Transcript Social, Cultural, and Religious Influences on Child Health Promotion

Influences on Child Health Promotion
and Pain
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
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Provide an understanding of family nursing
interventions.
Discuss the influence of culture in healthcare
encounters
Discuss behavior pain measures, self-report
pain-rating scales, and multidimensional
measures.
Identify reasons that children's pain tends to
be undertreated.
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
2
Understanding family nursing
interventions.
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
3
Family Nursing Interventions
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Scenario
A mother brings her two children to the clinic for
their annual physical examinations. The
children are 2 and 5 years of age. The youngest
child is cared for at a local day care center, and
the 5-year-old child attends kindergarten. The
grandmother cares for the children for 2 hours
in the early evening until the mother finishes
work. The grandmother lives in a two-story
house on a busy road located in the city. The
mother reports a recent divorce, and the
children have no contact with their father.
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Sociocultural Influences
on Families
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Surrounding Environment
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School/learning environment
Peer cultures
Social roles
Local Community Influences
Social Determinants
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Race and ethnicity influence
Social class (wealth vs. poverty)
Religious and traditional influences
Mass media influences
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
6
The influence of culture in healthcare
encounters
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Culture in Healthcare
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Describe health beliefs and health practices
of various cultural or ethnic groups
Provide examples of how religious beliefs
affect health practices.
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Percentage of Foreign Born
Location
Rate
United States
13.1%
Washington State
13.5%
King County
21.5%
Beacon Hill
44.4%
King County. (2013). Foreign born. King County, 2008-2012 average. Retrieved from:
http://www.kingcounty.gov/healthservices/health/data/%7e/media/health/publichealth/documents/indicators/Demographics/ForeignBorn.ashx 9
.
Cultural Competence
“Cultural competence is grounded in the
appreciation of the profound influence of culture
in people’s lives, and the commitment to
minimize the negative responses of healthcare
providers to these differences” (Paasche-Orlow,
2004).
Paasche-Orlow, M. (2004). The Ethics of cultural competence. Academic
Medicine, 79(4), 347-350.
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Cultural Traditions to Maintain,
Protect, and Restore Health
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Physical aspects of caring for the body
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Special clothes
Foods
Medicines
Feelings, attitudes, rituals, actions related to
health
Spiritual aspects of health
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Identity (who I am)
Customs/prayers/healing
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PAIN ASSESSMENT
Behavior pain measures, self-report pain-rating scales, and
multidimensional measures.
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Pain Assessment: Influencing
Factors
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Age
Developmental level
Cause and nature of the pain
Ability to express the pain
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Pain Assessment Tools
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Behavioral
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Infants to age 4 years
Physiologic
Self-report
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Not valid for children younger than 4 years
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Behavioral Pain Assessments
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Assessment of vocalization, facial expression,
and body movements with specific tool
Most reliable for short, sharp pain
Most reliable for pain in infants
Less reliable for recurrent or chronic pain
Less reliable for pain in older children
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May not correlate with child’s self-report of pain
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Behavioral Pain Assessment Tools
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FLACC: Face, Legs, Activity, Cry and
Consolability
CHEOPS: Children's Hospital of Eastern
Ontario Pain Scale
TPPPS: Toddler-Preschooler Postoperative
Pain Scale
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FLACC
From Merkel, S. I., Voepel-Lewis, T., Shayevitz, J. R., & Malviya, S. (1997). The FLACC: A behavioral scale for scoring postoperative pain in young children.
Pediatric Nursing,
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23(3), 293–297.
FACES Pain Scales
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Wong-Baker FACES Pain Scale: Six cartoon
faces
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Smiling face = “no pain”
Tearful face for “worst pain”
The child chooses a face that describes his or her
pain
The WB FACES widely used in United States
Bieri Faces Pain Scale—Revised: Six faces =
0 to 5
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No smiling face at the “no pain” end
No tears face at the “most pain” end
Equivalent to a 0 to 10 metric system
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FACES Scale
International Association for the Study of Pain (IASP) ©2001.
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Numeric Pain Ratings
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For 8 years and older
0 to 10 scale widely used
Easy to use
Little research for reliability and validity
Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
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Neonatal Pain, Agitation, and
Sedation Scale (NPASS)
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Used in neonates from 23 weeks of gestation
up to 100 days of age
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Children with Communication and
Cognitive Impairment
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Difficult to measure pain
High risk for inadequate treatment of pain
NCCPC: Non-Communicating Children’s Pain
Checklist
PICIC: Pain Indicator for Communicatively
Impaired Children
R-FLACC: Revised Face, Legs, Activity, Cry
and Consolability
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R-FLACC
Lisa Peters. 2013. Pain in children with developmental disabilities
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When assessing the pain of a 15-year-old who is
developmentally delayed and unable to speak,
which is the appropriate pain assessment tool?
A. FACES
B. FLACC
C. N-PASS
D. R-FLACC
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LA
CC
0%
RF
SS
0%
NPA
0%
FL
AC
C
FA
CE
S
0%
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Reasons that children's pain tends to be
undertreated.
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The nurse is monitoring a 3-year-old child
receiving a morphine drip. The child’s respiratory
rate is 14 breaths/min and heart rate is 64
beats/min. The child is exhibiting which of the
following?
ic a
tio
ns
of
m
o.
..
0%
co
m
pl
pa
in
Ca
rd
ia
c
ic a
tio
ns
o
...
Ad
eq
ua
te
pi
ra
to
ry
Re
s
0%
co
nt
ro
l
0%
co
m
pl
A. Respiratory
complications of
morphine
B. Adequate pain control
C. Cardiac complications of
morphine
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Cultural Barriers to Pain Treatment
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Inadequate assessment of pain
Concern about side effects and tolerance of
analgesics
Fear that pain means worse disease
Reluctance to report pain
Reluctance to take pain medications
Lack of adherence to treatment plan
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Barriers to Pain Management
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Family issues and relationships
Fears and concerns about addictions
Lack of knowledge about pain
Inappropriate use of pain medications
Ineffective management of adverse effects
from medications
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What are the Harmful Effects of
Unrelieved Pain in Pediatric Clients?
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Physiologic stress
response
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Chronic pain
syndromes
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Patient/Family Education
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Discuss educational needs surrounding use
of opiates for analgesia in infants and
children
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Addiction/dependence
Cause and effect of psychologic dependence
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Children with Chronic Illness and
Complex Pain
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Difficult to isolate pain symptom from other
symptoms
Rating pain does not always accurately
convey to others how they really feel
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