PAEDIATRICS AND

PAEDIATRIC NURSING
By Benkele R. G.
BScN., PaedN., RN., EN.

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 1. HISTORICAL
DEVELOPMENT OF
PAEDIATRIC NURSING

By Benkele R. G.
BScN., PaedN., RN., EN.

12/09/21 2
 Introduction

• Colonial America children were born into a

world with many hazards to their heath and
survival.
• Physicians were few; midwives were untrained
• Books that provided information on childcare
and feeding were scarce
• Only available to a minority of literate parents.

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 Introduction, cont….

• Native American children were treated for

diseases according tradition of each tribe -
mixture of medicine, magic and religion.
• Epidemic diseases included smallpox,
measles, mumps, chickenpox, Influenza
diphtheria, TB, yellow fever, cholera,
whooping cough and dysentery.
• Dysentery surpassed all others as causes of
childhood death.

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 Introduction, cont….

• Consequences of childhood illness, injury and

effects of child labor, poverty and neglect –
widely recognized during the industrial
revolution in the 19th Century.
• The end of 19th Century is often regarded as
the ‘Dark’ Ages Of Pediatrics.
• The 1st half of the 20th Century is regarded as
the ‘Dawn’ Of Improved Healthcare For
Children (Cone, 1976).

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 Study of Paediatrics

• Began in the last half of 1800s under the

influence of Prussian born physician - Abraham
Jacobi (1830-1919) referred as The Father of
Paediatrics
• With other physicians, he pioneered in the
scientific and clinical investigation of childhood
diseases.
• One outstanding achievement was the
establishment of “milk stations”

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 Study of Paediatrics, cont…..

• Mothers could bring sick children for treatment

and learn the importance of pure milk and its
proper preparation.
• The crusade for pure milk helped bring the dairy
industry under legal control.
• The decline in infant mortality since 1900 was
achieved through prevention and health
promotion measures – improved sanitation and
pasteurization of milk.

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 Study of Paediatrics, cont…..

• Before these regulations; unsanitary milk supply

was a chief source of infantile diarrhea and
bovine tuberculosis.

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 Social Welfare of Children

• Lillian Wald (1867-1940) a social reformer

founded the Henry – street settlement in New
York City - The ‘Founder’ of Public Health or
Community Nursing.
• Nursing services, social work and an organized
programs of social, cultural and educational
activities were being provided.
• As causes of diseases were identified, emphasis
on isolation and asepsis occurred.
• In 1900s children with contagious diseases were
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isolated from adult patients. 9
 Social Welfare of Children,
cont……

• Parents were prohibited from visiting because

they might transmit diseases to and from home
• Even toys and personal articles of clothing were
kept from the child.

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 Isolation and Asepsis

• Spits and Roberson in (1940) identified the

effects of isolation and maternal deprivation
• This brought a surge of interest in psychological
health of children
• Resulted in changes for hospitalized children,
such as rooming in, sibling visitation, child life
(play) programs such as pre-hospitalization
preparation, parent education and hospital
schooling.

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 Improvement of children’s
living conditions

• In 1909 President Roosevelt called the 1st

White House conference on children.
• The conference addressed the deplorable
working condition of youngsters under care of
dependant children in 1912.
• The US Children Bureau was established as a
result of this conference.

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 Improvement of children’s
living conditions, cont.....

• Studies of economics and social factors i.e

infant mortality, maternal death and maternal
and infant care stimulated the creation of better
standards of care for mothers and children and
led to the 1st maternity and infants Act.
• The Act provided grants to states to develop a
division of maternal department and influenced
creation of the American Academy of
Pediatrics (AAP).

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 Landmarks in development of
child health nursing
(Paediatric Nursing)

• 1771- New York hospital, one of the 1st

Teaching Hospitals in USA provided
classroom presentations designed for nurses.
• 1851-The Hospitals for sick children was
founded in London.
• 1855- One of the earliest known Paediatric
Textbook “How to Nurse Sick Children” was
published.
• 1855 – The Children’s Hospital of
Philadelphia, USA, was founded
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 Landmarks in development of
child health nursing
(Paediatric Nursing), cont……

• 1860 – Florence Nightingale opened her first

school of nursing connected with St.
Thomas Hospital in London.
• 1880 – Children Hospital Training School in
San Francisco offered formal classes to
educate nurses in the care of ill-children.
• During this period the role of the nurse was that
of a childcare taker.
• Nurses were responsible for maintaining
nutrition, hygiene and hydration.
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 Landmarks in development of
child health nursing
(Paediatric Nursing), cont……

• They played a major role in controlling the

spread of communicable disease by observing
sanitary measures.
• Nursing care like the medical practice it
supported, was curative rather than preventive.

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 Social influences on nursing

• 1886 – Nurses practiced in home without direct

physician supervision.
• 1893 – Lilian Wald opened the Henry Street
settlement house, which provided medical
social, cultural and education services to the
poor.
• 1896 – Nurses’ Association Alumni of the
United States and Canada was founded; later it
became the American Nurses’ Association
• 1903-Recognition of nurses was initiated.
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 Social influences on nursing,
cont…….

• 1912 – Us Children Bureau which oversees

children’s health and environment was
established.
• 1970’s – Health became a more comprehensive
concept than suggested by the traditional
definition, which indicated merely the absence of
diseases.
• Nurses began to view children holistically-i.e. in
relation to their biophysical, cognitive, affective
and social needs.

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• Nursing process cleave was developed. 18
 Social influences on nursing,
cont…….

• Nurses developed their roles as child advocates

ensuring the highest quality of health care for
children.

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 QUESTIONS?

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 Evolution of Child Health Nursing in
Zambia

• The vision to have a specialized course

for nurses caring for sick children has
began
• There are handful of nurses who have
been trained outside the country
• Their registration in Zambia costs
K1,000,000 currently
• The impact of these nurses on the care of
sick children has been negligible
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 Evolution of Child Health Nursing in
Zambia, Cont…………………………

• They are not very sure about its history

in Zambia – no available documents
• Efforts have started to write the Evolution
of Child Health Nursing in Zambia

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 QUESTIONS?

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 Current barriers to health
care services that remain:

• Financial barriers- e.g. Inability to pay for

services.
• Systems barriers- e.g. Having to travel great
distances for healthcare.
• Knowledge barriers- e.g. Lack of use and
understanding of the need for parental or child
health supervision.

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 Future Trends
• Shift in focus from treatment of disease to
promotion of health will expand the nurses role
in ambulatory care, with prevention and health
teaching receiving a major emphasis.
• Technologic advances related to patient care as
well as knowledge in computer in the work
setting.
• Changing demographics and their impact to
paediatric nursing

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 Qualities of a good Paediatric
Nurse
• 1.   Good observer.
• 2.    Honest and truthful.
• 3.    Sympathetic, kind, patient and cheerful.
• 4.    Love to work with children.
• 5.    Interested in family care.
• 6.    Able to provide teaching to children and
their families.

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 Roles of a Paediatric Nurse
1. Therapeutic Relationship- to relate
meaningfully to the children and their families
and yet separate enough to distinguish their
own feelings and needs.
2. Family Advocacy - the nurse must work with
family members, identify their goals and needs
and plan interventions that best meet the
defined problems - assists to make informed
choices

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 Roles of a Paediatric Nurse,
cont........
3. Health Teaching - involves transmitting
information at the child’s and family’s level of
understanding and desire for information -
appropriate health teaching with generous
feedback and evaluation to promote learning.
4. Support /Counselling
 support -by listening, touching, physical
presence- most helpful with children because
they facilitate non-verbal communication

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 Roles of a Paediatric Nurse,
cont........
 counselling- mutual exchange of ideas and
opinions that provide the basis for mutual
problem solving. Also enables the family to
attain higher level of functioning, greater self
esteem and closer relationships.
5. Restorative Role - most basic of the nurse’s
role. Meeting the physical and emotional needs
of the patients, continual assessment and
evaluation of physical status. The nurse must
be aware of normal findings in order to
intelligently identify and document deviations

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 Roles of a Paediatric Nurse,
cont........
6. Coordination and Collaboration - as a
member of the health care team, the nurse
coordinates and collaborates nursing services
with the activities of other professionals - multi-
disciplinary team (MDT) approach
7. Ethical Decision Making - ethical dilemmas
arise when competing moral considerations
underline various alternatives.
 may include; autonomy, nonmaleficence,
beneficence and justice.
 The nurse’s role as a member of the health care
team is to participate in ethical decision making.
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 Roles of a Paediatric Nurse,
cont........
8. Research - Current emphasis on measurable
outcomes to determine the efficacy of
interventions – Evidence Based Practice
(EBP). Nurses must constantly question why
something is effective or not.
9. Health Care Planning - Nurses must
incorporate a political component into their
professional role identity and must also affect
the decision-making body of government.

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 Roles of a Paediatric Nurse,
cont........
 Knowledge and awareness of community
needs, an interest in government formulation
bills, support of politicians to ensure passage of
(or rejection) of significant legislation and active
involvement in groups dedicated to the welfare
of children

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 QUESTIONS?

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 REFERENCES
• Wong D. L., Hockenberry, M. J., Wilson, D.,
Winklstein, M. L. and Kline, N. E. (2003).
Wong’s nursing care of infants and children,
(7th ed.), St Louis: Mosby.
• Hockenberry M. J., Wilson D., & Winkelstein
M. L. (2005). Wong’s essentials of pediatric
nursing, (7th ed.), St Louis: Mosby.

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