PAEDIATRICS AND PAEDIATRIC NURSING

Sarika Yadav Asst Lecturer

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HISTORICAL DEVELOPMENT OF PAEDIATRIC NURSING

1.

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Meaning
The term Paediatrics is derived from the greek word pedia meaning a child . iatrik means meaning treatment and ics means branch of science. So, paediatrics is a science of child care, preventive as well as curative.

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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.

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In 1900s children with contagious diseases were isolated from adult patients.

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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 childrens 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 childrens 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 Childrens 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 childrens health and environment was established.

1970s 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.

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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. 3. Honest and truthful. Sympathetic, kind, patient and cheerful.

4.
5. 6.

Love to work with children.

Interested in family care. 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 childs and familys 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 nurses 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 - multidisciplinary 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 nurses 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). Wongs nursing care of infants and children, (7th ed.), St Louis: Mosby. Hockenberry M. J., Wilson D., & Winkelstein M. L. (2005). Wongs essentials of pediatric nursing, (7th ed.), St Louis: Mosby.

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Early history of worlds paediatric development

Hippocrates (460-370 B.C)
The father of morden science ,devoted a great part of his treatise to children and made many significant observation on disease found in children. Galen (1200-1388 A.D) wrote extensively on in Greek on the care of infant and child.
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Contd
The first English book on childrens disease called book of children was written by Thomas Phaer in A.D 1545.

The first first printed book on paediatrics was in Italian (1472) by Bagallarders little book on disease in children
The worlds first Paediatrician Kashyapa and Jeevaka were Indian who lived in sixth century B.C and whose pioneering works on child care and child care and children's disease.

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Contd..
The morden concept of child health emphasis on continous care of whole child
At present ,in child health care more emphasises given on preventive approach rather than curative care only.

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 The increasing complexity of medical and nursing technique has created the need of special area of child care.
In early days , present medical techniques were treating both adults and child as same. Now the child care has prime importance , as a mortality are higher in this group.

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 The reasons for development of paediatrics are :a) high infant mortality rate

b)
c) d)

low birth weight

child mortality immunization rates

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 Services in order to these causes affect provided for people: 1) institutional care : children were cared as adults in these hospitals following the deaths and diseases, these childrens were kept isolated from other children to prevent from contact of diseases. Children were ambulated as soon as possible and made to visit play rooms, where they can be with other children.
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Family centered care

Family centred nursing care was recent trend in developed countries where the children were not treated as patients. But the attention was given on medical problems.
The care giver realized that the family, community, society surroundings the child have a particular way of life or culture.

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 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.

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Regionalized care
Providing high quality medical care in paediatrics was important for best resources in diagnosis and treatment.
Some of the branches of paediatrics , medicine and surgery.

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Other innovative child health programmes

Many paediatric hospitals have home care program for child illness like leukaemia , haemophilia etc
By hospitalization childs condition is monitored at home for continuing care.

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Child health care in india

Children are the most important age group in all societies .
Health status and health behaviour of later life and laid down at this stage

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MCH
MCH services is the methodof delivering health care to these groups .
The MCH services contain the preventive ,promotive, curative , and social aspects of obstetrics , paediatrics , family welfare , nutrition , child development and health education.

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 The ultimate objectives of MCH services is life long health.

The specific objectives for the services include reduction of mortality and mortality rates for mother and children and promotion of reproductive health along with child health.

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 The components of mch services include six sub areas ,

maternal health

family planning
child health School health

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care of handicapped children and care of children in special setting such as day care centres.

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RCH
Reproductive and Child Health (RCH) has been defined as a state in which People
have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and childbirth safely, the outcome of pregnancy is successful in terms of maternal and infant survival and well being; and couples are able to have
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sexual relations free of the fear of pregnancy and contract diseases.

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The RCH programme is envisaged to provide an integrated package of services, which will include the following:

Services for mothers during pregnancy, child birth and post-natal period, and also safe abortion services, whenever required. Services for children like newborn care, immunization, Vitamin A prophylaxis, Oral Rehydration Therapy (ORT) for diarrhoea, management of Acute Respiratory Infections (ARI), anaemia control etc.
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 Services for eligible couples through availability and promotion of use of contraceptive methods, and infertility services when required. Prevention and management of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs). Adolescent health services including counselling of family life and reproductive health.
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The recommended package of services

Essential newborn care
Exclusive breast feeding and weaning Immunization Appropriate management of diarrhoea Appropriate management of ARI

Vitamin A prophylaxis
Treatment of Anaemia
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ICDS

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Introduction
Over 130 million babies are born every year, and more than 10 million infants die before their fifth birthday (6), almost 8 million before their first.

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 Many countries have set under-five and maternal mortality reduction as their key development goal, as suggested by international conferences such as the World Summit for Children in 1990, the United Nations Millennium Declaration and the United Nations Special Session on Children in2002

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Vital statistics are considered as the indicators of health.

Important vital statistics are birth rate and death rate Child health status is assessed through measurement

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 Measurement of growth and development is also an important indicator of child status.

In many indicators, mortality rates are still the only sources of information about child health.

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Perinatal Mortality Rate

Perinatal Mortality Rate = late fetal and early neonatal

deaths weighing over 1000gm at birth 1000

total live birth weighing over 1000 gm at birth

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It gives a good indication of the extent of pregnancy wastage as well as quality and quantity of health care available to mothers and children. Perinatal mortality is a problem of serious dimensions in all counteries

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 A number of social and biological factors are known to be associated with perinatal mortality

The risk factors are

a) low socioeconomic status b) high and low maternal age c) bad obstetrical history d) maternal malnutrition e) Severe anaemia f) multiple pregnancy
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 Cause of perinatal mortality :

antenatal intranatal postnatal asphyxia LBW babies

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congenital anomalies
birth injury perinatal infections
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 Reduction and prevention of perinatal mortality can only be possible with better maternal and child health.

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Neonatal Mortality rate

Neonatal Mortality Rate = Number of deaths of

children under 28 days of age in a year

1000 Total live birth in same year

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 WHO estimates during the year 1995 ,globally there were 36 neonatal deaths per 1000 live births .
In India in 2003 37 per 1000 live births

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Others 11% Prematurity 8%

Diarrhoea 20%

Asphyxia 10%

ARI 25% Sepsis 26%

Others 13%

Primary causes of neonatal deaths in India

(Source: National Neonatology Forum and Saving Newborns lives, 2004)

Prematurity 15% Sepsis 52%

Asphyxia 20%

infant mortality in India

Causes of

 A new " Home based New Born Scheme" will try to reduce India's high neonatal mortality rate (NMR).

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 Common causes of IMR are:

antenatal intranatal postnatal asphyxia LBW babies

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congenital anomalies
birth injury perinatal infections
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hemolytic disease
condition of placenta and cord diarrheal diseases ARI and tetanus

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 It can be reduced by adequate antenatal and intranatal care including essential newborn care at all levels preventing and managing the causes.

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Postnatal Mortality Rate

Postnatal Mortality Rate = number of deaths of children between

between 28 days and 0ne year of age in a given year 1000 total live birth in same year

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 The main cause of death during post neonatal period are diarrhoea and ARI
Malnutrition is the additional factor which predisposes various infections In developed countries it is mainly caused by congenital anomalies.

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 In 2003 postnatal mortality rate was estimated 23 per live births.

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Infant mortality rate

Number of deaths of infants under one year old in a given year per 1,000 live births in the same year; included is the total death rate, and deaths by sex, male and female. This rate is often used as an indicator of the level of health in a country.

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 Infant mortality rate = Number of deaths

to infants under age 1 X 1,000 ___________________________________________ Total live births

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Coun 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 try India 64.9 63.19 61.47 59.59 57.92 56.29 54.63 34.61 32.31 30.15 49.13 47.57

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Under five Mortality rate

Child mortality, also known as under-5 mortality, refers to the death of infants and children under the age of five.

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Causes of under five mortality

acute respiratory infections
diarrhea measles malaria malnutrition

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 The united nations adopted Declaration of the rights of the Child, on 20th November ,1959,to meet the special needs of the child .

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Rights of the child

Right to develop in an atmosphere of affection and security and protection against all forms of neglect , cruetly ,exploitation and traffic

Right to enjoy the benifits of social security ,including nutrition , housing and medical care .
Right to name and nationality . Right to free education .
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Right to full opportunity for play and recreation.

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 Right of special treatment , education and appropriate care ,if handicapped

Right to be among the first to recieve protection and relief in times of disasters. Right to learn to be a useful member of society and to develop in a healthy and normal manner and in conditionsbof freedom and dignity.
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 Right to be brought up in a spirit of understanding , tolerance ,friendship among people , peace and universal brotherhood. Right to enjoy these rights , regardless of race , colour, sex, religion , national or origion

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