The Impact of Amplification on Cognitive Screening Test Scores.

Hearing loss is associated with cognitive decline in older adults. Research has shown that hearing loss negatively affects cognitive screening test measures as patients may mishear verbally administered questions. The purpose of the current study was to investigate the impact of amplification on performance on a commonly used cognitive screening test. Thirty older adults with hearing loss underwent testing with the Mini-Mental State Examination (MMSE) in three conditions: without hearing aids, with hearing aids, and with a personal listening device (PLD). Performance on the MMSE significantly improved with the use of hearing aids or a PLD. Amplification and the use of communication strategies should be considered when administering cognitive screening measures to older adults. Failure to account for hearing status may lead to invalid results and can increase the likelihood of over-referral for further assessment. [Journal of Gerontological Nursing, 48(7), 31-37.].

Effect of Reduced Audibility on Mini-Mental State Examination Scores.

BACKGROUND: The interaction of audition and cognition has been of interest to researchers and clinicians, especially as the prevalence of hearing loss and cognitive decline increases with advancing age. Cognitive screening tests are commonly used to assess cognitive status in individuals reporting changes in memory or function or to monitor cognitive status over time. These assessments are administered verbally, so performance may be adversely affected by hearing loss. Previous research on the impact of reduced audibility on cognitive screening test scores has been limited to older adults with sensorineural hearing loss (SNHL) or young adults with normal hearing and simulated audibility loss. No comparisons have been conducted to determine whether age-related SNHL and its impact on cognitive screening tests is successfully modeled by audibility reduction. PURPOSE: The purpose of this study was to examine the effects of reduced audibility on the Mini-Mental State Examination (MMSE), a common bedside cognitive screening instrument, by comparing performance of cognitively normal older adults with SNHL and young adults with normal hearing. DESIGN: A 1:1 gender-matched case-control design was used for this study. STUDY SAMPLE: Thirty older adults (60-80 years old) with mild to moderately severe SNHL (cases) and 30 young adults (18-35 years old) with normal hearing (controls) served as participants for this study. Participants in both groups were selected for inclusion if their cognitive status was within normal limits on the Montreal Cognitive Assessment. DATA COLLECTION AND ANALYSIS: Case participants were administered a recorded version of the MMSE in background noise at a signal-to-noise ratio of +25-dB SNR. Control participants were administered a digitally filtered version of the MMSE that reflected the loss of audibility (i.e., threshold elevation) of the matched case participant at a signal-to-noise ratio of +25-dB SNR. Performance on the MMSE was scored using standard criteria. RESULTS: Between-group analyses revealed no significant difference in the MMSE score. However, within-group analyses showed that education was a significant effect modifier for the case participants. CONCLUSIONS: Reduced audibility has a negative effect on MMSE score in cognitively intact participants, which contributes to and confirms the findings of earlier studies. The findings suggest that observed reductions in score on the MMSE were primarily due to loss of audibility of the test item. The negative effects of audibility loss may be greater in individuals who have lower levels of educational attainment. Higher levels of educational attainment may offset decreased performance on the MMSE because of reduced audibility. Failure to consider audibility and optimize communication when administering these assessments can lead to invalid results (e.g., false positives or missed information), misdiagnosis, and inappropriate recommendations for medication or intervention.

Motivating Reading Compliance: Adaptation of Monte Carlo Quizzes for Online Delivery.

Getting students to complete reading assignments is often a source of frustration for nurse educators. Monte Carlo Quizzes (MCQs) were adapted for online delivery in a hybrid nursing course to encourage timely completion and deep processing of readings. Students indicated that MCQs motivated them to complete the assigned readings and to read more carefully. However, there were no significant differences on scores for other course assignments between those who completed readings and those who did not.

Describing Older Adults' Awareness of Fall Risk Using Situation Awareness Research Techniques: A Pilot Study.

The purpose of the current study was to evaluate efficacy of techniques adapted from situation awareness research for describing how older adults perceive and understand fall risk factors in the context of daily routine. Eleven older adults watched a video of an older woman performing daily activities. Thirteen intrinsic, extrinsic, and behavioral fall risks were embedded throughout the scenario. The video was periodically frozen/blanked from view while participants answered questions about their understanding of the situation and associated story elements. Participants perceived a variety of fall risk factors but did not necessarily interpret them as indicating fall risk. Many fall risks held non-fall meaning for participants (e.g., newspapers on the floor meant the woman liked to read). Although four participants readily identified a fall risk situation, seven did not until they were explicitly asked to consider safety. Study techniques were effective for describing situation awareness of fall risk and several suggestions for improvement are described. [Res Gerontol Nurs. 2016; 9(4):161-166.].

Use of the Pathfinder scaling algorithm to measure students' structural knowledge of community health nursing.

In nursing education, measures of structural knowledge have not been widely used to assess student learning. Some authors have suggested concept mapping as a way to measure structural knowledge, but this approach can be subjective and otherwise problematic. Pathfinder, a computer-based network scaling technique, offers an alternative, quantitative method for representing and evaluating structural knowledge. The purpose of this study was to investigate structural knowledge as a learning outcome for baccalaureate nursing students by using Pathfinder techniques. Results revealed that students' structural knowledge increased in internal consistency and became more similar to instructors' knowledge during a course in community health nursing. Students with structural knowledge that was most coherent and similar to the instructors' performed better in the course. Students' structural knowledge characteristics differentiated between high-performing and low-performing students. Findings support the use of structural knowledge representation with Pathfinder scaling techniques as a way to operationalize learning.

Assessing dynamic mental models: unfolding case studies.

Excellence in critical thinking skills requires well-developed situational mental models: integrated knowledge of how concepts and principles relate to a specific client's condition and care. The authors describe the use of unfolding case studies as a strategy for eliciting and evaluating students' changing mental models. Unfolding cases offer a practical method for capturing the dynamic nature of situational mental models and revealing significant errors in students' problem-solving cognitions that would not otherwise be obvious.

Setting valid cut-off scores for competency.

Results of competency, or certification, tests can have serious consequences for individuals tested, for employers, and for the public. However, the validity of testing outcomes depends not only on the validity of the test's content but also on the validity of the score selected as the passing, or cut-off, score. This article describes procedures and techniques for use by staff development professionals to ensure systematic, rational, and defensible cut-off scores for competency tests.