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63-277

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  1. 63-277 NURSING CARE OF CHILDREN AND YOUTH WITH EPISODIC AND LONG-TERM HEALTH NEEDS 63-277 Winter 2004

  2. Pediatric Nursing As Specialty • Complex – multiple ages & stages • Anatomy & physiology different from adult • Growth & developmental stages • Full of change • Atraumatic care • Family centred care • Emphasis on anticipatory guidance, risk reduction, injury prevention 63-277 Winter 2004

  3. Changing Pediatric Scene • Partnership with families •  technology • Changing demographics • Smaller families • Ethnic diversity •  survivors of premature births •  demands for adolescent care • Movement of care into home/community 63-277 Winter 2004

  4. Key Elements of Family Centred Care • partnership model • family is the “constant” • effective communication with parents • honour cultural diversity • support family strengths & resources • recognize & respect methods of coping • facilitate flexible plans of care 63-277 Winter 2004

  5. Nursing Care with Children & Families • Orient to “care by family” approach • Increase family involvement • Learn interpersonal skills • Self-awareness • Critical thinking - purposeful, organized, goal-directed 63-277 Winter 2004

  6. INPUT NEEDS PROBLEMS GOALS DESIRES of Individuals Families Groups THROUGHPUT CONCEPTS – LIFE TASKS Adaptation (Stresses & Strains) Maturation TOOLS Problem-Solving/Decision-Making Communication Teaching/Learning Management/Change Caring OUTPUT BEHAVIOURS Protective Nurturative Generative CLIENT SYSTEMS Intrapersonal Interpersonal Community BEVIS’ NURSING SYSTEM ASSESSMENT DIAGNOSIS  PLANNING INTERVENTION  EVALUATION 63-277 Winter 2004

  7. Use of Nursing Process • Assessment • Physiological • History, examination, diagnostics • Developmental • Developmental stages & tasks • Client & family • Psychosocial • Culture, language, religion • Economics • Family roles, health beliefs • Communication 63-277 Winter 2004

  8. Nursing Process(cont’d) • Diagnosis & Planning • NANDA • Parenting & family diagnoses • Family-centred care goals/beliefs & identified health goals • Collaboration – mutual identification of goals 63-277 Winter 2004

  9. Nursing Process(cont’d) • Interventions • creative nursing • interdependent nursing actions, collaboration • identify supports/resources, referrals • teaching/learning • ensure safety, security of child • care appropriate to age & development • caring, compassion, comfort 63-277 Winter 2004

  10. Ethical Decision-Making • Autonomy • Non-maleficence • Beneficience • Justice 63-277 Winter 2004

  11. Ethical-Legal Issues • Atraumatic care • Consent for treatment • Maintaining nursing records • Confidentiality • Research with children 63-277 Winter 2004

  12. UN Bill of Rights (1959) & Convention of Rights (1989) • Definition of a ChildA child is recognized as a person under 18, unless national laws recognize the age of majority earlier 63-277 Winter 2004

  13. Children’s Rights • Freedom from discrimination • Conditions of freedom & dignity • Name & nationality • Adequate nutrition, housing, recreation and medical services • Care of parents – moral, material security • Protection from neglect, exploitation • Education • First to receive protection and relief • Be brought up in a spirit of understanding, tolerance, friendship among peoples, peace & universal brotherhood 63-277 Winter 2004

  14. Advocacy • Intervene to prevent developmental & health problems • Work with families to identify needs, strengths, goals, and plans • Educate about available services • Promote children’s well-being through teaching, counseling, holistic care, collaboration 63-277 Winter 2004

  15. Best Practice • Evidence-based practice & research • Optimize care & standards • Share & disseminate findings • Future • Collaborative management, ambulatory care, home care, health promotion • RNAO Best Practice Guidelines 63-277 Winter 2004

  16. RNAO BPG: SUPPORTING & STRENGTHENING FAMILIES 63-277 Winter 2004

  17. Levels of Prevention • Primary • Health promotion, disease & injury prevention • Secondary • Screening & early diagnosis • Tertiary • Disease management, optimizing rehabilitation 63-277 Winter 2004

  18. Community Assessment • Demographics • Population • Culture, ethnicity • Social class • Family size, types 63-277 Winter 2004

  19. Community Systems • Health & social services • Communication • Recreation • Physical environment • Education • Safety & transportation • Politics & government • Economics 63-277 Winter 2004

  20. Cultural Assessment • Cultural diversity, subcultures, minorities • Class structure – upper, middle, lower • “Culture shock” – new immigrant experience • Barriers – language, habits, attitudes & beliefs, isolation • Stereotypes & prejudices • Cultural health practices 63-277 Winter 2004

  21. Poverty • Episodic or chronic • Visible or invisible • Homelessness, migrant populations • Issues: •  chronic illnesses, injuries, dental caries, etc. • poor nutrition • lack of resources • delayed growth & development •  teen pregnancies 63-277 Winter 2004

  22. Nursing Activities for the Community • Needs assessment – community priorities • Public Health • Health assessment, disease surveillance, policy development • Health promotion • Perinatal care, screening clinics, parenting skills education, education on health/injury risks • Injury Prevention • Develop and implement prevention strategies 63-277 Winter 2004

  23. Haddon Phase-Factor MatrixUseful for planning, strategy identification, resource allocation 63-277 Winter 2004

  24. Haddon Phase-Factor MatrixApplication to Playground Safety 63-277 Winter 2004

  25. Vital Statistics • Mortality: number of deaths in a specific period (rate/100,000 population) • Infant Mortality Rate: number of deaths during 1st year of life (rate/1000 births) • Morbidity: prevalence of a specific illness (rate/1000) • New Morbidity: pediatric social illnesses e.g. poverty, abuse, violence, school failure, divorce 63-277 Winter 2004

  26. Perinatal inheritence Optimal weight Nutrition Injury/violence Environmental risks (pollution) Access to health care Substance use/abuse Exposure to tobacco, alcohol Sexual behaviour Mental health Gender (female) Dominant ethnic group Family income Home location Education Leading Health Indicators for Children 63-277 Winter 2004

  27. Leading Causes of Infant Mortality • Congenital anomalies • Prematurity • Low birth weight • Sudden infant death syndrome (SIDS) • Maternal complications in pregnancy • Newborn birth complications • Respiratory distress syndrome (RDS) • Infections – bacterial sepsis • Birth asphyxia • Intrauterine hypoxia 63-277 Winter 2004

  28. Leading Causes of Childhood Mortality • After 1 year of age • Injuries/accidents are leading cause of death • Adolescence: higher risk for – • Injury • Homicide • Suicide • Cancer • Heart disease 63-277 Winter 2004