NURS 2546 Week 11-12 Notes PDF

WEEK 11: School Aged Children and Adolescents Growth and Development of School-Aged Children (Age: 5-11 years old) - Biological, emotional and cognitive changes - School-aged children vary in many ways according to race, gender, ethnicity, and class - For e.g., medicine wheel i...

WEEK 11: School Aged Children and Adolescents Growth and Development of School-Aged Children (Age: 5-11 years old) - Biological, emotional and cognitive changes - School-aged children vary in many ways according to race, gender, ethnicity, and class - For e.g., medicine wheel in Indigenous Teachings (7-14 years as “fast-life”- they believe the most growth and learning happens) - Growth in Height and Weight: children gain approximately 2-3 kg and grow around 5 cm each year - 5 years - 18.7 kg, 110 cm - 10-12 years- 24.5-58 kg and between 127-162.5 cm - Boys tend to be slightly taller and heavier than girls initially (may become obese) - By the end of school-age years, most girls begin to suppress boys in ht. And wt. (normal) - Physical maturity is not necessarily correlated with emotional and social maturity Growth and Development of School-aged Children: - Refine their Physical and Motor Development - Mental - Adaptive - Personal-Social - Socialization - Peer groups - Early: few gender differences exist, share games, and other activities. Later: become more marked - 1st: learn to appreciate others perspectives, argue, persuade, and compromise to sustain friendships - 2nd: Become more sensitive to peer group norms, adapting behaviour to gain acceptance. Learn to dress, talk, and behave in a manner acceptable to the group. - 3rd: Peer interactions foster close “best friend” relationships. Relationships are more intimate - Physical and Motor Development: During the school-aged years, children refine their physical and motor skills, which contribute significantly to their overall development. This phase is characterized by increased coordination, strength, and control over their bodies. - Gross Motor Skills: become for adept to larger movements, involving legs, arms (e.g. sports) - Fine Motor Skills: ability to perform smaller, more precise movements (e.g. arts and crafts, handwriting) Growth and Development of School-aged Children: - Age 5 yrs: handedness is established. Tie shoelaces, use scissors, or pencil well. - Handedness: Hand preference (right or left) is established, allowing children to develop better control over fine motor skills  - Fine Motor Skills: Most children can now tie shoelaces, use scissors, and handle pencils skilfully - Age 6 yrs: loss of first tooth. Like to draw, print and color/vision until maturity. - Commonly lose their first baby tooth (key milestone) vision reaches full development, better hand-eye coordination - Age 7 yrs: jaw begins to expand to accommodate permanent teeth - Jaw begins to expand to make space for incoming permanent teeth. This supports structural changes in facial development - If adult tooth is injured, depending on the type of injury, this can be an emergency for e.g. sports injury - Age 8-9yrs: use of cursive writing, read classic books - Age 10-12 yrs: write letters, read things with enjoyment, more coordinated and steadier on their feet - Slimmer look - Biking, climbing, easier to do more activities, decreases in head and waist circumference - Posture increases: - Climbing, biking, and other activities easier - Decrease in head and waist circumferences - Face grows faster; skull and brain grow very slow and increase little in size - Teeth—primary (deciduous) teeth are lost during this age span Assessment Approach: School-age Children - Include the school-age child in history taking and assessment - Through play, drawing pictures - Additional details provided by the parents - Provide age-appropriate explanations and terminologies - Consider the child and families previous health care experience - Talk to them directly, refer to parents for additional information - Allow child to share thoughts and feelings, call medical instruments special tools to make them more comfortable - Can be more trusting but if they have had negative experience may be more hesitant Assessment: - General appearance (posture, hygiene, development) - Vital signs - Apical impulse location: left midclavicular, 4th intercostal space - Growth Measurements: compare results of height and weight - Head-to-toe assessment - Least to most invasive - least= not touching the child, invasive= blood pressure or axillary temp. - Order of examination must be varied to suit the situation and consider the child and family’s previous experiences - Screening: routine checks to detect potential health issues: hearing, dental screening Maturation: Prepubescent- Pre-adolescence: - Preadolescence: generally lasting about 2 years, spanning from end of middle childhood up to approx. age 13th birthday - Puberty signals the beginning of the development of 2nd sex characteristics - Girls: 10 years (breasts, pubic hair) - Boys: 12 years - Age of onset of pubescence: average of 2 years earlier in girls - Either early or late appearance of these characteristics can be a source of embarrassment and uneasiness to both sexes - How early is too early? Before 8, could indicate a tumour to slow down growth Erikson’s Psychosocial Development Theory: - A sense of industry or accomplishment vs a sense of inferiority - Children are eager to develop skills and participate in meaningful and social useful work - They acquire a sense of personal interpersonal competence, want to engage in tasks that can be carried through to completion Gain satisfaction - Social activities where they compete with others, cooperate with others and to cope effectively with people. Take pride in learning new skills - Reinforcement in the form of grades, material rewards, additional privileges, and recognition provides encouragement and stimulation - Peer approval is a strong motivating power - No child is able to do everything well so they will feel some degree of inferiority when they encounter specific skills they cannot master Piaget’s Cognitive Development Theory: - Concrete operation –using thought processes to experience events and actions - Egocentric Mental processes see things from another’s point of view - Making judgements based on what they see what they reason. (perceptual thinking conceptual thinking) - Able to use memories of past experiences to evaluate and interpret the present - Concept of conservation - Concrete Operational Stage (ages 7-11), children begin to think logically about concrete events. They shift from egocentric thought to understanding other perspectives, making judgements based more on reasoning than perception. This stage also introduces conceptual thinking, where children can use past experiences to interpret present situations - A key milestone is the concept of conservation—understanding that quantity remains the same despite changes in shape or appearance (e.g. knowing that liquid poured into a different container retains the same volume) Bullying: - “any recurring activity and targeted aggression that is intended to harm or bother, either physical or otherwise” (p. 962) - Bullies: defiant toward adults, antisocial, break school rules, dominant personalities, lack of from parental involvement and nurturing, and may experience or witness violence or abuse at home - Boys: direct - Girls: indirect - Cyberbullying - May experience headaches, stomach aches, school absenteeism, withdrawal, anxiety, depression, low self-esteem and may lead to suicide  - Needs to be managed by adults, acknowledge the problem and take steps in to stop it - Children need empowerment strategies - Anti Bullying interventions at schools - Online safety—do not give out personal information. Choose strong passwords. Be careful what you share online. Set social media accounts and profiles “private.” Don’t meet up with people you meet online. How Common is Bullying: Coping with Concerns Related to Normal Growth and Development: - School experience (family centered care) - Be supportive, be positive. Support and encourage activities - Foster the development of hobbies and collections - Meet the teachers. Demonstrate an interest in what the child is learning. Avoid dictating a study time but do enforce rules - Latchkey children: child who is left home alone or unsupervised after school or when their parents are away at work. - Limit-setting and discipline. Set the stage: - (1) a calm, organized and comfortable space; - (2) age-appropriate toys; - (3) routine with scheduled time quiet activities and some outdoor and other physical activities; - (4) standard sleep routines and - (5) regular mealtimes and healthy snacks to avoid irritability from hunger - No spanking Coping with Concerns Related to Normal Growth and Development: - Dishonest behaviour: - Lying, stealing, and cheating - Together with an appropriate and reasonable punishment - Stress and fear (exposed to family conflict, poverty …)  - Cause long-term adjustment and health issues - Conflict with family, interpersonal relationships, poverty, and chronic illness, increasing violence in society - Identify the source of the stress promptly Work to reduce the source of stress Referral to social services if necessary - Advocate for honesty Guidance for Parents During School Years: - Age 5 to 6 years: - Prepare parents for potential strong food preferences and potential refusal of specific food items - Prepare parents to expect an increasingly ravenous appetite - Prepare parents for emotionality as the child experiences mood changes - Help parents anticipate the child’s continued susceptibility to illness - Review the immunization schedule with parents—if tetanus schedule of 4 initial doses is completed before age 4, a fifth dose of tetanus toxoid is recommended at school entry by age 6 (Government of Canada, 2021) - Teach injury prevention and safety, especially bicycle safety - Encourage parents to respect the child’s need for privacy - Prepare parents for the child’s increasing interests outside the home - Help parents understand the need to support the child’s interactions with peers - Age 7-10 years: - Prepare parents to expect an improvement in their child’s health with fewer illnesses, although allergies may increase or become apparent - Prepare parents to expect an increase in minor injuries in their child - Advise parents to use caution in selecting and maintaining sports equipment and re-emphasize focus on safety (see Chapter 35) - Prepare parents to expect increased involvement with peers and interest in activities outside the home - Emphasize the need to encourage independence in the child while maintaining limit-setting and discipline - Prepare maternal figure to expect more demands from the child at age 8 years - Prepare paternal figure to expect increasing admiration from the child at age 10 years; encourage father-child activities - Prepare parents for prepubescent changes in girls - Ages 11 to 12 years: - Help parents prepare the child for body changes of pubescence - Prepare parents to expect a growth spurt in girls - Make certain the child’s sex education is adequate with accurate information - Prepare parents to expect energetic and stormy behaviour at age 11 years, possibly becoming more even-tempered at age 12 years - Encourage parents to support the child’s desire to “grow up” but to allow regressive behavior when needed - Prepare parents to expect an increase in the child’s masturbation- given them awareness and knowledge - Instruct parents that the amount of rest the child needs may increase - Help parents educate the child regarding experimentation with potentially harmful activities Guidance for Parents During School Years: - Health Guidance - Immunizations- Human Papilloma Virus (HPV), Hep. B, Meningitis (at the 12 year mark) - Help parents understand the importance of regular health and dental care for the child - Encourage parents to teach and model sound health practices, including diet, rest, activity, and exercise - Stress the need to encourage children to engage in appropriate physical activities - Emphasize the importance of providing a safe physical and emotional environment Safety and Injury Prevention: - Age 6 to 9 years (Greig Health) - sports/protective gear to prevent injury - Supervise when swimming - Screen time limit for tablet and watch out what they are watching Strategies for Good Sleep Habits: - School age children should get 10-12 hours of sleep - Avoid junk food 3 hours before bed - Avoid electronics 2 hours before bed Adolescence: Normal Growth and Development During Adolescence (13-19 y/o) - Growth, cognition, identify, relationships with parents, relationships with peers, sexuality and psychological health (Table 40.1) - Pubertal growth spurt gains, - Final 20% to 25% of height - Up to 50% of the ideal adult body weight - Boys: Less rapid epiphyseal closure, taller, longer arms and legs, wider shoulder - Girls: broader hip development - Hypertrophy of the laryngeal mucosa and enlargement of the larynx and vocal cords. Deeper voice. - Active sebaceous gland- Acne - Heart size, blood volume, and systolic BP increase in size and strength; HR decreases; Respiratory vital capacity increases; Decline in basal metabolic rate Age Timeline: - School aged children: ages up to 10 yrs - Early Teens: ages 11 to 14 (2nd sex characteristics appear) - Middle Teens: ages 15 to 17 - Late Teens: 18 to 20 Pubertal Sexual Maturation: - Puberty: the reproductive organs begin to function, and the 2nd sex characteristics develop - Females: 1st menstrual period - Males: less obvious indications - Tanner stages of sexual maturation (1 to 5)– assessment of pubertal development - Sequence is predictable - Based on the visual or described secondary sex characteristics and genital development - Changes that occur throughout the body as a result of hormonal changes - Girls: breast size and shape and distribution of public hair - Boys: Size and shape of the penis and scrotum and shape and distribution of pubic hair Tanner’s Stages: Stage Physical Development (Girls) Physical Development (Boys) 1. Pre-Puberty No breast development or pubic hair No genital growth or pubic hair 2. Early Breast buds form; sparse, fine pubic Testes enlarge; sparse, fine Puberty hair begins pubic hair begins 3. Mid-Puberty Breasts enlarge; darker, coarse pubic Penis lengthens; darker, coarse hair pubic hair 4. Late Areolae protrude, pubic hair covers Penis thickens; pubic hair covers Puberty more area more area 5. Full Breasts mature; pubic hair adult-like Genitals mature; pubic hair Maturity and fully distributed adult-like and fully distributed Easy memory tip: -1st Stage: No changes -5th Stage: Adult stage Usual Sequence of Maturational Changes: 1. Girls: - Breast changes - Rapid increase in height and weight  - Growth of pubic hair - Appearance of axillary hair - Menstruation (usually 2 years after first signs) - Abrupt deceleration of linear growth 2. Boys: - Enlargement of testis - Growth of pubic hair, axillary hair, hair on upper lip, hair on face and elsewhere on body (facial hair, usually appears about 2 years after appearance of pubic hair) - Rapid increase in height - Changes in the larynx and consequently the voice (usually take place along with the growth of the penis) - Nocturnal emissions - Abrupt deceleration of linear growth Assessment: - Privacy and confidentiality - Caregiver presence with permission - Consent/autonomy - Vital signs– similar to adults - General appearance - Head-to-toe assessment - Least to most invasive - Some things need to be reported- abuse, concerning findings – need to be aware of the stuff that needs to be reported – speak privately for sensitive topics, treat them similar to adults Erikson: Identity Vs. Confusion: - Developing a sense of identity - A stable, coherent picture of oneself - Establishing autonomy from parents - Group identify - Individual identify - Peer support is paramount Adolescent Conceptions of Self: - Adolescent egocentrism  - Adolescents often exhibit self-focus, believing that others are constantly observing and evaluating them, which can heighten self-consciousness - Self-absorption - This tendency can lead to overemphasis on personal experiences and emotions, often referred to as the “imaginary audience” where teens feel they are the center of others’ attention - Health-related beliefs - adolescents may develop beliefs about health and risk that influence their choices, sometimes underestimating risks due to feelings of invincibility or focusing on short-term rewards - Changes in social cognition - Understanding of others thoughts and feelings - Roles - Effect on health-related choices Piaget: Emergence of Formal Operational Thought: - Formal operational thought - Abstract thinking - Concrete thought - Think beyond the present (e.g. college and occupational possibilities) - Decision-making abilities increase - May not use formal operational thought and reasoned decision making all the time – choices - More advanced cognitive abilities, abstract normal thought, reason through possibilities, hypothetical situations - Think of outcomes not tied to experiences, think of the future, better decision making, weight the consequences and alternatives, make impulsive and emotionally driven actions/decisions Promoting Optimal Health During Adolescence: - Influence of peers (could relate to peer pressure) based on appearance, peer pressure etc. - Obesity - Hypertension and hyperlipidemia - Personal care - Vision, hearing - Posture - Body art, Tanning (exposure to health risks) - Mental health - Stress reduction - Nursing role: develop skills to cope with stress and change and skills to become involved in personally meaningful activities- promote resilience and reduce stress - School and learning problems - Infectious diseases/immunizations - Sexual health  - Media influences are pervasive - Knowledge often inaccurate - Need for factual information, presentation based on developmental maturity - Importance of sexual aspects of interpersonal relationships - Pregnancy, abortion and birth control - Adolescents often engage in risk-taking behaviours, making injury prevention a priority. Education and awareness about safety in various activities can reduce injury risks. - Should get 9-10 hours of sleep - No caffeine after the afternoon - Avoid electronics before bed - Avoid exercise 3 hours before sleep Guidelines: Interviewing Adolescents - Ensure confidentiality and privacy; interview the adolescent without their parents - Ask which pronouns the adolescent would prefer be used during your discussion - Offer a nonthreatening explanation for the questions you ask: “I’m going to ask a number of questions to help me better understand your health” - Maintain objectivity; avoid assumptions; judgements, and lectures - Ask open-ended questions when possible; move to more directive questions if necessary - Begin with less sensitive issues and proceed to more sensitive ones - Use language that both the adolescent and you understand. Clarify terms, such as “having sex” or “hooking up.” - Restate: Reflect back to the adolescent what they said, along with feelings that may be associated with their descriptions - Ask the adolescent if the practitioner may share general (or specific) information gathered in the health examinations and interview with their parents. Reiterate that the teen’s confidentiality will be maintained if they refuse to give permission (unless life-threatening information is shared) HEEADSSS: - The HEEADSSSS assessment is a psychosocial interview framework commonly used in adolescent health care to explore various aspects of a young person’s life. How to Assess for Sensitive Topics: - Sensitive topics include: - Sexual orientation, sexual/gender identification, STIs, sexual abuse, and related topics - Cognizant of the significant psychological, psychosocial, and medical challenges - Approach in a non-judgemental, sensitive, and respectful manner; maintain confidentiality; Appreciate the adolescent’s feelings and remain sensitive to their need to talk about the topic - Use preferred pronouns; tell them what you think, but not what to do, empower the  teen Social Issues Related to Sexual Orientation and Gender Identity: - Rejection or estrangement from family - Social rejection and exclusion - Physical, social or emotional harassment, including cyberbullying - Pressure to “change” their sexual orientation or gender identity - Lack of positive role models and representation in educational materials or in the media - Lack of respect for chosen names and gender pronouns Week 12: Family, Social, Cultural Influences in Children’s Health Elements that Impact Children's Health in Canada: - Current status - Positive and negative indicators - Infant mortality rate - Children with increased morbidity - Social determinants of health - Health inequalities among children - Food insecurity - Mental health - Immunization - Health promotion Positive Indicators that have Improved: - Overall income inequality - Child income poverty - Neonatal mortality - Teen alcohol consumption - Teen births - Teen suicide - Child homicide Negative Indicators have worsened over time: - Disparities income: families with lower incomes are being left behind - Of youth excluded from adequate education and employment - Children from families with lowest incomes being left farther behind - Air pollution in cities: affects people who have respiratory symptoms the most - Unhealthy overweight - Teen mental health concerns - Bullying: cyberbullying is the worst Infant Mortality Rate: Canada  - Number of deaths per 1000 live births during first year of life - Indigenous: more than double (social factors) - Risk factors: Sudden infant death syndrome (SIDS), prematurity, congenital disease, respiratory illness, lack of oxygen, structural and functional birth defects - Other Risks: low maternal education, inadequate housing, lack of access to care, food insecurity, unemployment, poverty, LIVING IN REMOTE AREAS - Slipping Global ranking - From 10/24 (1980) to 30/38 (2021) data from organization of economic co-operation and development - 3.7/1000 is the norm but for people living in remote areas it is 1.6x higher Risk Factors for Infant Death: - Low maternal education - inadequate housing - Lack of access to health care - Food insecurity - Poverty - Unemployment Childhood Morbidity: - Prevalence of specific illnesses in the population at a particular time - Children with increased morbidity: - Homeless and immigrant children - Children living in poverty - Indigenous people - Children in care of child services - Low-birth-weight children - Children with chronic illnesses - Immigrant adopted children Incorporating Family Centered Care: - Creating goals - Goal: to improve the quality of healthcare for children - In context of the family - Develop a trusting and collaborative relationship with the child and family - Maintain a therapeutic/professional relationship - Philosophy of Care: - Canadian pediatric nursing standards: 1. Supporting and partnering with the child and family 2. Advocating for equitable access and the rights of children and their family  3. Delivering develop appropriate pediatric care 4. Creating a child and family friendly environment 5. Enabling successful transition Sick Kids Model: - Composed of: 1. Systems 2. Elements 3. Outcomes Pediatric Nursing: - Family advocating and caring: - United Nations Declaration of the Rights of the Child - Non-discrimination - The best interest of the child - The rights to life and development - Participation – “Children’s views should always be taken seriously, no matter their age” - How? - Disease prevention and health promotion - Health teaching - Support and counselling - Coordination and collaboration - Health care planning: helping families cope with end of life care Nursing Interventions: Picture - Behaviour modification: use simple language to help children understand, provide atraumatic care, give positive reinforcement (ex. stickers), continue to tell the child they are doing a good job - Providing information and technical expertise: share with the family some tips and tricks in providing their children with medication Atraumatic Care: - Interventions eliminate or minimize psychological and physical distress  - Atraumatic care is concerned with the who, what, when, where, why, and how of any procedure performed on a child. - Overriding goal: First do no harm. - 3 principles: - Prevent or minimize the child's separation from the family: if the parent is able to stay with the child, encourage it, distract both the parents and the child, explain to the parent what is happening and have someone who is able to provide them with information. - Promote a sense of control: give them options, involving them in decision making (older children) - Prevent or minimize bodily injury and pain: pharmacological and nonpharmacological interventions (give sucrose or distract them) Jordan’s Principle: - Jordan's Principle makes sure all First Nations children living in Canada can access the products, services and supports they need, when they need them. Funding can help with a wide range of health, social and educational needs, including the unique needs that First Nations Two-Spirit and LGBTQQIA children and youth and those with disabilities may have. - Jordan's Principle is named in memory of Jordan River Anderson, a young boy from Norway House Cree Nation in Manitoba. - Ensure that all first nation children living in canada have access to products and resources when they need them most Communicating with families; - Parents - Children - Strategies and barriers Different Strategies for Communicating with Parents: - Encouraging parents to talk and ask questions: use the white board in the room to write down questions they have regarding their child's care - Directing the focus - Listening and cultural awareness - Providing anticipatory guidance - Avoiding blocks (barriers) to communication - Communicating with families through an interpreter Blocks to Communication:  - Communication barriers (nurse) - Socializing: over socializing is a communication block - Giving unrestricted and sometimes unasked-for advice - Offering premature or inappropriate reassurance - Giving over-ready encouragement - Defending a situation or opinion - Using stereotyped comments or cliches - Interrupting and finishing the person's sentence - Talking more than the interview - Forming prejudged conclusions - Signs of Information Overload (Patient) - Long periods of silence - Wide eyes and fixed facial expression - Constant fidgeting or attempting to move away - Nervous habits, such as tapping, playing with hair - Sudden disruptions, such as asking to go to the bathroom - Looking around - Yawning, eyes drooping - Frequently looking at a watch or clock - Attempting to change the topic of discussion Different Strategies for Communicating with Children: - Communication and development of thought processes - Ages and stages: write terminology, right tone, get to their level - Communication techniques - Word choices - tone - Use of play be honest Erkison’s Psychosocial Development Theory: - Trust vs Mistrust (birth to one year) - Autonomy vs shame and doubt (toddler) - Initiative vs guilt (preschooler) - Industry vs inferiority (school-age children) - Identity vs confusion (adolescence) Communicating with Children: - Allow children time to feel comfortable. - Avoid sudden or rapid advances, broad smiles, extended eye contact, or other gestures that may be seen as threatening. - Talk to the parent if the child is initially shy.  - Communicate through transition objects such as dolls, puppets, and stuffed animals before questioning a young child directly. - Give older children the opportunity to talk without the parents present. - Assume a position that is at eye level with the child (see Figure 30.3). - Speak in a quiet, unhurried, and confident voice. - Speak clearly, be specific, and use simple words and short sentences - State directions and suggestions positively - Offer a choice only when one exists. - Be honest with children - Allow them to express their concerns and fears - Use a variety of communication technique Infants: 1. Infants respond to nonverbal communication behaviours of adults, such as holding, rocking, patting, cuddling, and touching. 2. Use a slow approach and allow the infant to get to know the nurse. 3. Use a calm, soft, soothing voice. 4. Be responsive to cries. 5. Talk and read to infants. 6. Allow security objects if the infant has them Toddlers: 1. Approach the toddler cautiously. 2. Remember that toddlers accept the verbal communications of others literally. 3. Learn the toddler’s words for common items and use them in conversations. 4. Use short, concrete terms. 5. Prepare the toddler for procedures immediately before the event. 6. Repeat explanations and descriptions. 7. Use play for demonstrations. 8. Use visual aids such as picture books, puppets, and dolls. 9. Allow the toddler to handle the equipment or instruments; explain what the equipment or instrument does and how it feels. 10. Encourage the use of comfort objects. Preschoolers: 1. Seek opportunities to offer choices. 2. Speak in simple sentences.  3. Be concise and limit the length of explanations. 4. Allow asking of questions. 5. Describe procedures as they are about to be performed. 6. Use play to explain procedures and activities. 7. Allow handling of equipment or instruments, which will ease fear and help to answer questions. School- Aged Children: 1. Establish limits. 2. Provide reassurance to help in alleviating fears and anxieties. 3. Engage in conversations that encourage thinking. 4. Use medical play techniques. 5. Use photographs, books, dolls, and videos to explain procedures. 6. Explain procedures and care in clear terms. 7. Allow time for composure and privacy. Adolescents: 1. Remember that the adolescent may be preoccupied with body image. 2. Encourage and support independence. 3. Provide privacy. 4. Explain the limits of confidentiality 5. Use photographs, pamphlets, and videos to explain procedures. 6. Engage in conversations about the adolescent’s interests. 7. Avoid becoming too abstract, too detailed, and too technical. 8. Avoid responding in a way that could be taken as prying, confronting, condescending, or expressing judgmental attitudes. Cultural and Religious Influences: - Beliefs and values about each facet of life and is passed from one generation to the next - Acculturation refers to changes that occur within one group or among several groups when people from different cultures come in contact with one another. - Spiritual care: aim to increase the spiritual well-being of the person and family Promoting Culturally Safe Care: - Reflect and recognize the influence of your own ethnicity and culture and their effects on your life.  - Recognize the diversity of needs and experiences of the persons you serve. - Obtain details based on personal information given by the patient or family members rather than making assumptions. - Use simple language when discussing procedures, if necessary. - Explore what is acceptable and suited to the patient or family for their care. - Involve family members with the consent of the patient. - Work out a mutually acceptable schedule of caring for the patient: what is convenient for the caregiver Roles: - Traditional roles of parents: role modelled what were considered appropriate sexual behaviour and family responsibilities. - Gender specific roles served were intended to provide stability and prolonged care for children. - Parental/sibling roles have changed - Shifts in the economy - Increased opportunities for women - Evolving gender roles within the family structures - Families with Lone-parent, same-sex or transgender parents - Greater variety in family configurations Determinants of Health: - Child with type 1 diabetes - Are the broad range of personal, social, economic and environmental factors that determine individual and population health. 1. Income and social status 2. Employment and working conditions 3. Education and literacy 4. Childhood experiences 5. Physical environments 6. Social supports and coping skills 7. Healthy behaviours 8. Access to health services 9. Biology and genetic endowment 10. Gender 11. Culture 12. Race / Racism Social Determinants of Health:  - refer to a specific group of social and economic factors within the broader determinants of health. These relate to an individual's place in society, such as income, education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups such as Indigenous Peoples, LGBTQ and Black Canadians. - Health inequity refers to health inequalities that are unfair or unjust and modifiable. For example, Canadians who live in remote or northern regions do not have the same access to nutritious foods such as fruits and vegetables as other Canadians. - Differences in the health status of individuals and groups are called health inequalities. Type 1 diabetes: - Requires careful balance of food intake, daily active living and insulin administration - Health inequities exist for children living in low-income families - Family income determines access to quality food, ability to secure transportation for medical appointments and access to medical supplies - Family income may also influence access to organized physical activities - 80 multiple-choice questions - 35 maternity questions - 45 paediatric questions - Scantrons - No calculations - December 5th, 1400 -1600 hr. - TC Sobeys - Bring YU card, or a valid passport - (no practicum card or driver license)