CURRENT TRENDS IN PEDIATRIC NURSING

PEDIATRICS:

The term ‘pediatrics’ is derived from the Greek words ‘pedia’ means child, ‘iatric’ means
treatment and ‘ics’ means branch of science. Thus, pediatrics means the science of child care and
scientific treatment of childhood diseases. Pediatrics is synonymous with child health.

Or it can be defined as the branch of medical science that deals with the care of children from
conception to adolescence in health and illness. It is concerned with preventive, promotive,
curative and rehabilitate care of children.

INTRODUCTION:

Remarkable changes have occurred in the field of pediatric nursing in recent years due to
changing needs of society, medical and technological advances, political interests and changing
trends within the nursing profession. Other influencing factors are consumers demands,
increased public awareness and greater understanding of child health problems along with
psychological aspects of illness and hospitalization.

In earlier days, present medical techniques were treating both adults and child as same. Now the
child care has prime importance, as a mortality and morbidity are higher in this group. The child
health care has evolved from a sideline of maternal medicine or a specialty that focuses on the
child and the child’s family in health and illness through all phases of development.

 Modern approach of child health care emphasizes on preventive care rather than curative
care.
 Growth of specialization within the field of pediatric medicine has had an impact on
nursing care of children.

The services in order to these causes affect provided people. These are

1. Concept of establishment of under five clinic

2. Continuous care of whole child (wholistic care)
3. Modern concept in hospitalization
4. Family centered care

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 5. High technology care
6. Evidence based practice
7. Case management
8. Child oriented environment
9. Atraumatic care
10. Cost containment
11. KMC(kangaroo mother care)
12. IMNCI
13. Newer diagnostic and treatment modalities and nursing practice
14. Ethical decision making and legal safeguard
15. Quality assurance and cost effectiveness
16. Acceptance of beneficial traditional practices
17. School teacher involved in care of hospitalized child.
18. Disease prevention and health promotion
19. Expanded role of pediatric nurse
20. Modalities of nursing practice
21. Emphasis on preventive rather than curative approach
22. Emergence of super specialized areas in pediatric nursing
23. Multi disciplinary team collaboration.

1) CONCEPT OF ESTABLISHMENT OF UNDERFIVE CLINIC:

The concept of under – five clinic is derived from the well baby clinic of the west, for
comprehensive health care of children of children below five years of age. The clinic provides
preventive services along with health supervision, treatment , nutritional surveillance and health
education.

Under – five age groups are vulnerable and special risk group constituting a major portion of
total population with high death rate. The important causes of morbidity and mortality of this
group are mainly, ARI , diarrhea, neonatal and perinatal diseases, infections and accidents. These

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conditions are mostly preventable with adequate health care. This groups also needs regular
monitoring for growth and development.

The services provided by the clinic are set out in the symbol, which has been proposed for under-
fives clinics in india.The apex of the large triangle represents care in illness, the left triangle
represents adequate nutrition, the right triangle represents immunization and the central red
triangle represents family planning. The line bordering the big triangle represents health teaching
to the health.

Care in
illness

Famliy
Planning

adequate Immuniz-
nutrition ation

Care in illness:

The care of illness for children provided in the under – 5 clinics includes the followings:

1. Diagnosis and treatment of:

a) Acute illness e.g. oral rehydration therapy.
b) Chronic illness including physical , mental , congenital and acquired abnormalities.

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 c) Disorders of growth and development.
2. X-ray and laboratory services
3. Referral services.

Adequate Nutrition :

Adequate nutrition is vital for growth and development of children . The health worker should
ensure about adequate breastfeeding , weaning and balanced diet of the under – 5 children .
almost all nutritional disorders like PEM , anemia, rickets, nutritional blindness occur in this age
group.

Immunization:

Immunization of six killer diseases viz – tuberculosis, diphtheria, pertussis, tetanus,

poliomyelitis and measles.are administered as per national immunization schedule
recommendation. The health worker should motivate and promote the immunization acceptance
to prevent morbidity , mortality and disability hazards by these six killer diseases.

Family Planning:

The family planning program is successfully conducted through these clinics. The mothers
attending the clinic receives counseling with different aspects of family planning practices,
which is an significant concern for the health and well – being of the child.

Health Education:

Health education to the mother is an essential and compulsory activity of the under-five clinic.
The mothers should receive the informations on various aspects of child care and child rearing
practices. Preventive measures against malnutrition , ARI , diarrhea tuberculosis, worm
infestations, etc. should be informed to the mothers to improve awareness about the disease and
its prevention.

2) CONTINOUS CARE OF WHOLE CHILD (WHOLISTIC CARE):

This concept was found basically in pediatric by “ Maslow’s hierarchy of needs”. It
focus on wholistic care of child.

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 As per this concept if we want to have healthy growth of a child , we should fulfill these
following needs of the child and will be able to make a child healthy.

a) Physiological Needs:

Physiological needs are the physical requirements for child survival. If these requirements are
not met, the child body cannot function properly and will ultimately fail. Physiological needs are
thought to be the most important; they should be met first.

Air, water, and food are metabolic requirements for survival in all animals, including humans

It will fulfill the thirst , hunger needs of the child. It will help to prevent malnutrition of other
opportunistic disease. Sound sleep will contribute to physical , mental and spiritual development.

Clothing and shelter provide necessary protection from the elements .

b) Safety & security:

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With their physical needs relatively satisfied, the individual's safety needs take precedence and
dominate behavior. In the absence of physical safety – due to war, natural disaster, family
violence, childhood abuse, etc. In the absence of economic safety – due to economic crisis and
lack of work opportunities – these safety needs manifest themselves in ways such as a preference
for job security, grievance procedures for protecting the individual from unilateral authority,
savings accounts, insurance policies, reasonable disability accommodations, etc. This level is
more likely to be found in children because they generally have a greater need to feel safe.

Accidents are becoming reasons for child death. So the area of child where he or she is living
should be free from all types of hazards. Feeling of security should be there so that child feels
that there is someone is there to care him/her.

Safety and Security needs include:

 Personal security
 Financial security
 Health and well-being
 Safety net against accidents/illness and their adverse impacts
c) Love & belongingness:

After physiological and safety needs are fulfilled, the third level of human needs is interpersonal
and involves feelings of belongingness. This need is especially strong in childhood and can
override the need for safety as witnessed in children who cling to abusive parents. Deficiencies
within this level of Maslow's hierarchy – due to hospitalism, neglect, shunning, ostracism, etc. –
can impact the individual's ability to form and maintain emotionally significant relationships in
general, such as:

 Friendship
 Intimacy
 Family

In this child have to provide love , care , affection & intimacy to child as it will help in
psychological development. Child will also have good emotional development.

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 d) Self esteem:

Esteem presents the typical human desire to be accepted and valued by others. People often
engage in a profession or hobby to gain recognition. These activities give the person a sense of
contribution or value. Low self-esteem or an inferiority complex may result from imbalances
during this level in the hierarchy. People with low self-esteem often need respect from others;
they may feel the need to seek fame or glory. However, fame or glory will not help the person to
build their self-esteem until they accept who they are internally. Psychological imbalances such
as depression can hinder the person from obtaining a higher level of self-esteem or self-respect

Every individual require recognition , respect in society. So to Make them socially independent
and help to make their identity.

Maslow states that while he originally thought the needs of humans had strict guidelines, the
"hierarchies are interrelated rather than sharply separated". This means that esteem and the
subsequent levels are not strictly separated; instead, the levels are closely related.

e) Self Actualization:

What a man can be, he must be."This quotation forms the basis of the perceived need for self-
actualization. This level of need refers to what a person's full potential is and the realization of
that potential. Maslow describes this level as the desire to accomplish everything that one can, to
become the most that one can be Individuals may perceive or focus on this need very
specifically.

For example, one individual may have the strong desire to become an ideal parent. In another,
the desire may be expressed athletically. For others, it may be expressed in paintings, pictures, or
inventions.

As we know that everyone have different kinds of abilities. So we have to create such type of
environment so that child may develop and use their abilities and IQ. As the child develop
physically , socially emotionally and intellectually child will develop a self image about oneself.

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 3) MODERN CONCEPT IN HOSPITALIZATION:
 Flexible visiting hours.
 Rooming In
 Parents support groups
 Comprehensive nursing care
 Self care

As we know hospitalization means shifting the child from home environment and placed in
hospital for observation.

 Flexible visiting hours:

Every hospital have an policy for making time schedule to meet the admitted child. It will
not interrupt the routine activities of hospital. It will also minimize the stress level. It also
helps in exploring out the feelings of family members.
 Rooming In:
In this there is allowance of one parent to stay with the admitted child. Separation can
create a higher degree of stress on parents and as well as in child.
 Parents support groups:
Parents who have the interest and who are passionate about service can consider joining
parents support group. These group advice , and support one another and encourages the
child that after the treatment he/she will return home.
 Comprehensive nursing care:
Previously when child is admit in hospital, the focus on physical needs only. But in
modern , the main focus on overall needs – physical , emotional , spiritual or
psychological and social needs.
 Self care:
The nurse should encourage child to actively involved themselves in the care of their
health (i.e. physical or physiological inability)
- To guide the child for self care to do work
- To perform the exercises for healthy life style

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 4) Family centered care:

The philosophy of family centered care recognizes the family as the constant in a child’s life.
Services systems and personnel must support , respect , encourage and enhance the strength and
competence of the family by developing a partnership with parents. Nurses support families in
their natural care giving and decision making roles by building on their unique strengths and
acknowledging their expertise in caring for their child both within and outside the hospital
setting. The philosophy acknowledges diversity among family structures and backgrounds;
family goals, dreams , strategies and action;and family support ,service and information needs.

Family centered nursing care recent trend in developed countries where the children (sick) were
not treated as patients. But the attention was given to their medical problem.

The care giver realized that the family , community , society surrounding the child have a
particular way of life or culture. Their health is influenced by these and other factors. Separating
a sick child from family for hospital will not provide his basic demands and needs so the care
will be provided in home , depending on family characteristics.

Family centered care- concepts :

 Enabling:

It is based on quality care and promote physiological and psychological care of the family. It also
provide family education. Enable families by creating opportunities and means for all family
members to display their current abilities and competences to acquire new ones.

 Empowering:

Interact such that families maintain or acquire a sense of control over their lives and
acknowledge positive changes. Foster the strength of family to cope and withstand stress and
help in decision making.

5) High technology care:

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The advancement in the diagnostic technology has made detection of many disorders even in the
foetal period. Laboratory methods to assess foetal maturity and health of the feotus in the womb.
As the technology increases , so does our ability to provide sophisticated medical devices to
children to sustain life itself.

6) Evidenced based practice:

It is the collection, interpretation , and integration of valid, important and applicable patient-
reported, nurse-observed, and research –derived information. EBP combines knowledge with
clinical experience and intuition.

It provides a rational approach to decision making that facilitates best practice. EBP is an
important tool that complements the nursing process by using critical thinking skills to make
decisions based on existing knowledge. The traditional nursing process approach to patient care
can be used to conceptualize the essential components of EBP nursing.

It is a systematic approach. In evidence based practice , nurse need to make decision on the best
available evidences. EBP in nursing provides a systematic approach to enable nurses to
effectively use the best solution related to nursing practices. It also provide the quality care to the
patient.

7) Primary nursing :

It include 4 aspects:Continuity care, commitment , accountability , responsibility.

The system of primary nursing provide extreme commitment to patient accountability . 24 hour
responsibility and accountability by one nurse for the care of small group of patient is possible
with primary nursing.

8) Case management:

It is consider as an extension of primary nursing. It is usually used in outpatient setting by

assigning a case management to a patient or a group of patients. It is an approach to coordinate

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care and control costs. The benefits of case management include improved patient/ family
satisfaction. Case managers are responsible and accountable for particular groups of patients and
often use timeless derived from standards of care.

9) Child oriented environment:

A child friendly environment should be provided to a child who is admitted to hospital. Play
materials also provided to child. There is safety protection in the child ward. Provide education
to the child

. The need for play to be organized under skilled supervision to reduce the negative effects of
separation of mother and child, disturbance of routine and lack of training for doctors and nurses
regarding the emotional and mental needs of children.

Objectives of play:

increase the child’s ability to cope with a hospital admission.

- facilitate appropriate channels of communication between the child, the family and relevant
health care professionals

create an environment where stress and anxiety are reduced

10) Atraumatic care:

Although tremendous advances have been made in pediatric care, much of what is done to
children to cure illness and prolong life is traumatic, painful, upsetting and frightening.

Unfortunately, attempts to minimize the trauma of medical interventions have not kept pace with
technologic advances. With knowledge of the stressors imposed on ill children and their families

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and armed with interventions that are safe and effective in eliminating or reducing the stressors,
health professionals must direct their attention to providing atraumatic care.

It is the provision of therapeutic care in settings by personnel and through the use of
interventions that eliminate or minimize the psychologic and physical distress experienced by
children and their families in the health care system.

The overriding goal in providing a traumatic care is first do not harm.

It means not harming the child or not producing any injury to child.

 It promotes sense of comfort.

 It prevents injury and minimize the pain.
 Prepare the child before procedure.
 Respect religious differences
 Provide privacy
 Minimizes the child separation from family.

11) Cost containment:

The cost containment process is an important management function that helps keep costs down
to only necessary and intended expenses in order to satisfy financial targets.

 Reduces cost of hospitalization.

 Reduce mortality rates, hospital stay, complications.
 Increase family satisfaction
 Intuitive and scientific care to patient and family
 It prevent duplication of nursing care

12) KMC(Kangaroo Mother care)

Dr. Edger Ray, Dr Martinez and Dr Charpak in late 1970s introduced the kangaroo mother care.

It is the special way of caring low birth weight (LBW) infants by skin –in-skin contact.

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It promotes their health and welling by effective thermal control, breastfeeding and bonding.
KMC initiated in hospital and continued at home.

 Two components of KMC are: skin to skin contact and breast feeding.
 In this baby should be placed between the mother’s breast in an upright position.
 Baby’s head should be turned to one side and in a slightly extended position which helps
to keep the airway open and allow eye to eye contact between mother and baby.
 Baby’s hip should be flexed and abducted in a frog like position the arms should also be
flexed and placed on mother’s chest.
 Baby’s abdomen should be placed at the level of mother’s epigastrium.
 It was done on thousands of babies to check the mortality rate and hence it was
decreased. Other than he identified that it is helping baby to maintain body temperature
on skin to skin contact and mother’s breathing and heartbeat stimulate the baby as it
reduce the occurrence of apnea. And duration of KMC should not be less than 1 hour to
avoid frequent handling which may be stressful to the baby.

13) IMNCI:
It is the integrated management of neonatal and childhood illness.
Its main aim is to reduce the under-five mortality.
In this the main focus is given to sick infants of age up to 2months and all sick children
age 2 months up to 5years.
The IMNCI strategy includes both preventive and curative interventions that aim to
improve practices in health facilities, the health system and at home. At the core of the
strategy is integrated case management of the most common neonatal and childhood
problems with a focus on the most common causes of death.
The strategy includes three main components:
 Improvements in the case-management skills of health staff through the provision
of locally-adapted guidelines on Integrated Management of Neonatal and
Childhood Illness and activities to promote their use;
 Improvements in the overall health system required for effective management of
neonatal and childhood illness

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  Improvements in family and community health care practices.
An essential component of the IMNCI guidelines is the counseling of caretakers about home
care, including counseling about feeding, fluids and when to return to a health facility.

14) Newer diagnostic and treatment modalities and nursing practices:

Newer diagnostic technique is used to identify the disease condition.
Newer treatment technique means provide care to the person
For example: if a child with renal calculi, then perform ultrasonography and IV
Pyelography and to provide treatment like: IV fluids and water to drink
Nursing practices: In this standard protocols are there to how to provide care to child,

15) Ethical decision making and legal safeguard:

Whenever you make a decision, the nurse should follow some rules and have critical
thinking and skills.
 Informed consent and assent: Nurse should take consent and assent about the procedure
he or she perform. In this child and his relatives agreed for the further procedure
proceeding.
 Beneficence: It states that when nurse decide regarding child care, nurse should know
about the benefits of child instead of hospital.
 Justice: If nurse make decision about care of patient, it should not discrimination based
on age, race, caste , religion or color.

16) Quality assurance and cost effectiveness:

When a nurse provide care to child the 2 things he or she should kept in mind:
 Try to provide quality care as best as possible. Advance care with minimum
utilization of resources, money, manpower etc.
 Before beginning a treatment, examine the child through clinical approach ,
diagnostic test then nurse find the problem and then look the treatment modalities.

17) Acceptance and beneficial traditional practices:

There are some traditional practices which is exist in society. These practices transmit
from one generation to other. These practices are also helpful in interacting in child
health. These are beneficial to child health.

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 Practices:
-useful traditional practices
-harmful traditional practices
-doubtful traditional practices
-inconsequential traditional practices
-nose and ear piercing
1. Useful traditional practices:
Example: drinking milk avoiding tea or coffee to have fair complexioned baby. Due to
this false belief child suffers from growth retardation. As drinking milk makes the bone
strong.
 Abstinence during pregnancy
 Isolation of mother child for 40 days:
Separate the mother and child for at least 40 days.
They are placed at separate room from family members.
The basic concern is that:
 To care the new born baby
 To prevent from infection
 Oil massage and sun bath:
The massage is given by coconut oil or mustard oil

Purpose :

o For smoothen the skin

o Improve the circulation
o Static heart rate and respiratory rate
o Good sleep
o No risk of hypothermia
o Improves appetite

Sun bath:

Expose the baby to the sun is to prevent from hypothermia and sunbath with garlic that act as
anti microbial effect.

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  Instillation of colostrum in the eyes:
Colostrum act as antimicrobial agent so to prevent from eyes infection it is used due to
rich in antimicrobial effect.
2. Harmful traditional practices:
Eating less food during pregnancy
 Bathing the baby at birth: after delivery, dry bath should be given to newborn baby or
oil bath also.
 Application of kajal in eyes: for better looking and to prevent infection like trachoma
 Instillation of oil in the nostrils: to moisturize the skin and for smoothen the skin.

It can cause pneumonia due to aspiration of oil drops.

3. Doubtful or uncertain practices:

 Janam ghutti: it can cure constipation or diarrhea
 Brandy for URI/pneumonia: to cure sneezing
4. Inconsequential traditional practices:
 Pre lacteal feeds
 Glucose water
 Honey
 Cow’s urine
 Donkey’s milk
5. Nose and ear piercing:
 Remove nazar by applying kala tikka behind the ear or on forehead.
 Buying the bath clothes only after birth and not wearing any of stitch cloth at 6th day of
life.

18) School teacher involved in care of hospitalized child:

Illness and hospitalization lead to loss of school days and education for some children.

In an attempt to accommodate the educational needs of children and young people in hospitals,
many pediatric hospitals have teachers who provide one-on-one teaching either in a hospital
classroom or at the bedside of children who are hospitalized for extended periods.

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The involvement of a teacher in a patient’s total care enhances the student’s learning potential
while ill and facilitates a smoother return to school.

Sometimes, the teacher’s responsibility may include course selection or rearranging timetables,
work completion, test or examination proctoring and/or initiating an identification, placement
and review committee if the illness has affected the patient’s learning abilities.

By providing this liaison work, the hospital teacher can facilitate the school program at a time
when the parents are possibly very preoccupied with workplace demands and other children at
home, in addition to caring for a sick hospitalized child.

19) Disease prevention and health promotion:

Every nurse involved with child care must practice preventive health care. Regardless of the
identified problem, the nurse’s role is to plan care that fosters every aspect of growth and
development. Based on a thorough assessment process, problems related to nutrition ,
immunization , safety , dental care, development, socialization , discipline or schooling often
become obvious. Once the problem is identified, the nurse acts to intervene directly or to refer
the family to other health care providers or agencies.

The best approach to prevention is education and anticipatory guidance. In this text each
chapter of health promotion includes sections on anticipatory guidance. An appreciation of the
hazards or conflicts of each developmental period enables the nurse to guide parents regarding
childbearing practices aimed at preventing potential problems. One of the most significant
examples is safety. Because each age-group is at risk for special types of injuries, preventive
teaching can significantly reduce injuries, lowering permanent disability and mortality rates.

Prevention also involves less obvious aspects of child care. Besides preventing physical disease
or injury, the nurse also promotes mental health, for example, it is not sufficient to administer
immunizations without regard to the psychologic trauma associated with the procedure.
Optimum health care involves providing care with a humane approach the nurse and all other
health care professionals must ensure that humane care is provided.

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 20) Expanded role of pediatric nurse:

The ever -expanding demands of medical and nursing practice emerging challenges in different
aspects of child care, consumer demands and improved technology have necessitated the highly
specialized roles of pediatric nurse.

The role of the pediatric nurse is both caring and curing. Caring is a continuous process in boh
wellness and illness. It refers as helping. guiding and counseling, curing refers to the act of
diagnosis and management, usually during illness. Pediatric nurse have the responsibilities of
providing nursing care in hospitals, home, clinic, school and community where children and their
parents have health counseling needs.

The characteristics social behavior of the pediatric nurse as role model for the child care can be
summarized as follows:

1. Primary caregiver: pediatric nurse should provide preventive, promotive , curative and
rehabilitative care in all levels of health services, as therapeutic agent. She/he acts as case
finder and compassionate skilled caregiver as needed by the today’s society. Health
assessment , immunization , primary health care and referral are basic responsibilities at
the community level as quality care provider.
2. Health educator: important role of the pediatric nurse is to deliver planned and
incidental health teaching and information’s to the parents, significant others and children
to create awareness about healthy lifestyle and maintenance of health.
3. Nurse counselor: problem solving approach and necessary guidance in health hazards of
children to minimize or to solve the problems and to help the parents and family
members for independent decision making in different situations are essential role of the
pediatric nurse in the present health care delivery system.
4. Social worker: nurse can do case work especially for children and try to alleviate social
problems related to child health. She/he can participate in available social services or
refer the child and family for necessary social support from the child welfare agencies.

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 5. Manager: the pediatric nurse is the manager of pediatric care units in hospital, clinics
and community. She/he should organize the care orderly for successful outcome with
better prognosis and good health.
6. Child care advocate: child or family advocacy is basic aspect to comprehensive family
centered care. As an advocate, the pediatric nurse can assist the child to obtain best care
possible from the particular units. Advocacy can range from consulting dietary
department for special foods to arrange team meeting to discuss plan of care.
7. Recreationist: this supportive role of pediatric nurse is important for the child to adjust
to the crisis imposed by illness or hospitalization. she/he can organize play facilities for
recreation and diversion for child’s emotional outlet.
8. Nurse consultant: the pediatric nurse can act as consultant to guide the parents and
family members for maintenance and promotion of health and prevention of childhood
illness.

An important function of pediatric nurse is the psychological care that helps children and parents
to adapt in illness and hospitalization. Provide encouragement to children and give emotional
support to children,

Thus the function of pediatric nurse are directed towards the welfare of children and their
family , promotion of growth and development towards highest possible state of heath of
children, prevention of diseases and injuries, meeting health needs and rehabilitating children in
the family and community.

21) Modalities of nursing practice:

There are various methods of nursing practice in various clinical settings. These are:

 Functional nursing: there are 2 types of nurse:

 Registered nurse
 Licensed practice nurse

Assignment of nursing function is: registered nurse

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Administration of medication: in this RN provide the medicines to all the child in a ward.

Administration of IV infusion: nurse is responsible for providing IV

Dressing: applied dressing to the child according to need

Licensed practice nurse: provide bed bath to the child as he needed.

Advantages: it accomplishes the work in short span of time

Disadvantages:

 it fragments the nursing care

 it decreases the nurse accountability and responsibility
 it makes the nurse client relationship difficult
 Team nursing: there is a nurse leader (RN) and under them there is some other nurses
 Registered nurse
 Licensed practice nurse
 Med aid nurse

With the nurse leader, all the nurses under the supervision of her, work in a collaborated manner
like in assessment of child

Discuss the care aspect and how to provide

The team leader rendered the team care the child

Advantages:

 It involves all team member in planning the patients nursing care through the use of team
conferences writing a nursing care plan
 It provides the best care at the lowest cost

Disadvantages:

 It can be difficult to find the time for tem conferences and care plans
 In this, the leader have only significant responsibility and authority.

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  Primary nursing: primary nurse that can provide care to a client from the time of
admission till discharge

It can be registered nurse(RN)

Execution of nursing care is dedicated by primary nurse to secondary nurse to secondary nurse
during other shift

Advantages:

 To provide for increased autonomy on the part of nurse thus increasing motivation,
responsibility and accountability.
 It ensures the more continuity of care
 It enhances nurse client relationship.

Disadvantages:

 All the nurses in hospital should be RN so, it increases the cost over the hospital
 Sometime it RN is not efficient, it may spoil the whole practice.
 Case method:
Case method of nursing provides for 1:1 RN to client ratio an provision of constant care
for specific period of time.
This method is similar is similar to that of primary nursing except that the relief nurses on
other shifts are not associated RN
 Joint practice:
Nurses and physicians collaborating as colleagues to provide present care. They may
used mutually agreed on protocols to manage care within primary setting

22) Emphasis on preventive rather than curative approach:

At present, in child health care more emphasis given on preventive approach rather than curative
care only. Primary health care concept with team approach and multidisciplinary collaboration
are adopted for child care. The challenge for this time is to study child health in relation to
community, to social values and social policy. Increased public awareness, consumerism and

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family participation in child care newer trends. Family health a new concept is accepted for the
care of children in their families and families in society. Need based ,problem oriented , risk
approach care is practiced for better child health..

23) Emergence of Super specialized areas in pediatric nursing:

As we know that growth of sub specialties for the super-specialized care of children is recent
trend. The subareas are neonatology, perinatology, pediatric surgery, pediatric cardiology,
pediatric neurology, pediatric hematology, pediatric nephrology, preventive pediatrics, child
psychology, child psychiatry , pediatric intensive care unit, neonatal intensive care unit etc.
These are areas which require emergence treatment.

24) Multi disciplinary team collaboration:

When health issues are complicated and require specialized knowledge or resources not available
to the primary-care team, seniors may be referred to specialist practitioners or to specialized
multidisciplinary geriatric teams in the community, in hospitals, or in long-term care facilities.
Such referrals may result in a brief intermittent contact, or there may be prolonged involvement
with such specialists. In some cases, specialized teams assume primary-care responsibility, either
for a defined period or indefinitely.

The nurse, as a member of the health care team, collaborates and coordinates nursing services
with the activities of other professionals. Working in isolation does not serve the child’s best
interests. The concept of holistic care can be realized only through a unified, interdisciplinary
approach. Being aware of individual contributions and limitations to the child’s care, the nurse
must collaborate with other specialists to provide high-quality health services failure to recognize
limitations can be non-therapeutic at best and destructive at worst.

Every nurse works interdependently with the child and family , collaborating on assessing needs
and planning interventions so that the final care plan is one that truly meets the child’s needs.

BLIOGRAPHY:

 Data Parul.pediatric nursing second ed.New Delhi: Jaypee publishers’ 8, 26-28

 Wilson David, Hockenberry J . Marilyn essentials of pediatric nursing ed 8th Pp: 12-13

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