Valerie T. Cotter

An evaluation of dementia screening in the primary care setting

Purpose: To evaluate current screening methods for dementia to determine the most accurate and efficient tools for use in primary care. Data sources: Search included the following: Medline, CINAHL, BIOSIS, PsycINFO, ISI Web of Science, and Health & Psychosocial Instruments (1840–2005). The following search terms were used: screen, screening, tools, Mini Mental, MMSE, clock drawing, subjective memory, assessment, diagnosis, primary care, outpatient, community based, ambulatory care, dementia, cognitive impairment, and memory impairment. There was no limit to publication year. Articles excluded were those not published in English and those which used screening tools as part of diagnostic evaluation. The search revealed 581 relevant articles, which were narrowed to 20. Conclusions: The Mini Mental State Examination (MMSE) has high sensitivity and specificity in outpatients older than 65 years when age‐ and education‐specific cutoffs are used. The clock drawing test has lower sensitivity and specificity when used alone; however, in combination with the MMSE, its sensitivity is higher than that of the MMSE while specificity is slightly lower. Subjective memory complaints contribute diagnostic information; however, objective memory performance is a stronger predictor of future dementia. All measures are subject to influence by age, education, and other physical factors. The body of evidence regarding dementia screening methods has increased in recent years. The studies have been well conducted, of large sample size, in various geographic locations and populations, and by numerous investigators. Implications for practice: Dementing illnesses will become a common presentation in primary care. Currently, routine screening is not conducted although acceptable instruments, such as the MMSE, are available. Additional research on routine screening in primary care to bolster the current evidence, use of nurses as evaluators of cognition, and utilization of specialists is needed.

Student Perceptions of Cultural Competence Content in the Curriculum

The 31-item Blueprint for Integration of Cultural Competence in the Curriculum (BICCC) was used as an organizing framework and an evaluative tool to survey student perceptions of inclusion of cultural-specific content in undergraduate and graduate courses. Quantitative and qualitative data were used to complete this survey, which provided definitive information about the strengths and deficiencies of the curriculum initiative. Findings show that faculty made considerable progress with the curriculum integrative efforts. With responses of sometimes to quite often on the BICCC survey, 90% of the masters, 87% of senior, and 25% of first-semester freshmen participants reported a sufficient level of teaching in response to the survey items on aspects of culture and health. For all cohorts, the survey showed that content related to critique of health disparities research and theoretical formulation about culture, health, and nursing were not sufficiently addressed. Open-ended comments showed that freshmen reported a solid foundation of culturally related courses in arts and humanities courses; seniors disclosed a high level of knowledge about aspects of culture competence; and masters participants had high levels of self-awareness about values, cultural beliefs, and challenges of cross-cultural communication. The BICCC provided substantial information for faculty to address areas of omission, deficiency, and redundancy in the cultural competence education.

Cultural Competence in the Master's Curriculum-A Course Exemplar

This article focuses on the teaching-learning strategies for integration of cultural competence in the first clinical core course in Primary Care of the Middle Aged and Older Adult, a required course for graduate students enrolled in the Adult Health Nurse Practitioner Program, Gerontology Nurse Practitioner Program, and the Family Health Nurse Practitioner Program at the University of Pennsylvania School of Nursing. Multiple teaching-learning strategies for the first clinical course consisted of preliminary online self-assessment, clinical case scenarios, critique of multicultural clinical vignettes, and cultural assessment of the clinical agency. In the outcomes of these teaching-learning strategies, it was shown, through the use of reflective diaries of nurse practitioner students and course evaluations, that the multiple strategic approaches were effective for cultural competence integration within each of the nurse practitioner programs.

Self-concept in older adults: an integrative review of empirical literature.

The aging process leads to normative age-related bodily and functional declines and numerous social changes and life events that potentially threaten the self-concept. Despite these changes, the majority of older adults are able to maintain a positive sense of self and remain resilient. This article presents an integrative review of the empirical literature addressing self-concept in older adults.

Hope in early-stage dementia: A concept analysis

Hope is central to the adjustment process in early-stage dementia when trying to maintain a sense of normalcy and developing cognitive, social, and behavioral strategies to improve confidence. Maintaining hope, helping others, and living within a supportive social network can positively influence adaptation to daily living and to the preservation of self-concept. Utilizing Walker and Avants method of concept analysis, the literature was examined to explore hope in early-stage dementia and to identify the dynamics and components of the hope experience. Gaining an understanding of the concept of hope in early-stage dementia will aid nurses and other healthcare professionals to help people with early-stage dementia and their family caregivers find ways of maintaining hope and strengthening a sense of self.

Clinical evaluation tools for dual track adult and gerontology nurse practitioner students

Purpose: To describe the development of a dual track offering for the Adult Health and Gerontology Nurse Practitioner (AGNP) Programs at the University of Pennsylvania School of Nursing and share clinical evaluation tools used with nurse practitioner students in this curriculum. Data sources: Selected research and clinical articles. Conclusions: A variety of evaluation approaches are utilized in the AGNP student clinical performance evaluation. These incorporate the extended clinical practicum sequence for the dual track curriculum in addition to each individual programs objectives. Formative and summative evaluations include reflective logs, clinical documentation of patient encounters, preceptor evaluation, and faculty site visits. Self‐evaluative skills of the student and quality faculty feedback are two additional integral components that facilitate learning outcomes in the cognitive, psychomotor, and affective learning domains. Implications for practice: The summary of evaluation tools presented here is an example of how the AGNP Programs at the University of Pennsylvania School of Nursing effectively measure student progress in a curriculum model for dual track enrollment.

Student Drug Testing in Nursing Education

Nursing faculty and administrators have a responsibility to keep abreast of current research, legal regulations, and professional standards that affect students in the classroom and clinical setting. The purpose of this article is to examine whether empirical research supports the current trend of mandatory drug testing, provide a synopsis of current practice, and discuss the legal and ethical implications for nursing faculty.

Early Stage Dementia: Maximizing Self-Direction and Health

This chapter discusses early stage dementia including psychological response, individual needs, care partner roles, continuity of care and available resources. It highlights the importance of autonomy and empowering the individual with early stage dementia to be as independent as possible in areas of strength. This is demonstrated through the importance of early detection and diagnostic disclosure as well as having joint conversations about difficult topics with the individual in the early stages to further empower personal choice and voice. Overall, both the individual in the early stages and care partner(s) will go through a range of emotions that progress through stages of awareness, coping and self-evaluation. There are varying factors that can influence ones psychological responses pertaining to a diagnosis of dementia. Therefore, it is imperative that the individual in the early stages and care partner(s), with support from healthcare professionals, work together as a team thus enhancing a sense of control over this change of life situation through joint interventions and strategies.