Search results for Nursing

Summary

Introduction

One of the common questions asked by students and even staff involved in nursing education has been: ‘Why do we need a separate topic/chapter/course on Indigenous health?’ While this should be self-evident considering where the greatest health challenges of our time lie, it is not always clear. Indigenous peoples in countries such as Australia and Āotearoa New Zealand, although diverse in languages, cultures and histories, often share a common experience of profound relevance to health professionals today – an experience of being colonised that had detrimental and ongoing impact on health and well-being. However, in spite of these common experiences, there is also a resilience and capacity among Indigenous peoples that provides the community/primary health care nurse with an opportunity to affect real change towards better health outcomes.

This chapter introduces Indigenous approaches to health care that have relevance for the Australian and Āotearoa New Zealand contexts. Several of the principles for practice are readily transferrable to other culturally and linguistically diverse populations. The challenges are undeniably major, but the rewards are potentially transformative. Nursing training and education is most often located within mainstream, non-Indigenous settings. Health professionals who want to make a positive difference to the health outcomes of Indigenous clients should be equipped with knowledges and understandings which will facilitate effective engagement. Further, this chapter will examine the historical influences that have impacted on the health and well-being of Indigenous peoples in both Āotearoa New Zealand and Australia, and consider the need for adopting Indigenous approaches to health care practice and engagement such as cultural safety, cultural responsiveness and other cultural frameworks. Finally, it will examine the role of the community nurse in Indigenous primary health care.

A note on terminology before proceeding: ‘In the Australian context, the term “Indigenous” is used to refer to Aboriginal and Torres Strait Islander peoples and, with due respect, these terms are used interchangeably and acknowledge the diversity of languages and cultures that characterise Australian indigeneity’ (Rigby & Jeeawody, 2014, p. 283). In Āotearoa New Zealand, Māori are the first Indigenous peoples who can trace their ancestry and genealogy (whakapapa) right back to those who arrived in the early canoe fleet migrations of the mid-1300s (Ministry for Culture and Heritage, 2005) from the Tahitian and Hawai'iki regions.

Summary

Learning objectives

In this chapter you will:

• Develop an understanding of some common chronic conditions experienced by children and young people in Australia

• Review evidence-based symptom assessment and interventions associated with common chronic conditions experienced by Australian children and young people • Consider the developmental needs of children and young people in planning and implementing nursing care for chronic medical conditions

• Explore some of the educational, social and emotional challenges children and young people with chronic conditions face, specifically the transition to adult health-care services

Introduction

As a paediatric nurse, you will frequently care for children and young people with chronic conditions. Your initial contact may be during routine assessment, at diagnosis or during subsequent treatment (such as for the management of childhood cancers or type 1 diabetes). You may also be part of a team managing an acute illness in a child or young person with a chronic condition, as might occur during an exacerbation of asthma or a urine infection in a child with spina bifida. Depending on your role, your involvement may extend to a clinic, home, school or community – for example, if you are running a healthy weight program. If you work within one organisation or within one specialty practice for any period of time, you may form long-term relationships with chronically ill children and their families, becoming part of their lives as they grow into young people and adults – or, inevitably for some, until the end of their lives.

It is not usual to associate children and young people with chronic conditions, especially as some definitions relating to adult illness (such as cardiac disease) imply that chronic diseases are those for which action can be taken to prevent their occurrence (ABS, 2015a). However, the most recent available estimates indicate that between 2007 and 2008, 37 per cent of children and young people in Australia had at least one long-term chronic condition. This figure equates to more than 1.5 million future Australian adults (ABS, 2009). Asthma, diabetes and cancer are the most common chronic medical conditions affecting children in Australia, collectively accounting for 20 per cent of the burden of disease among children aged 0–14 years (AIHW, 2012), but the range of chronic conditions affecting children and young people is much broader.

Summary

Learning objectives

In this chapter you will:

• Develop your understanding of the evidence-based nursing assessments and interventions used in the care of acutely ill infants and young children

• Develop your understanding of the aetiology, signs and symptoms of key acute illnesses experienced by infants and young children in Australia

• Consider the developmental needs of infants and young children in the planning and implementation of nursing care

• Explore the impact of illness and hospitalisation on infants and young children

Introduction

Children contract infections regularly during early childhood, and are also at risk of injury; thus they can experience episodes of acute illness. For the most part, these episodes are of short duration and resolve with the care of parents at home, sometimes with support from community health care professionals such as a general practitioner. However, in some instances the illness can reach a level of severity that requires nursing care and medical treatment in a hospital setting. Children aged 0–4 years are the most common age group presenting for care in an emergency department (AIHW, 2015). Infants and children are still developing, so they have physiological and anatomical differences from adults that require specialist skills and knowledge. Hospital environments can be challenging for both the young child and their family. For many families, visiting the emergency department with their sick child may be the first time they have ever had to seek acute care from a hospital. It is important that nurses understand this, and that we ensure the child's care is delivered in a way that is supportive and respectful of the individual child and their family.

In Chapter 6, you were introduced to primary assessment of infants and children and recognition of the sick or deteriorating child. In this chapter, some key nursing considerations and interventions for the acutely unwell child will be discussed. Following this, you will explore some of the illnesses children can acquire that may require hospital care. You will be asked to reflect upon the nursing management of some of these conditions through review of case studies and reflective questions.

Summary

Learning objectives

In this chapter you will:

• Explore your understanding of the terms ‘research’, ‘evidence’ and ‘evidence-based practice’

• Be introduced to the core principles of human research ethics and research governance, and their application to paediatric research

• Develop your knowledge of techniques related to the development of research questions and the evaluation of evidence-based changes to practice

• Reflect on how you can use this knowledge in your work as a paediatric nurse to support evidence-based practice for children and young people, and encourage their partnership in research

Introduction

All people have a right to assume that health professionals are appropriately educated to focus their knowledge and skill on practice that is based on the best available evidence from research, and that this evidence informs the safety and quality of their care. Parents and carers of children and young people extend this assumption to health-care decisions made on behalf of those in their care. The tenet of using the best available evidence for decision-making is so self-evident and fundamental to health care that standards relating to quality, safety, research and evidence-based practice can be found in the professional registration standards of all health disciplines.

Research and evidence are intimately linked in nursing and health care, but each makes a slightly different contribution. We can broadly distinguish research as a systematic process for deriving new knowledge, and evidence as the knowledge that is produced and used. However, evidence from other sources is also used to inform health and treatment decisions – sometimes because good-quality evidence does not yet exist and sometimes because the evidence that does exist is not directly applicable to the context. The experience of the clinician or carer, the context of the health-care environment and the specific values and priorities of the child, family or community receiving care ultimately shape decisions about the quality of the evidence and how evidence is used. Sometimes these different sources of knowledge are categorised as external evidence (from research) and internal evidence (relating to the child, family, clinician or setting).

Summary

Learning objectives

In this chapter you will:

• Be introduced to the demographic profile of Australia's children and young people and the measures used to monitor their health and wellbeing

• Gain a sense of the current health and wellbeing of children and young people living in Australia

• Consider existing and emerging threats to the health and wellbeing of Australia's children and young people within a global context

• Reflect on your knowledge of the health and wellbeing of Australia's children and young people, and how you might use this knowledge in your work as a nurse

Introduction

This chapter examines the health of children and young people growing up in Australia. The aim is to consider children and young people in a more global context and as the future population of Australia. We will look at population characteristics, challenges to healthy growth and development, and emerging health and social trends. We will also define and describe some of the measures (or indicators) of children and young people's health referred to throughout the text.

The future role of the paediatric nurse is not only shaped by emerging physical threats such as childhood obesity, injury and chronic illness, but also by behavioural, developmental and mental threats resulting from the rapid social and environmental change affecting children and young people all over the world. We invite you to consider the idea that the health and welfare of the children and young people of Australia are as much determined by the context of the past and present as they will be by the context of the future.

As you read more widely about the health and wellbeing of children and young people, you will become aware of many different definitions and descriptors for age groups within this population. The Australian Bureau of Statistics (ABS), for example, defines children as those aged under 15 years of age and young people as being 15–24 years of age. In Australia, legal adulthood is established at 18 years of age, and the ABS defines young adults as being in the age range 18–34 years.

Summary

Learning objectives

In this chapter you will:

• Develop your understanding of evidence-based nursing assessments and interventions used in the care of infants, children and young people with complex medical needs

• Explore causes of complex medical health problems in children and young people

• Appreciate the critical role of families in the care of children with complex medical needs

• Consider resources and services available to families of children and young people with complex medical needs

Introduction

Children with complex medical needs and their families are important and frequent consumers of paediatric health-care services (Burns et al., 2011); however, their needs are not always met (Noyes et al., 2014). Most children with complex medical care needs are cared for at home, with parents primarily responsible for their day-to-day care, often with the support of ambulatory and outpatient services. Depending on the nature of the child's condition, they may require frequent admission to hospital, psychosocial and socioeconomic support, and resources to maintain health and enable participation in school and other activities of daily living (Burns et al., 2011). The care that parents may be required to provide at home is likely to include procedural care – tasks such as suctioning or medication administration, and physical care such as manual handling, feeding and toileting (Rehm, 2013).

Children and young people who are dependent on medical technology have a higher risk of severe acute illness and are more likely to require admission to an intensive-care unit (Burns et al., 2011; Rehm, 2013). Furthermore, some illnesses may be life-limiting, resulting in premature death in childhood, adolescence or early adulthood. Some children, young people and their families may require palliative care services towards the end of their illness.

It can be difficult to determine when a child can be defined as having complex medical needs (Cohen et al., 2011). What one family finds complex, another family may adapt to more easily. One child with a particular condition may have less severity and more function than another child with the same or a similar condition. Furthermore, the discussion around the care of children with complex medical needs has often used different terms for similar things – care that is ‘medically complex’, or children who are ‘technology dependent’ or ‘medically frail’.

Summary

Learning objectives

In this chapter you will:

• Be introduced to the concept of child rights, and in particular the rights of children and young people living in Australia

• Become familiar with the United Nations Declaration of the Rights of the Child

• Develop an understanding of how these rights translate into paediatric settings

• Develop an understanding of the purpose and intention of Australian policies that determine how, where and by whom children and young people will be cared for in the Australian health-care system

• Consider your professional priorities in relation to children's rights and child-protection Legislation

Introduction

This chapter builds on the information in Chapter 1 about the context of paediatric nursing in Australia. It is intended to provide a basis for understanding the ways in which children and young people's rights are upheld in Australia, particularly within the health-care system. This extends to child protection, including nurses’ legal and moral responsibility to report child abuse and neglect.

As a nurse working with children, young people and their parents, you will be challenged to consider many important issues regarding your involvement with them as active participants in their health-care decisions. In your practice, you will explain which treatments or interventions are necessary, and decide whether the child or young person has the capacity to understand the importance and consequences of the choices that you make in collaboration with them and their family. Your assumptions about childhood and the role of parents will underpin the way in which you approach the child or young person and their family. These assumptions need to be evaluated critically and open to scrutiny and review, so you can provide the best possible care within a variety of contexts. This can sometimes be challenging, as there is a disparity of power in the relationships between the child or young person, you and the family, and this needs to be acknowledged and addressed.

The purpose of this chapter is to provide insight into the ways in which human rights, and particularly child rights, inform paediatric nursing policy and practice in Australia. The chapter explains how current Australian legislation attempts to ensure that child rights are protected within the health-care system.

Summary

Learning objectives

In this chapter you will:

• Come to understand that the focus of paediatric nursing care includes both the child or young person and their family

• Explore contemporary family characteristics relevant to paediatric nursing

• Explore models of paediatric nursing care that promote family partnership and involvement

• Gain an understanding of family assessment and apply family assessment models to a case

• Gain an understanding of important considerations when conducting family assessment

Introduction

In paediatric nursing, families are central to the care of children – in fact, the patient is considered to be both the child and their whole family. In this chapter, you will explore what it means to be a family, learn about the models of paediatric nursing care that emphasise a focus on both the child and their family and discover the frameworks that can be used to assess families in paediatric nursing practice. You will also be invited to consider some of the tensions or challenges experienced by paediatric nurses during care for children and families.

Families in contemporary Australian society

Families in Australia today are diverse in terms of their structure, as well as their membership and functions. Because of this, the concept of ‘family’ is quite challenging to define. It is perhaps useful to think of McCaffery's (1968) reference to pain as being ‘whatever the patient says it is’ and consider families to be defined by their members; even though members of a family may have no blood relationship, they may consider themselves to be a family.

Contemporary Australian families may be:

Summary

Learning objectives

In this chapter you will:

• Be introduced to the concept of determinants of child and adolescent mental health

• Gain an understanding of mental disorders and mental health problems experienced in childhood and adolescence

• Become familiar with the importance of positive relationships, experiences and environments to developing adaptive responses to stress and change in children and young people

• Understand that mental disorder in childhood is a dimensional phenomenon

• Learn nursing skills that help promote good mental health and enhance resilience in children and young people

Introduction

The focus of this chapter is the role of the nurse in optimising child and youth mental health. An overview of mental disorders experienced during childhood and adolescence is followed by a discussion of mental health promotion for children and young people. In this edition, we have included a section on eating disorders. Although the lifetime prevalence of these disorders is very low, they are common, and nurses play an important role in the care of those affected children and young people admitted to hospital for treatment. The importance of working closely with the parents and families of children and young people disabled by mental illness and the services available to them is emphasised throughout the chapter.

The Australian Institute of Health and Welfare (AIHW) published the first national survey of child and adolescent mental health and wellbeing in Australia in 1998. The second survey was published in 2015 (Lawrence et al., 2015); it includes data on the use of mental health services by children, young people and their families. This national survey of mental health and wellbeing provides valuable information on the prevalence of child and youth mental disorders in Australia. The AIHW also publishes a list of services that exist for people living with a mental disorder and makes recommendations for services that are needed. The latest survey indicates that while the prevalence of mental health disorders for children and young people remained stable between 1998 and 2015, there was a significant increase in the use of mental health services for 4–17-year-old Australians.

Summary

We hope that you find this second edition of Paediatric Nursing in Australia: Principles for Practice useful as a contemporary primary resource for pre-registration students of nursing as well as new graduates practising in Australian paediatric settings. The second edition maintains a strong Australian focus. We have incorporated feedback from students, educators and our academic colleagues to improve each chapter and hope you are pleased with the result. We are most grateful to Cambridge University Press for offering to support us to publish the second edition.

The second edition of this text first sets the context within which student nurses can expect to practise paediatric nursing in Australia. It presents the profile of child health, illness and injury within Australian communities and includes details of national health trends for children and young people in Australia, in comparison with international trends.

Emphasis is given to evidence-based paediatric nursing assessment, nursing care and nursing interventions in paediatric settings. This includes acute care, complex care, care of the child with a chronic illness and childhood mental health care.

We are most appreciative of the superb effort of our contributing authors in sharing their expertise in this second edition. Sincere thanks to Robyn Galway, Ibi Patane, Robyn Rosina, Loretta Scaini, Lindsay Smith, Helen Stasa, Nerralie Shaw and Julia Taylor once again for their time and effort in creating this second edition of Paediatric Nursing in Australia: Principles for Practice.

Summary

Learning objectives

In this chapter you will:

• Develop an understanding of the physical and psychological problems experienced by children in end-of-life care

• Develop an understanding of some of the strategies used to address or manage these problems in paediatric end-of-life care

• Consider the importance of communication with the child/young person, parents, siblings and grandparents in paediatric end-of-life care

• Explore ways to support parents, siblings and grandparents in paediatric end-of life care

Introduction

Although children in Australia enjoy a long life expectancy and high level of wellbeing, paediatric death remains a sad reality for some families, and end-of-life care for children presents an important and challenging area of paediatric nursing practice.

The rate of child mortality in Australia more than halved from 30 to 13 deaths between 1986 and 2006, due to a reduction in the number of paediatric deaths from transport-related accidents; however, the mortality rate stabilised between 2006 and 2010 (AIHW, 2012). Among children aged 1–14 years between 2008 and 2010, the leading causes of death included injury (34 per cent), cancer (17 per cent) and nervous system diseases (11 per cent) (AIHW, 2012).

As a beginning paediatric nurse, it is important that you understand that the terms paediatric palliative care and paediatric end-of-life care are conceptualised differently, despite some overlap. Paediatric palliative care begins when a disease is first diagnosed, and continues throughout the illness trajectory. It therefore includes, but is not limited to, end-of-life care (Crozier & Hancock, 2012). The majority of paediatric palliative care is delivered by hospital-based or community teams in the last six months of a child's life (Crozier & Hancock, 2012). Paediatric end-of-life care is the care provided to the child and family towards the end of a child's life, and includes care of the child's body and support for the family following the child's death. Although there are distinctions between the two terms, in this chapter they will be used interchangeably.

The World Health Organization (WHO) definition of palliative care for children was developed in 1998 in recognition that paediatric palliative care, although related to adult palliative care, is a distinct and specialised area. The WHO (1998) definition includes the following principles:

Summary

Learning objectives

In this chapter you will:

• Gain an understanding of normal assessment findings in the paediatric patient and those indicating deterioration

• Learn how to recognise a sick or deteriorating child using an appropriate framework

• Develop an understanding of how to respond to a sick or deteriorating child and provide appropriate respiratory and circulatory support

• Learn the elements of paediatric cardiopulmonary resuscitation • Consider the importance of supporting families and parental presence during paediatric resuscitation

Introduction

As a nurse caring for paediatric patients, it is important for you to develop the ability to recognise and respond to a sick infant or child. The ability to do this is so important that a variety of projects have been undertaken, both internationally and throughout Australia, to ensure that nurses working with paediatric patients are able to recognise, respond promptly to and appropriately manage sick and deteriorating infants and children. Examples are the Between the Flags program in New South Wales, the Victorian Children's Tool for Observation and Response (VICTOR) and the Children's Early Warning Assessment Tool (CEWT) in Queensland. These programs aim to support the assessment skills of the clinician working with infants and children. Paediatric early warning tools help clinicians to recognise a deteriorating infant or child, and trigger an escalation in care to prevent further deterioration and achieve favourable outcomes. This chapter will provide you with a basic understanding and knowledge so that you will be able to recognise and respond to a sick and deteriorating child.

Clinical signs – a warning of deterioration – are often present in the paediatric patient as for as long as six to 12 hours before a catastrophic event. Failure to identify and treat these early warning signs can result in continued clinical deterioration until cardiopulmonary arrest. The poor outcomes associated with paediatric cardiopulmonary arrest emphasise the importance of being able to detect and respond to early signs of deterioration (McLellan & Connor, 2013).

The primary cause of paediatric cardiopulmonary arrest is respiratory in origin, and the second most common cause is circulatory failure.

Summary

Learning objectives

In this chapter you will:

• Be introduced to the ways in which children, young people and their families respond to disruptions in health

• Explore the relationship between responsive nursing practice and psychosocial development of children and young people

• Examine cultural factors that influence the ways in which children, young people and their families respond to disruptions in health

• Consider child behaviour and child development, and the impact of nursing practice on responses to experiences of illness

• Identify health-promotion and health-education strategies that aim to improve the health and wellbeing of Australian children and young people

Introduction

This chapter pays special attention to the responses of children, young people and their families to disruptions to a child's health. When a child experiences an acute or chronic illness, we can expect a number of emotional and behavioural responses. The paediatric nurse's knowledge of child behaviour and child development can be of great benefit in assisting parents and caregivers to promote resilience in the child or young person.

This chapter presents a series of case studies and case study resolutions to provide guidelines and recommendations for managing emotional and behavioural disorders related to children's experiences of illness. The case studies are presented within a framework of psychosocial development to best illustrate the relationship between child development and response to illness. The relationship is bidirectional – that is, responses are shaped according to the developmental stage of the child or young person, and development is impacted by the experiences of both acute and chronic illness. Consideration is given to cultural and social factors that influence the child's response to the experience of illness. This includes Aboriginal and Torres Strait Islander health considerations and the potential implications for care provided to children, young people and their families.

The psychosocial development of children and young people experiencing disruptions to health

Opportunities for developmental experiences that promote healthy psychosocial development may be limited or compromised by childhood illness. The presence of chronic illness may disrupt the pace and timing of developmental milestone achievements. Indeed, regression of previously mastered milestones may be observed. Long absences from school and limited opportunities for taking responsibility and the experience of achievement can compromise psychosocial developmental mastery.

Summary

Learning objectives

In this chapter you will:

• Develop your understanding of evidence based nursing assessments and interventions used in the care of acutely ill young people

• Develop your understanding of the aetiology, signs and symptoms of key acute illnesses experienced by young people in Australia

• Consider the developmental needs of young people in the planning and implementation of nursing care

• Explore the impact of illness and hospitalisation on young people

Introduction

In this chapter, we focus on the nursing care of young people, or adolescents. The transition to adolescence is a complex and critical period of development, with significant social, emotional and physical changes. Similar to childhood, adolescent development and maturation is complex, and differs between individuals. When planning nursing care, consideration for the individual adolescent, their characteristics and their stage of development is essential.

The reasons why adolescents require admission to hospital are more likely to be related to an injury or chronic condition. While most injuries are mild, and can be managed at home by parents, there are times when care and treatment for injury or illness results in the admission of the young person to hospital. The nursing care of children and young people with a chronic condition is addressed in Chapter 10. In this chapter, we will focus on the care of young people who need nursing care due to common acute injuries. In addition, the management of young people with appendicitis will also be explored in this chapter, as the peak incidence of this condition occurs in young people. Adolescence is a time when many young people begin to experiment with alcohol and other substances, and this can result in acute and unexpected illness. Thus the management of a young person with alcohol ingestion is also reviewed.

Key issues for young people during Hospitalization

Injury, illness and admission to hospital can be significant interruptions in the life of a young person. Wherever possible, we do our best to minimise the disruption by avoiding admission and providing ambulatory care in the community when it is available and appropriate to do so. However, some situations do require admission; when this occurs, ideally a young person is best cared for in an adolescent unit – an environment that understands the unique psychosocial and physical needs of adolescents.

Nursing

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1773 results in Nursing

5 - Indigenous health and well-being: wise and responsive practice in primary health care

Summary

10 - Evidence-based nursing assessments and interventions: The child and young person with a chronic illness

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Contents

8 - Evidence-based nursing assessments and interventions: The acutely ill child

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List of contributors

5 - Research in the paediatric setting

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1 - Australia's children and young people

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Index

11 - Evidence-based care of children with complex medical needs

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2 - Child rights in Australia

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3 - Family and community

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7 - Mental health and illness in childhood and adolescence

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Preface

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Frontmatter

12 - End-of-life and palliative care in Australian paediatric care settings

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6 - Recognising and responding to the sick child

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4 - Psychosocial development and response to illness

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9 - Evidence-based nursing assessments and interventions: The acutely ill young person

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2 - Clinical skills and nursing care

10 - Medication administration

Nursing

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