Introduction

• Family: 2+ persons who are bounded together by ties of mutual consent, birth, and/or adoption and together assume responsibilities for one another
• Colonial North America: childbirth difficult and dangerous; high( 50 %) mortality rate in children
• • Pre 16th century: Indigenous people balanced health by respecting earth & each other
  • 16-17 century: Europeans brought lethal disease
  • 18-19 century: poor health, high morality, epidemics, Indigenous children removed from homes to attend residential schools.
• • 1900s parents discouraged to visit hospitalized children
  • 1960s child-family centered pediatric nursing care
  • Present CNA and other organizations offer specialized training in pediatric nursing
• Factors that impact maternal & child health: Family, genetics, society, global society, culture, health status & lifestyle, access to health care, improvements in diagnosis & treatments and empowerment of health care consumers
• Advance Directives: A document that specifies a person's wishes regarding medical treatment in the event that they are unable to communicate their wishes.
• Confidentiality: Laws governing how personal information is gathered, sorted, and used

  • The Privacy Act (1995)
  • Personal Information Protection and Electronic Documentation Act (2000)
• Confidentiality (exceptions) Mandatory Reporting:

  • Physical or sexual abuse
  • Injuries due to weapons or criminal acts
  • Infectious diseases
  • Threat to self or to an identifiable person
• Ethical & Legal issues (perinatal considerations)

  • Abortions, substance use, intrauterine therapy, maternal-fetal conflict, stem-cell research, umbilical cord banking
• Ethical & Legal issues (pediatric considerations)

  • Informed consent: legal age, legal guardian for minors.
  • Nurse's responsibility: ensure completed signatures and serving as witness to signatures, & determining client understands what they are signing
• Special situations with informed consent

  • Parent unavailable, person in charge with written permission from parent for emergency treatment
  • OR: Verbal consent via telephone for emergency
• Exceptions to parental consent include: Mature minors, (court-determined or) emancipated minor, armed service member, marriage, financial independence living apart from parents, pregnancy (mother is under 18 years; homeless)
• Assent :A child’s participation in decision-making process about health care. Dependent on child’s developmental level, maturity, and psychological state
• Dissent: Disagreeing with treatment plan
• Refusal of medical treatment: Right of all clients, parental autonomy for child as fundamental. Possible related conflicts to religious, cultural beliefs and child's quality of life.
• Family violence: Family violence is the abuse of power within relationships, intimacy, dependency or trust that endangers the survival, security and well-being of another person.
• 5 Types of Abuse

  1. Emotional
  2. Financial
  3. Physical
  4. Sexual
  5. Spiritual
• Cycle of violence (phase 1)

  • Tension building
  • Anger, blaming & arguing occur
• Cycle of violence (phase 2)

  • Acute battering
  • Battering incidents occur
• Cycle of violence (phase 3)

  • Honeymoon phase
  • Batterer asks for forgiveness, promises won't happen again
• Potential Signs & Symptoms of Abuse

  -Withdrawn, unexplainable/ not treated injuries or not matching description, sick often, low confidence/self-esteem, behavioral concerns, mental health, regression, hygiene changes, overuse of health services, partner not leaving person's side
• Abuse interventions

  • Affirming statements "I believe you"
  • minor: Child Protective Services
  • adult: recommend support and resources, develop a safe plan can involve interdisciplinary teams
• Considerations for perinatal practice

  • Pre-Conception Health and Planning Support
  • Involvement of the family
  • Choice amongst healthcare provider options
  • Prenatal Care, Intrapartum Care and Postpartum Care
  • Newborn Care and Role adaptations
• Considerations for child health practice

  • Growth and development milestones
  • Communicating with the entire family
  • Anatomy and physiology changes throughout childhood
  • Family stress and impaired coping
  • Child stress and coping mechanisms
• Family centered care includes:

  • Collaborative partnership, mutual trust, sensitivity to client’s and family’s beliefs and those of their culture
• Family centered care includes:

  • Family as the constant
• Family centered care includes:

  • Support for uniqueness and diversity; encouragement and enhancement of family strengths and competencies
• Family centered care includes:

  • Greater family self-determination, decision-making, control, and self-efficacy
• Family Centered Care: An approach to planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among healthcare providers, patients and families
• 4 core concepts for Family Centered Care

  1. Dignity & Respect
  2. Information Sharing
  3. Collaboration
  4. Participation
• Friedman's Structural Functional Theory

  • Affective function: meeting love & belongings needs
  • Socialization & social placement function: teaching children how to take on adult roles in society
  • Reproductive function: continuing family/ society
  • Economic function: adequate resources & allocation
  • Healthcare function: healthcare provisions to keep family members healthy
• Calgary Family Assessment Model (CFAM): A framework for nurses working with families and performing assessments

  • 3 Components of family: structural, developmental, and functional components
• McGill Family Assessment Model of Nursing: A model focused on health promotion with families from a strengths -based approach

  • 4 pillars: health, family, collaboration, and learning
• Culturally competent NSG care includes: Cultural diversity, cultural competence (self-aware, knowledge, skills, encounter).
• Barriers to cultural competence include provider-related and system -related (resources)
• Community: a specific group of people, often living in a defined geographical area, who share common interests, interact with each other, and function collectively

  • A person is often a part of many communities
• Population: a group of people who share personal or environmental characteristics
• Birthing center: “home-like” setting; close to hospital if complications; “normalcy” of birth
• Home birth: family-centered birth; appropriate for women at low risk for complications
• Community based women's health care: Freestanding or hospital-based programs, screening, educational, counselling, wellness, alternative healing, and retail centers