In care and digitally savvy? Modern ICT use in long-term care institutions

ABSTRACT

Although information and communication technologies (ICTs), such as smartphones, tablets, and the internet, have all become increasingly important in modern society, available studies on the adoption of ICTs have mostly focused on healthy and community-dwelling “young-old” adults. Relatively little is known about ICT use among long-term care residents, such as “old-old” adults, who often have various functional impairments and live in institutionalized settings. The study includes data on ICT use (TV, radio, computers, smartphones, tablets, and internet) among a large sample of 940 residents (mean age: 87.6 years) living in 20 retirement homes in Zurich, Switzerland. Twenty-one percent of residents reported using the internet, 13% used a smartphone, and 5% used a tablet. Younger older adults, those with more education, those with lower nursing-care levels, and those who reported being particularly interested in technology were more likely to own more than one ICT device. Compared with nonusers, internet users were more likely to be younger, better educated, and more interested in technology in general. Modern ICT usage has reached the long-term care sector and appears to play a significant role in many residents’ lives. Researchers should continue to examine the role of ICTs in the lives of older adults in general and for residents in long-term care in particular, given that this population is often ignored in studies of older adults and ICT use.     

Deliberate Practice in Medicine: The Motivation to Engage in Work-Related Learning and Its Contribution to Expertise

This study examined physicians’ motivation to engage in work-related learning and its contribution to expertise development beyond work experience. Based on deliberate practice theory, semi-structured interviews were conducted with 17 residents and 28 experienced physicians in internal medicine, focusing on the activities they engaged in during work that might contribute to professional development and the goals underlying this behavior. Learning motivation was also measured using a goal orientation questionnaire. Expertise was measured by a case test derived from the Medical Knowledge Self Assessment Program (MKSAP). The interviews showed that participants’ learning was largely embedded in everyday work; most of their learning activities were inherent to the job rather than motivated by competence improvement goals. The problems encountered in patient care played a key role in prompting learning. Role, work experience and work situation affected the type of activities engaged in, as well as the intensity of practice. Deliberate engagement in work-related learning activities was related neither to goal orientations nor to case test performance, except activities by the experienced physicians to keep up-to-date. Work experience, in contrast, showed a clear positive relationship with the performance of residents. Two main conclusions can be drawn from this study: (1) patient care induced relevant learning activities aimed at performance improvement for the patient’s sake; (2) deliberate investments in learning can be enhanced to promote expertise development. Self-regulated learning by physicians needs to be strengthened and the organization for which they work should facilitate and encourage learning in daily practice.     

Evidence-based health promotion in nursing homes: A pilot intervention to improve oral health

ABSTRACT

Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts’ nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an intervention targeting Certified Nurses’ Aides (CNAs) was developed and tested. We hypothesized that following the training, CNAs would have increased knowledge and self-efficacy toward providing oral health care to the residents in their charge.

This pilot study used a one-group pretest-posttest design to test the effectiveness of a psycho-educational training intervention. Utilizing the constructs of knowledge and self-efficacy from the Theory of Planned Behavior and the Social Cognitive Theory, we framed the content of a training intervention and administered a 21-item instrument. The survey was distributed to the CNA staff of a single midsize nursing home immediately prior to and after the intervention. The 1-hour training intervention was empirically supported by formative data and delivered by dental faculty researchers.

Findings indicate increases in two areas of oral health knowledge: toothbrush position and frequency of brushing. Self-efficacy, however, did not significantly change. Although the results marginally supported our hypothesis, this pilot study demonstrates the feasibility of delivering interventions to CNAs who have direct responsibility for promoting the oral health of long-term care facility residents.     

COLLEGE STUDENTS' ATTITUDES TOWARD RESIDENTIAL CARE FACILITIES

This study was designed to explore college students attitudes toward residential care settings for older adults. Subjects were 109 female students aged 18 to 71 years (M = 24.8, SD = 9.49) and 22 male students aged 19 to 43 years (M = 23.3, SD = 5.24) enrolled in a Psychology of Aging course at a local state college. Students interviewed older residents of 96 different long-term care facilities and completed a questionnaire that assessed their impressions of the facility and its residents. Students openness to living in long-term care settings and positive and negative statements about the facility visited were the main measures of student attitudes toward such settings. Nursing homes were perceived more negatively than any other type of long-term care setting. Students who had been affected by meeting the needs of an elderly relative were more open to living in residential care settings, as were students who interviewed residents who were satisfied with their lives. Nursing homes elicited the least openness to living in residential care facilities, whereas assisted care and continuing care facilities elicited the most openness. Students who perceived residents as mentally alert made fewer negative statements about the facilities visited.     

Attitudes of Medical Students and Residents Toward Care of the Elderly

The research reported in this article examined attitudes toward the care of the elderly between and among medical students and residents in training. Data were collected with a 16-item attitude questionnaire. Participants were medical students in their introduction period (prior to clinical experience) and residents of the Department of Internal Medicine, Faculty of Medicine at Siriraj Hospital to answer. There was no difference in the attitudes toward the care for the elderly between medical students and residents. Prior exposure to the elderly may have an influence on attitudes toward the care of the elderly. The geriatric curriculum should be developed to correct misunderstandings and improve the attitudes of the students and residents.     

Dare to Dream: New Venture Incubator for Older Adults

The purpose of this article is to describe a project that aims to foster active aging through entrepreneurial activities among older adults. The project establishes the feasibility of implementing an intervention program that assimilates the concept and capabilities of entrepreneurship among older adults and supports them while launching new ventures. A 12-meeting training program was provided to the selected participants followed by continuing support through a tailor-made incubator. The pilot experiment selected a group of retirees who sought work and had no previous entrepreneurial experience. Of the 22 participants in the intervention program, 15 (70%) actually started a microenterprise based on their previously formulated ideas and past work experience and encouraged by participation in the program. Fostering older adults’ entrepreneurial activities has value much further than fulfilling individual needs because it provides benefits to the welfare of the community as well as to the economy. The pilot experiment suggests that this type of intervention program is feasible and warrants further studies.     

Exploring children’s perspectives of engagement with their carers using factor analysis

Positive engagement between a child and carer in out-of-home care is understood to have long-term benefits for children who have experienced abuse or neglect. This study analysed data from the ‘Views of Children and Young People in Foster Care 2009′ survey of 937 children in out-of-home care in Queensland, Australia, to identify factors that supported or hindered engagement between a child and carer. Exploratory and confirmatory factor analysis and structural regression were used. Findings suggest that children’s engagement with their carer is influenced by a range of internal and external factors including child characteristics, the care experience, contact with biological parents, and placement trajectory. Child engagement is important because it is central to positive outcomes such as placement stability in out-of-home care. Implications for policy and practice include the need for a structural response that supports building and maintaining positive child-carer relationships.     

Predicting Teacher Participation in a Classroom-Based, Integrated Preventive Intervention for Preschoolers

Preschools provide a promising setting in which to conduct preventive interventions for childhood problems, but classroom programs can only be effective if teachers are willing and able to implement them. This study is one of the first to investigate predictors of the frequency of teacher participation in a classroom-based, randomized controlled trial of an integrated prevention program for preschoolers. The intervention was designed to promote school readiness with an integrated social and academic program, to be implemented by teachers with the support of classroom consultants. The current study is part of a larger project conducted with Head Start and community child care centers that serve primarily economically disadvantaged families; 49 teachers from 30 centers participated in this study. Overall, teachers conducted approximately 70% of the program activities. Participation decreased significantly over time from the first to the final week of the intervention, and also decreased within each week of the intervention, from the first to the final weekly activity. Teachers working at community child care centers implemented more intervention activities than did Head Start teachers. Teacher concerns about the intervention, assessed prior to training, predicted less participation. In addition, teachers' participation was positively related to their perception that their centers and directors were supportive, collegial, efficient, and fair, as well as their job satisfaction and commitment. Teacher experience, education, ethnicity, and self-efficacy were not significantly related to participation. In multi-level models that considered center as a level of analysis, substantial variance was accounted for by centers, pointing to the importance of considering center-level predictors in future research.     

Exploring an intervention’s impact on everyday school activities

The focus of this paper is on a group of pupils with reading and writing difficulties who have been participating in an intervention study using assistive technology. That intervention study contained supervised training sessions with reading and writing tasks using an iPad with special supportive applications. The current study is a qualitative investigation of whether there has been any transfer from the intervention, to the pupils’ everyday school activities. Interviews with pupils and their teachers and observations during classroom lectures have been used to collect data. The results show that the pupils were positive to the assistive technology (the applications on the iPads), they found the apps easy to learn how to use and they appreciated the benefits they could give. Even so, only a few of the pupils had found use for and continued to use the tools after the intervention period finished. Possible reasons are that when the novelty wore off, students reverted to their usual study habits and that older students with many teachers and different classrooms were less able to adapt to using the apps. To improve transfer, it is suggested to introduce assistive technology earlier to students, in the younger grades, before study habits have been formed and to inform teachers about the use of AT in the classroom, including what is available and how it can benefit students.     

Development of a Curriculum for Long-Term Care Nurses to Improve Recognition of Depression in Dementia

There is increasing recognition of the severe consequences of depression in long-term care residents with dementia. Most health care providers are unprepared to recognize and to manage the complexity of depression in dementia. Targeted educational initiatives in nursing homes are needed to address this growing problem. This paper describes the development of competencies, learning objectives, and learning outcomes for a curriculum on depression in dementia for nurses working in nursing home settings. This work provides the foundation for a curriculum to improve learning for nurses and, ultimately, to advance health care outcomes for residents with cooccurring depression and dementia.     

The effects of experience of early intervention on low birth weight,premature children: The infant health and development program

This study explores individuals' experience of early intervention in two settings (the home and the child development center) and the effect of that experience on child and parental outcomes in the Infant Health and Development Program (IHDP). The IHDP was a randomized clinical trial designed to test the efficacy of educational and family support services on reducing developmental delays in low birth weight (LEW), premature infants (N = 985) during the first 3 years of life. This study focused on children in the intervention group who received at least one home visit and one day at the center each year (n = 296). Three approaches to measuring participants' experience of intervention were defined—number of contacts in the home and at the child care center (i.e., Exposure), number of activities presented per visit to the parent in the home or per day to the child at the center (i.e., Rate); and a combination of the parent's interest in the intervention activities in the home and the child's mastery of the intervention tasks taught at the center (i.e., Active Experience). More substantial contributions to both child IQ and the HOME scores at age 3 were found with the Active Experience approach than with the Exposure or the Rate approach, after controlling for initial background variables, family socioeconomic status, children's initial IQ, and parental cognitive ability. Further, a high level of Active Experience from both the parent and the child was associated with higher IQ scores at ages 1, 2, and 3 and higher HOME scores at age 3 than was found when only a high level of Active Experience from only the parent or the child, or neither, was involved. Implications for future intervention programs are discussed.     

Substance Abuse Policies in Long-Term Care Facilities: A Survey with Implications for Education of Long-Term Care Providers

The aging of the Baby Boom presents long-term care with many new challenges. Among these are the historically high levels of drug use by this cohort. This study surveyed administrators of licensed skilled nursing facilities in the Commonwealth of Kentucky regarding their perception of current drug use by residents, facility policies and procedures currently in place regarding illicit drug use, and their attitudes toward use of illicit drugs by residents. The results of interviews with 40 administrators or their designees revealed that they have experienced little problem with use or abuse of illegal drugs by residents. Fewer than one-third of the facilities had formal policies in place regarding illegal drug use. Only 10% had any experience with requests for medical marijuana, but almost one in five had a policy on the matter and nearly one-third stated they would support medical marijuana use by some of their residents if the matter arose. These authors recommend the following: (a) that the issue of illicit drug use needs to be addressed now before the situation becomes critical, (b) that administrators and staff need to be educated about recreational drug use and appropriate responses to drug abuse, (c) that screening instruments for drug abuse in this population should be developed and implemented, and (d) that policies regarding medical marijuana need to be adopted by all such facilities.     

PLANNING AN ELEARNING DEMENTIA CARE PROGRAM FOR HEALTHCARE TEAMS IN LONG-TERM CARE FACILITIES: THE LEARNERS’ PERSPECTIVES

This paper presents a needs analysis conducted to obtain information concerning online dementia care training of healthcare workers in long-term care (LTC) facilities. The resulting information was used to guide the development of an online dementia care training program designed to facilitate the acquisition of skills and knowledge necessary for healthcare teams to deliver better care to the residents with whom they work. Three focus groups were conducted at two sites across Canada. Data analysis revealed five major themes that will help program designers develop effective online learning programs. Recommendations for the development of an online dementia care program are proposed.     

Community involvement of persons with severe retardation living in community residences

A national survey was conducted with 294 community residential facilities (CRFs) serving adults with severe retardation. Respondents were asked to rate 38 community-based activities twice: one rating representing the activity involvement of the residents living in the CRFs, and one rating representing the perceived activity involvement of "average," well-integrated community members. Nonhandicapped community members were perceived to have significantly more involvement in 30 activities than adults living in CRFs. Group home and foster home residents were perceived to be more involved in employment or day activities outside the residence, use of health care services, walking or wheelchair strolling for pleasure, and use of parks or zoos than nonhandicapped community members.     

Technology’s role in learning at a commuter campus: The student perspective

Patterns of technology ownership and usage, as well as skills with and preferences for various technologies, affect the college experience (Educause 2012). Students at a commuter campus of a large Midwestern public university were surveyed about technology and the learning process: 94% of the respondents believed that technology had the potential to benefit learning and 85% thought it was central to their academic success. Students credited technology-enhanced courses with increased and more effective communication with instructors, the ability to better manage course activities and expanded opportunities for practice and reinforcement. Students’ prior experiences with a course management system affected their perceptions of the role of technology and their subsequent beliefs about the benefits of its use in their university courses. Implications for administrators who make decisions about faculty development, student retention and funding for technology-enhanced course offerings are discussed.     

红外多波长无创人体血糖检测技术研究

红外多波长血糖检测是利用人体血管红外线的热梯度光谱信息．通过数学模型求出血糖浓度的无创伤的检测方法，特别适用于长期、频繁的血糖检测。研究了红外多波长无创人体血糖检测关键技术，取得了实验室成果。     

Training day care program personnel in handling child abuse cases: intervention and prevention outcomes

Attempts have been made to provide day care services as part of a treatment plan and these services are also used as a preventive strategy. Day Care programs have the potential for providing growth experiences, supportive adult role models, and modeling parental skills in an atmosphere of understanding, respect and trust. There is a need, however, for day care professionals and paraprofessionals who come into contact with children to recognize problems of child abuse and neglect and to develop skills to deal with the range of inherent problems. A report on a training program for day care workers is presented in this article. A survey involving 84 day care programs in southeastern Pennsylvania was conducted and comparisons of intervention and prevention activities of two groups: those programs whose staff participated in the training and those whose staff did not, were made. Assessment of intervention activities shows that there is no difference between the groups. However, analysis of prevention activities shows that day care workers in the trained group were significantly more involved in prevention and high risk referral.     

Paired peer learning through engineering education outreach

ABSTRACT

Undergraduate education incorporating active learning and vicarious experience through education outreach presents a critical opportunity to influence future engineering teaching and practice capabilities. Engineering education outreach activities have been shown to have multiple benefits; increasing interest and engagement with science and engineering for school children, providing teachers with expert contributions to engineering subject knowledge, and developing professional generic skills for engineers such as communication and teamwork. This pilot intervention paired 10 pre-service teachers and 11 student engineers to enact engineering outreach in primary schools, reaching 269 children. A longitudinal mixed methods design was employed to measure change in attitudes and Education Outreach Self-Efficacy in student engineers; alongside attitudes, Teaching Engineering Self-Efficacy and Engineering Subject Knowledge Confidence in pre-service teachers. Highly significant improvements were noted in the pre-service teachers’ confidence and self-efficacy, while both the teachers and engineers qualitatively described benefits arising from the paired peer mentor model.     

A Modified Global Assessment of Functioning (GAF) Scale for Use in Long-Term Care Settings

ABSTRACT

Terminology in the Global Assessment of Functioning (GAF) Scale of DSM-IV often is irrelevant to the realities of nursing homes, assisted living centers, and similar facilities in which residents encounter stressors that are unique to their living environment and circumstances. As the mental health needs of long-term care residents are increasingly recognized and addressed, the need for population-congruent assessment becomes more desirable as well. This article suggests revisions to the current GAF that more accurately reflect psychological and social concerns common to the long-term care population. Several indications for the use of the revised scale are also offered.     

城镇化视野下的“村改居”社区认同性整合研究

在城镇化的背景下,针对“村改居”社区在整合过程中出现的问题,提出认同性整合的必要性和重要性。通过调查研究作出研究设计,论证假设,发现“村改居”社区认同性整合在利益整合体制和居民参与意识等方面的问题,指出认同性整合的关键在于完善社区保障制度和服务功能,增强居民参与及组织活动等。