Registered nurses' reflections on their educational preparation to work with older people

Gerontological educational interventions for student nurses: a systematic review of qualitative findings

OBJECTIVES

This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing.

METHODS

Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies.

CONCLUSIONS

Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.

The effectiveness of continuing professional development for the residential long-term care workforce: A systematic review

OBJECTIVES

To investigate the effectiveness of continuing professional development in residential long-term care.

DESIGN

Systematic review.

DATA SOURCES

PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), and Web of Science.

REVIEW METHODS

Empirical studies published between 2003 and 2023 describing the effectiveness of continuing professional development in long-term care were selected according to PRISMA guidelines. The type, topic, and effectiveness of continuing professional development activities in long-term care were analysed, in addition to facilitators and barriers. The protocol of this review is registered in PROSPERO.

RESULTS

A total of 155 studies were selected, including over 17,000 participants the majority of whom were nurses. The most common topics were 'dementia care' (n = 22; 14.2 %), and restraint use (n = 14; 9 %). The impact of continuing professional development was mainly evaluated in terms of 'participant satisfaction with continuing professional development' (n = 5; 3 %), 'staff knowledge' (n = 57; 37 %), 'staff competencies and skills' (n = 35; 23 %), 'resident outcomes' (n = 45; 29 %), and 'staff wellbeing' (n = 12; 8 %). A total of 64 (41 %) studies evaluated if impact of continuing professional development was sustained over time. 'Good organisation', 'a supportive learning environment', 'expressing personal preferences', and 'management support' were described as facilitators of continuing professional development.

CONCLUSIONS

Increasing numbers of long-term care residents with complex health conditions require nurses with advanced skills, such as dementia care. To improve the effectiveness of continuing professional development, support from managers, who adopt relational leadership styles, is instrumental to integrate new knowledge and skills into practice. This needs to be linked to career progression, and consequently increase the attractiveness of working in the long-term care sector. This could meet the dual goal of improving outcomes for residents and nurses' job satisfaction.

Nursing Students' Perceptions on a Pain Management E- Learning Module: An Exploratory Quantitative Study

BACKGROUND

Nursing students are graduating ill-prepared to assess and manage pain in older adults. To address this gap, we developed an e-learning module on the topic.

AIM

To examine nursing students' perceptions on a pain management e-learning module focused on older adults.

METHODS

Utilizing an exploratory quantitative design, we assessed nursing students' perceptions of the e-learning module. We used a feedback survey (four 5-point, Likert-type items) and one open-ended question to assess students' perceptions. Descriptive statistics were used to summarize students' perceptions and demographic characteristics. Responses to the open-ended question were content analyzed.

RESULTS

A total of 181 of 249 students completed the module, of whom two-thirds were female. Students perceived that the module enhanced their knowledge, confidence, and perception in working with older people. Students also found the method of instruction interactive and enjoyable.

CONCLUSIONS

The e-learning module on pain management was viewed by nursing students to be helpful and its interactive method of learning improved their knowledge, confidence, and perceptions of working with older adults in pain.

Gerontological nursing competencies: A scoping review

BACKGROUND

Despite decades of advocates striving to enhance gerontological content in baccalaureate nursing programs, nurses are still graduating with inadequate knowledge and skills to work with older adults. Scholars suggest that incorporating entry-to-practice gerontological competencies could be one way to improve graduating nurses' knowledge about older adults.

AIM

To examine the state of gerontological entry to practice competencies and standards for baccalaureate-prepared nurses around the world.

DESIGN

We conducted a scoping review of the literature using the Joanna Briggs Institute (JBI) framework and followed PRISMA-ScR guidelines to report findings.

METHODS

We performed searches from inception to June 20th 2022 in Medline and EMBASE via OVID, CINAHL via EBSCOhost, Scopus, and Cochrane Library via Wiley. We conducted a search on GOOGLE for grey literature. We included literature that examined 1) baccalaureate nursing programs, 2) gerontological competencies/standards, and 3) older people/adults.

RESULTS

We found 8 literature sources, 4 of which were academic papers and 4 documents describing gerontological entry-to-practice standards and competencies from national nursing associations. Gerontological competencies highlight providing person-centered care to older people and their families across many care contexts. This care includes relational and cultural competence, exhibiting professional values and screening for potential elder abuse. Scholars in two papers relayed their experiences incorporating gerontological competencies into their curricula and two studied student nurses' gerontological competency.

CONCLUSIONS

There is interest and some progress in developing and incorporating gerontological competencies in various countries but not enough. A coordinated approach to sharing information and expertise among nations is needed to develop international gerontological competencies to facilitate improved nursing care with older adults.

Exploring older people's experiences of the interpersonal care relationship between nurses and patients during hospitalization in the pandemic period: A qualitative study

AIM

This article presents the findings of a qualitative study focusing on the experiences of people aged over 70 years in the interpersonal nurse-patient care relationship in hospital settings during and after the COVID-19 pandemic. The aim was to analyse different aspects of this relationship, including nurses' behaviour and caring attitudes, the person-centred model of care, patients' involvement in their own care and communication in the hospital context.

DESIGN

An exploratory qualitative study was conducted on the basis of an interpretative framework.

METHODS

Six focus groups were conducted. A total of 34 participants were purposively recruited from three nursing homes in Spain, Italy and Portugal. Specific inclusion criteria were used to select participants.

RESULTS

Five main categories were identified. Analysis revealed the importance of empathy and sensitivity in caring relationships, as well as the need for personalized and patient-centred care. The importance of effective communication and recognition of ageist behaviour by professionals was highlighted. In addition, independent of the pandemic, situational factors in the hospital environment were identified that influence the interpersonal care relationship.

CONCLUSIONS

The study highlights the need to promote a person-centred model of care that takes into account the specific preferences and needs of older people. This is achieved by identifying elements of the interpersonal nurse-patient relationship. In addition to highlighting the disparity of opinion regarding an active or passive role in self-care and decision making, the importance of addressing ageism and improving communication is emphasized. WHAT PROBLEM DID THE STUDY ADDRESS?: The importance of the patient-nurse relationship in hospital care has been highlighted in previous studies. Critical elements of the patient care experience have been identified as empathy and effective communication. Ageism in healthcare has been recognized as a potential barrier to patient-centred care. WHAT WERE THE KEY FINDINGS?: The main findings highlight the importance of empathy and personalized care, emphasize the importance of effective communication and address ageist behaviours in the nurse-patient relationship. WHERE AND WHO WILL THE RESEARCH IMPACT?: By highlighting the need for person-centred care and improved communication strategies, particularly in the context of caring for older patients during and after the COVID-19 pandemic, this research will have an impact on healthcare professionals, policy makers and carers.

REPORTING METHOD

The COREQ guideline was used.

PATIENT OR PUBLIC CONTRIBUTION

This study adopted a collaborative approach to ensure that patient perspectives were integrated into the research process. We organized regular focus groups. Patients were actively involved in shaping the research questions, refining the study design and interpreting the emerging findings. Their valuable input helped us to understand the nuances of their experience and to prioritize the aspects that were critical to their well-being. In addition, their insights guided the development of practical recommendations aimed at improving the interpersonal care relationship between nurses and patients in hospital settings, ensuring that their voices were heard and reflected in the proposed interventions. This patient-centred approach fostered a sense of empowerment among the participants. It reinforced the notion that their experiences and opinions are integral to shaping healthcare practice.

Engaging post-secondary students in a multidisciplinary aging studies interest group

Little is known about student aging interest groups (AIGs) in post-secondary institutions. Our study evaluated awareness of a student aging interest group at a western Canadian university with no gerontology program. Additional goals included assessing interest in joining the AIG, participation rates among group members, and preferences for group activities. Using a mixed method approach we analyzed 13 years of administrative data recording 65 meetings and conducted a survey among group members and nonmember students across the university with a potential interest in aging (n = 52). Almost two-thirds of respondents (n = 33) were nonmembers with most of these (n = 24) having no prior knowledge of the AIG; 77% of students already aware of the AIG learned about it from a professor. Sixty per cent of respondents were in health-related faculties, with the remainder representing multiple disciplines and faculties. Group attendance was strongly influenced by student workloads and schedules, with average attendance rising by 27.3% during the shift to virtual meetings in 2020-21. Our results highlight the interdisciplinary nature of aging studies, the key role faculty members play in informing students about AIGs, and the broad range of interests that students have in issues related to age and aging.

Nursing students' experiences of a home visiting programme for older adults with multimorbidity (VISITAME project): A phenomenological study

INTRODUCTION

Nursing students should acquire competence in promoting self-care in older adults with chronic multimorbidity, but opportunities for clinical practice are limited. The implementation of a home visiting programme to community-dwelling older adults with chronic multimorbidity could contribute to nursing students' acquisition of this competence.

OBJECTIVE

The aim of our study was to understand the experience of nursing students participating in a home visiting programme to community-dwelling older adults with chronic multimorbidity.

DESIGN

Qualitative study based on Gadamer's hermeneutic phenomenology.

METHOD

Twenty-two in-depth interviews were conducted with nursing students participating in a home visiting programme. Data were recorded, transcribed and analysed following the procedure developed by Fleming.

RESULTS

Three main themes were extracted in the data analysis process: (1) 'living the theory. Experience as a catalyst for learning', (2) 'the home visiting programme as a tool for promoting competence in caring for older adults', and (3) 'when learning sparks interest in working with older adults'.

CONCLUSION

The home visiting programme to community-dwelling older adults has an important impact on the personal and professional development of nursing students. The experience of the home visiting programme leads to deep learning that sparks interest in caring for older adults. The implementation of a home visiting programme could be a beneficial strategy for the acquisition of competence to promote health and self-care.

The Role of an Exoskeleton Simulation of Senescence in Health Sciences Education

Background

Education in the formation of human capital in health constantly presents challenges. New tools in the emerging contexts may strengthen empathic attitudes. We developed an educational intervention that included a senescence simulator and assessed its impact on perception and attitudes in healthcare students.

Methods

A cross-sectional comparative study was conducted that assessed acquired knowledge and self-perception using a semistructured survey administered before and after the demonstration and intervention using the simulator and reported the experience through the role of the patient and caregiver. The data were analyzed statistically to identify the demographic characteristics and differences between the groups of students. The data were analyzed statistically to identify the demographic characteristics and differences between the groups of students in the responses pre-post intervention, using statistical software (IBM SPSS Statistics 26.0).

Results

Of the 256 participants surveyed before the intervention, 93.8% described cognitive deterioration as a significant disability and 53.1% considered the health system to be inadequate in meeting the needs of older individuals. Only 59.8% stated that the current academic training meets the educational requirements for the care of the elderly. In total, 98.9% of the participants reported that the simulator changed their perception by increasing their empathy. In total, 76.2% showed greater sensitivity to older adults and 79.3% reported that the experiential learning consolidated their professionalizing perspective. Among the younger participants (aged 18-20 years), sensitivity and reorientation toward pursuing an associated graduate degree were higher after the intervention (p=0.01).

Conclusions

Educational strategies, such as the senescence simulator, offer an experiential intervention that strengthens the knowledge and attitudes toward older individuals. During the pandemic emergency, it proved to be a useful educational strategy in consolidating caring behavior as a hybrid educational tactic. The senescence simulation enabled the participants to widen their educational and professional schemes to encompass the care of the older population.

E-learning modules to enhance student nurses' perceptions of older people: a single group pre-post quasi-experimental study

OBJECTIVES

To examine whether e-learning activities on cognitive impairment (CI), continence and mobility (CM) and understanding and communication (UC) improve student nurses' knowledge and attitudes in the care of older adults.

METHODS

A quasi-experimental single group pre-post-test design was used. We included 299 undergraduate nursing students for the CI module, 304 for the CM module, and 313 for the UC module. We administered knowledge quizzes, Likert scales, and a feedback survey to measure student nurses' knowledge, ageist beliefs, and feedback on the modules respectively.

RESULTS

Participants demonstrated significantly more knowledge and reduced ageist attitudes following the e-learning activities.

CONCLUSIONS

Findings suggest that e-learning activities on cognitive impairment, continence and mobility, and understanding and communication improve knowledge and reduce ageist attitudes among nursing students.

Care home managers' views on the media coverage of COVID-19 outbreaks in care homes for older adults: A case study in Stockholm

The COVID‐19 pandemic has particularly affected older adults and resulted in high rates of infections and deaths in care homes. We have conducted a case study in which three managers of care homes for older adults in central Stockholm have shared their thoughts on the media coverage of care homes for older adults during the COVID‐19 pandemic. We analysed the data using conventional content analysis and identified three themes and five categories. The results show that the managers experienced the media coverage of care homes during the pandemic to be negative and incomplete, causing feelings of sadness and shame amongst themselves and their staff. The negative media coverage further generated added workload as they had to arrange for discussions to answer questions by staff and close relatives of the residents. Informants also thought that there is a lack of knowledge about the role of care homes and subsequently what to expect of them. Finally, informants reported that the pandemic might create an opportunity for system‐level policy changes. In light of this, we discuss possible victim blaming of staff and how greater public awareness of the care home sector could facilitate for a debate on policy changes and the low social status of caring for older adults.

Ageism, moral sensitivity and nursing students' intentions to work with older people - A cross-sectional study

BACKGROUND

Nursing students' intentions to work with older people are low, despite a worldwide need for gerontological nursing, with ageism being the main culprit. Romania lacks legislation to prevent and combat elder abuse in healthcare, although it is alleged to be rampant among nursing staff. There is also a lack of research on nursing students' ageism toward older people and intentions to work with them.

OBJECTIVES

Since ageism conflicts with nursing ethics, we expect moral sensitivity to lower ageism and increase intention to work with older people, while also moderating other socio-psychological influences. Because ageism and intention to work with older people are largely predicted by the same variables, we hypothesize that ageism may function as a mediator. Finally, we explore ageism among Romanian nursing students and its predictors in a culturally sensitive manner.

DESIGN

This is a cross-sectional, descriptive survey study.

SETTINGS

The study was conducted in Romania.

PARTICIPANTS AND METHODS

408 nursing students completed online-administered questionnaires measuring intention to work with older people, ageism, moral sensitivity, death and ageing anxiety, knowledge of ageing, attitudes toward own ageing and intergenerational contact. Data were analyzed with Pearson's correlations, regressions with simple slope analyses and bootstrapped mediation analyses.

RESULTS

Ageism mediated the relationships between students' intentions to work with older people and knowledge of ageing, ageing anxiety, intergenerational contact quality, attitudes toward own ageing and moral sensitivity. Moral sensitivity decreased ageism and increased intention, while moderating the influence of contact quality, death and ageing anxiety, attitudes toward own ageing and knowledge of ageing on ageism. Additionally, it moderated the influence of perceived behavioral control on intention.

CONCLUSIONS

Integrating moral sensitivity training in the nursing curricula could both decrease ageism in nursing students and increase their intention to work with older people, providing an efficient and low-cost strategy to aid students consider gerontological nursing for career advancement.

Ageism against older patients in nursing: conceptual differentiations and the role of moral sensitivity

Ageism in nursing is difficult to identify, prevent and combat. Using a mixed-method approach in two exploratory cross-sectional studies (N = 512), we brought support for a proposed conceptual difference between ageism toward older adults and ageism toward older patients which may facilitate the identification of ageism in healthcare settings. We also investigated whether nurses' moral sensitivity could buffer the negative effect of socio-cognitive factors on ageism against older patients. Our findings supported our assumption, suggesting that fostering nurses' moral sensitivity could be a promising new avenue to prevent and combat ageism in nurses, together with comprehensive gerontological education meant to decrease stereotyping and help nurses fulfill their roles of moral advocates against older patient discrimination.

Improving practicing nurses' knowledge and perceptions of older people: a quasi-experimental study

OBJECTIVES

This study aimed to determine if an e-learning module about understanding and communicating with older people can improve practicing nurses' ageist perceptions about older people.

METHODS

We used a quasi-experimental pre-post-test design. Participants completed a 13-item Ambivalent Ageism Scale before and after completing the Understanding and Communicating with Older People e-learning module as well as a Likert-style feedback survey with the option for written feedback on an open-ended question.

RESULTS

Pre-post-test comparisons indicated a statistically significant decrease in ageist attitudes and self-reported increases in knowledge and confidence in working with older people. Qualitative analysis of written feedback revealed that most participants felt the module enhanced their understanding of older people.

CONCLUSIONS

The e-learning activity has the potential to improve practicing nurses' knowledge and perceptions about working with older people and is likely to be associated with better patient-level outcomes.

Perceptions and Expectations of Advanced Geriatric Nursing Role Development in Primary Health Care: A Qualitative Study Exploring Staff's Perspectives

PURPOSE

This qualitative study aimed to explore multidisciplinary members' perceptions and expectations of advanced geriatric nursing role development in primary health care.

PATIENTS AND METHODS

A multi-center, cross-sectional study based on semi-structured individual interviews was conducted with registered nurses, general physicians, and managers involved in the care of older people in primary health care between September 2020 and January 2021. Recruitment was purposive and the framework method was used to inductively analyze the data. The Consolidated Criteria for Reporting Qualitative research (COREQ) served to structure our manuscript.

RESULTS

In total, 29 registered nurses, 6 general physicians, and 10 managers from 8 health centers were interviewed. The relevant themes interpreted from the interview data were as follows: (1) the current roles of registered nurses in the care of older people; (2) the factors affect the advanced geriatric nursing role development; (3) expectations of the advanced geriatric nursing roles.

CONCLUSION

There is a need for appropriate educational programs, well-established laws, and regulations to support the sustainable development of advanced geriatric nursing roles. To build the expected role model, the nursing education program in the future should integrate gerontological nursing, public health nursing, and nursing management to maximize the role of gerontological nurse practitioners in primary health care.

Awakening Canadians to ageism: a study protocol

Background

Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies.

Methods

To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies.

Discussion

Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.

Improving student nurses' perspectives towards older people with an e-learning activity: A quasi-experimental pre-post design

BACKGROUND

Despite older people being the largest demographic accessing health care, nurses often lack knowledge about how to work with them and may hold ageist perceptions towards them. Previous research has identified the gaps in their education program and offered suggestions on what and how to fill those gaps in education related to older people. E-learning activities to fill these gaps were developed.

OBJECTIVE

The aim of this study was to determine if nursing students' perceptions about older people could be improved through an e-learning activity focused on communication and understanding older people.

METHODS

A quasi-experimental pre-post design was used to test whether the understanding and communication with older people e-learning activity improved student nurses' perceptions about older people. A feedback survey was also analyzed using descriptive statistics to understand students' perceptions of the learning activity.

RESULTS

There was a statistically significant decrease in participant's negative perceptions towards older people after completing the e-learning activity. Participants enjoyed the activity and believed that it improved their knowledge of older people, their confidence in working with older people, and their perceptions about older people.

CONCLUSIONS

The strength of the e-learning activity in this study is that the educator need not be an expert in order to use the activity in their course. In this way, knowledge about older people is facilitated despite the dearth of nurse educators with gerontological expertise. More research to test this activity in other universities is needed.

IMPLICATIONS FOR PRACTICE

Improved understanding and communicating with older people could improve person-centered-care. The flexible delivery of this learning activity could facilitate practicing nurses understanding and communication strategies if offered to them.

Harnessing nursing to diminish ageism

BACKGROUND

The common practice of making fun of aging and older people demonstrates that ageism towards older people is socially acceptable. It is so accepted that even those of us who are aging or have moved into the 'third act' believe and fear the negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Ageism is evident in work places, family relationships, when older people purchase goods and services, in health and social institutions and extends throughout professions that work with older people.

OBJECTIVES

We explore how nurses-the largest group of healthcare professions- may be inadvertently perpetuating negative perceptions about older people in nursing practice, nursing education, and through common misconceptions about what gerontological nursing means.

METHODS

This is discussion paper using the literature.

RESULTS

We suggest that nursing education is well situated to diminish negative perspectives of ageing by incorporating theories of life-course and harmonious aging into the holistic perspective of individuals that nursing is well known for.

CONCLUSIONS

Greater understanding about the diversity of ageing and the context that have influenced older persons could encourage nurses to treat them holistically with dignity, which would ultimately improve older people's experiences. Improving older persons' experiences is like paying it forward, as we all are ageing and if we are to have a different experience when we are old, it is necessary to diminish stereotypes about ageing, and work towards inclusion of older people in social and healthcare institutions.

IMPLICATIONS FOR PRACTICE

It is important for nurses, particularly those in nursing education, to support the incorporation of a life course and harmonious view of aging in which the social, political, and environmental context of individuals are viewed as part of the difference of ageing.

Working with older people: Beginning or end of a nurse's career?

BACKGROUND

The increasing numbers of older people (age 65+) make it important to understand how to attract nurses to work with this population.

METHODS

A secondary analysis using qualitative descriptive methods was used to understand how student nurses' perceptions about older people may influence their desire to work with older people.

RESULTS

Student nurses perceive a generational divide between them and older people, regardless of practice settings. They believe working with older people is heavy work, and not high acuity, and although good to learn skills as a student, not a population they want to work with until they are close to retirement themselves.

CONCLUSIONS

It is important to enhance nursing education so that students understand the older generation, how to communicate with them and the prevalence of older people in healthcare settings, so that they are more likely to choose to work with older people.