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The Nurse's Role in a Changing
Child Health Care Environment
Chapter 1
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Development of Pediatrics
• Arthur Jacobi
– Recognized as the father of pediatrics
– Helped found the American Pediatric Society in 1888
• Joseph Brennaman
– Suggested that the infants suffered from a lack of
stimulation
• Ren Spitz
– Coined the terms “hospitalism” and “anaclitic
depression”
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Development of Pediatrics (cont.)
• John Bowlby
– Explored the subject of maternal deprivation
– Revealed the negative results of the separation of
child and mother due to hospitalization
• Marshall Klaus and John Kennell
– Carried out studies on the effect of the separation of
newborns and parents
– Established that early separation may have longterm effects on family relationships
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Current Trends in Child Health Care
• Regionalized care
– Involves the centralization and regionalization
of maternity and pediatric services
– Often takes the patient and family far from
home, emphasizing the importance of familycentered care
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Advantages of Family-Centered Care
• Pays attention to each child’s unique emotional
development and social, scholastic, and physical
needs
• Helps family members alleviate fears and anxiety
• Helps family members function normally
• Facilitates understanding of the child’s condition
and the role of family in the healing process
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Demographic Trends Influencing the
Delivery of Child Health Care
• Shift in focus from the needs of women and children
to those of the elderly
• Growing percentage of minority populations
• Poverty
• Cost containment
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Cost Containment Strategies
• Prospective payment systems
• Managed care
• Capitation
• Cost sharing
• Cost shifting
• Alternative delivery systems
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Cost Containment Strategies
Implemented by Nurses
• Health promotion
• Case management
• Critical care paths
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Types of Payment for Health Services
• Private insurance
• Federally funded sources
– Medicaid
– State Child Health Insurance Program
– Specialized services
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Child Health Today
• Infant health status
• Child and adolescent health status
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Addressing Child Health Status
• National Commission to Prevent Infant Mortality
• Healthy People 2010
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The Nurse’s Changing Role in
Child Health Care
• Primary thrust of health care is toward prevention
• Nurses at all levels are legally accountable for their
actions
• Advance practice nurses have taken a significant
place in caring for childbearing and child-rearing
families
• Health teaching is an important aspect of promoting
wellness
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Critical Thinking
• Use of clinical judgment and purposeful thought
and reasoning
• Nurses become more proficient and effective at
meeting the needs of the patient
• Based on a systemic process and used as the nurse
follows the nursing process
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Steps of the Nursing Process
• Assessment
• Nursing diagnosis
• Outcome identification and planning
• Implementation
• Evaluation
• Documentation
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Nursing Diagnoses
• Actual nursing diagnoses
– Identify existing health problems
• Risk nursing diagnoses
– Identify health problems to which the patient
is especially vulnerable
• Wellness nursing diagnoses
– Identify the potential of a person, family, or
community to move from one level of wellness
to a higher level
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Nursing Actions
• Independent nursing actions
– Actions that may be performed based on the
nurse’s own clinical judgment
• Dependent nursing actions
– Actions that the nurse performs as a result of a
physician’s order
• Interdependent nursing actions
– Actions that the nurse must accomplish in
conjunction with other health team members
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins