Nursing science - Second year ▪️NursingSubject: Child health nursing ▪️Chapter 1: Introduction

Nursing science - Second year Nursing

Subject: Child health nursing

Chapter 1: Introduction 

Contents:

a) Modern concept in child health care

b) Trends in pediatric nursing

c) Role of pediatric nurses in child care

d) Emerging challenges, nursing process related to pediatric nursing

e) Concept of preventive pediatric

f) Vital statistics related to pediatrics as per the NRHS and Gol

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Topic 1. Modern concept in child health care

1. INTRODUCTION TO PEDIATRICS

The health of children has historically been of vital importance to all societies because children are the basic resources of the future of mankind. In any country, mothers and children constitute approximately 60% of the population. In India, woman of child bearing age (15-44 years) constitute 19% of the population and children under 15 years of age constitute about 59% of the total population. By virtue of their large number as well as because of being vulnerable to diseases, mothers and children are the major consumers of health services.

2. DEFINITION AND CONCEPT OF PEDIATRICS

The word "pediatric" is derived from Greek word 'pedia' meaning child and 'iatri' means treatment and 'ics' meaning branch of science. Thus, pediatrics is defined as the branch of medical science that deals with child development and care and with the diseases of childhood and their treatment.

Pediatrics refers to the comprehensive and continued care of children. It serves both in wellness and illness.

Abraham Jacob (1830-1919) is known as the 'Father of pediatrics' because of his many contributions to this field.

3. HISTORICAL BACKGROUND OF CHILD HEALTH

The continuance of any society depends on the succeeding generations. Since primitive times, welfare of children has been a sensitive index of general welfare of people.

In India and abroad pediatric population includes children up to 12 years of age. However in developed countries pediatric care is extended up to adolescent age. Previously pediatrics was limited to curative care. Many citations of child care are found in records of ancient civilization.

The historical background of pediatrics is as follows:

• The first citation of qualities of breast milk and child hygiene was in 225 BC in Indian 'Susruta Sanhita'.

• Hippocrates, a Greek philosopher (370-460 BC), also known as 'Father of Modern Medicine' has made significant contributions on diseases found in children.

• The first Indian pediatricians were Kashyapa and Jeevaka (6th century). They worked on children diseases and child care.

• The first manuscript on management of children diseases was written by Kashyapa and Samhita. Thereafter, Susruta and Samhita wrote about Ayurvedic medicine that can be used for children. It was the first written record of pediatrics anywhere in the world. Susruta was known as 'Indian Hippocrates'. He wrote on child rearing practices, infant feeding and diseases of childhood.

• Charak, was the court physician of Peshawar. He wrote on 'care and management of newborn in his Sansthan and Ashtanga- hridaya.

• Arab physician Rhazes (850-923 AD) wrote the first book on the diseases of children.

• In 1472 AD, first book written on pediatrics named 'Bagallarder's' was printed in Italian. This book was related to diseases of children.

• In 1545 AD, Thomas Phare wrote the first book in English on children's diseases.

• In 1802 first pediatric hospital was opened in Paris. In USA Children's Hospital of Philadelphia was opened.

• Pediatrics as speciality came into being in 1860, when Dr Abraham Jacob established first child clinic in New York and started giving special lectures on diseases of children.

• In 1888 AD the first department of Pediatrics was established in Harvard Medical School. At this time, it was realized that diseases of children are different from diseases of adults.

• In the 19th century, antenatal care and pediatric care developed. Slowly people started realizing about children's needs. The Lady Chelmsford All India League for Maternal and Child welfare was established in 1920. Efforts were made by the league to create public awareness about health problems of children by putting exhibitions, publishing a journal and celebrating baby weeks.

• In 1923, the first creche was opened in India to provide day care to children.

4. MODERN PEDIATRICS

It is difficult to say, when Pediatrics became a separate specialty. It developed gradually as the knowledge of developmental needs of children increased in society. Pediatrics as a specialty developed with the establishment of Department of Pediatrics in various medical colleges, establishment of separate pediatric units for children in general hospitals and fondling homes. Today we no longer consider children as miniature adults. Childhood is considered a separate phase of life.

The present concept of health care of child focuses on prevention of illness and promotion of health rather than treatment of illnesses alone. Present focus of pediatrics is shifting from traditional to process oriented one that is based on sound scientific rationale.

5. PEDIATRIC NURSING

Pediatric nursing is the branch of nursing concerned with care of infants and children. It focuses on providing holistic care to infants, children and adolescents. The goal of pediatric nursing is to foster growth and development of the child and promote optimum state of physical, mental and social wellness.

6. CURRENT CONCEPT OF PEDIATRIC NURSING

A- Advocate for child and family

C-Communicate for the child

A- Activate the Child's activities

D- Disseminate information related to child health programs

E-Educate the public about child health

M-Motivate people to participate in child care

I-Investigate available resources

C-Collaborate care

7. PRINCIPLES OF PEDIATRIC NURSING

1. The nurse should begin to build a working relationship with the parents and their children from the time of first contact with them.

2. The nurse should be aware that all behaviors of child are meaningful.

3. The nurse should accept the parents and their children exactly as they are.

4. The nurse should have empathy for parents and children.

5. The nurse should let the parents and children know that their problems are important and the nurse is there to aid in solution of those problems.

6. The nurse must be willing to acknowledge the parent's right to decision concerning their children.

7. The nurse allows the parents and children to express their emotions and even negative emotions.

8. The nurse should ask questions limited to a single idea or reference so that it is easy for the parents and child to understand what is being asked.

9. The nurse should speak in language which the parents and child can understand.

10. The members of health team must make the parents feel that they are working in a collaborative manner for the treatment of their child.

8. TRENDS IN PEDIATRIC NURSING

The latest trends in pediatric nursing are

1. Flexible visiting hours

2. Rooming-in

3. Parents support group

4. School teachers involved in care of hospitalized child

5. Play in school and hospital

6. Care by Parents/Family centered care

7. Health and nursing team

8. Evidence based practice

9. Prevention of disease and promotion of health.

9. MODERN PEDIATRICS

The factors responsible for growth of modern pediatrics are:

1. Progress of medical science and recent advancements in the field of medicine like newer antibiotics..

2. Development in the field of basic science including physics, chemistry and biology.

3. Increasing interest in public health and public welfare.

4. Improved social laws.

5. Improved health facilities.

6. Emphasis on disease prevention and health promotion.

7. Separate pediatric hospitals, MCH clinics, under five clinics and family welfare centers.

8. Child welfare programs.

9. Health promotion and disease prevention programs.

10. Growing realization of special needs of infant and children.

11. Changing attitude of society towards younger members of society. 

MCQ questions:

1. What is the modern focus of pediatrics?

a) Treatment of childhood diseases only

b) Prevention of illness and promotion of health

c) Developmental needs of children

d) Providing care for infants and adolescents

2. Who is known as the "Father of pediatrics"?

a) Abraham Jacob

b) Hippocrates

c) Kashyapa

d) Rhazes

3. What is the goal of pediatric nursing?

a) Providing holistic care to children

b) Treatment of childhood diseases

c) Prevention of illness in children

d) Promotion of social wellness in children

4. What are the principles of pediatric nursing?

a) Prevention, treatment, and education

b) Building a working relationship with parents and children

c) Providing holistic care and empathy

d) Collaboration with healthcare teams and families

5. Which of the following is a trend in pediatric nursing?

a) Increased use of traditional treatment methods

b) Limited involvement of parents in child care

c) Focus on evidence-based practice

d) Neglecting disease prevention and health promotion

6. What factors have contributed to the growth of modern pediatrics?

a) Progress in medical science and recent advancements

b) Lack of interest in public health and welfare

c) Decreased emphasis on disease prevention

d) Inadequate health facilities

Answers:

b) Prevention of illness and promotion of health

a) Abraham Jacob

a) Providing holistic care to children

b) Building a working relationship with parents and children

c) Focus on evidence-based practice

a) Progress in medical science and recent advancements

Short questions 

1. What is the main focus of modern pediatrics?

2. Who is considered the "Father of pediatrics"?

3. What is the goal of pediatric nursing?

4. Name one principle of pediatric nursing.

5. What are some trends in pediatric nursing?

6. What factors have contributed to the growth of modern pediatrics?

Long type questions 

1. Discuss the shift in focus from traditional to modern pediatrics. What are the key elements of the modern concept of child health care?

2. Explore the historical background of child health and pediatrics. How has the understanding of children's needs and diseases evolved over time?

3. Explain the role of pediatric nursing in providing holistic care to infants, children, and adolescents. Discuss the goals and responsibilities of pediatric nurses in promoting the physical, mental, and social wellness of children.

4. Elaborate on the principles of pediatric nursing. How do these principles guide nurses in building relationships with parents and children, promoting empathy, and respecting the rights and decisions of parents in the care of their children?

5. Analyze the current trends in pediatric nursing. Discuss the significance of flexible visiting hours, rooming-in, parent support groups, involvement of school teachers in the care of hospitalized children, and the promotion of health and disease prevention.

6. Evaluate the factors responsible for the growth of modern pediatrics. Discuss the impact of advancements in medical science, developments in basic sciences, changes in social laws and attitudes, and the establishment of specialized pediatric hospitals and clinics in the field of pediatric care.

Please note that these questions are designed to encourage in-depth and comprehensive responses.

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2. TRENDS IN PEDIATRIC NURSING

▪️INTRODUCTION

Remarkable change has occurred in the field of pediatric nursing in recent years due to the changing needs of society medical and technological advancing political interest and changing trends within the nursing profession.

▪️HISTORICAL PERSPECTIVES

The modern concept care is part of a great historical pageantry that involved cultures of many people present day child health nurse should know something of the part to appreciate the present fully.

▪️EARLY MODERN WORLD

In the 16TH century two great medical books were published:

1. “THE BOOK OF CHILDREN” by Thomas phare .2. “THE CHILDRENS BOOK” by Felix wurtz in Germany.

They found a lot of hazardous practices in feeding clothing. Rarely infants were breast fed, instead infants received different types of soups and sugar solutions or water.

In 1748 William Cadogans easy on nursing called attention to unhealthy children practices and identified over dressing, over feeding and poor diet as contributing factors to childhood illness. This encouraged breast feeding and urged parents to dress infants in loose and lightweight garments.

Abraham Jacobi ( father of pediatrics ). He started several new York hospitals and was one of the founders of the American pediatric society in 1888.

During the 19TH century people recognized the effects of childhood labor and poverty.

▪️MODERN CONCEPT OF CHILD CARE

Child health nursing is undergoing tremendous advancement just like pediatric medicine and surgery. The current trends in the practice are based on research that have taken place in the field of pediatric nursing.

▪️TRENDS ARE FOLLOWING:

1. Family centered care 2. High technology care 3. Evidence based practice 4. A traumatic care 5. Cost containment 6. Prevention and health promotion

1. FAMILY CENTERED CARE

It is based on philosophy that the quality care can be provided in an environment that supports family integrity and promotes psychological health of the family. Parents know best about their child's need more aware of their child's behaviour and habits.

2. HIGH TECHNOLOGY CARE

Advancement in the medical field has created the care of children too technologically versatile .The nurse also needs to be technologically competent enough to meet the nursing care need of children.The advancement in diagnostic technology has made detection of many disorders even in the fetal period .

3. EVIDENCE BASED PRACTICE In evidence based practice nurses need to make decisions on the best available evidence . Nursing provides a systematic approach to enable nurses to effectively use. Clinical practice guidelines and patient centered care will help the nursing team move toward evidence based practice and improve the process of care.

4. ATRAUMATIC CARE

It is a provision of therapeutic care set by personnel and with interventions to minimize the physical and psychological distress experienced by children and their families in the health care system.

5. COST CONTAINMENT

It is a management technique utilized to reduce the cost of hospitalization.

6.PREVENTION AND HEALTH PROMOTION

The pediatric nurse applied health promotion and health maintenance in all settings in which children are served .The nurse provides a comprehensive background on all aspects of children and the understanding of child growth and development. The majority of children's health problems are preventable .

MCQ:

1. Family-centered care in pediatric nursing focuses on:a. Providing care only to the child, excluding the family.b. Promoting the psychological health of the child.c. Excluding parents from decision-making processes.d. Supporting family integrity and involving parents in care decisions.

2. High technology care in pediatric nursing refers to:a. The use of advanced medical equipment and procedures.b. Eliminating technology from the care of children.c. Limiting the use of technological advancements in pediatric nursing.d. Excluding parents from understanding medical technology.

3. Evidence-based practice in pediatric nursing involves:a. Making decisions based on personal opinions and experiences.b. Ignoring research findings and relying solely on clinical judgment.c. Using the best available evidence to guide nursing practice.d. Relying on intuition and gut feelings when providing care.

4. Atraumatic care in pediatric nursing aims to:a. Minimize physical and psychological distress for children and their families.b. Maximize the use of painful procedures to diagnose and treat children.c. Exclude children from participating in their own care decisions.d. Focus only on physical distress while neglecting psychological well-being.

5. Cost containment in pediatric nursing is a management technique used to:a. Increase the cost of hospitalization for children.b. Reduce the quality of care provided to children.c. Minimize the expenses associated with pediatric nursing.d. Maximize the financial burden on families of hospitalized children.

6. Prevention and health promotion in pediatric nursing involve:a. Ignoring preventive measures and focusing solely on treatment.b. Providing comprehensive care to children regardless of their health status.c. Neglecting the understanding of child growth and development.d. Emphasizing the importance of preventive measures to avoid health problems in children.

Answers:

d. Supporting family integrity and involving parents in care decisions.a. The use of advanced medical equipment and procedures.c. Using the best available evidence to guide nursing practice.a. Minimize physical and psychological distress for children and their families.c. Minimize the expenses associated with pediatric nursing.d. Emphasizing the importance of preventive measures to avoid health problems in children.

Short answer questions:

1. What is family-centered care in pediatric nursing?2. How does high technology care impact pediatric nursing?3. What is evidence-based practice in pediatric nursing?4. Define atraumatic care in the context of pediatric nursing.5. What is the goal of cost containment in pediatric nursing?6. How does pediatric nursing contribute to prevention and health promotion?

Long answer questions:

1. A. Discuss the importance of family-centered care in pediatric nursing.

B. Explain how family-centered care principles can be applied in various healthcare settings to enhance the overall well-being of children and their families.

2. A. Explain the concept of evidence-based practice in pediatric nursing.

B. Discuss the steps involved in implementing evidence-based practice and how it can improve the quality of care provided to children.

C. Provide examples of how evidence-based practice can be applied in pediatric nursing scenarios.

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Topic 3. ROLE OF PEDIATRIC NURSE IN CHILD CARE

The role of the pediatric nurse is constantly changing. These changes are as a result of expanding medical and nursing practice, emerging challenges in different aspects of child care, consumer demands & technological advancements.

The role of the pediatric nurse may vary from one institution to others, but basic responsibilities remain the same.

1. ROLES OF PEDIATRIC NURSE ARE:

1. Primary care giver

2. Coordinator and collaborator

3. Advocate

4. Health educator

5. Consultant

6. Counselor

7. Case Manager

8. Recreationist

9. Social worker and

10. Researcher

1. Primary care giver: Pediatric nurses should provide preventive, promotive, curative and rehabilitative care in all levels of health services. In hospital, care of sick children includes comfort, feeding, bathing, safety etc. At community set up, basic responsibilities include health assessment, immunization, primary health care & referral etc.

2. Coordinator & Collaborator: The nurse plays an extremely important role with the combination of health care team members. Nurse maintains good inter personal communication with the child, family and health team members. The nurse coordinates nursing care with other services for meeting the needs of child. For ex: physician, social worker, surgeon, physiotherapist, dietician etc.

3. Nurse Advocate: The pediatric nurse acts as an advocate to safeguard the child's rights, to assist & to provide best care from the health care team. The nurse acts as a representative for the child, family & other health care providers. Ex: it can range from the consulting dietary department for special foods to arrange team meetings to discuss plans of care with other health team members.

4. Health Health Educator: The nurse's goal of health teaching is to provide information to the child parents and significant other about prevention of illness, promotion or health maintenance.

The characteristics of the nurse teacher include 4 C's:

C-Confidence

C-Competence

C-Communication

C-Caring & empathy

5. Nurse Consultant: The pediatric nurse can act as consultant to guide parents for maintenance and promotion of health. For ex: Guiding parents about feeding practices, accident prevention

6. Nurse Counselor: Providing guidance to parents in health hazards of children and help them for own decision making in different situations.

7. Case Manager: The pediatric nurse should organize care, monitor and evaluate patient treatment for successful outcome. She/he acts as a manager of pediatric care units in hospital clinics and community.

8. Recreationist: The pediatric nurse plays supportive role for the child to provide play facilities for recreation and diversion. It helps to decrease crisis imposed by illness or hospitalization

9. Social Worker: Pediatric nurses can participate in social services or refer child & family to child welfare agencies for necessary support.

10.Nurse researcher: Research is an integral part of professional nursing. Pediatric nurse should participate or perform research activities. It helps to provide basis for changes in nursing practice, improvement in the child health care and evaluate the care.

2. ROLE OF PEDIATRIC NURSE

The pediatric nurse's role is unique because of developmental immaturity and vulnerability of children. 

The goals of nursing care of children, based on primary health care are:

1. Promote the healthy maturation as a physical, intellectual and emotional being within the context of his family and communities (primary level).

2. Provide health care for the child who requires treatment from disease(s) (secondary level). Dealing with the child's disabilities (tertiary level). Therefore, the role of the pediatric nurse includes:

I. In Primary Level: Through health education to the child and his parents and providing the child's basic needs and immunization, she can:

1. Maintain a child's health.

2. Help the child achieve his optimum growth and development.

3. Prevent diseases and their complications.

II. In Secondary Level:

The nurse has to provide care to sick children and their families by:

I. Assessing their needs.

2. Planning for care.

3. Implementing the plan.

4. Evaluating children's conditions.

5. Providing heath teaching to children and their parents

III. In Tertiary Level:

The nurse should assist children to return to their maximal level of functioning following illness and/or disabilities.'

3. AS A NURSE DEPENDS ON:

1. Education

2. Experience

3. Job structure

4. Professional demand

5. Preventive care

6. Promotive care

7. Curative care

8. Health education

9. Restoration health

10. Co-ordination

4. NURSING TASK AND SKILL:

General nursing care:

1. Monitoring of vital signs

2. Administration of fluid and electrolytes and drugs 

3. Diagnostic and therapeutic procedures.

4. Nursing procedures

5. Resuscitation skills

6. Specialized nursing and monitoring skills

7. Vaccination

8. Prevention of nasocomial infection

9. Universal precaution

Through the international activities of WHO (world health organization). IMCI-(Integrated Management of Childhood Illness), UNICEF (United Nations International Children and Emergency Fund) and other health agencies are providing to develop the level of child; health care throughout the world. 

5. NOW DAYS THE CHILD CARE IS VERY MUCH IMPROVED IT INCLUDES: 

1. Hospital environment for a sick child

2. Advanced changes in medical and nursing care 

3. Expansion in independent role of the paediatric nurse

4. Paediatric nurse practitioner.

5. Paediatric clinic nurse specialists.

6. Paediatric nurse master clinicians.

6. OLD CONCEPTS AND NEW CONCEPTS

OLD CONCEPTS:

1. Disease (centered care)

2. Discourage the families on neglect of the female child

3. Care of the women after becoming pregnant

4. Special care during the last trimester and the postnatal period to the child born with congenital anomalies and hereditary disorders.

5. Caring of children after the birth only

6. Care of the sick children in the hospital

7. Care the physical condition of the child in hospital only

8. Not allowed the parent to be with the child in the hospital and reduce the visiting hours ward.

9. One of illness oriented

10. Only cleanliness and treatment oriented

11. Curative and rehabilitative care to the children in hospital only.

12. Adopt the indifferent attitude to child neglect & abuse by family and society.

NEW CONCEPTS

1. Child centered care

2. Take care of female children with Immunization of tetanus

3. Health education on planned parenthoods and doing the maternal health

4. Early identification & family counseling based on bio chemical screening & chromosomal studies it helps to prevent congenital anomalies and hereditary disorders in children.

5. Caring the health of the child from the day of conception.

6. Participate in the prevention of illness and health promotion activities.

7. Comprehensive cares of children in his home community health centers.

8. Ensuring that the children must stay with them and participate in the care, flexible visiting hours in paediatric

9. One of health oriented.

10. Warmth and love oriented.

11. Health promotion activities by ensuring environmental stimulation and intelligent manipulation of the environment, adequate play activities service related to the fertility, sex, education & counseling

12. Safe guarding and protecting the children rights by health providing. cultural practice & laws encouraging.

MCQ:

1. What is one of the primary responsibilities of a pediatric nurse?

a) Providing guidance to parents in health hazards of children

b) Coordinating and collaborating with healthcare team members

c) Administering vaccinations to children

d) Conducting research activities related to pediatric care

2. Which characteristic is essential for a pediatric nurse as a health educator?

a) Competence

b) Case management skills

c) Recreational abilities

d) Counseling expertise

3. What is the goal of nursing care in the primary level for children?

a) Prevention of diseases and their complications

b) Assisting children with disabilities

c) Providing care to sick children and their families

d) Monitoring vital signs and administering medications

4. In the tertiary level of nursing care, the pediatric nurse aims to:

a) Promote a child's healthy maturation

b) Prevent diseases and their complications

c) Help children achieve optimum growth and development

d) Assist children in returning to their maximal level of functioning after illness or disabilities

5. Which is a characteristic of the new concept of child-centered care?

a) Focus on disease-centered care

b) Neglect of the female child

c) Care of sick children only in the hospital

d) Ensuring children stay with their parents and participate in care

Answers:

b) Coordinating and collaborating with healthcare team members

a) Competence

a) Prevention of diseases and their complications

d) Assist children in returning to their maximal level of functioning after illness or disabilities

d) Ensuring children stay with their parents and participate in care

SHORT QUESTIONS 

1. What are some of the basic responsibilities of a pediatric nurse in providing care for sick children in a hospital setting?

2. Explain the role of a pediatric nurse as an advocate for children and their families.

3. What are the characteristics of a nurse teacher when it comes to health education for children and their parents?

4. Describe the role of a pediatric nurse as a case manager in organizing care for patients.

5. How can pediatric nurses contribute to research activities in the field of child health care?

Answers:

1. Some basic responsibilities of a pediatric nurse in providing care for sick children in a hospital setting include comfort, feeding, bathing, safety, and monitoring vital signs.

2. The role of a pediatric nurse as an advocate involves safeguarding the child's rights, assisting and providing the best care from the healthcare team, and representing the child, family, and other healthcare providers.

3. The characteristics of a nurse teacher in health education include confidence, competence, effective communication, and caring and empathy.

4. As a case manager, a pediatric nurse organizes care, monitors and evaluates patient treatment, and acts as a manager of pediatric care units in hospitals, clinics, and the community.

5. Pediatric nurses can contribute to research activities by participating in or performing research, which helps provide a basis for changes in nursing practice, improvements in child healthcare, and the evaluation of care.

ESSAY TYPE QUESTIONS:

1. Discuss the evolving role of pediatric nurses in child care, highlighting the factors contributing to these changes and their impact on healthcare delivery. Provide examples to support your answer.

2. Explain the various responsibilities and roles of a pediatric nurse in promoting the health and well-being of children. Discuss how these responsibilities differ in a hospital setting versus a community setting. Provide specific examples to illustrate your points.

3. Reflecting on the shift from old concepts to new concepts in child care, analyze the key differences and advancements in the approach to pediatric nursing. Discuss the implications of these changes for children's health outcomes and the overall quality of care provided by pediatric nurses.

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Topic 4. Emerging challenges, nursing process related to pediatric nursing

Emerging challenges, nursing process related to pediatric nursing

Emerging Challenges in Pediatric Nursing

Pediatric nursing faces various emerging challenges in the rapidly evolving healthcare landscape. 

Some of these challenges include:

1. Increasing prevalence of chronic conditions:

There has been a significant increase in the prevalence of chronic conditions in children, such as asthma, diabetes, obesity, and mental health disorders. Pediatric nurses must develop specialized knowledge and skills to effectively manage and provide care for children with these conditions.

2. Technological advancements: 

Advances in technology have transformed the field of pediatric nursing. Nurses need to stay updated with the latest medical devices, electronic health records, telehealth, and other technological tools to deliver high-quality care to children and their families.

3. Ethical dilemmas:

Pediatric nurses often encounter ethical dilemmas, such as decision-making for critically ill children, end-of-life care, and consent for treatment. These challenges require nurses to have a strong understanding of ethical principles and effective communication skills to support families and collaborate with healthcare teams.

4. Cultural diversity and health disparities: 

Providing culturally competent care to children from diverse backgrounds is crucial. Pediatric nurses must be knowledgeable about different cultural practices, beliefs, and healthcare systems to ensure equitable and inclusive care for all children. Addressing health disparities and advocating for vulnerable populations are additional challenges in pediatric nursing.

5. The Nursing Process in Pediatric Nursing

The nursing process is a systematic framework that guides the delivery of patient-centered care. It consists of five key steps: assessment, diagnosis, planning, implementation, and evaluation. 

In pediatric nursing, the nursing process is tailored to meet the unique needs of children and their families. 

Here's how each step applies in the context of pediatric nursing:

▪️Assessment: Pediatric nurses gather comprehensive data about a child's physical, developmental, psychosocial, and cultural aspects. They assess the child's growth and development milestones, nutritional status, family dynamics, and any specific healthcare needs.▪️Diagnosis: Based on the assessment data, pediatric nurses identify actual or potential health problems and formulate nursing diagnoses. These diagnoses are specific to the child's age, developmental stage, and healthcare goals.▪️Planning: Pediatric nurses collaborate with the child, family, and healthcare team to develop a holistic care plan. The plan includes specific goals, interventions, and expected outcomes. It takes into account the child's individual needs, preferences, and cultural considerations.▪️Implementation: Pediatric nurses execute the care plan and deliver evidence-based interventions to promote the child's health and well-being. This may involve administering medications, providing education to the child and family, coordinating referrals to specialists, and coordinating interdisciplinary care.▪️Evaluation: Pediatric nurses assess the outcomes of the care provided and determine if the desired goals have been achieved. They evaluate the child's response to interventions, reassess the care plan if needed, and collaborate with the child, family, and healthcare team to ensure ongoing quality care.

The nursing process is a dynamic and iterative framework that supports pediatric nurses in delivering safe, effective, and family-centered care. It facilitates individualized care planning, continuity of care, and promotes positive health outcomes for children.

6. Complex healthcare needs: 

Children with complex medical conditions, multiple comorbidities, or special healthcare needs require specialized care and management. Pediatric nurses must possess advanced knowledge, skills, and expertise to effectively address these complex healthcare needs.Trauma and injury management: Pediatric nurses often encounter cases involving trauma, injuries, and emergencies. Providing immediate and appropriate care for critically ill or injured children requires quick assessment, critical thinking, and effective teamwork.

7. Medication safety: 

Administering medications to children requires precise calculations, dosage adjustments based on weight and age, and vigilant monitoring for potential adverse reactions. Pediatric nurses must stay updated on safe medication practices, including accurate dosing and proper administration techniques.

8. Emotional and psychological support:

 Children and their families experience emotional and psychological challenges during hospitalization, diagnosis, and treatment. Pediatric nurses play a crucial role in providing emotional support, helping children cope with anxiety and fear, and facilitating effective communication between the child, family, and healthcare team.

9. End-of-life and palliative care: 

Pediatric nurses may encounter situations where children have life-limiting conditions or require end-of-life care. Providing compassionate and family-centered palliative care requires specialized knowledge, sensitivity, and effective communication to support the child and family during this difficult time.

10. Healthcare system limitations: 

Limited resources, staffing challenges, and constraints within the healthcare system can pose significant challenges for pediatric nurses. They must navigate these limitations while advocating for optimal care and ensuring the best outcomes for children.

11. Health promotion and disease prevention:

Pediatric nurses have a vital role in promoting health and preventing illness in children. This includes educating families about healthy lifestyles, immunizations, safety practices, and early identification of developmental delays or health concerns.

12. Keeping up with advancements: 

The field of pediatric nursing is constantly evolving with new research, technologies, and evidence-based practices. Pediatric nurses need to engage in lifelong learning, stay updated with the latest advancements, and continuously enhance their knowledge and skills to provide the best care for children.Addressing these challenges requires ongoing professional development, collaboration with interdisciplinary teams, advocacy for children's rights and healthcare needs, and a patient-centered approach to care. Pediatric nurses play a crucial role in meeting these challenges and ensuring the well-being and optimal health outcomes for children.

13. Family-centered care: 

Pediatric nurses strive to provide family-centered care, which involves actively involving and collaborating with the child's family in decision-making and care planning. However, challenges may arise when there are conflicting opinions or challenges in communication and understanding between healthcare providers and families.

14. Communication with children: 

Communicating effectively with children of different ages and developmental stages can be challenging. Pediatric nurses need to employ age-appropriate communication techniques, such as play therapy, distraction, and therapeutic communication, to establish trust and effectively convey information to children.

15. Cultural competence: 

Pediatric nurses encounter children and families from diverse cultural backgrounds, each with their own beliefs, practices, and values regarding healthcare. Providing culturally competent care requires an understanding of cultural nuances, effective cross-cultural communication, and sensitivity to cultural differences in healthcare decision-making and treatment preferences.16. Emergency and disaster response: 

Pediatric nurses may be involved in emergency response situations or disaster scenarios, where immediate and specialized care is required for children. These situations can be highly stressful and challenging, requiring rapid assessment, triage, and coordination of care amidst chaotic circumstances.

17. Advocacy for child rights: 

.Pediatric nurses play a crucial role in advocating for the rights and well-being of children. This includes safeguarding their rights to healthcare, education, safety, and protection from abuse or neglect. Advocacy efforts may involve collaborating with child protective services, legal authorities, and community organizations.

18. Transition to adulthood: 

Pediatric nurses are often involved in the transition of adolescents with chronic conditions from pediatric to adult healthcare settings. This transition can be challenging, as it requires addressing the unique needs of transitioning adolescents, ensuring continuity of care, and empowering them to take responsibility for their own health.

19. Burnout and self-care:

Pediatric nursing can be emotionally demanding and physically exhausting. Nurses may face burnout due to high workloads, emotional intensity, and exposure to traumatic situations. It is essential for pediatric nurses to prioritize self-care, seek support, and engage in strategies to prevent burnout and maintain their own well-being.

Addressing these challenges requires ongoing education and training, collaboration with interdisciplinary teams, cultural sensitivity, effective communication skills, and self-care practices. Pediatric nurses play a crucial role in overcoming these challenges to provide high-quality, compassionate care to children and their families.

▪️MCQ

1. The role of a pediatric nurse includes: a) Primary care giver b) Advocate c) Health educator d) All of the above e) None of the above

2. Which of the following is not a characteristic of a nurse teacher in pediatric nursing? a) Confidence b) Competence c) Communication d) Compassion and empathy

3.The nursing process consists of the following steps, except: a) Assessment b) Diagnosis c) Treatment d) Planning e) Evaluation

4. Which of the following is an emerging challenge in pediatric nursing? a) Increasing prevalence of chronic conditions b) Technological advancements c) Ethical dilemmas d) All of the above e) None of the above

5. Cultural competence in pediatric nursing involves: a) Providing care based on individual needs and preferences b) Understanding cultural practices and beliefs c) Promoting equity and inclusivity in care d) All of the above e) None of the above

6.  The primary goal of nursing care in primary level pediatric nursing is to: a) Maintain a child's health b) Help the child achieve optimum growth and development c) Prevent diseases and their complications d) All of the above e) None of the above

7. Which of the following is a challenge in pediatric nursing related to medication safety? a) Accurate dosing based on weight and age b) Administration techniques c) Monitoring for adverse reactions d) All of the above e) None of the above

8. The concept of family-centered care in pediatric nursing emphasizes: a) Involving and collaborating with the child's family in care planning b) Addressing the unique needs of the family as a whole c) Supporting effective communication between healthcare providers and families d) All of the above e) None of the above

Answers:

d) All of the above c) Communication c) Treatment d) All of the above d) All of the above d) All of the above d) All of the above d) All of the above

▪️Short questions

1. What are some of the roles of a pediatric nurse?2. How does a pediatric nurse act as an advocate for children?3. What are the characteristics of a nurse teacher in pediatric nursing?4. What steps are involved in the nursing process?5. What are some emerging challenges in pediatric nursing?6. How does cultural competence play a role in pediatric nursing?7. What are the goals of nursing care in primary level pediatric nursing?8. What are some challenges related to medication safety in pediatric nursing?9. What is family-centered care in pediatric nursing?10. How can pediatric nurses support the transition of adolescents to adult healthcare settings?

▪️Essay type questions

1. Discuss the evolving role of pediatric nurses in providing comprehensive care to children. Highlight the various responsibilities and functions they perform in different healthcare settings.

2. Explain the importance of family-centered care in pediatric nursing. Discuss how pediatric nurses can effectively collaborate with families to promote the health and well-being of children.

3. Discuss the challenges and ethical considerations involved in providing culturally competent care to pediatric patients from diverse backgrounds. How can pediatric nurses promote cultural sensitivity and ensure equitable healthcare outcomes?

4. Explore the impact of technological advancements on pediatric nursing practice. Discuss specific examples of technological innovations that have improved pediatric care and their implications for nursing practice.

5. Identify and discuss the emerging healthcare challenges faced by pediatric nurses. How can nurses adapt and respond to these challenges to provide high-quality care to children and their families?

6. Discuss the role of pediatric nurses in promoting health education and preventive care for children. Explain how nurses can effectively educate parents and caregivers about disease prevention, health promotion, and maintaining the overall well-being of children.

7. Explore the role of pediatric nurses in supporting the transition of adolescents with chronic conditions from pediatric to adult healthcare settings. Discuss the unique challenges faced by transitioning adolescents and the strategies nurses can employ to facilitate a smooth transition and continuity of care.

8. Reflect on the importance of self-care for pediatric nurses. Discuss the potential sources of stress and burnout in pediatric nursing and explore strategies that nurses can implement to prioritize their well-being and maintain professional resilience.

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5. PREVENTIVE PAEDIATRICS

CHILD HEALTH DEPENDS UPON PREVENTIVE CARE.

Majority of the child health problems are preventable.

▪️Preventive pediatrics is a specialized area of child health comprises efforts to avert rather than cure disease and disabilities.

▪️ Preventive pediatrics is defined as the prevention of disease and promotion of physical, mental and social wellbeing of children with the aim of attaining a positive health.

▪️Pediatrics is largely preventive in its objectives.

▪️It has been broadly divided into:

1. Antenatal preventive pediatrics2. Postnatal preventive pediatrics3. Social pediatrics

1. Antenatal preventive pediatrics:It includes care of antenatal mothers with• Adequate nutrition• Prevention of communicable diseases• Preparation for delivery and breast feeding• Mother craft training

2. Postnatal preventive pediatrics:• Promotion of breast feeding• Introduction of complementary• Feeding in appropriate age• Immunization• Prevention of accidents• Growth monitoring• Periodic health check up

3. Social pediatrics:It is defined as the application of principles of social medicine to pediatrics to obtain a more complete understanding of the problems of children in order to prevent and treat disease and promote adequate growth & development, through an organized health structure.

▪️Family Health MCH RCH BFHI ICDS National Health Mission:

• It means the overall health of the individual family members.

• It is influenced by the inter-relationship and interdependence of the physical and mental health status of the individual members of the family.• It is determined by the effective functioning of the family as biological and cultural unit.

▪️Aims of Family Health Services:

• Reduction of maternal, infant & child mortality and morbidity rates• Improve family planning practices• Nutritional status improvement• Increasing health awareness through health education in all aspects of health care

➖It refers to the health of mothers, infants, children, and adolescents.

➖It also refers to a profession within public health committed to promoting the health status and future challenges of this vulnerable population.

➖Reduction in the maternal, perinatal, infant and child mortality and morbidity

▪️PROMOTION OF REPRODUCTIVE HEALTH

Promotion of physical and psychological development of child and adolescents within the family

➖The Reproductive and Child Health (RCH) Programme was launched in October 1997 by government of India as per the recommendations of International conference on population development at Cairo in 1994.

➖The main aim of the programme is to reduce infant, child and maternal mortality rates.RCH Phase II began from 1 April 2005.

➖The components are:– Essential obstetrical care– Emergency obstetrical care– Strengthening referral system-- Strengthening project management– Strengthening infrastructure– Capacity building– Improving referral system– Strengthening MIS– Innovative schemes

▪️INTEGRATED CHILD DEVELOPMENT SERVICES:

Integrated Child Development Services (ICDS) is a government programme in India (Ministry of Social & Women’s Welfare) which provides food, preschool education, primary healthcare, immunization, health check-up and referral services to children under 6 years of age and their mothers.

The scheme was launched in 1975, discontinued in 1978 by the government of Morarji Desai, and then relaunched by the Tenth Five Year Plan.

The beneficiaries under the Scheme are children in the age group of 0-6 years, pregnant women and lactating mothers.

➖Objectives of the Scheme are:• to improve the nutritional and health status of children in the age-group 0-6 years;• to lay the foundation for proper psychological, physical and social development of the child;• to reduce the incidence of mortality, morbidity, malnutrition and school dropout;• to achieve effective co-ordination of policy and implementation amongst the various departments to promote child development;• to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

➖Services under ICDS - The ICDS Scheme offers a package of six services, viz• Supplementary Nutrition• Pre-school non-formal education• Nutrition & health education• Immunization• Health check-up and• Referral services

▪️THE NATIONAL HEALTH MISSION:

The National Health Mission (NHM) was launched by the government of India in 2013 subsuming the National Rural Health Mission and National Urban Health Mission. It was further extended in March 2018, to continue until March 2020. The National Health Mission (NHM) envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people's needs.

The main programmatic components include:• Health System Strengthening in rural and urban areas• Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A)• Communicable and Non-Communicable Diseases.

▪️CONCEPT OF UNDER FIVE'S CLINIC

The concept of under-five’s clinic is derived from the Well Baby clinic of the West, for comprehensive health care of children below five years of age.

This clinic provides preventive services along with health supervision, treatment, nutritional surveillance and health education.

▪️Care In Illness/Immunization/ Adequate Nutrition/ Family Planning:

Service provided in India: 70%-80% of illnesses can be treated with trained nurses.

They care:

a. Diagnosis and treatment of acute illness, chronic illnesses and disorders of growth and development.b. X ray and laboratory servicesc. Referral services

The health worker should ensure an adequate breastfeeding, weaning and balanced diet of the under-five.

a. Growth monitoring & plotting on ‘Road to Health Card’ for early detection of growth failure.b. Health checkups done every 3 to 6 months by physical examination & appropriate lab test.c. Maintain ‘child health card’ to identify ’at risk’ child.d. Food supplementation through ICDS Projects.

Immunization to prevent six killer diseases as per national immunization schedule is recommended. The health worker should motivate & promote the immunization acceptance to prevent morbidity, mortality and disability hazards by six killer diseases.

The mother attending this clinic receives counseling with different aspects of family planning practices, which is a significant concern for the health and well-being of the child.

It is an essential and compulsory activity of this clinic. The mother should receive the information regarding preventive measures against malnutrition, ARI, diarrhea, TB, worm infestations etc.

▪️THE SCHOOL HEALTH PROGRAM 

n 1960 the Ministry of Health, Government of India, set up a School Health Committee under the chairmanship of Smt. Renuka Ray, the then member of parliament to assess the standard of Health and Nutrition of school children and also to suggest ways and means of improving these. As per the recommendation of the committee, the School health program was initiated in 1962.

OBJECTIVES:

1. The promotion of positive health.2. The prevention of diseases.3. Early diagnosis, treatment and follow up of defects.4. Awakening health consciousness in children. 5. The provision of healthful environment

▪️Aspects of school health service:

1. Health appraisal of school children and school personnel2. Remedial measures & follow-up3. Prevention of communicable diseases4. Healthful school environment5. Nutritional services6. First aid & Emergency care7. Mental Health8. Dental Health9. Eye Health10. Health Education11. Education of Handicapped Children12. School Health Records

▪️WHO and UNICEF

WHO & UNICEF have developed a new strategy for management of common childhood illnesses, in an integrated manner, which are responsible for main causes of morbidity and mortality among children.

The overall objective is to reduce under-five mortality and morbidity in the developing countries by improving performances of health workers.

The remarkable components of this strategy are:1. Improvement of case management skills of health care providers2. Provision of essential drugs supplies3. Optimization of family & community practices in relation to child health, mainly care- seeking behaviour - refers to the exploitation of children through any form of work that deprives children of their childhood, interferes with their ability to attend regular school, and is mentally, physically, socially or morally harmful.

▪️CHILD LABOUR 

The term 'child labour', suggests ILO, is best defined as work that deprives children of their childhood, their potential and their dignity, and that is harmful to physical and mental development.

As per the Child Labour (Prohibition and Regulation) Act, 1986, amended in 2016 ("CLPR Act"), a "Child" is defined as any person below the age of 15, and the CLPR Act prohibits employment of a Child in any employment including as a domestic help. It is a cognizable criminal offence to employ a Child for any work.

UNICEF defines a street child as, "any girl or boy for whom the street (in the widest sense of the word, including unoccupied dwellings, wasteland, etc.) has become his or her habitual abode and/or source of livelihood; and who is inadequately protected, supervised, or directed by responsible adults".

The contributing factors responsible for this social problem are poverty, rapid urbanization, rural to urban or cross country mobility, broken family, loss of parents, natural or manmade disasters, accidents, child abuse and neglect & population explosion.

These children need support from NGOs to overcome their problems & to grow as a healthy individuthe governmental.

Free educational facilities, provision of health & welfare services, housing facilities, job opportunities, promotion of adoption, and rehabilitation services will be useful to reduce the problem to some extent. They need guidance & counseling facilities towards self support & problem solving. Or discrimination against females is more prominent in India and in developing countries.

For the promotion of status of girl child, UNICEF mentioned and emphasized on the long-lasting effects of the unfolding of potentialities of female children and empowerment of women. Govt. of India and various NGOs also planned several programs towards disappearance of gender bias and promotion of health of female children with equal opportunities as male children.

Female feticide is a challenging social problem related to gender bias especially in India. As per Census 2011, India has 48.53% female population compared to 51.47% male population. In rural areas, there are 949 females to 1000 men, while in urban areas there are 929 females to 1000 males. Ultimately this problem may disturb the total social structure and cultural harmony.

There is a legal ban on sex determination through Prenatal diagnostic technique Act 1994 came into force from January 1996. But still public awareness and prevention of female feticide are the most significant approaches to reduce this evil practice from society.

These important public health problems include all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (such as clergy, a coach, a teacher) that results in harm, potential for harm, or threat of harm to a child.

There are four common types of abuse and neglect:

• Physical abuse (75%) is the intentional use of physical force that can result in physical injury Examples include hitting, kicking, shaking, burning, or other shows of force against a child.

• Sexual abuse (20%) involves pressuring or forcing a child to engage in sexual acts. It includes behaviours such as fondling, penetration, and exposing a child to other sexual acts.

• Emotional abuse refers to behaviours that harm a child’s self-worth or emotional well- being. Examples include name calling, shaming, rejection, withholding love.

 • Neglect is the failure to meet a child’s basic physical and emotional needs. These needs include housing, food, clothing, education, and access to medical care, love & affection.

A combination of individual, relational, community, and societal factors contribute to the risk of child abuse and neglect.

RISK FACTORS FOR VICTIMIZATION

Individual Risk Factors:• Children younger than 4 years of age• Special needs that may increase caregiver burden (e.g., disabilities, mental health issues, and chronic physical illnesses)

RISK FACTORS FOR PERPETRATION

1. Individual Risk Factors:• Parents’ lack of understanding of children’s needs, child development and parenting skills• Parental history of child abuse and or neglect• Substance abuse and/or mental health issues including depression in the family• Parental characteristics such as young age, low education, single parenthood, large number of dependent children, and low income• Non-biological, transient caregivers in the home (e.g., mother’s male partner)• Parental thoughts and emotions that tend to support or justify maltreatment behaviours

2. Family Risk Factors:• Social isolation• Family disorganization, dissolution, and violence, including intimate partner violence• Parenting stress, poor parent-child relationships, and negative interactions

3. Community Risk Factors:• Community violence• Concentrated neighbourhood disadvantage (e.g., high poverty and residential instability, high unemployment rates, and high density of alcohol outlets), and poor social connections.

▪️COMMUNICABLE DISEASES

– National AIDS control programme– National Leprosy Eradication Programme– Revised National Tuberculosis Control Programme– National Vector Borne Disease Control Programme

▪️INTELLECTUAL DISABILITY RELATED SCHEMES–Sarva Shiksha Abhiyan–Disability Equity Training Programme etc.

▪️JANANI SURAKSHA YOJANA – Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NHM). It is being implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery among pregnant women.

▪️JANANI SHISHU SURAKSHA KARYAKARAM – Government of India has launched the Janani Shishu Suraksha Karyakaram (JSSK) on 1st June, 2011. The scheme is to benefit pregnant women who access Government health facilities for their delivery.

▪️MISSION INDHRADHANUSH - The mission Indradhanush which aims to cover all those children by 2020 who are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases.

▪️PROGRAMMES FOR NON COMMUNICABLE DISEASES– National Cancer Control Programme– National Mental Health Programme– National programme for Control of Blindness – National Programme for Prevention and Control of Deafness etc..

▪️NATIONAL NUTRITIONAL PROGRAMS– Integrated Child Development Services Scheme– Midday Meal Programme– Special Nutrition Programme (SNP)– National Nutritional Anaemia Prophylaxis Programme– National Iodine Deficiency Disorders Control Programme

▪️PROGRAMS RELATED TO SYSTEM STRENGTHENING / WELFARE– National Rural Health Mission– Reproductive and Child Health Programme– National Water supply & Sanitation Programme– 20 Points Programme

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PREVENTIVE PAEDIATRICS

Short Summary:

Preventive pediatrics aims at the prevention of disease in children rather than focusing on cure of disease

By preventing disease, the child can attain it’s genetic potential

There are 2 aspects of preventive pediatrics

1. antenatal

2. postnatal

Prevention of disease can be best achieved through primary healthcare activities such as:

1. growth monitoring

2. promotion of breast feeding

3. oral rehydration

4. community feeding

5. immunisation

6. nutritional surveillance

7. regular health checkups

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Topic 6: VITAL STATISTICS RELATED TO PEDIATRICS AS PER THE NRHS AND GOL

▪️Definition:- Vital statistics are conventionally numerical records of marriage births, sickness, and death by which the health and growth of community may be studied.

Or It is a branch of biometry that deals with data and law of human mortality, morbidity,& demography.

▪️Purpose:-

1) Community Health: To describe the level of community health, to diagnose community illness & to discover solutions to health problems.2) Administrative purpose: It provides clues for administrative action to create administrative standards of health activities.3) Health programmed organization: To determine success or failure of specific health programmed or undertake overall evaluation of public health work.4) Legislation purpose: To promote health legislation at local, state,& national level.5) Government Purpose: To develope, policies, procedure at state and central level.

▪️Uses:

1. To evaluate the impact of various National Health Programmes.2. To plan for better future measures of disease control.3. To explain the hereditary nature of the disease.4. To plan and evaluate economic and social development.5. It is a primary tool in research activities.6. To determine the health status of an individual.7. To compare the health status of an individual in one nation with others.

▪️Sources of Vital Statistics:

1. Civil Registration System: It is defined as the continous permanent and compulsory recording of the occurrence of vital events like live births, deaths, fetal deaths, marriages, divorces, as well as annulments, judicial separation, adoption. Civil registration is performed under a law and regulation so as to provide legal basis to the records and certificate made from system.

2. National Sample Survey: The data collected from the census are not very reliable and available only once in 10 years. In absence of reliable data from the civil registration system(SRS), the need for reliable statistics at national and state levels is being met through sample surveys launched from time to time.

3. Sample Registration System: In this system, there is continous enumeration of births and deaths in a sample of villages/urban blocks by a resident parttime enumerator and then an independent six monthly retrospective survey by a full time supervisor.

4. Health Surveys: A few important sources for demographic data have emerged. These are National Family Health Surveys(NFHS) and the District Levels Household Surveys(DLHS) conducted for evaluation of reproductive and child health programmes.

NFHS provide estimates of fertility, child mortality and a no. of fertility, child mortality and a no. of health parameters relating to infants and children at state level. The DLHS provide information at the district level on a no. of indicators relating to child health, reproductive health problems and quality of services availability to them.

▪️Important Vital Statistics

1. Crude Death Rate (CDR) = Total death in a given year X 1000 Average or mid year pop. of a year

2. Age-specific Death rate (ASDR):Nos. of death at age ’a’ X 1000 Mid-yrs pop. of a given year at age ’a’Crude rate is based on total population while a specific rate is based on the basis of age, sex, cause etc 10

3. Infant Mortality rate (IMR):Nos. of infant death in a year X1000 Nos. of live birth in the year

4. Neonatal Mortality Rate:Death under one months X 1000 Nos. of live birth

5. Post-neonates Mortality Rate:Death between 1st and 11 complete months x 1000 Nos. of live birth

6. Maternal Mortality Rate (MMR):Nos. of death of mother due to the cause related to maternity X 1000 Total nos. of live birth