Goals

• Increase quality and length of healthy life

• Eliminate health disparities

Leading Health Indicators

• Physical activity

• Overweight and obesity

• Tobacco use

• Substance abuse

• Responsible sexual behavior

• Mental health

• Injury and violence

• Environmental quality

• Immunization

• Access to health care

Sex—Preponderance of males; difference mainly the result of behavioral characteristics, especially aggression

Temperament—Children with difficult temperament profile, especially persistence, high activity level, and negative reactions to new situations

Stress—Predisposes children to increased risk taking and self-destructive behavior; general lack of self-protection

Alcohol and drug use—Associated with higher incidence of motor vehicle injuries, drownings, homicides, and suicides

History of previous injury—Associated with increased likelihood of another injury, especially if initial injury required hospitalization

Developmental characteristics

• Mismatch between child’s developmental level and skill required for activity (e.g., all-terrain vehicles)

• Natural curiosity to explore environment

• Desire to assert self and challenge rules

• In older child, desire for peer approval and acceptance

Cognitive characteristics (age specific)

• Infant—Sensorimotor: explores environment through taste and touch

• Young child—Object permanence: actively searches for attractive object; cause and effect: lacks awareness of consequential dangers; transductive reasoning: may fail to learn from experiences (e.g., perceives falling from a step as a different type of danger from climbing a tree); magical and egocentric thinking: is unable to comprehend danger to self or others

• School-age child—Transitional cognitive processes: is unable to fully comprehend causal relationships; attempts dangerous acts without detailed planning regarding consequences

• Adolescent—Formal operations: is preoccupied with abstract thinking and loses sight of reality; may lead to feeling of invulnerability

Anatomic characteristics (especially in young children)

• Large head—Predisposes to cranial injury

• Large spleen and liver with wide costal arch—Predisposes to direct trauma to these organs

• Small and light body—May be thrown easily, especially inside a moving vehicle

Other factors—Poverty, family stress (e.g., maternal illness, recent environmental change), substandard alternative child care, young maternal age, low maternal education, multiple siblings

• Incorporating into policy and practice the recognition that the family is the constant in a child’s life while the service systems and support personnel within those systems fluctuate

• Facilitating family-professional collaboration at all levels of hospital, home, and community care:

• Care of an individual child

• Program development, implementation, and evaluation

• Policy formation

• Exchanging complete and unbiased information between family members and professionals in a supportive manner at all times

• Incorporating into policy and practice the recognition and honoring of cultural diversity, strengths, and individuality within and across all families, including ethnic, racial, spiritual, social, economic, educational, and geographic diversity

• Recognizing and respecting different methods of coping and implementing comprehensive policies and programs that provide developmental, educational, emotional, environmental, and financial support to meet the diverse needs of families

• Encouraging and facilitating family-to-family support and networking

• Ensuring that home, hospital, and community service and support systems for children needing specialized health and developmental care and their families are flexible, accessible, and comprehensive in responding to diverse family-identified needs

• Appreciating families as families and children as children, recognizing that they possess a wide range of strengths, concerns, emotions, and aspirations beyond their need for specialized health and developmental services and support

All children need:

• To be free from discrimination

• To develop physically and mentally in freedom and dignity

• To have a name and nationality

• To have adequate nutrition, housing, recreation, and medical services

• To receive special treatment if handicapped

• To receive love, understanding, and material security

• To receive an education and develop his or her abilities

• To be the first to receive protection in disaster

• To be protected from neglect, cruelty, and exploitation

• To be brought up in a spirit of friendship among people

Is the provision of therapeutic care in settings by personnel and through the use of interventions that eliminate or minimize the psychologic and physical distress experienced by children and their families in the healthcare system.

Atraumatic care is concerned with the where, who, why, and how of any procedure performed on a child for the purpose of preventing or minimizing psychologic and physical stress.

The overriding goal in providing atraumatic care is, first, do no harm. Three principles provide the framework for achieving this goal: (1) prevent or minimize the child’s separation from the family, (2) promote a sense of control, and (3) prevent or minimize bodily injury and pain. Examples of providing atraumatic care include fostering the parent-child relationship during hospitalization, preparing the child before any unfamiliar treatment or procedure, controlling pain, allowing the child privacy, providing play activities for expression of fear and aggression, providing choices to children, and respecting cultural differences.

Is a cognitive process that uses formal and informal thinking to gather and analyze patient data, evaluate the significant of the information, and consider alternative actions.

Clinical reasoning provides a common denominator for knowledge that exemplifies disciplined and self-directed thinking. The knowledge is acquired, assessed, and organized by thinking through the clinical situation and developing an outcome focused on optimum patient care. Clinical reasoning transforms the way in which individuals view themselves, understand the world, and make decisions.

• Initial assessments and reassessments

• Nursing diagnoses and/or patient care needs

• Interventions identified to meet the patient’s nursing care needs

• Nursing care provided

• Patient’s response to and the outcomes of the care provided

• Abilities of patient and/or, as appropriate, significant other(s) to manage continuing care needs after discharge