Attitudes and Beliefs in Nursing Care - Literature review Example

Attitudes and Beliefs in Nursing Care Introduction Stigmatising attitudes against older adults are widespread in almost all settings. These attitudes comprise of prejudices, stereotypes and discriminatory behaviours (Aikaterini et al, 2009). In the work settings, younger applicants are often preferred over older applicants mainly because they are perceived to be more creative and energetic than older adults. At home, elderly people are often perceived as a burden thus they are subjected to neglect and exclusion. Some of the common stereotypes associated with older adults include negative attributes like stubbornness, sickliness, frailty, dependency and incompetency. Similar to other settings, stigmatising attitudes against older adults are also prevalent in the healthcare settings (Aikaterini et al, 2009; Duncan & Schaller, 2009; Reeder & Pryor, 2008). For instance, in the provided scenario, when a confused and dishevelled old patient comes to the Emergency Department, one of the nurses conveys a stigmatising attitude. The nurse responds by saying, “I really hate looking after old people-they’re senile and they smell.” This shows that, prejudices, stereotypes and discriminatory behaviours are evident within the healthcare settings. This paper seeks to critically analyse the attitudes and beliefs that underpin negative and stigmatising perceptions of old patients held by nurses within the clinical settings. Foremost, it will explore in general the common attitudes and beliefs held by nurses about older patients. Secondly, this paper will look at the causes of these attitudes and beliefs. Subsequently, it will explore how these attitudes and beliefs may impact on the nursing care of the patient described in the provided scenario. It will also explore how nurses’ values and beliefs could influence the practice of other professions within the healthcare settings. Attitudes and beliefs held by nurses about older patients Nilson, Linkvist, Rasmussen & Edvardsson (2012), note that older people visit healthcare facilities on a regular basis. Nonetheless, it is not unusual that they showcase some form of delirium, dementia or cognitive decline. A critical look at the symptoms portrayed by the patient described in the provided scenario, it is plausible to argue that the patient is to some extent demented, schizophrenic or has some form of mental disorder. Aikaterini et al (2009), observes that patients with mental disorders such as schizophrenia are often stereotypically considered as dangerous, unpredictable incompetent and childlike. Moreover, they are considered as incapable of making sound decisions thus their life decisions are made by their caregivers. Furthermore, many believe that such patients should be feared, monitored and segregated from “normal” people (Aikaterini et al 2009; Thornicroft et al, 2009). Hansson, Jormfeldt, Svedberg &Svensson (2011) further point out that some nurses believe that patients with mental disorders are social outcasts thus they should be subjected to social distance. Duncan & Schaller (2009) observe that negative attitudes towards old patients often coexist with a variety of positive values and attitudes (Kang, Moyle & Venturato, 2011). According to Duncan & Schaller, some of the common beliefs held by nurse about older patients are that they are incompetent, sickly and dependent. They also note that although older patients are often associated with negative traits, some are perceived as wise, nurturing and warm. Miller (2009) observes that some nurses believe that a certain degree of senility is normal in old people. Moreover, some believe that a decline in mental capabilities is normal in old age. Miller further observes that nurses are also known to believe that most old people are often depressed thus it is normal for them to withdraw from the rest of society. In addition to this, Miller points out that some nurses consider increased disability amongst old patients to be solely as a result of age-related changes (Miller, 2009). Causes of these attitudes and beliefs Gillis, MacDonald & MacIsaac (2008) attribute the lack of proper gerontological training as one of the causes of stigmatising beliefs and attitudes towards older patients. They observe that due to the lack of proper gerontological training nurses, are unable to understand the needs and conditions of older patients entrusted in their care. Similarly, Deltisidou, Voltyraki, Mastrogiannis, Mantzorou & Noula (2010) and Moyle et al (2008), agree that the adequate preparation of nurses is critical in the care of older patients. In order to avoid stigmatising attitudes Deltisidou et al suggest that a holistic knowledge of the ageing process is imperative among nurses. Gillis et al (2008), also attribute stigmatising beliefs and attitudes towards older patients to the lack of adequate nurse role models within the healthcare settings. Gillis et al (2008) note that, the presence of adequate nurse role models within healthcare systems helps to encourages responsible attitudes and behaviours, continuous learning and professional develop. Therefore, the lack of adequate nurse role models within the healthcare settings reinforces negative attitudes and beliefs about older patients (Gillis et al 2008). Edvardsson & Nay (2010) and Moyleet al (2010) attribute the lack of person-centred and evidence-based approaches to patient care as causes of negative attitudes and beliefs about older patients. They also note that the lack of staff training and education leaves room for stigmatising attitudes and beliefs about older patients to penetrate within healthcare systems. On the other hand, Nilson et al (2012) suggest that negative attitudes and beliefs about older patients are influenced by individual factors like nurse knowledge, education, age, cultural background and gender. They further observe that, factors like working conditions, culture of care and organisation also influence nurse attitudes and beliefs towards older patients (Kang et al, 2011). Nilson et al (2012) also suggest that the lack of training and clinical supervision can contribute to the development of negative attitude and beliefs towards older patients. Conversely, Duncan & Schaller (2009) assert that, prejudicial attitudes towards older patients emanate when nurses feel vulnerable to infectious diseases. They note that since many pathogens are microscopic and not detectable directly, some nurses rely on superficial behavioural cues or signs such as skins lesions or coughing to detect the presence of pathogens. Typically, the detection of disease-connoting cues is likely to prompt the activation of aversive cognitions into operational memory. This in turn motivates behavioural avoidance. The sentiments put across by Duncan & Schaller (2009) are evident in the provided scenario. In this scenario, the confused man who appeared in the emergency room looked dirty and disheveled. He had an acetone odour and a haematoma on his forehead. Based on Duncan & Schaller’s, it is plausible to argue that the nurse developed a negative attitude towards the old patient, due to his appearance which shows disease-connoting cues. The nurse may have felt that he is vulnerable to infectious diseases emanating from the old patient in the emergency room. As a result, he projected behavioural avoidance. Impact of nurse attitudes and beliefs Over the years, a considerable number of studies have explored and reported that nurse attitudes and beliefs significantly influence the quality of care in healthcare systems and the health outcomes of patients (Gillis et al, 2008; Duncan & Schaller, 2009; Simkins, 2008). Nilson et al (2012) observes that staff attitudes towards older patients influence the care process and determines whether their relationship with the patient becomes person-centered or symptom-oriented. According to Hansson et al (2011), negative beliefs and attitudes projected by nurses towards old patients with mental disorders is one of the most critical obstacles towards the realisation of successful treatment, inclusion and rehabilitation (Lambrinou et al, 2009). Moreover, Hansson et al note that negative attitudes projected by nurses affect disease progression and patient recovery. As a result of negative beliefs and attitudes, nurses show fear and reluctance to assist older patients. Delay in treatment may in turn result to disease progression and impede on patient recovery. In a study conducted by Simkins (2008), it was established that positive attitude towards old patients has a significant effect on lengthening their life span whereas stigmatising attitudes projected by nurses may result to the exclusion of older patients from aggressive treatments or clinical trials. Newton-Howes, Weaver & Tyrer (2008) further observes that when it comes to the treatment of older patients especially those with mental or personality disorders stigmatising attitudes may result to negative self-appraisal and make the development of therapeutic relationship with patients difficult. Newton-Howes et al (2008) notes that when dealing with older patients with mental or personality disorders, developing close therapeutic interpersonal relationships is imperative to their recovery. However, negative stigmatising attitudes and beliefs may make the development of therapeutic relationship with patients difficult thus impeding of on the recovery of the patient (Newton-Howes et al 2008). Negative beliefs and attitudes that nurses project towards old patients may also prevent old patients from seeking medical attention. Nash (2010) notes that stigma often inhibits people from seeking medical attention to the extent that when they do, their illness may have worsened significantly. Nash (2010) further points out that, negative and stereotypical beliefs may also negatively impact on the way that care is provided to older patients. He illustrates that sometimes nurses may have therapeutic fatalism towards older patients. For instance, they may consider it futile to stop older patients from smoking or taking alcohol mainly because they assume that they have been smoking for a long time thus it would be difficult for them to stop smoking. In this case, there is a prevailing assumption among nurses that older patients are not interested in their health when in fact they could be. Such beliefs or assumptions may prevent nurses and other specialists within the healthcare system from initiating treatments or other interventions that could help the patients’ recovery (Nash 2010). Furthermore, some nurses may consider behaviours associated with psychological disorder among older patients as deliberate or unconscious action in a bid to get attention. In order to discourage such behaviours, nurses tend to distance themselves emotionally, limit their communication with the patient address the patient in a sarcastic or patronising manner or keep the patient waiting. Such attitudes and beliefs are obviously negative and may make patients and their families highly dissatisfied with the care provided in healthcare systems. Similarly, such negative attitudes and beliefs may affect the ability of nurses and other health specialists within the healthcare system to plan and implement patient-focuses treatment or provide quality care to patients (Harrison & Hart, 2009; Elder, Evans & Nizette, 2009). Miller (2009) observes that attitude and beliefs based on age stereotypes may negatively influence health practices of not only nurses but also other specialists or health care staffs within the health settings. For instance, some nurses believe that behaviours exhibited by older patients such as forgetfulness, rowdiness, restlessness and careless are normal in aged people. Since nurses play a critical role in patient diagnosis, their opinion or assertions may affect the view of other medical specialists. When nurses overlook symptoms or attribute symptoms exhibited by older patients as normal, other health specialists are bound to overlook treatable conditions thus leading to negligence (Miller, 2009). In essence, negative or stereotypical beliefs and attitudes held by nurses about aging can negatively impact on how other healthcare specialist or workers deliver care and provide treatment to older patients (Schiavo, 2011). Conclusion Basically, this paper has critically examined the attitudes and beliefs that underpin negative and stigmatising perceptions of old patients held by nurses within health care systems. The findings of this paper show that, some of the common beliefs held by nurse about older patients are that they are incompetent, sickly and dependent (Duncan & Schaller 2009). Negative or stereotype attitudes and beliefs held by nurses emanate from lack of proper gerontological training, the lack of adequate nurse role models within healthcare systems, working conditions, feelings of vulnerability to infectious diseases and individual factors like nurse knowledge, education, age, cultural background and gender(Gillis et al 2008). It is also established in this paper that, negative or stereotype attitudes towards older patient negatively impacts on the quality of care provided, the recovery and overall health outcomes of old patients. In addition to this, since nurses play a critical role in patient diagnosis and care, negative and stereotype attitudes and beliefs projected by nurses can negatively impact on how other healthcare specialist or workers deliver care and provide treatment to older patients (Miller, 2009; Schiavo, 2011). References Aikaterini, A. Samakouri, M. Kalamara, E. Bochtsou, V. Bikos, C. & Livaditis, M. (2009). “Health service staff’s attitudes towards patients with mental illness.” Social Psychiatry and "Psychiatric Epidemiology 44:658-665. Deltisidou, A. Voltyraki, E. Mastrogiannis, D. Mantzorou, M. & Noula, M. (2010). “Nurse teachers’ and students nurses’ attitudes towards care the older people in a province in Greece”. Health Science Journal 4(4):245-257. 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