Problem-appropriate diagram instruction for improving mathematical word problem solving.

The use of diagrams can be effective in solving mathematical word problems solving. However, students worldwide do not construct diagrams unprompted or have trouble using them. In the present study, the effects of problem-appropriate diagram use instruction were investigated with an adaptation of the multiple baseline design method. The instruction for using line diagrams, tables, and graphs was provided to 67 junior high school students in a staggered manner and the effects on problem solving of three different types of problems was examined. The results showed that use of problem-appropriate diagrams increased and persisted over time. More importantly, the instruction led to increases in problem solving performance and to decreases in perceived cognitive load. These findings support the argument that effective diagram use depends on the acquisition not only of declarative knowledge, but also sufficient procedural and conditional knowledge.

Factors contributing to innovation readiness in health care organizations: a scoping review.

BACKGROUND: Increasing innovation readiness of healthcare organizations is necessary to meet upcoming challenges, including population aging, staff shortages and reduced funding. Health care organizations differ in the extent to which they are innovation ready. This review aims to clarify the concept of innovation readiness and identify which factors contribute to innovation readiness in health care organizations. METHODS: A scoping review was conducted based on the framework from Arksey and O'Malley. PubMed/MEDLINE, CINAHL and Web of Science were searched for studies that (a) aimed to contribute to scientific knowledge about innovation readiness of health care organizations, (b) were peer-reviewed, (c) reported empirical data and (d) were written in English, Dutch or German. Factors researched in the included studies were bundled into 4 overarching main factors and 10 sub-factors. RESULTS: Of the 6,208 studies identified, 44 were included. The majority (n = 36) of the studies had been conducted since 2011 and almost half of the studies (n = 19) were performed in hospitals. Of the 44 studies, 21 researched factors contributing to innovation readiness in the implementation stage of the innovation process. The authors used a variety of words and descriptions addressing innovation readiness, with hardly any theoretical frameworks for innovation readiness presented. Four main factors and 10 sub-factors contributing to the innovation readiness of health care organizations were summarized: strategic course for innovation, climate for innovation, leadership for innovation and commitment to innovation. Climate for innovation (n = 16) was studied the most and individual commitment to innovation (n = 6) was the least studied. CONCLUSION: Our study identified four main factors contributing to the innovation readiness of health care organizations. Research into innovation readiness of health care organizations is a rather new field. Future research could be directed towards defining the concept of innovation readiness and the development of a framework for innovation readiness. More understanding of the interplay of factors contributing to innovation readiness in all stages of the innovation process and in diverse health care settings can support health care managers to structurally embed innovation. This review contributes to the first stage of theory building on factors contributing to innovation readiness of health care organizations.

Integrated Care Components in Transitional Care Models from Hospital to Home for Frail Older Adults: A Systematic Review.

Introduction: Frail older adults frequently experience transitions from hospital to home due to their complex care needs. Transitional care models (TCMs) are recommended to tackle adverse outcomes in frail patients. This review summarizes the use of integrated care components in addressing transitional care from hospital to home, provides an overview on reported outcomes and describes the impact of identified components on the outcomes hospital readmission and emergency department visit. Methods: This study is part of the European TRANS-SENIOR project. PubMed, CINAHL and Embase were searched for studies in English, German and Dutch that describe a TCM for frail older patients including both pre- and post-discharge components. Results: Seventeen studies, covering 15 TCMs were included. All TCMs describe a person-centred, tailored, pro-active and continuous transitional care service. Components like a small sized care team, intensive follow-up, shared decision making and informal caregiver involvement are likely to be associated with reduced hospital readmission and ED visits. Twenty-seven transitional care outcomes were reported: 19 service outcomes, six patient outcomes and two provider outcomes. Conclusion: Heterogeneity in content and outcomes complicates between-study comparison, yet several components were identified that improved care outcomes. Patient and provider outcomes should be included in future research.

Listen, look, link and learn: a stepwise approach to use narrative quality data within resident-family-nursing staff triads in nursing homes for quality improvements.

PURPOSE: The use of qualitative data to assess quality of care in nursing homes from the resident's perspective has shown to be valuable, yet more research is needed to determine how this data can be used to gain insight into the quality of care within nursing homes. Whereas it is crucial to stay close to the stories that are the strength of qualitative data, an intermittent step to classify this data can support the interpretation and use. Therefore, this study introduces an approach that enables the use of narrative quality of care data to learn from and improve with. DESIGN: A cross-sectional mixed-methods study in which qualitative data were collected with the narrative quality assessment method Connecting Conversations and interpreted for analysis. METHODS: Connecting Conversations was used to collect narrative data about experienced quality of care in nursing homes according to residents, their families and nursing staff (triads). Data analysis consisted of coding positive/negative valences in each transcript. FINDINGS: A stepwise approach can support the use of narrative quality data consisting of four steps: (1) perform and transcribe the conversations (listen); (2) calculate a valence sore, defined as the mean %-positive within a triad (look); (3) calculate an agreement score, defined as the level of agreement between resident-family-nursing staff (link); and (4) plot scores into a graph for interpretation and learning purposes with agreement score (x-axis) and valence score (y-axis) (learn). CONCLUSIONS: Narrative quality data can be interpreted as a valence and agreement score. These scores need to be related to the raw qualitative data to gain a rich understanding of what is going well and what needs to be improved.

Implementing a multidisciplinary psychotropic medication review among nursing home residents with dementia: a process evaluation.

OBJECTIVES: Before drawing conclusions on the contribution of an effective intervention to daily practice and initiating dissemination, its quality and implementation in daily practice should be optimal. The aim of this process evaluation was to study these aspects alongside a randomized controlled trial investigating the effects of a multidisciplinary biannual medication review in long-term care organizations (NTR3569). DESIGN: Process evaluation with multiple measurements. SETTING: Thirteen units for people with dementia in six long-term care organizations in the Netherlands. PARTICIPANTS: Physicians, pharmacists, and nursing staff of participating units. INTERVENTION: The PROPER intervention is a structured and biannually repeated multidisciplinary medication review supported by organizational preparation and education, evaluation, and guidance. MEASUREMENTS: Web-based questionnaires, interviews, attendance lists of education sessions, medication reviews and evaluation meetings, minutes, evaluation, and registration forms. RESULTS: Participation rates in education sessions (95%), medication reviews (95%), and evaluation meetings (82%) were high. The intervention's relevance and feasibility and applied implementation strategies were highly rated. However, the education sessions and conversations during medication reviews were too pharmacologically oriented for several nursing staff members. Identified barriers to implementation were required time, investment, planning issues, and high staff turnover; facilitators were the positive attitude of professionals toward the intervention, the support of higher management, and the appointment of a local implementation coordinator. CONCLUSION: Implementation was successful. The commitment of both higher management and professionals was an important factor. This may partly have been due to the subject being topical; Dutch long-term-care organizations are pressed to lower inappropriate psychotropic drug use.

Partnerships in nursing homes: How do family caregivers of residents with dementia perceive collaboration with staff?

BACKGROUND: Partnerships between family and nursing staff in nursing homes are essential to address residents' needs and wishes. Collaboration is needed to create partnerships; nonetheless, challenges exist. AIM: This study aimed to gain insights into the experiences of families collaborating with staff. METHOD: Semi-structured interviews were held with 30 family caregivers of nursing home residents with dementia. FINDINGS: Data reflected three themes, which shaped collaboration with staff from families' perspective, 'communication', 'trust and dependency' and 'involvement'. DISCUSSION: Good communication appeared to be a requisite condition for having trust in staff and quality of involvement in residents' life. Good communication was described as having informal contact with staff, which enabled family and staff to build a personal connection. Consequently, this seemed to increase trust and satisfaction regarding involvement. CONCLUSION: Findings suggest that increasing informal contact and building a personal connection should be a priority for staff in order to improve collaboration and to create partnerships with families.

Interventions to foster family inclusion in nursing homes for people with dementia: a systematic review.

BACKGROUND: Family inclusion in nursing homes is central to the provision of individualized care for people with dementia. Although positive effects can be recognized, barriers have been identified that hamper family inclusion in nursing homes. Specifically for people with dementia, insight into the content of interventions to foster family inclusion is lacking. METHODS: A systematic review was performed by systematically searching the databases PubMed, Cinahl, PsycInfo and Embase. Studies were eligible if they examined (1) nursing home settings, (2) interventions to foster the inclusion of family members from people with dementia, (3) were original research articles in which effects/experiences of/with these interventions were evaluated, and (4) were written in English, Dutch or German. Findings were summarized systematically. RESULTS: Twenty-nine studies were included. Two interventions were targeted at creating family-staff partnerships from a two-way perspective. Other interventions focused on single components, such as including family members in formal decisions (n = 9), enabling them to make better informed decisions and/or participate more actively (n = 7), or providing psychoeducation for family members (n = 3). Within the interventions, family and staff members are often treated differently. Effects on actual increase in family inclusion remain unclear. CONCLUSIONS: Very few interventions exist that try to enhance equal family-staff partnerships in nursing homes. Future interventions should pay specific attention to mutual exchange and reciprocity between family and staff. As little is known about promising (components of) interventions to foster family inclusion in nursing homes for people with dementia, more effectiveness research is needed.

The Feasibility of Connecting Conversations: A Narrative Method to Assess Experienced Quality of Care in Nursing Homes from the Resident's Perspective.

Currently, residents living in nursing homes and their caring relationships are being placed more centrally in the care experience. Experienced quality of care is influenced by the interactions between residents, family and caregivers, who each have their own experiences and needs. Connecting Conversations is a narrative method aimed at assessing experienced quality of care in nursing homes from the resident's perspective by having separate conversations with residents, family and caregivers (triads), adopting an appreciative inquiry approach. This study presents how to use Connecting Conversations and its feasibility. Feasibility was assessed as performance completeness, protocol adherence and interviewers' experiences. Conversations were conducted by trained nursing home staff (n = 35) who performed 275 Connecting Conversations in another nursing home than where they were employed (learning network). Findings show it is feasible to perform separate appreciative conversations with resident-family-caregiver triads by an interviewer employed in another nursing home; however, protocol adherence was sometimes challenging in conversations with residents. Interviewers valued the appreciative approach, the learning network and the depth of the separate conversations. Challenges were experienced with scheduling conversations and receiving time and support to perform the conversations. Stakeholders should continue collaboration to embed Connecting Conversations into daily practice in nursing homes.

Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care.

OBJECTIVES: People with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff-resident interactions. DESIGN: An exploratory, cross-sectional study. SETTING AND PARTICIPANTS: In total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed. METHODS: Structured observations were carried out to assess the support of resident autonomy within staff-resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents' responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience. RESULTS: In total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents' needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations. CONCLUSIONS AND IMPLICATIONS: The findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents' individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.

Cross-Representational Signaling and Cohesion Support Inferential Comprehension of Text-Picture Documents.

Learning from a text-picture multimedia document is particularly effective if learners can link information within the text and across the verbal and the pictorial representations. The ability to create a mental model successfully and include those implicit links is related to the ability to generate inferences. Text processing research has found that text cohesion facilitates the generation of inferences, and thus text comprehension for learners with poor prior knowledge or reading abilities, but is detrimental for learners with good prior knowledge or reading abilities. Moreover, multimedia research has found a positive effect from adding visual representations to text information, particularly when implementing signaling, which consists of verbal or visual cues designed to guide attention to the pictorial representation of relevant information. We expected that, as with text-only documents, struggling readers would benefit from high text cohesion (Hypothesis 1) and that signaling would foster inference generation as well (Hypothesis 2). Further, we hypothesized that better learning outcomes would be observed when text cohesion was low and signaling was present (Hypothesis 3). Our first experimental study investigated the effect of those two factors (cohesion and signaling) on three levels of comprehension (text based, local inferences, global inferences). Participants were adolescents in prevocational schools (n = 95), where some of the students are struggling readers. The results showed a trend in favor of high cohesion, but with no significant effect, a significant positive effect of cross-representational signaling (CRS) on comprehension from local inferences, and no interaction effect. A second experiment focused on signaling only and attention toward the picture, with collection of eye-tracking data in addition to measures of offline comprehension. As this study was conducted with university students (n = 47), who are expected to have higher reading abilities and thus are less likely to benefit from high cohesion, the material was presented in its low cohesive version. The results showed no effect of conditions on comprehension performances but confirmed differences in processing behaviors. Participants allocated more attention to the pictorial representation in the CRS condition than in the no signaling condition.

The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial.

Objective: We studied the efficacy of biannual structured medication reviews to improve the appropriateness of psychotropic drug (PD) prescriptions for neuropsychiatric symptoms (NPS) in nursing home patients with dementia. Study Design and Setting: In this randomised controlled trial, the intervention encompassed a structured multidisciplinary medication review by physician, pharmacist and nurse. During this 18-month study, the patient's medical files were assessed every 6 months. The primary outcome was the appropriateness of PD prescriptions defined by the Appropriate Psychotropic drug use In Dementia (APID) index sum score, lower scores indicating more appropriate use. Results: At baseline, 380 patients were included, of which 222 were randomised to the intervention group. Compared to the control group, the APID index sum score in the intervention group improved significantly for all PD prescriptions (-5.28, P = 0.005). Conclusion: We advise the implementation of a structured, repeated medication review with the essential roles of pharmacist, physician and nurse, into daily practice. This work was supported and funded by the Netherlands Organisation for Health Research and Development (ZonMw). Netherlands Trial Register (NTR3569).

The influence of text cohesion and picture detail on young readers' knowledge of science topics.

BACKGROUND AND AIM: The effects of text cohesion and added pictures on acquired knowledge have been heavily studied each in isolation. Furthermore, studies on the effects of specific characteristics of pictures, whether facilitating or hindering, are scarce. Schnotz's ITCP Model (2014) allows to formulate hypotheses regarding the combined effect of text cohesion and presence and level of detail of a picture. This study investigates these hypotheses in the case of children reading scientific texts. SAMPLE: One hundred and one-second-, third-, and fourth-grade pupils with a mean age of 9 years, in the western United States. METHODS: Data were collected over three sessions to encompass an understanding of each pupil's knowledge based on prior sessions. RESULTS AND CONCLUSIONS: Results showed a significant increase in pupils' knowledge between pre-test and immediate post-test, but as hypothesized, no significant difference between levels of cohesion. No significant difference between types of pictures was detected. After 1 week, knowledge built with a high cohesive text significantly dropped with low-detail picture, whereas, with high detail, or no picture, there was no significant difference. Results suggested that when participants were given a low-detail picture with a low cohesive text, the integration process of the material was more restricted than with a high cohesive text.

Factors related to psychotropic drug prescription for neuropsychiatric symptoms in nursing home residents with dementia.

OBJECTIVES: The objective of this study is to explore factors that elucidate reasons for psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home (NH) residents with dementia. DESIGN: A qualitative study using a grounded theory approach. SETTING: Twelve NHs in The Netherlands. PARTICIPANTS: Fifteen physicians and 14 nurses. MEASUREMENTS: Individual, face-to-face, in-depth semistructured interviews. Interviews were audio recorded, transcribed, and qualitatively analyzed using Atlas.ti. RESULTS: The qualitative analysis revealed 4 emerging themes with factors either or both enhancing or limiting PD prescription, which we used to develop a conceptual framework. First, the mindset of physicians and nurses toward NPS and PDs appeared to contribute. Second, inadequate knowledge of and experience with NPS and limited people skills of nurses may induce PD prescription. Also, knowledge of effectiveness and side effects of PDs from education, literature, and guidelines, and previous personal experiences was considered relevant. Third, effective communication and cooperation between professionals and with family may improve the appropriateness of PD prescription. Fourth, external factors including staffing issues, nursing home setting, access to consultants, national and local policies, and zeitgeist were considered to affect PD prescription. CONCLUSION: We have developed a conceptual framework explaining how different factors influence PD prescription. This provides opportunities for improving PD prescription in NH residents with dementia.