This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.

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European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome.

This article is one in a series on the roles of adjunct clinical faculty and preceptors, who teach nursing students and new graduates to apply knowledge in clinical settings. This article describes the benefits and challenges of using a "flipped" classroom to promote active engagement among learners and more meaningful interaction between learners and educators.

'Flipping' the Classroom.

https://www.nursingsimulation.org/article/S1876-1399(13)00071-6/pdf

Standards of Best Practice: Simulation Standard I: Terminology

Development of safe nursing practice in entry-level nursing students requires special consideration from nurse educators. The paucity of data supporting high-fidelity patient simulation effectiveness in this population informed the development of a quasi-experimental, quantitative study of the relationship between simulation and student self-confidence and clinical competence. Moreover, the study reports a novel approach to measuring self-confidence and competence of entry-level nursing students. Fifty-three baccalaureate students, enrolled in either a traditional or simulation-enhanced laboratory, participated during their first clinical rotation. Student self-confidence and faculty perception of student clinical competence were measured using selected scale items of the Lasater Clinical Judgment Rubric. The results indicated an overall improvement in self-confidence and competence across the semester, however, simulation did not significantly enhance these caring attributes. The study highlights the need for further examination of teaching strategies developed to promote the transfer of self-confidence and competence from the laboratory to the clinical setting.

High-fidelity nursing simulation: impact on student self-confidence and clinical competence.

https://www.nursingsimulation.org/article/S1876-1399(12)00357-X/pdf

Evaluation of Simulation in Undergraduate Nurse Education: An Integrative Review

As use of simulations increases in nursing education, nurse educators are challenged to evaluate students' clinical judgment skills. The purpose of this article is to describe faculty development in the use of the Lasater Clinical Judgment Rubric (LCJR); faculty application of LCJR in evaluating students' clinical judgment skills during a simulation scenario; and faculty and students' perception transference from the simulation to the clinical setting. Tanner's Clinical Judgment Model was used in an assigned adult health simulation. Quantitative and qualitative data were collected from faculty and student evaluations and students' reflective statements. Findings support the importance of simulation's contribution to clinical judgment development. However, more work remains to improve the integration of clinical judgment and use of a conceptual framework and evidence-based rubric. For long-term change, both faculty and students need ongoing practice and encouragement in applying the clinical judgm...

A collaborative project to apply and evaluate the clinical judgment model through simulation.

Mentoring is important for the recruitment and retention of qualified nurse faculty, their ongoing career development, and leadership development. However, what are current best practices of mentoring? The purpose of this paper is to provide an overview of a model for excellence in establishing a formal mentoring program for academic nurse educators. Six themes for establishing a formal mentoring program are presented, highlighting best practices in mentoring as culled from experience and the literature. Themes reflect aims to achieve appropriately matched dyads, establish clear mentorship purpose and goals, solidify the dyad relationship, advocate for and guide the protege, integrate the protege into the academic culture, and mobilize institutional resources for mentoring support. Attending to the six themes will help mentors achieve important protege outcomes, such as orientation to the educator role, integration into the academic community, development of teaching, scholarship, and service skills, as well as leadership development. The model is intended to be generalizable for faculty teaching in a variety of academic nursing institution types and sizes. Mentoring that integrates the six themes assists faculty members to better navigate the academic environment and more easily transition to new roles and responsibilities.

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Best Practices in Academic Mentoring: A Model for Excellence

Clinical judgment development is critical to preparing students to safely meet the needs of an aging population. Evidence linking manikin-based simulation and clinical judgment is sparse. The purpose of this quasi-experimental international study was to determine the effect of expert role modeling on nursing students' clinical judgment in the care of a simulated geriatric hip fracture client. Students from five diverse schools (n = 275) participated in an unfolding simulation. Students were assigned to treatment or control groups. Treatment groups viewed an expert role model video. Trained observers rated student clinical judgment from selected video recordings using the Lasater Clinical Judgment Rubric (n = 94). Significant group differences (p = .000) were found for the clinical judgment dimensions of noticing, interpreting, and responding. Findings provide support for combining expert role modeling with clinical simulation to improve students' clinical judgment in the care of older adults.

Geriatrics in Simulation: Role Modeling and Clinical Judgment Effect

Assessment and Early Diagnosis of Dysphagia

One current higher education paradigm shift is the movement from traditional classroom settings and interactive television satellite transmission to course and program delivery via the World Wide Web (WWW). The authors describe the experiences of faculty in reconceptualizing and redesigning course and program delivery via the Internet. An electronic "template" has been collaboratively developed by multidisciplinary university partners to facilitate this work. The template incorporates an advanced nursing practice conceptual framework based on American Association of Colleges of Nursing (AACN) core educational essentials for advanced practice combined with a continuum of electronic course tools. Strategies, tools, and applications are discussed.

Linda Siktberg

Papers

A collaborative project to apply and evaluate the clinical judgment model through simulation.

Best Practices in Academic Mentoring: A Model for Excellence

Geriatrics in Simulation: Role Modeling and Clinical Judgment Effect

Assessment and Early Diagnosis of Dysphagia

Designing courses for the Internet. A conceptual approach.