Thesis (M.P.H.)--University of Michigan, 1945.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Thesis (M.P.H.)--University of Michigan, 1945.

<p> The purpose of this project is to identify a potential funding source and write a grant to provide art classes and art exhibits in Orange County, California to decrease mental health issues among older adults and to reduce mental health stigma. A comprehensive literature review found that art related activities are an effective way to reduce mental health issues among older adults. The search conducted identified a potential funding source to support the need for culturally competent art based mental health services. Mental health stigma results in numerous challenges for those with mental illness, their families, and the community. Art activities are low-cost, help decrease levels of stress, build self-esteem, and promote community involvement. If funded, this program could help older adults engage in the art related activities to improve their mental and physical health.</p>

<p> When children are engaged in school gardens, they aren&rsquo;t just digging in the dirt. School gardens have been shown to help improve student health by impacting food preferences and physical activity; to enhance learning in many subject areas; to encourage critical thinking skills by utilizing inquiry-based learning; and to engender a positive association with nature. Children from disadvantaged environments disproportionately may miss out on each of these important experiences. School gardens can serve as venues to enhance social justice by helping marginalized students access these advantageous experiences they otherwise might not have. Given the evidence that school gardens improve the educational experiences of students, this study explored how they can expand across varied schools and classes so that more students can enjoy their benefits. The research question posed was: What are the opportunities for and barriers to the expansion of the school garden and cooking program of Grow Pittsburgh, called Edible Schoolyard Pittsburgh (ESY)? As an evaluator, I worked collaboratively with a wide range of stakeholders, convening focus groups and discussions with staff, parents and guardians, classroom teachers, and principals. Incorporating feedback from stakeholders, and using a mixed methods design, I developed four instruments to investigate the research question: a survey of parents and guardians, student interviews, principal interviews, and a principal survey. In addition, an extant student survey concerning willingness to taste and try a new vegetable was used. An analysis of seven Likert scale and two yes-no questions found no significant differences between the parent and guardian responses of two schools surveyed, suggesting the program was implemented equally reliably in both schools. The Parent/Guardian Survey enjoyed a strong return rate of 65.5%. Comprised of two open-ended questions, it generated 768 individual comments, which were transcribed and grouped thematically. The general findings suggest areas of positive impacts in students&rsquo; willingness to try fruits and vegetables, students&rsquo; comfort in nature, and parents&rsquo; and guardians&rsquo; connection to their child&rsquo;s school. These observations merit further study. Barriers as identified by principals, teachers, and parents and guardians included limited instructional time, limited number of grades served, and limited curricula connection to subjects other than science. Opportunities which emerged from the data included overall robust stakeholder commitment, capacity, and confidence (3Cs), including principals choosing to pay for the program from their own budgets, parents and guardians showing strong confidence, and, in some schools, parent-teacher groups raising half the cost of the program. Recommendations of the study for successful scaling include implementing an intentional Improvement Inquiry and measuring and tracking of stakeholder 3Cs. Researchers and practitioners should continue to evaluate impacts of school gardens on students in academics, ecoliteracy, and health.</p>

<p> Hawaii Island has the highest incidence of rat lungworm disease (RLWD) of all the Hawaiian Islands and the mainland United States. The relatively recent introduction of the semi-slug <i>Parmarion martensi,</i> an effective intermediate host, and the wide-spread use of rainwater catchment systems may play a role. Studies were designed to investigate the ability of drowned gastropods to shed larvae, the location in a water column where larvae would most likely be found, the potential for larval passage through a 20&micro;m filter, and the ability of the larvae to survive outside the slug/snail host. Whole <i>P. martensi</i> shed many, viable <i> A. cantonensis</i> larvae with >90% of larvae found in samples taken from the bottom of the water column, suggesting they may settle near the bottom of a catchment tank. Larvae that were able to pass through a 20&micro;m sieve could not survive acid, were active for at least 56 days outside the slug host, and tested positive for RLW by qPCR. Larvae that could not pass through a 20&micro;m sieve were able to survive HCl-pepsin, were active for at least 21 days, and tested positive for RLW. First stage larvae can survive gut acid when swallowed after migration from the lungs but cannot withstand acid immersion again until they become third stage larvae.The study results merit further investigation into the potential link between poorly maintained rainwater catchment systems and the high incidence of RLWD on Hawaii Island, and the studies clearly demonstrate the need for control of hosts of <i>Angiostrongylus cantonensis.</i> </p><p> Hawaii&rsquo;s remote location makes food security an important issue. State-wide efforts to promote the Grow Local, Eat Local movement are reflected in the growing number of residential gardens, small farms, farmers&rsquo; markets, school and youth garden projects, and the recent passage of the Farm to School Bill. However, efforts to educate farmers, food handlers, and consumers about rat lungworm disease and the need for disease prevention and host control has not been similarly supported. In collaboration with five partner schools on Hawaii Island, the University of Hawaii, Daniel K. Inouye College of Pharmacy&rsquo;s Hawaii Island Rat Lungworm Working Group worked with students and teachers to develop an integrated pest management plan for school garden projects. Integrated pest management allows for the careful consideration of applications available to control a pest event and chooses those practices that are least harmful to human and environmental health. These best practices include preventative cultural practices, monitoring, mechanical control, biological control, and the responsible use of pesticides. Students were intensively educated about RLWD, the parasite&rsquo;s life cycle, and prevention measures. Using best management practices, we set up traps and collected data on gastropod species abundance, and shelter-type capture rate. Integrating STEM curriculum makes the project attractive to schools as it supports student academic success. Adoption of this management project by the many school and youth garden projects in areas of RLWD can exponentially increase community awareness, encourage control efforts, and potentially map disease risk.</p>

<p> Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew&rsquo;s health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (<i>p</i> &lt; .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.</p>

<p> Nurses at a suburban northeastern U.S. community hospital reported that they felt unprepared to effectively respond to a pediatric emergency. Empirical data were not available to identify if this local problem was due to a lack of the nurses&rsquo; self-confidence or if other factors were involved. The purpose of this study was to determine if there were relationships between nurses&rsquo; self-efficacy in pediatric emergencies and their knowledge of pediatric emergency care, as well as their years of clinical experience, nursing education, pediatric life support certification, specialty certification, and caring for pediatric patients. In addition, the research questions guided the investigation to determine if any of the variables could predict nurses&rsquo; self-efficacy in pediatric emergencies. The theoretical framework was based on Bandura&rsquo;s social learning theory, which incorporates the concept of self-efficacy, as well as Zimmerman&rsquo;s self-regulated learning theory. A quantitative correlational design was used with a convenience sample of 37 nurses. Self-efficacy was measured with the General Self-Efficacy Scale and knowledge was quantified using a 32-item researcher-developed instrument. The data were analyzed using multiple regression analysis and correlations. Results showed that none of the variables predicted self-efficacy; however, years of nursing education, pediatric life support certification, and clinical experience were all significantly related to knowledge. Based on the results, a 3-day educational program was developed to address pediatric emergency practice. The results of this study can direct positive social change by informing future nursing education and training efforts in order to improve the medical outcomes of pediatric patients.</p>

<p> Medication administration is an important task performed daily by nurses and is one of the key aspects of safe patient care. The multiple and varied roles of nurses, complexity of workplace, chaotic and technical nature of the work environment may result in cognitive overload that may overwhelm nurses, which may possibly lead to medication errors. All medication errors committed are considered serious events but some may consequently be harmful to patients. Research indicates that when medication errors occur the concern is usually for the patients involved in the incident. However, making a medication administration error has a lasting effect on the nurse as well as the patient (Schelbred &amp; Nord, 2007; Treiber &amp; Jones, 2010).</p><p> This study examined what it was like to make a medication error for eight registered nurses through in-depth and focused face to face interview using the descriptive phenomenological approach rooted in the philosophical tradition of Husserl. Two interviews were carried out with each participant and the research data were generated from a total of sixteen interviews and field notes. The transcripts were analyzed using the seven-step methodological guidelines developed by Colaizzi for data interpretation to understand the meaning of the nurses lived experiences of making medication errors.</p><p> Five theme categories emerged: Immediate <i>Impact: Psychological and Physical Reactions; Multiple Causes within Chaos: Cognitive Dimensions; Embedded Challenges: Healthcare Setting; Organizational Culture: Within the Place/Within the Person; Dynamics of Reflection: Looking Forward</i>. The essential structure of the phenomenon of making a medication administration error included the realization that a profound experience had happened to them. This resulted in physical and emotional upheavals, a threatened professional status, with low self-esteem and confidence. An overwhelming workload, a stressful work environment and ill-treatment by peers were descriptions of the cause of the errors. Nurses did offer ways to improve the system but felt their concerns were often not valued. Implications for nursing practice to improve patient outcomes, and for nursing education, to radically change the teaching of medication administration were formulated.</p>

<p> Lifelong learning in professional communities is changing to adapt to professions in the anesthesia field with input from the public and various stakeholders. An extensive review on learning styles identified a gap in literature, specifically evidence on sensory learning styles among adult professionals. Changes in Certified Registered Nurse Anesthetist (CRNA) recertification requirements, most importantly the incorporation of an assessment component, prompted the research to address CRNA enhancement methods in learning. The main purpose of the current study was to contribute to the body of literature if a CRNA&rsquo;s knowledge of sensory learning styles mix influences test score achievement. The posttest-only control-group design was utilized, wherein a Sensory Learning Styles Self-Assessment (SLS-SA) instrument was piloted to establish content validity and internal reliability prior to its application with the treatment group. The American Association of Nurse Anesthetists (AANA) Learn&rsquo;s Health and Wellness Module 1 provided the 10-hour posttest, which measured the test score achievement among participants. An analysis of variance (ANOVA) was conducted and yielded a nonsignificant effect of the current study&rsquo;s treatment on test score results among CRNAs. Interaction effects of the CRNAs&rsquo; gender and years of practice were also examined, which produced the same results (e.g., not significant). No effect was established in the current research, however, several research limitations were identified and specific outcomes on an individual participant level were acknowledged, which were recommended to substantiate further research. </p>