Student nurses attitudes towards the Care of Elderly Persons. A Pilot Study

Transcription

1 Student nurses attitudes towards the Care of Elderly Persons. A Pilot Study Kotzabassaki S 1., Vardaki Z 2., Andrea S 3., Parissopoulos S R.N., Ph.D., Assistant Professor, 2. R.N., Ph.D., Assistant Professor, 3. R.N., Ph.D., Assistant Professor Technological Educational Institution (TEI) of Athens, 4. R.N., M.Med.Sci., Staff Nurse, Sheffield Teaching Hospitals NHS Trust, UK Abstract: Greece is a country of ageing population. In the coming years, there will be a continuously increased demand for more nurses to be employed in the care of elderly patients. Literature suggests that the attitudes and values of the future health care providers will influence their decision to work with elderly people, as well as the quality of care delivered to them. In this paper the authors report the results of a pilot study conducted prior to the main research study. A qualitative approach was adopted. The objectives of the study were to 1. Examine students attitudes towards the care of elderly persons. 2. Identify relationships between prior experience with an elderly family member and students attitudes. 3. Identify relationships between nursing education and knowledge and attitudes held by students. 4. Discover students perceptions of nursing staff behaviour towards the elderly patients. 4. Find out future possible preferences of student nurses regarding work with elderly patients. Five students of the seventh semester were voluntarily interviewed. All students had experiences with grandparents. They felt that this experience affected their attitudes towards the care of their clients. Positive feelings were mainly described as love and affection. Negative feelings were attributed to loneliness experienced by elderly patients, and to improper care delivered to them. The students felt that nursing education was effective in preparing them to provide better care. Four out of five students replied that they would like to work with elderly patients after graduation. Key words: Elderly persons, student nurses, attitudes towards older people, care of elderly patients ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 1 - of 9

2 Introduction G reece is a country of ageing population. In 1998, the people over the age of 65 years made up 16.73% of the total population of Greece (N.S.S.G, 2001a). It is projected that the number of elderly people, especially those over the age of 80, will continuously increase (N.S.S.G, 2001b). This age group, often described as the older elderly people, will represent the single most common care group for nursing (Slevin, 1991). With the predicted increase in life expectancy, demands for services of health care workers will increase. The acute and long-term care needs of elderly people will increase the need for both formal and informal caregivers. Female family members often provided informal care. Nevertheless, changing societal trends toward fewer children per family and increased number of women in the work-force, suggest informal caregivers will be too old or unavailable to care for future elderly people (Emke- Poulopoulou, 1999). Hence, there will be an increased demand for professional nurses in elderly care. On the other hand, relevant research findings indicate that newly qualified nurses and nursing students are not in favour of working with older people. Studies on student nurses attitudes towards their choice to work in specific areas of nursing speciality indicate that gerontological nursing is not viewed positively. (Wright, 1988; Philipose et al., 1991; Haigh et al., 1994; Lusk et al., 1995; Happell, 1999). In a study conducted by Happel (1999), the preference of student nurses to work with elderly patients was the least favourable one. Midwifery and paediatric nursing ranked first and second in their preferences respectively. The unpopularity of this clinical speciality was attributed to the negative views with the specific clients, the working environment or their own previous experiences with elderly patients (Happel, 1999). Literature suggests that attitudes and values of the future health care providers, may have an impact on their desire to work with elderly people as well as on the quality of care being delivered to them (Ahmed et al., 1986; Pursey, & Luker, 1995). Since attitudes are important determinants of students future selection of work speciality, it is necessary to be aware about them. So far in Greece, there is no research to study this specific area of interest. In this paper the authors report the results of a pilot study conducted prior to the main research study. Literature review The majority of studies in the literature are of quantitative nature and they have investigated student nurses attitudes in relation to nursing education. Snappe s (1986) findings suggest that nurse education did not improve student nurses attitudes and Treharne (1990) found that the educational course on ageing had made attitudes worse. However findings have not been consistent. Haight et al. (1994) studied the effect of nursing education on ageism. It was found that nursing education has promoted positive feelings towards elderly individuals. Meanwhile, exposure to well elderly people had a lasting effect on student nurses attitudes. Haight et al. (1994) findings indicate that grandparents were positive role models for students, while older nurses have demonstrated more positive attitudes towards elderly people. Student nurses attitudes were shown to improve through their experiences with ill elderly in geriatric ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 2 - of 9

3 clinical placements (Sheffler, 1995). Theoretical knowledge has brought about the same effect. From all variables that Sheffler (1995) examined in relation to students attitudes only age was positively correlated. Student nurses in older age had more positive attitudes. These findings are congruent with the findings reported by Haight et al. (1994). In a more resent study, Sheffler (1998) examined again the effects of clinical placement, as well as the relationship between faculty s attitudes and knowledge and student s attitudes towards the elderly patients. Clinical placements in nursing homes were thought to influence positively students attitudes. Meanwhile there was a positive relationship between the educational staff attitudes and students attitudes, as well as between students level of knowledge and their attitudes towards the older adults. Dellasega, & Curriero (1991) measured student nurses preferences to work with elderly clients, after their exposure to two different educational settings, institutional and community. There was no significant change in students preferences to work with the older adults. Although students reported that their attitudes had been improved, the number of students who wanted to work with the elderly persons was still very small. No change in students attitudes was found in the research conducted by Edwards et al. (1992) and Lusk et al. (1995). In both studies, students seemed to hold misconceptions and anti net bias. Education and knowledge in these studies did not seem to influence students attitudes towards older people. In Lusk s et al. study (1995), students of all stages of educational process held misconceptions concerning the individual characteristics of elderly persons. They described elderly persons as irritated, angry, bored, lonely and highly vulnerable to accidents, injuries and criminal victimisation. Students also held misconceptions concerning the social aspects of ageing and financial status. Fagerberg & Ekman (1997) conducted a qualitative study in order to understand the perceptions and the attitudes of the first year students towards older people. The phenomenological study was the first part of a longitudinal research in which the students would be interviewed once per year. The type of placement acute, nursing home or geriatric ward did not seem to play any significant role in this study. However students said that they were able to understand the patient needs better and they accused the nursing staff primarily the nursing assistants, of lacking any understanding of the elderly patients and their needs. The researchers found it impossible, at this early stage of the study to determine what the students preferences were as far it concerned future employment choices post graduation. In summary, it can be assumed from literature review that findings regarding students attitudes towards elderly persons seem to be contradictory. Factors that appear to influence professionals attitudes towards elderly persons seem to be educational level and courses, clinical placements, amount and type of exposure to elderly persons, familiarity with elderly patients needs and problems and age. The objectives of the study The objectives of the study were to: 1. Examine student nurses attitudes towards the care of elderly persons 2. Identify relationships between any prior experience with an elderly family member grandmother or grandfather- and students attitudes ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 3 - of 9

4 3. Identify relationships between nursing education and knowledge and attitudes held by students for the care of elderly persons 4. Discover students perceptions of nursing staff behaviour towards the elderly persons 5. Find out future possible preferences of student nurses as whether they would work with elderly patients once they graduated The research design Because of the lack of previous research on attitudes towards the elderly persons in Greece, the researchers decided to adopt a qualitative approach. Their intention was to examine in depth what the students felt for older people. The sample The sample consisted of five student nurses who voluntarily accepted to participate in the study. All students were female, and they were at the end of their seventh semester and the beginning of the eight. At this stage of the curriculum the students have completed all theoretical and clinical education related to gerontological nursing. The gerontological course is primarily taught during the sixth semester. However, during the second semester of the curriculum, students are initially exposed to the care of healthy elderly people. Students attend to the family care course and have a two-day placement at a Day Centre for the Care of the elderly, four hours per placement day. Main objective of this activity is to observe and assess the nursing needs of older healthy individuals. During the third and forth semesters the students are exposed to acute care settings, such as medical surgical wards where they have another opportunity of caring for elderly people. There are no specialist units or wards in Greece, and the elderly patients are nursed in general wards, next to clients of young or middle age. In the sixth semester, students undergo the gerontological course. This is accompanied by a placement in nursing homes. Then, at the seventh semester, students have a placement at the Community Health Centres, where they make home visits and provide care to elderly patients. Therefore, considering the curriculum structure it was felt by the researchers that students at the end of their seventh semester would be aware of their attitudes towards the elderly people and their care. Method Students, who had accepted to participate in the study, were contacted by telephone to arrange an appointment. Prior to each arranged interview, the study participants had been informed of the purpose of the study, what it would entail, and how the deriving data would be treated, analysed and presented. An informed consent was obtained once the participants had been informed of confidentiality and anonymity of the data. Each interview was taperecorded and lasted approximately forty-five minutes. The interviews were semi structured and the student was asked to answer thirteen pre-written questions. Results Five interviews were conducted. Each interview was transcribed, and subjected to content analysis (Sachini Kardasi, 1997). 1. Attitudes to and relationships with family elderly person-grandmother and/or grandfather. Two of the participating students lived in the same home with their grandparents. The other three had their grandparents living nearby. Two of these three students mentioned that when their grandmothers had become very ill, the family brought them home in order to take care of them. The two old ladies were very ill and had died. One was suffering from ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 4 - of 9

5 dementia due to a series of cerebrovascular accidents and the other from dementia as a result of cerebral haemorrhage due to a fall. Both elderly ladies had difficulties with communicating. When the students were asked to describe their feelings about their grandparents, they said that they were pleased to have their grandmothers staying with them but they had wished they were able to communicate. The remaining three students described their relationship with their grandparents as a relationship of love, trust, affection, happiness and a relationship that made them feel safe. One student mentioned that when her grandmother had broken her leg and had been admitted to the hospital, she used to go to the hospital and stay with her in order to keep her company. The students were asked if they thought their own feelings had been affected by the fact that they had lived with their grandparents Four out of five agreed that living with their grandparents had an effect on their feelings towards the elderly people they had nursed. One said probably yes but not in a conscious manner. used to say that the old people have already contributed towards the new generation; therefore it was time the new generation offered help and provided the services they needed. In relation to experience of any negative feelings only one student mentioned that the elderly persons were sometimes peculiar in their behaviour and grouchy. However the student mentioned that this was not considered as problem, because they knew that this behaviour was due to their age and therefore they could understand it. One student mentioned that an older gentleman in the nursing home had caused her irritation, because he refused to co-operate and was not willing to talk to her. As this was her first experience with elderly persons in the nursing home, she was afraid that perhaps it was her fault and she blamed herself for failing to win his trust. After insisting efforts, she finally managed to make him accept her. Another student pointed out that sometimes she felt disappointed that her youth had been considered as a factor revealing inexperience, and therefore it was difficult for an elderly person to trust her skills and capabilities. 2. Positive and negative feelings towards the elderly clients The students were asked to describe an incident of care that showed either their positive or negative feelings towards an elderly patient. They described their positive feelings for their clients almost in the same way and with the same words they used to describe their relationships with their beloved family elderly person. The main word used was love. Other words were affection, understanding, safety and gratitude, and an obligation to help them meet various needs and mainly their need for communication. They felt that in the faces of these people they could see their own grandparents. They However a common negative feeling described by all students was the sadness and embarrassment they felt when some of their patients had not been cared properly. Some of them had been left unattended, and staff shortages and attitudes may have compromised the quality of care. These old people were either in the hospital or in the nursing home, or even in their own home. The loneliness expressed by the elderly clients, was another source of distress for the students. Some of them had no relatives. For some others it was the family who requested the services of nursing home or hospital, without showing any further concern. Even at home some elderly felt alone because their children did not visit them as often as they would like. The ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 5 - of 9

6 students described how anxiously these lonely elderly people were expecting them because they needed somebody to talk to. Meanwhile the students discussed their moral dilemmas regarding these people who were very old, and sometimes not properly attended by the nursing staff or by their relatives. Particularly for those who were bed bound having developed pressure sores and who were unable to feed themselves. According to the students feelings, nursing care should be improved. Nevertheless the thoughts expressed by the students are also related to cultural issues. Greeks are family centred and Greek children or grandchildren feel indebted to care for their elderly parents or grandparents (Raya, 1994; Iordanou et al., 2000). Therefore the students felt that the elderly patients should be within their home environment, they should receive help from their relatives especially from their children, and they should not die in a nursing home or in a hospital but in their own home environment. 3. Students perceptions of nursing staff attitudes and behaviour Students felt that the nursing staff ought to be accountable to provide proper care to elderly patients. Indeed the nursing staffs were responsible for the problems of care observed. The students however tried to rationalise their feelings, by emphasising the great shortage of nurses. Another problem mentioned by the students was the fact that there were many different levels of nursing staff. Sometimes it was nursing assistants that were called to care for the elderly patients and they did not have the proper knowledge and preparation to do it. This finding regarding the assistant nurses is congruent with the findings reported by Fagerberg & Ekman (1997). However the students felt that probably even the professional nurses who were older in age were not properly prepared to care for the elderly clients. This comes in contradiction with findings reported in the literature (Haight et al., 1994; Sheffler, 1995), indicating that older nurses have more positive attitudes towards elderly patients. Meanwhile, students believed that the attitudes of the nursing staff and even the medical staff towards elderly patients were primarily negative, and this had a bad effect on the quality of care. In addition, students felt that sometimes they were actively discouraged by staff to provide the care they had planned to. Literature has presented accounts of elderly care settings where nursing care was limited to bed and body work. These environments would create negative attitudes in those who are exposed to them. In a resent study in UK, nursing students in clinical placements are put off careers in elderly care when they see how poorly older people are treated (Murray, 2002). More than 700 students were interviewed on behalf of English National Board. They reported finding impoverished care environments in which staff exhibited negative attitudes towards older people and deliver care the students consider being of unacceptably low quality. 4. Effect of nursing education and knowledge on attitudes The students believed that their education was effective in helping them to be more positive and to provide better care: I learned how to care. If I don t know something I know were to find help. Now I give better care, better quality of care because the fact that you know that the elderly person has some specific needs helps in improving knowledge as well as communication skills. Yes the knowledge helped me to improve my understanding of the psychological needs of those people ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 6 - of 9

7 Only one student claimed that education did not improve her attitudes; this particular student was already familiar with treating elderly people due to her personal experience with her grandparents. They are like babies, she said. They need a stroke, a touch, they need affection. They don t want you to contradict them. They want you to do whatever they wish immediately However she admitted that She has put into practice her knowledge from gerontological nursing lectures, and what she had learned were appropriate for elderly client s care planning. 5. Student s perceptions of the services offered by the state and the nursing profession Students felt that so far the state had not offered to elderly persons the appropriate quality of services. They indicate that more money ought to be allocated so that services could be improved. Most of the students felt that priority should be given to the development of community services and home health care, but if an elderly patient needed to go to a nursing home, this should be feasible. Furthermore they felt that the discipline of nursing has developed during the last years. However more effort is needed. The education provided through the nursing programme is good and complete, but perhaps the older nurses need more training in relation to the care of older people. Two students mentioned that it is imperative to reduce the different levels of nursing staff existing at this moment e.g. nursing assistants, professional nurses to one graduate level only. In addition one student pointed out that future student nurses should not be selected solely on their grades but also according to their specific psychological profile. When this pilot study was conducted, students entered tertiary education according to their examination grades and not according to their preferences. Nursing is not a high profile and sought after profession in Greece. This meant that some of the students in the school of nursing had not wished to study nursing in the first place, but accepted the offer as they had not managed to enter the school of their choice. 6. Student s preferences to work with the elderly persons Four out of five students wanted to work with the elderly clients after graduation. One of them said: Yes but only under certain circumstances because I want to offer good quality services. She mentioned an example taken from a nursing home, where the elderly patients did not receive proper care due to shortage of professional nursing staff. And she continued: I would like very much if I were sure I could provide sound individualised care and were responsible only for a manageable number of elderly patients. Conclusions - recommendations The findings of this study suggest that although the theoretical preparation of the students in gerontological nursing is rather satisfactory, it seems that education provided within the clinical areas requires a re-examination in order to improve the quality and the quantity of the care provided. However this was only a pilot study that was carried out with the aim to provide information for designing the main study. In conclusion as this sample was small, it would not be appropriate to generalise the findings. However most of the findings are congruent with those reported to the literature. It is expected that more applicable results will be available when the main study will be completed. With the current changes in higher education in Greece, candidates of higher education can now choose the preferred school but of course again grade is important ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 7 - of 9

8 REFERENCES Ahmed, S., M., Kraft, I., A., & Porter, D., M. (1986). Attitudes of different professional groups toward geriatric patients. Gerontology and Geriatrics Education, 6(4), Dellasega, C., Curriero, F. (1991). The effects of institutional and community experiences on nursing students intentions toward work with elderly. Journal of Nursing Education, 30(9), Edwards, M., R., Plant, M., Novak, S., D. Beall, C., Baumhovern, A., L. (1992). Knowledge about aging and Alzheimer s disease among baccalaureate nursing students. Journal of Nursing Education, 31(3), Emke-Poulopoulou I. (1999) Greeks Elderly Citizens. Past Present and Future. Ellin, Athens Fagerberg I., Ekman S. (1997). First year Swedish nursing students experiences with elderly patients. Western Journal of Nursing Research, 19(2) Haight B., Crist M., Dias K., J. (1994). Does nursing education promote ageism? Journal of Advanced Nursing, 20, Happell, B. (1999). When I grow up I want to be? Where undergraduate student nurses want to work after graduation. Journal of Advanced Nursing, 29 (2), Iordanou, P., Babatsikou, F., Dontas, S.A., Beka, P. (2000). Family: an important uncovered need for the elderly living in nursing homes. In Hellenic Association of Gerontology and Geriatrics (H.A.G.G) (Ed), Topics on Gerontology and Geriatrics ( pp ). Athens: Synedron. Lusk, L., S., Williams, A., R. Hsuing, S. (1995). Evaluation of the facts on aging quizzes I and II. Journal of Nursing Education, 34(7), Murray, K (2002). Poor quality of elderly care deterring students. Nursing Standard, 16(29), 7. National Statistical Service of Greece (N. S. S. G). (2001b). Statistical Yearbook of Greece 2000, N. S. S. G, Athens. Philipose, V., Tate, J., & Jacobs, S. (1991). Review of nursing literature: Evolution of gerontological education in nursing. Nursing & Health Care, 12(10), Pursey, A., Luker, K. (1995). Attitudes and stereotypes: nurses work with older people. Journal of Advanced Nursing, 22, Raya, A. (1994). Nursing older people and solidarity between generations-a Greek perspective. In Papadantonaki A. (Ed.), Nursing Older people and Solidarity between Generations Proceedings (pp 29-38). Athens: Hellenic Graduate Nurses Association. Sachini-Kardasi, A. (1997). Research methods. Bita, Athens. Sheffler, J., S. (1995). Do clinical experiences affect nursing students attitudes toward the elderly? Journal of Nursing Education, 34(7), Sheffler, J., S (1998). Clinical placement and correlates affecting student attitudes toward the elderly. Journal of Nursing Education, 37(5), Slevin, O., D. (1991) Ageist attitudes among young adults: implications for a caring profession. Journal of Advanced Nursing, 16, Snape, J. (1986). Nurses attitudes to care of the elderly. Journal of Advanced Nursing, 11, Treharne, G. (1990). Attitudes towards the care of elderly people: Are they getting better? Journal of Advanced Nursing, 15, Wright L., H. (1988). A re-conceptualisation of the negative staff attitudes and poor care in nursing homes assumption. The Gerontologist, 28(6), National Statistical Service of Greece (N. S. S. G). (2001a). Greece in Numbers. N. S. S. G, Athens ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 8 - of 9

9 Address for correspondence: Stella Kotzabassaki R.N., Ph.D 39, Anastassaki St., A. Ilisia Athens Greece Tel: , Fax: ICUS NURS WEB J ISSUE 12 OCTOBER - DECEMBER 2002 (NURSING.GR) Page 9 - of 9