published_or_final_version / Public Health / Master / Master of Public Health

Thesis (Ph.D.)--George Mason University, 2008. / Vita: p. 144. Thesis director: P. J. Maddox. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing. Title from PDF t.p. (viewed July 3, 2008). Includes bibliographical references (p. 129-143). Also issued in print.

Thesis (DR. P.H.)--University of Michigan.

Thesis (DR. P.H.)--University of Michigan.

Caregivers often associate fevers with permanent harm and bring children to emergency departments (EDs) unnecessarily. However, families using EDs for nonurgent complaints often have difficulty accessing quality primary care. Mutual misconceptions among caregivers and healthcare providers regarding nonurgent ED use are a barrier to implementing meaningful interventions. The purpose of this project was to identify dominant themes in caregivers’ narratives about bringing children to the ED for nonurgent fevers. Thirty caregivers were recruited in a pediatric ED for participation in qualitative semi-structured interview from August to November 2014. Interview transcripts were coded and analyzed for themes. Caregivers’ decisions to come to the ED revolved around their need for reassurance that children were not in danger. Several major themes emerged: caregivers came to the ED when they felt they had no other options; parents feared that fevers would result in seizures; caregivers frequently drew on family members and the internet for health information; and many families struggled to access their PCPs for sick care due to challenging family logistics. Reducing nonurgent ED utilization requires interventions at the individual and structural level. Individual-level interventions should empower caregivers to manage fevers and other common illnesses at home. However, such interventions may have limited impact on utilization outcomes among families with poor access to primary care. Afterhours primary care should be expanded to accommodate families with rigid work schedules and limited transportation resources.

Unintentional injuries are the leading cause of death for children aged 5-19 Twenty-two million children are injured each year and approximately one quarter of these injuries occur on school premises. Schools must provide nursing services to children who attend school, but ratios of registered nurses to students is higher than the 1:750 recommended ratio. Current school teachers believe pre-service teachers should be trained in emergency care in teacher training programs. Yet, no research has been conducted to evaluate pre-service teachers’ knowledge and attitudes toward emergency care. The purpose of the study was to investigate pre-service teachers’ knowledge of and attitude toward emergency care in the school setting. A cross sectional group-comparison survey design was used. A 40-item questionnaire was administered to pre-service elementary teachers at Ball State University located in Muncie, IN. The questionnaire consisted of questions from “Emergencies in the school setting: Are public school teachers adequately trained to respond?” and Urban public school teachers’ attitudes and perceptions of the effectiveness of CPR and automated external defibrillators. Sub-group comparisons were made using bivariate and multivariate analyses of similar demographic, attitude, and knowledge questions. Findings indicated that pre-service teachers have a positive attitude toward emergency care, low levels of knowledge about emergency care, and a low level of willingness to provide emergency care in schools. In addition, when comparing pre-service teachers who had received emergency care training to those who did not, a statistically significant difference was found in their knowledge about emergency care. Emergency care training has limited influence on pre-service teachers’ attitudes and willingness to provide care. / Department of Physiology and Health Science

This dissertation examines how newborn medical care was institutionalized in hospitals across the United States between 1930 and 1980. Over that time, newborn medicine evolved from a relatively neglected domain of pediatrics into one of its most crowded arenas, anchored by new neonatal intensive care units (NICUs) where round-the-clock, high-tech care was provided to critically ill and premature newborns. Rather than focusing on therapeutic developments, “Newborn Country” uses space and place as analytic optics to understand the rise of the NICU. It argues that the course of newborn medicine was set in the process of answering questions about how to construct safe hospital environments for newborns and how to distribute specialized newborn care across a fragmented national landscape of hospital-centric medicine. Specific techniques of governance, from infection control protocols to health planning agendas, as well as their uneven and often unequal application, structured the spaces of promised health and healing that American newborns and their caretakers have moved through. The transition of birth from the home to the hospital demanded new spaces for newborn care, the safety of which were quickly cast into question by epidemics of hospital-associated infections. The organized response to these infections relied on the reallocation of hospital space through a gendered paradigm of aseptic discipline, but this paradigm fell apart in the face of hospital spaces defined by regimes of socioeconomic and racial segregation. In the 1950s, antibiotic-resistant infections in hospital nurseries challenged prevailing infection control strategies, exposing the porous boundaries between hospital environments and their surrounding communities and encouraging institutions to surveil their built and social ecosystems more actively. As antibiotic-resistant nursery infections waned in virulence in the early 1960s, freedom from the threat of infection opened the possibilities for newborn care. It facilitated new arrangements of space, labor, and neonatal patients that challenged norms of hospital safety but held immense promise for saving newborn lives. “Newborn Country” also considers the politics of organizing and distributing specialized newborn care, beginning with systems of emergency transport organized for premature infants in the 1930s and 1940s. Both emergency medical services and specialized newborn care were caught up in a wave of enthusiasm for “regionalizing” medical services within defined geographic areas in the 1960s. Hospitals enacted “perinatal regionalization” by creating hierarchical networks of care connected by a circulatory system of newborn transportation. In the 1970s, perinatal regionalization remade geographies of care under the new banner of perinatal health. As the decade came to a close and NICUs were increasingly identified as a source of institutional profit and prestige, perinatal regionalization became a contested stage for the spatial politics of allocating hospital resources.

The purpose of this current study is to examine the impact of non-pharmacologic pain interventions administered by trained Child Life professionals in an emergency department on pain perception in children. Results showed no significant decrease in children's pain report during the medical procedure compared to before the medical procedure. However, pain after the medical procedure is significantly less than pain during the medical procedure.