Portuguese nurses' knowledge of and attitudes toward hospitalized older adults

Nursing students' knowledge and attitudes toward older adults

Nursing students, as the future healthcare workforce, hold immense potential in providing quality care to older adults and becoming advocates for promoting aging and public health, thus contributing significantly to addressing the multifaceted challenges of our aging society. Nurses' knowledge and attitudes about aging affect health care quality. Negative and unattractive representations of the social problems associated with aging contaminate nursing students' attitudes. Nursing schools are challenged to develop new curricula to prepare future nurses for the inherent complexity of an aging society. This study aims to assess the knowledge and attitudes of nursing students toward older adults and identify the variables that can influence these attitudes. Quantitative research was carried out through the application of an online survey using a cross-sectional descriptive research design. A total of 182 nursing students completed the online survey. Progression in the nursing course was statistically significant; the more students advanced, the more positive attitudes and knowledge they revealed about aging; 39% of students have daily contact with their grandparents; however, only 14.8% would like to work with older adults. Multiple linear regression revealed that the most important factor for positive attitudes and knowledge about aging was regular contact with grandparents, followed by progression in the nursing course. The students' age was not a significant factor in improving attitudes or expanding knowledge regarding older adults. In a multidimensional logic, the deepening of knowledge about aging and the socialization of students with older adults are central factors that should reinforce curricula in nursing education.

Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care: A mixed-methods systematic review

BACKGROUND

Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the identified barriers and facilitators to the Theoretical Domains Framework and behaviour change techniques will inform an end-user and theoretically informed intervention to improve guideline uptake in the acute care setting.

OBJECTIVES

To synthesise quantitative and qualitative evidence on i) hospital clinicians' and inpatients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines.

DESIGN

A convergent integrated mixed-methods systematic review was conducted using the JBI approach.

DATA SOURCE

English language peer-reviewed studies published from 2009 to August 2022 were identified from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.

REVIEW METHODS

Included studies reported: i) acute care hospital clinicians' and patients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data, comparing clinicians' and patients' views. Barriers and facilitators associated with each main theme were mapped to the Theoretical Domains Framework and allocated to relevant behaviour change techniques.

RESULTS

Fifty-five out of 14,488 studies of variable quality (29 quantitative, 22 qualitative, 4 mixed-methods) met the inclusion criteria. Four main themes represent factors thought to influence the implementation of evidence-based guidelines: 1) nurse-led multidisciplinary care, 2) patient participation in care, 3) practicability of implementation and 4) attitudes towards pressure injury prevention and management. Most barriers identified by clinicians were related to the third theme, whilst for patients, there were multiple barriers under theme 2. Barriers were mainly mapped to the Knowledge domain and Environmental Context and Resources domain and were matched to the behaviour change techniques of "instruction on how to perform a behaviour" and "restructuring the physical environment". Most facilitators mentioned by clinicians and patients were related to themes 1 and 2, respectively, and mapped to the Environmental Context and Resources domain. All patient-related attitudes in theme 4 were facilitators.

CONCLUSIONS

These review findings highlight the most influential factors related to implementing evidence-based pressure injury care from clinicians' and patients' views and mapping these factors to the Theoretical Domains Framework and behaviour change techniques has contributed to developing a stakeholder-tailored implementation intervention in acute care settings.

PROSPERO REGISTRATION

CRD42021250885.

Promoting sleep in hospitals: An integrative review of nurses' attitudes, knowledge and practices

AIMS

To explore nurses' knowledge, attitudes and practices related to improving hospitalized patients' sleep.

DESIGN

Integrative review.

DATA SOURCES

We searched CINAHL, PubMed and PsycInfo electronically including a manual search of references listed within the relevant studies. Original, peer-reviewed studies published in English between 2000 and 2022 evaluating nurses' sleep knowledge, attitudes, or practices to improve inpatients' sleep were reviewed.

REVIEW METHODS

This review was guided by Whittemore and Knafl method and followed PRISMA guidelines to search the literature. Fifteen articles reporting nurses' sleep knowledge, attitudes or practices to improve inpatients' sleep were included. The quality appraisal was done using the Mixed Methods Appraisal Tool version 2018.

RESULTS

Inadequate training of nurses regarding sleep hygiene and insufficiency in sleep-promoting practices were apparent. Most studies reported that nurses hold positive attitudes about sleep. The acuity of patients' health conditions affected their perception of sleep priorities. Lack of organizational sleep policies/protocols and coworkers' attitudes negatively impacted nurses' motivation to implement sleep hygiene interventions. Interventions reported in the studies were reducing noise and nursing interventions at night, using a clock for time orientation, earplugs, reducing light, keeping patients awake during the daytime, maintaining comfortable room temperature and managing patients' stress. These practices were hindered by poor knowledge, negative attitudes, patients' acuity and lack of sleep assessment tools.

CONCLUSION

It is essential to support nursing practice to improve patients' sleep in hospitals through interventions that target nurses' knowledge, attitudes and confidence towards implementing sleep hygiene interventions to improve patients' sleep and, consequently, their health outcomes during hospitalization.

IMPACT

This integrative review explored nurses' knowledge, attitudes and practices to improve patients' sleep during hospitalization. It revealed that expanding nurses' sleep knowledge and empowering them to implement sleep promotion practices are needed. Nursing educators and leaders need to be involved.

NO PATIENT OR PUBLIC CONTRIBUTION

This paper is an integrative review and does not include patient or public contribution.

Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons

BACKGROUND

Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations.

OBJECTIVES

To examine nursing practice with older people through the lens of unconscious bias.

METHODS

In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care.

RESULTS

Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow.

CONCLUSIONS

Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice.

IMPLICATIONS FOR PRACTICE

Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person-centered care in unit practices.

Instrument Evaluation: Attitudes Toward Older Adults and Intent to Work in Geriatrics

ABSTRACT

Despite the increasing demand for nurses in geriatrics, interest lags in working with older adults. The Carolina Opinions on the Care of Older Adults instrument assesses attitudes toward older adults, with one subscale assessing intention to work with older adults. The instrument was used in a pretest/posttest study with prelicensure students enrolled in a gerontological nursing course. Posttest scores showed an improvement in attitudes toward older adults. The geriatric career choice subscale showed no pretest/posttest changes. The Carolina Opinions on the Care of Older Adults instrument is a suitable measure to assess changes in attitudes and intention to work with older adults.

Knowledge, Attitudes, Practices, and Associated Factors Towards Care of Elderly Patients among Nurses

Background

Ethiopia's elderly care service is relatively young and little is known about the practices or readiness of nurses to provide care. Nurses need to have good knowledge, a positive attitude, and experience when it comes to caring for the elderly or patients who are chronically providing quality care. This study aimed to assess the knowledge, attitudes, and practices towards care for elderly patients and associated factors among nurses working in adult care units of public hospitals in Harar, 2021.

Methods

An institutional-based descriptive cross-sectional study was conducted from February 12 to July 10, 2021. A simple random sampling technique was used to select 478 study participants. Data were collected by trained data collectors using a pretested self-administered questionnaire. From the pretest, Cronbach's alpha for all items was above 0.7 for all items. Data were entered into Epi Data v.4.6 and exported to the Statistical Package for Social Science Version 26 for binary logistic regression analysis. A P-value of 0.05 was used to declare a significant association between variables.

Results

The study revealed that 311 (69%) had inadequate knowledge. Having a first degree and an unfavorable attitude towards nurses showed a statistically significant association with nurses' inadequate knowledge. A total of 275 (61.0%) nurses were found to have an unfavorable attitude and were significantly associated with having a diploma and first degree, learning in a private organization, 6 to 10 years of experience, lack of training, and inadequate knowledge of nurses. A total of 297 (65.9%) study units had inadequate practice towards the care of elderly patients. Nurses' practices showed a significant association with the type of hospital, work experience, and adherence to guidelines with a response rate of 94.4%.

Conclusion

The majority of nurses had inadequate knowledge, an unfavorable attitude, and inadequate practice towards the care of elderly patients. Having a first-degree and an unfavorable attitude with inadequate knowledge, lack of training and inadequate knowledge, unfavorable attitudes and less than 11 years of experience, working in non-academic hospitals, and unavailability of guidelines with inadequate practices were significantly associated.

Factors associated with nursing students' attitudes toward older people: A scoping review

Nursing students rate geriatric nursing poorly in career preferences, but aging populations mean more older people require access to health care. Negative attitudes held by nursing students can lead to ageism affecting the quality of care provided. The purpose of this scoping review is to summarize research findings in the published literature relating to factors associated with nursing students' attitudes toward older people, and the tools used to measure these attitudes. The Joanna Briggs Institute guide for conducting a scoping review was used. Eleven databases and search engines were searched for international peer reviewed research articles published in English between January 2000 and February 2021. Sixteen articles were included in the review. This review highlights areas for affirmative action to improve undergraduate nursing students' attitudes toward older people to prepare them to work effectively in future health care systems. Positive attitudes were associated with: senior years of study; professional values (caring, professionalism, trust); education regarding care of older adults; knowledge about aging; contact with older family members; comfort communicating with older people; and willingness to work with older people following graduation. It also identified the need for a current, nursing-specific measure of attitudes toward older people.

The barriers and facilitators of developing clinical competence among master's graduates of gerontological nursing: a qualitative descriptive study

BACKGROUND

Clinical competence development is a main goal of specialized nursing courses. Nonetheless, some master's graduates of gerontological nursing programs have inadequate Clinical competence. The aim of this study was to explore the barriers and the facilitators to clinical competence development among the master's graduates of gerontological nursing.

METHOD

This qualitative descriptive study was conducted in 2020. Participants were twenty nursing master's students, master's graduates, and instructors of gerontological nursing. They were purposively selected from several faculties of nursing and midwifery in Tehran, Isfahan, and Kashan, Iran. Semi-structured interviews were held for data collection and the conventional content analysis proposed by Graneheim and Lundman was used for data analysis. Data were managed using the MAXQDA 10 software.

RESULTS

The main barriers to clinical competence development were students' neglectfulness towards learning, inefficiency of educational system, and ineffective management. The main facilitators to clinical competence development were effective educational planning and management improvement.

CONCLUSION

There are different personal, educational, and managerial barriers and facilitators to clinical competence development among master's graduates of gerontological nursing. Effective educational planning and management improvement are needed for clinical competence development among master's students and graduates of gerontological nursing.

Factors affecting care of elderly patients among nursing staff at the Ho teaching hospital in Ghana: Implications for geriatric care policy in Ghana

Introduction

The population of the aged is increasing globally and in Ghana. In 2020, the population aged over 60 years in Ghana was 2,051,903 and this is expected to reach 2.5 million by 2025 and 6.3 million by 2050. Despite the envisaged increase in the number and life expectancy of the older population in Ghana that will require nursing care, there is a paucity of data on nursing staff knowledge and attitudes toward elderly patients in Ghana.

Objectives

This study, therefore, assessed factors affecting the care of elderly patients among nursing staff in a tertiary referral health facility in the Volta region of Ghana.

Methods

The study employed a descriptive cross-sectional design using quantitative data collection approaches. A total of 150 nurses were sampled with a response rate of 95%. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23. The analysis included logistic regression to predict factors associated with nurses’ knowledge and attitude in caring for elderly patients, after multicollinearity diagnosis and controlling the effect of confounding variables.

Results

Majority (83.8%) of the nurses demonstrated good knowledge of the aging process, knowledge in the care of the elderly (88.7%), and (84.5%) had a positive caring attitude towards the elderly. Professional education, professional qualification, and knowledge on aged care were significantly associated with nurses’ attitude towards the elderly (p<0.001), (p<0.005), and (p<0.010), respectively. Lack of special wards/facilities emerged as the predominantly perceived barrier to caring for the elderly as per the nurses’ responses.

Conclusion

The majority of nurses demonstrated good knowledge and attitude in the aging process and care of the aged. Lack of special wards/facilities and lack of staff motivation were the leading perceived barriers to rendering care to the elderly. Scaling up gerontological nursing programs and establishing special aged care facilities in Ghana with appropriate policy guidelines and regulations for implementation of care will help improve nurses’ knowledge and caring attitudes toward the care of elderly patients. Likewise, a national geriatric care policy would help consolidate standard geriatric care in Ghana.

Evaluating Nurses' Knowledge of Pressure Injury Prevention: A Descriptive Study

OBJECTIVE

To evaluate nurses' knowledge on pressure injury (PI) prevention.

METHODS

Four hundred six nurses in Turkey participated in this descriptive study between January and February 2020. Participants completed an information form and the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI). The PUPKAI contains 26 items across six themes: (1) development, (2) classification and observation, (3) risk assessment, (4) nutrition, (5) interventions to reduce the amount of pressure/rupture, and (6) interventions to reduce the duration of pressure/rupture.

RESULTS

The mean age of the nurses was 26.93 ± 6.72 years. The mean total PUPKAI score was 11.80 ± 3.28. Almost all participants (91.6%) had insufficient knowledge on PI prevention. Male nurses scored higher on themes 1 and 2 than female nurses (P = .046, P = .029, respectively). Nurses with a postgraduate degree scored higher in total and on themes 2, 3, 5, and 6 (P = .001, P = .006, P = .011, P = .044, P = .029, respectively), and nurses with more than 10 years of service scored higher in total and on themes 4, 5, and 6 (P = .001, P = .002, P = .001, P = .026, respectively).

CONCLUSIONS

The nurses who participated in this study do not have enough knowledge on PI prevention.

Does caring lead to stigmatisation? The perception of older people among healthcare professionals and the general population: A cross-sectional study

BACKGROUND

It is well recognised that healthcare professionals are particularly at risk for developing a negative perception of older people. Indeed, in addition to receiving education centred on a biomedical view of ageing, they are constantly exposed to the most vulnerable and dependent older individuals.

AIM

The purpose of our study is to compare the perception of older people between health professionals, working in a nursing home and the general population.

METHODS

This is a cross-sectional study. The perception of older people was measured using two different instruments: the image-of-ageing question and the Aging Semantic Differential (ASD) scale. We performed t-test to compare the perception of older individuals between the general population and healthcare professionals.

RESULTS

The image-of-ageing question does not show any difference between the general population (n = 148) and healthcare professionals (n = 107). In these both groups, almost half of the words cited in reference to older individuals were negative. Concerning the ASD, results show that healthcare professionals have significantly more negative perceptions towards older individuals than the general population (with the control of age, gender and educational level).

CONCLUSION

Healthcare professionals seem to have a more negative view of older people than the general population. Their regular contact with the frailest older adults could explain this finding. Another hypothesis could be a non-optimal quality of contact in nursing homes.

IMPLICATIONS FOR PRACTICE

Such results highlight the importance to promote a more holistic view of ageing in educational programs of healthcare professional. Improving the quality of contact with nursing homes residents should be strongly considered to reduce ageism among healthcare professionals.

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.

Knowledge, attitude, and associated factors towards older people care among nurses working at public hospitals in West Shoa zone, Oromia region, Ethiopia

Background

Nurses’ knowledge and attitude regarding the care of older people can have an impact on patient outcomes such as reduced length of hospital stays, reduced readmission rates, and increased patient and family satisfaction. However, evidence is scarce in Ethiopia, particularly in the study area. Therefore, the study aimed to assess the knowledge, attitude, and associated factors towards the care of older people among nurses working at public hospitals in West Shoa Zone, Ethiopia.

Methods

Institutional based cross-sectional study was conducted from April1–30, 2021 among 423 nurses who were working in adult care units. Data were collected through a self-administered questionnaire. The sample was selected using simple random sampling. The logistic regression analysis model was fitted and the Adjusted Odds Ratio at 95% confidence interval was used. P-values less than or equal to 0.05 were considered statistically significant.

Results

A total of 411 nurses participated in the study with a 97.16% response rate. The mean age of the participants was 29.11 (SD ± 3.84) years. The study showed that 37.2% (95% CI: 33, 42%) of the participants had good knowledge and 45.7% (95% CI: 40.9, 50.6%) had a favorable attitude toward the care of older people. The significantly associated factors positively affected both the knowledge and the attitude of nurses. Age greater than 30 years (AOR:2.37, 95% CI: 1.18, 4.75), experience greater than 5 years (3.00: 1.21, 7.41), being BSc degree holder and above (3.57: 1.40, 9.09), lived with older people (2.14: 1.34, 3.42), and nurses working in adult intensive care unit (3.03: 1.03, 8.91) were significantly associated with knowledge. Likewise, being female (2.04: 1.33, 3.12), being BSc degree holder and above (2.77: 1.35, 5.65), lived with older people (1.59: 1.03, 2.44), and care for older people (1.63: 1.06, 2.53) were significantly associated with attitude.

Conclusion

In this study, less than half of the nurses had good knowledge and a favorable attitude towards the care of older people. Continuous professional development regarding the care of older people is important to enhance nurses’ knowledge and attitude.

Use of machine learning to transform complex standardized nursing care plan data into meaningful research variables: a palliative care exemplar

The aim of this article was to describe a novel methodology for transforming complex nursing care plan data into meaningful variables to assess the impact of nursing care. We extracted standardized care plan data for older adults from the electronic health records of 4 hospitals. We created a palliative care framework with 8 categories. A subset of the data was manually classified under the framework, which was then used to train random forest machine learning algorithms that performed automated classification. Two expert raters achieved a 78% agreement rate. Random forest classifiers trained using the expert consensus achieved accuracy (agreement with consensus) between 77% and 89%. The best classifier was utilized for the automated classification of the remaining data. Utilizing machine learning reduces the cost of transforming raw data into representative constructs that can be used in research and practice to understand the essence of nursing specialty care, such as palliative care.

Attitudes Toward Older Adults and Need for Education Among Nurses and Nursing Assistants

BACKGROUND

Attitudes toward older adults and education needs could influence the quality of care provided by nurses and nursing assistants. The goal of this study is to assess attitudes toward older adults and geriatric nursing education needs among nurses and nursing assistants working at long-term care hospitals in Korea.

METHOD

Data were collected with a structured self-reported questionnaire. The study included 124 nurses and 145 nursing assistants working at six long-term care hospitals in Korea.

RESULTS

No statistically significant difference was found between the nurses and nursing assistants in their attitudes toward older adults, with both groups showing neutral attitudes. Both nurses and nursing assistants had a high need for education in health issues affecting older adults.

CONCLUSION

To improve nursing quality, a practical and systematic curriculum on older adults and their health issues is needed for nursing staff working in long-term care hospitals. [J Contin Educ Nurs. 2021;52(11):517-524.].

Hospital nurses' empathy and moral sensitivity toward elderly care: A cross-sectional study

AIM

The aim of this study is to explore factors that influence elderly caring attitudes, with a focus on empathy and moral sensitivity.

BACKGROUND

Medical and nursing needs of the elderly have escalated as a consequence of changes induced by aging and the associated diseases and disabilities.

METHOD

A cross-sectional study involving 229 nurses from four general hospitals in South Korea was conducted. Questionnaires assessing demographic and work experience information, empathy (Empathy Construct Rating Scale), moral sensitivity (Korean version of the Moral Sensitivity Questionnaire) and elderly caring (Elderly Caring Attitude Scale) were used. Data were analysed using multiple regression analysis.

RESULTS

The factors influencing the caring attitudes of nurses were empathy, moral sensitivity, preference for geriatric nursing and experience with continuing education in geriatric nursing. The explanatory power of this regression model was 59.4%.

CONCLUSIONS

Strategies to enhance empathy and moral sensitivity of nurses and education related to geriatric nursing might help improve elderly caring attitudes.

IMPLICATIONS FOR NURSING MANAGEMENT

Continued education in geriatric nursing should be provided for nurses caring for the elderly. In terms of nursing management and education, it is necessary to consider and develop strategies to improve the empathy and moral sensitivity of nurses toward elderly patients.

Community nurses' attitudes, knowledge and educational needs in relation to urinary continence, continence assessment and management: A systematic review

AIMS AND OBJECTIVES

To identify, appraise and summarise the available evidence relating to community nurses' attitudes, knowledge and educational needs in relation to urinary continence.

BACKGROUND

Community nurses play a pivotal role in identifying and supporting individuals who experience urinary continence issues. Gaps in nurses' continence-related education and knowledge may contribute to sub-optimal assessment and management across the continuum of care.

DESIGN

A systematic review.

METHODS

MEDLINE, CINAHL Complete and EMBASE were searched from inception to November 2020; keywords used included community nurses, urinary continence, incontinence, knowledge, attitude and education needs. Given the degree of heterogeneity between included studies, a meta-analysis was not feasible. Included studies were critically evaluated; key study characteristics and findings pertinent to the review purpose were summarised. The review adhered to the PRISMA 2020 checklist.

RESULTS

Four studies reported in six papers were included. Community nurses lacked knowledge in certain areas of urinary continence and incontinence. Nurses reported they were adequately prepared but without sufficient knowledge to effectively care for those with urinary incontinence. Community nurses' attitudes to urinary incontinence were generally positive, but they demonstrated misconceptions that urinary incontinence was inevitable and less distressing for older people.

CONCLUSIONS

There is limited research exploring community nurses' knowledge, attitudes and education needs in relation to urinary continence and incontinence care. Community nurses may have knowledge gaps and less favourable attitudes to some aspects of urinary continence care.

Exploration of Geriatric Care Competencies in Registered Nurses in Hospitals

BACKGROUND

Older adults occupy one third of acute care hospital beds, and the regular duties of many nurses include caring for older patients. A working knowledge of geriatric care competencies is necessary for nurses to provide high-quality care to older patients and their families. It is unclear how nurses who work in acute care hospitals self-evaluate their geriatric care competencies and how these self-evaluated abilities differ from the objective abilities of these nurses.

PURPOSES

This study was designed to explore the geriatric care competencies of nurses in hospitals and to identify the factors associated with these competencies.

METHODS

This was a cross-sectional study. Nurses who were employed and directly caring for patients aged 65 years and older in any of the adult wards of a medical center located in southern Taiwan were recruited as participants. A structured questionnaire was developed based on a review of the relevant literature and validated using expert consensus. This questionnaire included a demographic datasheet, knowledge of geriatric care scale, attitude of geriatric care scale, self-evaluation of geriatric care competency, and geriatric care competency test. Descriptive and inferential statistics were used to analyze the geriatric care competencies of the participants and related factors.

RESULTS

One hundred seventy nurses were enrolled as participants. The average self-evaluation score for geriatric care competency was 67.74 (SD = 0.84). However, the average percentage of correct answers given on the geriatric care competency test was much lower (17.6%). The self-evaluation score was found to be significantly associated with job satisfaction and having received continuing education in geriatric care. In addition, age was shown to significantly affect the percentage of correct answers given on the geriatric care competency test.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

A significant gap was found between the self-perceived and actual competencies of nurses in terms of providing geriatric care. Appropriate policies are necessary to improve the geriatric care competencies of nurses working in hospitals and to oversee the implementation of effective educational methods in Taiwan.

Exploring the effect of professional experience on knowledge towards geriatric care among nurses working in adult care units

BACKGROUND

The elder population suffered from social, economic, and health (which includes physical) related problems. Thus, these problems are complex and interrelated, thereby requiring specific knowledge and expertise to meet them. However, there were limited researches previously done to explore nurse's knowledge towards geriatric care. Therefore, this study aimed to assess knowledge towards geriatric care and to examine its predictors in North east Ethiopia. The findings will be helpful to develop strategies that would promote nurses' knowledge, which in turn improves the quality of patient care and consequently, the health of older people.

METHODS

A facility-based cross-sectional study was conducted from March 8 to 28, 2020, among 335 nurses. Simple random sampling technique was employed to select study participants. A structured self-administered questionnaire was used to collect data on knowledge of nurses towards older adult care. A multivariable logistic regression model was applied to identify significant predictors and P-value< 0.05 was used to declare the significance of association.

RESULTS

In the study, a total of 335 nurses participated. About 192(57.3%) of them had poor knowledge towards older adult care. Thus, level of education (AOR = 1.9, 95%CI: 1.1-3.2), year of experience 1-5 year (AOR = 2.7, 95%CI: 1.5-4.9), 5-10 years (AOR = 2.5, 95%CI: 1.4-4.4), and previously living with older adult at home (AOR = 1.6, 95%CI: 1.05-2.7) were significant predictors of knowledge on older adult care.

CONCLUSIONS

Our study showed; most of nurses had poor knowledge of the care of elder patients. Level of education, level of experience, and lived with the older adult were factors that contributed for poor knowledge. Thus, professional organizations should focus on changing nursing curricula and providing professional development workshops to improve the knowledge of nurses on geriatric care.

Undergraduate healthcare students' personal experiences with older adults : A qualitative description study

BACKGROUND

Understanding students' experiences with regard to older adults is important for educators in developing specific educational strategies to encourage future healthcare professionals to consider the geriatric field as a career choice.

OBJECTIVES

The study explored Italian university healthcare students' experiences with older people and their perceptions of them at the beginning of their course.

DESIGN

A qualitative descriptive design.

SETTINGS

A Faculty of Medicine in Italy.

PARTICIPANTS

A sample of 15 students enrolled in healthcare courses was included.

METHODS

Semistructured interviews were conducted. The data were analyzed using inductive content analysis.

RESULTS

Six categories were identified. The young Italian students' first experiences with older adults were with their grandparents, representing their first models of aging. Grandparents were sources of emotional support. Older adults were seen as custodians of collective memory and as a guide for younger generations. The intergenerational relationship was characterized by respect and reciprocity. Young adults recognize the frailty and vulnerability of older adults and view intergenerational solidarity as a way to protect them. They imagined their own old age as characterized by strong family relationships and by active aging, due to their personal experience with their grandparents.

CONCLUSIONS

This study revealed mainly positive experiences and attitudes of healthcare students toward older adults. The students' relationships with their grandparents contributed greatly to this outcome.

Exploring literature on knowledge, attitudes, beliefs and practices towards urinary incontinence management: a scoping review

INTRODUCTION AND HYPOTHESIS

Urinary incontinence affects women of all ages, influencing 8.5% of the world's population in 2018. Effective management of urinary incontinence is influenced by patients help-seeking behaviour and services offered by healthcare professionals within the healthcare system. To facilitate behavioural change, it is important to understand the knowledge(Knowledge: "the comprehension and understanding of acquired facts or information about UI in adults"), attitudes (Attitude: "a predisposed perspective which influences nurses' thoughts, feelings, perceptions and behaviours towards care of adults with UI") and beliefs (Beliefs: "a theoretically conceptualized conviction or expectation regarding UI in general") of healthcare practitioners towards urinary incontinence management. The aim of this review is thus to systematically map the existing literature, reporting on how knowledge, attitude, belief and practices towards urinary incontinence management have been explored.

METHODS

Six databases were systematically searched. Included studies were published between January 2013 to January 2020 in English, investigating urinary incontinence management in women.

RESULTS

The search yielded 39 studies, with data emanating from 16 counties. Quantitative, Qualitative and mixed methodologies were used to explore the four concepts of knowledge, attitudes, beliefs and practices. A wide range of healthcare practitioners were questioned and management was explored in five healthcare settings. All factors explored related to the four concepts are reported and factors reaching consensus in included literature were highlighted.

CONCLUSION

The summarized factors can assist further investigations into the four concepts to change healthcare practitioner's behaviour towards urinary incontinence management.

Older adult care in nursing education: How have curricula been developed?

Given the rapidly growing older adult population, future nurses should increase their knowledge and skills in gerontological nursing to deliver high-quality care to older adults. The aim of this national survey (n = 40 nursing schools) was to analyse the status of gerontology education in Portuguese baccalaureate nursing programmes. Data were collected using a 51-item questionnaire about baccalaureate nursing education programmes and gerontology-related topics. Descriptive analysis was used. A total of 18 nursing schools returned the questionnaire (response rate = 45%). Results showed that 66.7% (n = 12) of nursing schools integrated gerontology content into several courses, 38.9% (n = 7) of them had stand-alone courses, and 11.1% (n = 2) of them had both options. The most significant factor inhibiting the development of the gerontological nursing curriculum was the negative image of gerontological nursing (44.4%). Gerontological-related competencies were identified in only two nursing programmes. Thirteen schools reported needing help to strengthen the gerontological content in the nursing curriculum. This study has demonstrated that gerontological content is covered in the nursing curriculum of all nursing schools. The increase of knowledge and skills in gerontological nursing and the development of a standard gerontological curriculum could contribute to enhancing gerontological nursing education and practice.

Construction and validation of an instrument for the structural assessment of wards for urinary continence in older adults

OBJECTIVE

to build and validate an instrument for structural assessment of wards for the preservation of urinary continence in hospitalized older adults.

METHOD

this is a methodological study divided into two stages. The first corresponded to an integrative literature review that guided the construction of the instrument. The second consisted of the content validation stage of the instrument, by means of expert consensus, using the Delphi technique. The selected experts were recognized in the field and authors of the articles included in the integrative review.

RESULTS

six experts participated in the content validation, which resulted in the "Instrument for Structural Assessment of Wards for the Preservation of Urinary Continence in Older Adults", composed of 27 items, distributed in three dimensions: "physical structure", "human resources", and "material resources". Two Delphi rounds were carried out for validation, resulting in a final version with 83% agreement among the experts.

CONCLUSION

the instrument reached content validity, requiring application for clinical validation. However, it can be used by researchers and health staff in hospital settings, in order to identify structural weaknesses and guide the priority of interventions for the quality and safety of this care.

Nursing Care for Hospitalized Older Adults With and Without Cognitive Impairment

BACKGROUND

The presence of cognitive impairment (CI) among hospitalized older adults (aged 85 years and older) could interfere with the identification and treatment of other important symptoms experienced by these patients. Little is known, however, about the nursing care provided to this group. Contrasting the nursing care provided to patients with and without CI may reveal important insights about symptom treatment in the CI population.

OBJECTIVE

The aim of this study was to examine the relationship of CI to nursing care provided and length of stay for hospitalized older adults using standardized nursing data retrieved from electronic health records.

METHODS

We conducted a comparative secondary data analysis. A data set of standardized nursing plan of care data retrieved from electronic health record data of nine units at four hospitals was analyzed. The plan of care data for this study were previously transformed into one of eight categories (family, well-being, mental comfort, physical comfort, mental, safety, functional, and physiological care). Fisher exact tests were used to compare the differences in the nursing care for hospitalized older adults with and without CI. Mixed-effects models were used to examine associations of patient's cognitive status and nursing care, and cognitive status and length of stay.

RESULTS

We identified 4,354 unique patients; 746 (17%) had CI. We observed that older adults with CI were less likely to receive physical comfort care than those without CI for seven of nine units. Older adults' cognitive status was associated with the delivery of mental comfort care. In addition, a worsening in cognitive status was associated with an increase in length of stay for older adults with CI.

DISCUSSION

Older adults with CI appeared to be undertreated for symptoms of pain when compared to those without CI across units. There is a need for further research to improve symptom recognition and management for this population. The presence of CI was associated with variation in nursing care provided and length of stay. Future studies that include the analysis of nursing data merged with elements stored in the electronic health record representing the contributions of other health professions are expected to provide additional insights into this gap.

Hospital care and urinary incontinence in the elderly

OBJECTIVE

to identify factors inherent in hospital care that favor urinary incontinence in the elderly.

METHOD

an integrative review with Scopus, CINAHL and Pubmed searches. Includes original articles, no language restriction, published between 2008 and 2018. Rated level of recommendation and level of evidence were assessed using the Oxford Center for Evidence-Based Medicine classification. Exploited content through thematic analysis in light of the Donabedian model.

RESULTS

13 articles constituted the sample. There were factors such as the unjustified and indiscriminate use of devices such as the geriatric diaper; hospital structure adversely affecting the needs of the elderly; and deficit in screening, risk identification and underreporting of the problem favor urinary incontinence in the hospitalized elderly.

CONCLUSION

modifiable factors related to hospital structures and care processes favor both the onset and worsening of urinary incontinence in the elderly.

Factors affecting undergraduate nurse educators' knowledge, skills or attitudes about older persons and their care: An integrative review

BACKGROUND

Nurses are increasingly expected to provide care for older persons; however, there are too few nurse educators with expertise in older person care to ensure students graduate with the requisite competencies.

METHODS

An integrative review, using Whittemore and Knafl's framework, was undertaken to identify and synthesise evidence about factors affecting nurse educators' knowledge, skills or attitudes about older persons and their care.

RESULTS

Forty-four articles met the inclusion criteria. All but three papers originated in the USA. Content analysis yielded three central themes: external-level factors, employer-level factors and individual-level factors. Findings demonstrated that external funding from philanthropic organisations and government agencies supported many of the national, regional and site-specific initiatives, which were, in many cases, underpinned by professional regulatory frameworks. Negative attitudes of administrators and reduced budgets of educational institutions impeded the availability of such initiatives. Negative attitudes of individual educators towards older person care and the specialty of gerontology constrained their pursuit of such learning, as did their lack of awareness of current gerontology resources.

CONCLUSIONS

The lack of educators with gerontology knowledge, skills and requisite attitudes requires a focused effort from external and professional bodies, and from educational institutions to ensure the resources are available to enhance educator expertise in gerontology. Rigorous study addressing the factors influencing educators' knowledge, skills or attitudes towards older persons and their care is required.

IMPLICATIONS FOR PRACTICE

Addressing the lack of nurse educator expertise in gerontology could help to ensure new nurses have the required competencies to provide quality older person care.

Nurses' emotional tone toward older inpatients: Do cognitive impairment and acute hospital setting matter?

The emotional tone of nurses' voice toward residents has been characterized as overly controlling and less person-centered. However, it is unclear whether this critical imbalance also applies to acutely ill older patients, who represent a major subgroup in acute hospitals. We therefore examined nurses' emotional tone in this setting, contrasting care interactions with severely cognitively impaired (CI) versus cognitively unimpaired older patients. Furthermore, we included a general versus a geriatric acute hospital to examine the role of different hospital environments. A mixed-methods design combining audio-recordings with standardized interviews was used. Audio-recorded clips of care interactions between 34 registered nurses (M _age = 38.9 years, SD = 12.3 years) and 92 patients (M _age = 83.4 years, SD = 6.1 years; 50% with CI) were evaluated by 12 naïve raters (M _age = 32.8 years, SD = 9.3 years). Based on their impressions of the vocal qualities, raters judged nurses' emotional tone by an established procedure which allows to differentiate between a person-centered and a controlling tone (Cronbach's α = .98 for both subscales). Overall, findings revealed that nurses used rather person-centered tones. However, nurses' tone was rated as more controlling for CI patients and in the geriatric hospital. When controlling for patients' functional status, both effects lost significance. To our knowledge, this is the first study that examined nurses' emotional tone in the acute hospital setting. Findings suggest that overall functional status of older patients may play a more important role for emotional tone in care interactions than CI and setting differences.

Student Nurses’ Perceptions About Older People

Educating nursing students about the ageing population is situated within negative societal, heath care and nursing perceptions. A cross-sectional design using Burbank’s perceptions towards older people scale was used to survey students in a pre-licensure nursing program in western Canada. Findings revealed that students’ perceptions about older people were lower in the third year of the nursing program and after four clinical experiences. We suggest that students’ first experiences in long-term care settings, in which they learn to provide basic care to older people, be balanced with experiences of older people in a variety of settings. Such experiences would allow students to develop the knowledge and skill needed to work with an ageing population with complex healthcare needs. More research is needed to better understand students’ experiences and perceptions about where in the program more learning strategies about how to best work with older people would be helpful.

Perspectives about Interprofessional Collaboration and Patient-Centred Care

Interprofessional collaboration is understood to improve efficiencies and quality of care but is associated with challenges such as professionals' differing routines, knowledge, and identities, as well as professional hierarchies and time constraints. Given these challenges, there is limited understanding of how professionals collaborate effectively in providing patient-centred care. This study, with a convergence triangulation mixed-methods study design, explored interprofessional staffs' perceptions of interprofessional collaboration and patient-centred care when working with hospitalized older adults. Thirty-six staff responded to a survey which included the Patient-Centred Care measure and the Modified Index of Interdisciplinary Collaboration; we also interviewed 14 nursing staff. Although all scores suggested a high value was placed on interprofessional collaboration, scores were low related to activities that facilitated team processes. We identified three themes from the data: knowing the patient/family, functional needs, and communication processes. Staff identified daily rounds with interprofessional teams as supportive of interprofessional collaboration and patient-centred-care.

The feasibility of implementing education on older person care to practice on medical units: Nurses' perceptions and the influence of practice context

AIM

As part of a larger primary study on evidence-informed practice with hospitalised older people, we aimed to (a) examine nursing staffs' perceptions of the interactive geriatric educational intervention and to explore how perceptions of their work context may influence their ability to enact the evidence-informed assessment and care approaches discussed during the educational sessions and (b) compare differences in perceptions of context between RNs, LPNs and HCAs.

METHOD

A survey-based evaluation that used both closed and open-ended questions was conducted as part of an interactive educational intervention on cognitive impairment and managing responsive behaviours. Data were gathered on participants' perceptions of the education intervention and organisational context.

RESULTS

Findings from this study suggest when education is tailored to nurses' articulated educational needs, it is well received; however, barriers to implementation exist. Assessment of the context by using a standardised survey tool to get the nursing staffs' perceptions of organisational context revealed strengths in leadership support and day-to-day interactions with other nurses and healthcare professionals, but potential barriers related to lack of facilitation to transfer new knowledge into practice existed.

CONCLUSION

Providing evidence-based education related to care of older patients and evaluating nursing staffs' perceptions of the education and their context has laid the groundwork for a long-term relationship with the managers and nursing staff on the participating medical units. Further investigation about how best to incorporate the facilitator role into the medical units to support evidence-based practices with older patients is warranted.  IMPLICATIONS FOR PRACTICE: While nurses are receptive to new knowledge, the unpredictable workload of acute care creates challenges to implementing this new knowledge. Assessment of contextual factors that influence evidence-informed practice facilitates planning for implementation of new knowledge and support practice change.

Preparing nurses and nursing students to care for older adults in lower and middle-income countries: A scoping review

BACKGROUND

The aim of this review was to examine the extent and nature of published literature on nurses' and nursing students' preparedness to care for older adults in lower and middle-income countries.

METHOD

A scoping review with 27 articles, guided by the Arksey and O'Malley (2005) framework was conducted. The following electronic databases were searched: MEDLINE, CINAHL, ERIC and SCOPUS. Grey literature using Google Scholar and ProQuest were also searched. Key search terms and subject headings such as "nursing students", "nurses", "stakeholders", "ministry of health", "readiness", "knowledge", "attitudes", "elder care", "seniors care" and "older adults" were used to identify relevant articles. Studies that reported on gerontological nursing, nursing students' and nurses' knowledge and attitudes towards older adults, and stakeholders/employers' views about nursing students' knowledge and attitudes towards older adults were included.

RESULTS

Nurses reported having moderate to insufficient knowledge in the care of older adults in the majority of the studies. Nursing students reported insufficient knowledge in the care of older adults. However, both nurses and nursing students reported positive attitudes towards the care of older adults but held misconceptions about caring for older adults. Nursing students also reported a low preference for working with older adults.

DISCUSSION AND IMPLICATIONS

The inadequate preparation of nurses and nursing students in the care of older adults means there are opportunities to enhance knowledge about health and nursing care in lower and middle-income countries and build on the positive attitudes towards older adults.

Developing Person-Centered Care Through the Biographies of the Older Adult

BACKGROUND

A lack of specialized knowledge about providing health care to older people decreases their health outcomes and quality of life. This article presents an innovative learning strategy for preregistration nursing students to raise awareness of person-centered care of the older adult.

METHOD

This report is based on the authors' own experience and includes comments from students to the authors who taught the unit of study from 2010 to 2015, supported by current literature and theory discussing contemporary educational strategies.

RESULTS

Students came to value the older adult as a person to whom they could relate and the learning promoted person-centered care delivery. Although many students found this approach to learning to be challenging, student feedback demonstrated that the overall reception of the strategy was very positive.

CONCLUSION

This strategy facilitated learning to improve person-centered care and addressed negative attitudes toward older adults, which improved health outcomes and their quality of life. [J Nurs Educ. 2018;57(12):742-746.].

Correlates of Ageism Among Health Care Professionals Working With Older Adults

Introduction: The changing proportion of older adults in society necessitates the need to determine the attitudes of health care professionals toward older adults. The purpose of this study was to explore attitudes of ageism and its correlates among health care professionals working with older adults. Method: This descriptive study was conducted in seven hospitals in five cities in Turkey. A total of 628 health care professionals participated in this study. The Fraboni Scale of Ageism (FSA) was used to collect data. Descriptive statistics, student’s t test, one-way analysis of variance and multivariate linear regression were used for data analysis. Results: The mean total score from the FSA was 56.9 ( SD = 8.0). Education (β = −.18, p < .001) and difficulty with the care of older adults (β = −.10, p < .05) were statistically significant predictors of the FSA score. Conclusions: The attitudes of health care professionals toward older adults were generally positive and affected by difficulty in providing care and the educational status of the health care professionals.

Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study

AIMS AND OBJECTIVES

To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications.

BACKGROUND

Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking.

DESIGN

Cross-sectional study.

METHODS

A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models.

RESULTS

Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia.

CONCLUSION

Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients.

Nurse perception of care of hospitalized older adults - a comparative study between northern and central regions of Portugal

Objective:

to analyze the relationship between the perceptions of nurses about geriatric care (GC) environment and geriatric nurses’ knowledge and attitudes according to unit type considering the northern and central regions of Portugal.

Method:

a cross-sectional study was developed among 1068 Portuguese’s nurses in five hospitals. The instrument was Geriatric Institutional Assessment Profile - Portuguese version. The independent samples t-test was when the assumption of normality was verified, otherwise, the Mann-Whitney U test was used. The level of significance was 5%.

Results:

the profile of perceptions of GC showed a relatively homogeneous pattern (no statistically significant results were found). For the geriatric care environment scale, only the CC/ED units presented significant differences in all considered subscales (resource availability; aging-sensitive care; institutional values; and continuity of care), with more positive perceptions among nurses in the northern region. In Professional Issues scales, only the scale perception of burden related with upsetting behaviors revealed significant differences between regions in all specialties.

Conclusion:

the findings suggest the need for increased investment by hospital leaders to promote a geriatric nursing practice environment that supports the specialized needs of hospitalized older adults.

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.

Urinary incontinence and its management in patients aged 65 and older in orthopaedic care - what nursing and rehabilitation staff know and do

AIMS AND OBJECTIVES

To describe what nursing and rehabilitation staff know and do with regard to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery.

BACKGROUND

Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent urinary incontinence, there are indications that these guidelines are not applied in hospital care.

DESIGN

A qualitative study with descriptive design was conducted in two orthopaedic units.

METHODS

Forty-six interviews and 36 observations of care were conducted from January-October 2014 and analysed with qualitative content analysis.

RESULTS

Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures.

CONCLUSIONS

Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing urinary incontinence.

RELEVANCE TO CLINICAL PRACTICE

An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.

A Multi-Method Study of the Geriatric Learning Needs of Acute Care Hospital Nurses in Ontario, Canada

Older people are at risk of experiencing functional decline and related complications during hospitalization. In countries with projected increases in age demographics, preventing these adverse consequences is a priority. Because most Canadian nurses have received little geriatrics content in their basic education, understanding their learning needs is fundamental to preparing them to respond to this priority. This two-phased multi-method study identified the geriatrics learning needs and strategies to address the learning needs of acute care registered nurses (RNs) and registered practical nurses (RPNs) in the province of Ontario, Canada. In Phase I, a survey that included a geriatric nursing knowledge scale was completed by a random sample of 2005 Ontario RNs and RPNs. Average scores on the geriatric nursing knowledge scale were in the "neither good nor bad" range, with RNs demonstrating slightly higher scores than RPNs. In Phase II, 33 RN and 24 RPN survey respondents participated in 13 focus group interviews to help confirm and expand survey findings. In thematic analysis, three major themes were identified that were the same in RNs and RPNs: (a) geriatric nursing is generally regarded as simple and custodial, (b) older people's care is more complex than is generally appreciated, and (c) in the current context, older people's care is best learned experientially and in brief on-site educational sessions. Healthcare providers, policy-makers, and educators can use the findings to develop educational initiatives to prepare RNs and RPNs to respond to the needs of an aging hospital population.