What patient characteristics guide nurses’ clinical judgement on pressure ulcer risk? A mixed methods study

Background

Nurses’ clinical judgement plays a vital role in pressure ulcer risk assessment, but evidence is lacking which patient characteristics are important for nurses’ perception of patients’ risk exposure.

Objectives

To explore which patient characteristics nurses employ when assessing pressure ulcer risk without use of a risk assessment scale.

Design

Mixed methods design triangulating observational data from the control group of a quasi-experimental trial and data from semi-structured interviews with nurses.

Setting

Two traumatological wards at a university hospital.

Participants

Quantitative data: A consecutive sample of 106 patients matching the eligibility criteria (age ≥18 years, no pressure ulcers category ≥2 at admission and ≥5 days expected length of stay). Qualitative data: A purposive sample of 16 nurses.

Methods

Quantitative data: Predictor variables for pressure ulcer risk were measured by study assistants at the bedside each second day. Concurrently, nurses documented their clinical judgement on patients’ pressure ulcer risk by means of a 4-step global judgement scale. Bivariate correlations between predictor variables and nurses’ risk estimates were established. Qualitative data: In interviews, nurses were asked to assess fictitious patients’ pressure ulcer risk and to justify their risk estimates. Patient characteristics perceived as relevant for nurses’ judements were thematically clustered. Triangulation: Firstly, predictors of nurses’ risk estimates identified in bivariate analysis were cross-mapped with interview findings. Secondly, three models to predict nurses’ risk estimates underwent multiple linear regression analysis.

Results

Nurses consider multiple patient characteristics for pressure ulcer risk assessment, but regard some conditions more important than others. Triangulation showed that these are measures reflecting patients’ exposure to pressure or overall care dependency. Qualitative data furthermore indicate that nurses are likely to trade off risk-enhancing conditions against conditions perceived to be protective. Here, patients’ mental capabilities like willingness to engage in one owns care seem to be particularly important. Due to missing information on these variables in the quantitative data, they could not be incorporated into triangulation.

Conclusions

Nurses’ clinical judgement draws on well-known aetiological factors, and tends to expand conditions covered by risk assessment scales. Patients’ care dependency and self-care abilities seem to be core concepts for nurses’ risk assessment.     

The mediating role of organizational justice in the relationship between transformational leadership and nurses’ quality of work life: A cross-sectional questionnaire survey

Background

The importance of transformational leadership for nurses’ well-being is increasingly acknowledged. However, there is a paucity of research examining the mechanisms that may explain the relationships between transformational leadership and nurses’ quality of work life.

Objectives

First, to examine two possible psychological mechanisms that link transformational leadership behaviors to nurses’ quality of work life. Second, to study the relationship between nurses’ quality of work life and their work engagement.

Design

Cross-sectional study design.

Settings

The study took place in 47 different hematology, oncology, and hematology/oncology units in France. Participants were nurses and auxiliary nurses.

Participants

343 nurses completed the questionnaire. Surveys were sent to all nurses working in the units. 95% were female, the average age was 36.30 years.

Methods

Nurses were asked to rate their supervisor's transformational leadership style and their perceptions of distributive and interactional justice in the unit. They were also asked to evaluate their own level of quality of work life and their work engagement.

Results

Distributive justice and interactional justice were found to fully mediate the relationship between transformational leadership and nurses’ quality of work life. In addition, nurses’ quality of work life positively related to their work engagement.

Conclusions

Transformational leaders may help ensure nurses’ quality of work life which in turn increases their work engagement. These leadership practices are thus beneficial for both employees and organization.     

Prevalence and correlates of influenza vaccination among non-institutionalized elderly people: An exploratory cross-sectional survey

Background

Worldwide pandemics of influenza virus caused extensive morbidity and mortality around the world and influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A large proportion of the Hong Kong elderly population has not undergone influenza vaccination. An exploration of the correlates will provide significant information to help identify ways of improving vaccination uptake among Chinese elderly people.

Objectives

To explore the prevalence and correlates of influenza vaccination Hong Kong Chinese elderly people aged 65 or above. To investigate any differences in attitudes toward influenza vaccination among Hong Kong elderly people with different levels of cognitive and physical functioning.

Design

An exploratory cross-sectional survey with two objective assessments was employed. Settings: Fifteen elderly centers in Hong Kong Special Administrative Region. Participants: A total of 816 Hong Kong Chinese elderly participants were recruited.

Methods

Face-to-face interviews were adopted to explore the demographic characteristics, perceptions, health status, knowledge, and resources of, and the influence of disease outbreaks on, influenza vaccination. Two objective validated instruments, the Chinese Mini-Mental State Examination (CMMSE) and the Barthel Index-Modified Chinese Version (MCBI) were used to assess the cognitive status and physical functioning of the participants.

Results

Approximately two in three individuals (62.4%) had undergone influenza vaccination. Lower cognitive and physical functioning scores were found among the non-vaccinated participants. Multivariate logistic regression analyzes revealed the significant correlates associated with influenza vaccination to be consideration of vaccination in the subsequent years (aOR = 7.877; p < 0.001); consideration of vaccination if all people aged 65 or above were eligible to receive free vaccination (aOR = 3.024; p = 0.002); the belief that there is a need to receive influenza vaccination following the Severe Acute Respiratory Syndrome (SARS) and avian influenza (aOR = 2.413; p = 0.001); receiving advice from nursing staff of elderly centers (aOR = 7.161; p < 0.001); the medical staff of elderly centers (aOR = 3.771; p < 0.001) or family members or friends (aOR = 3.023; p = 0.001).

Conclusions

The prevalence of elderly Chinese people undergoing influenza vaccination remains suboptimal. The government can promote vaccination by educating the public about the advantages, by publicizing locations where vaccinations are available, and having nursing, other medical staff, family and friends encourage elderly people to be vaccinated. A high vaccination coverage rate must be ensured to achieve international goals.     

Patient demographic characteristics and facial expressions influence nurses' assessment of mood in the context of pain: a virtual human and lens model investigation

Background

Sex, race, and age disparities in pain assessment and treatment have been reported in the literature. However, less is known about how these demographic characteristics influence nurses’ assessment of the emotional experiences of patients who are in pain.

Objectives

To investigate the influence of patient demographic characteristics and facial expressions on nurses’ assessment of patient mood in the context of pain.

Design

A cross-sectional study employing Virtual Human (VH) technology and lens model methodology.

Settings

The current study was delivered via the internet.

Participants

Participants consisted of 54 registered nurses currently engaged in clinical practice. Nurses were recruited from healthcare settings across the United States.

Methods

Nurses viewed 32 patient vignettes consisting of a video clip of the VH patient and text-based clinical summary information describing a post-surgical context. Patient sex, race, age, and facial expression of pain were systematically manipulated across vignettes. Participants made positive and negative mood assessment ratings on computerized visual analogue scales. Idiographic multiple regression analyses were used to examine the patient characteristics that were significant predictors of nurses’ assessment ratings. Nomothetic paired samples t-tests were used to compare ratings within cue for the entire sample.

Results

The results of idiographic and nomothetic analyses indicated that VH sex, race, age, and facial expression cues were significant predictors of the mood assessment ratings of many nurses. The age cue had the largest impact among the demographic variables.

Conclusions

The results of the current study suggest that patient demographic characteristics and facial expressions may influence how nurses assess patient emotional status in the clinical pain context. These findings may lead to greater awareness by individual nurses and nursing administrators about the influence of patient demographic characteristics on clinical decision-making. Future research is needed to better understand these relationships, with the ultimate goal of improving patient care.     

Impact of e-learning on nurses’ and student nurses knowledge,skills, and satisfaction: A systematic review and meta-analysis

Objective

To review the impact of e-learning on nurses’ and nursing student's knowledge, skills and satisfaction related to e-learning.

Design

We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to assess the impact of e-learning on nurses’ and nursing student's knowledge, skills and satisfaction. Electronic databases including MEDLINE (1948–2010), CINAHL (1981–2010), Psychinfo (1967–2010) and Eric (1966–2010) were searched in May 2010 and again in December 2010. All RCT studies evaluating the effectiveness of e-learning and differentiating between traditional learning methods among nurses were included.

Data extraction and quality assessment

Data was extracted related to the purpose of the trial, sample, measurements used, index test results and reference standard. An extraction tool developed for Cochrane reviews was used. Methodological quality of eligible trials was assessed.

Data synthesis

11 trials were eligible for inclusion in the analysis.

Results

We identified 11 randomized controlled trials including a total of 2491 nurses and student nurses’. First, the random effect size for four studies showed some improvement associated with e-learning compared to traditional techniques on knowledge. However, the difference was not statistically significant (p = 0.39, MD 0.44, 95% CI −0.57 to 1.46). Second, one study reported a slight impact on e-learning on skills, but the difference was not statistically significant, either (p = 0.13, MD 0.03, 95% CI −0.09 to 0.69). And third, no results on nurses or student nurses’ satisfaction could be reported as the statistical data from three possible studies were not available.

Conclusion

Overall, there was no statistical difference between groups in e-learning and traditional learning relating to nurses’ or student nurses’ knowledge, skills and satisfaction. E-learning can, however, offer an alternative method of education. In future, more studies following the CONSORT and QUOROM statements are needed to evaluate the effects of these interventions.     

Job satisfaction and job values among beginning nurses: a questionnaire survey

Background

Concepts such as the theory–practice gap and reality shock call attention to the challenges nurses experience in their professional lives. These challenges seem to be particularly acute in the transition from nursing school to work. Based on an assumption that the theories and skills taught in school are not directly applicable to nursing practice, beginning nurses may find that they are not prepared to do the work for which they have trained. Consequently, nurses may experience challenges to their work ideals, and their level of job satisfaction may decline. In addition, major life changes, such as buying a house/apartment, becoming a parent or getting married are likely to occur in the first year after graduation. Consequently, the emphasis on economic rewards may increase in the transition from school to work.

Objectives

To examine the relationship between work ideals, experiences of work and job satisfaction through a vital period in nurses’ careers. To compare beginning nurses’ job satisfaction, perceived job rewards and values with those of beginning doctors and teachers.

Participants

Survey data were collected from two cohorts of students in several educational programs in Norway. The survey was repeated among the same respondents, as workers, 3 years after graduation. Almost 3000 students were originally invited to participate. The response rate in the surveys varied from 59% to 80%.

Methods

Tabular analyses and linear regression models.

Results

The results indicate similarities in nurses’, doctors’ and teachers’ preferences for work, but differences in what they obtain. In the transition from school to work, nurses increase their emphasis on high income and job security, and 3 years after graduating, nurses’ emphasis on these two job values is higher than that of doctors and teachers. Nurses were fairly satisfied with their present job.

Conclusion

In terms of level of job satisfaction and their preferences for work, the transition from school to work for nurses seems less dramatic than initially assumed.     

Infection prevention as “a show”: A qualitative study of nurses’ infection prevention behaviours

Background

Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers’ practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned “How can nurses’ infection prevention behaviour be explained?” This paper presents one of three identified themes ‘Rationalising dirt-related behaviour’.

Design

This interpretative qualitative study uses vignettes, developed from nurses’ accounts of practice, to explore nurses’ reported infection prevention behaviours.

Participants

Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University.

Methods

Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method.

Results

The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a ‘show’ or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny.

Conclusions

This study contributes to the identification and explanation of nurses’ infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely ‘scientific’ understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection.     

Factors associated with nurses’ reporting of patients’ aggressive behavior: A cross-sectional survey

Background

Aggressive behavior and violence directed by patients at nurses are increasing worldwide. Aggressive behavior against nurses in their workplace can result in personal problems, such as impairment of physical and mental well-being, and, consequently, in organizational problems. Underreporting of patients’ aggressive behavior is prevalent among nurses. Although underreporting might lead to inefficient attention to strategies for preventing aggressive behavior, the reasons for such behavior not being reported frequently have not been well examined.

Objectives

To explore the frequency of nurses’ reporting to their managers of patients’ aggressive behavior by type and degree of impact suffered by the nurses, to examine the association between reporting of aggressive behavior and demographic factors, and to determine the reasons for underreporting.

Design

A questionnaire-based cross-sectional survey.

Setting

Six acute care hospitals in two regions in Japan.

Participants

A total of 1953 nurses working at general acute care hospitals participated.

Methods

Data were collected through a questionnaire seeking sociodemographic information, information on experience of aggressive behavior from patients, and the frequency with which they had reported such behavior in the previous month. The questionnaire also contained items assessing barriers to reporting of patients’ aggressive behavior. The association between the possible influencing factors and reporting behavior was assessed using multiple logistic regression analyses.

Results

Of the 1953 questionnaires distributed, 1498 (76.7%) were returned, and 1385 (70.9%) fully completed questionnaires were analyzed. More than one-third of the respondents had experienced the mildest assessed level of impact from patients’ aggressive behavior, and 70% of those hardly reported any incidents. The milder the impact was, the less the nurse victims tended to report the incident. Nurse's tendency to feel that aggressive behavior was mitigated by the situation, less work experience, and lack of confidence that management would defend staff nurses from patients’ aggressive behavior were found to be negatively associated with reporting behavior.

Conclusions

This study identified factors associated with nurses’ reporting of patients’ aggressive behavior. Underreporting was found to be associated with the level of impact, managerial attitudes, nurses’ work experience, and nurses’ perception that the behavior was mitigated by the situation. Improving education among nurses to promote reporting incidents and establishing an organized system is needed.     

Awareness,knowledge and beliefs about HPV,cervical cancer and HPV vaccines among nurses in Cameroon: An exploratory study

Background

While it is known that sub-Saharan African countries face multiple obstacles such as cost in adopting vaccination against human papillomavirus (HPV), the crucial role nurses can play in implementing such programs has not been adequately examined.

Objectives

To investigate the knowledge and awareness of HPV, primary cause of cervical cancer and HPV vaccine among nurses working at four Cameroon Baptist Convention Health Services facilities, and to explore what factors influence nurses’ willingness to inform and recommend HPV vaccine to adolescents and parents attending clinics.

Design and setting

A structured questionnaire survey was administered to a convenience sample of nursing staff working at the four health facilities.

Results

Of 192 eligible nurses 76 (39.6%) participated in the study. There were moderately low levels of knowledge about HPV infection and prevention of cervical cancer, but a moderately high level of knowledge about HPV vaccine. Although 90.8% acknowledged that cervical cancer is directly linked to HPV infection, nearly 32% failed to identify it as a sexually transmitted infection (STI), while 43.4% believed it is an uncommon infection. Willingness to recommend the HPV vaccine was moderate, with 69.7% intentionally initiating discussions with patients about the subject. The most important factors considered when deciding to recommend the vaccine included effectiveness (56.6%) and side effects/safety (11.8%). Cost was less of a concern (6.6%), likely due to the availability of donated vaccine.

Conclusion

Despite high awareness about HPV, more education about the virus, cervical cancer and the vaccine are required to further increase nurses’ willingness to recommend the vaccine and strengthen strategies for reaching adolescents through nurses in Cameroon.     

ICU nurses’ perceptions of responsibilities and organisation in relation to organ donation—A phenomenographic study

Objectives

According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses’ perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death.

Methods

A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas.

Results

The findings pertain to three domains: ICU nurses’ perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death.

Conclusion

The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses’ opportunities to fulfil their professional responsibility during the organ donation process.     

The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: A cluster randomised trial

Background

Patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy.

Objectives

The aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses.

Design

A cluster randomised trial was conducted between September 2006 and July 2008.

Settings

Ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward.

Participants

All nurses from participating wards.

Methods

A knowledge test measured nurses’ knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately.

Results

After correction for baseline, the mean difference between the intervention and the control group on hospital nurses’ knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% CI: −0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% CI: 0.10-0.81). For the other two topics there was no statistically significant effect. Nursing home nurses’ knowledge did neither improve (0 points, CI: −0.35 to 0.35) overall, nor for the separate subjects.

Conclusion

The educational intervention improved hospital nurses’ knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is needed.

Trial registration

ClinicalTrials.gov ID [NCT00365430].     

Nurses’ attitudes to mental illness: A comparison of a sample of nurses from five European countries

Background

Mental health problems are of serious concern across Europe. A major barrier to the realisation of good mental health and well-being is stigma and discrimination. To date there is limited knowledge or understanding of mental health nurses’ attitudes towards mental illness and individuals experiencing mental health problems.

Objectives

To describe and compare attitudes towards mental illness and those experiencing mental health problems across a sample of registered nurses working in mental health settings from five European countries and the factors associated with these attitudes.

Design

A questionnaire survey.

Settings

A total of 72 inpatient wards and units and five community facilities in Finland, Lithuania, Ireland, Italy and Portugal.

Participants

810 registered nurses working in mental health settings.

Methods

The data were collected using The Community Attitudes towards the Mentally Ill (CAMI) scale, which is a 40-item self-report questionnaire. The data were analysed using quantitative methods.

Results

Nurses’ attitudes were mainly positive. Attitudes differed across countries, with Portuguese nurses’ attitudes being significantly more positive and Lithuanian nurses’ attitudes being significantly more negative than others’. Positive attitudes were associated with being female and having a senior position.

Conclusions

Though European mental health nurses’ attitudes to mental illness and people with mental health problems differ significantly across some countries, they are largely similar. The differences observed could be related to wider social, cultural and organisational circumstances of nursing practice.     

The effects of clinical experience on nurses' critical event risk assessment judgements in paper based and high fidelity simulated conditions: a comparative judgement analysis

Background

Paper based simulated patients are widely used to analyse nurses’ clinical judgements. However, developments in the physical simulation of clinical environments offer exciting, but relatively underexploited, opportunities for exploring nurses’ judgements. Critical event risk assessment is an element of acute care practice which lends itself well to simulation and in which more clinical experience is often assumed to lead to better quality judgements.

Objectives

To model nurses’ judgements of critical event risk using physical and paper simulation and to examine whether improving fidelity via physical clinical simulation impacts on the apparent benefits of clinical experience on nurses’ judgement performance.

Design

A comparative clinical judgement analysis.

Setting

A university in Northern England.

Methods

Sixty-three nursing students and 34 experienced nurses made dichotomous risk assessment judgements (“at risk” or “not at risk”) in response to 25 paper and physical simulated scenarios. These were randomly generated from a dataset of real patient case records. Clinical outcomes (the judgement criteria) for a ‘correct’ judgement were derived from the same case records. Logistic regression models were constructed to derive statistics for each nurse representing various measures of judgement performance: achievement (r_a), consistency (R_s) and clinical information use (G). These statistics were known as Lens Model statistics (from the psychological theory of Brunswik's Lens Model of judgement). Performance measures for novice and experienced nurses were compared.

Results

No significant differences in judgemental achievement (r_a) between experienced nurses and students were observed in either paper or high fidelity clinical simulations. Similarly, there were no significant differences in the nurses’ abilities to correctly match the ways they synthesised clinical information with the optimum synthesis required by the task (policy matching) (G). When faced with “paper patients” experienced nurses exercised more cognitive control/consistency (R_s) than students (P = 0.04). However, this heightened control in experienced nurses was absent when those same nurses made judgements in the higher fidelity clinical simulation environment.

Conclusion

Clinical experience made no difference to nurses’ judgement achievement (accuracy) in either the lower fidelity paper scenarios or the higher fidelity setting of the clinical simulation unit. The significant impact of clinical experience on judgement consistency was negated by the increases in fidelity offered through clinical simulation.     

A sexual health care attitude scale for nurses: development and psychometric evaluation

Background

Oncology nurses should possess a high level of sensitivity while dealing with patients’ sexual health needs. However, sexual health care is still inadequately addressed because of barriers such as conservative beliefs and incorrect assumptions regarding sexual issues. Most scales for measuring attitude toward sexual health care were insufficient to establish the instrument's validity and did not focus on oncology nurses.

Aims and objective

The purpose of this study was to develop a scale considering cultural contexts to investigate nurses’ attitude toward sexual health care in patients suffering from cancer.

Design

This study was designed for scale development.

Methods

A preliminary version of the instrument was developed through a literature review and interviews with 10 oncology nurses; this version consisted of 42 items rated on a 3-point scale. Eight experts reviewed the questionnaire for content validity and consolidated 36 items. Data were collected from 342 oncology nurses in Korea. Exploratory factor analysis was performed, and reliability was assessed using Cronbach α values. Pearson correlation coefficients were used to test the concurrent validity.

Results

Exploratory factor analysis revealed 17 items (4 factors), which account for 70.49% of the total variance. The 4 factors were (1) discomfort in providing sexual health care (7 items), (2) feeling uncertain about patient's acceptance (4 items), (3) afraid of colleagues’ negative response (3 items), and (4) lack of environmental support (3 items). Correlation of the sub-factors ranged from 0.35 to 0.63. The Cronbach α value was 0.92. Significant negative correlations were found between the attitude toward sexual health care and the Sexuality Attitudes and Belief Survey (r = −0.57, p < 0.001).

Conclusion

The scale of attitude toward sexual health care showed validity and reliability in evaluating the attitude of oncology nurses toward sexual health care and can be used to identify attitudinal barriers in nurses as well as to develop and test educational interventions for the improvement of sexual health care.     

Nurses’ attitudes towards older people: A systematic review

Background

The population is ageing globally. Older people are more likely to have chronic diseases and disabilities and have contact with health services. Attitudes of healthcare professionals affect the quality of care provided and individual career preferences.

Aim

To examine the international research relating to registered and student nurses’ attitudes towards older people and the potential underpinning variables.

Methods

A systematic search of 8 databases covering English and Chinese language publications since 2000 was undertaken which identified 25 papers.

Findings

Reported attitudes towards older people were inconsistent with positive, negative and neutral attitudes being noted across registered and student nurses and appear to be slightly less positive since 2000. A range of variables have been examined as potential predictors of nurses’ attitudes with age, gender and education level being investigated most frequently but none were consistent predictors. Preference to work with older people and knowledge of ageing appeared to be associated with positive attitudes towards older people.

Conclusions

There is a growing need for registered nurses committed to working with older people, however, there is a dearth of well designed studies which investigate both the attitudes of registered and student nurses and the associated factors, and test interventions to inform workforce strategies.