The purpose of this mixed methods study was to describe the cognitive processes/knowledge sources used by Emergency Department (ED) nurses in decision-making activities regarding triage and pediatric pain assessment and management. Deficiencies persist in ED pediatric pain assessment, and management methods or approaches that might help resolve these deficiencies have not been identified previously. Methodology triangulation with sequential use of qualitative- quantitative methods provided a rich description of knowledge sources and cognitive processes used by ED nurses relative to pediatric pain assessment decisions. Based on qualitative results, a set of vignettes was developed to assess ED nurses. Data analysis using ordinal logistic regression with a cumulative logit model identified patient and nurse variables which influence triage acuity decisions. Five common themes emerged from the qualitative data; 1) Age of the child is important, 2) Behavior can tell a lot, 3) Really looking at the patient, 4) Things that help make decisions, and 5) Things that hinder decisions. Ordinal logistic regression analysis of the quantitative data identified predictor variables of infants compared to school-age children, Hispanic ethnicity, moderate number of years of ED experience (11 -20 years) and years of education that were associated with higher triage levels .The implications of this new knowledge include changes in ED triage nurse practice towards pain assessment, and increased awareness of the need for education in use of pain assessment tools. Additional implications include education related to pain management practices by ED physicians and pain medication protocols at triage. This information may enhance triage and care of the pediatric patient experiencing pain, expand the knowledge base of emergency nursing, identify areas in which to implement changes, assist in improving care provided to children experiencing pain, and provide direction for future education, training, and research.

The objective of this thesis is to develop a maintenance approach that fulfills the requirements of Industry 4.0. It explores the role and importance of maintenance activities in today’s industry. Then, it develops the features and tasks required to be performed by maintenance to fulfill the demands of Industry 4.0. Finally, it develops a reference model to be used in designing maintenance system for Industry 4.0. To perform these studies, real data were collected and applied as well as a typical scenario was implemented. The results achieved in the papers of this thesis are 1) a mathematical representation and application of a model that identifies, analyses and prioritizes economic weakness in working areas related to production, 2) a model that analyses, identifies and prioritizes failures that impact the competitive advantages and profitability of companies, 3) characterization of a suitable maintenance technique for Industry 4.0 and 4) a reference model i.e. a framework, that could be utilized to develop a maintenance approach for Industry 4.0. The conclusion of this thesis confirms that maintenance has a significant impact on companies’ competitive advantages, other working areas and profitability. To achieve a suitable maintenance technique for Industry 4.0, this technique must be able to monitor, diagnose, prognosis, schedule, assist in execution and present the relevant information. In order to perform these tasks several features must be acquired, the most important features are to be: digitized, automated, intelligent, able to communicate with other systems for data gathering and monitoring, openness, detect deviation in the condition at an early stage, cost- effective, flexible for adding new CM techniques, provide accurate decisions and scalable. The developed framework could be used as a base to design a maintenance system for Industry 4.0. This study contributes to our understanding of the maintenance importance in today’s industry and how to develop a maintenance approach for Industry 4.0.

Municipal leaders in the United States face difficult decisions when prioritizing nonmandated civic projects for funding, especially when operating budgets are restricted. This phenomenological study investigated municipal leaders' decision-making processes in a state in the southern United States, using a conceptual framework based on rational choice theory, bounded rationality, and group decision-making theory. It specifically explored personal and organizational decision-making processes related to the prioritization and funding of nonmandated civic projects via in-depth interviews with a convenience sample of 15 municipal leaders. Thematic analysis identified expert opinions, the time and cost to complete a project, the perceived value relative to expense, and the availability of additional funding sources as themes important to understanding participants' decision-making processes. Organizational factors that were important in these decisions included the need for clearly defined responsibilities and consistency in funding decisions. No clearly defined organizational processes were in place in any of the participants' municipalities, and the participants noted that areas such as infrastructure improvements, traffic congestion, community involvement, and formal processes in their municipalities were in need of improvement. Positive social change can flow from greater governmental transparency through municipal decision makers' adoption of systematic decision-making systems and processes. Positive social change can also result from greater inclusiveness through increased public outreach efforts. Results add to the research base by contributing to a better theoretical understanding of organizational decision-making processes in the municipal context.

This project looks at the development and use of a new delivery system for broadcast television news and its relation to the Uses and Gratifications and Push/Pull Theories. An in-home study of interactive news was conducted for two weeks, allowing people access to three local and 5 national newscasts via one interactive newscast. Users were able to access the interactive newscast whenever and however they wanted via their television or computer, as long as they had an internet connection. The results of this study show how the system was used,what specific actions were taken, and where the potential lies for further research.

Following the enactment of the Affordable Care Act (ACA) in 2010, politicians, media, and lobbyists rendered a number of conflicting and confusing interpretations of its merits and demerits. Such interpretations intensified the skepticism and concerns of small business enterprise (SBE) owners. The purpose of this study was to develop a representative, prioritized list of SBE owners' concerns or resistance factors. The goal was to create a useful guide for SBE owners who are seeking ways to reducing the adverse financial impact of the law. With social choice theory as the theoretical framework, 50 randomly selected SBE owners across 5 distinct industry groups from Richmond, Virginia, participated in an online, cross-sectional, pairwise comparison survey. The overall results of an analytic hierarchy process indicated that the top-ranked resistance factor of SBE owners was insurance premiums, followed by quality of care and the tax burden. However, these rankings were not uniform among industry groups. With a focus on these crucial concerns, SBE owners could benefit by seeking approaches to reduce the business costs of health care. The implications for positive social change include the potential for business organizations, researchers, and policymakers to channel SBE owners' voice for a socioeconomic growth by addressing their concerns in seeking improvements from the ACA.