CURRENT TRENDS IN PEDIATRIC NURSING

INTRODUCTION

• Nursing of infant’s, children and adolescents is consistent with the

definition of nursing as “the diagnosis and treatment of human responses
to actual or potential health problems”. This definition incorporates the
four essential features of contemporary nursing practice.

• Attention to the full range of human experiences and responses to health

and illness without restriction to a problem focused orientation.

• Integration of objective data with knowledge gained from an

understanding of the patient or group’s subjective experience.

• Application of scientific knowledge to the process of diagnosis and

treatment

• Provision of a caring relationship that facilitates health and healing.

CURRENT TRENDS
THE CURRENT TRENDS IN PEDIATRIC NURSING INCLUDES: -

 Family centered care

 A traumatic care

 Disease prevention and health promotion

 Health education

 Support and counseling

 Coordination and collaboration

 Research
FAMILY CENTERED CARE

• The philosophy of family centered care recognizes the family as the

constant in child’s life. Families are supported 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 need of all family members not just
the child’s are considered.

• Two basic concepts in family centered care are

• Enabling

• Empowerment.

• Enabling

• Professional enables families by creating opportunities and means for

all family members to display their present abilities and competencies
and to acquire new ones that are necessary to meet the needs of child
and family.

• Empowerment

• Empowerment describes the interactions of professional with families

in such a way that families maintain or a sense of control over their
families and acknowledge positive changes that result from helping
behaviors that focus their own strengths abilities and actions

• The parent professional partnership is a powerful mechanism for

enabling and empowering families.

ATRAUMATIC CARE

Atraumatic care is the provision of therapeutic care in settings, by personnel

and through the use of interventions that eliminate or minimize the
psychological or physical distress experienced by the child and family in the
health care systems.
The overriding goal in providing atraumatic care is ‘’FIRST DO NO HARM’ ’

Three principles providing the frame work of achieving this goal are

• Prevent or minimize child’s separation from family

• Promote a sense of control

• Prevent or minimize bodily injury and pain.

EXAMPLES OF PROVIDING ATRAUMATIC CARE includes

• Fostering the parent child relationship during hospitalization.

• Preparing the child before any unfamiliar treatment or procedure.

• Controlling pain

• Allowing the child privacy

• Providing play activities for expression of fear and aggression.

• Providing choices to children

• Respecting cultural differences.

CASE MANAGEMENT

• Case management was developed as an approach to coordinate care and

control costs. Although the movement began in adult care, it was quickly
adapted to pediatric care.Benifits of case management such as improved
patient and family satisfaction, decreased fragmentation of care, and the
ability to describe and measure outcomes for a homogenous group of
patients becomes apparent.
DISEASE PREVENTION AND HEALTH PROMOTION

• Current trends in health care have focused on prevention of illness and

maintenance of health rather than treatment of disease or disability ..
Regardless of the identified problem the role of the nurse is to plan care
that fosters every aspect of growth and development based on thorough
assessment process, dental care, problems related to
nutrition ,immunizations, safety, ; development, socialization ,discipline
or schooling often becomes 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.

One of the most significant example is safety because each age group is
at risk of special type of injuries preventive teaching can prevent most
injuries ,thus significantly lowering permanent disability and mortality
rates from injuries. Besides preventing physical disease or injury, the
nurses’ role is also to promote mental health.

• In 1965specialised pediatric nurse practitioner programs began to

develop and have led to several specialized ambulatory or primary care
role for nurses. The thrust of these programs have been to educate
nurses beyond the basic preparational stage in areas of child health
maintenance so that all children can receive high quality care.

• The clinical nurse specialist [CNS] role was developed in an attempt to

provide expert nursing care.CNS is competent in providing nursing care
during all stages of illness or wellness and functions in many setting as
hospital, home, community care long term facility.CNS serves as a role
model for the staffs clinical practice as a researcher to validate nursing
observation and interventions as a change agent with in the health care
system, and as a consultant and teacher to health care team.
HEALTH EDUCATION

• Health teaching may be a direct goal of the nurse, such as during

parenting classes or may be indirect such as helping parents and
children understand a diagnosis or medical treatment, encouraging
children to ask questions about their bodies, referring families to health
related professional or lay groups, supplying patients with appropriate
literature and providing anticipatory guidance.

SUPPORT OR COUNSELING

• Attention to emotional needs requires support and sometimes

counseling Support can be offered in following ways, listening touching
and physical presence.Counselling involves a mutual exchange of ideas
and opinions that provides the basis for mutual problem solving. It
involves, teaching, techniques to foster the expression of feelings or
thoughts and approaches to help the family cope with stress. Optimally
counseling not only helps resolve a crisis or problem but also enables
the family to attain a higher level of functioning, greater self-esteem,
and closer relationships.

COORDINATION AND COLLABORATION

The nurse as a member of health care team collaborates and co-ordinates

nursing services with the activities of other professionals. The concept of
holistic care can be realized only through a unified inter disciplinary
approach.

RESEARCH
 Practicing nurses should contribute to research because they are the
individuals observing human responses to health and illness.

 The current emphasis on measurable outcomes to determine the

efficacy of interventions demands that nurses should know whether
clinical interventions result in positive outcome for their clients. This
 demand has influenced the current trend towards evidence based
practice, which implies questioning ‘why’ something is effective and ‘if’
there a better approach.

 The concept of evidence based practice also involves analyzing and

translating published clinical research into the everyday practice of
nursing.
 CURRENT STATUS OF CHILDREN IN INDIA
• Children are the most important age group in all societies. Health status
and health behavior of later life are laid down at this stage. Child health
care should include specific biological and psychological needs that
must be met to ensure the survival and healthy development of child,
the future adult.

CHILD HEALTH CARE IN INDIA

• Children under the age group of five years are grouped with the
mothers considering as vulnerable and sick groups comprising about
32%of total population in India.

• The mother and child health services [MCH] are the method of delivering
health care to these specific groups.

• The components of MCH services include six subareas

• Maternal health

• Family planning

• Child health

• School health

• Care of handicapped children

• Care of children in special settings such as Day care centers.

• The MCH services at present are provided through Reproductive and

Child Health Programe.RCH program in corporates components related
to

• Child survival and safe mother hood

• Family planning
 • Prevention of RTIs STDs and AIDS.

Other than RCH programs various health programs are initiated by the
government of India to improve the survival of children. Other child health
services include

• Integrated child development services [ICDS].

• Under five clinics

• School health services

• Postpartum services through postpartum units

• Baby friendly hospital initiative

• Child guidance clinic.

Child health services are delivered through Anganwadi centers [ICDS center]
at village level, Sub center clinics, PHC clinics, outreach services by home visits
and camps in hospital as indoors and outdoors. These services are available
both in urban and rural areas through different infra structures. The specific
low cost simple measures are organized for the child through various
approaches for saving lives of millions of children on priority basis.

CHILDHOOD UNDER THREAT

According to resent UNICEF report titled “childhood under threat”, over one
billion children have been denied their childhood. Many factors including
wide spread poverty and AIDS have failed to fulfill the goals on their
improvement. Their right to a healthy life has remained a distant dream by the
failure of government to carry out human rights and economic reforms.

UNICEF report

• It is reported that in India

A girl child is the worst victim since she is often neglected .640 million children
lack adequate shelter

• 400 million have no access to safe drinking water

 • 270 million lack health care amenities

• 140 million especially girls have remained outside the ambit of formal
schooling.

• More than 150 million children are malnourished.

• 147 million children live in kucha houses

• 85 million children are not immunized.

• 27 million are severely underweight.

• 33 million children have never been to school.

• 25-30 million children spent their lives in streets.

• 6.6 million Children suffer from brain damage due to iodine deficiency.

• In India 1.5 million suffer from vitamin A deficiency and discriminated

because of the preference for a boy child in traditional Indian society.

Children are considered as an asset of a nation and their welfare reflects the
nation’s prosperity and economic development. This report reflects the
darker view of conditions of millions of children in India.

CHILD HEALTH STATISTICS

STATISTICS RELATED TO CHILD HEALTH IN INDIA

• Vital statistics are considered as indicators of health. Important vital

statistics are birth rate and death rate.
 • Child health status is assessed through the measurement of mortality
and morbidity. Measurement of growth and development is also an
important indicator of child health status.

• The frequently used mortality indicators of child health care are the
following

• Perinatal mortality rate.

• Neonatal mortality rate.

• Post neonatal mortality rate

• Infant mortality rate

• Under five mortality

PERINATAL MORTALITY RATE

• Late fetal and early neonatal deaths

Weighing over 1000 grams at birth x 1000

Total live births weighing over 1000 grams at birth

• PMR; per 1000 births ranged from 61.5 10 161 in India and 13.8 to 38.6
in UK.

• It was observed that PMR decreased from 131.2 to 114 per 1000 births,
primarily due to reduction in early neonatal deaths

• Neonatal deaths are deaths occurring during the neonatal period i.e.
from birth to 28 completed days of life.

Number of deaths of children under 28 days of age in a year X 1000

Total live births in the same year

 • The neonatal period is the most vulnerable time for a child. The good
news is that it is declining globally. The world wide neonatal mortality
rate Fell by 47 % between 1990 and 2015 from 36 to 19 deaths per
1000 live births over the same period, the number of newborn babies
who died within the first 28days of life declined from 5.1 million to 2.7
million in the same year

POST NEONATAL MORTALITY RATE

• Post neonatal mortality rate is defined as the ratio of the post neonatal
death in a given year to the total number of live births in the same year
usually expressed as a rate /1000

• Number of deaths of children between 28 days and one year of age in a

given year X 1000

Total live births in the same year

• In India post neonatal mortality rate is estimated to be 16/1000 live

births in urban areas and 26 /1000 live births in rural areas

INFANT MORTALITY RATE

• The ratio of infant’s deaths registered in a given year to the total

number of live births registered in the same year usually expressed as a
ratio / 1000 live births.

• Number of deaths of children less than one year of age in a year X 1000

Number of live births in the same year

IMR is usually regarded as the most sensitive indicator of the health status the
community.

• Infant mortality is down and there is improvement in immunization

coverage in 13 states. The survey was conducted in andraparesh ,bihar ,
goa, Haryana ,Karnataka,
MP ,Meghalaya ,Sikkim ,tamilnadu ,telangna ,Tripura , uttarakhand,
 west Bengal and union territories of Andaman and Nicobar islands and
Puducherry.

• The Union Health Ministry released the results for the phase of the
National Family Health Survey (NFHS) 2015-2016 that showed
dramatic improvements in maternal and infant mortality, immunization
coverage, nutrition, and such criteria in 13 states that were covered in
this phase. The earlier survey was conducted in 2005-2006.

• The results shows that all these places have an infant mortality rate
(IMR) of less than 51 deaths per 1000 live births, with Andaman
recording the lowest of 10 deaths and Madhya Pradesh recording 51.
The current national IMR is 37.

UNDER FIVE MORTALITY RATE

• The annual number of deaths of children under five years expressed as a

rate per 1000 live births.

• Number of deaths of children less than five years of age in a year x

1000

Number of live births in the same year.

• In 2015, the under five mortality rate in low income countries was 76
deaths per 1000 live births-about 11 times the average rate in high
income countries ( 7 deaths per 1000 live births) globally under five
mortality has decreased by 53% from an estimated rate of 91 death per
1000 live births in 1990 to 43 deaths per 1000 live births in 2015.

Child Health Indicator Current status NHP Target

IMR (Infant Mortality Rate) 34 (SRS 2016) 28 by 2019

Child Health Indicator Current status NHP Target

Neonatal Mortality rate 24 (SRS 2016) 16 by 2025

Under 5 Mortality Rate 39 ( SRS 2016) 23 by 2025

SOCIAL FACTORS AFFECTING CHILDHOOD IN INDIA

 • Child Labour

• Child marriage

• Juvenile deliquency

• Poor socioeconomic status and lack of basic needs.

CHILD LABOR IN INDIA

 India accounts for the second highest number where child labor in the
world is concerned. Africa accounts for the highest number of children
employed and exploited. The fact is that across the length and breadth
of the nation, children are in a pathetic condition. While experts blame
the system, poverty, illiteracy, adult unemployment; yet the fact is that
the entire nation is responsible for every crime against a child. Here is a
look at the various labour activities involving children, across the length
and breadth of India.

BONDED CHILD LABOUR

This is also known as slave labor and is one of the worst types of labour for
children and adults, alike. In fact, in 1976 the Indian Parliament enacted
the Bonded Labour System (Abolition) Act; herein declaring bonded illegal.
However, the fact remains is that this system of working still continues.
According to certain experts approximately 10 million bonded children
labourers are working as domestic servants in India. Beyond this there are
almost 55 million bonded child labourers hired across various other
industries.

• Child Labour in the Agricultural Sector:

According to a recent ILO report about 80% child labourers in India are
employed in the agriculture sector. The children are generally sold to the
rich moneylenders to whom borrowed money cannot be returned.

• Children Employed At Glass Factories:

• According to recent estimates almost 60,000 children are employed in
the glass and bangle industry and are made to work under extreme
conditions of excessive heat.

• Child Labour in Matchbox Factories:

• Of the 2,00,000 labour force in the matchbox industry, experts claim

that 35% are children below the age of 14. They are made to work over
twelve hours a day, beginning work at around 4 am, every day.

• Carpet Industry Child Labour:

• According to a recent report by the ILO almost 4, 20,000 children are

employed in the carpet industry of India.

• The Other Industries:

• According to researchers there are about 50,000 children employed in

the brass industry of India and around the same amount in the lock
industry

CHILD MARRIAGE

• Child marriage is a crippling medical and social burden to women in

India and poses a demographic threat to the entire world.

• Specialists in public health from India and the US looked at data for
22,807 women aged 20-24, selected from a geographical and social
cross-section of Indian society

• A total of 44.5% of the women had been wed by the time they were 18,
set as the legal age for marriage since 1978. Of these, 22.6% had been
married before the age of 16 and 2.6% before the age of 13.

• Women who had been child brides were 37% more likely not to have
used contraception before their first child was born; seven times more
likely to have three or more births; and three times more likely to have
a repeated child birth in next 24 months.
• They were also more than twice as likely to have multiple unwanted
pregnancies, nearly 50% more likely to have an abortion and more than
six times more likely to seek sterilization compared with counterparts
who had married after the age of 18. Child brides were also at greater
risk of a fistula—a tear in the genital tract—as well as pregnancy
complications and death and sickness as a result of childbirth.

• The legal age of marriage in India is 18 for women and 21 for men.

JUVENILE DELIQUENCY

• Deliquency is a kind of abnormality when an individual deviates from

the course of normal social life. His behavior is called 'Delinquency'.
When a juvenile, below an age specified under a statute exhibits
behavior which may prove to be dangerous to society and / or to
himself he may be called a Juvenile delinquent. Juvenile delinquents are
those offenders including boys and girls who are normally under 16
years of age. A Juvenile delinquent is a young person incorrigible or
habitually disobedient.

• Act of delinquency may include:

• 1. Running away from home without the permission of parents.

• 2. Habitual behavior beyond the control of parents.

• 3. Spending time idly beyond limits

• 4. Use of vulgar languages

• 5. Wandering about rail roads, streets market places

• 6. Visiting gambling centers

• 7. Committing sexual offences

• 8. Shop-lifting

• 9. Stealing etc. Juveniles may do such activities singly or through a gang.

• There are other social or environmental factors which leads them to be
a delinquent.

a) School Dissatisfaction - Some students get dissatisfied with school life.

Parental irresponsibility, unmanageable student teacher ratio, lack of
entertainment and sports facilities in school, in difference of the
teachers may contribute to this. Such dissatisfied students become
regular absentees in schools and start wandering their own and
become gamblers, eve-teachers, pick pockets, drunkards, smokers and
drug addicts.

b) Films and pornographic literature have also added to the magnitude

of delinquency. Cinema, television and obscene literature may often
provoke sexual and other impulses in adolescents. Hence they may
start their adventure in satisfying them in the process of which they
commit crimes.

c) There are other social or environmental factors which leads them to

be a delinquent.

STREET CHILDREN

Street children is a term used to refer to children who live on the

streets of a city. They are basically deprived of family care and
protection. Most children on the streets are between the ages of about
5 and 17 years old, and their population between different cities is
varied.

• WHO offered the following list of causes for the phenomenon:

• family breakdown
• armed conflict
• poverty
• natural and man-made disasters

• famine
• physical and sexual abuse
• exploitation by adults
• dislocation through migration
• urbanization and overcrowding
• acculturation
• disinheritance or being disowned
 CONCLUSION

India is home to the world’s largest population of street children, estimated at

18 million. The Republic of India is the seventh largest and second most
populous country in the world. With acceleration in economic growth, India
has become one of the fastest growing developing countries. This has created
a rift between poor and rich; 22 percent of the population lives below the
income poverty line. Owing to unemployment, increasing rural-urban
migration, attraction of city life and a lack of political will, India now has one
of the largest number of child laborers in the world. As citizens of India let us
join our hands to uplift the status of children in our country.

References

• Marilyn J Hockenberry,David Wilson,Wong’s Essentials of Pediatric

nursing,8th edition, Mosby publications,Newyork,page 10-15

• www.India country statistics.com

• www.vital statistics. com

• www.current status of children.com

 HOLY FAMILY HOSPITAL

SEMINAR
ON
TRENDS IN PEDIATRIC AND PEDIATRIC
NURSING
AND
CURRENT STATUS OF CHILD HEALTH
IN INDIA

SUBMITTED TO: SUBMITTED BY:

Madam Sherley Thomas Mary Menu Ekka.

Associate Professor
College Of Nursing M.Sc Nursing 1st year.