1. Dirks, Fran MSN, RN, FNP-BC


New standards and guidelines in pediatrics and obstetrics.


Article Content

Pediatric nursing standards. According to a report from the Federal Interagency Forum on Child and Family Statistics, America's Children in Brief: Key National Indicators of Well-Being, 2008 (, the 73.9 million U.S. children under age 18 made up 25% of the country's population in 2007. The health conditions affecting this population are significant: 9% of children ages five to 17 have activity limitations resulting from chronic health conditions, 9.3% of children ages 17 or younger have asthma, 17% of children ages six to 17 are overweight, 5% of children ages four to 17 have emotional or behavioral problems, and the rate of deaths from injury among adolescents ages 15 to 19 is 49.8 per 100,000. In addition, of children ages 17 or under, 11.7% are uninsured and 6% have no regular health care provider, 19.5% of children ages 19 to 35 months are behind in their vaccination series, and 24.3% of children ages two to 17 do not receive regular dental care. Pediatric nurses and advanced practice pediatric nurses face these staggering problems every day. The substantial task of caring for these patients is made even more difficult by the need to care for the family and larger community in order to properly care for the children.


A little more than a year ago, however, the American Nurses Association (ANA) issued Pediatric Nursing: Scope and Standards of Practice to support, guide, and define pediatric nursing


This publication is a groundbreaking joint effort of the National Association of Pediatric Nurse Practitioners, the Society of Pediatric Nurses, and the ANA. It combines the three organizations' pediatric nursing scope and standards documents to articulate a new and improved set of standards that are applicable in all areas and at all levels of practice. It was designed for use by practicing nurses, educators, the public, and the health care community, as well as by legislators (to guide health policy).


The scope of pediatric nursing practice is tackled first, with its varied aspects divided into sections addressing the "health care home," family-centered care and management styles, and evidence-based practice. The areas of pediatric nursing practice, and the educational requirements for each, are also addressed in this section, as are the settings for pediatric nursing practice. Discussions of culturally competent care, professional trends, ethical issues, and advocacy follow.


Set out next are the six standards of pediatric nursing practice, based on the nursing process. Assessment, diagnosis, outcomes identification, and planning are the first four. Implementation, the fifth, is divided into subsections and includes coordination of care and case management; health teaching; health promotion, restoration, and maintenance; consultation; prescriptive authority and treatment; and referral. Evaluation is the final standard. Each standard is accompanied by measurement criteria, all of which must be met to achieve the standards of practice. Additional criteria are described for the advanced practice nurse.


The 10 standards of professional performance, delineated next, describe competent professional behavior. They include quality of practice; professional practice evaluation; education; collegiality; collaboration; ethics; research, evidence-based practice, and clinical scholarship; resource use; leadership; and advocacy. As with the standards of practice, each of these has measurement criteria, with additional criteria for advanced practice nurses.


The book also reprints the original scope of practice documents for reference. It can be purchased at


New breastfeeding guidelines were issued in 2007 by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). The second edition of Breastfeeding Support: Prenatal Care Through the First Year is based on a comprehensive literature review and analysis and reflects current evidence-based nursing practice. The guidelines address the period before conception, prenatal care and counseling, and breastfeeding support and promotion from birth through the first year of life. Judith Poole, PhD, past president of AWHONN, said in a press release that the guidelines seek to "increase breastfeeding rates and help improve the health of newborns by ensuring that nurses have access to the most up-to-date evidence-based information so that they can deliver consistent breastfeeding education and support to new mothers."


A special section is devoted to helping nurses support breastfeeding in mothers of preterm and vulnerable newborns. A "Quick Care Guide" gives easy-to-use patient assessment and teaching points for working with mothers who are breastfeeding term and preterm neonates. Continuing education contact hours can be earned with this revised edition. Purchase it at AWHONN's online store at


A patient booklet on perinatal depression,Depression During and After Pregnancy: A Resource for Women, Their Families, and Friends, can help nurses help the 10% to 20% of women who experience symptoms of depression during their pregnancy or within a year after the birth. Most symptoms begin soon after the birth.


The booklet, issued by the Health Resources and Services Administration (HRSA), is intended to raise awareness and improve treatment of perinatal depression. It offers easy-to-understand explanations of the warning signs of perinatal depression and simple steps a woman can take to get help if she is experiencing symptoms. It also suggests ways family members can help.


The booklet can be read online or downloaded as a PDF at It's also available free from HRSA as a booklet in English and Spanish. Additional resources for women and their families are available from HRSA's Maternal and Child Health Bureau (


Fran Dirks, MSN, RN, FNP-BC


cordinator of Nursing Resources and a family NP in New York City: