concepts, roles, and issues Flashcards
name some different roles of the nurse in pediatrics
- direct care provider (tailored to childs developmental stage)
- patient/fam educator
- patient advocate
whats needed to effectively educate children and families
planning and preparation as well as understanding of the childs developmental and cognitive level
describe being a patient advocate
- enable child/fam to deal with changes in health in their own way
- awareness of fams needs and resources
- assist in making informed choices and act in childs best interest
what is case management
- process of coordinating healthcare services for children w complex health conditions, in which a nurse performs long term coordination to help a child receive timely access to needed health servies in a safe, high quality, and cost effective manner
- provides continuity of care
- creating an interdisciplinary plan to address significant health probs in a child
- considers fam wishes
whats included in case management
- medical and nursing needs
- developmental needs
- educational needs
- psychosocial needs
describe research
- studies effectiveness of new treatments
- evalutae interventions for improved outcomes
- may reduce cost of care
- increases integration of EBP
- all nurses can participate in research
what was the major cause of death back in the day for kiddos
infectious disease
describe the evolution of pediatric care
then:
- imited visiting hours
- extended stays
- children treated the same as adults
now:
- parents stay at bedside
- shorter stays with many procedures done on outpatient basis
- recognition of childhood and special needs of child
describe clinical reasoning
utilizing the nursing process
- analyzing data from the history, physical exam, and lab tests
- discriminating between signs, therapies, or appropriate nursing actions
- seeking additional appropriate care to provide
- using logical reasoning when developing a plan of care
- identifying expected outcomes associated with plan of care
- evaluating outcomes and need for modification
describe critical thinking
individualized reasoning process used to problem solve
describe EBP
- problem solving approach that combines best evidence with clinical expertise, patient circumstances/values/preferences
- provides bridge between research and practice
describe clinical practice guidelines (clinical pathways)
- collaboration of evidence based and expert opinion
- used to decide appropriate care
- sets standards and benchmarks
- often set by national health organizations like American Academy of Pediatrics
- describe sequence and timing of interventions that should result in expected patient outcome
describe fam centered care
- building collaborative relationships between health professionals and families
- respectful of diversity, beliefs about the nature of the childs condition, and ways to manage it
- always ask families about their normal routines at home and try to incorporate it into care at hospital
- families are partners in care of child
- recognize importance of fam presence and involvement in helping child recover from illness and injury
what is infant mortality
death within the first year of life
what are some causes of neonate mortality (birth - 28days)
- congenital malformations (#1 cause)
- low birth weight, prematurity
- maternal or birth complications (placenta probs, premature rupture of membranes)
what are some causes of infant mortality (28days - 1yr)
- congenital malformations (#1 cause)
- low birth weight (#2)
- SIDS (#3 - teach about safe sleep practices)
- unintentional injury (#4 - suffocation, homicide, MVA, drowning)
whats the leading cause of death in children 1-19yrs
- injury is the leading cause of death
- education of parents and families very important
describe childhood mortality
- death rates for children greater than1yr of age are less than that for infants
- ages 5-14 have the lowest death rate
- sharp increase occurs in adolescence - injuries, homicide, suicide
describe child morbidity
illness or injury that limits activity, requires medical attention or hospitalization or results in chronic condition
what are some factors that contribute to increased morbidity
- homelessness
- poverty
- low birth weight
- chronic illness
- foreign born, adopted children
- attendance at day care
name some different programs for healthcare financing
- CHIP
- medicaid
- private insurance
describe CHIP
- serves uninsured children up to age 19
- whe income is too high for medicaid but inadequate for private insurance
describe ACA
- for kids with incoe too high for both CHIP and medicaid
- no exclusion for preexisting chronic conditions
- no annual limits
- allow kids to stay on parents insuance until 26
describe nurse practice act
- regulated by each state
- defines legal roles and responsibilities of nurses
describe standards of clinical practice
- developed by ANA, SPN, NAPNAP
- defines standards for nursing care and performance
describe informed consent
- must be given voluntarily and prior to procedure or enrolling a child in research
- children are not considered competent to make informed healthcare decisions
- legal guardians are requested to give informed consent on behalf of child
- formal preauthorization for an invasive procedure - signed and witnessed
- also needed for participation in research
- focuses on the comprhension by patient and fam of what is going to be done
what information must be provided in order to obtain informed consent
- explanation of condition
- detailed description of treatment
- risks and benefits of treatment
- possible alternative treatments
- right to refuse treatment for child
who is legally responsible for obtaining informed consent?
physician
whats the nurses role in informed consent?
responsible for making sure it is present and available before procedure
when parents are divorced, who is eligible to consent to medical treatment of the child
only the parent with legal authority may give consent
either parent may consent in cases with shared custody and they meet with social services
a child under 18yrs can give consent if they are:
- parent or pregnant
- emancipated minor (legally)
- seeking birth control, mental health or substance abuse treatment
parents have legal authority about health care choice except when…
- choice doesnt permit life saving treatment for child
- potential conflict of interest between child and parent (abuse)
what is confidentiality
information discussed during care will ot be shared without patient permission
hat are some exceptions to confidentiality
- adolescent with a reportable disease like STI (public health hazard)
- suspected child abuse
- suicide risk
what are some concerns to take with confidentiality and adolescents
- speak with patient separately, away from parents
- speak with parents alone
describe the atmosphere with confidentiality and adolescents
- close doors when collecting med history
- create comfortable atmosphere for discussion
what are some limitations to confidentiality and adolescents
- explain parameters of confidentiality
- identify siuations in which confidentiality may be breached
- encourage conversation with parents if able and safe
- never promise that nothing will ever be shared
describe patient self-determination act
- informs patient of their rights about preferences for treatment options and making advanced directives like living wills and durable power of attorney
- especially important for adolescents with life threatening conditions
describe DNR/AND
- more common for children with terminal illnesses
- children may be cared for at home or hospice
- community issue - state parameters put in place to honor
describe ethics
- ethical issues may include saving newborns with severe impairments, genetic testing or organ transplants
- ethics committees are in all hospitals
- know personal feelings on ethical issues
