39.4 The Nurse’s Role in Preventing Illness

Assist with Family Planning

Although a midlevel provider, physician assistant, nurse practitioner, or physician is required to write a prescription for contraception, registered nurses play a key role in instructing patients how to use contraception. Most outpatient clinics that provide family planning services have nurses who provide one-on-one instruction on how contraception works, what to do if a dose of contraception is missed, and under what circumstances patients should use a backup contraception method. Nurses are also the ones who frequently provide education on different contraception options and manage the after-hours phone line for patients who have questions when the clinic is closed.

Prenatal Education

Nursing prenatal education is aimed at helping expecting parents learn and implement healthy habits during pregnancy. The habits focus on the nutritional needs of the pregnant person and developing fetus, information on substances to avoid during pregnancy, and guidance on exercise and sleep requirements during pregnancy. The most important nutritional advice is to emphasize the importance of taking adequate folic acid throughout pregnancy. Pregnant persons also need to be reminded that alcohol, cigarettes, and illicit drugs will potentially harm the developing fetus. Most pregnant persons can continue their prepregnancy exercise routine, but a new exercise regimen should not be started during pregnancy. Pregnant persons should expect to be tired during pregnancy, particularly in the first trimester.

The nurse also educates expecting parents about pregnancy warning signs and when to seek medical attention during pregnancy. The pregnant person should be taught to seek medical attention for vaginal bleeding, persistent headaches, or unusual swelling in the hands or face. Vaginal bleeding is a sign of miscarriage, while persistent headaches and unusual swelling are associated with preeclampsia.

Facilitate Bonding

When a caregiver and a baby feel a strong attachment to each other, this is known as bonding. Many parents feel love, joy, and a sense of protection for their baby. However, this bond does not happen instantly for all parents. For many parents, bonding is a process. It can take days, weeks, or longer to fully bond with a newborn. This is especially true if the newborn is admitted to the hospital after birth or is adopted. Parents need to be supported through this process and be reassured that they are not bad parents if bonding takes longer than expected.

Nutritional Support

One of the primary developmental tasks during the newborn period is to establish a feeding schedule. Not only does feeding provide a bonding opportunity, but it is also the sole source of nutrition for the infant. A preterm neonate needs 100 to 150 kcal/kg per day of nutrition, whereas a term neonate needs 100 to 120 kcal/kg per day (Patel & Rouster, 2023). If infants are breastfed, parents should be instructed that newborns feed approximately every two hours. Both breastfed infants and formula-fed newborns should have frequent weight checks to ensure that they are getting enough nutrition. Newborns should regain their birth weight by 2 weeks of age and then gain an average of 1.1 oz (30 g) per day (Desiraju, 2018).

Whether parents choose to breastfeed or bottle feed, nurses should provide guidance on best feeding practices. People who have given birth who breastfeed should be advised that breastfeeding can be a challenge. For many, it can take time for the milk to come in, and not all newborns learn to latch, suck, and swallow easily. The first three days after birth, the breast makes a thick, yellowish liquid called colostrum, a nutrient-dense liquid that also helps bolster the newborn’s immune system. The person who gave birth may feel like their breasts are hard, full, and warm as the colostrum ends and the breast milk starts to come in. During this time, the person who gave birth may need to breastfeed more frequently. If parents have any concerns about breastfeeding, they should speak with a lactation consultant.

If parents choose to bottle feed, they should receive instructions on selecting an infant formula, safely storing and preparing formula, and determining how much and how often the baby should feed. The U.S. Food and Drug Administration (FDA) regulates commercial formulas to ensure they meet the minimum nutritional requirements. Most infants tolerate standard milk-based formulas. Infants should not be switched to a specialty formula without speaking to their pediatrician. It is also not recommended that parents use homemade formula. Parents need to be advised to follow the instructions to prepare the formula and to avoid leaving the formula at room temperature for more than two hours. Formula can be safely stored in the refrigerator for up to twenty-four hours.

Newborns have small stomachs and feel full after 1 to 2 oz (28 to 57 g) of formula. Parents should start by offering 1 to 2 oz (28 to 57 g) every two to three hours. Most formula-fed infants feed eight to twelve times in a twenty-four-hour period. If the baby shows signs of hunger, offer them more formula. However, infants who have distended abdomens or frequently spit up may be overfed. It is important that parents consistently feed their baby when they show signs of hunger but avoid overfeeding (CDC, 2023d).

Health Promotion Screenings

There are several routine health promotion screenings for newborns. Newborns undergo a blood test to screen for genetic, endocrine, and metabolic disorders. Each state determines which disorders are included on their newborn screen. However, phenylketonuria (PKU), a rare metabolic disorder that can cause intellectual disabilities but is highly treatable with diet modification, is tested for in all fifty states. Other routine newborn health screenings include hearing screens, vision screens, and congenital heart defect screens.

Vaccinations

Infants are at-risk for infections because their immune system is not mature. Giving recommended immunizations throughout infancy and childhood is the best way to protect infants from infection. Most infants receive their first hepatitis B immunization prior to leaving the hospital after birth. After that, multiple immunizations are scheduled at 2 months, 4 months, 6 months, and 12 months of age. Nurses should encourage parents to stay up to date on their child’s vaccine schedule. Immunizing children against the most common diseases helps keep them healthy and safe (CDC, 2023b).

Environmental Safety

The gross motor skills of toddlers develop rapidly, and toddlers are on the go. With the increase in their mobility comes concerns with protecting them from harm. There are specific tasks that parents should do to protect their toddlers (Michigan Government, 2023):

• Place plug covers over electric outlets.
• Block stairs with a gate.
• Lock doors to hazardous areas like the garage or basement.
• Lock up medicines and household cleaners.
• Keep sharp objects in a safe place.
• Check toys for loose parts.

Supervised Independence

One of the primary developmental goals of toddlers is to gain a sense of independence. As they mature, children become less dependent on their parents. Toddlers love doing things for themselves and are very egocentric. Parents need to let toddlers try new things and master new skills, but they still need constant supervision. Toddlers do not have the cognitive ability to think through what might happen. If they see something up high that they want, they will climb up to try to get it without any regard to the possibility of falling. Parents need to give toddlers the space to explore their environment while constantly keeping an eye on them so they do not get hurt.

Language Development

During the first three years of life, the brain is still developing. During this time frame, children learn language easily. By age 2 years, children should have a fifty-word vocabulary and should use two-word sentences. As they continue to develop, their vocabulary grows, and they begin using plural words, saying things in the past tense, and adding inflection to questions. By age 3 years, their speech is usually understood well by their immediate family and caregivers. If parents are worried about a speech delay, they should speak to their pediatrician. Some children are slow talkers but catch up with their peers, while others may have a developmental delay or a hearing problem that makes it harder for them to learn to speak (NIH, 2022).

Healthy Eating Habits

Childhood obesity is a serious problem in the United States. Children with higher weight are more likely to become adults with higher weight and to struggle with chronic health conditions related to obesity. One of the best ways to prevent obesity is to establish healthy eating habits early in life. There are several techniques to help preschool children develop healthy habits to last a lifetime (Society of Behavioral Medicine, 2023):

• Stock the house with healthy food and teach by example. Children often develop the same eating habits as their parents.
• Encourage autonomy and healthy choices by offering two to three healthy food options each day.
• Focus on the health benefits of nutritious foods (e.g., “Eating veggies helps you grow big and strong”).
• No foods should be forbidden. Instead, encourage moderation, and set limits on unhealthy food.

Promoting Early Learning

Attending preschool is a great way to get children ready to start school. Children who attend preschool learn how to function in a group setting, follow rules, and learn basic academic skills. There are also specific parenting techniques that engage preschool children and help them get the most out of their preschool experience. Nurses should teach parents to talk to their children about their school experiences. The parents should ask questions, such as “What did you do in school today?” or “What is your favorite part of class?” It is important to give children time to respond and to add new vocabulary to the conversation. Parents can also promote early learning by reading to their children at home and reinforcing concepts that they learn at school (American Speech-Language-Hearing Association, 2023).

Environmental Safety

More than one-third of child injuries and deaths happen at home. Teaching parents how to make the home environment safe is crucial for keeping kids safe. Preschool children need less supervision than toddlers but should still be kept out of areas like the basement or the garage. Also, it is important to keep medicine out of the reach of children. Children in this age group should be supervised when playing around water or playing sports that could result in injury. Families that have swimming pools should use a pool fence with a gate that locks (National Safety Council, 2023).

Positive Self-Esteem

One’s self-esteem, or the feeling of self-appreciation, is an important building block in childhood development. Children with high self-esteem are more likely to do well in school, participate in school activities, and be willing to try new things. Encouraging self-esteem in school-age children will help them adapt to changes in adolescence and later in adult life. The home environment contributes profoundly to their self-esteem. A specific step to develop positive self-esteem is to give positive reinforcement. Also, children should be encouraged to try different extracurricular activities to develop a sense of what they are good at and what they like.

Anticipatory Guidance

To build healthy parent-child relationships, parents need practical strategies to meet their children’s developmental needs and address the stressors children face at school. Nurses play a crucial role in advising parents and providing concrete solutions to conflicts that could affect their family. In this age group, many children have access to smartphones and computers. Cyberbullying is becoming more prevalent, and schools and school nurses need effective strategies to educate parents about the risks children may face and ways to help protect children with parental controls and open conversation.

School Violence

School violence is violence that happens at school. It disrupts learning and has negative consequences for the students and the community at large. Examples of school violence include the following:

• bullying or cyberbullying
• fighting
• weapon use
• sexual violence
• gang violence

School violence is a serious social problem in the United States. According to the National Center for Education Statistics (NCES), approximately twenty students per 1,000 experience nonfatal school violence every year (NCES, 2023). There are specific steps schools can take to reduce school violence (National Associations of School Psychologists, 2023):

• Teach about the importance of resisting peer pressure.
• Encourage students to report potential school violence.
• Create an anonymous reporting system that students, teachers, and parents can use.

Support Learning Needs

Adolescence can be a challenging time for parents and teachers. In this age group, students are caught between two worlds—childhood and adulthood. They strive for independence yet yearn to be part of a clique. During this development time, it can be difficult to support adolescents’ learning needs. The best approach is to focus on their desire to form bonds with peers. School lessons should be structured so that teens can work in groups. Also, teachers should try and form a connection with students. For adolescents who are homeschooled, encourage participation in peer activities in the community. For example, adolescents could participate in social organizations like the 4-H club or in community sports programs. Although adolescents are trying to establish their own identity, they still value the opinion of adults, even if they do not always act like they do. Having teachers and coaches demonstrate a genuine interest in adolescents’ unique talents will go a long way in supporting their academic success (Association for Supervision and Curriculum Development, 2004).

Healthy Eating Habits

Encouraging healthy eating habits is important during adolescence. Most adolescents in the United States eat a diet that is low in fruits, vegetables, and calcium-rich foods and high in fat. Skipping meals is also a common concern, especially among teenage girls. Also, many teens experiment with fad diets or become vegetarians. Various factors impact the dietary choices that teens make. Peer group association and familial cultural norms are the two biggest factors. Addressing dietary concerns is best approached by having an open mind about the teen’s choices and providing education about what nutrients might be missing. Special screening and education should be tailored toward this population regarding eating disorders. Also, healthcare providers should screen adolescents for anemia or other potential dietary deficiencies that are identified through their history and physical (Daly et al., 2022).

Behavioral Safety

Adolescents’ interests in new experiences and their drive for independence are natural and help them mature. By pushing boundaries, teens learn to become self-reliant. However, pushing boundaries can lead to risk-taking behavior. Parents, teachers, and nurses need to help teens manage risks that threaten their behavioral safety. Although adolescents are maturing rapidly, they still need adult supervision. Parents should be aware of what their teens are doing and with whom. If the teen breaks the rules, there should be consequences. Also, parents should have high expectations for their teens, and they should openly discuss the importance of safety.

Support Mental Health

The number of adolescents reporting mental health issues is increasing. According to the CDC, in 2021 42 percent of high school students felt persistently sad, and 22 percent seriously considered suicide (CDC, 2023d). Schools and school nurses play an important role in overcoming this crisis. Having support programs in place at school can help teens form connections with other students and teachers. Preventing social isolation is an important tool in supporting the mental health of teenagers (CDC, 2023d).