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Accident and Injury Prevention in Children of Mothers Struggling with Substance AbuseMary P. Curtis, PhD, RN, ANPGoldfarb School of Nursing at Barnes Jewish College

Margaret Bultas PhD, RN, CPNP-PCSt. Louis University School of NursingBackgroundChildhood unintentional injuries are the leading cause of death among children ages 1-19 yearsThere are an estimated 8.7 million children and teens (birth to age 19) that are treated in Emergency Departments for unintentional injuries An estimated cost of $87 billion dollarsMore than 9,000 die as a result of their injuriesone every hour

Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2012)PreventableUnintentional injuries are preventable and predictableChilds development cannot be alteredParents can be taught to assess their childs environment in order to reduce injury risks

Study AimsTo identify the causative risk factors for accidents and injuries in children of mothers who are struggling with substance abuse To identify new strategies to prevent accident and injuries in this population.

Theoretical FrameworkPenders Revised Health Promotion Model (2006)

"The HPM attempts to depict the multidimensional nature of persons interacting in their interpersonal and physical environments as they pursue health" (p. 50).

Source: Pender, , Murdaugh, & Parsons, 2006 Pender's 1996 revised Health Promotion Model (HPM) (Pender, Murdaugh, & Parsons, 2006), served as the conceptual framework for this study. "The HPM attempts to depict the multidimensional nature of persons interacting in their interpersonal and physical environments as they pursue health" (p. 50). One of Pender's major assumptions is that individuals in all their psychosocial complexity interact with their environment, progressively transforming the environment while at the same time being transformed.In attempting to influence health-promoting behaviors, Pender's model advocates being cognizant of the individual's characteristics and experiences, including biological, psychological, and sociocultural factors. Predicting of future health-promoting behavior begins with developing awareness of relevant past behavior, and then identifying behavior-specific cognitions and affects. These variables are considered to have major motivational significance because they are subject to modification. The individual variables of perceived benefits of action, personal barriers of action, perceived self-efficacy, activity-related affects, situational influences, and interpersonal influences can be modified to increase health-promoting behaviors.Self-efficacy is defined as the judgment of personal capability to organize and carry out a particular course of action. Activity-related affect is the subjective feelings prior to, during, and following an activity. Interpersonal influences include behaviors, beliefs, and attitudes of others. Pender considers the primary sources of interpersonal behaviors to be family, peers, and health care providers. Behavior-specific cognitions and affects are influenced by immediate competing demands and preferences that can lead to a commitment to a plan of action and to health-promoting behavior, which is the desired outcome of the HPM. An important theoretical assertion of Pender's model is that families, peers, and health care providers are important sources of interpersonal influences that can increase or decrease commitment to and engagement in health-promoting behavior.

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Site

Queen of Peace Center A comprehensive family-based behavioral health center for women struggling with substance abuse Gender focused female recovery center

Study Methods & ProceduresMixed methodsPre-Test Post-Test evaluation after attending a parenting classHome Simulation ActivityPhotovoice Parenting ClassAccident and Injury PreventionBasic First Aid1.5 hoursAttend as part of their treatment program

Simulation Activity

Goldfarb School of Nursing sponsored vanParticipants walk through a simulated home environment and identify hazards

Home Simulation Activity

Intentional Hazards

Intentional Hazards

PhotovoiceHome Safety ChecklistTake pictures of the hazards that they identify in their home or the community in which they liveNo pictures at QOP or any QOP sitesNo pictures of people No pictures of childrenParticipatory action research method in which individuals photograph their everyday health and work realities

Wang & Redwood-Jones, 2001.PhotovoiceInitially developed by Wang & Burris in 1994, to support a Womens Reproductive Health and Development Program in Yunnan, China. 1. Enable people to record and reflect on their personal and their communitys strengths and concerns2. Promote critical dialogue and to enhance knoweldge about issues through group discussions of photographs3. Reach policy makers

Disposable CameraHome Safety ChecklistTake pictures of the hazards that they identify in their home or the community in which they liveNo pictures at QOP or any QOP sitesNo pictures of people No pictures of children

Interview Pictures developedSecond interview focuses on the stories of the picturesStrategize and assist them with making their environment saferSample Interview QuestionsTell me about some of your pictures that you took.What do you feel was the most important information that you gained from the safety class or home simulationHave you used any of the first aid that was taught? How confident do you feel about providing basic first aid?Have you made any changes in your home or environment because of what you learned in the class?Have there been any accidents or injuries for your child(ren) since we last met?

Compensated for their timeGift card for first interview and home simulation activitySecond gift card for returning camera and second interview.$20.00 Gift Card to Walgreens each time

ResultsClass taught 12 times134 mothers attended the classes87 Pre and post tests returned from the class. 55 mothers agreed to participate in the home simulation26 mothers completed the photovoice 2nd interview

Of those 87 women, 55 of them agreed to participate in the simulation part of the study. That is 63% of those that completed the classroom pre-post test activity.

Of those 55 women who completed the simulation and interview, 26 have completed the last phase of the study. This last phase is where they went to their home environments and photographed pictures of hazards that could result in an injury to their child or others.

So 30% of the women who completed the pre and post test class activity completed the entire study. 19ParticipantsParticipant ScoresN = 52 ParticipantsScore RangeTest Average in PercentageMean ScoreSDWritten Pre-Test0-3245.4%14.545.21Written Post-Test0-3255.7%17.834.33Home Simulation 0-3158.6%18.174.77Overall, test scores improved during the enrollment in the study (See Table). Written test scores had a possible 32 points and the home hazard simulation score had a possible 31 points. Test averages for the written pre-test was 45.4% and the average written post-test score was 55.7%. The average home simulation score was 58.6%. When comparing written pre-test, post-test, and home simulation scores, there was a significant increase in the written pre- and post-test scores after participants engaged in the home injury classroom intervention (p = 0.000). There was also a significant increase in the written pre-test score compared with the home simulation score (p = 0.001). There was no significant difference between the written post test score and the home simulation score. Results can be found in Table 2.

21Paired Sample for ComparisontdfSignificanceWritten Pre- Test and Written Post- Test-5.156510.000Written Post- Test and Home Simulation Score -0.404510.688Written Pre- Test and Home Simulation Score-3.662510.001When comparing written pre-test, post-test, and home simulation scores, there was a significant increase in the written pre- and post-test scores after participants engaged in the home injury classroom intervention (p = 0.000). There was also a significant increase in the written pre-test score compared with the home simulation score (p = 0.001). There was no significant difference between the written post test score and the home simulation score. Results can be found in Table .

22Simulated Activity Results for Selected ItemsItemParticipants Identifying HazardN= 52% of Participants Infrequently Identified ItemsPurse Left Out1528.9%Electric Cords Hanging 1528.9%Box of Toy Beads Out1426.9%Frequently Identified ItemsCurling Iron Out4382.7%Hair Dryer Out4484.6%Iron Left Out4586.5%Several items in the home hazard simulation activity were, in general, infrequently identified (See Table). These items included purse being left out and open, electrical cords hanging down, and a box of beads open and left out. There were three hazards frequently identified by participants in the home hazard activity. They included a curling iron, a hair dryer, and an iron all left out and in reach. 23General Themes from Recorded Interview #1Lots of stories of burns and burn injuries in the home LightersCurling IronsHot PlatesIronsKitchen Scalds from not liquids and foodsPedestrian InjuriesAnimal bitesSuffocation

Photographs-- Clutter

Photographs Kitchen Hazards

PhotographsBathroom Hazards

PhotographsOutdoor Hazards

Sample Quotes/StoriesMy son he was in the room and I was in the living room and he got a hold of some curling irons and burned his leg. I kind of felt like an irresponsible parentMy son was 1 years old, climbed up on the table to get the oatmeal, and the oatmeal had fell and he had on a t-shirt and not no pajamas and the oatmeal had scalded on his left thighActually it wasnt my fault, but the gas can was left in my back yard, my husband was cutting the grass over the weekend and I had children I was babysitting for as well. One of the neighbor kids came down the hill and got a hold of the gas can and dumped it on top of one of the toy cars and I guess he had matches or something and my daughter who was like 4 told him dont do that, which he did. He set it on fire and he caught himself on fire, and we got sued because the gas can should've been put upInjuries from Falls

I had a one year old and my aunt had these steps, probably 14 steps, we didnt have any childproof gate up and shes very determined to go up the steps. We was downstairs on the lower level and she takes it upon herself to go up the steps all the time and I guess I got kind of off doing something else where I wasnt really paying attention to her. She went up all them steps and she came tumbling down. My cousin seen her but she couldnt catch her in time. So she fell, she skipped like the first half of the steps and then kind of hit down and then hit to the floor. We rushed her to the hospitalInjuries from Falls..My child fell down the stairs because there was a bucket of mop water and it was slippery and she fell down the stairs, that all I can rememberI went downstairs to answer the door. One door came from the kitchen and then you do down the staircase and then there's the back door. So I went downstairs to answer the door and forgot that she could walk, and to close, because it was just me and her at home, and I forgot that she could walk and she moved just that quickly and she fell down the steps

Automobile InjuriesMy 9 year old grandchild was hit by a car when he was 6 my daughter pulled up in front of the school and the teacher be in the yard and let them out the back, and he said there go my mother right there and the teacher aw and just waved and he started running. Well he ran out in the street and a car, it was a one way street, was coming and hit him. She said she was looking out the rearview mirror and saw the car coming and saw him and she was like up oh, hes gonna get hit by a car and bam!

Dog BitesDog always did well with the children, but one day she had a sucker in his hand an the dog, I guess, wanted the sucker instead and so it went to lick at her hand, I guess she wouldnt let go so it tried to lift up on her hand and got his tooth lodged in her hand. The tooth severed the tendon inside of her hand, so we left there, we went to the hospital and she got an infection in her hand, her hand swelled all the way to her elbow.

Suffocations..she didnt have a crib and she had been sleeping in another room, there were two mattresses but no box spring and no headboard. So she slept on the mattress, so when I got ready to put the baby to sleep, I had a water bed and I also had two other girls, they were younger at the time, in the bed, and I didnt want the baby to get hurt with us in the bed. So I put the baby to sleep in the room on the bed, like I always do, set her in the middle of the bed, and she had scooted or rolled or something, and I woke up, I gave her the last bottle, and when I woke up in the morning she had rolled in between, she was in between the mattress and the wall, she had suffocated.Thank you!