The interaction of audition and cognition has been of interest to researchers and clinicians, especially as the prevalence of hearing loss and cognitive decline increases with advancing age. Cognitive screening tests are commonly used to assess cognitive status in individuals reporting changes in memory or function or to monitor cognitive status over time. These assessments are administered verbally, so performance may be adversely affected by hearing loss. Previous research on the impact of reduced audibility on cognitive screening test scores has been limited to older adults with sensorineural hearing loss (SNHL) or young adults with normal hearing and simulated audibility loss. No comparisons have been conducted to determine whether age-related SNHL and its impact on cognitive screening tests is successfully modeled by audibility reduction.The purpose of this study was to examine the effects of reduced audibility on the Mini-Mental State Examination (MMSE), a common bedside cognitive screening instrument, by comparing performance of cognitively normal older adults with SNHL and young adults with normal hearing.A 1:1 gender-matched case–control design was used for this study.Thirty older adults (60–80 years old) with mild to moderately severe SNHL (cases) and 30 young adults (18–35 years old) with normal hearing (controls) served as participants for this study. Participants in both groups were selected for inclusion if their cognitive status was within normal limits on the Montreal Cognitive Assessment.Case participants were administered a recorded version of the MMSE in background noise at a signal-to-noise ratio of +25-dB SNR. Control participants were administered a digitally filtered version of the MMSE that reflected the loss of audibility (i.e., threshold elevation) of the matched case participant at a signal-to-noise ratio of +25-dB SNR. Performance on the MMSE was scored using standard criteria.Between-group analyses revealed no significant difference in the MMSE score. However, within-group analyses showed that education was a significant effect modifier for the case participants.Reduced audibility has a negative effect on MMSE score in cognitively intact participants, which contributes to and confirms the findings of earlier studies. The findings suggest that observed reductions in score on the MMSE were primarily due to loss of audibility of the test item. The negative effects of audibility loss may be greater in individuals who have lower levels of educational attainment. Higher levels of educational attainment may offset decreased performance on the MMSE because of reduced audibility. Failure to consider audibility and optimize communication when administering these assessments can lead to invalid results (e.g., false positives or missed information), misdiagnosis, and inappropriate recommendations for medication or intervention.
Excellence in critical thinking skills requires well-developed situational mental models: integrated knowledge of how concepts and principles relate to a specific client's condition and care. The authors describe the use of unfolding case studies as a strategy for eliciting and evaluating students' changing mental models. Unfolding cases offer a practical method for capturing the dynamic nature of situational mental models and revealing significant errors in students' problem-solving cognitions that would not otherwise be obvious.
Results of competency, or certification, tests can have serious consequences for individuals tested, for employers, and for the public. However, the validity of testing outcomes depends not only on the validity of the test's content but also on the validity of the score selected as the passing, or cut-off, score. This article describes procedures and techniques for use by staff development professionals to ensure systematic, rational, and defensible cut-off scores for competency tests.
<h4>ABSTRACT</h4> <P>In nursing education, measures of structural knowledge have not been widely used to assess student learning. Some authors have suggested concept mapping as a way to measure structural knowledge, but this approach can be subjective and otherwise problematic. Pathfinder, a computer-based network scaling technique, offers an alternative, quantitative method for representing and evaluating structural knowledge. The purpose of this study was to investigate structural knowledge as a learning outcome for baccalaureate nursing students by using Pathfinder techniques. Results revealed that students’ structural knowledge increased in internal consistency and became more similar to instructors’ knowledge during a course in community health nursing. Students with structural knowledge that was most coherent and similar to the instructors’ performed better in the course. Students’ structural knowledge characteristics differentiated between high-performing and low-performing students. Findings support the use of structural knowledge representation with Pathfinder scaling techniques as a way to operationalize learning. </P> <h4>AUTHOR</h4> <P>Received: July 29, 2005</P> <P>Accepted: November 11, 2005</P> <P>Dr. Azzarello is Associate Professor, University of Oklahoma College of Nursing, Oklahoma City, Oklahoma.</P> <P>Address correspondence to Jo Azzarello, PhD, RN, Associate Professor, University of Oklahoma College of Nursing, 1100 North Stonewall Avenue, Oklahoma City, OK 73117; e-mail: <a href="mailto:jo-azzarello@ouhsc.edu">jo-azzarello@ouhsc.edu</a>.</P>
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