Pediatric Nursing Care Plans - Research Paper Example

Pediatric Nursing Care Plans Introduction Children are not small adults. They have unique psychological, physiological and cognitive needs at each stage of development. Thus, health promotion, disease prevention and health restoration in children require attention and care of not only the parents and other family members, but also health providers. Pediatric nurses work with parents and other family members of children in the community and also in acute care settings in order to not only protect but also enhance the well-being of the infants and children with aims and objectives to help them reach their fullest potential (Luxner and Jaffe, 2005). Several strategies have been developed to enhance the care provided to children. One such strategy is development of nursing care plans. In this essay, pediatric nursing care plans in general, will be discussed. Nurse care planning According to Luxner and Jaffe (2005), "nurse care planning is the application of the nursing process to a specific client situation." Nurses play an important role in the health promotion of an individual due to their direct contact and proximity with the patients. The 3 basic roles of a nurse are that of a practitioner, leader and researcher. As a practitioner, the nurse attends to all the medical needs of the patient and as a leader she takes decisions which relate to, influence and facilitate the actions of others with an aim to achieve a particular goal. As a researcher, the nurse aims to implement studies to determine the actual effects of nursing care and to work towards further improvement in nursing care (Nettina, 2006). As far as taking care of children is concerned, the role of nurses is further emphasized. Though, traditionally the care of the child has been the responsibility of family members; children merit special attention from health care providers too. The role of nursing is authenticated in helping people move towards independence in all activities of daily living. They take up the role of a family member. Their actions have an impact on the individual and affect their levels of dependence/independence and these include biological, psychological, socio-cultural, environmental and politico-economic variables (Roper et al, 2002). The steps in the nursing process are assessment, nursing diagnosis, planning, implementation and evaluation (Baillie, 2005; Nettina, 2006). Assessment is the systematic collection of data which are markers of the health status of the individual and help in identifying any health related problems. Nursing diagnosis is the actual identification of the disease process which needs to be dealt with. Planning is a process of setting health related goals that are aimed to resolve the potential health problems identified by means of nursing diagnosis. Implementation is the means of delivering the plan to achieve the set goals. Evaluation is determination of patient's response to the interventions made towards the achievement of goal (Nettina, 2006). Nursing care plans Consumers of health care expect a certain standard of care that is affordable and has optimal outcomes. The need for health care services that are expensive are scrutinized by third party providers. The outcomes of health are reported by the health care organizations to federal, state and independent agencies with intentions to verify standards of practice and also to attract health providers and consumers. There is demand for treatment that is most effective and also cost efficient. Thus, there is collaborative responsibility for restoring clients to health and this is demonstrated by clinical pathway or care maps. These are also known as nursing care plans and they are defined as "care management tools that outline the expected clinical course and outcomes for specific client type” (Luxner and Jaffe, 2005). Nursing care plans are very essential for continuum of care. The construction of plans is usually agency specific, "but it typically follows the client's length of stay on a day-to-day basis for specific disease process or surgical intervention” (Luxner and Jaffe, 2005). Nursing plans are clinical tools that organize, direct and time the activities related to major care and also various interventions of the multidisciplinary team for a particular procedure or diagnosis. The design of the nursing plans is intended to minimize delays, maximize the utilization of appropriate resources and promote care of high quality and standard. According to Barnum (1999; cited in Luxner and Jaffe, 2005), "nurse care planning is the application of the nursing process to a specific client situation (Luxner and Jaffe, 2005). Nursing care pathways identify standard outcomes of the client against which the efficiency of care may be measured. It also helps the care team through a sequence of interventions in the interdisciplinary team which include various standardized aspects like family teaching, client, medications, nutrition, activities, treatments and diagnostic studies. The clinical pathway is developed in collaboration will all the members of the health care team and includes time frames that are not only predictable but also established. Each hospital day is considered as an event requiring newer interventions for continuum of care. Consistency of clinical activities will be there when such tools are applied. Also, because of standardization of clinical practice, these tools provide scope for measurement of improvement of performance not only within an agency, but also between similar agencies over a period of time (Luxner and Jaffe, 2005) Nursing care plans that are well designed help the patient move from one level of care to the another. They also help the nurse not only monitor, but also guide the progress of the particular health condition of the client including care in end-of life situations and also in preventive and restorative phases. According to (Luxner and Jaffe, 2005), “care planning organizes and coordinates client care according to relevant standards, promotes consistency and communication between caregivers, and incorporates the problem solving process which integrates responsiveness to client needs and cost efficiency." Several studies have demonstrated the effectiveness of nursing care plans in pediatric services. Boisclair-Fahey (2009) conducted a study to evaluate the efficacy of individualized care plans in increasing continence in children with dysfunctional elimination syndrome. From the reports of the study it was found that 100 percent of children could achieve continence after application of individualized treatment plans. Effectiveness of care plans in congenital disease management was demonstrated by Moodie (2010) recently. Rotter et al (2010) conducted a systematic review to assess the effectiveness of structured clinical pathways on patient outcomes, professional practice, duration of stay in the hospital and hospital costs. From the results of the study it was evident that care plans not only reduced the duration of stay in the hospital, but also reduced complications, decreased hospital costs and improved documentation. According to Rotter et al (2010), "clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimize clinical outcomes whilst maximizing clinical efficiency." Kulkarni et al (2011) reported that clinical care pathways improved use of hospital resources in endocrine surgery. Thus nursing care plans are very efficient tools on patient management. Process of nurse care planning The process of developing individualized nursing care plans involves steps similar to those in the nursing process. 1. Collection of assessment data This is done from sources that are available like parents of the child, the child itself and from family members. More often that not, parents are the best sources of information. In some cases like asthma, teachers and classmates also are useful sources of information. Other sources of information, especially, those related to in-hospital management include physician notes, nursing flow notes, laboratory reports and progress notes from other health professionals like physiotherapist and dietician. The current status of the pediatric patient can be assessed through observation, interview, cues from parents and examination. Based on these data, information must be organized and then the problems and needs must be categorized priority wise. 2. Identification of nursing diagnosis that are viable This can be done based on data from assessment. Diagnostic process is usually individualized based on the condition of the child and information from the parents and examination. 3. Identification and meeting of the goals with reference to specific outcomes Goals pertain to the diagnosis and clinical condition of the patient and the intentions of goal are resolution of the the identified problems within a time frame that is reasonable to the patient. 4. Designation of interventions to meet the goals with intentions to resolve the nursing diagnosis. Interventions must be chosen in a manner that are consistent with the medical orders by the pediatrician. Along with these, independent and collaborative nursing interventions are needed like assessment of the perception of pain of the child, positioning of the child, teaching the child to ask for medication before the pain becomes severe and administration of medications of pain. 5. Evaluation of the effectiveness of the plan Goals and observable outcomes desired will help in assessing the need for ongoing evaluation and also updating of the plan. Evaluation of the criteria for outcome at the specified time with help in indicating either resolution of the problem of the need for continuation of the care plan or the need to revise the plan. Types of pediatric nurse care plans In children, there are basically four types of pediatric nursing plans. They are: 1. Basic care plan 2. Hospitalized child care plan 3. Child abuse care plan 4. Dying child care plan Basic care plan Children who are healthy are assessed at regular intervals in order to monitor their growth and development, provide vaccination to prevent infectious diseases, promote wellness and also to provide anticipatory guidance to their parents, care-takers and other family members. Nursing care plan for healthy children is based on detailed nursing history, assessment and examination and also review of laboratory and other diagnostic findings. The parent or the care-taker of the child is included in each and every aspect of care of the child. Specific data related to the child is inserted within parenthesis whenever possible. Basic care plan can be understood through the following diagnosis. The most common nursing diagnosis in well child is health-seeking behaviours by parents. This is based on the belief of the parents in the benefits of health promotion and health screening of the child. The goal of this nursing diagnosis is continuation of health seeking behaviours by parents. The outcome criteria that are desired are keeping up with all scheduled appointments of the well-child and addressing of concerns related to the health and well-being of the child with the health care provider. Interventions related to this diagnosis are establishment of comfortable environment both for the child and the parent through provision of privacy and approaching the child appropriately by listening attentively and by giving sufficient time to address the concerns of the child and the parent. The rationale for this intervention is promotion of comfort and also a sense of safety for the child and the parent so that stress during health care visits is decreased. Other aspects which are addressed under basic health care plan are health screening and education, development of the child, care of infant, immunisation behaviour and enhancement of development (Luxner and Jaffe, 2005). Pediatric nursing plan for hospitalised child A child may be hospitalized due short term illness, acute exacerbation of long term illness, surgery and emergency. Whatever may be the cause, hospitalisation is a source of crisis to the patient and his or her family members. Responses to admission to hospital are dependent on the age of the child and developmental level of the child. Common responses include separation anxiety, injury, loss of control and pain. ease of transition from home to hospital depends on the preparedness of the child for it and also whether physical and emotional needs of the child have been met., Well being and adjustment of the child can be enhanced by providing appropriate information to the family, supporting the family and also be encouraging the family members to take part in the care of the child. Common nursing diagnoses with reference to a hospitalized child rare disturbed sleep pattern, imbalanced nutrition, pain, delayed growth and development, impaired physical mobility, anxiety, deficient diversional activity, powerlessness and risk of trauma (Luxner and Jaffe, 2005). Pediatric care plans for child abuse Child abuse is a common problem all over the world. It is prevalent in all races, socio-economic groups and religions. While in the first place it is difficult to identify abused children, it is more difficult to handle the management of these children. The definition of child abuse and neglect varies from state to state and country to country. According to the definition extended by the Federal Child Abuse Prevention and Treatment Act (Child Welfare Information Gateway), any act that amounts to any sort of physical or psychological harm to the child is called child abuse. The definition is for that abuse caused by caregiver or parent of the child. Also, failure to act, because which serious harm has resulted, is also considered as abuse or neglect. It is important to note that harm or negligence caused by other acquaintances or strangers is not considered as child abuse or neglect. The most common type of child abuse is physical abuse. Anger on the part of the parent or caregiver can miscalculate the extent of damage that can be inflicted to the child resulting in physical injuries. In most cases, the injuries are unintentional. Physical abuse can occur from any form of physical act either by parent or caregiver or by any other person who is responsible for the child (Child Welfare Information Gateway, 2008). The injury may range from simple bruise to severe fractures. Since bruise is an indication of damage to body tissue and breaking of blood vessels, discipline methods which cause bruises are considered as child abuse (American Academy of Pediatrics). The physical abuse may even lead to death. These injuries are termed abuse irrespective of the intentions behind the acts. Common nursing diagnoses with reference to child abuse based on which nursing interventions are determined are imbalanced nutrition, risk for impaired skin integrity, delayed growth and development, anxiety, coping, impaired parenting and risk for trauma. Interventions for children with suspected abuse are aimed at coping, reduction of anxiety, parent education, risk detection and risk identification Luxner and Jaffe, 2005). Nursing care plan of dying child Care of dying child includes various emotional and nursing interventions that are necessary to support the child who is totally dependent and also the grieving family. Nursing considerations in this regard mainly involve dissemination of information to the child who basically has various perceptions and fear about death that are related to the age and development of the child. Not only the child, even the the family members must be handled with care, sensitivity and honesty. The nurse also must help the child to move through various stages of awareness and acceptance and also help the patient face various stages of grieving. the child and family members must be provided appropriate information about death that is specifically age related Luxner and Jaffe, 2005). Interventions for this category of patients are mainly administration of medications that promote optimum comfort, prevent pain, facilitate rest and provide optimum functions of the body. Common nursing diagnoses are disturbed sleep pattern, impaired physical mobility, imbalanced nutrition, risk for impaired skin integrity, disturbed thought process, ineffective airway clearance, constipation, pain, anticipatory grieving, anxiety, dysfunctional grieving. Nursing interventions are aimed for this group of patients are increased quality of life, comfort, control of pain, reduction of anxiety and family coping (Luxner and Jaffe, 2005). Limitations Nursing care plans can only guide, but not dictate the course of the patient. They also do not take into account additional problems of the patient which can affect recovery like emotional problems, financial status, etc. Also, not all aspects of the care of the patient can be included within the care plan Luxner and Jaffe, 2005). Conclusion Pediatric nursing is a challenging task because of the various physiological and development needs of the child and each age group and each developmental stage is different. Thus, children require attention of parents, family members, care takers and health providers not only when they are unwell, but also when they are growing. To enhance care of children and optimize the outcomes of nursing care, pediatric nursing tools are useful. References Baillie, L. (ed.) (2005). Developing Practical Nursing Skills. (2nd ed.). London: Hodder Arnold. Boisclair-Fahey A. (2009). Can individualized health care plans help increase continence in children with dysfunctional elimination syndrome? J Sch Nurs., 25(5), 333-41 Child Welfare Information Gateway. (2008). Child abuse and neglect. Retrieved on 18th Feb, 2011 from Kulkarni, R.P., Ituarte, P.H., Gunderson, D., Yeh, M.W. (2011). Clinical pathways improve hospital resource use in endocrine surgery. J Am Coll Surg., 212(1), 35-41 Luxner, K.L., and Jaffe, M.S. (2005). Delmar's Pediatric Nursing Care Plans. London: Thomson Delmar Learning. Moodie, D.S. (2010). Outcomes research-standardized clinical assessment and management plans. Congenit Heart Dis., 5(4), 337. Nettina, S.M. (2006). Manual of Nursing Practice. (8th ed.). New York: Lippincott Williams & Wilkins. Roper, N., Logan, W. & Tierney, A. (1996). The Elements of Nursing Model for nursing based on a Model for Living. (4th ed.). 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