Influence of nurses' knowledge of ageing and attitudes towards older people on therapeutic interactions in emergency care: A literature review

Use of an age-simulation suit as an empathy-building method for dental students: a pre-post study

Background

The aging of the population highlights the need to establish empathetic connections with older adults. To achieve this, age simulation suits have been designed, allowing users to experience the physical limitations associated with aging. This study aimed to evaluate the experience of dental students with these devices, using psychometric tools to measure the impact on their understanding and empathy.

Methods

A pre/post-test study was conducted with the participation of 63 dental students from Rey Juan Carlos University who were fitted with an age simulation suit and asked to perform different tasks. Psychometric tools were used to assess specific parameters. Empathy was measured using the Jefferson Empathy Scale, emotional intelligence was assessed with the Trait Meta-Mood Scale-24 (TMMS-24), and the emotional attention dimension was analyzed using the Positive and Negative Affect Schedule (PANAS).

Results

The scores on the Jefferson Empathy Scale significantly improved from 88.44 ± 6.8 to 91.06 ± 10.11 after using the simulation suit (P < 0.026). Pearson's product moment correlation analysis showed no significant positive association or correlation between age and scores from the three questionnaires. In the rest, a positive and significant correlation was observed (P < 0.0001).

Conclusions

Age simulation activities effectively enhance empathy among dental students. However, more studies are needed to foster positive attitudes toward aging and prevent negative stereotypes.

Using critical reflection to enhance the care of older people: a practice example

Reflection is an essential aspect of nursing practice that facilitates continuing professional development and practice improvement. Critical reflection is a more in-depth form of reflection and can be described as a creative, dynamic and transformative learning process that enhances practice by promoting self-awareness and critical thinking. Older adults often present with complex and multiple healthcare needs. Engaging in critical reflection can assist nurses to provide the high-quality, person-centred care required to meet those needs, support older people to retain their independence and enhance their well-being. This article discusses critical reflection within the context of nursing older people and describes various models that can be used to support the reflective process. The authors use a practice example to illustrate how using critical reflection in practice can enable nurses to develop a deeper understanding of themselves and use what they have learned to enhance their delivery of person-centred care.

Considerations of Intersectionality for Older Adults with Palliative Care Needs in the Emergency Department: An Integrative Review

Purpose of Review

We sought to identify current interventions, research, or non-research evidence that has direct or indirect consideration of intersectionality in the care of older adults in the emergency department (ED). An integrative review informed by Crenshaw's Theory of Intersectionality was conducted in accordance with Whittemore and Knafl's five-stage methodology. A rigorous review process determined appropriateness for inclusion, and articles were analyzed for areas related to direct or indirect relationship to intersectionality.

Recent Findings

Older adults aged 60 and above in the United States (US) account for more than 20% of ED visits annually, and half of older adults will visit the ED in their last year of life. There has been a growing focus on adapting the ED to meet the palliative care needs of older adults, but relatively little consideration has been given to older adults' intersectional identities.

Summary

Six articles were identified that provided indirect insights into the status of intersectionality in ED-based palliative care for older adults. Two areas of interest were identified: (1) intersectional elements or reference to such elements embedded within the studies; and (2) the challenges of adapting quantitative methodologies to incorporate variables and approaches that would allow for intersectional analysis. This review highlights areas for future research along with recommendations for adopting an intersectional framing into commonly used methodologies.

Association of Ageism With Death Anxiety, Self-Esteem, Interpersonal Reactivity, and Symbolic Immortality Among Nurses

According toterror management theory (TMT), older adults may often be a reminder of death for younger adults. Therefore, dealing with older adults may be associated with increased levels of death anxiety and decreased levels of self-esteem, interpersonal reactivity, and symbolic immortality, leading younger adults to develop ageist attitudes and behaviors in defense. However, to date, these associations have not been empirically examined, especially among nurses. Self-report questionnaires were used on a sample of 163 nurses to explore the issue of ageism among nurses from the TMT perspective. The results indicated that, after controlling for sociodemographic variables, high levels of death anxiety and low levels of self-esteem, interpersonal reactivity, and symbolic immortality were associated with increased levels of ageism among nurses. Thus, the current study uses TMT to explain ageism among nurses, and the study findings may contribute to the development of psychological interventions aimed at reducing nurses' ageism.

Evaluation of the feasibility of an Education-Career pathway in Healthcare for Older People (ECHO) for early career nurses

BACKGROUND

Rapid population ageing is driving demand for qualified gerontological nurses. Yet, early career nurse attrition and limited focus on retention in the speciality limits supply.

OBJECTIVES

To test the feasibility and acceptability of an Education-Career pathway in Healthcare for Older People (ECHO) intervention for early career nurses to improve retention and capability in gerontological nursing. ECHO is a multicomponent intervention with integrated education, career planning and coaching components, tested over two 6-month cycles.

METHODS

A feasibility study with a pre-post design using a multi-methods evaluation. Twenty-nine early career nurse participants were recruited from eight NHS acute and community care Trusts in England. ECHO participants completed online questionnaires at baseline (Time 1), 6-month (T2, end of intervention) and follow-up at 18 months from baseline (T3). Outcome measures were career intention, self-reported knowledge, career planning confidence, and burnout using the Maslach Burnout Inventory. Qualitative interviews were undertaken with participants (n = 23) and organizational stakeholders (n = 16) who facilitated ECHO. Data analysis used descriptive statistics and non-parametric tests for paired data and thematic analysis for qualitative data.

RESULTS

Overall, 19 of 29 participants (65%) completed all aspects of the intervention. The evaluation was completed by 23 participants. ECHO was well received by participants and stakeholders. At T3, the 23 participants were working in the speciality, though two had changed organizations. There was a significant improvement in self-reported gerontological knowledge, pre 87 (IQR 81-102), post 107 (IQR 98-112) p = 0.006, but no significant changes in other outcomes. In qualitative data, participants and organizational stakeholders held similar views, presented under four main themes: intended outcomes (personal and professional development, raise gerontological profile, expand horizons); nurse retention-a double-edged sword, ECHO logistics, and sustainability.

CONCLUSION

Education-Career pathway in Healthcare for Older People was feasible and may positively impact early career nurse retention, capability and socialization into gerontological nursing. ECHO requires further refinement and piloting, but learning can contribute to retention strategies.

IMPLICATIONS FOR PRACTICE

Attracting and retaining early-career nurses to the gerontological speciality requires greater innovation, organizational and senior nurse leadership.

Healthcare Professionals' Views and Perspectives towards Aging

Improving care for the older population is a growing clinical need in the United States. Ageism and other attitudes of healthcare professionals can negatively impact care for older adults. This study investigated healthcare professionals' (N = 140) views towards aging and characterized a confluence of factors influencing ageism perspectives in healthcare workers using path analysis models. These models proposed relationships between aging anxiety, expectations regarding aging, age, ageism, and knowledge. Aging anxiety had a less critical role in the final model than hypothesized and influenced ageism in healthcare workers through its negative effect (β = -0.27) on expectations regarding aging. In contrast, aging knowledge (β = -0.23), age (β = -0.27), and expectations regarding aging (β = -0.48) directly and inversely influenced ageism. Increased knowledge about the aging process could lower ageism amongst healthcare professionals and improve care for older adults. The results put forth in this study help to characterize and understand healthcare workers' complex views towards the aging population they often encounter. Moreover, these results highlight the need and utility of leveraging practitioner education for combating ageism in the clinical setting.

Evaluation of Nurses’ Knowledge and Attitudes towards Older Adults and Associated Factors

Background:

Due to the increased risk of developing chronic diseases among older adults, their demand for health care has increased. Preparing nurses to care for the older adults is one of the most difficult challenges in nursing education.

Objective:

This study investigated nurses’ knowledge and attitudes towards older adults and demographic and occupational features that affect them.

Methods:

This cross-sectional study was conducted on 412 participants from July to October 2020. Patients were selected using a random sampling method. Three questionnaires were used: a socio-demographic form, an Older Patient in Acute Care Survey, and a Knowledge about Older Patients-Quiz.

Results:

According to the Pearson correlation test, there is a statistically significant and positive correlation between knowledge and general opinion (P = 0.000), (r = 0.271) as well as between practice experiences and general opinion (P = 0.000), (r = 0.205) of nurses about older adult’s care. There was no statistically significant relationship between knowledge and practice experiences (P = 0.857), (r = -. 009).

Conclusion:

Having a better understanding of the needs of the older adults would improve the quality of care that nurses provide to them.

Curriculum, Theory, and Practice: Exploring Nurses’ and Nursing Students’ Knowledge of and Attitudes towards Caring for the Older Adults in Canada

Background

Caring for older adults is among the most challenging issue of public health and social care systems in modern societies. By enhancing the nursing curriculum, nursing students will be qualified to provide gerontology care, and they will be acknowledging and working to eliminate ageism from the health care system.

Purpose

This study explores nurses’ and nursing students’ knowledge and attitudes in caring for older adults and addresses the factors contributing to nurses’ perspectives. It also examines the nursing curriculum's contributions to nurses’ knowledge and attitudes and provides suggestions aimed at reconfiguring the nursing curriculum for comprehensive gerontology nursing care.

Methods

A mixed-method research design was utilized, and quantitative and qualitative data were collected from 90 nurses and nursing students through an online questionnaire. Data were analyzed via SPSS and NVivo 12 software programs.

Results

The results revealed that most nurses possess neutral attitudes toward caring for older patients, and their knowledge ranged from average to above-average levels. Statistical analysis revealed no statistically significant difference between gender and nurses’ attitudes or between gender and knowledge. Similarly, there was no statistically significant difference between work status and nurses’ attitudes. Results showed a statistically significant positive correlation between nurses’ attitudes and knowledge level. This study demonstrated the positive impact of the Canadian nursing curriculum on nurses’ knowledge and attitudes.

Conclusion

The current study recommends providing gerontology nursing courses as a mandatory separate course in nursing education to enhance nursing students’ knowledge and skills for high-quality gerontology nursing care.

Epidemiology and Clinical Characteristics of Older Patients Transferred from Long-Term-Care Hospitals (LTCHs) to Emergency Departments by a Comparison with Non-LTCHs in South Korea: A Cross-Sectional Observational Study

The South Korean population is rapidly aging, and the number of older patients in long-term-care hospitals (LTCHs) continues to increase. This study aims to investigate the epidemiologic data, characteristics, and clinical outcomes of patients aged 65 years and older transferred from LTCHs to emergency departments (EDs). This is a retrospective study based on National Emergency Department Information System data from 2014 to 2019. Of the 6,209,695 older patients visiting EDs for disease treatment, 211,141 (3.4%) were transferred from LTCHs. Among patients from LTCHs (211,141), 24.2% were discharged from EDs, 43.0% were admitted to general wards, 20.7% were hospitalized in intensive care units, 3.1% were transferred to another hospital, 6.1% returned to LTCHs, and 2.1% died in EDs. ED stays were the longest for those returning to LTCHs (710.49 ± 1127.43 min). Foley catheterization (40.3%) was most frequently performed in preventable ED visits. In South Korea, older patients being discharged from the ED or returning to LTCHs, after being transferred from LTCHs to EDs, increased. ED stays among older LTCH patients were longer than among non-LTCH older patients, contributing to congestion. To reduce avoidable transfer to EDs from LTCHs, it is necessary to discuss policies, such as expanding appropriate medical personnel and transitional treatment.

Nurses’ attitudes towards hospitalized older adults in a tertiary care setting in Ghana

Introduction

The increasing population of older adults and rapid increases in co‐morbidities globally has necessitated the need for a healthcare delivery system that meets the multifaceted needs of the growing population of older adults. Concurrent with these rising complex health needs is the importance of positive, non‐judgmental attitudes of health services providers towards older adults. Moreover, this is particularly important in the nursing profession, given nurses' significant and crucial roles in healthcare settings.

Aim

The study aimed to evaluate nurses’ attitudes towards older adults in a tertiary hospital in Ghana.

Design

It employed a descriptive cross‐sectional quantitative design.

Method

Data were collected from 160 registered adult medical and surgical ward nurses using the Ageism Attitude Scale (AAS).

Results

Findings indicated that more than half of the participants had a diploma in general nursing. None of the nurses surveyed specialized in the care of older adults, and the mean age of participants was 30.14 (3.75) (minimum 24 and maximum 42 years). Female nurses had more positive attitudes than their male counterparts. Although the surveyed nurses reported a somewhat positive attitude towards older adults, there was no correlation between nurses' education levels and positive attitudes.

Study of the attitudes and future intentions of nursing students towards working with older people: an observational study

BACKGROUND

Older people are increasing in the world leading to the fact that many nursing students will work in geriatric care setting. It was also reported the lack of knowledge and interest in working with older people by many nursing students. Therefore, the aim of the study is to explore the attitudes, wills, and intentions for the care of older people from nursing students.

METHODS

A sample of 383 students (mean age between 17 and 24; females: 76.2%) was divided according to the year. A questionnaire and three scales investigating the attitude for working with older persons (Kogan, Aday-Campbell, Nolan scales) were administered. Simple correlations across the three scales and the comparisons in means by year of graduation were reported.

RESULTS

Of the 383 students, 69.7% would take care of an older person, with the previous experience with older patients being the most important determinant in positive attitude of students in working with older people. The Kogan scale revealed a relatively positive attitude towards older people of the students involved; the Aday's scale a reasonable willingness to take care of the older people; the Nolan scale a fair intention. Aday's scale significantly correlated with Nolan's scale and with Kogan's scale as well as the Nolan scale correlated with the Kogan scale.

CONCLUSION

Our study suggests that the quality of care provided to older people is related to the attitudes of health professionals indicating that nursing educators should adopt effective strategies to increase and promote students' positive attitudes to older people.

Impact of settings and culture on nurses' knowledge of and attitudes and perceptions towards people with dementia: An integrative literature review

BACKGROUND

Well-trained nurses are required to support dementia patients; however, the quality of the provided dementia nursing care can be impacted by nurses' knowledge, attitudes and perceptions towards people with dementia.

AIM

To obtain an overview of the current nursing practice towards people with dementia around the world.

DESIGN

An integrated literature review was conducted based on Whittemore and Knafl's method.

RESULTS

A total of 72 articles met the inclusion criteria. Three main themes were identified: (1) nurses' knowledge, attitudes and perceptions towards dementia; (2) nursing experience of caring for people with dementia in acute and community care settings; and (3) dementia nursing care across health regions.

CONCLUSION

Nurses play the role of facilitators in the efficient delivery of quality care for dementia patients. A variety of attitudes and perceptions towards people with dementia were found to be triggered by the severity of dementia, religion, ethnicity and gender.

IMPLICATIONS FOR PRACTICE

Healthcare organisations and educational settings need to coordinate and function together to improve nurses' knowledge and encourage positive attitudes towards people with dementia.

Improving nursing students' perspective taking, perceptions of humanness, and attitudes toward older adults

Whereas prior work has examined the role of nursing courses in improving empathic skills and reducing dehumanization of older adults, little research has explored how perspective taking and perceptions of humanness of older adults acquired through nursing curricula predict attitudes toward this age group. Nursing students (N = 43) completed surveys at the beginning (Time 1) and end of gerontological coursework (Time 2). Perspective taking and perceived human nature and human uniqueness of older adults increased from Time 1 to Time 2. Perceived human nature of older adults was associated with more positive attitudes at the end of the semester, compared to the beginning. Improved perceptions of the human nature of older adults also predicted lower ageism at the end of the semester. Strategies for improving perspective taking and perceptions of humanness of older adults in nursing courses are discussed.

Factors Affecting Attitudes towards Older People in Undergraduate Nursing Students

Background: The population of older people is increasing worldwide. The social and healthcare systems need many nurses to care for the elderly. Positive attitudes increase the preference to work with older people and improve the quality of care. This study describes attitudes towards the elderly in a sample of nursing students, and analyzes the potential factors influencing these attitudes. Methods: A cross-sectional study was carried out in nursing students during the academic course 2017–2018. Kogan’s Attitude Toward Old People Scale was used to assess student attitudes towards older people. Results: The study included 377 undergraduate nursing students, of which 75.9% were women. The mean age was 22.23 (5.69) years. Attitude proved positive, with a mean Kogan’s score of 131.04 (12.66). Women had higher scores than men, with a mean difference of 7.76 (95% CI: 4.87–10.66; p < 0.001). The male sex, age ≥ 25 years, and previous experience with institutionalized older adults worsened attitudes, while studying the subject of geriatrics, each higher course within the degree, work placements in hospitals and nursing homes, and previous experience with community older adults or with older relatives favored a more positive attitude. Participants with no interest in working with older adults yielded lower scores. Conclusions: Attitudes towards the elderly among nursing students are positive. Women have a more positive attitude. Analyzing the factors that improve attitudes in nursing students is suggested, as it may contribute to improve nursing care.

Ageism, Aging Anxiety, and Death and Dying Anxiety Among Doctors and Nurses

Ageism is an important phenomenon that affects individuals and how society relates to older adults. It is important to evaluate ageism in the medical staff because of its potential effect on treatment for older adults. A cross-sectional study to assess the negative attitudes of doctors and nurses toward older adults was conducted using the Fraboni Scale of Ageism (FSA), a method for evaluating attitudes toward ageism in medical teams. Additional variables associated with ageism such as aging anxiety, and death and dying anxiety were also assessed. The study population included doctors and nurses working in a large university hospital or in community clinics in southern Israel. In all, 431 questionnaires were collected, 203 from the hospital (47.5%) and 224 from the community (52.5%). Of these, 216 (50.1%) were from doctors and 215 (49.9%) from nurses. The mean ageism score in the FSA was 2.8. In a linear regression model, doctors were less ageist than nurses; ageism was directly associated with aging anxiety, and dying anxiety, and was inversely associated with death anxiety. Among doctors, prominent ageist attitudes were directly associated with aging and dying anxiety, inversely associated with graduation from medical school in Israel, and death anxiety. Among nurses, prominent ageism attitudes were directly associated with dying anxiety and inversely associated with work in the hospital. Ageist attitudes were found among doctors and nurses in both the hospital and community clinics. The results emphasize the need to raise awareness of ageism in medical teams and to include this subject in professional training programs designed to reduce its prevalence.

Ageing simulation in health and social care education: A mixed methods systematic review

AIM

To identify, evaluate and summarize evidence from qualitative, quantitative and mixed method studies conducted using age suits or other age simulation equipment, with health and social care students.

DESIGN

Convergent segregated mixed method review design as outlined by the Johanna Briggs Institute.

DATA SOURCES

CINAHL (+ with Full Text), MEDLINE, PsycINFO, PubMed, SocINDEX, Web of Science, Cochrane Library, Emerald Insight, Proquest nursing, Science Direct, Wiley Online and BioMed Central (January 2000-January 2020).

REVIEW METHODS

Convergent segregated synthesis was used to synthesize evidence from the studies and the MERSQI checklist used to appraise quality.

RESULTS

A total of 23 studies were reviewed: one randomized control, two post-test only randomized control, three quasi-experimental, 15 one-group pre/post studies and two qualitative studies. Of the seventeen studies carrying out inferential statistics on attitude scores post intervention, 11 reported an improvement, three indicated no significant change and three reported worsening scores. Key themes included use of appropriate scales, type of equipment used, location and length of interactions, debriefing and contextualization of interventions in broader teaching.

CONCLUSION

The impact of ageing simulation interventions on health and social care student's attitudes to older people was predominantly positive. However, further high-quality research is warranted to understand the optimal use of such interventions in the context of health care for a growing ageing population.

IMPACT

It is important health and social care staff have appropriate knowledge and training to enable them to provide high-quality care to older people and challenge potential ageism in the system. This review adds to the body of work around the use of simulation and experiential learning to educate health and social care students about ageing and ageism. It also offers recommendations for using ageing simulations effectively to inform attitudes of prospective professionals who will influence future health and social care.

Attitudes to ageing: an overview of Australian perspectives of health support systems for the older person

OBJECTIVES

Older adults utilise health care systems to a higher frequency than younger groups, and are more vulnerable to system bias regarding ageing and expectations of old age. This narrative review attempts to outline the available literature regarding how various health support systems perceive the older adult, with an Australian focus.

CONCLUSIONS

Perspectives on ageing are generally negative regardless of health industry. Possible contributors to this include elements of death anxiety, inadequate education and inadequate occupational exposure during training.

Stigmatisation of those with mental health conditions in the acute general hospital setting. A qualitative framework synthesis

RATIONALE

Patients with long-term mental health conditions often have complex physical, mental, and social needs. They are frequent users of the acute general healthcare system, but can experience stigmatising attitudes and behaviours, and structural discrimination. We wished to improve understanding of stigmatisation in the acute healthcare setting, to target areas for future intervention.

OBJECTIVE

A synthesis of qualitative literature was undertaken in order to understand how patients with long-term mental health conditions are stigmatised, or otherwise treated, within the acute healthcare system.

METHOD

A theory-driven framework approach was implemented. Existing stigma theory was used to outline a framework for categorizing stigmatising and non-stigmatising phenomena within the acute healthcare system.

RESULTS

A systematic literature search of qualitative studies identified a sample of 51 studies that would inform the framework. Using data in these studies, a final theoretical 'best fit' framework was developed. In this framework there is an overarching pattern of labelling and stereotyping, plus five ways in which patients with mental health conditions are stigmatised in the acute healthcare system: devaluation, social control, avoidance, rejection, and failure to act. In addition, the framework outlines positive attitudes and behaviours - valuing, adjustment, responding, legitimising, and positive action - which contrast with the stigmatisation patterns.

CONCLUSIONS

The study offers a framework for identifying stigmatisation and positive treatment of those with mental health conditions in an acute health setting. This framework is of potential value in targeting areas for improved quality of care and may have utility beyond this setting and stigmatised group.

Ageism in Nursing

Stereotypes of older adults and assumptions of old age as a time of dependency and vulnerability affect not only how older adults are perceived and treated by society, but how they are treated by members of the nursing profession as well. When nurses display ageist attitudes, it can be harmful to older patients both physically and emotionally. In this review article the author describes some of the literature related to ageism in nursing, discusses how ageism can affect the quality of the care that is provided to older adult patients, and explains theories that may help explain ageism in nursing.

Gender analysis of nurses' attitude towards care of the elderly with dementia in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria

This study assessed nurses' knowledge and attitudes by gender toward the care of elderly patients with dementia and explored gender differences in attitudes and associated factors in Obafemi Awolowo University Teaching Hospital, Ile-Ife. The study adopted a sequential explanatory mixed method design to obtain data from 100 nurses selected through a multistage sampling technique. Data analysis was done at univariate, bivariate, and multivariate levels with a significance at P < .05. Findings revealed that a majority of the nurses have good knowledge and attitudes toward the care of elderly patients with dementia. Previous experience in a specialized unit (Odd = 2.879, CI = 0.013-8.287, P = .047) was the main predictor for the nurses' attitude.

Effectiveness of interventions to alleviate emergency department crowding by older adults: a systematic review

BACKGROUND

The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions.

METHODS

Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects.

RESULTS

Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician.

CONCLUSION

Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention's effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures.

TRIAL REGISTRATION

The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).

Factors Affecting Care Workers' Coping Abilities in Emergencies to the Korean Elderly

This study provides basic data for enhancing coping abilities in emergencies concerning direct long-term care (LTC) workers, which is necessary for providing safe care for elderly patients living in facilities and at home. A survey was conducted including 327 care workers who officially qualified as long-term providers for elderly patients through elderly care facilities and a domiciliary service center. The majority (91.4%) of the care workers surveyed experienced an emergency, but of them, only 36.4% performed first aid and 56.8% failed to perform first aid, for which the emergency was reported to nurses. The average score regarding first aid knowledge was 8.40 out of 21, and the mean scores for the subtopics of basic life support and general first aid were low (3.56 out of 7 and 5.84 out of 14, respectively). Nearly three-quarters (72.5%) responded that they were unaware of emergency coping methods, and the score for coping abilities in emergencies was also low (52.93 out of 100). The results indicate that factors affecting coping abilities in emergencies were related to the size of the workplace and first aid experience. We propose the development and implementation of an emergency coping training program focusing on case studies for direct LTC workers.

Geriatric Education Programs for Emergency Department Professionals: A Systematic Review

OBJECTIVES

To evaluate geriatric education programs for emergency department (ED) professionals based on: content and teaching methods and learning outcome effects and factors promoting or hindering program implementation.

DESIGN

Systematic review.

SETTING

ED.

PARTICIPANTS

Physicians, nurses, and medical residents working in the ED.

METHODS AND MEASUREMENT

Five major biomedical databases were searched for (quasi) experimental studies, published between 1990 and April 2018, evaluating geriatric education programs for ED professionals. Data were synthesized around study quality, learning participants, teaching content and methods, and Kirkpatrick learning outcomes.

RESULTS

Nine before‐after studies were included. Learners were mostly ED residents and, to a smaller extent, ED nurses and physicians. Study quality was moderate, with the lowest scores on sampling and instrument validity. Programs varied from a 1‐day workshop to a 2‐year curriculum, mostly combining didactic lectures with active and experiential learning formats. Topics commonly addressed included managing: geriatric syndromes, trauma and falls, medication, atypical presentations, and care transitions. Statistically significant improvements were mostly found in learners' knowledge acquisition (six studies). Significant improvements were also found in single studies on: self‐reported geriatric screening, documentation of geriatric care, and appropriate urinary catheter placement. Factors promoting program implementation included: solving competing educational demands and busy work schedules, embedding the program in preexisting curricula, and close collaboration between emergency and geriatric medicine faculties.

CONCLUSIONS

Various geriatric education programs improve the geriatric knowledge of ED professionals and seem to positively impact their clinical practice. However, more program evaluations with larger study samples, and use of valid and reliable outcome measures, are needed to provide robust evidence on the effectiveness of such programs. J Am Geriatr Soc, 1–8, 2019. J Am Geriatr Soc 67:2402–2409, 2019

Exploring Inpatient Medication Patterns: A Big Data and Multilevel Approach

PURPOSE

Exploratory study to examine inpatient medication administration patterns.

METHODS

Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared.

RESULTS

On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when "unit" replaced "nurse" as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes.

DISCUSSION

Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.

Comparison of Thai older patients' wishes and nurses' perceptions regarding end-of-life care

BACKGROUND

Achieving a "good death" is a major goal of palliative care. Nurses play a key role in the end-of-life care of older patients. Understanding the perceptions of both older patients and nurses in this area could help improve care during this period.

OBJECTIVES

To examine and compare the preferences and perceptions of older patients and nurses with regard to what they feel constitutes a "good death."

RESEARCH DESIGN

A cross-sectional study.

PARTICIPANTS AND RESEARCH CONTEXT

This study employed a self-report questionnaire that asked about various options for end-of-life care. It was distributed to older patients who attended the outpatient clinic of internal medicine and nurses who worked at two medical schools in Thailand from September 2017 to February 2018. Patients were asked to respond to the questions as if they were terminally ill, and nurses were asked to imagine how older patients would answer the questions.

ETHICAL CONSIDERATION

Approval from Institutional Review Board was obtained.

FINDINGS

A total of 608 patients and 665 nurses responded to the survey. Nurses agreed with concepts of palliative care, but they rated themselves as having poor knowledge. The patient respondents felt that it was most important that they receive the full truth about their illnesses (29.2%). The nurses thought the most important issue was relief of uncomfortable symptoms (25.2%). On seven out of the 13 questions, nurses overestimated the importance of the relevant issue to patients and underestimated the importance on one question (p < 0.05).

DISCUSSION

Both nurses and older patients signified concepts of palliative care, but nurses felt that they lacked adequate knowledge. Nurses estimated that patients would have positive attitudes toward autonomy and the closure of life affairs to a significantly greater degree than the patient respondents.

CONCLUSIONS

We recommend that palliative care education be improved and that steps be taken to allow for more effective nurse-patient communication with regard to the patients' end-of-life wishes.

The effects of empathy skills training on nursing students' empathy and attitudes toward elderly people

BACKGROUND

Nursing students' empathy and positive attitudes toward elderly people could help provide improved elderly care in their future practice. This study aimed to investigate the effects of empathy skills training on nursing students' empathy and attitudes toward elderly people.

METHODS

This quasi-experimental study was conducted in Yasuj, Iran in 2014. The sample consisted of 63 students at Hazrat Zeinab Nursing and Midwifery School who were randomly divided into a control (n = 31) and an intervention group (n = 32). The intervention group attended an eight-hour workshop on empathy skills that was presented through lectures, demonstration, group discussions, scenarios, and questioning. The data were collected using the Persian versions of Kogan's Attitudes towards Old People Scale and Jefferson Scale of Physician Empathy-Health Professionals Version. Then, the data were entered into the SPSS software, version 19 and were analyzed using descriptive statistics, chi-square test, t-test, and repeated measures analysis of variance.

RESULTS

The results showed that the empathy skills training program had a significant impact on the students' mean scores of empathy and attitudes toward elderly people (p < 0.001). The intervention group's mean score of empathy increased from 77.8 (SD = 10.7) before the intervention to 86 (SD = 7.3) immediately after that and 85.2 (SD = 8.9) 2 months later. Their mean score of attitude also increased from 110.8 (SD = 10.9) before the intervention to 155.2 (SD = 23.4) immediately after the intervention and 158.6 (SD = 23.2) 2 months later. Additionally, the empathy and attitude scores of the intervention group were significantly higher than those for control group immediately and 2 months after the intervention.

CONCLUSIONS

Empathy skills training improved the nursing students' empathy and attitudes towards elderly people. Therefore, empathy training is recommended to be incorporated into the undergraduate nursing curriculum.

Impact of the applied simulated and integrated learning approach on nursing assistants' knowledge and confidence caring for frail seniors in nursing homes

Background

Increasing importance is being placed on optimizing the role of Nursing Aides (NAs) in improving quality of care for nursing home (NH) residents. One approach to do so is to have NAs participate in assessments embedded within the Minimum Data Set (MDS). This pilot study aimed to design and evaluate the Applied Simulated and Integrated Learning Approach (ASILA) program, a novel innovative training program for NAs employed in NHs to enhance their ability to assess residents within an inter-professional framework.

Methods

A mixed quantitative and qualitative repeated measures design was used to assess changes in NAs' knowledge and perception of assessments and resident clinical outcomes. Additionally, focus groups were conducted with NAs upon completion of the ASILA program. A total of 23 NAs and nurses in NHs in two Canadian provinces participated. The ASILA pilot program consisted of three selected modules; each module including an evidence-informed case-scenario, assessments, the use of appropriate MDS tools and documentation, care planing and reporting systems. ASILA was delivered over the course of two days per home. The primary outcome measure focused on the impact of ASILA on NA knowledge and confidence in assessing residents and understanding the relevance and use of elements if the MDS tools. Secondary outcomes included NAs' satisfaction with ASILA and the impact of ASILA on resident clinical outcomes. Data were collected one week prior, immediately after, and three months after the ASILA program.

Results

Following ASILA, NAs reported increased knowledge test scores and confidence in assessing residents by using MDS tools, although this did not reach significance after multiple testing (p = 0.0256 and p = 0.1541 respectively). NAs reported more confidence in providing care to residents (77.8%) and felt that the care provided was more resident-centered (83.3%) than before the ASILA program. There were no significant trends in improved resident outcomes following ASILA.

Conclusion

Pilot findings indicate that the ASILA program could be a successful approach to support NAs to enhance their ability to assess residents in an inter-professional framework.

Emergency nurses' knowledge and self-rated practice skills when caring for older patients in the Emergency Department

BACKGROUND

Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses' knowledge and self-assessment of care for older patients is poorly understood.

AIM

To assess emergency nurses' knowledge and self-rating of practice when caring for older patients.

METHODS

A cross-sectional self-report survey of emergency nurses (n=101) in Melbourne, Australia.

RESULTS

Mean scores were 12.7 (SD 2.66) for the 25-item knowledge of older persons questionnaire, and 9.04 (SD 1.80) for the 15-item gerontic health related questions. Scores were unaffected by years of experience as a registered nurse or emergency nurse. More than 80% of nurses rated themselves as 'very good' or 'good' in assessing pain (94.9%), identifying delirium (87.8%), and identifying dementia (82.8%). Areas with a 'poor' ratings were identifying depression (46.5%), assessing polypharmacy (46.5%) and assessing nutrition (37.8%).

CONCLUSIONS

There was variation in knowledge and self-rating of practice related to care of older patients. The relationship between knowledge and self-ratings of practice in relation to actual emergency nursing care of older people and patient outcomes warrants further exploration.

Nurses' attitudes towards older people care: An integrative review

AIMS AND OBJECTIVES

To examine hospital nurses' attitudes towards caring for older adults and delineate associated factors contributing to their attitudes.

BACKGROUND

Population ageing is of international significance. A nursing workforce able to care for the ageing population is critical for ensuring quality older adult care. A synthesis of research related to nurses' attitudes towards older adult care is important for informing care quality and the nursing workforce issues.

METHODS

A systematic integrative review process guided the review. Cumulative Index of Nursing and Allied Health Literature and Medline databases were searched for primary research published between 2005-2017. A total of 1,690 papers were screened with 67 papers read in-depth and eight selected for this review that met the inclusion/exclusion criteria.

RESULTS

Nurses' held coexisting positive and negative attitudes towards generic and specific aspects of older adult care. Negative attitudes, in particular, were directed at the characteristics of older adults, their care demands or reflected in nurses' approaches to care. Across jurisdictions, work environment, education, experience and demographics emerged as influences on nurses' attitudes.

CONCLUSION

There is a paucity of research examining nurses' attitudes towards older adult care. The limited evidence indicates that attitudes towards older people care are complex and contradictory. Influences on nurses' attitudes need further study individually and collectively to build a strong evidence base. Interventional studies are needed as are the development of valid and reliable instruments for measuring nurses' attitudes towards older adult care.

RELEVANCE TO CLINICAL PRACTICE

Bolstering postgraduate gerontological preparation is critical for promoting nurses' attitudes towards older adult care. Creating age-friendly work environments, including appropriate resource allocation, is important to support older people care and facilitate positive nursing attitudes.

Attitudes to ageing among older Norwegian adults living in the community

Attitudes toward ageing have powerful influences and impact older adults' own perception of health, quality of life and utilisation of health and social care services. This study describes attitudes to ageing among 490 Norwegian older adults living in the community who responded to The Attitudes to Ageing Questionnaire. Results showed that in spite of physical changes and psychological losses, the attitudes of older adults support life acceptance with gained wisdom in feeling that there were many pleasant things about growing older and that their identity was not defined by their age. They demonstrated the ability to incorporate age-related changes within their identities and at the same time maintain a positive view of self. Although they acknowledged that old age represented a time of loss with decreasing physical independence, they meant that their lives had made a difference, they wanted to give a good example to younger persons and felt it was a privilege to grow old.

A critical review of published research literature reviews on nursing and healthcare ageism

AIMS AND OBJECTIVES

To establish how common and impactful nursing and healthcare ageism is and whether proven interventions or prevention methods exist.

BACKGROUND

Ageism has been a concern since 1969 when it was first introduced as a concept for social reform. As ageism has been linked to lower quality health services and reduced health care access, it is imperative that healthcare and nursing ageism is prevented or identified and reduced or eliminated.

DESIGN

A qualitative narrative review of published research literature reviews using a scoping design to map all published reviews was undertaken. The EBSCO Discovery Service (providing access to articles in 271 databases, including MEDLINE and CINAHL) and Directory of Open Access Journals (providing access to over 9,000 open access journals) were used to find review articles. Using predetermined inclusion and exclusion criteria, and limited by English language and peer-review publications, 12 eligible reviews were identified and information from them was systematically identified, assessed and synthesised.

RESULTS

The 12 reviews did not provide clear and convincing information to determine how common and impactful nursing or healthcare ageism is, nor what can best be done to prevent or address it. Although each review had value since research literature was collected and discussed on nursing or healthcare ageism, the array of literature search and analysis methods, and diversity in conclusions reached about the evidence is highly problematic.

CONCLUSION

Research literature reviews offering a more balanced perspective and demonstrating greater care in finding and using quality evidence are needed.

RELEVANCE TO CLINICAL PRACTICE

At this point in time, there is no clear understanding of how widespread and impactful nursing or healthcare ageism is, and what can best be done to prevent or address it. Nurses need to be aware that ageism may be common and impactful, and guard against it.

Emergency nurses attitudes towards older people in the emergency department: a cross-sectional study

AIM

To report nurses' attitudes towards older people in the emergency department (ED).

BACKGROUND

A nurse's attitude towards an older person can have an effect on nurses' work practices and interactions and can result in adverse outcomes for the older person.

DESIGN

A national cross-sectional survey using a previously validated instrument Older Person in Acute Care Survey (OPACS) was conducted to measure emergency nurses' attitudes towards older people in their care.

METHODS

Members of the College of Emergency Nursing Australasia (CENA) were invited to participate in the study. There were 371 (39%) completed surveys returned.

RESULTS

The OPACS survey identified that ED nurses have positive attitudes towards older people in the ED.

CONCLUSION

The implications for practice are clinically significant because positive attitudes can result in prevention of discrimination and marginalisation of the older person in the ED.

Sexuality, sexual health and older people: A systematic review of research on the knowledge and attitudes of health professionals

OBJECTIVES

Sexuality remains important to older people and should be recognised as an important part of their overall care. However, this appears to be poorly understood and addressed by many healthcare professionals. This systematic review reports on knowledge and attitudes of health professionals towards sexuality and sexual health of older people, including factors that impact knowledge and perceptions.

REVIEW METHODS AND DATA SOURCES

The review, conducted using Joanna Briggs Institute methods, included 23 studies of varied methodology published between January 2004 and January 2015.

RESULTS

Findings indicated that healthcare professionals often consider older people's sexuality as outside their scope of practice and there is lack of knowledge and confidence in this area. Cultural norms and taboos, length of time spent working with older people, familiarity with the older person, previous training and degree of exposure to people who are not heterosexual were all identified as factors that impact knowledge and attitude.

CONCLUSIONS

Better role modelling and education are needed to improve knowledge and attitudes toward later life sexuality.