Graphic Novela: Mexican American Families' Use of Community Services for Older Adults.

Knowledge gaps exist about how to help Mexican American (MA) families seek assistance when their capacity to assist older family members is challenged. MA families may resist confronting unpleasant but real situations with the older adult, for example, the need to access long term support services (LTSS), because of cultural and structural barriers. The purpose was to describe stakeholders' reactions to a culturally focused graphic novela created in partnership with a community advisory council. Qualitative description with content analysis of a focus group's reactions to the graphic novela was used. Results included positive reactions as well as suggestions for improvement and dissemination. Graphic novelas can be an effective medium for modeling conversations about older adults' needing additional care, and demonstrating how to identify and access available LTSS or other services. Included is a description of the researchers' process of partnering with diverse stakeholders, which is essential for creating new solutions.

"Tipping point" concept analysis in the family caregiving context.

AIM: Analyze the concept "tipping point" in the older adult family caregiving context to further knowledge about caregiving families, enhancing transdisciplinary theory, research, and practice. BACKGROUND: While used commonly in some disciplines, how "tipping point" has been used in health care, generally, and in relation to caregiving families, specifically, is less clear. This project was conducted to offer conceptual clarity to tipping point. DESIGN: Walker and Avant's framework. DATA SOURCE: Searches of scholarly literature in PsycINFO, CINAHL, and PubMed using the search term "tipping point" in either title or abstract. REVIEW METHODS: Definitions used were extracted; instances when the concept was implied but the actual term "tipping point" was not used and contexts where the term was used or implied were identified. RESULTS: The composite definition of a caregiving tipping point is a seemingly abrupt, severe, and absolute change event involving either the older adult or caregiver(s), or both that indicates a breakdown in the status quo of the caregiving system. CONCLUSIONS: Transdisciplinary research, care, and policy should treat caregiving families as complex systems, use longitudinal assessments, and include colloquial communication. Early detection of impending tipping points will provide family-centered decisional support and enhance families' quality of life and safety.

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition; emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; and recognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.

Objective structured clinical examination and advanced practice nursing students.

Educators, challenged to measure clinical competency impartially in Advanced Health Assessment courses, have used Objective Structured Clinical Examination (OSCE) and standardized patients (SP). Faculty-trained laypersons act as patients (SP) for students in a clinical laboratory setting using a standardized, scripted scenario. Students typically are evaluated during the examination and receive instant feedback from the SP. There has been little evidence that supports this as the best way to measure student's clinical competency. This study's purpose was to compare outcomes of graduate nursing students completing a traditional methods Health Assessment course to those students using OSCE and SPs. Problem-based Learning Theory guided the quasi-experimental study that included 37 students divided into research and control groups. There were statistically significant differences between the two groups for the final practical examination grades, clinical preceptor evaluations, satisfaction scores, and self-evaluations of skills at the course's end. Research group's course scores were higher than the control group. There was no difference between group's self-evaluation for their current assessment skills. This intervention had a positive impact on students' outcomes. Educators should incorporate SPs and OSCE to improve clinical competency scores, course satisfaction, and preceptor evaluations. Future studies should include a longitudinal design and qualitative student feedback.