Actual Encounters Research Articles

Radiology resident proficiency in pediatric trauma cases: a comparative analysis based on trauma center status using the WIDI SIM exam.

To investigate the correlation between pediatric and adult trauma center status and radiology resident performance on pediatric trauma cases using the WIDI SIM exam. The WIDI SIM is a validated computer-aided simulation that assesses radiology residents' preparedness for independent call duty. It includes 65 cases across various imaging modalities derived from actual patient encounters. Faculty score free-text responses using a standardized 0-10 scale rubric. We analyzed 8,488 WIDI SIM exam scores from 35 pediatric trauma cases across 52 programs. A negative binomial regression model adjusting for resident level, imaging modality, and case specialty was employed to evaluate the impact of pediatric and adult trauma center status on resident performance. Both pediatric trauma center status (p = 0.0005) and adult trauma center status (p = 0.0003) were significant predictors of higher resident scores. Resident level was also significant, with higher-level residents performing better than first-year residents (p < 0.001). Residents performed worse on MR and US modalities compared to CT, and performance varied by case specialty. Radiology residents' pediatric trauma imaging skills are significantly linked to pediatric and adult trauma center status. Given most pediatric traumas occur outside pediatric trauma centers, targeted training strategies should be considered to ensure residents develop essential diagnostic skills.

A phenomenological study of mathematics in the world: discriminate learning experience, impressions and actual encounters of students

A phenomenological study of mathematics in the world: discriminate learning experience, impressions and actual encounters of students

Is elderspeak communication in simulated hospital dementia care congruent to communication in actual patient care? A mixed-methods pilot study.

Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. The purpose of this mixed-methods study was to determine if simulation accurately captures elderspeak communication by nursing staff in hospital dementia care. A 3-part mixed-methods design in which (1) three dementia care simulations were designed and validated by a panel of experts, (2) communication by nursing staff completing each simulation was quantitatively compared to communication during actual patient care, and (3) views on the realism were explored using within- and across-case coding. Three simulations using different modalities (manikin, role-play, and standardised patient) were designed and validated with eight experts using the Lynn Method. Ten nursing staff were audio-recorded and their communication was coded for elderspeak communication. Results for each simulation were compared using Wilcoxon signed-rank test to recordings taken during actual dementia care encounters. Debriefings were coded for realism and results were converged. The average time using elderspeak during naturalistic care was 29.9% (SD = 20.9%) which did not differ from the average amount of elderspeak used across the three simulations modalities which ranged from 29.1% to 30.4%. Qualitative results suggested a lack of realism with the manikin condition and the nursing staff indicated preference for the simulation with the standardised patient. Communication elicited in the dementia care simulations was congruent to communication produced in actual dementia care but preference was for the standardised patient. Elderspeak communication can be accurately produced in the simulated environment which indicates that simulation is a valid method for person-centred communication training in nursing staff. Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. Elderspeak communication captured in the simulated environment was congruent to communication nursing staff use during actual patient care to hospitalised persons living with dementia. This study empirically identifies that communication is elicited in similar patterns by nursing staff in the simulated environment compared to the naturalistic care environment which demonstrates that simulation can be used as a valid tool for education and research on person-centred communication. STROBE. No Patient or Public Contribution.

Trauma-Informed Care as a Universal Precaution: A Brief, Case-Based, Educational Primer Featuring Role-Playing and Individual Self-Reflection Exercises.

Despite its growing popularity, the implementation of Trauma-Informed Care (TIC) in standard medical practices remains insufficient. A workshop, featuring role-playing scenarios and individual self-reflection exercises, was developed to enhance compassion among health care providers. The workshop was created by a multidisciplinary team of community pediatricians, pediatric intensivists, psychologists, and palliative care physicians, was structured around key elements and principles of TIC, and was based on actual patient encounters. The 90-minute session included didactics, role-playing, writing and self-reflection exercises, and large-group debriefings, and it was presented at two academic meetings. It is currently available as an open-sourced, freely accessible website. The workshop was attended by individuals with varying levels of training and experience. Of approximated 80 participants, 39 responded to surveys about baseline knowledge and workshop satisfaction, and 24 completed self-perceived pre- and postknowledge surveys. Nearly 90% had limited prior exposure to TIC. All rated the workshop highly, with no significant differences based on workshop facilitation. Nearly 95% felt that they learned something that would impact their day-to-day practices. Self-perceived pre-post knowledge showed statistically significant improvements. This workshop is feasible and can potentially increase health care professionals' capacity to care, decrease moral injury, and alleviate burnout from difficult cases.

Acknowledging religion in cognitive behavioural therapy: The effect on alliance, treatment expectations and credibility in a video-vignette study.

Developing mental health services which are accessible and acceptable to those from minority backgrounds continues to be a priority. In the United Kingdom, individuals who identify with a religion are underrepresented in Talking Therapies services as compared to those with no religion. This necessitates an understanding of how therapy is perceived. This online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility and expectations of therapy in a non-clinical sample of British Muslims. A video-vignette experimental design was used in which participants who self-reported as either high or low in religiosity were randomly allocated to receiving information about cognitive behavioural therapy either with or without an explicit mention of religion as a value in the therapeutic process. One hundred twenty-nine British Muslim adults aged 18-70+ years from various ethnic backgrounds participated in the study. Between-subjects ANOVAs showed that scores on the perceived credibility of therapy and treatment expectations were significantly higher when religion was explicitly mentioned by the 'therapist', but that acknowledging religion did not impact upon anticipated alliance. These findings suggest that mentioning religion as a value to be considered in therapy has some positive impacts upon how therapy is perceived by British Muslims. Although video vignettes do not provide insight into the complexity of actual therapeutic encounters, acknowledging religion in mental health services more broadly remains an important consideration for improving equity of access and may bear relevance to other minoritized groups.

Ruling Relations Coordinating the ‘Migrant Family’ in Institutional Encounters between Finnish Social Work Professionals and Migrant Service Users

Abstract Despite the growing body of literature on how migrancy transforms family relations, surprisingly little research exists on how ‘migrant family’ takes shape in institutional encounters. In this article, we analyse the negotiations on when and how family relations become addressed in encounters between social workers and migrant service users. Drawing from institutional ethnography, we understand the local service encounters as actively regulated by extra-local relations of ruling, represented here mainly by texts such as legislative acts, service descriptions and professional guidelines. The results show that the ways in which family is present and addressed in the institutional encounters often became an act of balancing between a broader understanding of family relations building on the service user’s self-definition as well as psychosocial and holistic professional ideals, and a narrower administrative understanding rooted in the Finnish legislation on social security and immigration. The legislative texts thus become a strong relation of ruling that coordinates the actual encounters and what happens in them. Nevertheless, family is essential to human subjectivity, and if the institutional encounters focus only on those family relations recognised by the legislation, important aspects of human relations remain unseen.

Actual encounters of the kidney kind: Exploring 48 cases of renal collision tumors through the lens of literature

Multiple tumors of different lineages merging into a single mass, termed collision tumors, are considered a rare phenomenon in the kidney. Tumor components, or partners, may be malignant (including metastatic disease), borderline, or benign. We report the largest cohort to date of 48 cases.The cases were identified from the archives of three institutions in the last 16 years, including 43 (90%) with 2 tumor partners (dyad) and 5 (10%) with 3 partners (triad), totaling 101 individual neoplasms. The majority of cases involved immunohistochemical workup, and 5 underwent FISH or molecular studies.Forty (83%) cases featured a malignant entity, including all triads. Twenty dyads and two triads were composed entirely of malignant tumors. The most common malignant partner was clear cell renal cell carcinoma (RCC) (N = 19) followed by papillary RCC (N = 17). Nine (19%) cases featured borderline entities, including 5 multilocular cystic neoplasms of low malignant potential and 6 clear cell papillary renal cell tumors. Twenty one (44%) cases contained a benign partner, including 6 benign dyads. Papillary adenoma (N = 13) and oncocytoma (N = 8) were most common. Epithelial tumors were present in all 48 cases, and non-epithelial neoplasms in 9 cases (19%).Our cohort includes many novel combinations and collision partners with rare entities such as SDH-deficient RCC, TFE3-rearranged RCC, eosinophilic solid and cystic RCC, and acquired cystic disease associated RCC. A comprehensive literature review and analysis of collision tumor phenomenon in kidney placed these cases in context suggesting that collision tumors of the kidney are more common than previously recognized.

Quality of breaking bad news to patients diagnosed with neoplasia of the uterine cervix

ObjectiveLittle is known about the quality of receiving bad news (BN) for women diagnosed with cervical neoplasia. We evaluated adherence to the SPIKES protocol in three cohorts of women with different stages of the disease and treatment modalities.Patients and methodsWe included women with cervical cancer who underwent radical vaginal trachelectomy (RVT group, n = 110), radical hysterectomy or chemo-radiation (HE/RCT group, n = 101), and women with CIN 3 treated by loop excision (CIN group, n = 108). We asked the participants about how they received the bad news delivery in reality and how they would envision an ideal communication process based on the main items of the SPIKES protocol. The participants filled out a questionnaire with 38 items of the Marburg Breaking Bad News (MABBAN) Scale representing the six SPIKES subscales.ResultsOnly 72% of all patients reported being satisfied with their BBN experience. The following factors were considered important by 90% of the patients: an undisturbed atmosphere, taking enough time, coherent explanation of the disease, and the possibility to ask questions. However, the reality of their experiences fell significantly short of their expectations. Asking about the patient’s knowledge of the disease, addressing their concerns, allowing them to show emotions, providing clarity about the change in quality of life, informing them about alternative therapies, and involving them in further planning were also significantly lacking in the actual BBN encounters compared to the patients’ preferences. The experience of RVT patients was more negative compared to the HE/RCT patients (p = 0.036). The CIN patients had an overall satisfactory impression (p < 0.0001).ConclusionThe process of breaking bad news in German women diagnosed with cervical neoplasia requires substantial improvement. The SPIKES protocol can be used as a guideline for enhancement but should be supplemented by incorporating a second consultation as the norm rather than the exception. Continuous monitoring and improvement of the quality of BBN is recommended for all oncologic institutions, utilizing the MABBAN questionnaire as a valuable tool.

Stereotyping and biased language in online environments: Misconceptions, decontextualization, and identity projections

Stereotypes are overgeneralized assumptions about different groups of people based on their nationality, ethnicity, gender, race, religion, or other social categories. This study examines the role of context in stereotypes found on online media. In particular, the study focuses on stereotypes of the Lebanese and Saudi people by examining the reactions of YouTube users to 30 YouTube videos. Ten of these videos present Lebanese and Saudi individuals positively, 10 neutrally, and 10 negatively. The data was collected from YouTube users’ comments on these 30 videos and analyzed mainly by identifying common themes and patterns. The findings showed that stereotypes were virtually absent in the YouTube users’ comments on the positive and neutral videos. However, they were prevalent on the negative videos. Most of the stereotypes found in the data were factually inaccurate, reductionistic, or decontextualized in nature. Only a few seemed to be based on real-life experiences or actual encounters with Lebanese or Saudi people. Overall, the findings suggest that, although some may be based on real-life experiences, stereotypes are often emotionally triggered and represent an overreaction to context-specific narratives, events, or actions. The findings will be discussed in terms of identity dynamics in the Arab World.

How Self-Efficacy and Agency Influence Risky Sexual Behavior among Adolescents in Northern Uganda

Background: Risky sexual behaviors remain common among adolescents regardless of those with comprehensive knowledge of safer sex practices. Self-efficacy has been shown to have a positive relationship with safer sex practices. Thus, investigating self-efficacy, and enhancing it to agency is important. The current study explores the predictors of self-efficacy for avoiding risky sexual behaviors and what limits agency among sexually active adolescents (15–19 years) in Northern Uganda. Methods: The study consisted of a sub-sample of 396 sexually active adolescents (145 in school, 251 out of school) interviewed as part of a household survey for the program on Advancing Sexual Reproductive Health and Rights in Northern Uganda. Poisson and Poisson regression models with survey weights were implemented in Stata. Results: A total of 94% of male and 64% of female adolescents reported self-efficacy to avoid unsafe sex, including using condoms and avoiding multiple sexual partnerships or transactional sex. At multivariable analysis, a higher proportion of adolescents who listened to a radio or television program about sexual and reproductive health within the past 12 months had self-efficacy as compared to others (PR = 1.13, p-value = 0.002). Similarly, higher proportions of adolescents who knew all the sexual and reproductive health (SRH) rights (PR = 1.33, p-value = 0.007) and who had comprehensive knowledge about pregnancy, prevention of sexual transmission infections, and sources of SRH services (PR = 1.24, p-value = 0.013) had self-efficacy as compared to others. However, among those who reported self-efficacy, 42% of the girls and 53% of the boys could not uphold their self-efficacy in actual sexual encounters in the past 12 months. Partner’s refusal or girls’ fear to ask their sexual partner to use a condom were commonly cited reasons. Alcohol consumption was associated with failure to act on one’s self-efficacy (RR = 0.74, p-value = 0.048). Conclusions: Programs should target self-efficacy beliefs and attempt to enhance them into agency by increasing positive and decreasing negative expectations associated with risky sexual behavior.

A qualitative analysis of trust and distrust within patient-clinician interactions

ObjectivesTrust represents a key quality of strong clinician-patient relationships.1 Many have attempted to assess patient-reported trust. However, most trust measures suffer from ceiling effects, with no variability, making it not possible to examine predictors of trust and distrust. Rather than rely on patient reports, we created a codebook for instances of trust and distrust from actual patient-clinician encounters. MethodsThree coders conducted a qualitative analysis of audio recordings among patient-cardiologist outpatient encounters. ResultsWe identified trust and distrust based on vocal and verbal cues in the interactions. We found consistent patterns that indicated patient trust and distrust. ConclusionOverall, this work empirically validates a new more accurate measurement of trust for patient-doctor interactions. InnovationWe are the first to use audio recordings to identify verbal markers of trust and distrust in patient-clinician interactions. From this work, others can code trust and distrust in recorded encounters rather than rely on self-report measures.

Living Insider Positionality with Co-ethnics in Everyday Life

Abstract In this article I reflect on how I was perceived by members of my own ethnic community in Pretoria, South Africa, in everyday interactions. In these interactions, I was viewed as an integral part of the community, rather than a detached academic. I employ the theory of community researcher and the theory of the everyday to frame my experiences and my argument. Recent debates on insider/outsider positionalities conceptualize co-ethnic migrant researchers as situational insiders. Drawing on my lived experiences, however, I argue that my insiderness has been consistently embraced by my co-ethnics. To establish strong rapport with members of their co-ethnics, migrant researchers need to maintain close social contact, informality and casualness, in their everyday interactions to enhance their positionality as trusted insiders during future actual research encounters. This study contributes to theoretical understandings of migration studies and researcher positionalities.

Taking Flight: Narratives, Logistics, and Risks of Chemsex Scenes in the Philippines

ABSTRACT Chemsex – the use of specific, illicit substances to facilitate and enhance sexual encounters – has been documented extensively across the Global North using qualitative methodologies. Elsewhere, however, little is known about the phenomenon. Our article addresses this gap in the scholarly literature by exploring how chemsex encounters transpire in the Philippines. Through semi-structured interviews, we demonstrate the spatiotemporal nature of chemsex scenes, showing how people move between physical and virtual domains across time as they find sexual partners, procure drugs, and organize and attend the actual encounter. Consequently, the risks faced by chemsex practitioners – to health and to security – are also spatiotemporally plotted within intersecting physical and virtual risk environments, and best mitigated by a form of experiential expertise that is likewise temporally determined. Ultimately, chemsex scenes in the Philippines are distinguished from the rest of the world by the state-led “war on drugs.” We consider our findings in the context of this war, showing how its very real and often fatal threats have shaped the way people navigate chemsex scenes and mitigate the risks through “counterpublic health” measures, and how its prominent ideologies and discourses are reflected in the ways by which people make sense of their drug use.

Strategies to Improve Teaching Point-of-Care Ultrasound at the Bedside.

Point-of care-ultrasound (POCUS) is becoming a core clinical skill in many medical specialties. Teaching POCUS at the bedside allows for observation of learners during actual patient encounters, provides a medium for role modeling skills and behaviors, and incorporates all core POCUS competencies. Nonetheless, bedside teaching can be time consuming and intimidating for learners and teachers, and the full benefits of teaching at the bedside can be difficult to attain. We provide strategies for improving bedside POCUS teaching based on our collective experience as medical educators and POCUS instructors at both the undergraduate and graduate levels in medical education.

Context-dependent alarm responses in wild vervet monkeys

The alarm calls of nonhuman primates are occasionally cited as functionally equivalent to lexical word meaning in human language. Recently, however, it has become increasingly unlikely that one-to-one relations between alarm call structures and predator categories are the default, mainly because many call types are produced in multiple contexts, requiring more complex notions of meaning. For example, male vervet monkeys produce the same alarm calls during encounters with terrestrial predators and neighbouring groups, suggesting that recipients require additional information to attribute meaning to the calls. We empirically tested the hypothesis that vervet monkeys take contextual information into account when responding to each other's alarm calls. In playback experiments, we exposed subjects to recordings of male alarm barks during actual intergroup encounters (predator unlikely) or when there was no intergroup encounter (predator likely). Subjects responded more strongly in the no intergroup encounter situations, typically associated with discovering a hiding predator, measured in terms of startle responses, vigilance behaviour and gazing towards the presumed caller. We discuss the significance of using contextual information for meaning attribution in nonhuman primate communication.

Analysis of Citizens' Risk Perception and Behavior based on the Record of Asian Black Bears Appearing in Ishikawa Prefecture in 2020 and their Experience of Encountering

The purpose of this study was to examine how to coexist with black bears in Ishikawa Prefecture, where a record number of black bears appeared in the autumn of 2020, and to understand the current risk perception and coping behavior of prefectural residents, which could serve as a basis for the formation of a coexisting society. In line with the studyʼs objectives, we conducted a questionnaire survey using LINE, which has a high penetration rate, to conduct efficient sampling in rural areas where it is not easy to collect data according to regional characteristics and resident attributes. The survey was conducted in February 2021, with a sample size of 1,742 valid responses from the entire prefecture. Analysis of the obtained data showed that citizensʼ risk perception of bear encounters was increased by the occurrence of bears in their living areas and their experiences of encountering bears. Residents who had bear encounters in their living areas relied on various information sources, had higher knowledge, and took actual encounter avoidance actions when they had experienced encounters. Information communication is needed to stimulate more encounter avoidance behavior, for example, by communicating standards of real encounters.

Understanding AI-based customer service resistance: A perspective of defective AI features and tri-dimensional distrusting beliefs

Communicating with customers through AI-based chatbots in customer service (AISC) has become increasingly popular for many companies. However, in actual service encounters, AISC seems defective and is not always accepted by customers. Occasionally it is even resisted. This study aims to investigate such customer resistance. In addition to two cognition-centered AI features (i.e., irrelevant and biased information) discussed in prior studies, this study proposes that lack of empathy is another key feature of defective AI (i.e., in its emotional dimension) and investigates the underlying mechanism of empathy. Specifically, this study proposes three pathways in which empathy functions are lacking. A survey was conducted to test our hypotheses, and the results suggest that lack of empathy has three effects on customer resistance: direct, indirect, and moderating. Finally, theoretical contributions and practical implications are discussed.

Surgeons Receiving Information About Patient Language Reflecting Unhelpful Thoughts or Distress About Their Symptoms Identify Such Language More Often Than Those Who Do Not Receive This Information.

Unhelpful thoughts and feelings of distress regarding symptoms account for a large proportion of variation in a patient's symptom intensity and magnitude of capability. Clinicians vary in their awareness of this association, their ability to identify unhelpful thoughts or feelings of distress regarding symptoms, and the skills to help address them. These nontechnical skills are important because they can improve treatment outcomes, increase patient agency, and foster self-efficacy without diminishing patient experience. In this survey-based study, we asked: (1) Are there any factors, including exposure of surgeons to information about language reflecting unhelpful thoughts about symptoms, associated with the total number of identified instances of language rated as reflecting unhelpful thoughts or feelings of distress regarding symptoms in transcripts of patient encounters? (2) Are there any factors, including exposure of surgeons to information about language reflecting unhelpful thoughts about symptoms, associated with the interobserver reliability of a surgeon's identification of language rated as reflecting unhelpful thoughts or feelings of distress regarding symptoms in transcripts of patient encounters? Surgeons from an international collaborative consisting of mostly academic surgeons (Science of Variation Group) were invited to participate in a survey-based experiment. Among approximately 200 surgeons who participate in at least one experiment per year, 127 surgeons reviewed portions of transcripts of actual new musculoskeletal specialty encounters with English-speaking patients (who reported pain and paresthesia as primary symptoms) and were asked to identify language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms. The included transcripts were selected based on the rated presence of language reflecting unhelpful thinking as assessed by four independent researchers and confirmed by the senior author. We did not study accuracy because there is no reference standard for language reflecting unhelpful thoughts or feelings of distress regarding symptoms. Observers were randomized 1:1 to receive supportive information or not regarding definitions and examples of unhelpful thoughts or feelings of distress regarding symptoms (referred to herein as "priming") once at the beginning of the survey, and were not aware that this randomization was occurring. By priming, we mean the paragraph was intended to increase awareness of and attunement to these aspects of human illness behavior immediately before participation in the experiment. Most of the participants practiced in the United States (primed: 48% [29 of 60] versus not primed: 46% [31 of 67]) or Europe (33% [20 of 60] versus 36% [24 of 67]) and specialized in hand and wrist surgery (40% [24 of 60] versus 37% [25 of 67]) or fracture surgery (35% [21 of 60] versus 28% [19 of 67]). A multivariable negative binomial regression model was constructed to seek factors associated with the total number of identified instances of language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms. To determine the interobserver agreement, Fleiss kappa was calculated with bootstrapped 95% confidence intervals (resamples = 1000) and standard errors. After controlling for potential confounding factors such as location of practice, years of experience, and subspecialty, we found surgeons who were primed with supportive information and surgeons who had 11 to 20 years of experience (compared with 0 to 5 years) identified slightly more instances of language believed to reflect unhelpful thoughts or feelings of distress regarding symptoms (regression coefficient 0.15 [95% CI 0.020 to 0.28]; p = 0.02 and regression coefficient 0.19 [95% CI 0.017 to 0.37]; p = 0.03). Fracture surgeons identified slightly fewer instances than hand and wrist surgeons did (regression coefficient -0.19 [95% CI -0.35 to -0.017]; p = 0.03). There was limited agreement among surgeons in their ratings of language as indicating unhelpful thoughts or feelings of distress regarding symptoms, and priming surgeons with supportive information had no influence on reliability (kappa primed: 0.25 versus not primed: 0.22; categorically fair agreement). The observation that surgeons with brief exposure to supportive information about language associated with unhelpful thoughts and feelings of distress regarding symptoms identified slightly more instances of such language demonstrates the potential of training and practice to increase attunement to these important aspects of musculoskeletal health. The finding that supportive information did not improve reliability underlines the complexity, relative subjectivity, and imprecision of these mental health concepts. Level I, therapeutic study.

ADVANCING RESEARCH ON PERSON-CENTERED COMMUNICATION IN DEMENTIA CARE

Abstract Communication is an essential component to achieving person-centered care. However, few measures exist for measuring person-centered communication and methods vary widely on measuring communication. The purpose of this symposium is to provide an overview of methods and recent findings related to research on person-centered communication. Four presentations will highlight a variety of methods and a variety of populations. Presentation one compares the congruence of communication by hospital nurses in a simulated care setting to communication during actual care encounters with hospitalized patients with dementia. Presentation two evaluates the impact of validation by family caregivers to persons living with dementia (PLWD) using a time sequential analysis of second-by-second coding of the caregiver’s communication and the PLWD behavioral response. Presentation three introduces the Changing Talk Scale (CHATS) as a tool to measure gains in knowledge of person-centered communication in the nursing home setting. Presentation four determines the impact of person-centered care versus task-centered care on mealtime behaviors in nursing home residents with dementia using a psychometrically established behavioral coding scheme and time-sequential approaches. Communication strategies to use with PLWD frequently lack sufficient evidence to be deemed effective or person-centered. Advanced methods are needed to understand what constitutes person-centered communication based on behavioral responses and other health outcomes off PLWD. This symposium provides an overview of these methods with formal and informal caregivers and PLWD in varied care settings including the community, hospitals, and nursing homes.

ESTABLISHING THE VALIDITY OF SIMULATION TO CAPTURE ELDERSPEAK COMMUNICATION IN DEMENTIA CARE

Abstract Using simulation may be an innovative approach for evaluating dementia care in research and education. The purpose of this study was to determine if communication in the simulated environment is congruent to communication in the naturalistic environment. Nursing staff (n=10) were each audio-recorded caring for an actual hospitalized person living with dementia (PLWD), and in three simulations evaluating the use of a manikin, young nursing assistant, and trained older adult standardized patient acting as the PLWD. The audio-recordings were coded for elderspeak (i.e., infantilizing) communication. Reactions to each simulation were gathered and qualitatively analyzed. The amount of elderspeak and neutral communication in the actual care encounters did not significantly differ (p&amp;gt;.05) from the communication in any of the three simulations indicating that simulation may be a valid method to capture elderspeak by nursing staff. The nursing staff indicated that the standardized patient provided the most realistic simulation.