Pediatric Nursing: Treating the Family

Pediatric Nursing: Treating the Family

When nurses think of going into pediatric nursing, they often think of working with a specific age in the wide range of newborn baby to 18-year-old young adult. But what many might not realize is how working with a child also includes working closely with a family as well. In fact, when pediatric nurses think of caring for a patient, they consider the care of the family as part of the whole child, says Shirley Wiggins, PhD, RN, president of the Society of Pediatric Nurses.

As families have evolved to range from the traditional family of a mom and dad with kids, today’s family structure takes on a whole new shape. It can include same gender parents, grandparents as primary caregivers, parents living together or apart, foster parents, aunts, uncles, cousins, and even close friends who comprise the family unit.

So while pediatric nurses tend to the needs of the child, they also remain mindful of the emotions and experiences of the child’s family. “Education is a critical point with families, and it’s what they need,” says Wiggins. But not all families are ready for specific information at the same time. A pediatric nurse’s job includes being able to read a family’s readiness. “What is the capacity of that child and that family both developmentally and at that time,” says Wiggins.

When families have information, they can help support the child even more, and pediatric nurses are there to help them through that process. “You see how powerful the family is in our society,” says Wiggins. “In difficult times, you see how amazing they are. They dig deep.”

Although Wiggins says many pediatric nurses come right from nursing school, there are many who choose the field during a mid-career change. Wiggins says it’s often the call of working with children and in partnership with families that draw nurses in. “Sometimes what drives it is they encounter a family and a child speaks to them,” she says.

Wiggins says no matter where you are coming from in your career, it helps to have an open mind when you think about how you would fit into a pediatric nursing position. “Be open to the that fact that each family is unique,” she says. “Be flexible to just listen.” Families and children often come as one unit, so pediatric nurses see the whole picture.

Pediatric Nursing: Treating the Child

Pediatric Nursing: Treating the Child

Of all things pediatric nurses might have in common – the education, experience, and common patient group – what really knits this group together is one thing, says Shirley Wiggins, PhD, RN, president of the Society of Pediatric Nurses.

I have to say we look at this as our passion where others might see it as a challenge,” she says. “Integrating the care of the child and family is our passion.”

In fact, at a recent meeting Wiggins asked what brought the nurses in attendance to the pediatric nursing field, and many nurses reported that they decided on pediatric nursing fairly early on.

What does it mean to be a pediatric nurse? “The whole emphasis on the Institute of Medicine’s patient centeredness is what pediatric nursing is,” says Wiggins. “It’s what we love to do, and it’s what keeps us there.”

Pediatric nursing works with an age range of patients that encompasses newborn babies all the way to the young adults of 18 years of age, so centering care on the patient means taking in a broad cognitive and physical spectrum. “The approach is developmental and we focus on that child and where they are,” says Wiggins. With all work done within the network of the family, pediatric nurses recognize that patient support comes in all manner of people – from the parents of an infant to the close friends of a teenager.

There are currently more than 180,000 professional registered pediatric nurses providing care, in various settings including home care, ambulatory clinics, schools, public health, colleges of nursing, hospice and palliative care, says Wiggins.

And Wiggins says pediatric nurses, who are often seen as working with the more vulnerable age groups, are amazed at the resilience of children. “There is great strength in children,” she says. Pairing that show of strength with a love of fun and goofiness lends to a very unique workday for most pediatric nurses.

We all laugh because there are aspects of pediatric nursing that are really fun,” says Wiggins. In the seriousness of the work they are doing, they can’t forget to add the whimsy that kids often love – whether that’s cat’s ears at Halloween or singing familiar songs with the kids.

And a team approach to nursing children is essential, says Wiggins. Teams of medical personnel and child life specialists offer the support the child and the child’s family need. Wiggins says a good pediatric nurse has the same qualities that make any nurse exceptional. “Be the one that asks questions and sees issues and wants to make it better,” she says. “There’s lots of good communication when we work with others and in the Society of Pediatric Nurses we look at evidence-based standards in pediatric nursing with discussion boards and communication that looks at substantiating what we do.”

Wiggins herself said she knew during her nursing student days that this was going to be her direction. Even at the end of a challenging day in clinical, she thought of what she needed to do to be able to do have days like that for the rest of her career. “It didn’t feel like work,” she says. “It was an opportunity.”

And, yes, pediatric nurses are in a field that could make them prone to compassion fatigue because of the heartbreak they encounter routinely. When nurses mention things only another nurse would understand, pediatric nurses share a special bond of caring for ill children, some of whom do not recover. Because of that, there are lots of protections and processes in place for pediatric nurses to help manage the emotional fallout that can happen and to keep them close to other pediatric nurses who have almost all experienced similar joys and sorrows.

Wiggins points to the DAISY Foundation awards, which recognizes outstanding nurses and the “super-human” work they do with patients and families in difficult times. The awards can help acknowledge that nurses struggle with emotions right alongside families and patients they care for.

If pediatric nursing is something that intrigues you, it’s worth looking into getting some first-hand experience to see if it’s a good fit.

A Proactive Program

Teen pregnancy, once a declining problem, is once again on the rise, particularly in minority communities. To combat the trend, one Massachusetts nurse started a program aimed at educating students and parents about teen pregnancy before it occurs. Anh Lewin, B.S.N., R.N., who works for Pediatrics West, started The Smart Sex Program for Teens in 2008 with a $5,000 grant from Fallon Community Health Plan, an insurance and health care provider. The program is held for two hours over a two-week period while a separate session for parents, called “Let’s Talk,” is a two and a half hour, one-time program.

Located in Groton and Westford, Massachusetts, Pediatrics West provides health care to some schools in those towns as well as in Chelmsford, Lawrence, Pepperell, and Tyngsborough. Lewin also has offered the program in nearby Lowell, which is the fourth-largest city in Massachusetts and has the highest percentage of native Cambodians of any place in the United States. Lawrence, meanwhile, is known as the “Immigrant City” and has always been a multi-ethnic and multicultural gateway with a high percentage of foreign-born residents, according to the city’s website.

The Smart Sex Program for Teens is free. It includes instruction on communication, the reproductive system, puberty, sexually transmitted diseases, protection, abstinence, and relationships.

For the parent workshop, there is a modest fee. “For the parents, we teach them all the facts. Now we want you to teach your kids how you feel about the situation,” Lewin says. “We ask, them, ‘What is your opinion?’ You have to give kids your values. We do not do that. We spend four to five hours with them. You have your entire life with your child. It is not one talk; it is multiple talks. It is talks that should start when they are really young, so you are always comfortable talking about it.”

To learn more, visit the Pediatrics West educational programs website (

New federal grants help minority infants in Utah

Every newborn enters the world with the unlimited promise and potential of a life yet to be lived. However, alarming research conducted in Utah has revealed that all babies may not have the same chances, particularly those born to African Americans and Pacific Islanders. According to the Utah Department of Health’s Center for Multicultural Health, Pacific Islander infants (those under 12 months) experience about 8.8 deaths out of every 1,000 births, compared to about 4.5 deaths out of every 1,000 births statewide. Utah’s infant mortality rate hasn’t exceeded eight deaths per 1,000 births in over 20 years. In light of these facts, the U.S. Department of Health and Human Services recently decided to provide over $130,000 over a three-year period to help specialists study mortality rates within various populations in Utah.

Center specialist April Bennett says the information gathered from this process will be used to implement many interventions and outreach programs for minority women. Surveys will be conducted to help expecting mothers identify obstacles that they may experience during pregnancy, such as maternal obesity, smoking, poverty, etc. The ultimate goal is to help them lead better lifestyles.

The number of uninsured in the state has risen in the past 10 years, with Hispanics holding the highest number at 35.7%, compared with only 11.1% of all Utahans. In 2001, 25.8% of Hispanics were uninsured. For uninsured mothers, this means inadequate prenatal care, which can lead to premature labor and put the lives of their infants at risk. Various health department surveys have shown that African Americans have the highest rates of pre-term births of all infants in Utah, one of the underlying issues contributing to a higher infant mortality rate in the state. But, the U.S. Department of Health and Human Services is determined to make an impact on this issue immediately, starting with studying the contributing factors, such as insufficient insurance and a lack of access to care.

Siblings and autism

Siblings of children with autism are at a higher risk of also having the disorder than previously thought. Researchers at the Mind Institute at the University of California, Davis have found that siblings of children with autism spectrum disorder have a 1 in 5 chance of also being autistic, when previous statistics said there was a 1 in 10 chance of the sibling having the disorder.

The latest research came from the largest study to date on the risk of autism among siblings. Published in the journal Pediatrics and supported by Autism Speaks and the National Institutes of Health, the research followed 664 eight month-old infants, who had siblings with ASD, until they reached 36 months. Nineteen percent of the siblings were diagnosed with the disorder, which puts siblings of children with autism at a 20 times greater risk of developing ASD than the general population.

Keeping families and patients informed and aware of emerging research like this is important. Researchers urge families who have children with autism and are considering having more children to prepare to watch younger siblings more closely as they develop. Potential signs of autism can display even in infancy. On their website, Autism Speaks has a list of signals for parents to look out for as early as three or four months. Some of the potential signs include a lack of smiling at six months or an absence of gestures like pointing, waving, or babbling, at 12 months. Early detection, diagnosis, and intervention have been shown to positively improve the effects of the disorder in a child’s behavior.