1. Chapter 2 Contemporary Issues in Women’s, Families’ and Children’s Health Care

2. The Public Health Intervention Model
An inclusive framework developed, refined and critiqued by nurses around the country.
Population – based
Includes 17 categories of Interventions (see next slide, p. 31 text)
Interventions targeted towards:
Individuals/families (micro-level)
Communities, larger institutional and societal systems
Environment (macro-level)

3. Chapter 2 Contemporary Issues - Framework

4. Contemporary Issues Healthy People 2020Initiative Societal Trends
Primary Prevention
Secondary Prevention
Tertiary Prevention
Societal Trends
Epidemiology – statistical analysis of the distribution and determinants of disease in populations over time
Mortality
Morbidity

5. MORTALITY Rates
Neonatal : number of deaths in first 28 days of life per 1,000 live births
Infant: Number of deaths in first 12 months of life per 1,000 live births
Childhood: Death rate of children 1-14 years old per 100,000 population over a period of time
Low birthweight (< 2,500 g) and prematurity are major indicators of infant health and mortality. Congenital anomalies are the leading cause of infant mortality in the USA. The leading cause of death in children 1 – 14 years is motor vehicle accidents. Many of these deaths are preventable by teaching use of car seats, seatbelts, not “drinking and driving”, avoid driving tired, distractions like cell phones and texting a major new cause of accidents. Children must also follow pedestrian safety rules.
Other causes of childhood mortality are suicide, homicide and HIV infection.

6. 2013: US Ranks 27th/ 34 countries of the Organization for Economic Cooperation and Development.

7. MORBIDITY
Prevalence of a specific illness in a population at a particular time
Difficult to define and record because of varying definitions
Most important aspect of morbidity is the degree of disability produced: for children the number of days they missed school or were confined to bed

8. School Days Missed due to Asthma http://www. ncbi. nlm. nih
Out of 1537 tracked absences that resulted from illness, 478 (31%) were due specifically to asthma-related symptoms.
Children with asthma are absent from school more often compared to their healthy peers and this appears to be driven by the underlying severity of symptoms. (J Sch Health. 2006;76(1):18-24).

10. Pediatric Nursing in Health Care Settings
Primary Level: Focuses on health promotion and illness prevention, typically occurs in the Community (school, clinics, daycare, camps, offices)
Secondary Level: Focuses on diagnosis and treatment of illnesses in acute treatment centers (hospitals, ED, ICU, surgical and psychiatric centers)
Tertiary Level: Involves restorative, rehabilitative or quality-of-life care in rehab centers, hospice programs or home health agency service

11. What do You Think?
List the top 3 issues facing children and families today.

12. Factors Influencing Child Health12

13. Societal Trends Aging Population with Chronic Illnesses
Increased Racial and Ethnic Diversity
Disparities in Health Care
Patterns of Physical Fitness
Intersection of Race, Class and Health
Technology
Immigration

14. Health Status by Age Group
Infants and Young Children
Focus on prevention and early intervention
Screening for Growth and Development: achieved or delayed
Anticipatory Guidance
Immunizations
Health Issues by Age group
SIDS
Congenital malformations
Cancers
Violence
Abuse and Neglect
Lead exposure
Asthma
ADD/ADHD
Autism
Transgender
Obesity
Infections

15. Adolescents
Self-esteem, peer pressure, physical/emotional/reproductive changes
Need patience, someone to listen
Families
Support/Lack of
Stresses
Financial challenges
Access to Health Care
Homelessness
Human Genome Project – 2003 US Dept. of Energy and National Institutes of Health mapped the 20-25,000 genes in human DNA

16. Politics, Socioeconomics, and Culture: Contemporary Influences and Trends
Politics local, state and federal: laws, funding, policies
Health – care Delivery: access, expense, quality, focus
Public Policies and Programs: WIC, School Lunch, Medicaid, Title XIX, Family and Medical Leave Act 1993, Affordable Care Act 2010
Trends
inequality access and quality of health care: vulnerable populations - low-income, homeless, elderly, immigrants & refuges, rural
Increasing poverty, wage gap
Communication and Digital Divide: access to health information, social media
Abused and Neglected children
Violence: physical, sexual, guns
Gay, Lesbian and Transgender individuals
Substance abuse
Cultural and Religious influences: language, practices, female roles, effect of media
Self-Care and Patient Involvement: early discharge, support groups
Complimetary and Alternative Therapies
Delivery systems: telehealth
National and Global Health

17. Community-Based Care Ambulatory Care, home health care, occupational health, school health and hospice settings
Current trend > health promotion and primary health care
Children cared for at home do better physically, emotionally, growth and development-wise. Quality of Life
Nurses provide a large percentage of this community care

18. Standards of Care
A minimally accepted action, skill and knowledge level expected of an individual
Developed by:
The Society of Pediatric Nurses (SPN) specific standards of care and professional performance for pediatric nurses. The web site:
National Association of Pediatric Nurse Practitioners (NAPNAP)
American Nurses Association (ANA)

20. Ethical & Legal Issues Related to Children and Families
“Bill of Rights” for children
Ethics committee
Ethical Practice – being sensitive to the sanctity and quality of human life
Autonomy: freedom to choose
Beneficence: actions that benefit others
Nonmaleficence: avoid causing harm
Justice: acting fairly
Veracity: telling the truth
Fidelity: keeping promises, maintaining confidentiality and privacy

21. Legal Issues
Minors – child under the age of 18 (age of majority) generally need consent of legal guardian for medical treatment
Consent/Informed Consent
Provide parent/legal guardian with information about treatment/procedure
Obtain written consent

22. Special Considerations and Exceptions
Emergency situations
Parental Refusal of Care: religious, quality of life
Mature minor: adolescent 14 or older
Emancipated minor: military, married, financially independent, in college, mother under 18
Specific care to minors (by state)
Contraception, pregnancy counseling, prenatal care
STI’s and communicable diseases (HIV)
Substance abuse and mental illness

23. IMPORTANT CONSIDERATIONS
Know the Laws of the State in which you practice!
Obtain ASSENT of the child
Child participates in decision making process related to health care
Consider age, developmental level, maturity. May be as young as 7 years
Children involved in research: consent of parent, assent of child and perceived benefit to child

24. Advanced Directives
Patient Self-Determination Act of 1990 established concept of advanced directives
Children and family have right to determine wishes related to life-saving measures
DNR (Do Not Resuscitate) or new term AND (Allow Natural Death)

26. Exceptions to Confidential Treatment in Children
Suspicion of physical or sexual abuse
Injuries caused by a weapon or criminal act
Child a threat to themselves or someone else
Certain infectious diseases: TB, Hepatitis, HIV, other STI’s

27. Trends in Clinical Practice
Nurses involved in Quality Improvement, delivery of cutting-edge care in a variety of isettings
New technologies, Electronic Health Record
Aging population
Group health care, medical home
Advanced nurse roles
Telemedicine
Holistic nursing
Community based nursing

28. End of Chapter 2