Positively influencing student nurse attitudes toward caring for elders: results of a curriculum assessment study

A scoping review of ageism towards older adults in cancer care

INTRODUCTION

Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology.

MATERIALS AND METHODS

We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis.

RESULTS

We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology.

DISCUSSION

Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings. 249/250.

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

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

Nursing students' perceived value of the work environment: A discrete choice experiment

The purpose of this study was to elicit graduating undergraduate nursing students' perceived value of the work environment in aged care. Applying a cross sectional design, an electronic questionnaire was sent to 625 graduating undergraduate nursing students from three schools of nursing in Jiangsu Province, China. A discrete choice experiment questionnaire with eight choice-set questions was performed. In total, 267 nursing students (42.7%) responded to the questionnaire. We found that nursing students valued excellent working conditions the highest (OR = 3.632 [2.846~4.635]), followed by adequate formal professional development activities (OR = 2.252 [1.907~2.660]), good/excellent safety management (OR = 2.214 [1.828~2.682])/ (OR = 2.202 [1.758~2.759]), and 10% higher earnings (OR = 1.615 [1.360~1.919]). Based on these findings, the study provided information to improve the recruitment of nursing students to work with older adults. Findings suggest that students may be 44.07~73.41% more likely to choose working with older people when valued job characteristics are present.

Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis

Background. Research has found a strong link between ageism, in the form of negative stereotypes, prejudice, and discrimination toward older people, and risks to their physical and mental health. Little is known, however, about the effectiveness of strategies to reduce ageism. Objectives. To assess the relative effects of 3 intervention types designed to reduce ageism among youths and adults-education, intergenerational contact, and combined education and intergenerational contact-by conducting a systematic review and meta-analysis. Search Methods. We searched PubMed, PsycINFO, AgeLine, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Index Medicus, Database of Abstracts of Reviews of Effects (DARE), Epistemonikos, Cochrane Database of Systematic Reviews, Campbell Collaboration, PROSPERO, GreyLit, and OpenGrey. We identified additional records by hand-searching reference lists of relevant review articles as well as records included in the meta-analysis. Two independent reviewers completed the search and screening process. Selection Criteria. Eligible studies were those that (1) evaluated an intervention designed to reduce ageism, (2) examined at least 1 ageism outcome in relation to older adults, (3) used a design with a comparison group (randomized or nonrandomized), and (4) were published after 1970, when the ageism concept was developed. Data Collection and Analysis. Two independent reviewers extracted study-level data from records using a common data collection spreadsheet. They also assessed study quality by using the Cochrane Risk of Bias Tool, and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool to assess quality of outcome evidence. Primary outcomes were attitudes toward older people and accuracy of knowledge about aging and older people. Secondary outcomes included comfort with older adults, anxiety about one's own aging, and interest in working in the field of geriatrics or gerontology. We carried out meta-analyses with statistical mixed models. Main Results. We identified 63 eligible studies (1976-2018) with a total sample of 6124 participants. Ageism interventions demonstrated a strongly significant effect on attitudes (differences of standardized mean differences [dD] = 0.33; P < .001), knowledge (dD = 0.42; P < .001), and comfort (dD = 0.50; P < .001), but no significant effect on anxiety (dD = 0.13; P = .33) or working with older adults (dD = -0.09; P = .40). Combined interventions with education and intergenerational contact showed the largest effects on attitudes. We found stronger effects for females and for adolescent and young adult groups. Authors' Conclusions. Interventions are associated with substantial reduction in ageism and should be part of an international strategy to improve perceptions of older people and the aging process. Additional research using more rigorous designs to examine the effects of interventions is strongly recommended. Public Health Implications. Ageism has well-established negative effects on the physical and mental health of older people. Findings suggest that relatively low-cost, feasible strategies involving education and intergenerational contact can serve as the basis of effective interventions to reduce ageism.

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.

Survey of attitude towards and understanding of the elderly amongst Chinese undergraduate medical students

Background: Gerontology has an increasing role in medicine and public health. The provision of better medical services to the elderly closely correlates with the attitude towards and understanding of the elderly by medical personnel.

Objectives: We investigated factors affecting a medical student’s choice of gerontology as a career. This included a survey of attitude towards the elderly and understanding of aging among first and third year Chinese undergraduates. Data between students in different streams, at different levels, and between sexes were compared.

Methods: Convenience sampling was used to recruit 335 undergraduate medical students in Sichuan for a survey using Kogan’s Attitudes toward Older People Scale (KAOP) and Palmore’s Facts on Aging Quiz (FAQ1) as tools.

Results: Among undergraduates, 71.3% did not acquire significant knowledge about the elderly (mean KAOP score 139.5 ± 16.0); and had a mean score of knowledge of aging (12.2 ± 2.7). The majority of first year students (98.7%) and third year students (98.8%) had a positive attitudes (KAOP > 102). The KAOP score among first year students was higher than that among third years (P < 0.01). Students with an interest in problems of the elderly had significantly higher scores and were more willing to consider careers in gerontology than students without an interest in the elderly (P < 0.01).

Conclusions: The majority of Chinese undergraduate medical students surveyed had positive attitudes towards elderly. We recommend greater accessibility of courses in gerontology to meet the increasing need for personnel in this health care sector.

Impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults: A Quasi-experimental study

BACKGROUND

With an aging population, it is critical that nurses are educated and prepared to offer quality healthcare to this client group. Incorporating gerontology content into nursing curricula and addressing students' perceptions and career choices in relation to working with older adults are important faculty concerns.

OBJECTIVES

To examine the impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults and career intentions.

DESIGN

Quasi-experimental, pre- and post-test design.

SETTING

Medium-sized state university in the Mid Western United States PARTICIPANTS: Data were collected from three student cohorts during the spring semesters of 2012 (n=98), 2013 (n=80) and 2014 (n=88) for a total of N=266 with an average response rate of 85%.

METHODS

A survey instrument was administered via Qualtrics and completed by students prior to, and following completion of the course.

RESULTS

There was an overall significant increase (p=0.000) in positive perceptions of working with older adults among nursing students following completion of the course. The majority of participants (83.5%) reported having previous experience with older adults. Those with previous experience had higher perception scores at pre-test than those without (p=0.000). Post-test scores showed no significant difference between these two groups, with both groups having increased perception scores (p=0.120). Student preferences for working with different age groups suggested an overall increase in preference for working with older adults following the course.

CONCLUSIONS

A course in gerontological nursing, incorporating learning partnerships with community dwelling older adults, promotes positive perceptions of working with older adults, independently of the quality of prior experience. There was some evidence that students changed their preferences of working with different age groups in favor of working with older adults. Further research should be conducted to determine the mechanisms through which this takes place.

The education received by nursing students regarding nursing older people: a scoping literature review

The situation of an ageing population is a priority for all levels of society globally, particularly related to the subsequent increased demand for care. Nurses are often the primary source of this care; therefore, research is required to develop the curricula of nursing education, to help them meet this demand. The primary aim was to analyse empirical studies that have tackled nursing students' education concerning nursing older people. This analysis was targeted at generating an overall picture of the research in this field in order to determine the areas that require further study. A scoping literature review was conducted through systematic searches in the following electronic databases: Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Education Resources Information Center (ERIC). These searches were limited to studies with an available abstract, in English, which were conducted between 1999 and 2012. Two researchers independently applied the same inclusion and exclusion criteria to select the studies for analysis. In total, 66 articles were included in the analyses. The results were validated by the research team. The primary research areas identified included both the learning outcomes and the implementation of nurses' education in caring for older people. Students' general attitudes towards older people and ageing dominated the studies regarding learning outcomes. There was a large variation in the description of the validity and trustworthiness of the studies, with most being only at a moderate level. A limited number of studies examining the specific learning outcomes and factors influencing the implementation of education exist. Vague reporting about the validity and trustworthiness of the studies limits the use of their findings. More well-designed studies are needed to guide educational strategies to improve students' competence in nursing older people and to promote this field as a career choice.

Nursing student attitudes toward and preferences for working with older adults

A growing aging population will require nurses who prefer to work with older adults. Schools of nursing have used several strategies to improve students' attitudes, and encourage preferences for working with older adults. However, research on these strategies is inconsistent, with some programs improving students' attitudes whereas others have no effect. More recent studies have found that although attitudes have improved, working with older adults is generally the least preferred area of nursing. The purpose of this longitudinal mixed methods study is to describe and explain student nurse attitudes and preference changes over time. Eighty undergraduate nursing students were surveyed over 2 years. Students' attitudes and preference for working with older adults improved over time. However, their preference to work in nursing homes was consistently ranked last among the 10 choices for work preferences. In focus groups, students reported that the gerontological course dispelled myths about caring for older adults, and that clinical placement played a major role in influencing student work preferences.

Career preferences of nursing students

This study investigates novice and experienced student nurses' attitudes about caring for patients across the lifespan. Students were also asked why they would enjoy or not enjoy caring for children and older adults. Both novice (n = 114) and advanced (n = 56) nursing students were relatively positive about caring for patients across the lifespan. However, novices were significantly more negative about working with older patients, particularly after experiencing a first clinical placement. In contrast, a significant quadratic effect was found for advanced students, indicating more negativity about working with both children and older adults. When giving reasons for why they would enjoy caring for older patients, novices were more likely than were advanced students to focus on stereotypical characteristics and on negative health outcomes of older adults as a group. Overall, results suggest that the attitudes driving career interests in nursing students change as training advances.

Developing positive attitudes toward geriatric nursing among Millennials and Generation Xers

Despite the increase of the older adult population, there exists a shortage of health care professionals trained to help this population remain independent as long as possible. Ageism, common among younger adults, affects the capacity building of health care for older adults. Research has indicated that increased knowledge about older adults, as well as exposure to the elderly, may alter nursing students' attitudes regarding careers in gerontological nursing. However, questions remain as to what are the most effective ways to provide gerontological content in nursing programs and enhance attitudes toward older adults.With the understanding that younger adults see a need to balance work and play, a baccalaureate nursing program provides examples of ways to accomplish this through integration of courses, simulations, positive images of aging, and learning activities that enhance empathy for both frail and healthy older adults.

Interdisciplinary integration of the CVS module and its effect on faculty and student satisfaction as well as student performance

BACKGROUND

Beyond the adoption of the principles of horizontal and vertical integration, significant planning and implementation of curriculum reform is needed. This study aimed to assess the effect of the interdisciplinary integrated Cardiovascular System (CVS) module on both student satisfaction and performance and comparing them to those of the temporally coordinated CVS module that was implemented in the previous year at the faculty of Medicine of the King Abdulaziz University, Saudi Arabia.

METHODS

This interventional study used mixed method research design to assess student and faculty satisfaction with the level of integration within the CVS module. A team from the medical education department was assembled in 2010/2011 to design a plan to improve the CVS module integration level. After delivering the developed module, both student and faculty satisfaction as well as students performance were assessed and compared to those of the previous year to provide an idea about module effectiveness.

RESULTS

Many challenges faced the medical education team during design and implementation of the developed CVS module e.g. resistance of faculty members to change, increasing the percentage of students directed learning hours from the total contact hour allotted to the module and shifting to integrated item writing in students assessment, spite of that the module achieved a significant increase in both teaching faculty and student satisfaction as well as in the module scores.

CONCLUSION

The fully integrated CVS has yielded encouraging results that individual teachers or other medical schools who attempt to reformulate their curriculum may find valuable.

A critical review of interventions addressing ageist attitudes in healthcare professional education

BACKGROUND

As the population ages, the demand for health care services will increase. Evidence suggests that the pervasive negative societal beliefs regarding aging and older persons are also found among occupational therapy students and practitioners. These attitudes can negatively affect healthcare service provision.

PURPOSE

To determine the strength of the evidence regarding educational interventions used to modify ageist values and beliefs of health care professionals.

METHODS

A critical review of the literature was undertaken to evaluate methodological quality of relevant outcome studies.

FINDINGS

. Of the fifteen studies meeting the inclusion criteria one was rated as "strong" evidence, and the remainder lacked methodological rigour. Such results make it difficult to decide the usefulness of including educational interventions in health care curricula to negate ageism.

IMPLICATIONS

Research specific to occupational therapy is required as our unique frames of reference and theoretical models to guide practice may preclude generalizability of research from other professional groups.

'With a bit of tweaking…we could be great'. An exploratory study of the perceptions of students on working with older people in a preregistration BSc (Hons) Nursing course

BACKGROUND

With ageing demographics, it is important that nurse education curriculum can prepare students to work with older people.

AIMS AND OBJECTIVES

To explore students' perceptions of working with older people and the extent to which their preregistration curriculum is preparing them for this role.

DESIGN

A qualitative research design, incorporating focus groups in data collection.

METHODS

Four focus groups were held in January 2011, involving a total of 32 students undertaking a preregistration BSc (Hons) nursing degree course.

RESULTS

An overt focus in the preregistration curriculum on acute and critical care and perceived deficits in care of older people content left some students feeling underprepared to work with older people and to challenge ritualistic practice. Clinical placement experience and mentor support appeared to be influencing students' decisions about whether they would consider working with older people in the future.

CONCLUSION

Education providers should ensure that students are adequately prepared to work with older people and that students are supported when they observe poor practice. A finding that observation of ritualistic practice could prompt some students to consider working with older people, warrants further research. Implications for practice. Nurse educators should evaluate the content and delivery of their preregistration courses to ensure that the prerequisite knowledge, skills and attitudes required to work with older people are accorded appropriate value and attention.

Nursing students? career preferences: a Norwegian study

AIM

This paper is a report of a study to identify Norwegian undergraduate nursing students' career preferences at the beginning and end of their nursing education programme, together with their reasons for these preferences.

BACKGROUND

International studies have shown that recruitment and retention of nurses in areas such as aged care and psychiatric nursing is difficult. It is important to know why some working areas are popular whilst others are not, so that nursing schools produce graduates who meet the needs of the community.

METHODS

All students starting their nursing education programme in 2001/2002 in five Norwegian university colleges were invited to complete questionnaires at the beginning and end of their nursing education programme. In phase 1, 620 of 782 commencing students completed questionnaires (response rate 79.2%). In their third year, phase 2, 473 questionnaires were distributed (response rate 82.6%, n = 386). The questionnaire included closed questions about career preferences and open-ended questions seeking the reasons for the preferences.

RESULTS

The study revealed changes in preferences between the beginning and the end of the nursing education programme. In phase 1, midwifery and paediatric nursing were ranked highest and in phase 2 working in medical/surgical ward, midwifery and psychiatric nursing were preferred. Working in aged care institutions remained unpopular throughout. Clinical experiences and professional challenges were often given as reasons for preferences.

CONCLUSION

Nursing educators, clinical nurses and policymakers must reconsider their priorities and improve working conditions for nurses in aged care in order to meet society's need for nurses.

A comprehensive systematic review of evidence on the effectiveness and appropriateness of undergraduate nursing curricula

Objectives  The objective of this review was to appraise and synthesise the best available evidence on the effectiveness and appropriateness of undergraduate nursing curricula. Inclusion criteria  This review considered research papers that addressed the effectiveness and appropriateness of undergraduate nursing curricula. Studies of higher evidence levels were given priority over lower-evidence studies. Participants of interest were undergraduate nursing students, nursing staff and healthcare consumers. Nursing staff outcomes, consumer outcomes and system outcomes (e.g. competency, satisfaction, critical thinking skills, healthcare consumer rights and cost-effectiveness) that impact on the evaluation of undergraduate nursing curricula were considered in the review. Search strategy  The search strategy sought to find both published and unpublished studies and reports limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of the text contained in the title and abstract, and of the index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Finally, the reference list of all identified reports and articles was searched for additional studies. Methodological quality  Each paper was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Unified Management, Assessment and Review of Information (SUMARI) package. Results  A total of 16 papers, experimental and textual in nature, were included in the review. The majority of papers was descriptive and examined the relationships between nursing curricula and specific learning outcomes such as critical thinking skills. Because of the diverse nature of these papers, meta-analysis of the results was not possible and this section of the review is presented in narrative form. In this review, four undergraduate nursing curriculum models were identified: integrated curriculum, subject-centred curriculum, problem-based learning, and an integrated critical thinking model. It was possible to examine the effectiveness of an integrated curriculum model and a subject-centred curriculum model; however, the other two models could not be compared because of a lack of evidence. Conclusion  The evidence regarding the effectiveness and appropriateness of undergraduate nursing curricula is notably weak because of the paucity of high-quality comparative studies and meaningful outcome measures of available studies. Therefore, no strong conclusion can be made regarding the effectiveness and appropriateness of undergraduate nursing curricula.

Caring for the elderly: changing perceptions and attitudes

The aging population is currently one of the main issues facing international health care systems. It is a recognized fact that with advancing age, the likelihood of developing health problems and chronic disease will increase and the demand for health care resources will escalate. This will impact hospitals and long-term care facilities. Our young nurses of the future will be faced with the challenging task of caring for this elderly population. A review of the literature revealed that nursing students have a negative attitude toward the elderly. This may be affected by personal beliefs, values, culture, experience, or observations. Their perceived attitudes toward the gerontology field will make it difficult to recruit the nurses required in this area. This article will explore these issues and examine the role of all health care professionals to help change their attitudes and develop a more positive relationship to meet the needs of this unique population.

Integration of Gerontology Content in Nongeriatric Undergraduate Nursing Courses

During the last several years, a school of nursing in the southeastern United States has made concerted efforts to integrate geriatric content into every undergraduate course except obstetrics. Even the pediatric nursing course has infused content about grandparents, both as care providers for children and as extended family members. Faculty expertise and passion for teaching geriatric best practices stimulated innovative and creative student experiences without overwhelming curricular revision. This article describes how gerontology content was incorporated into each curricular area and provides examples of classroom and clinical teaching strategies that were successful at this school.

A comprehensive systematic review of evidence on the effectiveness and appropriateness of undergraduate nursing curricula

OBJECTIVES

The objective of this review was to appraise and synthesise the best available evidence on the effectiveness and appropriateness of undergraduate nursing curricula.

INCLUSION CRITERIA

This review considered research papers that addressed the effectiveness and appropriateness of undergraduate nursing curricula. Studies of higher evidence levels were given priority over lower-evidence studies. Participants of interest were undergraduate nursing students, nursing staff and healthcare consumers. Nursing staff outcomes, consumer outcomes and system outcomes (e.g. competency, satisfaction, critical thinking skills, healthcare consumer rights and cost-effectiveness) that impact on the evaluation of undergraduate nursing curricula were considered in the review.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished studies and reports limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of the text contained in the title and abstract, and of the index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Finally, the reference list of all identified reports and articles was searched for additional studies.

METHODOLOGICAL QUALITY

Each paper was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Unified Management, Assessment and Review of Information (SUMARI) package.

RESULTS

A total of 16 papers, experimental and textual in nature, were included in the review. The majority of papers was descriptive and examined the relationships between nursing curricula and specific learning outcomes such as critical thinking skills. Because of the diverse nature of these papers, meta-analysis of the results was not possible and this section of the review is presented in narrative form. In this review, four undergraduate nursing curriculum models were identified: integrated curriculum, subject-centred curriculum, problem-based learning, and an integrated critical thinking model. It was possible to examine the effectiveness of an integrated curriculum model and a subject-centred curriculum model; however, the other two models could not be compared because of a lack of evidence.

CONCLUSION

The evidence regarding the effectiveness and appropriateness of undergraduate nursing curricula is notably weak because of the paucity of high-quality comparative studies and meaningful outcome measures of available studies. Therefore, no strong conclusion can be made regarding the effectiveness and appropriateness of undergraduate nursing curricula.