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Are Ball Pits the Playground for Potentially Harmful Bacteria?(fast food restaurants’ children play areas)

Pediatric Nursing March 1, 1999 | Davis, Sandra G.; Corbitt, Amy M.; Everton, Virginia M.; Grano, Catherine A.; Kiefner, Pamela A.; Wilson, Angela S.; Gray, Mark Ball pits are popular recreational equipment located within admission-free play areas at fast food restaurants. These ball pits were created as safe, secure play environments to entertain and occupy children during their meal. Padded floors and pits of small plastic balls reduce the risk of serious injury when compared to traditional outdoor playgrounds (see Figure 1).

[Figure 1 ILLUSTRATION OMITTED] The cleanliness of the play areas at admission-free, fast food restaurants is an important health and safety issue for children. Presently, cleaning protocols have not been established or implemented within these ball pits. Pits contain hundreds of colorful, plastic balls that children slide into, jump onto, or bury themselves within, making them a popular attraction and a perfect place for microorganisms to breed. The high turnover of children who play in the ball pits, the close contact that children have with each other, and the difficulty of disinfecting every ball within the ball pits pose a potential public health risk within the pediatric population.

Statement of the Problem The popular ball pits located within fast food restaurants across the country may be one of many culprits responsible for the spread of disease within the pediatric population. Through observance of the children and casual surveys of the caregivers, the researchers discovered that children who attended the ball pits had a higher incidence of illness after playing in the ball pits. This suggested that there was something within the ball pits placing the children at a higher risk for disease.

The ball pits are constructed with an inadequate drainage system, which may allow fluids to accumulate in the bottom of the ball pit. The researchers suspected a lack of cleanliness and a high level of normal human flora within the ball pits. They also suspected there would be some nonhuman flora present within one of the ball pits due to the close proximity to a local petting zoo.

Though most bacterial organisms are harmless in low numbers, there is a level that when reached can give these bacteria disease-causing capabilities. Diseases may be readily transmitted from one individual to another when significant levels are reached. The close contact that the children have with each other, the lack of cleaning, and accumulation of bacterial organisms in the ball pits could account for the signs and symptoms experienced by the children. Therefore, the researchers set out to identify the bacterial organisms present within the ball pits.

Although everyone is at risk for contracting an infectious disease, young children are especially vulnerable because they explore their world by touching and putting objects into their mouths (“The ABCs of safe and healthy child care,” 1997). This exploration, along with first time exposure to many different microorganisms and an immature immune system, put children at an “increased risk for many infectious diseases” (Healthy People 2000: National health promotion and disease prevention objectives: Full report with commentary, 1992, p. 512). Children who eat and play in the ball pits interchangeably, without properly washing their hands, establish a cycle of organism transmission where microorganisms are transferred to and from animate and inanimate objects, potentially creating a public health risk.

Purpose of the Study The purpose of this pilot study was to identify the bacterial organisms living and multiplying within the ball pits located in admission-free, fast food restaurants. Included in the identification process were microorganisms with the potential to place children at an increased risk for disease. The following research questions were addressed: (a) Do ball pits in fast food restaurants contain bacterial organisms that place children at a potential health risk? and (b) What are the bacterial organisms identified, through laboratory study, in the ball pits in fast food restaurants?

The researchers developed the following hypotheses:

1. A breeding ground for potentially harmful bacterial organisms would be found within the ball pits at admission-free, fast food restaurants; and 2. The bacteria found would have the potential to place our pediatric population at an increased risk for disease transmission.

Review of the Literature To date, no previous studies have been conducted concerning microorganisms in ball pits at admission-free, fast food restaurants. However, studies have been conducted concerning microorganism transmission among the pediatric population in day care settings. These studies have shown that children who attend day care centers are at an even greater risk for exposure to infectious diseases (Rader, 1993; Young, 1997). Children in day care are exposed more frequently to various organisms that cause respiratory infections, influenza, otitis media, and gastrointestinal disturbances (“The ABCs of …,” 1997). According to Healthy People 2000 (1992), children who attend day care centers are three to four times more likely to have gastrointestinal disturbances than their stay-at-home counterparts. The increased risk stems from increased exposure to the hands of others, toys, diaper changing areas, floors, table tops, chairs, and food preparation areas that are touched by many dirty hands on a daily basis (“The ABCs of …,” 1997). All facilities and supplies in day care centers, including toys, can harbor many disease-causing organisms (Young, 1997). Many sources recommend that handwashing and a thorough cleaning process be implemented in all day care settings (“The ABCs of …,” 1997; Lopes, 1993; Rader, 1993; Young, 1997). Although implementation can reduce the spread of infectious diseases, only strict compliance to these recommendations will ensure healthy and happy children in day care centers. While illnesses cannot be prevented, the means to reduce the risk of infection exist. By reducing the risk of infections, an improvement will be seen in the overall health of children who attend day care centers, as well as all children in the community (Healthy People 2000, 1992).

Day care centers are not the only places where children play together and come into contact with organisms that cause infectious diseases. Other high-risk areas include indoor and outdoor playgrounds, specifically, the ball pits located in the play areas at fast food restaurants around the country. Although these commercial food establishments must adhere to the Food and Drug Administration’s (FDA) model of sanitation and food protection codes (Young, 1997), there is no literature supporting CDC recommendations for cleaning and disinfecting the areas in which these children play. Since children play in extremely close proximity in these ball pits, there is a risk for the spread of disease. Although the risk is present, the literature does not indicate that information currently exists regarding the health safety of these play areas.

Theoretical Framework According to epidemiology and the principles of organism transmission, a complex relationship exists among causal agents, susceptible persons, and environmental factors. The intact chain of transmission requires a reservoir/host, mode of escape from the reservoir/host, entry into a new host, and susceptibility of the next host to the infectious disease (Thompson, McFarland, Hirsch, & Tucker, 1993). A reservoir/host is a person, animal, arthropod, plant, soil, or organic substance in which an infectious agent lives and multiples. The agent depends on the reservoir for its production and consequent survival (Thompson et al., 1993). The close contact of children playing in the ball pits, combined with organisms present on the surface of the balls, increase a child’s risk of coming in contact with harmful pathogens, posing a public health risk. web site fast food restaurants

The organism escapes from the reservoir at the site of the multiplication of the organism. Portals of exit may be the genitourinary tract, the gastrointestinal tract, the oral cavity, the respiratory tract, open lesions, or mechanical escape. There may be more than one portal of exit for any one disease process. The duration of escape coincides with the period of communicability and varies with each disease. The portal of exit determines its mode of transmission (Thompson et al., 1993). The ball pits located at fast food restaurants are open to children of all ages. Children who wear diapers or who are attempting to toilet train may unknowingly cause fecal or urinary contamination within the ball pits. Additionally, the close proximity in which children play while in the ball pits creates the likelihood of pathogen transmission between children who are infectious and those who are not.

Susceptibility refers to those host conditions that increase the probability that disease may develop in the host. Susceptibility is affected by specific resistance factors such as immunologic responses and nonspecific body defenses against disease agents (Thompson et al., 1993). Young children have immature immune systems making it difficult to resist many harmful organisms in the environment. For this reason, this particular population is placed at increased risk of developing illness from exposure to harmful pathogens (Wong, 1997).

Method The population consisted of admission-free, fast food restaurants offering play pits containing multicolored, round, hollow, plastic balls for children aged 2-10 years in urban communities in the midAtlantic coastal region. The sample consisted of three randomly selected, admission-free, fast food restaurants. Two of the play pits were indoors while one was outdoors.

Specimens were collected from five areas of the bottom tarp within the ball pit, one from the center, and four from areas equidistant to each other. The rules on entering the pits varied from pit to pit. Most of the play pits had posted signs stating that children could not be any taller than four feet in height. No age requirements were noted on any of the posted signs. The researchers entered the pits with their own children, which was not acknowledged or addressed by restaurant management. This routine was followed with each data collection in order to incur a consistent, representative sample of bacteria in the ball pits. The study was performed covertly to obtain adequate specimens from the ball pits in the fast food restaurants that met the study’s criteria. The researchers entered the pits with sterile culterettes. The culturette consisted of a plastic tube containing a sterile polyester-tipped swab and a small glass ampoule of transport medium. After swabbing, the polyester-tipped swab was returned to the tube and the ampoule crushed, forcing the swab into the transport medium. This procedure was accomplished while children were playing.

Prior to obtaining the specimens, it was insured that no cleaning protocol was in place and that the ball pits had not been cleaned in the past 2 weeks. Cleaning protocols were investigated by verbally contacting the appropriate personnel at the chosen restaurant. Management was questioned on cleaning protocol guidelines and when they were last implemented on the playpit area.

Specimens were collected in the early afternoon with indoor temperatures ranging from 65 to 75[degrees]F and outdoor temperatures ranging from 50 to 60[degrees]F. It had rained 5 hours prior to obtaining the specimens from the outdoor play pit. Visual inspection of all 3 play pits revealed an overall lack of cleanliness. The guidelines for establishing visual cleanliness were established prior to specimen collection and were agreed upon by all the researchers. All the play pits were visually inspected, to include cleanliness of the colored plastic balls, soiled floors, wet pooled areas, refuse, and personal wear in the play pit.

Five members of the research team obtained specimens according to protocols set by Christopher Newport University’s (CNU) biology department. Microbial swab samples were collected from multiple locations within each ball pit. A plastic template was used to ensure that each swabbed area was 10 cm-squared.

In the microbiology lab at CNU, each swab was aseptically transferred to 2 ml of trypic soy broth (TSB) and incubated for 30 minutes at room temperature. Serial 10-fold dilutions of the samples were then prepared in physiological saline, and 100 ul aliquots spread plated on trypticase soy agar (TSA). The plates were incubated for 24 hours at 37[degrees] Celsius before the number of viable colony forming units per each 10 cm-squared sample was counted. The appropriate biochemical panels, either a Dade Microscan Gram Negative Combo 4, or Dade Microscan Gram Positive Combo 6 (Dade International, Inc., West Sacramento, CA) were then used in order to identify the individual colonies found on the TSA plates.

Results The data collected in the ball pits revealed that there were bacteria present. An increased level of normal human flora as well as nonhuman flora were discovered within the ball pits (see Table 1).

Table 1. Bacterial Organisms Identified in Three Ball Pits

Organism PIT A(*) PIT B(*) PIT C(*)

Staphylococcus aureus 4.2 28.7 32.0 Staphylococcus epidermidis 0 68.6 4.4 Escherichia coil 1.0 0 32.6 Bacillus cereus 0 0 6.6 Serratia marcescens 0 2.7 0 Streptococcus 22.9 0 24.3 Stenotrophornonas 2.1 0 0 Pasteurella multocida 7.8 0 0 Acinetobacter Iwoffi 30.7 0 0 Planococcus 30.2 0 0 Yersinia enterocofitica 1.0 0 0 (*) The numbers in the columns represent the number of colonies identified in each ball pit.

Source: M. Gray, personal communication, 15 April, 1998.

The normal human flora discovered primarily covered the integumentary, enteric, and urinary system. The integumentary bacterial organisms included Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis). According to Virella (1997), S. aureus is by far the most important human pathogen among the staphylococci. Although S. aureus and S. epidermidis are often considered normal flora, in favorable conditions they have been known to cause serious infections, from benign skin infections to systemic illness (Virella, 1997; Walker, 1998).

The enteric bacterial organisms included Escherichia coli (E. coli) and Serratia marcescens (S. marcescens). E. coli bacteria are part of the normal intestinal flora in both animals and humans. This organism has been associated with diseases involved in almost every human tissue and organ system, which are usually opportunistic in nature (Virella, 1997; Walker, 1998). E. coli is also responsible for causing some community-acquired urinary tract infections and several strains of diarrhea. S. marcescens can be found in low numbers in feces and is commonly associated with human disease. Serratia is responsible for causing pneumonia and sepsis, especially among immunocompromised patients, and is nosocomial in nature in 75% to 90% of the Serratia born infections (Walker, 1998). Streptococcus was also identified within this study. “The genus Streptococcus includes a large number of species, some of which are frank pathogens, and others that are members of the normal flora of the oropharynx and gastrointestinal tract. Diseases associated with streptococci range from dental plaque and trivial skin infections to life-threatening complications such as necrotizing fasciitis, toxic shock, rheumatic fever, and glomerulonephritis” (Virella, 1997, p. 105).

A number of nonhuman flora were identified in this study. These include Bacillus cereus, Yersinia enterocolitica, Pasteurella multocida, Stentrophomonas, Acinetobacter Iwoffi, and Planococcus. Bacillus cereus is a harmless saprophyte associated with cereal grains and soil. It can only survive on human skin but can cause opportunistic infections and diarrhea in the right conditions. Stentrophomonas is associated with animals, especially foul, and has been responsible for several opportunistic infections. It is currently becoming a significant hospital-acquired pathogen and is known to be resistant to most of the commonly used antipseudomonal drugs (Walker, 1998). Pasteurella multocida is recovered from both animals and humans but is most commonly associated with chicken dander. This organism is responsible for a number of infections among the human population, usually related to contact with domesticated animals. Yersinia enterocolitica is an organism distributed among lakes and reservoirs that has been associated with episodic outbreaks of diarrhea, lymphadenopathy, pneumonia, and spontaneous abortions among various animals. Acinetobacter Iwoffi has been associated with a number of human infections including pneumonia, endocarditis, meningitis, skin and wound infections, peritonitis, and urinary tract infections. This particular species is resistant to a number of antibiotics including penicillin, ampicillin, and cephalotin; most strains are resistant to chloramphenicoi (Virella, 1997).

Discussion The results of this pilot study demonstrate that bacteria were present within the sample ball pits. Though most are harmless in small numbers, others demonstrated growth capable of inducing illness in humans. The children who play within these contaminated areas are at the greatest risk for acquiring infectious disease. The presence of potentially harmful bacteria within the ball pits should raise concern about the cleanliness of the pits and the potential for disease transmission.

Due to the health risks that these areas pose to our nation’s children, further research is currently being conducted to identify a correlation between the children playing in ball pits and the incidence of illness. Data collection is complete and preliminary results are showing an even greater number of pathogens present in the sample of play areas tested. Of the more than 150 children who participated in the correlation study, a significant number of these children reported symptoms of illness 5 to 10 days after exposure. The data, along with the microorganisms identified in the play areas, are currently being analyzed to discover if the bacteria located in any specific play area can be directly related to the illnesses reported. If a strong correlation between the two is discovered, further research will be needed to identify the appropriate cleaning protocol necessary for sanitizing these areas, leaving them free of harmful bacteria.

It is essential to note that the pilot study had several limitations. These included the small sample size, time constraints for data collection, geographic constraints, covertness, and selective media. The limitations influence the generalizability of the study.

Implications for Nursing The presence of bacterial organisms within the ball pits indicates the need for child protection measures. Nurses, both inpatient and public health oriented, need to inform parents and caregivers of the risks associated with play in the ball pits. The goal is not to discourage use of the play areas, but to educate parents and caregivers on preventive measures in an effort to increase safety. One measure includes handwashing education, for the parents as well as the children, before and after play. Without proper handwashing, a persistent cycle of microorganism transmission may occur. According to several sources, handwashing is the single most preventive measure in disease control (“The ABCs of …,” 1997; Rader, 1993). Thorough understanding and acknowledgment is also needed concerning the cycle of microorganism transmission so that caregivers can take the necessary precautions to protect their children.

Nurses, as well as nursing students, can play a vital role in both community health education and disinfection protocol development for the fast food restaurant play areas, contributing to public health awareness. Health care providers should be educated about the potential dangers associated with the ball pits so that they can successfully educate the public concerning health promotion and disease prevention.

There are several areas of this study from which nurses can initiate further research. Nurses can examine effective ways in which to clean the ball pits and promote the implementation of the necessary cleaning protocol. Indoor and outdoor play areas can be examined for differences in bacterial organisms, and implementation studies can be conducted regarding handwashing incidence following education.

The final concern and recommendation for nursing includes the development of public policies regarding the cleaning and disinfection of the play areas and ball pits in admission-free, fast food restaurants. It is essential that public policy be formulated and public health procedures implemented to ensure the safety of these facilities. If we are to meet the goals of Healthy People 2000 (1992) in decreasing the incidence of infectious disease, the public must join together in promoting the safety and well being of all children exposed to potentially harmful organisms in play areas, particularly those that combine play and food consumption.

Acknowledgment: The authors acknowledge Kimberly Robertson and Susan Tipton for their assistance in the microbial analysis; and Sigma Theta Tau, Epsilon Chapter, and Christopher Newport University for financial assistance in completing the collaborative project.

CE POSTTEST Keeping Children Safe and Healthy Throughout the year, injury prevention and health promotion are important aspects of the pediatric nurse’s role. However, the focus of this role changes somewhat as summertime approaches and children are less confined by the structured school setting. Pediatric nurses who stay current on strategies and equipment that help keep children safe and healthy can provide the guidance families may need as they plan vacations and other summertime activities with their children.

This continuing education series features three articles that focus on health promotion and injury prevention. The first article presents findings from a study that examined health and lifestyle behaviors of a sample of urban elementary school children. The second article discusses the recent literature on pediatric occupant car safety and its clinical implications. The third article reports the results of a study that identified bacterial organisms harmful to children in ball pits in three fast food restaurants and describes the nurse’s role in public awareness though health education. see here fast food restaurants

ASSIGNMENT Polivka, B., & Ryan-Wenger, N. (1999). Health promotion and injury prevention behaviors of elementary school children. Pediatric Nursing, 25(2), 127-134, 148.

Murphy, J. (1999). Pediatric occupant car safety: Clinical implications based on recent literature. Pediatric Nursing, 25(2), 137-148.

Davis, S., Corbitt, A., Everton, V., Grano, C., Kiefner, R, Wilson, A., & Gray, M. (1999). Are ball pits the playground for potentially harmful bacteria? Pediatric Nursing, 25(2), 151-155.

Objectives:

1. Discuss the importance health promotion and injury prevention for children.

2. Describe the health and lifestyle behaviors of a sample of urban elementary school children.

3. List three strategies for reducing serious and fatal injuries for children in motor vehicle crashes.

4. Discuss the implications of the findings of a covert pilot study regarding bacterial organisms found in ball pits.

5. Explore the pediatric nurse’s role in health promotion and injury prevention.

This offering for 3.0 contact hours is provided by Anthony J. Jannetti, Inc., which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC-COA). Anthony J. Jannetti, Inc. is an approved provider of continuing education by the California Board of Registered Nursing, CEP No. 5387.

Articles accepted for publication in the continuing education series are refereed manuscripts that are reviewed in the standard Pediatric Nursing review process with other articles appearing in the journal.

This test was reviewed and edited by Judy A. Rollins, MS, FIN, Pediatric Nursing associate editor; Veronica D. Feeg, PhD, FIN, FAAN, Pediatric Nursing editor; and Marion E. Broome, PhD, RN, a Pediatric Nursing editorial board member.

Questions

1. One of the major purposes of Polivka and Ryan-Wenger’s study was to a. determine smoking rates of elementary school children.

b. identify parental influence on health promotion behaviors of young children.

c. explore elementary school children’s health status and health lifestyle behaviors.

d. implement an injury prevention intervention for school-age children.

e. assess gender and racial differences related to risky health behaviors.

2. Accidental drowning is the leading cause of death in children 5-14 years.

a. True.

b. False.

3. The research design used in the study reported in this article was a. cross-sectional b. case-control.

c. longitudinal.

d. experimental.

e. ex post facto.

4. Findings from the study indicated that youth in specialized behavioral classrooms reported a. more health promotion activities.

b. always staying away from guns more than other youth.

c. watching TV more often than other youth.

d. smoking more than youth in regular classrooms.

e. never wearing a seat belt more often than youth in comparison classrooms.

5. An implication for nursing practice based on the findings of this study is that nurses a. should do home visits to determine the presence of a fire extinguisher.

b. work collaboratively with others to implement bicycle safety camps.

c. encourage youth with SED to eat multiple small meals since these children are typically underweight.

d. implement an in-school nap program so that children get adequate rest.

e. recommend disbanding DARE programs since most of the respondents reported not using drugs.

6. Motor vehicle crashes are the leading cause of death for children ages a. 1 and under.

b. 1 to 4.

c. 5 to 12.

d. 13 to 16.

e. 17 to 19.

7. Basic safety tips to minimize the risks related to air bags include:

a. Avoid placing rear-facing infant car seats in front of air bags.

b. Situate children in the back seat properly restrained for size and weight.

c. For children 12 and older, position the front seat to allow at least 10 inches between the child’s sternum and the dashboard.

d. a and b only.

e. a, b, and c.

8. Car seat recommendations for infants over 20 pounds include:

a. Place the car seat facing the rear in the center back seat.

b. Place the car seat facing forward in the center back seat.

c. Place the car seat in the front seat of cars with air bags.

d. Route the car safety belt through the lowest slot in the car seat.

e. Fasten the car seat harness loosely.

9. Which statement is correct regarding the use of booster seats?

a. Booster seats are designed for children who weigh 40-60 pounds.

b. Children whose shoulders are too broad for a toddler car seat are better protected in a booster seat.

c. Children whose ears are above the back of the toddler car seat are usually ready to “graduate” to a booster seat.

d. Lap/shoulder belt systems are not compatible with booster seats.

e. a, b, and c.

10. Which of the following statements is accurate for lap/shoulder seat belt use in older children (larger than 60 pounds)?

a. The lap portion of the belt should fit snugly across the thighs and not ride up on the abdomen.

b. The shoulder portion of the belt should fit snugly across the clavicle and lower neck.

c. The shoulder portion of the belt may be worn behind the back in this age group.

d. Incorrect seat belt use most frequently leads to pneumothorax.

e. Statistics show that lack of seat belt use does not affect risk for injury in motor vehicle crashes.

11. Which of the following increases the young child’s risk for contracting infectious diseases?

a. Exploration of the world by touching and putting objects into the mouth.

b. First time exposure to many different organisms.

c. An immature immune system.

d. a and c.

e. a, b, and c.

12. Which of the following puts children at increased risk for infection while playing in admission-free ball pits located within fast food restaurants?

a. Close proximity during play.

b. High level of human and non-human flora.

c. Lack of proper handwashing.

d. All of the above.

e. None of the above.

13. Which of the following behaviors are described as useful in preventing the spread of infectious diseases at admission-free ball pits located at fast food restaurants?

a. Frequent handwashing.

b. A proper and frequent cleaning protocol of the balls within the ball pit.

c. Allowing children to play and eat interchangeably.

d. a and c.

e. a and b.

14. Which organism, identified in the study by Davis and colleagues, is responsible for causing pneumonia and sepsis and is nosocomial in nature?

a. Pasturella Multocida b. S. Marcessens c. E. coli d. Serratia e. Streptococcus

15. The single most important goal in informing parents and caregivers of the risks associated with play in the ball pits is to a. discourage use of the play areas.

b. develop a disinfection protocol for cleaning the ball pits.

c. educate parents and children about the importance of handwashing before and after play.

d. educate parents and caregivers about the cycle of microorganism transmission.

e. develop public policies regarding the cleaning and disinfection of the play areas.

References Healthy People 2000: National health promotion and disease prevention objectives: Full report commentary. (1992). Washington, DC: USDHHS, Public Health Service.

Thompson, J.M., McFarland, G.K., Hirsch, J.E., & Tucker, S.M. (1993). Mosby’s clinical nursing (3rd ed.). St. Louis: Mosby-Year Book, Inc.

Virella, G. (1997). Microbiology and infectious diseases (3rd ed.). Baltimore, MD: Williams & Wilkins.

Walker, T.S. (1998). Microbiology. Philadelphia: W.B. Saunders and Company.

Wong, D.L. (1997). Whaley & Wong’s essentials of pediatric nursing (5th ed.). St. Louis: Mosby-Year Book, Inc.

Sandra G. Davis, BSN, RN, is Critical Care Nurse, Coronary Care Unit, Riverside Regional Medical Center, Newport News, VA.

Amy M. Corbitt, BSN, RN, is Staff Nurse, Special Care Nursery, Riverside Regional Medical Center, Newport News, VA; and Neonatal Intensive Care Unit, Medical College of Virginia Hospital, Richmond, VA.

Virginia M. Everton, BSN, RN, is Staff Nurse, Adult Medicine, Georgetown University Medical Center, Washington, DC.

Catherine A. Grano, BSN, RN, is Staff Nurse, Labor and Delivery, Williamsburg Community Hospital, Williamsburg, VA.

Pamela A. Kiefner, BSN, RN, is Staff Nurse, Oncology, Riverside Regional Medical Center, Newport News, VA.

Angela S. Wilson, MSN, RN, is Instructor of Nursing, Christopher Newport University, Newport News, VA.

Mark Gray, PhD, is Associate Professor of Biology, Christopher Newport University, Newport News, VA.

Davis, Sandra G.; Corbitt, Amy M.; Everton, Virginia M.; Grano, Catherine A.; Kiefner, Pamela A.; Wilson, Angela S.; Gray, Mark