Nursing Staff Attitudes towards the Elderly - Essay Example

Nursing Staff’ Attitudes towards the Elderly Introduction With the many health degeneration identified among elderly, it has been a challenge for most health practitioners to maintain their best attitude and professionalism at most times. This portion will review literature on nursing staff' attitudes towards the elderly to gain insight on what to recommend and how to improve this condition. Discussion: International nursing studies indicate that health services have been identified as one of the main public agencies at the interface of ageism and negative attitudes (Lotian, 2001). It was found that nurses and nursing students often possess unfavourable attitudes towards older adults (Courtney, 2000). In fact, in Sweden, nursing students were found to have more negative attitudes than qualified nurses (Soderhamn, 2001), while in the UK, the ageist attitudes held by nurses were also proposed to have affected the dignity and autonomy of older patients (Seedhouse, 2002). When older patients are perceived as being cantankerous and complaining by nurses, consequence would most likely that the quality of care delivered and the recovery of patients is affected (Courtney, 2000). Overview: Ageing of the Australian population has occurred rapidly in recent years. The greatest increases in number have been indicated among the very old or those aged 80 years or over. The aged population from 65 and older has been predicted to reach 22% or 5 million by the year 2051, doubling that of 1991 or 11% at 1.9 million according to Clare (1994). Likewise, it was said that gerontological nursing is still an unpopular speciality and nursing student’s interest in pursuing it as a career decreases during their education (Slevin, 1991). The health-care system has been heavily influenced by social developments and ageist stereotypes, combined with increases in the aged population (Palmer, 1994). In as much as older people are perceived by policy makers and society in general as problems requiring considerable attention and resources (Palmer, 1994), it had also been indicated that increases in the Australian health-care costs have been attributed to the increases in the aged population. Nevertheless, Palmer (1994) found that these increases are more closely linked to social and political changes than a physiologically ageing population. Accordingly, changes in the health-care system were influenced by the major political parties’ social and economic policies, the need to contain hospital operating costs and the promotion of community care for the chronically ill, disabled and frail aged (Courtney, 1997). But it has to be noted that many family members are no longer able to care for their older relatives due to social factors such as increases in divorce and participation of women in the workforce. This has dramatically decreased the availability of informal community support systems for future generations of older people upon which the government has relied heavily since the 1985 de-institutionalisation of aged care to hostel and home-based care (Gibson, 1998). Nurse Attitude Several studies have identified factors, such as area of practice, age, gender and years in clinical practice, as affecting nurses’ attitude strength (Lookinland, 1991). Soderhamn and colleagues found younger and male nurses possessing more negative attitudes in comparison with older and female nurses. Soderhamn’s (2001) research also demonstrates that higher education, gerontology courses and more years of clinical experience were found to be associated with less negative attitudes. Another influence is area of clinical practice influencing attitude strength (Soderhamn, 2001). Cited as example was that nurses working in acute settings were found to use more negative stereotypical labelling to describe their older patients to student nurses than those working in elder-care settings (McLafferty, 2004). These factors to ageism are important to note as these have implications for nurse education and training. Attitudes of Nurses in Long-term Care Settings Registered nurses in long-term care settings hold neutral to slightly positive attitudes towards the elderly, although these attitudes are less positive than those of other areas: nurses in teaching, health department or rehabilitation services areas (Slevin, 1991). Also, nurses in long-term settings do have more positive and less negative attitudes towards the elderly than either licensed practitioner nurses or nursing aides (Smith, 1982). According to Bowling (1991), an interest in working in this area highlighted potential problems for their own old age when they feared they, like their older patients, would be made to feel useless and not needed. The negative aspects identified of this work are the high dependency of patients, difficulties of structuring nursing work with older patients and lack of staffing (Bowling, 1991). Older Patients in the Acute-care Settings Some research examining the care older patients receive in the acute-care settings indicate a potentially dangerous place for older patients (Waltman, 1993). It was suggested that these patients are more likely to develop postoperative complications and nosocomial infections than younger patients (Voss-Morice, 1996). Likewise, in some hospitals, patients’ dependence is encouraged as it is quicker ‘to do’ for older patients than they had on admission (Waltman, 1993). In addition, it was also established that many older patients are discharged to their homes and many receive limited family or community assistance (Mistiaen, 1997). Aside from the mentioned, they are often uninformed about their illness and recovery, medications and recommended lifestyle changes, leading to high readmission rates (Mistiaen, 1997). Influence on Practice of Nurses’ Attitudes Towards Older Patients Perception and attitudes towards older patients significantly influence nurses’ practice. Helmuth et al (1995), demonstrated that those who reported holding negative attitudes towards older patients held positive attitudes towards restraint use and stereotyped older patients rather than regarding them as individuals (Wilkes, 1998). It was found that nurses who placed a high degree of importance on talking to patients held more positive attitudes than those who placed a high degree of importance on general nursing care such as bathing or toileting as specified by Armstrong-Esther (1989). Older patients were perceived as pleasant to interact with, but they were not perceived as being capable of making their own decisions or carrying out important functions (Helmuth, 1995). Influence on attitudes of nurses’ professional education It was also established that nurses with a higher level of professional education had more positive attitudes towards older people (Armstrong-Esther, 1989). Carter and MacInnes (1996) found that educational interventions improved nurses’ decision-making practices with older patients from a ‘medically orientated, professional’ approach to a ‘patient choice’ approach allowing patients more control over decisions relating to their care and place of residence following discharge. Knowledge and Attitudes of acute-care nurses towards older patients Authors Aim Participants Method Findings Armstrong-Esther Discover attitudes towards 74 nurses (50 RNs) Self-report survey Overall slightly positive attitudes et al. 1989 older patients, investigate 4 BNs, 20 RNAs) KOP correlated with: factors influencing attitudes and 8 volunteers Developed clinical Higher professional education items Demographics Preferred working area geriatrics Response rate 79% and rehabilitation Higher rating given to basic care Lower rating given to basic care Prevost et al. 1991 Identify the knowledge and 162 nurses (69 ICU Self-report survey Overall moderately positive attitudes attitudes of acute-care nurses and 93 KOP, FAQ towards ageing and low knowledge Nurses towards older medical-surgical Demographics levels Patient Response rate Knowledge and attitudes towards unknown older patients were positively correlated ICU nurses had higher knowledge and attitude scores than medical- surgical nurses Hope 1994 Examine nurses’ attitudes 76 trained nurses Self-report postal Overall positive attitude towards older patients (38 acute elderly survey More positive attitudes in nurses in in different care care and 38 medical KOP, FAQ the acute elderly care than the settings Demographics medical area Response rate 57.7% Predictors of medical - nurses attitude: gerontological education predicted attitude and gerontological education, age and knowledge accounted for 5% of variance Lookinland & Anson Identify factors promoting 61 acute-care Self-report survey Overall positive attitudes 1994 favourable attitudes in nurses RNS and 62 HSS KOP Nurses: and future health care Six nonrelated items more favourable attitudes than HSS professionals Demographics female more favourable than male Response rate: attitudes were affected by ethnicity RNs 74% HSS: HSS 91% no gender differences students in acute-care had more positive than those in long-term care setting Helmuth 1995 Discover nurses attitudes 52 RNs and LPNs Observations 3 weeks Overall slightly positive attitudes towards older people from 3 acute medical prior to a self-report Nurses found older patients: and the use of restraint -surgical wards survey slightly personally acceptable ASD, PRUQ slightly ineffective at adaptation and Restraint use data sheet goal direction Demographics slightly positive attitudes towards Response rate 61% the use of restraints to ensure Patient safety Carter & MacInnes Identify change in nurses Medical nurses Self-report survey Change in medical nurses attitude attitudes to the care of pre 42, post 46 1 week pre and from a “professional” elderly patients “at risk” community nurses: 8 months post (doctor/nurse) care approach to a of continued hospital care pre 42, post 35 intervention “patient choice” approach in Developed items from decisions relating to the care and MACT placement of elderly patients at risk Response rate unknown of continuing hospital care Community nurses: “patient choice” approach Wilkes et al 1998 Examine nurses’ knowledge 261 nurses Self-report survey Overall negative attitudes with a of and attitudes towards (73.9% from FAQ, ASD significant drift towards older patients in the acute medical-surgical Demographics ambivalence hospital setting area) Response rate 31.4% Overall reasonable knowledge about older people Images of long-term care It has been established decades earlier that the glamour associated with technical skills and high status nursing has done little to promote the expertise of caring for older people. The historical image of caring for this client group in specialized settings has done little either. Likewise, long-term care has been associated with the workhouse and the supposedly “asylum” where recipients of caring occupied a marginalized and stigmatized position in society inclusive of their own families (Goffman, 1961). Goffman (1961) described the ‘total institution’ controlled the behaviour of both ‘inmates’ and staff with emerging highly stylized and ritualistic behaviour patterns. But it was suggested that these could be justified in terms of meeting the aims and functions of the institution (Goffman 1961). In addition, Norman (1997) builds upon this image, citing reports of the low morale and demoralization among staff in both nursing and residential care. This arises from a number of contributory factors which identify as quantitative overload, qualitative underload, lack of control and lack of social support (Norman, 1997). Negative perspectives are also suggested to be perpetuated by the use of a low skill mix of the staff employed to care for older people in specialized areas for the continued care of older people. Hill et al (1987) established that as the dependency of the patients in a setting rose, so the number of registered and learner nurses fell. Nevertheless, the acceptance of an untrained worker caring for a highly dependent older person does little to dispel the view that such work is unskilled (King 1995). King argues that this area of care is complex, demanding and sophisticated but need to be nurtured. Articulating skills It was suggested that older people have extremely complex health care needs, especially those in continuing care (UKCC 1997). Likewise, if the needs of older people and the skills required to address them are not recognized or acknowledged by staff, they will be unable to articulate or justify them to nursing students and colleagues who come to their practice settings. It was added that older people have different but equally expert needs as other people in need of care but these seem to remain unrecognized, being perceived as ‘basic’ rather than ‘skilled’. The role of education It seems that the processes of nurse education have failed to convey the expertise required where caring activities predominate. Stevens and Crouch (1995) suggested that this view contrasts with the espoused ‘essence’ of nursing which is perceived to be that of holistic therapeutic care. They added that one of the reasons for this is because the principles of therapeutic care and expertise are usually illustrated using examples from highly technical areas such as intensive care units. Elzinga, suggests that the caring stance was grafted onto a scientific core with the help of a philosophical discourse and the incorporation of humanistic studies. In addition, as in Bourdieu’s terms, Stevens and Crouch assert that the pedagogic work undertaken to embed student nurses in their appropriate ‘habitus’ defines technological/scientific expertise as the most significant ‘symbolic capital’ of the profession. The UKCC (1997) emphasized that patient care in these areas is very much nurse-led, and calls for skilled decision-making and problem-solving skills which require autonomy, independent control and responsibility, often within exposed and vulnerable situations, if good effective care is to be delivered. Add expert interpersonal skills with effective interdisciplinary and collaborative working in order to fully meet the needs for satisfactory elderly care (Philipose et al. 1991). These are valuable aspect of giving quality person-centred care to older people in these settings. Nevertheless, this could not compensate an inadequate support system provided and a lack of opportunity for ongoing professional development, as may occur in some settings (King, 1995). Lack of supportive strategies in isolated or unsupported environments and situations may in fact result in the nurse being forced to lower standards and struggle to obtain resources already identified. This could lead to poor delivery with an inadequate knowledge of the complex needs of older people (Beckingham & Du Gas 1993). In these unsupported areas, care may become compromised and contributes directly to the poor reputation of some settings caring for older people, and the general low status and stereotyping of caring for older people (Knowles & Sarver 1985). Conclusion In consideration of the foregoing, elderly care must be incorporated in the nursing education curriculum. The elderly population is growing in steady pace and their must be given importance by concerned agencies: education, health, community and social services. It was understandable that lack of enough exposure in elderly care render negative attitude among nurses. Therefore it must be instilled among them that getting old is a normal cycle undergone by everybody else and it must be with the premise of the golden rule that elderly care is conducted “ do unto others what you would want others do unto you”. Reference: Armstrong-Esther CA, Sandilands ML, Miller D. Attitudes and Behaviours of nurses towards the elderly in an acute care setting. Journal of Advanced Nursing 1989; 14: 34-41 Bowling A, Formby J. Nurses’ attitudes to elderly people: A survey of nursing homes and elderly care wards in an inner-London health district. Nursing Practice 1991; 5: 16-24 Butler R.N. (1975) Why Survive Being Old in America? Harper & Row, New York, NY, USA. Carter H, MacInnes P. Nursing attitudes to the care of elderly patients at risk of continuing hospital care. Journal of Advanced Nursing 1996; 24: 448-455 Clare R, Tulpule A. Australia’s Ageing Society. Parkes: Economic Planning Advisory Council, 1994. Courtney M, Minichiello V, Waite H. Aged care in Australia: A critical review of the reforms. Journal of Aging Studies, 1997; 11: 229-250 Courtney M, Tong S, Walsh A. Acute-care nurses’ attitudes towards older patients: A literature review. International Journal of Advanced Nursing 2000; 6: 62–69. Cummings E. & Henry W. (1961) Growing Old. The Process of Disengagement. Basic Books, New York, NY, USA. Gibson D. Aged care: Old policies, New Problems. Singapore: Cambridge University Press, 1998; 3-28 Glasspoole LA, Aman MG. Knowledge, attitudes, and happiness of nurses working with gerontological patients. Journal of Gerontological Nursing 1990; 16: 11 - 14 Gunter L.M. (1971) Students’ attitudes toward geriatric nursing. Nursing Outlook, 19, 466–469. HAS (1998) ‘Not Because They Are Old’. Dignity on the Ward. Health Advisory Project 2000, London. Helmuth AM, Lookinland S, Anson K, McCabe BW. Nurses’ attitudes towards older persons on their use of physical restraints. Orthopaedic Nursing 1995; 14: 43-51 Hope KW. Nurses’ attitudes towards older people: a comparison between nurses working in acute medical and acute care of elderly patient settings. Journal of Advanced Nursing 1994; 20: 605-612 Lookinland S, Anson K. Perpetuation of ageist attitudes among present and future health care personnel: Implications for elder care. Journal of Advanced Nursing 1995; 21: 47-56 Lotian K, Philp I. Care of older people: Maintaining the dignity and autonomy of older people in the healthcare setting. British Medical Journal 2001; 322: 668–670. McLafferty I, Morrision F. Issues and innovations in nursing education: Attitudes towards hospitalized older adults. Journal of Advanced Nursing 2004; 47: 446–453. Mistiaen P, Wijkel D, De Bont M, Veeger A. The problems of elderly people at home one week after discharge from an acute care setting. Journal of Advanced Nursing 1997; 25: 1233-1240. Palmer GR, Short SD. Health Care and Public Policy: An Australian Analysis, 2nd edn. Melbourne: Macmillan Education Australia, 1994; 283-289. Passuth P. & Bengston V. (1996) Sociological theories of ageing. current perspectives and future directions. In: Ageing for the Twenty-First Century (Quadagno J. & Street D. eds), St Martin’s Press, New York, NY, USA. Prevost S, Wilson E, Gerber D. Acute care nurses’ knowledge and attitudes related to aging, Heart and Lung 1991; 20: 302 Royal Brisbane Hospital. Quality Assurance Report. Brisbane: Royal Brisbane Hospital: 1996 Seedhouse D, Gallagher A. Undignifying institutions. Journal of Medical Ethics 2002; 28: 368–372. Sheffer S. (1995) Do clinical experiences affect nursing students attitudes towards the elderly. Journal of Nursing Education, 34 (7), 312–316. Slevin ODA, Ageist attitudes among young adults: Implication for a caring profession. Journal of Advanced Nursing 1991; 16: 1197-1205. Smith SP, Jepson V, Perloff E. Attitudes of nursing care providers towards elderly patients. Nursing and Health Care 1982; Feb: 93 – 98 Soderhamn O, Lindencrona C, Gustavsson SM. Attitudes towards older adults among nursing students and registered nurses in Sweden. Nurse Education Today 2001; 21:225–229. Treharne G. (1990) Attitudes towards the care of older people: are they getting better. Journal of Advanced Nursing, 15 (7), 777–781. UKCC (1986) Project 2000. A New Preparation for Practice. UKCC, London. Voss-Morice S. Geriatric Nursing. The Skidmore Roth Outline Series. Aurora, CO: Skidmore-Roth, 1996 Waltman RE. 5 goals for managing older patients, Nursing 93; 1993 Jan; 62 – 64 Wilkes L, LeMiere J, Walker E. Nurses in an acute care setting: Attitudes to and knowledge of older people. Geriaction 1998; 16: 9-16 Beckingham A.C. & Du Gas B.W. (1993) Promoting Healthy Aging: a Nursing and Community Perspective, Mosby, St Louis, MO, USA. Hill S.N., Milnes J.P., Rowe J. et al. (1987) Nursing the immobile: a preliminary study. International Journal of Nursing Studies, 24 (2), 123–128. Knowles, L. & Sarver V. (1985) Attitudes a¢ect quality care. Journal of Gerontological Nursing, 11 (8), 35–36. King T.I. (1995) Gerontological courses for undergrads. The Canadian Nurse, May, 27–31. Norman I. (1997) Supporting paid carers. In: Mental Health Care for Elderly People (Norman I. & Redfern S. eds), Churchill Livingstone, London, 476–498. Goffman E. (1961) Asylums. Essays on the Social Situation of Mental Patients and Other Inmates (Reprinted). Doubleday & Co., London. Elzinga A. (1990) The knowledge aspect of professionalisation. The case of science-based nursing education in Sweden. In The Formations of Professions, Sage, London, 150–173. Philipose V., Tate J.&Jacobs, S. (1991) Review of nursing literature: evolution of gerontological education in nursing. Nursing Health Care, 12 (10), 524–530. UKCC (1997) The Continuing Care of Older People. UKCC, London. Stevens J. & Crouch M. (1995) Who cares about care in nursing education. Journal of Nursing Studies, 32 (3), 233–347. Read More