LAUSR

Reliability and validitymeasurement issues are nothing new to clinical nurse specialists (CNSs). Over the years, this journal has published a plethora of articles addressing measurement, and as students, CNSs were educated in programs about the importance of reliability and validity as applied to instrument selection, usage, and interpretation of scores. As a result, healthcare organizations know that their CNSs are the go-to professionals when a process or outcome needs to be measured. A recent announcement from the Montreal Cognitive Assessment (MoCA) Clinic and Institute demonstrated the importance of liability as a third element to be considered when selecting and using instruments for measurement and evaluation. Liability is nothing to be taken lightly, particularly in the field of geriatrics, where measures of cognition are used to inform life-changing decisions for older adults that can trigger complaints by patients and families unhappy with the results. Cognitive problems amongolder adults arewidespread. Cognitive screening is frequently performed by healthcare providers across all practice settings, but not all of them are qualified to administer these seemingly simple instruments. An up-to-date, reliable cognitive screen that produces valid results is imperative for determining if anolder adult should undergo more extensive cognitive testing to determine a diagnosis, appropriate treatment, decision-making capacity, or continued ability to drive. For decades, healthcare professionals across all settings have utilized the Mini-Mental Status Examination (MMSE) as an important screening instrument. However, an alternative to the MMSE was developed in the 1990s when a cost became associated with administering the MMSE. The MoCA, developed in 1996, was subsequently adoptedbymanyhealthcareorganizationsbecause therewere no associated costs and the psychometric testing properties (validity and reliability) of the MoCA were determined to be similar to those of the MMSE. In addition, the MoCA was determined to be more sensitive to cognitive changes among older adults with mild cognitive impairment, not just those with dementia. As of September 1, 2019, all new users of the MoCAwill be required to complete training and testing to obtain certification to administer the MoCA (https://www.mocatest. org/training-certification/?access). Current users will have 1 year to complete their training (by September 1, 2020). Standardized training and validation of competency testing will take 1 hour to complete. Cost for this training, testing (3 trials allowed over a 2-month period), and a 2-year certification will be $125.00. Information about institutional licensing and group accounts is available (https://www. mocatest.org/contact/). The requirement for training enacted by theMoCA Clinic and Institute is the result of legal threats made by patients and families who have disagreed with diagnoses that have been based uponMoCA results. Specific complaints by patients and families included the following: their provider not being trained to administer the instrument and their provider not being able to interpret the results. As the Institute warns, ‘‘If you wish to continue using the MoCA Test without being officially trained and certified, you will be at increased risk for administration, scoring and interpretation errors which could lead to misdiagnosis and liability’’ (https://www.mocatest.org/training-certification/?access). Rather than not using the MoCA to avoid being vulnerable, embracing the certification process will strengthen nursing practice. Understanding a patient’s cognitive status allows us to more effectively communicate with older adult patients. In addition, when performed on a regular basis (eg, annually), testing allows the patient and family to have Author Affiliation: Professor, University of San Diego Hahn School of Nursing, California. The authors report no conflicts of interest. Correspondence: Ann M. Mayo, DNSc, RN, CNS, FAAN, University of San DiegoHahnSchoolofNursing, 5998Alcalá Park, SanDiego,CA92110 ([email protected]). DOI: 10.1097/NUR.0000000000000474