Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Pain is an inherently subjective experience and should be assessed and treated as such; however, it is well documented that pediatric pain remains under assessed and under treated by nurses and healthcare professionals. To treat pain adequately, ongoing assessment of its presence and severity is critical to improving outcomes for pediatric patients. Although reliable, valid, and clinically sensitive assessment tools are available to healthcare providers, self-report is considered the "gold standard" to assess pain given its subjective nature. Children, particularly those between 1 and 7 years of age, are one of the most vulnerable populations with respect to poor pain management. Due to progression of cognitive development, they often lack the verbal fluency or vocabulary needed to describe the location, radiation, quality, and intensity of the pain they experience. As a result, pain often goes under treated; and, studies reveal that inadequately treated pain can have a detrimental impact on the course of childhood development. In order to prevent mismanagement of pain, parental pain reports are often used when self-report is inadequate or unable to be provided. This thesis provides a comprehensive review of research literature regarding the role of the parent in pediatric pain assessment and the ability of parents to serve as a proxy in reporting pain for their child. Studies included methods and behaviors parents use to assess their children's pain; parental assessment with use of clinically reliable pain measurement tools; and, comparisons of parental pain assessments to those made by nurses and healthcare professionals. The findings of the review of literature were used to make recommendations for nursing research, education and clinical practice.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Purpose: The purpose of this study is to determine the impact that the introduction of articaine has had on local anesthetic selection by general and pediatric dentists for use in three different age groups of children.Methods: Using a cross sectional survey design, a questionnaire regarding the use of local anesthetics in children was mailed to a random sample of 500 general dentists from North Carolina, 500 general dentists from Virginia, and all 230 pediatric dentists from North Carolina and Virginia. The 16-item questionnaire included questions regarding the preferred local anesthetic to use in three different age groups, 2-3 years of age, 4-6 years of age, and 7-10 years of age. Furthermore, the questionnaire also included questions specifically on articaine use in the three different age groups and any related side effects. The association between dental practitioner type and anesthetic use was tested using chi-square or Fisher's exact test.Results: A sample of 337 dentists completed the questionnaire. There was no significant difference in preference of articaine except in older patients aged 7-10 years old where general dentists prefer articaine significantly more than do pediatric dentists (28.1% versus 15.9%). Lidocaine with epinephrine was the local anesthetic that was most preferred in all age groups by all practitioners. Pediatric dentists preferred lidocaine more often than general dentists and general dentists preferred lidocaine without epinephrine more often than pediatric dentists. Twenty-one percent of all dentists surveyed have used articaine in children under 4 years of age and 13% list articaine as the preferred local anesthetic for children under 4 years of age.Conclusion: While lidocaine with epinephrine is still the preferred local anesthetic for use in children, the use of articaine in children is very prevalent among general and pediatric dentists. Articaine use becomes more prevalent as the age of the patient increases and many pediatric and general dentists are using articaine in children under four years of age.

Purpose: To assess dental students and pediatric dental residents’ knowledge and attitudes towards motivational interviewing and evaluate the efficacy of a pediatric-focused brief motivational interviewing training program. Methods: A total of 66 participants were enrolled; 35% were third year dental students, 46% were fourth year dental students and 18% were pediatric dental residents. Participants completed three questionnaires: the first before the training, the second immediately after the training and the third approximately 3.5 months after the training. Results: A significant increase in correct responses was found for 4 of the 5 questions assessing participants’ knowledge. Participants were satisfied with the training (94%) and were interested in further training (89%). Participants believed patients and their parents would benefit from the intervention (97%). Conclusions: The pediatric-focused BMI training program is a valuable addition to pre-doctoral and residency curricula by preparing students and residents to employ this beneficial technique.

Missed nursing care, according to Kalisch and Williams, is nursing care that is not completed to the highest quality of care, leading to an increase in hospital costs and poor patient outcomes. Missed nursing care can occur with any patient population; however, a survey by Kasich called the MISSCARE Survey has only been used in the adult and neonatal populations. Pediatric patients are a diverse and complex subset of the population, differing greatly from the adult and neonatal populations, thus identifying a need for a focused pediatric survey to effectively study missed nursing care in the pediatric setting. The purpose of this research, therefore, was to create and validate a pediatric nursing care survey A convenience sample of 10 pediatric experts completed the Expert Panel Survey to determine a content validity ratio (CVR) and content validity index (CVI) of a modified, MISSCARE Survey (Kalisch & Williams, 2009). Items determined to be essential by ninety percent or more of the participants (CVR> 0.78), were included in the MISSCARE-Pediatric Survey. Results showed that the CVI of the MISSCARE-Pediatric Survey determined by the Expert Panel was 0.9, meaning the items are essential to the pediatric population (Gilbert & Prion, 2016a). The created MISSCARE-Pediatric Survey includes 18 questions in section A (Types of Missed Nursing Care), 28 questions in section B (Reasons for Missed Nursing Care), and 9 questions in Demographics. Future research will determine content reliability of the MISSCARE-Pediatric Survey.

Pediatric obesity has become a major health care concern over the last several decades. This condition can lead to detrimental life-long physical and mental comorbidities. Pediatric primary care providers have a unique opportunity to both prevent and treat pediatric obesity in their clinics. However, discussing this topic with families can be uncomfortable and time consuming. Time efficient resources to educate and increase confidence are needed to improve the management of pediatric obesity. This quality improvement project integrated the Healthy Care for Healthy Kids by the National Institute for Children's Healthcare Quality (2014) into the electronic medical record at a pediatric primary care office in rural East Tennessee. This toolkit included handouts, management algorithms, and provider education for pediatric obesity. After an 8-week implementation period, improvements in lab draws and evaluation of a family's readiness to change were noted. Overall, providers reported the toolkit was helpful and improved patient interaction. Currently, the clinic is still utilizing the integrated resources and handouts.