Rural physicians' attitudes toward the elderly: evidence of ageism?

Rural elderly patients receive health services primarily in the outpatient setting, with their primary care provider often serving as their only point of contact with the health care system. Little is known however about the attitudes of physicians, and more specifically attitudes of those practicing in rural locations, toward differing age groups of the elderly. The current study was undertaken to examine the perceptions and attitudes of rural Florida physicians who routinely provide care for the elderly. We utilized an existing and validated survey instrument designed to measure the perceptions and attitudes of health professionals toward 3 different cohorts of elderly people: the elderly population in general, the elderly population older than 85 years, and the nursing home population. The study provides evidence that physicians who routinely provide care for the elderly in rural Florida demonstrate ageist perceptions, especially against those older than 85 years and the nursing home population. The trends identified are important because they may directly influence the quality of care that this population receives.     

Interprofessional Experiences and Attitudes Toward Interprofessional Health Care Teams Among Health Sciences Students

This study examined how the interprofessional experience, including education and practice, affects graduate health science students’ attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient’s care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.     

Impact of an interprofessional community-based educational experience on students' perceptions of other health professions and older adults

Caring for older adults has become increasingly complex due to multiple health and societal factors. The purpose of this study was to evaluate the impact of an interprofessional community-based educational project on students' attitudes toward other health care professions and older adults. A pretest and posttest quasi-experimental research design was implemented with 64 participating students from four health care professions (nursing, occupational therapy, physical therapy, and pharmacy). These students completed the Interdisciplinary Education Perception Scale (IEPS) and Survey of Attitudes on Aging Scale (SAAS) before and following an educational experience with older adults. Qualitative data were collected through student reflection journals and focus groups with participating students. The results of the study showed that interprofessional community-based learning had a significant impact on some students' attitudes toward older adults. The difference between pretest and posttest reached a statistically significant level on the SAAS in occupational therapy (p = 0.013) and physical therapy students (p = 0.044). No significant differences, however, were found between the pretest and posttest in pharmacy (p = 0.097) or nursing students (p = 0.144). Similarly, the experience also had a positive impact on some students' perceptions of other health care professions as measured by the IEPS. A significant difference was found between the pretest and posttest in occupational therapy (p = 0.000) and physical therapy students (p = 0.028). This study indicates that interprofessional community-based learning can be an effective method for some students to increase their understanding and respect toward other health professionals and older adults.     

Home health care workers' attitudes toward the elderly

This study examined home health care workers' attitudes toward the elderly and their elderly clients. Data were collected from a convenience sample of 106 home health care workers in South Central Florida in October 1994, using the Attitudes Toward the Elderly Questionnaire (ATE). Estimated internal consistency reliability of the scale was .60, using Cronbach's alpha. Findings suggest that home health care workers have positive attitudes toward the elderly, their elderly clients, and provide a reasonable level of service for them. Also, findings suggest that overall the attitudes and perceptions among urban and rural home health care workers are similar.     

Service learning in medical and nursing training: a randomized controlled trial

The purpose of this study was to explore the long term effect of a service learning project on medical and nursing students' knowledge in aging and their attitudes toward older adults. A total of 124 students were recruited and then randomized to intervention group (IG) and control group (CG). A pre-and-post-intervention design measured students' knowledge in aging (using modified Palmore's Fact on Aging Quiz) and attitudes toward older adults (using Kogan's Old People Scale). A total of 103 students completed all the activities and questionnaires. After the intervention, there were significant differences between the IG and CG on Palmore's mental health (MH) (P = .04), Palmore's total score (P = .02) and Kogan's negative attitudes toward older adults (P = .001). All students increased their positive attitude toward older adults after the intervention. However, both the IG and CG showed a decrease in positive attitudes 1 month after the interventon, and such decrease varied, depending on the programme which students attended. The current study showed that the 10-week service learning activities significantly increased medical and nursing students' overall knowledge of aging and their understanding of mental health needs in old age, and reduced their negative attitudes toward older adults. However, the effect is not long-lasting. On the other hand, its effect on positive attitudes toward older adults cannot be concluded. Periodic contacts with older adults via service learning activities may be needed to sustain attitude change toward older adults.     

The earlier,the better: the effect of early community contact on the attitudes of medical students to older people

BACKGROUND: Early clinical contact for medical students is an important curricular innovation. We wished to determine if early contact with older people in the second year of a more vertically integrated medical undergraduate programme influenced attitudes to older people and if any effect was synergistic with the effect of an existing fourth year course. SUBJECTS: Second and fourth-year medical students. METHODS: We used a modified version of the Rosencranz-McNevin semantic differential on ageing to assess attitudes of medical students before and after a one-week early community contact week. Some second-year students were followed into fourth year and the effect on their attitudes of a health care of the elderly course was measured. We compared these data with attitude scores from an earlier cohort of students who had undertaken the fourth-year but not the second-year component. RESULTS: Contact with older people during second-year had a significantly favourable effect on attitudes to older people, especially for students who saw older people in the community rather than in rest homes. The attitudes towards older people of students who had undertaken a fourth-year clinical health care of the elderly attachment were significantly better on two of three subscales than those of fourth-year students who had not seen older people during their second year. CONCLUSION: Contact with older people early in a medical student's training, and within a more vertically integrated programme, has a positive effect on attitudes to older people. This effect may be synergistic with contact later in training.     

Does knowledge count? Attitudes toward smoking among medical,nursing, and pharmacy students in Hungary

Despite the fact that cigarette smoking in East Europe is a major health problem, no effective health policy responses have been developed thus far. Health care professionals represent a valuable resource for tobacco control. Therefore, we wanted to obtain information about the acceptance of smoking among medical, nursing and pharmacy students (n = 270) in Szeged, Hungary. The self-administered questionnaire contained items on smoking behavior, beliefs and attitudes related to smoking. ²-test were used to determine differences in the attitudes among students. Smoking was the most frequent among nursing students, followed by medical students. Pharmacy students not only reported smoking the least but they also showed the most acceptable attitudes toward smoking. The high frequency of smoking among students suggests that they themselves are unable to cope with avoiding the dangers of smoking. Moreover, responses reflect a generally poor appreciation of responsibility that health care professionals have in prevention. There is a need for an increasing emphasis on smoking-related attitude formation among medical and nursing students.     

Attitudes towards community medicine: a comparison of students from traditional and community-oriented medical schools

OBJECTIVE: To compare the attitudes towards community medicine of first and final year students from two Australian medical schools. METHOD: In 1995, medical students from Newcastle University (a problem-based, community-oriented curriculum) and Adelaide University (a more traditional lecture-based curriculum) were asked to complete the Attitudes to Community Medicine questionnaire. This is a valid and reliable 35 item survey assessing six key domains of community medicine. The two medical schools differ in their methods of selection and curriculum delivery, and also in curriculum content. RESULTS: Response rates averaged 95% for first year and 81% for final year students. Students selected into both medical schools were found to have positive attitudes with respect to most aspects of community medicine. However, those entering Newcastle had more positive attitudes toward community medicine overall than their Adelaide counterparts. They also scored more positively on subscales relating to holistic care and evaluation of health care interventions. Students who were older and female scored more positively on some subscales, but correction for age and gender did not change the conclusions about medical school differences. CONCLUSION: This study suggests that selection criteria, and probably curriculum style and emphasis, have an influence on the attitudes that medical students possess and later develop toward community medicine.     

Contradictions in elderly care: a descriptive study of politicians' and managers' understanding of elderly care

The care of older people in Sweden has undergone several major reorganisations during the past decade. The healthcare organisation, governed by the county councils, previously had the responsibility of providing care services for elderly people. However, the local municipalities have taken over that duty since 1992. The obligation of the health services is now restricted solely to medical issues. The present study focused on the understanding that politicians and managers have about caring for older people. A section of Stockholm with a population of 320,000 inhabitants was studied. The authors hypothesised that differences in understanding might have an impact on the services of care which older people receive. Interviews were conducted with eight leading politicians and 12 managers responsible for elderly care services. The main focus of inquiry concerned the participants' understanding of caring for older people. The results indicate that politicians and managers in elderly care sometimes have divergent views on how the care should be developed and produced to best serve older people. Five themes of understanding elderly care services and eight contradictory statements among the respondents were identified. A follow-up group session with the respondents was conducted to discuss the results of the interviews. The different ways of understanding elderly care services showed a complex and fragmented organisation lacking clear goals, structures and leadership. However, the authors found a willingness among respondents to collaborate with one another, as well as indications of positive attitudes toward improving healthcare, domiciliary and nursing care of older people.     

Interdisciplinary didactic instruction at academic health centers in the United States: attitudes and barriers

Interdisciplinary care is a method of providing patient care through a team approach that incorporates the efforts of various health care providers. Studies show that this approach can improve patient care and decrease overall costs to the healthcare system. Despite the evidence for the benefits of interdisciplinary care, there are no well-defined models for training students during their didactic years to become members of an interdisciplinary team. This study utilized an investigator-developed questionnaire to determine the attitudes of administrators of professional schools in the USA toward interdisciplinary education, identified the perceived barriers to interdisciplinary education, examined the extent to which interdisciplinary education is occurring at academic health center campuses, and identified the courses that might best be taught in an interdisciplinary format. Administrators from medicine, nursing, and pharmacy hold positive attitudes toward interdisciplinary instruction. Respondents from nursing and pharmacy hold more favorable attitudes than their counterparts from medicine. Positive attitudes are seen more frequently among females than males, and among respondents from public single and multi-campuses than from private campuses. This study demonstrated that administrators espouse very positive attitudes toward interdisciplinary education, although they perceive the barriers to interdisciplinary education and the courses most suited for anointer disciplinary approach differently. More discussions among administrators of various disciplines may allow barriers to be overcome and allow development of interdisciplinary didactic courses that could test the hypothesis that these courses are more cost effective and more likely to foster interdisciplinary teamwork in the clinical setting. This revised version was published online in June 2006 with corrections to the Cover Date.     

The effect of an interdisciplinary community health project on student attitudes toward community health,people who are indigent and homeless,and team leadership skill development

This study examined whether students' attitudes about community health practice, attitudes toward people who are indigent and homeless, and perceived leadership skills changed after participation in a planned interdisciplinary community health experience with an urban homeless or formerly homeless population. Data were collected from medicine, nursing, occupational therapy, physical therapy, and social work students who participated in the community health experiences and from students in these disciplines who did not participate in this curriculum. The interdisciplinary community health curriculum and practicum experiences, based on the Community Health Empowerment Model (CHEM), were designed and implemented by a coalition of community and academic partners. Students in the CHEM project self-selected into the curriculum and initially showed more positive attitudes about community health and indigent and homeless people than their peers not participating. Despite the CHEM students' positive initial attitudes, data from pretests and posttests revealed a significant positive change in their attitudes toward community health practice at the completion of the curriculum.     

Tolerance of intimate partner violence and sexist attitudes among health sciences students from three Spanish universities

ObjectiveTo explore university health science students’ intimate partner violence tolerance and sexist attitudes and to examine their trend throughout the academic years.MethodsCross-sectional study of students of both sexes of the degrees of medicine, nursing, and psychology from three selected Spanish universities (n = 1,322). Data were collected anonymously using two validated scales: the Dating Violence Questionnaire (DVQ-R) and the Gender Role Attitudes Scale (GRAS). Logistic regressions were used to compare tolerance toward violence and sexist attitudes across the degrees. The evolution of these variables throughout different academic courses was assessed.ResultsOf the sample, 62.8% were tolerant towards intimate partner violence. The percentage of tolerant students was significantly higher in Psychology (75.9%) than in Nursing (57.7%) and Medicine Degrees (60.3%). A higher percentage of sexist students was also found in psychology students (80.8%) than in nursing (62.2%) and medicine students (62.7%). Compared to the first-year students, female medicine students of the last courses were less tolerant to intimate partner violence (p-trend <0.001), and male medicine students had less sexist attitudes (p-trend = 0.002).ConclusionsTolerance of intimate partner violence and sexist attitudes were very high, especially among psychology students. These indicators were significantly better among medicine students of higher courses, suggesting a positive effect of medical training. Intimate partner violence in the university education of the future health professionals should be addressed..     

Nursing autonomy plays an important role in nurses' attitudes toward caring for dying patients

The aim of this study was to clarify the relationship of nursing autonomy and other factors related to attitudes toward caring for dying patients. A cross-sectional survey of nurses was conducted in November 2003 using a self-administered questionnaire. We collected demographic data from 178 (75%) participants and used the Frommelt Attitude Toward Care of the Dying scale, Form B, Japanese version (FATCOD-Form B-J), the Pankratz Nursing Questionnaire (PNQ), and the Death Attitude Inventory (DAI). FATCOD-Form B-J measures nurse's attitude toward caring for dying patients. It includes two subscales: positive attitude toward caring for the dying patient and perception of patient- and family-centered care. The PNQ measures nursing autonomy of individual nurses and has three subscales: nursing autonomy and advocacy, patients' rights, and rejection of traditional role limitations. The DAI measures attitudes toward death in context of Japanese cultural characteristics. It includes seven subscales: afterlife beliefs, death anxiety, death relief, death avoidance, life purpose, death concern, and supernatural beliefs. We investigated the factors associated with the FATCOD-Form B-J. Support of a mentor regarding end-of-life issues (beta = .19, P = .001), death avoidance domain of the DAI (beta = -.14, P = 0.03), life purpose domain of the DAI (beta = .23, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .51, P = .001) were selected as significant independent variables by multivariate analysis to evaluate nurses' positive attitudes toward caring for dying patients. Death anxiety domain of the DAI (beta = -.17, P = .02), patients' rights domain of the PNQ (beta =.46, P = .001), and rejection of traditional role limitations domain of the PNQ (beta = .34, P = .001) were selected as significant independent variables by multivariate analysis to evaluate the nurses' perception of patient-and family-centered care. In conclusion, nursing autonomy plays an important role in the attitudes of Japanese nurses who care for dying patients. Educational and administrative efforts to strengthen nursing autonomy are necessary.     

泰国高中生对青少年怀孕、人工流产及医疗服务设施态度的调查

目的:了解高中生对青少年怀孕、人工流产及医疗服务设施的态度,分析个人因素、家庭因素及环境因素对他们所持态度的影响。方法:采用自行设计量表,于2003年初在泰国某中学对270名高中生进行抽样调查。结果:大多数被调查者对青少年怀孕持消极态度(52.6%),对青少年人工流产和医疗服务设施持积极态度(56.7%和56.3%)。每月所得花费、亲戚给予相关教育及同伴给予安全性行为信息影响他们对青少年怀孕的态度;年龄、年级高低、父母职业、父母亲戚或卫生人员给予相关教育、同伴给予安全性行为信息影响他们对青少年人工流产的态度;年级高低、每月所得花费、父母教育程度、父母亲戚或卫生人员给予相关教育影响他们对医疗服务设施的态度。结论:个人家庭以及环境因素均可影响泰国高中生对青少年怀孕、人工流产及医疗服务设施态度。     

Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning

OBJECTIVES: The belief that the effectiveness of patient care will improve through collaboration and teamwork within and between health care teams is providing a focus internationally for 'shared learning' in health professional education. While it may be hard to overcome structural and organizational obstacles to implementing interprofessional learning, negative student attitudes may be most difficult to change. This study has sought to quantify the attitudes of first-year medical, nursing and pharmacy students' towards interprofessional learning, at course commencement. DESIGN: The Readiness for Interprofessional Learning Scale (RIPLS) (University of Liverpool, Department of Health Care Education), was administered to first-year medical, nursing and pharmacy students at the University of Auckland. Differences between the three groups were analysed. SETTING: The Faculty of Medical and Health Sciences, University of Auckland. RESULTS: The majority of students reported positive attitudes towards shared learning. The benefits of shared learning, including the acquisition of teamworking skills, were seen to be beneficial to patient care and likely to enhance professional working relationships. However professional groups differed: nursing and pharmacy students indicated more strongly that an outcome of learning together would be more effective teamworking. Medical students were the least sure of their professional role, and considered that they required the acquisition of more knowledge and skills than nursing or pharmacy students. CONCLUSION: Developing effective teamworking skills is an appropriate focus for first-year health professional students. The timing of learning about the roles of different professionals is yet to be resolved.     

The Aging Game: improving medical students' attitudes toward caring for the elderly

OBJECTIVES: The objective of this study was to evaluate the effectiveness of a modified aging game to enhance medical students' attitudes toward caring for elderly patients, enhance empathy for elderly patients, and improve general attitudes toward the elderly. DESIGN: Preintervention and postintervention study PARTICIPANTS AND SETTING: All 84 students from 2 first-year medical school classes INTERVENTION: The aging game takes place over a period of 3 hours with a group of 10 to 12 students and 5 to 6 facilitators, and includes experiential learning about polypharmacy, medication cost, loss of functional status, semi-independent living, and living in a long-term care facility. MEASUREMENTS: Scores obtained through a modified Maxwell and Sullivan questionnaire, and the Aging Semantic Differential (ASD). RESULTS: There was a statistically significant improvement in 6 of the 8 attitudes toward caring for elderly and a statistically significant increase in empathy towards elderly patients following the aging game. There was a statistically significant change on 23 out of 32 ASD questions. There was no evidence of differences in the scores from pre-course to post-course by gender age group, interest in Family/Internal Medicine, or prior geriatric experience. Following the game, 77 (93%) of the students said they would take the course if not mandatory (P = .0001). A majority stated the aging game added significantly (61.5%) or moderately (37.3%) to their knowledge and skills in patient care for the elderly. CONCLUSION: A simulation experience like the aging game is an effective method of increasing the empathy and attitudes toward caring for the elderly early in the medical school curriculum. Longitudinal assessment of the effect of the aging game in maintaining the positive effect on empathy and attitudes toward caring for the elderly and especially in clinical practice needs to be done.     

Medical students'' attitudes to old people and career preference: a comparison of two universities

Medical students' attitudes to old people were compared at broadly similar points in their education at two medical schools, one with a department of health care of the elderly (Nottingham), the other without such a university department (Leeds). The students were tested at both schools before their clinical training in care of the elderly, using a modified Rosencranz-McNevin semantic differential scale to measure general attitudes to old age, and a Likert scale to measure attitudes to medical care. Questions were also asked about career preferences. Both groups of students showed similar general attitudes to ageing. The Nottingham students showed more positive attitudes to care of old people, and this was reflected in career preferences.     

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.     

A brief training program on resident assessment instrument improves motivation of nursing home staff

The Resident Assessment Instrument (RAI) has been designed to improve the quality of assessment and care in nursing home patients through a better understanding of resident needs. We organized three short courses (two weeks) on RAI, involving sixty-six nursing home health professionals. The course provided students both a theoretical and practical knowledge of RAI. At the end of the program, participants were asked to answer to an anonymous questionnaire about the course itself and their future professional motivation. The participants showed increased motivation and attitudes toward the elderly care. The good results obtained indicates that RAI not only may improve quality of nursing home care, but it is also an useful tool in the training of geriatric professionals enhancing their motivation and job satisfaction.