1. The definition of healt h. Organization of w ork of home by the nurse Prepared by MD, Ass. Prof. Kovalchuk T.A. Department of Pediatrics # 2.

2. What is What is health? The World Health Organization (WHO) defined health in its broader sense in 1946 as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. Although this definition has been subject to controversy, in particular as having a lack of operational value and the problem created by use of the word "complete", it remains the most enduring. Classification systems such as the WHO Family of International Classification, including the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Diseases (ICD), are commonly used to define and measure the components of health.

3. Moments in America for All Children Every 1 second a public high school student is suspended. Every 9 seconds a high school student drops out*. Every 10 seconds a public school student is corporally punished“. Every 17 seconds a child is arrested. Every 37 seconds a baby is born to a mother who is not a high school graduate. Every 56 seconds a baby is born into poverty. Every 1 minute a baby is born to a teen mother. Every 2 minutes a baby is born at low birth weight (less than 5 lbs., 8 oz.). Every 4 minutes a baby is bon to a mother who had late or no prenatal care; a child is arrested for drug abuse. Every 7 minutes a child is arrested for a violent crime. Every 10 minutes a baby is born at very low birth weight (less than 3 lbs., 4 oz.). Every 19 minutes a baby dies. Every 41 minutes a child or youth under 20 dies from an accident. Every 2 hours a child or youth under 20 is killed by a firearm or is a homicide victim. Every 4 hours a child or youth under 20 commits suicide. Every 19 hours a young person under 25 dies from HIV infection. * Based on calculations per school day (180 days; 7 hours/day). Children's Defense Fund. (2000). The state of America's children yearbook. Washington, DC: Author.

4. Community health nursing is defined as "the care pro­vided by educated nurses in a particular place and time directed toward promoting, restoring, and preserving the health of the total population or community" (Smith & Maurer, 2000).

5. Roles of the Community Health Nurse Clinician Function. Combines nursing, epidemiology, case management, resource coordination, expertise in working with families, into formulating health policy, assessing communities, and carrying out all phases of population-focused programs. Examples. Provides information to a group of teenagers regarding safe sex practices. Plans, imple­ments, and evaluates a program to decrease drug use by adolescents.

6. Roles of the Community Health Nurse Advocate Function. Advocates for the child and their family by promoting their needs and desires. Examples. Speaks for the needs of a family with a child who is dependent on technology who are facing homelessness.

7. Roles of the Community Health Nurse Collaborator Function. Collaborates with other health care members, social service agencies, judicial systems, and schools to ensure holistic care. Examples. Works with a caregiver, teacher, principal, physician, and social worker to develop a plan to faciliate the successful integration of a child with a disability into a public school setting.

8. Roles of the Community Health Nurse Consultant Function. Serves as an expert (teacher, leader, resource person) who is able to propose solutions for identified problems. Examples. Organizes a child and family health fair.

9. Roles of the Community Health Nurse Counselor Function. Helps clients choose appropriate solutions to their problems. Examples. Works with caregivers to decide if their child who is dependent on technology should attend school or be tutored at home.

10. Roles of the Community Health Nurse Educator Function. Teaches health promotion and disease prevention activities as well as maintains optimal levels of health and wellness. Examples. Teaches a prenatal class on nutrition and healthy habits.

11. Roles of the Community Health Nurse Researcher Function. Participates in research that will be of benefit to the community. Should include identifying prob­lem areas; collecting, analyzing, and intrepreting data; applying findings, and evaluating, designing, and conducting research. Examples. Identifies an area where environmental toxins near a popular playground are jeopardizing the health of children and develops solutions that will promote health and well-being.

12. Roles of the Community Health Nurse Case manager Function. Develops and coordinates services for a selected client and family. Examples. Coordinates all the services needed by a child recuperating from a hospital stay to ensure a healthy recovery: occupational therapy, physical therapy, tutoring, as well as financial resources for the caregivers.

13. Standards of care for the pediatric nurse: Collects health data Analyzes the assessment data in determining diagnoses Identifies expected outcomes individualized to the client Develops a plan of care that prescribes interven­ tions to attain expected outcomes Implements the interventions identified in the plan of care Evaluates the child's and family's progress toward attainment of outcomes

14. Standards of professional performance for the pediatric nurse: Systematically evaluates the quality and effectiveness of pediatric nursing practice Evaluates her or his own nursing practice in relation to professional practice standards and relevant statutes and regulations Acquires and maintains current knowledge in pediatric nursing practice Contributes to the professional development of peers, collegues, and others Makes decisions and takes actions on behalf of children and their families that are determined in an ethical manner Collaborates with the child, family, and health care providers in providing client care Uses research findings in practice Considers factors related to safety, effectiveness, and cost in planning and delivering care

15. Standards and guidelines for pre licensure and early professional education for the nursing care of children and their families Child, family, and societal factors 1.Concept: Anatomic structures and physiologic and psychological processes in neonates, infants, children, and adolescents Goal The nurse will integrate knowledge of the unique anatomic structures, physiological and psychological processes of children from birth through adolescence to make assessments, plan, implement, and evaluate care. 2.Concept: Health behaviors Goal The nurse will use opportunities to positively influence the health behaviors of children and their families. 3.Concept: Separation, loss, and bereavement Goal The nurse will provide supportive care for children and families experiencing separation, loss, and/or death. 4.Concept: Economic, social, and political influences Goal The nurse will use knowledge of how the larger environment influences the child's health and develop­ment and the family's care to (a) make assessments, plan strategies, and implement approaches that are in accord with the family's economic and social situation and available resources, and (b) work with others in the community to make and implement plans for the health care needs of children.

16. Standards and guidelines for pre licensure and early professional education for the nursing care of children and their families Clinical problems or areas 1.Concept: Safety and injury prevention Goal The nurse will provide and promote safety in order to prevent injuries and support the development of the child. 2.Concept: Children with chronic conditions or disabilities and their families Goal The nurse will make assessments, plan strategies of care, and intervene in ways that promote the growth and development of the child with a chronic condition or disability. Additionally, the nurse will support the child's and family's management of care and promote a healthy family lifestyle. 3.Concept: Children with acute illness or injuries and their families Goal When providing care to children with acute illness or injuries and their families, the nurse will make assessments, plan strategies of care, and intervene in ways that promote the growth, development, and safety of the child.

17. Standards and guidelines for pre licensure and early professional education for the nursing care of children and their families Care delivery 1.Concept: Family-centered care Goal A The nurse will use the family-centered approach to: (a) assess needs, plan and implement interventions, and evaluate outcomes relevant to the health care needs of children in partnership with them and their families; (b) work with other health care providers and the family to promote coordinated service delivery; and (c) advo­cate for family-centered care of children. Goal B The nurse will participate in developing and working within service delivery systems to support practice that is consistent with principles of a family-centered approach. 2.Concept: Cultural competence Goal The nurse will acknowledge and integrate into health care the beliefs, practices, and values of cultural groups defined by geography, race, ethnicity, religion, or socioeconomic status. 3.Concept: Communication Goal The nurse will communicate effectively with the child, family, and others who participate in the care and education of the child and family. 4.Concept: Values and moral and ethical reasoning Goal The nurse will respond to ethical, moral, or legal health-related dilemmas in ways that promote the devel­opment of families and children, assist them in making decisions, and support them in implementing the deci­sions.

18. What is home health care? Stanhope and Lancaster (1996) define home health care as "an arrangement of health-related services provided to people in their place of residence“ Home care services can be provided for either short-term or long-term needs. Referrals for home antibiotic therapy, home phototherapy, and home visits to new mothers are examples of children and families needing short-term home care services.

19. Short-term care of children The focus for short-term care is on primary and secondary prevention of disease. Primary prevention involves interventions for children that promote health and prevent disease processes from developing. Teaching new mothers how to perform infant care is one example of a home care service that is primary prevention. Secondary prevention aims to detect disease in the early stages before clinical signs and symptoms manifest in order to intervene with early diagnosis and treatment. The goal is to reverse or reduce the severity of the disease or provide a cure. Home phototherapy or short-term nursing visits to teach diabetes care would be examples of home care services that would provide secondary prevention (Stanhope & Lancaster, 1996). Tertiary prevention is directed toward children with clinically apparent disease. The aim is to ameliorate the course of disease, reduce disability, or rehabilitate. Examples of ter­tiary prevention include services provided by home care agencies that are long term, such as provision of care for a child who is dependent on technology, or hospice care (Smith & Maurer, 2000).

20. The home visit Reifsnider (1996) describes how therapeutic relationships are developed between the nurse and caregivers when home visits are planned and implemented in phases. The phases of the home visit are: Preinteraction — meeting the child and family and performing the assessments. Engagement/active participation — outlining plans and initiating interventions. Termination — evaluating the interventions and determining future rehabilitative needs.

21. Preinteraction phase The preinteraction phase includes activities performed prior to the first home visit. Before making the home visit the nurse will benefit from collaborating with the physician either through direct contact or through the physician's report sent to the agency. Physician's orders and the medical plan of care should be reviewed. Contact should be made with other interdisciplinary team members involved in the child's care.

22. Engagement/Active Participation Phase During this phase the home health care nurse begins to build the nurse-client relationship. The nurse carries out an initial client, family, and environmental assessment. Thorough assessments should be conducted. Collaboration with the child and caregivers and clarification of roles are done in the active participation phase.

23. Termination Phase The home health care nurse evaluates the child's status and the caretakers' ability to assume responsibility for the child's total care. Part of the termination process involves collabora­tion and coordination with other disciplines involved in the care of the child. Plans for terminating home care should begin during the engagement and active participation phase so that the continuity of care that was started can be main­tained. During the termination phase, it may be necessary to continue with some rehabilitative services, such as speech, physical, or occupational therapies. Allowing for the family to evaluate the home care services is important at this time. The home care agency should have standard forms that are sent to families that allow them to routinely evaluate the home care service received.

24. Frequency of home visits The American Academy of Pediatrics (AAP) recommends health supervision visits in next periods: newborn, 2 weeks, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years and yearly through age 21.

25. Principles to determine professional boundaries and professional behavior Be responsible for delineating and maintaining boundaries. Examine any boundary crossing, be aware of its potential implications, and avoid repeated crossings. Be aware of the care setting, community influences, client needs, and the nature of therapy since they affect the delineation of boundaries. Avoid actions that overstep established boundaries to meet the needs of the nurse. Avoid dual relationships, in other words, where the nurse has a personal or business relationship as well as the professional one. Be aware of the complexity of post- termination relationships in which the client needs additional services. It may be difficult to determine when the nurse-client relationship is truly terminated.

26. Thank you for attention!