Acute-care nurses' attitudes towards older patients: a literature review

With increases in life expectancy and increasing numbers of older patients utilising the acute setting, attitudes of registered nurses caring for older people may affect the quality of care provided. This paper reviews recent research on positive and negative attitudes of acute-care nurses towards older people. Many negative attitudes reflect ageist streotypes and knowledge deficits that significantly influence registered nurses' practice and older patients' quality of care. In the acute setting, older patients experience reduced independence, limited decision-making opportunities, increased probability of developing complications, little consideration of their ageing-related needs, limited health education and social isolation. Available instruments to measure attitudes towards and knowledge about older people, although reliable and valid, are outdated, country-specific and do not include either a patient-focus or a caring perspective. This paper argues for the development and utilisation of a research instrument that includes both a patient focus and a caring dimension.     

Attitudes towards hospitalized older adults

BACKGROUND: A number of studies have explored nurses' attitudes toward older people. However many of those have produced inconclusive results. Moreover dated attitudinal measures have been used to answer a broad range of questions relating to older people. AIM: The aim of this paper is to report a study examining whether negative attitudes and beliefs toward older adults persist. METHODS: Focus group interviews were used identifying factors which may influence attitudes and beliefs both negatively and positively. Nine Registered Nurses from care of older adult areas, four from acute areas, six nurse teachers, and 17 nursing students participated in the study. Ten themes were identified from the findings. FINDINGS: The findings show that the student nurses had varying experiences in older adult settings. Some of which had the effect of turning them away from the specialty. However, nurses who worked with older adults were very positive about their work and the nursing opportunities they had to offer student nurses. They were rather critical of the content of the pre-registration curriculum, which they perceived to over-rely teaching the negative aspects of ageing, and there was also criticism of the currency of teachers' knowledge. Nurses who worked in acute settings also did not escape criticism, in that they were identified as attributing a lack of sense of humour to older adults. The limitations include the small sample size although it is congruent with qualitative research. CONCLUSIONS: All nursing staff need to be more aware of their influence on the attitudes of student nurses toward older people. Good practice includes the ability to demonstrate that older people in hospital settings are valued. Nurse teachers need to review the way they prepare students for this specialist work in order to avoid inadvertently conveying negative attitudes.     

英国护士的老年态度模型构建研究

目的:探索英国护士对老年人的态度,并构建态度模型,为进一步的干预提供信息及依据。方法:对英国伦敦某护理学院参加继续教育课程的730名注册护士进行问卷调查,调查内容包括护士基本资料、是否喜欢护理老年患者、老年知识和对老年人态度等。结果:共收回有效问卷580份,有效回收率为79.5%。本研究构建的态度模型中,纳入的因素能解释43.6%的预测变量,包括对变老的焦虑水平、对老年人使用健康资源的态度、老年知识、喜欢护理老年患者、教育与年龄的交互效应。结论:纳入的因素能较好地解释态度,提示应该制定相关的干预措施,高校及教育机构应该逐步增加老年人方面的教育内容。本研究肯定了干预措施的重要性,对老年人的健康服务提供具有重要意义。     

An evaluation of the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people

Objectives.  This paper reports the results of a study that aimed to evaluate the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people.
Background.  With repeated exposure to very sick older people in hospitals or nursing homes, nursing students are at risk of adopting stereotypical views about this section of the population as frail and dependent.
Design.  A pre- and post-test design was used to conduct the study.
Methods.  Using Kogan's Attitudes Towards Old People Scale, the attitudes of nursing students were tested at the beginning of a degree programme in Adult Nursing ( n  = 130) and one year later ( n  = 94) following a series of visits to a well-older person in the community.
Results.  Nursing students reported positive attitudes towards older people and these were retained throughout the first year of their nurse training. No statistically significant differences were found associated with any of the five independent variables in either pre- or postintervention students.
Conclusions.  The attitudes of nursing students towards older people remained positive. While it is possible that the experiential and educational interventions utilized in this study may have contributed to the retention of positive attitudes, further research is required to test this hypothesis.
Relevance to clinical practice.  Nurses have a major role to play in responding to the health and social care needs of older people and their families. The cultivation of positive attitudes is a key factor in enabling practising nurses to respond to this challenge.     

Student nurses' attitudes towards working with older patients

BACKGROUND: The ageing of the United Kingdom (UK) population means that the care of older people will become an increasingly important part of nurses' remit. However, employment statistics suggest that this is an unpopular nursing specialism. This may be due to a number of factors, one of which may be nurses' negative attitudes towards working with older people. This constitutes a potential problem, especially if such attitudes have an impact on the quality of care provided. AIM: To examine the attitudes held by student nurses towards working with older patients. METHODS: Questionnaires incorporating Likert-type scales, two vignettes and demographic questions were designed using the theory of planned behaviour. These were distributed to 172 student nurses undertaking preregistration nursing courses in the UK during the academic session 2000-2001. RESULTS: Student nurses displayed positive intentions towards working with older patients. These were based on their own attitudes and beliefs about what others would wish them to do. Participants believed that their behaviour towards older patients was to a large extent under volitional control. Analysis of the beliefs underlying student nurses' views showed that they differentiated between those participants who had a relatively positive approach to their work with older patients and those with a less positive approach. In addition, the results offered mixed support for the view that more knowledgeable or experienced nurses hold more positive views towards older people. CONCLUSIONS: The findings offer some support for previous studies that have looked at the more general issue of attitudes towards older people. However, the results also indicate that a more rigorous and more highly focused approach to the study of such attitudes is required if the research is to be relevant to the issue of working with older patients. The theoretical, methodological and practical implications of the findings are discussed.     

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.     

Analysis of instruments measuring nurses' attitudes towards research utilization: a systematic review

AIM: This paper is a report of a systematic review describing instruments used to measure nurses' attitudes towards research utilization. BACKGROUND: Researchers need to have the tools to measure nurses' attitudes. However, limited literature critically analyses instruments and the concepts that comprise nurses' attitudes towards research utilization. DATA SOURCES: A search of the literature from 1982 to 2007 was performed using the Cumulative Index to Nursing and Allied Health Literature, Health and Psychosocial Instruments, PubMed and MEDLINE data bases. The search terms were nursing research, research utilization, instruments, and nurses' attitudes. A total of 186 sources were identified, of which 25 were reviewed. METHODS: Fourteen instruments met the criteria for in-depth critical analysis of psychometric properties and concepts, and were included in the final review. Each instrument item was judged to be relevant to direct, indirect, persuasive and overall research utilization as defined by Estabrooks. Instruments were arranged from the strongest to the weakest reliability of the subscales to determine the instrument with the strongest psychometric properties. RESULTS: Indirect and overall research utilization was measured by all of the instruments. Ten instruments measured direct research utilization and nine instruments measured persuasive research utilization. The Research Utilization in Nursing Survey by Estabrooks, as adapted by Kenny, was an instrument with strong psychometric properties measuring all four concepts of nurses' attitudes towards using and participating in research and was clinically feasible. CONCLUSION: Many published instruments are available for use by nurse researchers to measure nurses' attitude towards research utilization, but only one has been subjected to rigorous testing: the Research Utilization in Nursing Survey by Estabrooks.     

Factors associated with nurses' willingness to handle abuse of older people

AimThe aim of this study was to explore predictors of nurses' willingness to handle abuse of older people.BackgroundAbuse of older people is a long-discussed healthcare issue worldwide. Although nurses are considered capable of identifying and reporting cases of abuse of older people, no study has been conducted in Taiwan on nurses' willingness to handle abuse of older people.DesignA cross-sectional design was used.MethodsThe study was conducted from May to June 2019. A convenience sampling was adopted to survey 555 nurses from a medical center in Taiwan. Data were collected using the Knowledge of Abuse of Older People Scale, Attitudes Towards Older People Scale, Attitudes Towards Handling Abuse of Older People Scale, Willingness to Handle Abuse of Older People Scale, and personal characteristics. Pearson correlation coefficient analysis, independent sample t-test, one-way analysis of variance, and multiple linear regression were performed.ResultsParticipants scored an average of 2.98 out of 4 on the Willingness to Handle Abuse of Older People Scale, indicating that they were inclined to do so. Attitudes towards older people, knowledge, attitudes towards handling abuse of older people, awareness of the hospital's reporting procedure and dissemination of information related to abuse of older people, sex, age, and clinical work experience explained 41.4% of the variance of willingness. Participants' attitudes toward handling abuse of older people was the most important predictor of their willingness to do so.ConclusionsTo improve nurses’ willingness to handle cases of abuse of older people, particularly that of male nurses, hospital authorities should provide in-service training and education and disseminate information on the subject matter. Nursing schools should prioritize offering gerontological nursing courses to foster nursing students’ positive attitudes toward older adults and handling abuse of older people.Tweetable abstractNurses' attitudes toward handling abuse of older people were the most important predictor of their willingness to handle abuse of older people.     

Nurses’ attitudes towards physical activity care among older people

Aims and objectives. To understand nurses’ attitudes towards physical activity care for older people in long‐term care facilities. Background. In long‐term care facilities, a common approach to daily physical activity is based on the identifiable portions of daily life during which the activity occurs. However, older people are at risk of falling when they perform daily physical activities. Nurses are the first‐line caregivers. What nurses’ think and do regarding older people’s participation in daily physical activities in long‐term care facilities is very important in terms of the clinical decision‐making regarding older people’s physical activity care. Design. An exploratory qualitative design. Methods. Twenty nurses with more than three years of clinical experience from 13 long‐term care facilities located in northern Taiwan were sampled purposively. Data were collected though semi‐structured interviews. The constant comparative data analysis method was used throughout the research. Results. Five themes emerged from the data analysis: ‘recognising the importance of participation in daily physical activity’, ‘encouraging participation in physical activity’, ‘respecting the autonomy of the residents regarding participation in physical activity’, ‘preventing falls’ and ‘facing a dilemma’. Conclusions. This study identifies that there is a conflict between the nurses’ perceptions of the residents’ daily physical activities, the risk of falls and encouraging greater independence. The majority of staff employed in long‐term care facilities is nursing personnel, and it is these nurses who have the most contact with the residents. It is therefore believed that nurses can make the greatest difference to the residents’ lives and support the quality of care if they can resolve this conflict. Relevance to clinical practice. The results suggest the need to increase the nurses’ knowledge base regarding the benefits of physical activity and also highlight the potentially adverse effect of restraint usage by nurses.     

Mental health nurses' attitudes towards severe perinatal mental illness

Title.  Mental health nurses' attitudes towards severe perinatal mental illness.
Aim.  This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.
Background.  Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.
Methods.  Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.
Findings.  Participants did not perceive any difference between symptoms during perinatal and non-perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision-making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.
Conclusion.  Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.     

Community nurses' health promotion work with older people

AIMS: This paper reports a study describing community nurses' health promotion work with older people aged 50 years and above, and exploring particular health promotion initiatives for older people that would have transferability potential. BACKGROUND: With the ageing of populations worldwide, community nurses in primary healthcare settings have a key contribution to make to the health improvement agenda for older people, yet little is known of the extent of this aspect of their work. METHODS: Questionnaires were sent to 1062 community nurses in six Scottish National Health Service Boards - public health nurses/health visitors, district nurses, general practice nurses, community psychiatric and learning disability nurses and combined duty nurses; 373 (35%) responded, 30 of whom were interviewed by telephone. The data were collected in 2003-2004. FINDINGS: Findings confirmed the wide scope of health promotion, much of which may be embedded and unrecognized. Creative group work showed promise in achieving heath gain for older people, and a range of partnership approaches - interdisciplinary, multidisciplinary and interagency - was evident. Theoretical input and project opportunities within educational programmes had been a catalyst for health promotion initiatives in practice. However, evidence of audit, evaluation, and active involvement of older people in planning health promotion was limited. Funding of health promotion initiatives was vital to sustainability. CONCLUSION: There is merit in making the health promotion work of community nurses more visible through audit and systematic evaluation; promoting the active involvement of older people; strengthening partnership working; and further raising the profile of health in later life within undergraduate and postgraduate community nursing programmes.     

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.     

Professional influences on the provision of mental health care for older people within a general hospital ward

Recent policy initiatives within the United Kingdom have recognized that effective care for older people can only be achieved if health care staff are willing and skilled enough to address patient needs in a holistic way. The preliminary stages of the action research project described here focused on the perceptions of nursing staff regarding the factors that impacted on their ability to address mental health needs within a general hospital ward. A phenomenological approach allowed us to identify the experience of addressing mental health needs in this setting from the perspective of the research participants. A focus group was facilitated with nursing staff whose primary professional focus was the provision of physical health care within an older adult unit. Thematic content analysis was used to analyse the focus group data, and four key themes emerged, namely 'disruption', 'role conflict', 'professional resources' and 'professional distress'. These themes provide a focus for the ongoing development of the action research methods and will embed future work in the experience of those charged with ensuring that mental health care is a key element of their practice. This study highlights the urgent need for further work in this area, as we contend that it is only by addressing the professional needs of the staff concerned, that effective patient-centred care can be ensured.     

Health professionals' attitudes toward older people and older patients: A systematic review

Attitudes toward older people and older patients among healthcare professionals are of concern throughout the world, but there are no recent systematic reviews which have examined and compared the attitudes across the various healthcare professionals who provide healthcare to older people. A comprehensive literature search (2000–2011) was undertaken on electronic databases (CINAHL, MEDLINE, EMBASE, British Nursing Index, PsycINFO, Chinese Biomedical database, China Medical Academic Conference and China Academic Journal) using a combination of terms. We identified 2179 articles indexed with these terms. Initial screening was undertaken by two researchers and then checked by a third researcher. In total, the reviewers selected 117 articles which, on the basis of their abstracts, appeared to meet the criteria for inclusion. We obtained the full texts and two reviewers assessed each full text paper to further examine whether it met all the criteria. The final review identified 51 studies. Publications over the last 10 years show that attitudes towards older people and older patients range from neutral to positive among healthcare professionals and highlight the need for well-designed studies of both qualified and student healthcare professionals recruiting random samples across multiple sites and utilizing validated instruments consistently to permit comparison over time and across countries.