EXPANDED AND EXTENDED ROLE OF PEDIATRIC NURSE

S. K Mohana sundari

Introduction Pediatric nursing is a specialized area of

nursing practice It concerning the care of the children from

conception till adolescent It includes preventive, promotive, curative and

rehabilitative care of childrenThe pediatric nurse involves in giving

assistance care and support to the growing and developing children to achieve their individual potential for functioning with fullest capacity

Role of the pediatric nurse It includes both caring and curingCaring is the continuous process in both illness

and wellnessCuring refers to the act of diagnosis and

management usually during illnessPediatric nurse have the responsibilities of

proving nursing care in hospital, home clinics, school and community

The role of pediatric nurse may vary from one institution to other institution.

Qualities of pediatric nurse Be a loving person and have liking for the children Have patience, pleasant appearance, and ability to

understand the child’s behaviour Be able to maintain good interpersonal relationship

and to provide safety and security to the children. Be friendly, honest, gentle, diligent and humorous Have good observation, judgment and communication

ability based on scientific knowledge and experience Be well informed, skillful, responsible, truthful and

trustworthy.

Extended role of pediatric nurse 1.Primary care giver Pediatric nurse should provide preventive, promotive,

curative and rehabilitative care of children, Care in all levels of health services, as therapeutic

agent. She act as case finder and compassionate skilled

caregiver as needed by the today's society. Primary care includes providing comfort, feeding,

bathing, safety etc. Health assessment and immunization is primary care

in the community,

Health educatorThe important role of nurse is to deliver

planned and incidental health Care teaching and information to the patient

It is given to create awareness about healthy life style and maintenance of health change in health behaviour

To bring change in attitude and to develop healthful practices regarding child care

It is initiated by pediatric nurse as change agent and health educator.

Nurse counselor Problem solving approach and necessary guidelines in

health hazards of children to minimize or to solve the problem

To help the parents and family member for independent decision making in different situation

Social worker She can do case work especially for children and try

to alleviate social problems related to child health. She can participate in available social services Can refer child and family for necessary social

support from the child welfare agency.

Team coordinator and collaboratorPediatric nurse should work together and in

combination with other health care team members towards better child health care.

She should act as liaisons among the members and maintain good interpersonal relationship

The nurse interprets the objective of the health care of to the family and coordinates nursing services with other services necessarily for the child

Cooperation and good communication among team members should be promoted by nurse.

ManagerThe pediatric nurse is the manager of pediatric

Care in hospital, Clinics, and community .She should organize the care orderly for

successful outcome with better prognosis and good health

Child care advocateChild or family advocacy in basic aspects to

comprehensive family centered careAs an advocate the pediatric nurse can assist

the child to obtain the best care possible from the particular units.

Recreationalist The supportive role of pediatric nurse is important for

the child to adjust to the crisis imposed by illness or hospitalization

She can organize play activities for recreation and diversion for child’s emotional outlet

Nurse consultant she can act as a consultant to guide the parents and

family members for maintained and promote of health and prevention of childhood illness

The nurse can help the older children to become responsible for their own action.

ResearcherNursing research is the integral part of

professional nursing.Pediatric nurse should participate of perform

research projects related to child health.Clinical and applied research provides the

basis for changes in nursing practice and improvement, in the health care of children

Therapeutic relationship It I the essential foundation for quality nursing care. She must relate children and family in a meaningful

way, and yet remain separate enough to distinguish their own feeling and needs in a therapeutic relationship

Caring well defined boundaries separate the nurse from the child.

This boundaries are positive and professional and promote the family’s control over the child’s health care with in a therapeutic relationship.

Restorative roleNurses are intimately involved with meeting

the physical and emotional need of children, including feeding, bathing, toileting, dressing, securing, and socialization

The nurses must aware of normal findings to identify and document deviation

She should never lose the sight of the child individually.

Emotional as developmental needed because these needs influenced the course of the disease.

Ethical decision makingEthical dilemmas arise when competing moral

consideration undertaken various alternative. parents, nurses, physician and other health

care team members may reach different but morally defensible decision by assigning different weight to the competing moral values

Nurses must determine the most beneficial or least harmful action with in the frame work of societal morals, professional actions, standards, the laws, institutional rules, religious tradition , the family values and the nurse personal values

Health care planningToday’s nurses role has expanded beyond the

nuclear of the family to include the community based- health- driven system.

Traditionally nurses were involved in public health either on a continuous or episodic basis.

Nurses were involved in health care having on a political or legislative level frequently.

Health care planning involves not only providing new services to children and their family but also promoting the highest quality in existing services.

The functional role of nurseThe nurse may be described broadly not as a

parents substitute but a ‘father friend” In this role the nurse may plan and actually

provide comprehensive care to children as in primary nursing or many function as a member of a nursing team.

Responsibility to communityTo fulfill many of these responsibilities the

individual nurse must function not only in care of episodic or distribution care but also in broader community effort.

In this way the nurse can become, consumers, community officials and planner and professional and as lawyer , educator, and other members of the health team.

Legal aspectsBasically the licensing laws have been and

written to protect the health care consumer from harmful, unsafe or unprepared health care providers

Consumers now also looking at them law to determine whether, infact they are providing this protection.

Nurses are responsible for their own actionThe responsibility to use reasonable care in

action directed towards other

Expanded role of nurseThe 1st expanded role for nurse was developed

during the 190’s at the university of Loroda with the inception of the pediatric nurse practitioner practice.

PNP was enacted to provide pediatric care in ambulatory community health setting.

In 2000 the national sample survey of registered nurse estimated there were 102,829 nurse practitioner with 14,643 are prepared an clinical nurse specialist.

Advanced practice registered nurse {APRN} The term APRN is being increasing used by

legislative and governing bodies to desirable the collection of registered nurse.

APRN has education beyond 4 years B.Sc (n) In addition to increased educators, the APRN role

requires extra responsibility, critical thinking and judgment.

APRN includes Nurse practitioner Clinical nurse specialist Certified nurse midwife Certified registered nurse anesthetists.

Pediatric nurse practitioner In 15 PNP program was developed and leed to

several specialized ambulatory primary care role for nurses.

This program provides education beyond B. Sc (N) preparation in area of child health maintenance.

PNP are health care provider who are dedicated to improve child health care by working with pediatrician and other health care workers

Functions of pediatric nurse practitionerProvide health maintenance care for children

including well child examination.Perform routine developmental services.Diagnose and treat common childhood illnessProvide anticipatory guidance regarding

common child health concern.Provide childhood immunization.

Functions of Acute care and specialist PNP Perform school physical examinationProvide care to children who are acutely

chronically ill.Perform in-depth physical examination. Inspects result of laboratory and diagnostic

test.Order medication and perform therapeutic

treatment in a variety of setting.

Job duties of PNPEffectively identifies, evaluates, and addresses

disease prevention and health promotion issue of the population.

Work with independent and interdependent relationship with members of the medical staff.

Responsible for the diagnosis and treatment of acute, chronic and long term health care issues.

Maintaining legible, accurate and confidential medical records.

Analyze new knowledge gained from conference, workshops, professional training.

Chronic ill care concentrationThe chronic ill care concentration includes

clinical course in specific specialty area approved by program faculty.

This concentration prepares the PNP students for a care of children with chronic condition.

The PNP interact with other health care worker to [provide health care to chronically ill children

The scholarly inquiry praxis for students is diagnosed to focus on an issue or top relevant to care of children with chronic illness.

Advanced pediatric nurseThe curriculum includes classroom and clinical

experience in advanced health assessment, physiology And pathophysiology management with common and complex illness condition.

Graduate of the program with a specialization APPN an preparing to become leader in care of children across the health and illness spectrum and across institutional boundaries.

There are eligible for state licensure as a nurse practitioner and for rational certificate as PNP.

Acute care pediatric nurse practitioner It is 2 years program leading to the master of science

degree ACPNP are advanced practice who provides expert

clinical care to acute and critically ill children at risk of dying

ACPNP is the only course which provides training in end of life care and palliative care focus as part of course.

graduate are eligible for state licensure as a nurse practitioner

The program has been approved by pediatric nursing certificate boadr. .

Goal of ACPNPTo provide advanced nurse who will promote

the health and development of children and adolescents as individual and as population group encountering health care system with the urban and rural environment.

To promote expert clinical care to meet the specialized physiological and psychological need of the children.

PNP – primary care The PNP – primary care program offers one clinical

specialty treat which involves primary care for children with acute and chronic illness.

Graduate of this clinical specialty prepared to provide comprehensive health care need of infants, children , adolescent and their families in a variety of setting.

Graduate are required to complete 500 hours of clinical practice.

The 4 hour graduate program can be completed in one calendar year of full time study or may be part time.

Family nurse practitionerFNP is a registered professional nurse with

advanced education and clinical training to provide health care to individuals across the lifespan and there families.

Function is to provide multidisciplinary, culturally competent , community based care

They provide opportunity for students to acquire current knowledge.

Provide age appropriate , age specific quality care.

THE CLINICAL NURSE SPECIALISTAct as researcher to validate nursing

observation and intervention a change agent with in the health care system

Provide consultant services.The CNS role has developed within each of the

traditional specialty area as well a subspecialty such as cardiovascular, oncology, and neurology.

Both CNS and PNP are called as advanced nurse practitioner.

Critical care neonatal nurseThe nurses are theoretically ad technically

prepared to provide effective nursing careThe training and education can be given in

hospital setting in the form of certified continuous education program.

The program is to prepare nurse to function as SNN/CCNN

The post basic specialty education will positively influence the role of SNN/CCNN.

Neonatal nurse practitionerNMP can be created from the cadre of nurse

who passed out from college of nursing with b.sc/ m.sc degree with neonatology as specialty as any b.sc nurse who undertaken specialization training in neonatal care and has hands on training in practical care of newborn for reasonable period of time

In the NICU it is essential to provide highly desirable quality of care with 24 hours coverage for each of there roles.

Conclusion

Journal reference

Theory application (general system theory)

Assignment (role of pediatric nurse in community)

Bibliography