Natalie F. Douglas

Perceptions of Speech-Language Pathologists Linked to Evidence-Based Practice Use in Skilled Nursing Facilities

PURPOSE This study explored whether perceptions of evidence or organizational context were associated with the use of external memory aids with residents with dementia in skilled nursing facilities (SNFs). METHOD A survey design, supplemented by a small sample of exploratory interviews, was completed within the Promoting Action on Research Implementation in Health Services framework. Ninety-six speech-language pathologists (SLPs) and 68 facility rehabilitation directors (FRDs) completed the Organizational Readiness to Change Assessment (Helfrich, Li, Sharp, & Sales, 2009) in relationship to the use of external memory aids. Five SLPs completed an interview exploring perceptions of evidence and context in relationship to memory aid use. RESULTS SLPs and FRDs had favorable perceptions of evidence supporting memory aids. FRDs perceived the organizational context of the SNF more favorably than SLPs. SLP participants used external memory aids in the past 6 months in 45.89% of cases of residents with dementia. For SLP participants, a 26% (p < .05) increase of external memory aid use was associated with every 1-unit change in favor of the evidence. Interview data revealed barriers to external memory aid implementation. CONCLUSIONS Part of evidence-based practice implementation may be influenced by clinician perceptions. Efforts to increase implementation of external memory aids in SNFs should address these clinician perceptions.

Control and description of visual function in research on aphasia and related disorders

Background: Most experimental and assessment tasks in studies of neurogenic language disorders rely on visual information processing. Failure to describe and/or control for visual function may lead to invalid data collection and interpretation. Aims: An empirical study was initiated to describe current practice and needs for improvement in the description of and control for visual acuity, colour perception, visual fields, visual attention, and oculomotor functions. Methods & Procedures: Data were collected from all articles (N = 668) on aphasia (subsequent to left hemisphere damage) and related language disorders (subsequent to TBI and right hemisphere damage) in adults published during a 10‐year period in each of 17 journals. Outcomes & Results: Few authors control for or describe even basic aspects of vision. Conclusions: Specific needs and strategies for improvement are discussed. The need for improved continuing education concerning means of screening for various forms of visual function is highlighted. Researchers are encouraged to employ basic screenings corresponding to the visual functions implemented in their assessment and experimental tasks for a given study. Improved feedback to manuscript authors and those seeking grant funding regarding appropriate control for and description of visual function is advocated.

Will You Still Need Me When I'm 64, or 84, or 104? The Importance of Speech-Language Pathologists in Promoting the Quality of Life of Aging Adults in the United States into the Future

In the next two decades, there will be advances in the diagnosis and treatment of the disorders of aging that have the potential to change the way speech-language pathologists (SLPs) are trained and provide services to individuals with a continuum of cognitive communication challenges. SLPs will address the needs of the aging adult who continues to reside in the community and desires to maintain an independent and meaningful life, as well as those who require a supportive residential setting to achieve a satisfying quality of life. Evidence-based strategies and intervention approaches for the range of goals that will address the desired functions of a meaningful life for individuals faced with cognitive communicative challenges are outlined. Institutional barriers to the implementation of documented evidence-based approaches will need to be reduced through a variety of organizational and systems changes. The projected outcome of these changes will be the creation of a person-centered culture of care that promotes dignity, choice, and engagement in meaningful activities through the end of life.

Implementation Science: Buzzword or Game Changer?

PURPOSE The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. METHOD Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science theories and methodologies are provided, including an overview of hybrid research designs that simultaneously investigate clinical effectiveness and implementation as well as an introduction to approaches for engaging stakeholders in the research process. A detailed example from education is shared to show how implementation science was utilized to move an intervention program for autism into routine practice in the public school system. In particular, the example highlights the value of strong partnership among researchers, policy makers, and frontline practitioners in implementing and sustaining new evidence-based practices. CONCLUSIONS Implementation science is not just a buzzword. This is a new field of study that can make a substantive contribution in communication sciences and disorders by informing research agendas, reducing health and education disparities, improving accountability and quality control, increasing clinician satisfaction and competence, and improving client outcomes.

Supporting evidence-based practice in speech-language pathology: A review of implementation strategies for promoting health professional behavior change

Abstract Evidence-based practice (EBP) is recognized as being essential to optimizing service provision and attaining positive client outcomes in speech-language pathology. Yet, there are a number of barriers to attaining EBP in speech-language pathology, including how to support clinicians to successfully change their practices and behaviors. Drawing from the field of implementation science, the authors describe several implementation strategies that researchers can use to facilitate the behavior of health professionals towards adopting empirically supported practices. Key studies are identified that provide practical advice for researchers on how to select and study specific implementation strategies in the service of enhancing EBP in real-world environments. An illustrative example from physical and occupational therapy illustrates how researchers might apply this advice in their own research designs. Ultimately, well-designed studies using multifaceted implementation strategies are needed to reduce the research-to-practice gap in speech-language pathology.

Person-Centered, Skilled Services Using a Montessori Approach for Persons with Dementia

&NA; The current mandate for person‐centered care throughout the health care system, and especially in the nursing home industry, requires that speech‐language pathologists ensure that the services they provide to elders with dementia are skilled, person centered, and relevant to positive overall health outcomes. Guidelines developed by the Association Montessori International Advisory Board for Montessori for Aging and Dementia are one avenue toward such skilled and person‐centered services. The purpose of this article is to provide clinicians with practical strategies for guiding their assessment, goal writing, and intervention plans to meet the expectations of a person‐centered approach to services for elders with dementia, using the Montessori approach as a philosophical guide.

Employee attitudes towards aggression in persons with dementia: Readiness for wider adoption of person-centered frameworks

WHAT IS KNOWN ON THE SUBJECT Person-centered care, as compared to standard approaches, is a widely accepted, evidence-based approach for managing aggressive behaviour in persons with dementia. The attitudes, beliefs and values of long-term care and mental health nursing employees are important prerequisites to implementing person-centered practices. Research shows that nursing employees typically support person-centered approaches; however, less is known about the attitudes of non-nursing employee groups. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE Nurse managers and administrators tended to agree with person-centered approaches for managing aggression in dementia, suggesting some prerequisites are in place to support wider adoption of person-centered frameworks. Employees with more resident contact tended to support person-centered approaches the least, suggesting discipline-specific trainings may not be adequate for preparing frontline staff to use person-centered techniques. Attitudes towards aggressive behaviour may be especially varied and contradictory within certain employee groups, providing implications for facility-wide initiatives. IMPLICATIONS FOR PRACTICE Person-centered values and practices should be monitored and reinforced across the organization. Person-centered trainings should be interdisciplinary in nature and focused on care areas, such as mealtime or bathing. Long-term care facilities should consider allowing nurse management and registered nurses to share the burden of direct resident care with frontline employees on a more regular basis. ABSTRACT Introduction Implementing person-centered care requires shared attitudes, beliefs and values among all care employees. Existing research has failed to examine the attitudes of non-nursing employees. Aim This study examined attitudes towards aggression among nursing and non-nursing employees to address gaps in existing research and assess readiness for wider adoption of person-centered frameworks. Method The Management of Aggression in People with Dementia Attitude Questionnaire was used to survey attitudes of employees in Michigan-based nursing homes. Results Overall, employees preferred person-centered over standard approaches. Job title was a significant predictor of paradigm support. Frontline employees were found to support person-centered attitudes the least. Wide-ranging responses were noted within employee groups. Discussion Job title may influence the degree to which an employee supports and utilizes person-centered approaches. Employees with the most contact with persons with dementia may be the least likely to implement person-centered approaches. In contrast to prior studies, years of experience was not a significant predictor of attitude towards aggressive behaviour. Wide-ranging responses indicate that employee attitudes are varied and complex. Implications Person-centered approaches should be trained within care areas rather than individual employee groups. Programs should be interdisciplinary and seek to establish a shared understanding of person-centered beliefs and values.

CERTIFIED NURSING ASSISTANTS ARE NOT TOO BUSY TO IMPLEMENT EXTERNAL MEMORY AIDS FOR RESIDENTS WITH DEMENTIA: EVIDENCE OF A TRAINING GAP

banks, credit unions, mutual fund companies, insurance companies, retirement plan custodians, alternative investment companies and independent wealth advisors. This entire industry is now tasked with implementing procedures and protections to enable respectfully empowering older investors while also averting elder financial exploitation (most often by family members). Analysis includes longevity and generational wealth data for the Baby Boomers, the terms and characteristics for dementia and cognitive impairment, the impact of aging on financial reasoning, the privacy problems and costs in the industry’s adhering to US Treasury Department’s Financial Crimes Enforcement Network (FinCEN) “red flags” for detecting financial exploitation, and the liabilities for failing to identify loss of capacity or simplify communications for seniors with limited reasoning. ven if efforts to protect against Elder Vulnerabilities become a major focus of industry regulators, research indicates the population volume and longevity of the Baby Boomers will lead to an alarming number of Americans becoming victims of elder financial exploitation. Conclusions: Key findings are that even if efforts to protect against Elder Vulnerabilities become a major focus of industry regulators, research indicates the population volume and longevity of the Baby Boomers will lead to an alarming number of Americans becoming victims of elder financial exploitation.