Laura Wagner

Complex Sentence Production by Adolescents with Down Syndrome.

The use of complex syntax was investigated in narrative language samples of older children and adolescents with Down syndrome ( n = 24) and a group of typically developing children matched on mean length of utterance. Both groups used conjoined and subordinate sentence forms and did not differ significantly in either the proportion of utterances containing complex sentences or in the variety of complex sentence types used. The analysis of developmental patterns suggested a similar order of acquisition across groups. The findings indicate that syntactic development in individuals with Down syndrome continues into late adolescence and is not limited to simple syntax. This study does not support earlier findings of a critical period effect in syntactic development in Down syndrome based on age or syntactic complexity.

Consequences of an Intervention to Reduce Restrictive Side Rail Use in Nursing Homes

OBJECTIVES: To examine the effect of an advanced practice nurse (APN) intervention on restrictive side rail usage in four nursing homes and with a sample of 251 residents. A secondary question explored the association between restrictive side rail reduction and bed‐related falls.

Nurses' Perceptions of Safety Culture in Long‐Term Care Settings

PURPOSE To describe perceptions of workplace safety culture among nurses employed in long-term care (LTC) settings. DESIGN A cross-sectional survey. Respondents were licensed nurses (N=550) with membership in gerontological nursing professional organizations in the United States (n=296), Canada (n=251), and other (n=3). METHODS An anonymous, self-administered, mail-in questionnaire, which included the Hospital Survey on Patient Safety Culture as well as questions about individual and institutional characteristics. The survey included key aspects of safety culture, such as work setting, supervisor support, communication about errors, and frequency of events reported. FINDINGS Nurse-managers reported significantly more positive safety culture perceptions compared with licensed staff nurses. Additionally, licensed nurses employed in government-run facilities had significantly less positive safety culture perceptions compared with those working in nonprofit organizations. CONCLUSIONS Interventions designed to improve safety culture in LTC settings should be focused on the concerns of licensed staff nurses and the improvement of communication between these nurses and their managers. CLINICAL RELEVANCE Enhancing safety culture in long-term care settings may facilitate improvements in resident safety. Assessment of workplace safety culture is the first step in identifying barriers that nurses face to provide safe resident care.

Nurses Improving Care for Healthsystem Elders - a model for optimising the geriatric nursing practice environment.

Aims and objectives To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background The NPE is a system-level intervention for promoting quality and patient safety; however, there are population-specific factors that influence the nurses’ perception of their practice and its’ relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs Discursive paper. Method In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals’ systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff’s perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults.

Contractures in Frail Nursing Home Residents

Contractures are a common but preventable consequence of prolonged physical immobility among nursing home residents. Significant for their associated costs in institutions rendering care to frail elder residents, contractures further reduce mobility and increase the risk of other outcomes of decreased mobility, such as pressure ulcers. This secondary analysis examines the prevalence of contractures in 273 residents who participated in an interventional study focusing on reducing restrictive siderails. Almost two thirds of the participants had at least 1 contracture, with the most common locations being the shoulder and knee. Presence of pain and being non-White were significant predictors of contracture presence. This study highlights the high prevalence of contractures, the underlying factors associated with them, and the need to prevent or minimize contracture formation, including the role restorative nursing care plays in this avoidable condition.

Children's perception of dialect variation

A speakers regional dialect is a rich source of information about that person. Two studies examined five- to six-year-old childrens perception of regional dialect: Can they perceive differences among dialects? Have they made meaningful social connections to specific dialects? Experiment 1 asked children to categorize speakers into groups based on their accent; Experiment 2 asked them to match speakers to (un)familiar cultural items. Each child was tested with two of the following: the childs Home dialect, a Regional variant of that dialect, and a Second-Language variant. Results showed that children could successfully categorize only with a Home vs. Second-Language dialect contrast, but could reliably link cultural items with either a Home vs. Second-Language or a Regional vs. Second-Language dialect contrast. These results demonstrate five- to six-year-old childrens developing perceptual skill with dialect, and suggest that they have a gradient representation of dialect variation.

Assessing resident safety culture in nursing homes: using the nursing home survey on resident safety.

Objectives: To examine the overall responses of nursing home staff to a newly developed nursing home specific survey instrument to assess patient safety culture (PSC) and to examine whether nursing home staff (including administrator/manager, licensed nurse, nurse aide, direct care staff, and support staff) differ in their PSC ratings. Methods: Data were collected in late 2007 through early 2008 using a survey administered to staff in each of 40 nursing homes. In 4 of these nursing homes, the responses of different staff were identified. The Nursing Home Survey on Patient Safety Culture was used to assess the 12 domains of the PSC and identify differences in PSC perceptions between staff. Results: For the 40 nursing homes in the sample, the overall facility response rate was 72%. For the 4 nursing homes of interest, the overall facility response rate was 68.9%. The aggregate Nursing Home Survey on Patient Safety Culture scores, using all staff types for all survey items, show that most respondents report a poor PSC. However, administrators/managers had more positive scores than the other staff types (P < 0.05) across most domains. Conclusions: Staff in nursing homes generally agree that PSC is poor. This may have a significant impact on quality of care and quality of life for residents.

Nursing home deficiency citations for safety.

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.

Understanding completion entailments in the absence of agency cues

This study investigated the role that agency information plays in childrens early interpretations of grammatical aspect morphology, in particular, the progressive -ing and simple past forms. Fifty-nine children (two-, four- and five-year olds) were presented with a forced-choice sentence-to-scene matching task very similar to the one used by Weist and colleagues (Weist, 1991; Weist, Wysocka & Lyytinen, 1991; Weist, Lyytinen, Wysocka & Atanassova, 1997), except that here the scenes contained only information about the relative completion of the object of the event and no information about the state of the agent of the event. In contrast to previous research, the children here did not succeed at this object-oriented task until as late as age five; moreover, also contra previous work, when they did succeed, their performance tracked the formal entailments of grammatical aspect. Thus, subjects consistently matched the perfective sentence to the completed event (reflecting the perfectives entailment of completion) but never consistently matched the imperfective sentence to either scene (reflecting the imperfectives lack of entailments). It is argued that agent-oriented meaning, in particular, intentionality, has priority in the mapping process over object-oriented completion entailments.

Interpretation of Contrastive Pitch Accent in Six- to Eleven-Year-Old English-Speaking Children (and Adults).

Both off-line and on-line comprehension studies suggest not only toddlers and preschoolers, but also older school-age children have trouble interpreting contrast-marking pitch prominence. To test whether children achieve adult-like proficiency in processing contrast-marking prosody during school years, an eye-tracking experiment examined the effect of accent on referential resolution in six- to eleven-year-old children and adults. In all age groups, a prominent accent facilitated the detection of a target in contrastive discourse sequences (pink cat → green cat), whereas it led to a garden path in non-contrastive sequences (pink rabbit → green monkey: the initial fixations were on rabbits). While the data indicate that children as young as age six immediately interpret contrastive accent, even the oldest child group showed delayed fixations compared to adults. We argue that the childrens slower recovery from the garden path reflects the gradual development in cognitive flexibility that matures independently of general oculomotor control.