Dionne Eleazar P.

Pastrana Group 4

Barriers to Effective Pediatric Asthma Care: Implications for Practice

The effective clinical management of children with asthma should be based on a clear understanding of pathogenesis, current pharmacologic recommendations, and suggested environmental interventions (see Box 1 for a partial list of professional resources). Providers should individualize the education of the patient and family based on an a thorough assessment of the child's and family's resources, health care beliefs, access to health care services, and management styles. As is the case for other children with chronic illnesses, effective care coordination for asthmatic children is important to link families with health care services and minimize the negative effects of economic and sociocultural barriers to care. In recent years, faculty at the Yale University School of Nursing Pediatric Nurse Practitioner (PNP) Specialty who also practice at Yale New Haven Children's Hospital (YNHCH) have spearheaded a number of initiatives to promote effective care coordination and implement outreach programs when appropriate for asthmatic children and their families. Two of these efforts are the Asthma Care Coordination Program at YNHCH Pediatric Primary Care Center (PCC) and the Asthma Outreach Program under the auspices of the YNHCH Environmental Health Program. At PCC, primary health care, preventive services, and illness care are provided to approximately 8000 pediatric patients. More than 500 patients have been identified with asthma ranging in severity from mild intermittent to severe persistent. In 2002, 424 PCC patients were seen in the ED with the diagnosis of asthma, and 106 of the patients were admitted to the hospital. To reduce these numbers, a task force was organized to evaluate the asthma care provided to PCC patients. The goals for the asthma initiative were to improve patient care, decrease hospitalizations and ED use, decrease absenteeism from school and work for parents, and improve the overall wellness of children with asthma. Steps were taken to incorporate the NHLBI guidelines to ensure accurate classification of asthma, appropriate step-wise therapy, recommended testing (eg, yearly pulmonary

function tests), utilization of specialty services (eg, home health care; pulmonary, allergy and immunology consults; the YNHCH Asthma Outreach Program), and education of patients and families. A separate asthma clinic (within PCC) was established specifically for ED and hospital follow-up patients, asthma teaching and asthma maintenance care (in close collaboration with the primary provider). Currently, outcomes of the asthma clinic are being tracked to determine of this intensified effort may yield improvements in the rates of ED use and hospitalization. The Asthma Outreach Program (AOP) is a unique multidisciplinary program that conducts home visits to children in the New Haven, Connecticut area with poorly controlled moderate or severe persistent asthma. The multidisciplinary team consists of PNPs, social workers, a psychologist, a bilingual outreach worker, and attending physicians. The program offers a comprehensive, ecologic approach to asthma case management for the affected children and their families. The service is conducted as an adjunct to the care received by the child's primary care provider (PCP) and the pediatric pulmonology team. As a part of the AOP, the PNP advocates for the client with asthma and their family members and provides case management services in the home, clinic setting, and hospital. In the home setting, the PNP provides asthma education regarding the disease process, medications, and equipment to clients and their families; conducts full home environmental assessments using an ecologic model; conducting physical and developmental assessments as appropriate; monitors and adjusts the clinical plan as indicated; assists in locating information and resources of related problems such as food allergies; and consults and coordinates with other members of the AOP, the child's PCP, and the pulmonology team. In the clinic setting, the PNP may do a comprehensive intake history, evaluate the client's respiratory status, develop an asthma plan of care with consultation, and provide asthma education. Case management in the hospital setting includes monitoring the client's progress from an outpatient case management perspective, providing consultation regarding discharge planning, and ensuring follow-up care at the pulmonary clinic or at the PCP's office

Gillen Megan Bunga

Group 4

Pediatric Home Care: A Growing Health Care Trend That Needs To Be Addressed

The United States at the present time is wrestling with the formulation of its policy towards its millions of chronically disabled youngsters. The debate will grow louder with each passing year as the number of such infants increases both in absolute terms and as a percentage of the total population. Large numbers of youngsters who have birth defects or suffer other problems are being housed in hospital intensive care units. These children owe their lives to new life sustaining technology. It is doubtful that many of them would have survived five to ten years ago. Some of them have been in hospital ICUs continuously for several years. It is the same wonderful new technology to which they owe their very lives that has kept them dependent on hospitals, which until now, was the only place where life sustaining equipment and trained personnel were available. Tremendous change has occurred these past few years in care options for chronically ill children. The refinement of technology and greater numbers of trained health care professionals in the care and special needs of this population have made it possible to move large numbers of these disabled youngsters from hospitals back into their homes. Pediatric home care is truly an idea whose time has come. Pediatric home care has numerous advantages. In just about every case, parents prefer to have their children at home with them and often, it is better for their kids. Second, it is in the interest of society to keep families together. Third, it is a more humane option. The phenomenon of large numbers of chronically impaired youngsters is new to America. This poses an enormous number of complex social, political and ethical issues.

One of the missions of the National Association for Home Care and Hospice is working to inform the public, Congress and the media on these complex issues; and point to the best possible solutions. Much research is still needed, and we do not have all the answers. But the best data available indicates the following: Approximately 20 million children are afflicted with a chronic illness or disability in the United States, of whom about one million would be considered severely impaired. Eleven of the most common chronic illnesses among children are: juvenile-onset diabetes, muscular dystrophy, cystic fibrosis, spina bifida, sickle cell anemia, congenital heart disease, chronic kidney disease, hemophilia, leukemia, cleft palate and severe asthma. It is not uncommon for a child to suffer from multiple disabilities. Until recently, these children have had little choice but to live in institutions. The cost of their care has been enormous. It is estimated that children with the eleven diseases above make up roughly 40 percent of all hospital days used by children. Children also make up a disproportionate percentage of the nations accident victims. When they are added to the total, it is possible to reach the conclusion that children with birth defects or disabilities caused by accidents, account for half of all childrens hospital expenses each year. Many of these children could be cared for safely at home by the people who love them the most their families. New technology, which can be less costly, and the help of trained medical personnel can bring these children home.

NEW TRENDS FOR PEDIATRIC PATIENTS

PEDIA WARD

SUBMITTED TO Ma am Baby Villanueva

NARRATIVE REPORT
On the first day of our orientation about the pediatric ward I ve learned a lot our CI and TL teach us on how to handle an pediatric client many thing I ve learn in our duty at that area many client are very approcetiable them surely I remember this duty as the part of my liffe as student nurse first of all the area wise nice and the staff nurse are approcetiable , in my experince in my duty I realise that toxicity in not useful in the area we must be calm and delightful way to have duty in the area for the hospital many thing I tought that it was very difficult but in your heart abd way on how to deal with the client it is very easy to duty on that ward, surely I asure when I have my job I will use my learning to be a good nurse and be a polite nurse to my patient for my Clinical instrusctor thank you for teaching me in the pediatirc ward I assure that this knowledge will make me one of the good nurse in the institution when I having my work as a staff nurse . then thank for my group mate for there time to help me and teach me on how to handle the toxicity.