Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment – a survey in a Swedish healthcare setting

The aim of this study was to investigate (i) attitudes among Registered Nurses (RNs) and Nursing Assistants (NAs) regarding pressure ulcer prevention, (ii) knowledge among RNs and NAs of pressure ulcer prevention and treatment, (iii) practice of risk assessment and documentation regarding pressure ulcers among RNs and NAs and (iv) to identify perceived possibilities and barriers in pressure ulcer prevention and treatment. In this cross-sectional study, a total of 230 questionnaires were distributed to an equal number of RNs and NAs in both municipality as well as hospital care settings. The response rate was 67% (n = 154). In general, all respondents displayed good knowledge on prevention and treatment of pressure ulcers and demonstrated a positive attitude towards this area of care. However, answers provided to some questions indicate that recent research findings and guidelines have not succeeded in reaching out to these occupational groups. Furthermore, only 37% (n = 55) of the participants said that they have an agreed strategy for the prevention of pressure ulcers in their unit. These shortcomings may affect the quality of care provided to the patient and lead to pressure ulcers developing as a consequence. Today, evidence-based methods for risk assessment are available but are not adopted and used in practice. The study highlights the need to further reduce the gap between research and practice.     

Attitudes of nursing staff working with older people towards nutritional nursing care

Aim. The aim of this study was to examine attitudes of the nursing staff in geriatric care towards factors of importance for nutritional nursing care. Background. Studies show that nutritional risk assessment is seldom performed on older patients as routine and very few patients have a nutritional care plan. Patients in long‐term care who are easy to feed are also found to be looked upon more positively than those with high feeding needs. Methods. A total of 252 registered nurses and nurse aids working at geriatric rehabilitation and medical care clinics and resident homes participated in the study. Attitudes were examined using the Staff Attitudes to Nutritional Nursing Care Geriatric scale. The scale includes 18 items and was designed as a one to five‐point Lickert‐type scale. It gives a total score and five subscales representing the dimensions ‘Norms’, ‘Habits’, ‘Assessment’, ‘Intervention’ and ‘Individualization’. A higher score indicates a more positive attitude. Results. Of all nursing staff, 53% displayed a positive attitude towards factors of importance for nutritional nursing care and the rest displayed a neutral or negative attitude. The ‘Intervention’ dimension, dealing with nutritional problems and how to manage them, reflected the highest level of positive attitudes, which represents 71% of the nursing staff. The ‘Norms’ dimension had the lowest relative frequency of positive attitudes, 27%. The registered nurses held significantly more positive attitudes than the nurse aids did. Conclusions. Nutritional issues comprise an important and time‐consuming responsibility in geriatric care; however, nursing staff do not show an unequivocal positive attitude regarding this responsibility. The consequences this entails for the older patient need to be examined further. Relevance to clinical practice. Nursing staff play an important role in caring for patients who are malnourished or at risk for malnutrition. Positive attitudes might hinder the development of undernourishment or the further worsening of an already undernourished patient's condition.     

Pressure ulcers: Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP)

Background

Pressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking.

Aims and objectives

Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP).

Design

Prospective psychometric instrument validation study.

Methods

A literature review was performed to design the instrument. Content validity was evaluated by nine European pressure ulcer experts and five experts in psychometric instrument validation in a double Delphi procedure. A convenience sample of 258 nurses and 291 nursing students from Belgium and The Netherlands participated in order to evaluate construct validity and stability reliability of the instrument. The data were collected between February and May 2008.

Results

A factor analysis indicated the construct of a 13 item instrument in a five factor solution: (1) attitude towards personal competency to prevent pressure ulcers (three items); (2) attitude towards the priority of pressure ulcer prevention (three items); (3) attitude towards the impact of pressure ulcers (three items); (4) attitude towards personal responsibility in pressure ulcer prevention (two items); and (5) attitude towards confidence in the effectiveness of prevention (two items). This five factor solution accounted for 61.4% of the variance in responses related to attitudes towards pressure ulcer prevention. All items demonstrated factor loadings over 0.60. The instrument produced similar results during stability testing [ICC = 0.88 (95% CI = 0.84-0.91, P < 0.001)]. For the total instrument, the internal consistency (Cronbachs α) was 0.79.

Conclusion

The APuP is a psychometrically sound instrument that can be used to effectively assess attitudes towards pressure ulcer prevention in patient care, education, and research. In further research, the association between attitude, knowledge and clinical performance should be explored.     

外科相关临床护理人员对压疮预防态度及其影响因素的调查研究

摘要：目的：调查外科护理人员对压疮预防的态度，并分析其影响因素。方法：采用描述性研究设计，通过压疮预防态度量表（Attitude towards Pressure ulcer Prevention instrument, APuP）调查我院从事外科护理专业的102名护士对压疮预防的态度，并分析人口学特征、教育背景、工作科室、工作时间、有无定期接受压疮护理培训等对压疮预防态度的影响。结果：本组护士APuP量表平均总分为（42.4±4.2）分，占满分的81.5%。各子项得分由高至低依次为压疮对患者的影响、压疮预防的优先次序、压疮预防的个人胜任能力、压疮预防的责任感和对压疮预防效果的信心，分别占各子项满分的88.9%、83.6%、76.4%、52.8%和51.6%。单因素分析发现，定期接受压疮护理培训的护理人员APuP得分显著提高（P＜0.05），而不同性别、年龄、教育背景、工作科室、工作时间的护理人员APuP得分比较差异并无统计学意义（P＞0.05）。结论：我院外科护理人员对压疮预防的态度总体较为积极，但个人责任和信心方面有待提高，针对压疮的定期护理培训，有助于提高护理人员对压疮预防的积极性。     

护理人员压疮护理知信行现状调查

目的调查护理人员压疮知识、态度和行为的现状,为规范压疮管理提供参考依据。方法选取西安市4所二级及以上医院的515名临床护理人员,采用自行设计的压疮护理知识、态度、行为问卷进行调查。结果护理人员压疮知识得分为（105．11±33．37）分,总正确率64．88％;态度得分为（42．52±5．34）分;行为得分为（57．28±7．91）分;知识与态度、知识与行为、态度与行为均呈正相关（P〈0．01）。结论护理管理者应加强对护理人员压疮新知识、新技能的培训,转变其对压疮的负性态度,保持正性行为,从而提高压疮护理质量。     

Nurses’ pressure ulcer related judgements and decisions in clinical practice: A systematic review

BackgroundPressure ulcers are considered to be an adverse outcome of care that should never occur in clinical practice. The formation of a pressure ulcer is also perceived to be an indicator of poor quality nursing care. Therefore, pressure ulcer prevention is a priority for nurses, healthcare professionals and healthcare organisations throughout the world. A key factor in pressure ulcer prevention and management is individual nurse decision making.ObjectivesTo synthesise the literature on the judgement and decision making of nurses in relation to the assessment, prevention, grading and management of pressure ulcers in all care settings (hospital and community).DesignA systematic search of published literature relating to judgement and decision making in nurses, with a focus on the prevention and management of pressure ulcers.MethodsA search of electronic databases from 1992 to present, together with hand searching of the reference lists of retrieved publications, to identify published papers that reported results of studies evaluating the decision making of nurses in relation to the prevention and management of pressure ulcers. Abstracts were independently reviewed by two authors and full text of potentially relevant articles retrieved. Each paper included in this systematic review was evaluated using recognised appraisal criteria relevant to the specific study design. Included papers provided empirical data on key aspects of nurses’ pressure ulcer related judgements and decision making. Data were synthesised into themes using narrative analysis.ResultsSixteen studies and one systematic review were included in the review, focusing on pressure ulcer risk assessment, pressure ulcer prevention, grading of pressure ulcers and treatment decisions. The results indicated that assessment tools were not routinely used to identify pressure ulcer risk, and that nurses rely on their own knowledge and experience rather than research evidence to decide what skin care to deliver.ConclusionsEmphasising pressure ulcer risk assessment and pressure ulcer grading in clinical practice is unlikely to deliver improved outcomes. Further research into nurses’ pressure ulcer related judgements and decision making is needed and clinicians must focus on the consistent delivery of high quality care to prevent and mange pressure ulcers to all patients in clinical practice.     

Investigating factors associate to nurses' attitudes towards perinatal bereavement care

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% (n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.     

Staff attitudes towards older patients with cognitive impairment: need for improvements in acute care

nilsson a., lindkvist m., rasmussen b.h. & edvardsson d. (2012) Journal of Nursing Management  20, 640–647 Staff attitudes towards older patients with cognitive impairment: need for improvements in acute care Aim To explore the attitudes held by staff working in acute care units towards patients aged 70 years or older with cognitive impairment, and to explore factors associated with negative attitudes. Background Hospital staff attitudes towards older patients with cognitive impairment are of concern as older people are the main hospital users, and because staff attitudes influence care quality and uptake of evidence-based care. Method A cross-sectional survey design was used to collect data from staff (n = 391). Results Staff attitudes were not explicitly negative. However, higher perceived strain in caring for older patients with cognitive impairment, higher perceived prevalence of these patients in the ward, being younger and working as an assistant nurse were associated with negative attitudes. A majority of staff reported that these patients received the best possible care, but few reported formally assessing cognitive status or working with evidence-based care protocols. Conclusion Staff characteristics associated with negative attitudes were described and staff perception that patients received best hospital care, despite limited cognitive assessments and care guidelines, indicate areas for improvement. Implications for nursing management Supporting young staff and assistant nurses, and implementing cognitive assessments and evidence-based guidelines can promote positive attitudes and best practice.     

Pressure ulcer prevention in nursing homes: views and beliefs of enrolled nurses and other health care workers

Background. In the Netherlands much attention has been paid to pressure ulcer prevention. National guidelines on pressure ulcer prevention were developed in 1985 and adapted in 1992 at the request of a national organization for quality assurance in health care. Several studies indicate that nurses seem to be insufficiently informed about pressure ulcer preventive activities. There is, however, no information available about the reasons why nurses seem to be insufficiently informed. Aims and objectives. This study was planned to elucidate the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention and about issues related with pressure ulcer prevention. Design. A qualitative study with semi‐structured, tape‐recorded interviews. Method. Interviews were conducted with enrolled nurses, team leaders, head nurses, staff nurses and physicians. The interviews were coded and analysed. Results. Analysis of the interviews revealed that today's pressure ulcer preventive activities are very much based on old traditions in nursing. It also showed that enrolled nurses have no intention to change the care they deliver with regard to pressure ulcer prevention. Conclusions. It is concluded that a systematic approach is necessary to change nursing thinking and acting with regard to pressure ulcer prevention. Relevance to clinical practice. This study gives an overview of the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention. These views and beliefs can be used as a starting point for effective implementation of guidelines regarding the prevention of pressure ulcers.     

ICU护士预防医疗器械相关性压力性损伤知信行的现状调查

目的 调查ICU护士预防医疗器械相关性压力性损伤的知信行现状并探索其影响因素,旨在为临床开展相关教学、培训提供依据。方法 采用临床护士预防危重患者医疗器械相关性压力性损伤知信行量表,使用便利抽样法从河南省18个地级市中各选取1所三级医院及1所二级医院成人ICU的1 664名护士作为调查对象,进行问卷调查,并分析影响因素。结果 共回收有效问卷1 610份。ICU护士医疗器械相关性压力性损伤知信行总量表、知识维度、态度维度、行为维度得分分别为（136.93±20.42）分、（50.21±11.28）分、（38.14±5.46）分和（48.58±9.03）分。多元线性回归分析结果显示,ICU护士预防医疗器械相关性压力性损伤知识的主要影响因素为医院级别,态度的主要影响因素为医院级别、职称、职务、科室类别,行为的主要影响因素为知识、态度、年龄、性别及职务。结论 ICU护士对预防医疗器械相关性压力性损伤的态度较为积极,但知识及行为有待提高。护理管理者应根据护士的不同特征进行预防医疗器械相关性压力性损伤知识的培训,通过强化知识建立积极态度,从而带动护理行为改变,提高重症患者的护理质量。     

Pressure ulcers: implementation of evidence-based nursing practice

AIMS: A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. BACKGROUND: The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. METHOD: The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. RESULTS: Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. CONCLUSIONS: There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and mechanisms for addressing the barriers.     

Retracted: Investigating factors associated with nurses’ attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong

Aims. To explore nurses’ attitudes towards perinatal bereavement care and to identify factors associated with these attitudes. Background. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and that nurses with positive attitudes to bereavement care can help bereaved parents to cope during their grieving period. Design. Survey. Method. Data were collected through a structured questionnaire; 657 nurses were recruited from Obstetrics and Gynaecology units in Hong Kong and Shandong during 2006. Outcome measures included attitudes towards perinatal bereavement care, importance of hospital policy and training support for bereavement care. Results. The majority of nurses in this study had a positive attitude to bereavement care. Results show that only 21·6% (n = 141) of the nurses surveyed had bereavement‐related training. In contrast, about 89·8% (n = 300) believed they needed to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·5% (n = 592) would share their experiences with their colleagues and seek support when feeling under stress. A regression model showed that age, past experience in handling grieving parents, recent ranking and nurses’ perceived attitudes to hospital policy and training provided for bereavement care were the factors associated with nurses’ attitudes to perinatal bereavement care. Conclusions. Nurses in both cities emphasised their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used by nursing educators to educate their students on issues related to delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula.     

An inquiry into the attitudes of qualified nursing staff towards the use of individualized nursing care plans as a teaching tool

This paper summarizes a research study inquiring into the attitudes of qualified nursing staff towards the use of individualized nursing care plans as a teaching tool. The survey was conducted in medical and surgical wards used for nurse training, in two hospitals. In common with many hospitals, the introduction ofthe nursing process into the surgical wards is of more recent origin than the medical areas, so would this be reflected in the attitudes of staff? Results indicated an overall positive attitude of all staff, although significant differences were identified between the grades of staff participating in the study and between the two hospitals. There was no significant difference shown in the comparison of all surgical staff with all medical staff, but the ward sister demonstrated a more positive attitude than staff nurses or enrolled nurses. The length of time care plans had been in use and whether the Open University Programme P553 had been completed, were taken into consideration. Analysis ofthe individual statements which clustered around the same theme is discussed. Possible factors affecting the attitudes identified are suggested and recommendations which include ongoing educational support, in particular for the enrolled nurse, and exploration ofthe ‘role model’ function ofthe ward sister made. Finally, the method of study is critically examined.     

People with HIV/AIDS: who cares?

People with HIV/AIDS: who cares? Studies have shown that some nurses, doctors and other carers have negative attitudes towards people with human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Some cope by avoiding working with such patients, while others just do the best they can. But does it matter? This paper describes a review of the literature on the impact of attitudes to care and the barriers affecting the quality of care for people with HIV/AIDS by professional health care workers and other carers. Most of the reports identified were based on attitude scales, mostly unique and often unvalidated. Attitudes of health care workers based in the community, and ‘house keeping’ staff such as porters, receptionists, etc., have been neglected areas of research. There is also little information about the culture of organizations and the attitudes of individuals with HIV/AIDS to care. Only three references were found in which both patients’ and carers’ attitudes to each other were considered and none of these looked at negative feelings and their impact. There is scope therefore to investigate the attitudes of patients and carers towards each other and how this can effect the quality of care. It is anticipated that the benefits of such investigations could lead to the development of educational strategies designed to improve the quality of patient care.     

Pressure ulcer prevention: the role of the multidisciplinary team

Pressure ulcer prevention has long been a priority for health professionals; however, poor pressure-ulcer-related practices like poor documentation continue to be identified. Research has shown that the attitude and behaviour of some nurses towards pressure ulcer prevention are not conducive to the best possible patient outcomes.This article reviews the findings of a Straussian grounded theory study, which sought to ascertain the value that is placed on pressure ulcer prevention by nurses, but also revealed the role that other health professionals in the multidisciplinary team play in the maintenance of skin integrity. The findings of this study which are presented in this paper highlight a number of important issues. Firstly, nurses are expected to know how to prevent and manage pressure ulcers, but in reality they are very reliant on the advice and support of other health professionals to maintain their patients' skin integrity. In addition,the level of support that nurses get from other health professionals in the multidisciplinary varies tremendously. Therefore, nurses in clinical practice need to be proactive in seeking input from other health professionals, as there are many members of the multidisciplinary team who are able to give them the advice and support that they need in prevention and management.     

Senior nurses' control expectations and the development of pressure ulcers

AIM: The aim of this research was to establish whether the attitudes and expectations of senior nursing staff might adversely affect patient outcomes in the prevention of pressure ulcers. The hypothesis was that nursing locus of control affects clinical outcomes in patients. In particular, it affects departmental prevalence of pressure damage. METHOD: A population of nurses (n = 439) in an acute and community NHS trust were surveyed to test knowledge, control beliefs and value of pressure ulcer prevention relative to prevalence. The research was designed to provide different data against which to test the hypothesis: first, to assess acceptability of nurses' knowledge of prevention and appropriate use of risk assessment and equipment; second, to calculate a mean departmental pressure ulcer prevalence; and third, to measure locus of control and value, which is the focus of this article. RESULTS: There were strong associations between departmental prevalence of pressure ulcers and attitudes of senior nursing staff. For example, the more that ward sisters believed they could control pressure ulcer prevention, the higher the prevalence of ulcers in their department. The more that sisters believed that they could not control prevalence, the lower the prevalence of ulcers. CONCLUSION: The study shows that failure to account for beliefs, values and expectations of staff could lead to patient harm. It is suggested that it might be counterproductive to put great effort into developing clinical guidelines and refinement of risk assessment methods. The findings have important implications for nursing, and challenge the assumption that nurse leaders are universally beneficial to patients.     

Attitudes toward dementia‐related aggression among staff in Japanese aged care settings

Aim and objective. This study investigated attitudes of Japanese aged care staff toward aggression by people with dementia. Relationships between staff attitudes, professional characteristics and clinical practice were explored. Background. Aggressive behaviour is often demonstrated by people with dementia and may be influenced by many factors including an inability by the individual to appropriately express their needs, difficulties with assessment, as well as organisational and practice issues. Design. Survey. Method. Twenty‐seven facilities/organisations located in the western and middle parts of Japan were surveyed. Staff (n = 675) employed in these facilities provided personal and professional information and completed the Attitudes Towards Aggression Scale. Results. Staff who were older, had more clinical experience, higher education and/or a higher position reported more positive attitudes towards patient aggression. Staff with negative attitudes towards patients who are aggressive reported using chemical and/or physical restraint more often than staff with positive attitudes. Conclusions. Dementia education as well as restraint policy will be useful in addressing negative staff attitudes, in particular it may help to reverse the myth that restraint is necessary for staff protection. Furthermore, staff counseling may help to reduce stressors and to change staff negative attitudes towards people with dementia who display aggression. Relevance to clinical practice. The findings show that negative staff attitudes may adversely affect clinical decision making and patient care. Measuring attitudes can identify areas requiring education or skill development and enable changes in attitudes to be monitored over time.     

Portuguese nurses' knowledge of and attitudes toward hospitalized older adults

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses′ education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross‐sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence‐based guidelines in their practice.     

A comparison of acute and long-term health-care personnel's attitudes towards older adults

Considerable variations in the quality of care older adults receive may depend much on the attitude of staff towards them. The attitudes of nurses, assistant personnel and porters towards older adults were assessed. Determinants affecting this judgement, such as age, gender, education, years in practice and care setting, were also assessed. Ninety-nine (acute) and 87 (long-term) hospital employees completed the self-report Kogan's Attitude Towards Old People scale. Significant statistical differences in negative attitudes were found between assistant personnel and nurses and between porters and nurses; these non-professionals believed that older adults were irritable, grouchy, complaining and untidy. Practice area had no influence on attitudes; attitudes were, however, significantly predicted by education levels. Findings suggest that, irrespective of setting, assistant personnel and porters possess significantly greater negative attitudes towards older adults than nursing staff. Furthermore, these negative attitudes seem to be a function of lower educational achievement. Implications for informing practice, education and policy-makers are discussed.