Purpose: Compare the efficacy of two benzodiazepines (diazepam or midazolam) in combination with meperidine and hydroxyzine for pediatric dental sedation. Methods: A randomized, double blind observation study of behaviors and outcomes related to two sedation groups. Frankl and Houpt behavior scores were recorded at three time points: injection time, initiation of treatment and at the end of treatment. Postoperative phone call surveys were conducted within eight hours of discharge to assess sleep, activity, and behavior. Results: A total of 40 sedation subjects were included in the study, of which 20 were treated with diazepam triple Combination (Di+M+H) and 20 with midazolam triple regime (Mi+M+H). Treatment was successful for 45% of cases with midazolam and 70% with diazepam (P value=.20). Houpt sleep scores were significantly higher for diazepam than midazolam at injection (P-value=.0043) and during treatment (P-value=.0152). Although Frankl scores, Houpt move and Houpt cry scores tended to favor diazepam, none were statistically significantly different. More abnormal behavior was reported with midazolam, though not statistically significant (35% vs 6%, P-value=.0854). Postoperative sleep time was longer for midazolam, but not significantly different (median sleep time: 61 vs 45 minutes, P-value=.2071). Conclusion: The diazepam, meperidine, hydroxyzine triple combination sedation regimen shows promising results as a successful alternative to midazolam triple combination. Longer postoperative monitoring may be required with diazepam, but this study has shown postoperative sleep times to be less than previously reported. Larger sample size is needed to determine if the current trend will be maintained.

USE OF EMOJI IN PAIN LEVEL ASSESSMENT IN PEDIATRIC DENTAL PATIENTS Purpose: The purpose of this study is to determine the efficacy of a pain scale with Emoji images in comparison to the commonly used Wong-Baker FACES® pain scale. Methods: Healthy, English-speaking patients aged 4-17 presenting to the VCU Pediatric Dental clinic and the operating room and presenting to the MCV Pediatric Emergency Room were asked to rate their pain using the Wong-Baker FACES® and Emoji scales. These patients were then asked to select which pain scale they preferred. Results: A total of 151 children were enrolled in the study. The proposed Emoji scale was preferred by 86% of enrolled children (n=151). Children rated their pain the same on the two scales 78% of the time indicating a weak overall agreement between the two scales as defined by Cohen’s Kappa (k=0.5863, 95% CI: 0.47-0.70). In the instances of disagreement, 82% were within one image on the pain scale. There was a roughly even split between which scale corresponded to the higher pain level (56% Wong-Baker was higher and 44% Emoji was rated higher). Conclusions: A majority of the patients surveyed presented with no pain. The Emoji scale showed moderate agreement with the Wong-Baker FACES scale. A majority of the patients preferred the Emoji scale demonstrating the strong communicative utility of Emoji.

Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury.Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Therefore this research has the potential of informing the speciality practice of acute care pediatric nursing.Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse "works with" the child to maintain and advance medical stability. Nursing interactions are an important part of "working with", communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate.An effective working-relationship with a nurse and family is founded on trust. Trust is an accepted part of our day-to-day lives and how to develop a trusting working-relationship with the child and family has not been explored prior to this research. Grounded theory methods supported the process of exploring the social processes of "building trust" whilst "working with" families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to "work with" and support the re-establishment of the parenting role. The "stepping in and out" of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to "be with", using chat to get to know each other, involving and supporting the family to parent a "different" child and reassuring and giving realistic hope to help the child and parents cope with their changed future.A substantive theory of the concept of "building trust to work with" has been developed using grounded theory methods. The theory has been conceptualized using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident.

Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury.Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Therefore this research has the potential of informing the speciality practice of acute care pediatric nursing.Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse "works with" the child to maintain and advance medical stability. Nursing interactions are an important part of "working with", communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate.An effective working-relationship with a nurse and family is founded on trust. Trust is an accepted part of our day-to-day lives and how to develop a trusting working-relationship with the child and family has not been explored prior to this research. Grounded theory methods supported the process of exploring the social processes of "building trust" whilst "working with" families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to "work with" and support the re-establishment of the parenting role. The "stepping in and out" of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to "be with", using chat to get to know each other, involving and supporting the family to parent a "different" child and reassuring and giving realistic hope to help the child and parents cope with their changed future.A substantive theory of the concept of "building trust to work with" has been developed using grounded theory methods. The theory has been conceptualized using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (156 leaves, ill., 30 cm.) in North Shore Theses Collection. (T 618.920028 HAL)

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M. Phil.)--University of Hong Kong, 1994. / Includes bibliographical references (leaves 192-201).

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (MSc.(Anatomy)--Faculty of Health Sciences)-University of Pretoria, 2004. / Summary in English and Afrikaans. Includes bibliographical references.