respect, communication, partnership  Decreased stress for children and families Increased adherence to plans of care Improved child and family sleep & nutrition Benefits of FCC Decreased disruption of family routines Increased child and family satisfaction with care Two outcomes = enabling & empowerment for the ped patient and their families  Appropriate introduction Assurance of privacy and confidentiality explore family situation and dynamics, and be careful with your words and questions Communicating Encourage parents to talk with Parents Direct the focus Listen and be culturally aware Provide anticipatory guidance Avoid blocks to communication be careful if they're using a Communicate through an interpreter family member to translate ensure privacy admision/discharge be present and spend time with the pt and child in the room opens the communication - mostly general conevrsation doesn't have to be about the kids it allows for raport  Appropriate introduction Assurance of privacy and confidentiality Communicating Nonverbal communication is important with Children Consider communication and development of thought processes across age groups Guidelines p.726 & 730 Creative Communication Techniques *Box 30.3  don't need to know this The Paediatric Nurse always: STANDARD I: Supporting Establishes an intentional therapeutic relationship with the child and family and Partnering with the Child and their Family Respects the child and family in goal setting and decision making Paediatric Nurses partner Collects and uses information from the child and with the child and their family context to inform care family to achieve their Communicates with both child and family as partners optimal level of health and in care well-being leading to Advocates for optimal use of resources to support the resilient families and child and family healthy communities. Recognizes and fosters the parenting role to support child well-being Canadian Paediatric Nursing Standards, 2017  don't need to know this The Paediatric Nurse always: Completes a child and family assessment STANDARD IV: Creating a Child Demonstrates cultural competency and humility in and Family Friendly Environment all child and family interactions Engages with child and family in all care decisions Paediatric nurses play an essential and plan of care in a respectful non-judgmental, culturally safe manner role in creating a child and family friendly environment that Shares information relevant to plan of care and collaborates with and amongst circle of care welcomes families and promotes providers hope and healing. It is understood Recognizes and fosters family strengths and supports that the environment changes as the child grows and is influenced Uses strategies to support and foster resiliency by multiple factors including but Demonstrates caring and compassion to both child not exclusive to psychological, and family spiritual, and social. Canadian Paediatric Nursing Standards, 2017 Growth and Development NUR373: Week 1 Sandra Merklinger Growth quantitative change, measurable includes physical changes in weight, height, head & chest circumference objective data growth patterns & parameters weight, length/height, dentition we want to see children growig along their curve and that they don't drop from that if their lengh and height are going to drop, it takes longer to fall off the curve  milestones for growth chart General u Birth weight doubles by approx. 6 months Patterns of u Birth weight triples by end of 1st year Growth: u Birth weight quadruples by 2 1/2 years Weight all newborn babies it is normal to lose up to 10% of their birthweight but they should gain it back by 2 weeks of age 22  u Birth length increases by General 50% by end of 1st year Patterns of u Height at 2 years is approx. half adult height Growth: u Birth length doubles by age 4 Length / u Birth length triples by age Height 13 u By age 4, height = weight 23  u Teeth erupt by 6 months bottom teeth erupt first and then top? General u 6 - 8 teeth by 1st year central incisors (bottom) and lateral incisors (4 upper teeth) 1st & 2nd year molars Patterns of u u Canine/cuspid (eye) teeth Growth: u By age 3 has 20 baby teeth Dentition u Around age 6 baby teeth start to fall out, adult teeth come in 24 Development qualitative change, less easy to measure includes acquisition of gross & fine motor skills, personality and cognitive development only memorize the major milestones (ex: when should a child be crawling or sitting on their own developmental milestones etc) directional trends cephalocaudal (head to toe) an infant can control their head before they can walk proximodistal (near to far) infants have shoulder before they have hand control should also be bilateral and symetrical differentiation (simple to complex activities and functions) learns to grasp a crayon then they can make a mark then make shapes then draw more precislely (progressive)  personality and cognitive skills develop similarly to biological growth so new accomplishments build on previosluy mastered skills most widley accepted theory of personality devlopment - Child Development Theories comment on the stage of development for each of * Erikson these groups * Piaget might be overlap put both in there if it has toddler and school age 26 Erikson’s Psychosocial Developmental Theory most widley accepted theory of development describes key conflicts or core problems that the individual strives to master during critical periods in personality development no core conflict is ever mastered completely but remains a current problem throughout life always trying to master it 8 stages - first 5 relate to childhood  learn the world is good, and can be trusted, and basic needs are met, this provides the foudnation for all succeeding stages helps them expeerince unfamiliar situations with security (enjoy when they're thrown in the air) infants where basic needs are not met, will be mistrustful (alarming) assess the dynamic in the room what the parents do at home, explore that further etc or let someone else know and they can go and do an assessment Trust vs uInfant Mistrust u~ birth - 1 year vital signs: if we wanna help them feel trsut and secure put the infant in mum or dad's lap keep them bundled as much as they can (only expose what they need) 28  independance, voclaize "no", if they're consistnaly critazied they'll devleop shame and doubt so let them choose their clothes and food (within reason), let them feel in control vital signs: give them a choice "which arm do you want for BP?" "the cuff will give you a hug" let them touch the cuff play with it Autonomy uToddler vs Shame u~ 1 - 3 years & Doubt 29  learning about env through play, bold, compeetive, learning new repsonsibilites, learning right form wrong - allow them to play and be creatuve with minimal adult interaction to get them to feel guilt if constanlty critized Initiative uPreschooler vs Guilt u~ 3 - 6 years vital signs: let them squeeze the bulb, play with the cuff, put on parents etc show it on their teddy bear "do you want to listen to your heart too or mum and dad?" share the stetehscope 30  eager to devlop skills to participate in meaningful activities learning to cooperate and self worth is peer focused inferiortiy: arises if they're being bullied, or too many expectations for them Industry vs uSchool Age Inferiority u~ 6 - 12 years vital signs: give them a job to do hold the thermometer, weite down the temp and vital signs give them something to do 31  who they are, gaining independance, peers are very important to them, listen to peers not parents, forming self concept, preocupied wirh how they look, previous trust in their body can be shaken as they change - if they're encouraged they ca have a strong sense of securitty role confusion: strugles for their role as a group member, and going btwn maturity and child like behaviour because happens if they don't reciev enocurgameneet or a sense of security Identity vs uAdolescent Role u~ 12 - 18 years Confusion vital signs: offer privacy, listen to them if they don't want vitals in the morning, maybe negotiate with them 32 Piaget’s Cognitive Developmental Theory helpful for procedures and engaging in health teaching concerned with how children learn to reason, use language and think rather than what they learn cognitive development occurs gradually, sequentially and without regression... development moves from simple to complex, begins with concrete situations and objects, and proceeds to abstraction Piaget’s Cognitive Developmental Theory include this on infancy and todleer age groups on Sensorimotor (birth - 2 years) the chart for assignemnt Preoperational (2 - 7 years) toddler, preschool, and school age Concrete Operations (7 - 11 years) school age Formal Operations (11 years - adult) * Note: watch this theory in action - video posted on Quercus