The Effects of Institutional and Community Experiences on Nursing Students' Intentions Toward Work With the Elderly

The impact of care experience prior to commencing pre-registration nurse education and training: A scoping review

OBJECTIVES

Compassion in nursing and interventions to support it are of international relevance and concern. Prior care experience as a prerequisite for entry into pre-registration nurse education is suggested as a means of improving compassion. The impact of prior care experience has not been comprehensively reviewed, therefore the potential effectiveness of prior care experience as a means of improving compassion is unknown. The scoping review question was 'What is known about the impact of care experience prior to commencing pre-registration nurse education and training?' The primary objective was to scope and synthesise existing literature relating to the topic and ascertain key themes pertaining to impact. A secondary objective was to appraise literature, to contextualise findings and assess the state and stage of knowledge and research in the area.

DESIGN

The review was guided by Arksey and O'Malley's methodological framework and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist.

DATA SOURCES

Health sciences databases CINAHL, Medline and PubMed.

METHODS

Databases were searched in February 2019, updated August 2021. Data (study characteristics, findings, methodological observations) were extracted from papers meeting inclusion criteria (including peer-reviewed empirical papers with English language, electronic full-text available) and findings thematically analysed.

RESULTS

Forty-five papers from 14 countries were included. The majority (64.4 %) were published in Europe (31.1 % in the United Kingdom) between 2010 and 2021 (69 %), 60 % from 2013. Four qualitative themes (compassionate care, commitment, competence and communication) describe the impact of prior care experience, which was variable.

CONCLUSIONS

Evidence to support the effectiveness of prior care experience as a prerequisite for entry into nurse education to improve compassion, is inconsistent and insufficient. The literature displays methodological limitations and conclusions should be interpreted in light of these caveats. Recommendations are made for future research, to improve quality and comparability.

"Where would I prefer to work after graduation?" Career preferences of students attending Italian nursing schools

BACKGROUND

Worldwide, nursing students have reported a preference for working in intensive care, paediatrics, and operating theatres after graduation, disregarding psychiatry and geriatrics. Many factors can influence student choices. Educators need to know students' preferences and influencing factors in order to plan appropriate interventions to orient future nurses towards the clinical areas that are most in need of trained and motivated nurses.

OBJECTIVES

To identify career preferences and student-related factors that influence the career intentions of students attending Italian nursing schools.

DESIGN

A cross sectional design.

SETTING

The study was conducted in 14 Italian nursing schools.

PARTICIPANTS

Students enrolled on a three-year undergraduate nursing program were invited to participate.

METHODS

A questionnaire was used to collect sociodemographic data and clinical area preferences. A multivariate binary logistic regression was performed to identify the student characteristics influencing career choices.

RESULTS

1534 students were enrolled in the study. Students preferred working in paediatrics, emergency departments and operating theatres, and these preferences were consistent in all of the three years. Psychiatry and geriatrics were the clinical areas least preferred in all the three years. Age, gender, nationality, and university attended were the factors that predicted students' preferences for specific clinical areas.

CONCLUSIONS

In line with international literature, students attending Italian nursing schools expressed preferences for working in some clinical areas and to disregard others. Nursing curricula and internships need to be reviewed in terms of declared and hidden curriculum in order to enable students to view all areas of practice as equally valuable.

Nutrition students improve attitudes after a guided experiential assignment with older adults

OBJECTIVE

Develop, implement, and evaluate an intervention (a guided experiential assignment) to improve nutrition students' attitudes toward working with older adults.

DESIGN

A quasi-experimental design with an additional qualitative component (mixed methods).

SETTING

A North Central land-grant university.

PARTICIPANTS

100 college students from an upper-level community nutrition course.

INTERVENTION

Students were randomly assigned to conduct a guided experiential assignment (dietary behavior change project) working with either an older adult (intervention, n = 52) or a younger adult (comparison, n = 48). Each student conducted 3 client interviews and completed a project report by responding to reflective questions about changes in beliefs, values, and self-efficacy in working with older adults.

MAIN OUTCOME

The primary outcome was attitudes toward older adults as changed in reference to students' beliefs, values, and self-efficacy in working with other adults. Additional outcomes were knowledge of aging and interest in working with older adults.

ANALYSIS

General linear model multivariate/univariate analysis and content analysis were conducted on the quantitative and qualitative data, respectively.

RESULTS

The intervention group had significantly increased scores on attitudes toward older adults relative to the comparison group. This finding appeared as a result of changes in beliefs about older adults and the increased value and self-efficacy in working with this group by most students in the intervention group.

CONCLUSION AND IMPLICATIONS

Completion of a guided experiential assignment with older adults in the community was an effective method to improve students' attitudes. Used in the curriculum for nutrition students, this technique might help to improve both attitudes toward and self-efficacy in working with older adults.

Nursing Students' Perceptions of Self-Determination in Elderly People

The purpose of this study was to compare nursing students' perceptions of self-determination in elderly patients before and after clinical training in long term care institutions as a part of their course in gerontological nursing. A pre- post-test design was employed. The data were collected by questionnaires completed by students at one nurse education organization college in Finland (pre-test n ± 120, response rate 95%; post-test n ± 115, response rate 91%). The students' perceptions of elderly patients' self-determination were more positive after their clinical training period concerning to what extent elderly patients are able to control their treatment and what kind of support they received from nurses to exercise their self-determination. The students' perceptions remained stable concerning how important self-determination is to elderly patients, and how willing and knowledgeable they are about using their self-determination. Ethics teaching, together with high quality clinical training placements, should be assured early during nursing studies.

Introducing Baccalaureate Student Nurses to Gerontological Nursing

The faculty at the University of Missouri-Columbia Sinclair School of Nursing (MUSSON) developed and implemented a gerontological nursing care course, with support from the Health Resources and Services Administration, the American Association of Colleges of Nursing, and the John A. Hartford Foundation. The course, with both didactic and clinical components, was mandatory for all students in the baccalaureate program. The course drew on two resources unique to the MUSSON: Senior Care, the school's home care agency, and TigerPlace, a retirement community closely linked to the school. Goals of the course were to increase knowledge of gerontology and gerontological nursing and to promote more positive student attitudes toward older adults. Evaluation of six semesters of pretest and posttest data found that knowledge increased although attitudes toward older adults did not become more positive. However, despite the lack of quantifiable improvement in attitudes, some students wrote positive comments on end-of-semester course evaluations about experiences and interactions with older adults during the course.

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.

The nature of long-term care nursing work

Data from a pilot study on the nature of nursing work in long-term care (LTC) facilities are compared with data on nursing work in intensive care units (ICUs). The comparison suggests that the LTC nursing work environment is a complex, demanding, and interesting one that is different from, not less than, nursing work in acute care environments. The data also suggests that nursing educators and researchers should reconsider LTC nursing work environments. Long-term care nursing offers an ideal, relatively controlled environment for research on what nursing work is and how nursing interventions affect patient outcomes. Long-term care nurses, whose daily work has always involved working with a variety of professional and unlicensed staff members, can serve as models for delegation and interpersonal skills. Finally, the LTC setting offers the ideal environment for clinical sites in connection with the proposed curriculum changes in end-of-life care for patients and their families.

Gerontology Coursework in Undergraduate Nursing Programs in the United States: A Regional Study

Because of the changing demographics, it is increasingly necessary for nurses to acquire competence in gerontology. In this article, the authors present the findings of a study investigating the extent to which undergraduate nursing programs in the United States include gerontology. Fifty-six undergraduate nursing programs in the United States were examined. In this study, course content and program curricula were examined to assess the extent to which programs include gerontological content, either integrated into other courses, or as required, stand-alone courses. The sample was randomly chosen from the Northeast, South, West and Midwest regions. All programs were accredited. More than 85% of programs evaluated did not require coursework in gerontology. The authors suggest that nurses are not being educated adequately to care for older adults.

Positively influencing student nurse attitudes toward caring for elders: results of a curriculum assessment study

Exposure to gerontological content has been shown to positively influence student attitudes toward elders. Our School of Nursing recently phased out one curriculum while implementing a new integrated curriculum. In the former, aging content was presented in a first-semester senior course. In the new curriculum, students were introduced to aging concepts in first-semester junior courses and additional content was integrated throughout the program. The purpose of this study was to evaluate the effectiveness of the new integrated curriculum compared to the former in positively influencing attitudes toward caring for elders. An attitudes questionnaire was administered at 3 time points to students in each curriculum. Both groups, but particularly the integrated group, demonstrated statistically significant improvements in attitudes over time.

Influencing Aspects in Nursing Education on Swedish Nursing Students' Choices of First Work Area as Graduated Nurses

It is difficult to recruit RNs to positions in various areas of elder care. The aim of this study is to understand the meaning of Swedish nursing students' reasoning during education about where in the health care system they would like to work as RNs after graduation. The students were interviewed using the same guide at the end of each of their three academic years. In the second and the third year the students kept diaries about their clinical education. A phenomenological-hermeneutic method of analysis was used, and eight themes appeared vital for the students' choice of work area after graduation. The deeper interpretations of the results imply that the students received contradictory messages during the education in elder care. Students found that nurses working in this field were often isolated with no apparent support system, which in turn reinforced their own ambivalence and reluctance towards future work in elder care.

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.

Gerontological nursing content in baccalaureate nursing programs: findings from a national survey

Given the prevalence of elderly people in the health care system, it behooves the nursing community to assure that every nurse graduating from a baccalaureate nursing program has a defined level of competency in care of the elderly. To accomplish this, it is necessary to establish a baseline of the current status of geriatric content in the baccalaureate curriculum. This article provides such baseline data using the findings of a national study of geriatrics in baccalaureate nursing programs. The study, conducted in 1997, was distributed to the universe of baccalaureate nursing programs (n = 598). The findings are based on a respondent pool of 480 programs (80.3 per cent response rate). The survey covered a range of educational topics, including curriculum, content, faculty preparation, and how programs define their needs for further curriculum and faculty development. The data analysis included the identification of baccalaureate nursing programs with exemplary offerings in geriatric care. Finally, in the discussion section, recommendations are advanced for the full integration of geriatric content into baccalaureate nursing programs.

Senior centers. Shifting student paradigms

The purpose of this study was to evaluate an innovative service learning experience for new nursing students involving senior citizen centers. Junior nursing students (n = 128) were assigned in cohorts to one of five centers for a 5-week rotation. A questionnaire was administered post hoc to the students, teaching assistants, center directors, and a sample of senior citizens at each site. The majority of students believed the experience was a valuable part of the curriculum and saw prospects for community health nursing roles. However, they had concerns regarding losing time in acute care and relevance and number of assignments, and reported some difficulty in applying classroom content in the setting. Directors and senior citizens were universally positive about the experience. Student and teaching assistant reports were key in revising the curriculum. Revisions include logistics of the placement of the experience and assignments as well as incorporation of this experience within the community context.

First-year Swedish nursing students' experiences with elderly patients

Nursing students' attitudes toward elderly people have frequently been found to be negative. This study's aim was to describe the experiences of first-year nursing students with elderly people. Thirty students from 3 Swedish nursing colleges, interviewed during the last weeks of their first year, were asked to describe a memorable event that had occurred when they were caring for an elderly patient. The narratives were analyzed phenomenologically. Three perspectives emerged: the students' perceptions of the patients, the staff's roles, and their own roles. From these, two phenomena were identified: patients' helplessness and students' identification/nonidentification of the individual patient. Students described difficult situations for elderly patients; patients with difficult diseases, anxiety, pride; and conflicting views of how to treat patients.

Baccalaureate Student Gerontological Nursing Experiences: Raising Consciousness Levels and Affecting Attitudes

The purpose of this study was to evaluate perceived learning and attitude changes of nursing students (n = 144) toward care of the elderly population as a result of a senior capstone course in gerontological nursing. Theory content emphasized maximizing individual capabilities of the elderly and quality of life. Clinical placements occurred in a variety of community and institutional settings, with a wide spectrum of elderly. Student attitudes were assessed using researcher-designed tools for quantitative and qualitative outcome measurements. Significant improvements in student attitudes were found (p < 001). Community-based settings provided significantly more positive experiences (p < .05) compared with institutional care. Qualitative findings revealed students gained positive awareness plus growth in professional abilities. We conclude that a senior capstone course with multi-site, independent, innovative projects can produce positive attitudes and heightened consciousness regarding gerontological nursing. Other nurse educators can benefit from these findings.