Older patients in the acute care setting: rural and metropolitan nurses' knowledge, attitudes and practices

ABSTRACT: Many studies reporting nurses' knowledge of and attitudes toward older patients in long-term care settings have used instruments designed for older people. However, nurses' attitudes toward older patients are not as positive as their attitudes toward older people. Few studies investigate acute care nurses' knowledge of and attitudes toward older patients. In order to address these shortcomings, a self-report questionnaire was developed to determine nurses' knowledge of, and attitudes and practices toward, older patients in both rural and metropolitan acute care settings. Rural nurses were more knowledgeable about older patients' activities during hospitalisation, the likelihood of them developing postoperative complications and the improbability of their reporting incontinence. Rural nurses also reported more positive practices regarding pain management and restraint usage. However, metropolitan nurses reported more positive attitudes toward sleeping medications, decision making, discharge planning and the benefits of acute gerontological units, and were more knowledgeable about older patients' bowel changes in the acute care setting.     

Knowledge, attitudes, and dietary practices of female athletes

The relationship between the nutrition knowledge and attitudes and dietary practices of adolescent female athletes was studied, using a 24-hour recall and a 48-hour food record with a modified version of the self-administered knowledge and attitude questionnaire of Werblow et al. Analysis indicated that the diets were similar to those of other teenage girls in the United States. The calculated mean values for vitamins A and C were more than 100% of the RDAs, while those for calcium and iron were less than 67% of the allowances. The mean energy value was less than recommended and may have been inadequate for the active subjects. Food consumption analysis showed that of total servings, the milk and meat groups accounted for only about 10% each and that more than 30% came from the "others" group. Although the subjects had some common misconceptions about nutrition, they were generally knowledgeable as well as positive in their attitudes toward nutrition. Nutrition knowledge and attitudes were positively correlated, indicating that the more nutrition knowledge a subject had, the more positive was the attitude toward nutrition, and vice versa. However, no significant correlation was found between nutrition knowledge or attitudes and dietary intake, suggesting that factors other than nutrition knowledge and attitudes, such as a concern for weight and a dependence on others for food selection, played a role in determining the food practices of the subjects.     

Nurses’ knowledge and attitudes regarding nutrition in the elderly

Background-aims  Nurses in the community are in contact with the elderly at different levels of care. The aim of this study was to assess nurses’ knowledge and attitudes regarding nutritional-care for the elderly, and the impact of their attitude on the quality of assessment-care they provide to this growing population in need of nutritional-care. Methods  A structured questionnaire was distributed by mail to 600 nurses working in Maccabi-Health-Care-Services (MHS). The questionnaire assessed different aspects of elderly nutrition. Results  The vast majority (91%) of the participants reported treating elderly in their practice. Religious nurses and the nurses with an individual orientation specialty reported more positive attitudes about nutritional-care for the elderly than others did (p=0.05). Nurses with a bachelor’s degree had better attitudes than registered nurses about the importance of nutrition for the elderly (p< 0.01). Younger nurses were found to be more knowledgeable than older ones (p< 0.04). The nurses perceived nutrition as influencing different health conditions, and 85% pointed to the importance of feeding at the end of life. Conclusions  Nurses working in the community recognize the impact of proper nutrition on elderly patients’ health, but need more training in screening for nutritional problems in the elderly.     

Evaluating rural nurses for preparation in implementing nutrition interventions.

With the increase in wellness programs, earlier hospital discharges, higher health care costs, and more home health care, rural nurses are required to generalize their practices and draw from a more extensive knowledge base. The purpose of this study was to examine nursing interventions, specifically nutrition education practices, based on nutrition knowledge that is used in health promotion. A stratified random sample of rural nurses from hospitals, nursing homes, and community health agencies in North Dakota was invited to participate in this study. Data were obtained via questionnaires. The questionnaire consisted of two parts: the first analyzing demographic data and the second analyzing nutrition knowledge. Nutrition information requests were received by 90.9 percent of the practicing registered nurses. The community/public health nurses had the highest nutrition knowledge scores while medical-surgical hospital nurses had the lowest nutrition knowledge scores. With nutrition information and education being a frequently sought intervention by the rural health client, it would seem that registered nurses should be highly prepared and knowledgeable to meet these clients' needs.     

Medical students' readiness to provide lifestyle counseling for overweight patients

In order to assess medical students' readiness to engage in lifestyle counseling regarding nutrition, physical activity, and other health behaviors, the authors examined the knowledge, attitudes, and health behaviors of medical students. The authors analyzed questionnaire responses of 290 medical students in their first, second, or third year. Students were generally knowledgeable about cardiovascular disease risk factors, however they were less knowledgeable about body mass index (BMI) and specific nutrition and physical activity recommendations. Students were confident in the ability of physicians to change patients' health behaviors and had positive attitudes about providing lifestyle counseling. The upper-level students held significantly less positive attitudes than the first-year students. Almost half the sample reported regularly making unhealthy dietary choices. Only 23% of the sample met the public health guidelines for accumulating 30 min of moderate activity on at least 5 days a week. Third-year students engaged in significantly less activity than their underclassmen. Although medical students express positive attitudes toward providing lifestyle counseling, they require more instruction in the areas of weight screening, nutrition, and physical activity recommendations in order to be helpful to their patients. Because physicians who practice health behaviors are more likely to provide counseling, it would be beneficial to integrate an emphasis on student health into medical curricula.     

Practices and Attitudes of Missouri School Nurses Regarding Immunization Records and Select Immunizations of Graduating High School Seniors

School nurses play a key role in maintaining a healthy student population, and one of their roles includes maintaining vaccination records. Further, they can play an important role in advocating for human papillomavirus (HPV) and meningococcal vaccination for students. All Missouri public high school nurses were sent an electronic survey addressing the knowledge, attitudes, and practices regarding immunization records and HPV and meningococcal vaccination of high school seniors. Approximately 75% of nurses reported their schools did not have or they did not know if the school had a written policy regarding the release of vaccination records. Approximately 1/2 and 1/3 of nurses do not communicate with parents/students about HPV or meningococcal vaccines, respectively. Although most favorable toward meningococcal, nurses had positive attitudes toward both vaccines. Recommendations include establishment of written policies regarding vaccination record release, and future research should focus on evaluating school nurses’ communication methods regarding HPV and meningococcal vaccination.     

Men's and women's knowledge and perceptions of breast cancer and mammography screening

BACKGROUND: Although most men are not directly affected by breast cancer, they participate in decisions influencing breast cancer screening and contribute to shaping the social norm on mammography screening. This study tested the hypothesis that men may be less knowledgeable than women about breast cancer and mammography and have less favorable perceptions of mammography screening. METHODS: A survey was mailed to 952 women and 370 men aged 40 to 80 years, randomly selected from the general population of Geneva, Switzerland. Information collected included knowledge and perceptions about breast cancer and mammography, familiarity with screening recommendations, and perceived usefulness of an organized screening program. RESULTS: Men were almost as knowledgeable as women about breast cancer (difference in z-scores: -0.12; 95% CI: -0.25, 0.02; P = 0.10) and breast cancer screening (difference: -0.12; 95% CI: -0.25, 0.02; P = 0.09). Both men and women perceived mammography screening to be useful, but men had significantly higher z-scores of positive attitude toward mammography than women (difference: 0.28; 95% CI: 0.14, 0.42; P < 0.001). Younger and more educated respondents of either sex were both more knowledgeable and more favorably inclined toward screening. CONCLUSION: Men were as knowledgeable about breast cancer and mammography screening as women but had more favorable attitudes toward breast cancer screening than women. Actions to strengthen community support for mammography screening programs should primarily target older and less educated persons of either sex.     

Attitudes toward gay men and lesbians and related factors among nurses in Southern Taiwan

OBJECTIVES: The aims of this study were to explore different dimensions of the attitudes toward gay men and lesbians among nurses in southern Taiwan and to examine the association between attitudes and intention to provide care to homosexual individuals. The factors related to attitudes towards gay men and lesbians by nurses were also examined. METHODS: In total, 1824 nurses from a medical centre and two regional teaching hospitals in southern Taiwan were recruited into this study. We used the Attitudes Toward Homosexuality Questionnaire (ATHQ) to examine four-dimensional concepts toward homosexuality among nurses. The association of attitudes with the intention of taking care of homosexual patients was examined. Correlations of attitudes toward homosexuality with demographic and occupational data, sexual orientation, knowledge about homosexuality, and experiences of having contact with gay men and lesbians were examined using a stepwise multiple linear regression. RESULTS: Participants had the most negative attitude toward homosexuality in the 'contact' and 'stereotypes' dimensions, followed by the 'morality' dimension and then the 'condemnation/tolerance' dimension. Nurses with more negative attitudes toward homosexuality had lower intentions of taking care of patients with a homosexual orientation. Nurses who had friends or relatives with a homosexual orientation, had a higher educational degree, and had provided care to homosexual patients were more likely to have positive attitudes toward homosexuality. In contrast, nurses who had worked for a longer period, labelled themselves as being absolutely heterosexual, and were religious were more likely to have negative attitudes toward homosexuality. CONCLUSIONS: The factors related to attitudes toward homosexuality identified in this study have to be taken into consideration when intervening for nurses' attitudes toward gay men and lesbians.     

Nutritional knowledge, attitudes, and food patterns of women athletes

Nutritional knowledge, attitudes, and food patterns of women athletes at the University of Nebraska at Lincoln were studied. Mean test scores for nutritional knowledge were higher for questions relating to "nutrition for the athlete" than to "general nutrition." Attitudes toward nutrition were generally favorable, with a positive correlation between nutritional knowledge and attitudes. Athletes who had received some form of nutrition education had higher nutritional knowledge and attitude scores than those who had not. Respondents were especially concerned with diet as it relates to weight control; those with higher knowledge scores consistently followed food patterns for weight-control diets similar to those used in training and pre-event diets.     

Hospice and primary care physicians: attitudes,knowledge, and barriers

Underuse of hospice services is a significant problem in the United States. Primary care physicians constitute an increasing referral base and have been hypothesized to be important barriers to increased use. We conducted a mail survey of 131 primary care physicians (overall response rate of 72 percent), examining their attitudes toward, knowledge about, and perceived benefits and barriers to hospice care. Physicians demonstrated very favorable attitudes towards hospice. They had correct knowledge about most aspects of hospice, and, where they did not, they were far more likely to be uncertain than erroneous. Primary care physicians perceived many benefits to hospice care and identified patient and family readiness as the major barrier to earlier hospice referrals. A significant subgroup had concerns about problems in interacting with hospices. There were very few differences between family practitioners and general internists. These findings have many implications for directing collaborative efforts between primary care physicians and hospices to improve end-of-life care.     

Knowledge, values, attitudes and behavioural intent of Nova Scotia nurses toward AIDS and patients with AIDS

To assess the knowledge, values, attitudes and behavioural intent of Nova Scotia nurses toward AIDS and patients with AIDS, questionnaires were sent to a random sample of 400 general duty nurses. Analysis of the 179 returned questionnaires (45%) showed that although 88% of the nurses indicated that they intended to nurse patients with AIDS, the quality of the nursing care might be inadequate because (1) there was lack of knowledge about AIDS, especially outside urban Halifax; (2) half the nurses were undecided and 10% were very negative toward homosexuals and patients with AIDS; (3) although nurses perceived staff in hospital as reflecting positive attitudes toward care of patients with AIDS, those closest to the nurse (spouse, family and friends) were perceived as negative to her caring for patients with AIDS; and (4) nurses found media sources of information about AIDS more helpful than professional sources.     

Knowledge,attitudes, beliefs,and behaviors of parents and healthcare providers before and after implementation of a universal rotavirus vaccination program

ObjectiveIn Canada, rotavirus vaccine is recommended for all infants, but not all provinces/territories have publicly funded programs. We compared public and healthcare provider (HCP) knowledge, attitudes, beliefs, and behaviors in a province with a public health nurse-delivered, publicly funded rotavirus vaccination program to a province with a publicly funded, physician-delivered program. A third province with no vaccination program acted as a control.DesignInformation about knowledge, attitudes, beliefs, and behaviors of parents whose children were eligible for the universal program and healthcare providers responsible for administering the vaccine were collected through the use of two validated surveys distributed in public health clinics, physicians’ offices, and via e-mail. Early and postvaccine-program survey results were compared.ResultsA total of 722 early implementation and 709 postimplementation parent surveys and 180 early and 141 postimplementation HCP surveys were analyzed. HCP and public attitudes toward rotavirus vaccination were generally positive and didn’t change over time. More parents postprogram were aware of the NACI recommendation and the vaccination program and reported that their healthcare provider discussed rotavirus infection and vaccine with them. Prior to the program across all sites, more physicians than nurses were aware of the national recommendation regarding rotavirus vaccine. In the postprogram survey, however, more nurses were aware of the national recommendation and their provincial universal rotavirus vaccination program. Nurses had higher knowledge scores than physicians in the postprogram survey (p < 0.001). Parents of young infants were also more knowledgeable about rotavirus and rotavirus vaccine in the two areas where universal programs were in place (p < 0.001).ConclusionsImplementation of a universal rotavirus vaccination program was associated with an increase in knowledge and more positive attitudes toward rotavirus vaccine amongst parents of eligible infants. Nurses involved in a public health-delivered vaccination program were more knowledgeable and had more positive attitudes toward the vaccine than physicians in a jurisdiction where vaccine was physician-delivered.     

To bleed or not to bleed: young women's attitudes toward menstrual suppression

The purpose of this study was to investigate women's knowledge about and attitudes toward the medical suppression of menstruation. One hundred and three female undergraduate students completed several questionnaires. Thirty-five percent of the participants were familiar with menstrual suppression, and 12% reported using birth control methods to suppress their menses; oral contraceptive users were more knowledgeable about menstrual suppression than other women. Women who regarded menstruation as bothersome and shameful were more supportive of suppression than women with more positive attitudes. Women who scored higher on measures of body consciousness were not more likely to support menstrual suppression or to report a desire for more information about menstrual suppression. Future investigations of women's attitudes toward menstrual suppression could inform reproductive health care and health education.     

Nurses' perceptions of hospice palliative care volunteers

A total of 50 nurses (hospital and home care) responded to a survey designed to measure: (1) their attitudes toward, and knowledge of, hospice palliative care volunteers; (2) the types of tasks they felt it was appropriate for volunteers to perform; and (3) how valuable they felt different members of the hospice palliative care team are. In addition, they were asked to respond to some open-ended questions (eg, "Do you feel that it is appropriate for hospice palliative care volunteers to know patient medical information?"). The nurses' responses to the "Attitude/Knowledge" part of the survey revealed that they generally held positive attitudes toward volunteers. The majority of the nurses felt that it was appropriate for volunteers to perform most of the tasks listed, except for hands-on patient care. Nurses rated the value of nurses, family members, doctors, and pharmacists significantly higher than volunteers. Fifty-three percent of the nurses felt that volunteers should know patient medical information, and 77% thought that volunteers should have the opportunity to provide input regarding patient care. Also, 75% of the nurses felt that volunteers made their jobs easier, and 56% felt that volunteers should be included in team meetings. When asked to list the topics covered in a hospice palliative care volunteer training program, 73% of the nurses indicated that they were not sure or did not know what topics were covered, indicating a lack of knowledge regarding volunteer training.     

The link between daycare experience and attitudes toward daycare and maternal employment

Participants (n = 308; mean age = 20 years) completed questionnaires about their history, attitudes, and expectations regarding childcare, maternal employment and future parenting. Participants who experienced non-parental care as children had more favorable attitudes toward such care and toward maternal employment than did home-reared participants. A dose-response effect was identified, as increased time in care predicted more favorable attitudes toward it. Females in particular had significantly more positive attitudes than males toward non-parental daycare and maternal employment, as well as higher expectations regarding the rewards of parenting. Among several demographic variables considered in this study (including age, sex, year in college, employment status, parents' marital status, family size, and birth order), early child care history was the strongest predictor of attitudes toward childcare and maternal employment.     

Knowledge,attitudes, and behaviors of dietitians and nurses regarding meat

Dietitians and nurses frequently respond to client questions regarding nutrition; however, only limited research data are available on the information they provide to consumers about the controversial issue of meat in the diet. This study was designed to determine the level of knowledge of dietitians and nurses regarding meat, and to compare the attitudes and meat consumption patterns of the two groups. Mailed surveys were returned by 457 Missouri dietitians and 581 nurses. Dietitians were more knowledgeable about meat than nurses; only 80% of the nurses identified beef as an important source of iron, compared with 98% of the dietitians. More dietitians than nurses correctly estimated the calorie content of 3 oz of beef, although the majority of both dietitians and nurses overestimated the calories in meats. Both nurses and dietitians reported decreasing their own consumption of pork, eggs, beef, and cheese over the past three to five years and increasing their consumption of chicken and fish; however, nurses reported greater dietary changes. In contrast to nurses, dietitians believed that information from meat industry groups was useful. Almost all dietitians agreed with the statement that beef could be part of a healthful diet. Overall, dietitians appeared to view the concept of meat as a part of a healthful diet more favorably than did nurses.     

Attitudinal and Behavioral Changes Concerning “Mad Cow Disease” Among Nurses in Lebanon

The current study included a sample of 159 nurses from the American University of Beirut's Medical Center (AUB-M.C), the St. Georges Hospital, and the Sacré Coeur Hospital in Lebanon. The aim of this study was to assess knowledge, attitude, and behavioral toward “Mad Cow Disease” (MCD) among these nurses. Nurses completed self-administered anonymous survey. The results of the study showed generally that nurses were not very knowledgeable about MCD. However, a high percentage of nurses answered questions related to the following categories: concentration of agent in the central nervous system (96%), fatality (86%) of the disease, causative agent (70%), similarity between new variant of Creutzfelt-Jakob Disease (nvCJD) and Bovine Spongiform Encephalopathy (BSE) (67%), treatment (65%), and existence of diagnostic test (64%). On the other hand, less than one-half of the participants reported the correct answers to: early symptoms (26%), possibility of transmission among humans (36%), contracting disease from gelatin (40%), and the number of reported cases worldwide (21%).

Age and hospital had no significant impact on the level of knowledge about MCD. Regarding sources of information about MCD, Nurses who used the Internet or WHO as a source of knowledge were significantly more knowledgeable than those who did not. But nurses who used the Ministry of Public Health as a source of information were significantly less knowledgeable than those who did not. The majority of nurses were concerned about the disease. In fact, 51 % considered themselves at risk of contracting MCD and 60% believed that the chance of acquiring the disease through the consumption of contaminated food products is high. In response to this concern, 81% decreased or completely stopped their consumption of beef. Age, level of knowledge, and attitudes were not determinants of changes in nutritional behavior.

The results obtained from the current study shed light on the knowledge, attitude, and behavior of nurses in the Greater Beirut area toward MCD.     

Health care providers' attitudes toward nutrition

A survey questionnaire, assessing general attitudes toward the importance of nutrition in the prevention of disease and the maintenance of good health, was administered to physicians, nurses, dentists, and technicians at five U.S. Army medical centers. The various groups of health care specialists differed significantly on many items concerning the importance of good nutrition and eating habits for maintenance of good health and for recovery from illness, as well as on items concerning the importance of nutrition knowledge and training in their health care professions. More agreement was found among the groups on items concerned with the relationship between disease states and dietary factors and the effectiveness of health education programs in the prevention of various diseases. Self-reports of personal health habits did not correlate with scores on survey items concerned with the importance of good nutrition, suggesting that personal attitudes toward nutrition may be unrelated to other health practices.     

Nutritional knowledge of nurses in long-term health care facilities

Nurses practicing in long-term care facilities were surveyed on the adequacy of their nutrition education, nutrition knowledge, and general attitudes about the diet of elderly residents. While 78% of the 95 responding nurses reported taking a required nutrition course during their training, only 61% indicated the quantity of their nutrition education was sufficient and 66% indicated the quality of their education was sufficient. The mean nutrition knowledge score was 60% correct with 51 subjects scoring at this level or less. Since the nurse is such an important caregiver for the institutionalized elderly it is recommended that more emphasis be placed upon nutrition of the elderly in the nurses' education as well as the provision of more inservice training for practicing nurses utilizing the registered dietitian.     

What Do Resident Physicians Know about Nutrition? An Evaluation of Attitudes,Self-Perceived Proficiency and Knowledge

Objective: Despite the increased emphasis on obesity and diet-related diseases, nutrition education remains lacking in many internal medicine training programs. We evaluated the attitudes, self-perceived proficiency, and knowledge related to clinical nutrition among a cohort of internal medicine interns.

Methods: Nutrition attitudes and self-perceived proficiency were measured using previously validated questionnaires. Knowledge was assessed with a multiple-choice quiz. Subjects were asked whether they had prior nutrition training.

Results: Of the 114 participants, 61 (54%) completed the survey. Although 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. There was no correlation among attitudes, self-perceived proficiency, or knowledge. Interns previously exposed to nutrition education reported more negative attitudes toward physician self-efficacy (p = 0.03).

Conclusions: Internal medicine interns’ perceive nutrition counseling as a priority, but lack the confidence and knowledge to effectively provide adequate nutrition education.