C h a p t e r 1
Introduction to Child Health and Pediatric Nursing
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role for pediatric nursing. The advanced practice role is
an expanded nursing role that requires additional edu-
cation and skills in the assessment and management of
children and their families. The pediatric nurse practitio-
ner (PNP) has a master’s degree and national certifica-
tion in the specialty area. The PNP is an independent
and autonomous practitioner. The PNP provides health
maintenance care for children (such as well-child exami-
nations and developmental screenings) and diagnoses
and treats common childhood illnesses. He or she man-
ages children’s health in primary, acute, or intensive
care settings or provides long-term management of the
child with a chronic illness. The family nurse practitio-
ner (FNP) and neonatal nurse practitioner (NNP) func-
tion in a similar manner to the PNP but provide care
to individuals throughout the lifespan and to newborns,
respectively. The clinical nurse specialist has a master’s
degree and provides expertise as an educator, clinician,
or researcher, meeting the needs of staff, children, and
families.
Take Note!
The American Academy of Colleges of Nursing has
recommended that nurse practitioner education be
moved from the master’s to the doctoral level by the year
2015 (Sperhac & Clinton, 2008).
Standards of Care and
Performance in Today’s
Environment
In any role, the professional pediatric nurse is held
accountable for nursing actions that adhere to the
standards of care. A
standard of care
is a minimally
accepted action expected of an individual of a certain
skill or knowledge level and reflects what a reasonable
and prudent person would do in a similar situation.
Professional standards from regulatory agencies, state
or federal laws, nurse practice acts, and other specialty
groups regulate nursing practice in general. The National
Association of Pediatric Nurse Practitioners (NAPNAP),
the Society of Pediatric Nurses (SPN), and the American
Nurses Association (ANA) have formulated specific stan-
dards of care and professional performance for pediatric
clinical nursing practice (Table 1.2).
These standards are tools that determine if care
constitutes adequate, effective, and acceptable nursing
practice. They also serve as guides and legal measures
for this special area of practice. These standards pro-
mote consistency in practice, provide important guide-
lines for care planning, assist with the development of
outcome criteria, and ensure quality nursing care. The
ANA-SPN standards specify what is adequate and effec-
tive for general pediatric nursing and promote consis-
tency in practice.
ETHICAL AND LEGAL ISSUES
RELATED TO CARING
FOR CHILDREN
Parents and guardians generally make choices about
their child’s health and services. As the legal custodi-
ans of minor children, they decide what is best for their
child. Nurses caring for children and their families make
the child’s and family’s needs a priority. Moral develop-
ment (the ability to function in an ethical manner) and
the legal requirements involved in working with children
affect pediatric nurses on a daily basis. Pediatric nurses
must function within ethical and legal boundaries related
to their care. They must understand their state’s legal
requirements for routine care, consent for treatment,
hospitalization, and research.
Take Note!
As advocates for children, nurses support policies
that protect children’s rights and improve chil-
dren’s health care.
Ethical Issues Related to
Working With Children
and Their Families
Pediatric nurses must examine their own values so that
they can provide nursing care in an ethical manner. Each
situation must be evaluated individually. The nurse’s rela-
tionship with the child and family is of prime importance.
Every day pediatric nurses encounter families from a wide
variety of religious, cultural, and ethnic backgrounds, and it
is critical to treat each family with respect. Family-centered
care focuses on the needs of the child and family together
and involves ethical treatment of the child. Advances in
science and technology have led to an increased number
of ethical dilemmas in health care. Many facilities have
formed institutional ethics committees. These committees
not only provide case-by-case review and resolution of
ethical dilemmas but also review existing institutional poli-
cies and provide education to staff, physicians, children,
and families on ethical issues (Nelson, 2007).
Practicing ethically begins with being sensitive to
the sanctity and quality of human life. An ethical nurse is
accountable and uses sound reasoning to resolve ethical
challenges. Ethics includes the basic principles of auton-
omy, beneficence, nonmaleficence, justice, veracity, and
fidelity. The nurse must understand these principles in
order to analyze and respond to ethical dilemmas. Auton-
omy refers to the freedom to choose and self-determi-
nation in regard to making health care decisions. Gen-
erally, parents have the autonomy to make health care
decisions for their child. In certain situations, however,
older children have the autonomy to give assent to care
(see below), and in special situations, adolescents are
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