Stephanie L. Ferguson

The national campaign to prevent teen pregnancy.

Approximately 1 million teenagers in the US become pregnant annually of which less than 20% are planned. The countrys 1992 teen pregnancy rate of 96 per 1000 females aged 15-19 was higher than that of any other industrialized country. This high level of unplanned teen pregnancy cuts across all ethnic economic and social groups affecting the entire nation. While unmarried teenagers should be encouraged to refrain from sexual intercourse those who choose to have sex need to have access to contraceptive methods which will prevent both unwanted pregnancy and the transmission of sexually transmitted diseases. US President Bill Clinton in January 1995 challenged the nation to build a grassroots effort to prevent teen pregnancy. A group of leaders met that challenge in establishing the National Campaign to Prevent Teen Pregnancy a nonprofit nonpartisan initiative supported solely by private donations. The campaign aims to reduce the US teen pregnancy rate by one-third by 2005 by taking a strong position against teen pregnancy getting the help of the media supporting and stimulating state and local government leading a national discussion in an effort to build common ground and ensuring that local community efforts are based upon research about what works.

Cultural competence: A critical factor in child health policy

C RIME, POVERTY, lack of education, lack of health insurance, and access to health care are just a few risk factors that effect childrens physical and emotional health. Several of these risk factors are far more common among specific ethnic and cultural groups. However, there is a paucity of nursing literature that examines cultural issues in child health policy. This article will address information regarding cultural competence and child health, and make recommendations regarding a culturally competent model of policy development for child health issues.

Child Care Health Consultants Still in Demand: Pediatric Nurses Are an Asset

Nurses in the role of Child Care Health Consultants can best provide education and services to positively impact the health and safety of child care programs and child health outcomes. RESEARCH AND RECOMMENDATIONS substantiating the value of child care health consultants (CCHCs, 2009) have been circulating in the form of professional articles, research papers, and policy initiatives for over two decades. A CCHC is a health professional with experience in pediatric care and knowledge in resources and regulations related to the care of children in day care settings (American Academy of Pediatrics [AAP], American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education, 2002). According to the United States Census Bureau (2010), 24% of children aged 0–4 years spend most of the time in a center-based setting, such as a day care, nursery schools, preschools, and Head Start (http://www.childstats.gov/americaschildren/famsoc3.asp). With a significant amount of the pediatric population enrolled in center-based settings, the CCHC has the knowledge and expertise to impact the health status of this population. In the current era of health care reform, when community-based care and interdisciplinary collaboration are paramount, the CCHC is in a pivotal position to endorse the licensure of day care settings and to provide consultation to day care providers to make a safe and positive impact on individual and population health outcomes. Nakatsukasa-Ono, Loe, and Harris (2006) suggest that providing health care consultations to child care professionals improves child health outcomes. This was further substantiated by Graville (2011). Graville also advocates for the role of the CCHC in improving child outcomes and day care centers in todays health care and child care environments. She noted that day care settings that use CCHCs experience improvements in child health outcomes in the following areas: compliance with health polices, improved immunization rates, increased access to medical and dental

A profile of ethical principles

E VERY DAY the pediatric nurse is faced with various ethical issues such as a child rejecting a parents decision on a course of treatment, or whether a family chooses compassionate care over surgical management of a malformed and mentally retarded infant. Working with ethical issues requires skill in the processes of values clarification, ethical decision making, self-awareness, empowerment, transcultural sensitivity, and challenging injustice (Burkhardt & Nathaniel, 1998). An understanding of basic ethical principles can help the pediatric nurse recognize ethical dilemmas and seek equitable resolutions for the parties involved. This article briefly discusses six ethical principles that are helpful to pediatric nurses when confronted with ethical dilemmas in the pediatric work place. Those principles are autonomy, beneficence, nonmaleficence, confidentiality, veracity, and justice. Ethical principles are defined as basic and obvious moral truths that guide deliberation and action (Burkhardt & Nathaniel, 1998). The first principle, autonomy, means self-governing or self-determination in making decisions for oneself. It denotes having the freedom to make independent choices (Burkhardt & Nathaniel, 1998; Greipp, 1997). Within bioethics, autonomy means that individuals have the right to information and, on the basis of this input, the right to agree or to refuse to participate in research or to undergo the treatment being proposed. The pediatric nurse is obligated to respect decisions of parents made on behalf of their children and of children considered old enough to make their own decisions. An exception may be when parents decide on a course of action for their child that is harmful and might lead to death (Davis, Aroskar, Liaschenko, & Drought, 1997). Loewy (1996) writes that decisional capacity is never absolute but is limited by the circumstances of the illness, as well as by the particular social and cultural conditions in which individuals find themselves. Generally by age 12, the child can begin to make decisions about his or her health care treatment. An example of an ethical dilemma involving the principle of autonomy is when the child decides to refuse a plan of treatment agreed on by the parents and the health care team. Anna, age 12, suffers from lymphoma with a prognosis of 6 months to live. Aggressive chemotherapy might extend her life a maximum of 6 months. Members of the health care team, including oncologists and nurses, have shown much compassion in frank discussions with Anna and her distraught parents. During several hospitalizations in the last year, Anna has observed how other children have responded to chemotherapy. She asks her parents to cancel the scheduled chemotherapy regimen. Daily discussions over the next few days with Anna and her parents provide them with additional information and unhurried time to insist on treatment or to support Annas wishes. The hospice nurse meets with Anna and her parents to explain the hospice programs support for patients and families. After consultation with family members and friends, Annas parents decide to acknowledge the independence they have instilled in her upbringing by honoring her requests. Anna is discharged to home and admitted to the palliative care program in her community. The challenge for the nurse and other health care providers is to help mediate a compromise or resolution between the child, parent, and the health care providers to protect the independent choice of the mentally competent child. The principle of beneficence is well known to nurses. Beneficence is described as the active doing of goodness or kindness (Burkhardt & Nathaniel, 1998; Mappes & DeGrazia, 1996). This principle