Do nurses stereotype the aged?

Difficulties experienced by nurses in older patient care and their attitudes toward the older patients

BACKGROUND

There is little known about nurses' attitudes toward older people in Turkish society, particularly within centers providing care to older patients.

OBJECTIVE

This research was conducted to determine nurses' attitudes toward older patient care and the difficulties they experience.

DESIGN

A descriptive research design was used.

SETTINGS

The research population comprised 282 nurses working in the clinics of public hospitals in central Erzurum that mostly accommodate older patients.

METHODS

Participants completed questionnaires regarding descriptive characteristics, the type of difficulties they experienced in older patient care, and the Turkish version of Kogan's Attitudes Toward Old People Scale. Data were evaluated by using percentage, Kruskal-Wallis variance analysis, t test and Mann-Whitney U test.

RESULTS

The study revealed that nurses experienced difficulties due to the inadequacy of physical conditions and technical equipment in hospitals; administrative problems; communication problems; and insufficient knowledge, skills and experience in older patient care. The nurses' overall attitude toward the older people was found to be positive (98.83 ± 11.19).

CONCLUSIONS

The difficulties experienced by nurses in this sample resulted from the lack of technically equipped hospitals or clinics for older patients and the inadequacy of nurses' gerontology education. Despite these factors, the nurses' attitude toward older people was positive.

Challenging the discourses of nursing ageism

The nursing literature is replete with reports of nursing negativity in relation to elderly people. The bulk of these reports are based on studies of nurses' attitudes and career preferences. This paper challenges the discourses of nursing ageism constructed by these studies by arguing that they do not take into account the links between discourse, power and social processes. Data were obtained using semi-structured questionnaires and interviews in order to explore student nurses' reasons for undertaking a nursing degree course, their career specialty preferences, the rationale behind these preferences and their views of working with elderly patients. All transcripts were subjected to both content analysis and discourse analysis. The findings reveal no clear link between attitudes towards elderly care and career preferences and little evidence of ageism.

"As a Young Girl, I ..." The Benefits of Narrational Relationships in the Lives of Older Residents

1. Using story telling with the older resident provides an opportunity for the nurse to demonstrate caring, and a common reality between them is developed. 2. Story telling by older residents, far from merely "living in the past," can promote their health and well being. 3. In the narrational relationship between nurse and older resident, story telling is encouraged and supported; for the nurse, this means valuing oneself, older adults, and story telling.

Perceptions about nursing care. Comparing elders' and nurses' priorities

1. Data were collected from staff nurses on medical-surgical units at two area hospitals and from elders at eight local senior citizen groups and five housing communities. 2. Elders rated physical comfort activities and psychosocial activities related to communication higher than did nurses. 3. Nurses rated activities related to discharge planning higher than did elders. 4. Knowing which care activities elders consider important can aid nurses in easing the trauma of hospitalization by guiding the provision of care that meets the needs, expectations, and desires of the elderly.

Nurses' memory of patient's pain

This descriptive study examined the relationship between nurses' memory of patient's pain and patient stereotyping. The patient vignette information recalled by 148 nurses was content analyzed for accurate items, accurate analgesic items, and how accurately the patient's pain was recalled. Stereotyping was measured by z-scores for time planned for pain assessment and analgesic administration. No significant relationship was supported between memory and stereotyping. Nurses either recalled the patient's pain accurately (n = 58), inaccurately (n = 18), or completely omitted (n = 70) this information. Further study is needed to explore why nurses recalled the patient's pain differently, and how this might impact pain relief efforts.

Client age, gender, behaviour: effects on quality of predicted self-reactions and colleague reactions

This comparative study shows biases relative to client age, gender and behaviour demonstrated by 268 female nurse subjects. A repeated measures design was utilized. All three main effects were significant (p < 0.001) for how respondents predicted that they would react to various clients and also how they predicted that their colleagues would react. Most two-way and three-way interaction effects were significant. Subjects demonstrated more favourable reactions to nice, young, male clients and least favourable reactions to not nice, old male clients. Study subjects predicted more favourable self-reactions to simulated clients than for their colleagues. What should be important to every professional as a result of this study is the need to be aware of self-biases, which may cause errors in decision-making and nursing care interventions and lead to ethical violations with clients.

Attitudes towards the old and death, and spiritual well-being

The purpose of this research was to determine the interrelationship of attitudes towards older people, death attitudes, and the spiritual well-being of 300 nursing students. Instruments employed were Kogan's Old People Scale, the Death Anxiety Scale, the Death Depression Scale, and the Spiritual Well-being Scale. Pearson product-moment correlation coefficients and multiple-regression analysis were used to test the hypotheses. Hypotheses were supported predicting an inverse relationship between attitudes towards older people and death anxiety and death depression (p<.01), and a positive relationship between spiritual well-being and negative attitude towards older people (p<.01). Data did not support the hypothesis that death attitudes and spiritual well-being would account for greater variance in attitudes towards older people than either single variable alone. From a step-wise multiple-regression analysis, race/ethnicity and death attitudes together accounted for 21% of the variance in attitudes towards older people. Study results demonstrated that Caucasian nursing students hold positive attitudes toward older people. Implications for health care are discussed with particular emphasis on potential strategies for education.

Predictors of attitudes toward three target groups of elderly persons: the well, the physically ill, and patients with Alzheimer's disease

This research compared attitudes of 143 nursing home employees toward three hypothetical target groups of older adults: well elderly persons, physically ill elderly persons, and elderly persons with Alzheimer's disease. Staff provided successively less positive evaluations of physically ill elderly persons and elderly persons with Alzheimer's disease compared to well elderly persons. Age, education, and contact with grandparents differentially predicted positive evaluations toward well and physically ill older adults. Self-efficacy was a significant predictor of positive evaluations across all target groups. Findings suggest that interventions designed to increase staff members' feelings of self-efficacy may lead to more positive evaluations of elderly clients and, ultimately, improved quality of care.

Who cares about care in nursing education?

Many sources indicate that nurses have a negative view of work with ageing patients. Wide-spread stereotypes concerning old age no doubt exercise influences in the formation of nurses' attitudes. The research reported here suggests that nurses' negative attitudes towards the elderly are consolidated rather than dissolved in the course of their training. The reasons for this may not, in fact, lie in the nature of the gerontology components (small as they usually are) of the curriculum. Rather, the course (or the "professional socialisation" process) as a whole appears to carry messages that devalue personal care duties--contra the prestige of activities attached to all levels of medical technology. The ageing patient, often requiring much hands-on (the body) care is thus located well outside areas of work which are perceived by nurses to include clearly focused professional pathways.

The Impact of Continuing Education on Patient Outcomes in the Elderly Hip Fracture Population

As the health care system is oriented to provide service with finite dollars, nursing educators are being asked to demonstrate how continuing education for staff improves patient outcomes. The purpose of this study was to evaluate the impact of an orthopedic-geriatric continuing education program for nurses on the elderly patient who had sustained a hip fracture. A significant difference was found between the control and experimental unit patients with respect to time to first ambulation and length of stay on the orthopedic unit.

Promoting quality and cost-effective care to geropsychiatric patients

The goals of the project described here were to reduce the length of hospital stay, decrease financial losses, improve care for the elderly, and improve the attitudes and knowledge of nursing staff caring for the elderly. Data collected included reimbursement information, nursing staff variables, and outcomes of patient care. Staff knowledge and attitudes were measured by Palmore's "Facts on Aging" and Kogan's "Old People Scale." Patient data were collected through a retrospective review of records. Central to the project was the utilization of a geropsychiatry clinical nurse specialist who facilitated a number of interventions. Length of hospital stay and financial losses were significantly reduced. A change in knowledge levels and positive attitudes of nursing staff occurred, although the change was not statistically significant. An association between attitudes and job satisfaction was found, and patient outcomes were improved in approximately half the cases. Specialized programming can enhance the care of geropsychiatry patients and can be cost-effective.

A survey of gerontological curricula in Canada generic baccalaureate nursing programs

1. This study surveyed the status of gerontological curricula in the Canadian generic baccalaureate nursing programs--and the opinions of provincial "experts"--on the requirements of gerontological nursing to determine how nurses are or should be prepared to meet the health care needs of aging Canadians. 2. Questions were formulated to explore the following issues: nursing models used by the schools, faculty preparation, integration of gerontological nursing content, curriculum content, and gerontological clinical experiences required. 3. The study indicated the following: students were not introduced to a consistent philosophy of health for the older client in either the academic or clinical setting; 5% of the faculty had a master's or doctorate with a focus in gerontology; 2.5% of the students chose a gerontological nursing practicum in their last year; 69% of the 49 listed topics were taught in an integrated manner; and 7.4% of the clinical hours had a gerontological focus. 4. The experts recommended the following: 53% of the topics be integrated and that 47% of the topics be taught in a specific course; patient care problems and techniques receive more emphasis in the clinical area; 21% of the clinical hours concentrate on gerontological nursing; and clinical experiences occur in a variety of health care settings to illustrate the elderly's coping abilities to achieve a sense of well-being.

The psychogeriatric nurse's decision-making process in a mental hospital

This article looks at the psychogeriatric nurse's decision-making process in a mental hospital. The subjects consist of 26 nurses working on the psychogeriatric wards of one hospital. The data were collected by a questionnaire (N = 26), content analysis of nursing plans (N = 56), and observation of nursing plans meetings (N = 15). The results on the different phases of the decision-making process suggested that nurses had little difficulty with the identification of problems. Data collection tended to concentrate on the physical side of nursing work. The setting of explicit targets for nursing care proved to be difficult. The vast majority of the nurses (85%) felt that decision-making on different nursing alternatives was only moderately or not at all successful. Over half of the nurses felt that their ability to evaluate the outcome of treatment and nursing was either satisfactory or poor.

The models of nursing activity in the basic care of demented patients living in institutions

The chief concern of this article is the basic care of demented patients living in institutions. The data for the study were collected by observing basic care situations and interviewing practising nurses. The analysis was based on continuous comparative analysis. Five models of nursing activity were identified: rejective, routinized, robot-like, cassette-like, and skillful. Nurses concentrated more on obligatory daily activities than on the individual needs of demented patients, on the special characteristics of dementia, or on encouraging spontaneous activity among demented patients. The nurses tended to look at demented patients chiefly in terms of the abilities they had lost and the disturbance they caused; less attention was given to their remaining facilities, such as their sense of humor and their ability to enjoy things and to establish contact through gestures and physical touching.

The nurse's decision-making process and the implementation of psychogeriatric nursing in a mental hospital

This study looks at the psychogeriatric nurse's decision-making process and on this basis seeks to describe the implementation of psychogeriatric nursing in a mental hospital. The subjects consist of 26 nurses working on the psychogeriatric wards of one hospital. The data were collected using a questionnaire (n = 26), a 1-week time-usage analysis, content analysis of nursing plans (n = 56), and observation of planning meetings (n = 15). The results for different phases of the decision-making process suggested that nurses had little difficulty with the identification of problems. Data collection tended to concentrate on the physical side of nursing work. The setting of explicit targets for nursing care proved to be difficult. The vast majority of the nurses (85%) felt that decision-making on different nursing alternatives was only moderately or not at all successful. Over half of the nurses felt that their ability to evaluate the outcome of treatment and nursing was either satisfactory or poor. Time-usage analysis indicated that the nurses had frequent interaction with their patients in connection with basic care, although the nurses themselves did not regard this part of their work as active interaction with the patient.

Urinary incontinence: nursing home staff reaction toward residents

1. ISQ-SR is a reliable and valid tool to measure psychological stress associated with working with urinary incontinent patients. 2. ISQ-SR can be used to measure efficacy of continuing education programs aimed at reducing staff stress associated with urinary incontinence. 3. Eighty percent of the staff reported that they looked for ways to help patients with their incontinence all the time, but only 50% said that they felt comfortable working with urinary incontinent patients all of the time. 4. Sixty-three percent of the staff reported that they felt frustrated about working with urinary incontinence some of the time, indicating a need for continuing education.

The Effects of Institutional and Community Experiences on Nursing Students' Intentions Toward Work With the Elderly

The intentions of nursing students toward working with older adults are similar to those of nurses in general. Several authors have suggested that educational interventions are the key to reversing the reluctance of nursing students to work with elderly persons. In this longitudinal study, the intentions of 39 junior baccalaureate nursing students were examined at three points: prior to any treatment, after clinical work with aged persons in an institutional setting, and after clinical work with aged persons in a community setting. The analysis of variance model run on this data revealed no significant differences in students' intentions as a consequence of their clinical experiences.

The relationship of age, gender, and exercise practices to measures of health, life-style, and self-esteem

A study of 478 adults from a rural-urban region was conducted to determine differences in health and life-style measures based on age, gender, and exercise involvement that would provide data to incorporate in healthy-living programs. Pender's Health Promotion Model provided the framework for the study. Significant results related to age, gender, exercise, and initiation and maintenance of health-promoting practices were found.

Ego defensiveness and its relationship to attitudes of registered nurses toward older people

This study was designed to simultaneously examine the relationship between select independent variables and attitudes of registered nurses toward older people. Emphasis was placed on exploring the relationship between ego defensiveness and attitudes. Data analysis was based on the responses of 255 registered nurses. The following variables were found to be significantly related to attitudes: ego defensiveness, age, highest level of education, position, close personal relationship with an older person and perception of a relationship with an older person. The findings serve as a cautionary signal that attitudes of registered nurses toward older people may not be as positive as recent literature has indicated.

Stereotyping by nurses and nursing students: a critical review of research

Thirty-eight empirical studies of stereotyping by nurses and nursing students were critically examined and discussed. The review was conducted and reported as though it were primary research. Subjects were the studies examined, methods were the reviewing procedure, data were attributes of the studies, and results were the conclusions drawn. The research on nurses' stereotypes has been characterized by: the use of one method of data collection, usually questionnaires; the measurement of the presence or absence of specific stereotypes; and nonprobability sampling techniques. There is some evidence that nurses stereotype other people based on age, sex, attractiveness, personality, diagnosis, social class, and family structure. Suggestions for adding to this body of knowledge are made.