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1. A_Gemini

   http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463034

   Like the medical field of pediatrics, pediatric nursing did not develop as a specialty in the United States until the second half of the nineteenth century. In colonial America, most children were delivered with the help of midwives and cared for by their families, using folk medicine. Only the wealthy were attended by physicians, who were limited in what they could actually do for their patients.

   The founding of The Children’s Hospital, the first hospital in the United States specifically for the care of children, in Philadelphia, Pennsylvania, in 1855 [7] is generally regarded as the event that marks the beginning of pediatric nursing as a specialty. The hospital also had a dispensary and provided home care. Its purpose was both to provide excellent care for its patients and to decrease childhood mortality in the United States through research [8]. Other hospitals were opened for children in major US cities during the second half of the nineteenth century, including Boston (1869), the District of Columbia and New York (1970), San Francisco and Albany, New York (1875), Detroit (1877), and St. Louis (1879) [8].

   Ironically, hospitals during this period usually did not admit children with communicable diseases because of high mortality rates [9]. The rise of hospital schools of nursing in the late nineteenth century may be partly responsible for the change in this policy. Walton and Connolly believe that it is no accident that the Children’s Hospital of Philadelphia began admitting children suffering communicable diseases in 1895, the same year it opened its own school of nursing [9]. The hospital then had enough staff with the knowledge to provide the level of care, observation, assessment, and education that these children and their families needed.

   In addition to hospital nurses, some private-duty nurses specialized in care of children. Nurses also were involved in providing care to children and health promotion through the public and private community health initiatives of the late nineteenth and early twentieth centuries. An in-depth discussion of their activities is beyond the scope of this paper, but a few examples will be presented.

   Nurses played a major role in the “child-saving movement” in early twentieth century [7]. Many health practitioners focused on improving the artificial feeding of infants and children to decrease their mortality rates [10–12]. Publicly and privately funded milk depots, which provided pasteurized milk at low prices to those who could afford to pay and at no cost to the indigent, often employed nurses to educate mothers about proper handling and storage [11]. Eventually home visitation services were added, and the depots became child health stations stressing illness prevention [11, 12].

   Lillian Wald and Mary M. Brewster began living and working as visiting nurses in New York’s Lower East Side in 1893. In 1895, Wald opened the Nurse’s Settlement House on Henry Street, and, by 1909, thirty-seven nurses were employed. Additional services included nurses’ training, obstetrical services, first aid homes throughout the community where nurses treated minor injuries and illnesses, educational programs for the community, and social clubs for children. A demonstration project that Wald initiated in 1902 at a New York school was the start of school nursing [13, 14].

   Nurses also were involved in federal programs to improve the health of children. The Sheppard-Towner Act of 1921, which provided money for states to improve maternal-child health, resulted in the employment of many nurses in infant welfare centers, maternity centers, and educational classes for mothers, midwives, and mothers’ helpers. The act was renewed in 1927 but was allowed to expire in 1929 [14, 15].

   The move to improve nursing education during this era, especially that of the public health nurse, also benefited pediatric nursing in general. The section on pediatric nursing in the 1917 Standard Curriculum for Schools of Nursing (Standard Curriculum) stated that classes on pediatric nursing were to include lectures on social issues and psychology, infectious diseases, orthopedic and surgical conditions, and information about infant feeding and child development “to give a good sound basis for later work in connection with milk depots, baby welfare, school-nursing and other fields of work where knowledge and skill in children’s nursing are of essential importance” [16].

   In 1923, the Committee for the Study of Nursing Education, commissioned by the Rockefeller Foundation, published their recommendations in Nursing and Nursing Education in the United States, a document commonly known as the Goldmark Report. It had some harsh words for the state of nursing education in general and its inability to provide adequate education for public health nurses in particular. A major problem was that hospital training schools existed to serve the needs of particular hospitals; at times, education in some areas would be shorted if a particular institution did not need it. For example, of the twenty-three schools surveyed, seven gave no training in communicable diseases, one of the biggest causes of mortality in young children, while five gave no training in pediatrics. One conclusion of the report was that because hospital training schools had an inherent conflict of interest, university nursing programs at the time needed to be strengthened and more should be developed to provide an alternative source of education for those desiring to become nurses [17].

   Later in the century, pediatric nursing would be directly involved in the move toward advanced degrees and advanced practice. For example, the first nurse practitioners were pediatric nurse practitioners [18].

   The pediatric nursing curriculum has also reflected changing attitudes and research on many issues, including the involvement of families in the care of children. While those involved in public health nursing, including Wald, thought that mothers were essential for the survival of their children, many nurses in acute care settings in the late nineteenth and the first half of the twentieth century “viewed mothers as unnecessary, bothersome, and at times, even harmful in the care of hospitalized children” [18]. In addition, the hospitalization period was viewed as a chance to educate poor children about good health habits and inculcate the values of the middle class into them without the interference of their parents [7]. The effects of maternal deprivation were little understood. As a result, hospital visitation policies greatly restricted the frequency and amount of parental visits. In contrast, the second revision of the Standard Curriculum, published in 1937, emphasized that to promote normal child development, “The hospital routine visiting schedule should assist in maintaining home contacts through visiting of children by their parents” [19].

   However, it took the cumulative effect of research in the 1940s, 1950s, and 1960s on the effects of maternal deprivation to bring about real change in attitudes and policies [20]. Many nurses were involved in this effort, including researcher and educator Florence Blake, who demonstrated the positive effects of involving families in the care of children in her text, The Child, His Parents and the Nurse [21]. The push toward true family-centered care began in the 1980s and was spurred on by then Surgeon General C. Everett Koop’s 1987 report on children with health care needs, which called for community-based, family-centered care [22]. A consequence of practicing family-centered care for pediatric nurses is that they must now learn theories of multicultural care and family theory [23].