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Survey of registered nurses' attitudes toward elderly patients

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Survey of registered nurses' attitudes toward elderly patients

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Content SURVEY OF REGISTERED NURSES' ATTITUDES TOWARD ELDERLY PATIENTS by Sung Ja, Kho A Thesis Presented to the FACULTY OF THE SCHOOL OF GERONTOLOGY UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE (Gerontology) December 1994 UNIVERSITY OF SOUTHERN CALIFORNIA LEO N A R D DAVIS SCH O O L O F G ER O N TO LO G Y University Park Los Angeles, CA 90089 This thesis, written by _________ kl-fO,____ 4 U i / C j 7 A ____________________ under the director of b ets' Thesis Committee, and approved by all its members, has been presented to and accepted by the Dean of the Leonard Davis School of Gerontology, in partial fulfillment of the requirements for the degree o f ___________________________________________________ Dean Date 27; TH ESIS CO M M ITTEE / i w / / ____________________________________ Chairman ' / aJ j U jU Ifa • _____________________________ ii TABLE OF CONTENTS Page LIST OF TABLES.................................... iv ABSTRACT.......................................... V Chapter I. INTRODUCTION................................ 1 The Problem The Purpose Obj ectives Limitations of the Study 11. REVIEW OF THE LITERATURE................... 9 Age Experience Geriatrics Education Formal Education Level Race/Ethnicity Family Background Job Satisfaction Nurses' Preferences for Work with the Elderly III. STUDY QUESTIONS AND HYPOTHESES............. 21 Methods Sample Data Collection Measurement IV. RESEARCH FINDINGS.......................... 26 Nurses’ Preferences for Work with the Elderly Education Degree Year of Graduation Location of Nursing Program Education in Gerontology Year of Licensure Years of Experience Elderly Relatives Living at Home Age Racial/Ethnic Background Results iii chapter IV (Continued) Pape Nurses1 Attitude Toward the Elderly and Mean Score Nurses' Job Commitment and the Relationship with Attitude Nurses1 Satisfaction in Work with the Elderly V. DISCUSSION 52 Suggestions for Further Study REFERENCES 56 APPENDIX 62 iv LIST OF TABLES Table Page 1. Characteristics of the Sample and Preferences for Work with the Elderly................................... 27 2. Mean Score of Nurses' Attitude Toward the Elderly ..................... 36 3. Nurses' Career Commitment to Work with Elderly Patients........................ 42 4. Nurses' Satisfaction in Work with Elderly Patients ............................ 48 V ABSTRACT The number and proportion of elderly in the United States will increase within the next few decades thereby increasing proportionally the demands for professionals to work with elderly clients. There have been many studies that have examined nurses' attitudes and preferences for work with the elderly; however, the result of previous research is s omewhat inconclus ive. In the present study of nurses who are working with elderly patients, no relationship was found between the independent variables (education degree, year of graduation, location of nursing program, gerontological education, year of licensure, years of experience, elderly relatives living at home, age) and preferences for work with the elderly. However, a significant relationship was found between race/ethnicity and preferences for working with this age group among nurses. Nurses who had a higher education degree, longer experience living with or caring for an elderly person, and who were older were found to have stronger job commitment and higher satisfaction from working with the elderly. 1 CHAPTER I INTRODUCTION The number of old-old persons over 85 will increase dramatically in the next few decades, and there will be more demand for professionals to work with older clients. According to recent population profiles, there were 31.6 million people aged 65 or older in 1990, and the number will continue to increase (American Association of Retired Persons & Administration on Aging, 1991). By the year 2000, it is estimated that 13.1% of the population will be 65 or over and 1.7% of the population will be 85 or over. The most rapid growth will occur in the number and proportion of persons aged 85 and over. Increasing age is associated with the utilization of health and social resources. Persons aged 65 and over use health care at a rate more than three times higher than younger cohorts (American Association of Retired Persons & Administration on Aging, 1987). The impact of chronic health problems increases with age. Of those 85 and older, more than 60% had one or more functional deficiences (Institute for Health and Aging, 1985) . Thus, those 85 and older have the greatest need for services. This population growth will contribute to the increased demand for all personnel, especially nurses. Therefore, professional nurses are expected to assume a significant role in responding to the future health care needs of older people (NIA. Projections, 1985). In order to do so effectively, it is important to identify variables that influence nurses' service to older people, especiallly their atti tudes toward older people. During the past 40 years, there has been a large number of studies of attitudes of nurses toward growing old and older people (Brower, 1985; Gomez et al., 1985; Schoer, 1993; Winger, 1986). These studies showed that nurses' attitude were generally rather negative. Furthermore, research suggests that nurses, as a group, prefer not to work with older patients (Kayser & Minnigerode, 1975; Williams, Lusk, & Kline, 1986). However, little has been done to investigate nurses' satisfaction from work with the elderly population. By evaluating attitudes and job satisfaction of nurses, as well as preferences for work with the elderly population, a determination can be made about the quality of care given to old people today and what can be expected in the future. 3 The Problem The problem which motivated this study was the evaluation of attitude, job satisfaction and work prefer ence of registered nurses working with an elderly popula tion in the acute hospital setting. The reason the acute hospital setting was chosen was because of easy access to the sample. The researcher has been working as a regis tered nurse at St. Vincent Hospital for more than five years. The increasing demand for registered nurses to work with elderly patients is evident in an acute hospital setting. Health care professionals can expect to spend as much as 75% of their time with the elderly (Butler, 1980) , and those working in hospital settings can anticipate that 40% of their beds will be occupied by persons 65 and over each day (Ferrini & Ferrini, 1989). But, studies show that registered nurses are not adequately prepared to work with the elderly population in the acute hospital, possibly due to inadequate gerontology and geriatric education (Hucksadt, 1993; Joel, Baldwin, & Stevens, 1989), resulting in an appropriate knowledge deficit (Dye & Sassenrath, 1979). According to Gwyneth (1990), attitudes of trained staff are found to be quite neutral toward the elderly. Nolan (1993) noted that nursing care for the elderly at the present time does not represent the best solution and that there is a need for a fundamental re-appraisal of sources of job satisfaction for nurses working with elderly patients. Also, Gwyneth (1990) noted attitudes of trained staff are found to be quite neutral in their beliefs about the elderly. Ageism, a term first described by Robert Butler, MD, means that the elderly are devalued simply because they are old. It is disturbing to think that health care profes sionals have a negative bias in caring for elderly pa tients, especially since many patients are old. A number of studies have shown that attitudes of student nurses and nursing-care providers are generally rather negative (Benson, 1982) . Negative or neutral attitudes may be associated not only with job preferences but also with quality of care and patient outcomes. While empirical support for this assertion is limited, research conducted by Hatton (1977) indicated that a direct association may exist between nurses' attitudes and the percentage of their interactions with older patients that are positive. Although Hatton's results, which were based on observations of only seven nurses, did not reach statistical significance, they strongly suggested that further research should be conduct ed in this area. Other research has documented that health care personnel's positive attitudes as perceived by patients may contribute to recovery or rehabilitation. (Winger, 1986). Reed (1992) and Tibbitts (1979) are suggesting that negative stereotypes of older people in American society were giving way to more favorable percep tions at both the societal and professional levels. There are many factors that influence nurses' attitudes toward elderly patients, nurses' job satisfaction and preferences for work with the elderly. Therefore, this study focused on the age, education (content, place, and year), experience, race, and family background of nurses. The Purpose The primary purpose of this study was to examine whether registered nurses' age, education (content, place, and year), experience, race, and family background related in a positive manner to their attitudes, job satisfaction and preferences for work with the elderly. The study was designed to obtain information regarding nurses' attitudes toward elderly patients, job satisfaction, and preference for work with elderly patients in the acute hospital setting. There were three targets to this study: nurses' preferences for work with elderly patients, nurses' attitudes toward working with elderly patients, and the relationship between attitudes toward working with elderly patients and perceived career commitment and job satisfac tion among registered nurses. 6 The first purpose of the study examined nurses' attitudes toward the elderly patient. Nurses' attitudes were examined and compared to their level of education (content, place, year of graduation, and degree) , licensure and personal information (year of licensure, experience), and personal information (family background, age, and race). The second aspect of the study was to assess the variables which are associated with nurses' preferences for work with elderly patients. Third, the study examined career commitment and job satisfaction among registered nurses. In this way, variables could be identified that affect nurses' attitudes; thus finding a way to improve provision of health care for the elderly population. Objectives Nurses' attitudes towards old people have been the subject of much research in recent years. These studies show nursing is not immune to society's negative views of the aged (Elmore, 1964? Fisher, 1977? Maddox & Tillery, 1988). Researchers have attempted to determine which factors can improve nurses1 attitudes for work with elderly patients. But, little effort has been directed toward identifying nurses' job satisfaction and preferences for work with elderly patients in the acute hospital setting. Since the elderly are major users of health services (Owen, 1976) and nurses are primary providers of care for the elderly (Bagshaw & Adams, 1986), measuring nurses' atti tudes, satisfaction, and preferences for work with the elderly population are crucial factors to improving health care for the elderly population in the future. Limitations of the Study The study has five noteworthy limitations: 1. Registered nurses from one acute hospital (St. Vincent Medical Center, Los Angeles) participated in the survey, therefore, results of the survey are reflective only of this group and may not reflect the overall opinions of registered nurses. 2. By using accidental sampling, 75 registered nurses from St. Vincent Medical Center, Los Angeles, participated in the survey. Thus, sample size and method of sampling limits the generalizability of the findings even within this location. 3. Limited in sample size, the sample is nonrepre sentative of nurses in general but reflects the varying ethnic composition of nurses working in this hospital. (7.0% Hispanic, 22.0% white, 7.0% black, 30.0% Asian, 2.9% Pacific Islander, 29.0 Filipino, 1.0% Other). 4. The indication of years of experience as a nurse was based on time in the United States only, without inclusion of experience in a foreign country. 5. There was inadequate isolation of potentially confounding variables such as age, education, race, and experience. 9 CHAPTER II REVIEW OF THE LITERATURE A person1s image is very much influenced by societal views. Self-perceptions are very much shaped by the messages from others regarding their perception (Ward, 1984) . Society in The United States remains youth-oriented and continues to value productivity, physical performance, and physical appearance (Gioella, 1985) . Unfortunately, society's attitude that it is miserable to grow old has been shared by many health professionals (Carroll, 1993). Often they have little motivation or incentive to work with older people. It is still relatively unprestigious, and a number of health professionals still believe that when it comes to the distribution of resources and services, elderly people are among the least deserving (Kermis, 1987). Nursing students (Gillis, 1973; Gunter, 1971; Kayser & Minnigerode, 1975) and registered nurses (Camp bell, 1971; Gillis, 1973; Kayser & Minnigerode, 1975) have expressed unwillingness or reluctance to work with elderly clients in general hospitals and nursing homes compared with clients in other age groups. 10 Identification of variables that influence nurses' attitudes toward older people has been attempted by a number of researchers (Campbell, 1971; Carmel et al., 1992; Giardina-Roche, 1990). Variables examined include age, educational level (degree, content), experience, family background, and race. Despite the number of studies conducted, there is little agreement regarding which of the variables has a significant influence on attitude. Age Several studies were designed to examine the relationship between age and the attitude of registered nurses toward older people (Brower, 1981; Campbell, 1971; Gillis, 1973; Meyer, Hassanein, & Bahr, 1980). In 1985, Gomez et al. conducted a study to find the relationship between age and attitudes toward older people. It was noted that subjects in the older age group (34 to 41 years old) had a much more positive attitude toward aging than did the younger age group (19 to 33 years old). This can be explained, perhaps, because the older-aged group of subjects had parents closer in age to their elderly patients and they were getting old. This finding has pedagogical implications that suggest younger-aged students require additional consideration when the nurturing of positive attitudes toward the elderly is an objective 11 (Gomez, 1985). O'Hanlon et al. performed a study to examine the relationship between age and either knowledge of or attitude toward aging. In general, older subjects had higher knowledge scores and more positive attitude scores than did younger subjects (O'Hanlon et al., 1993). Taylor and Harned (1978) also considered the age variable. They reported that all scores were within the positive to neutral range, with younger nurses scoring more positively than did older nurses. However, they did not report whether the difference was statistically significant, because age is confounded with years of experience with both nursing in general and work with old people in particular. Thus, while the Gomez and O'Hanlon studies showed a strong association between age and attitudes toward old people, other studies have failed to demonstrate such an association (Holtzman & Beck, 1981; Taylor & Harned, 1978). Experience Nurses are the primary care providers for the elderly (Bagshaw & Adams, 198 6). Numerous studies have examined whether experience is associated with attitudes of nurses toward the elderly. Attempts to determine attitudes toward the elderly have been characterized by the same problems which have prevailed in other attitude research. Consistency between 12 attitude and experience has been difficult to demonstrate, but there are some approaches that show a relationship between attitude and past experience. Giardina-Roche (1990) performed a study to examine whether past experience among nurses had an association with attitudes towards old people. It was noted that education, age, and sex of the subject had no significance in the attitudes of nurses. However, nurses with more positive experience in the past with the elderly indicated more positive attitudes towards elders. Thus, nurses' attitudes have been related to the characteristics of the patients for whom they care. Brown (1971) noted high negative correlations between the attitude scores and negative behaviors such as incontinence and soiling behavior. Fielding (1979) also investigated the relationship between nurses' attitudes and experience. She found a significant variation in nurses' ratings in that continuing care ward patients were rated significantly more negatively than were day hospital patients. On the other hand, other researchers (Hart et al., 1976; Gomez et al., 1985) have demonstrated a change in the attitudes of nurses toward older people in a positive direction. Gerda noted that there was a signifi cant increase in positive attitudes toward the elderly among beginning baccalaureate nursing students immediately after a three-week clinical experience with the ill elderly 13 in nursing homes (Gerda, 1985). Also, Hart et al. found when students had a guided learning experience with ill elderly following a structured experience with healthy elderly persons, their attitudes were about as positive as those of students who had had only structured contact with the healthy elderly. Thus, while the Giardina-Roche (1990) , Brown (1971) , and Fielding (1979) showed a positive association between past positive experience and attitudes toward old people, other studies showed a positive association between experiences whether positive or negative and attitudes toward old people (Hart et al., 1976; Gomez et al., 1985; Gerda, 1985). Geriatrics Education Numerous studies have been performed to evaluate the effects of courses in gerontology on changes in knowledge, attitudes, and work preferences among nursing. Several studies have suggested that nursing students have inade quate knowledge about aging (Dye & Sassenrath, 1979; Holtzman & Beck, 1981; Hucksadt, 1983; Palmore, 1980; Reed et al., 1992). These studies support the contention that many nursing education programs lack sufficient gerontology content (Hucksadt, 1983; Joel, Baldwin, & Stevens, 1989; Johnson & Connelly, 1990a; Tappen & Brower, 1985) or consistent gerontology content (Johnson & Connelly, 1990b) . Reed (1992) found these knowledge deficits made nurses 14 ineffective in working with older people. Also, Reed (1992) found that nurses tended to identify these barriers as directly related to the structure and process of education, including inadequate curriculum time and a lack of academic role models. Some approaches designed to induce positive attitu- dinal changes toward older people were implemented with nursing students, but were largely unsuccessful. Gunter (1971) found that fewer students expressed an interest in working with older people following a course in gerontolog ical nursing than had done so at the beginning of the course. Tollett and Thornby (1982) demonstrated that the amount of geriatric and gerontology content in courses did not appear to influence students' attitudes about older people. Dye (1979) concluded, in a study of registered nurses enrolled in graduate study, that attitudes held by the participants were powerfully resistant to change. Carmel et al. (1992) conducted a study to find the rela tionship between knowledge, attitudes, and preferences among social work, medical, and nursing students. No significant changes in the level of knowledge and in the attitude and work preferences of any of the studied groups was found. Carmel et al. (1992) concluded that there was no correlation among knowledge, attitudes, and work preferences within each of the three groups which implies that increased knowledge about the elderly does not 15 necessarily lead to changes in negative attitudes and work preferences. On the other hand, certain researchers (Hart, Freel, & Crowell, 1976? Heller & Walsh, 1976? Wilhite & Johnson, 1976) have demonstrated some success in changing the attitudes of nurses toward old people in a positive direction. Thus, these findings suggest a need for didactic and experiential learning opportunities for nursing students. Advanced level of education appears to be associated with decreased stereotyping of the aged, but it does not seem to increase preferences for working with the aged (Campbell, 1971). Formal Education Level Several studies were conducted to compare the attitude of nurses with different academic degrees towards the elderly. As with other studies, consistency of the relationship between degree and attitudes toward the elderly was difficult to demonstrate. Campbell (1971) investigated whether level of degree had any affect on attitude. Campbell hypothesized that nurses with a Bachelor of Science Degree would have more positive attitudes than those with an Associate Degree, diploma, or credits in courses. But, the results were not as hypothe sized. Campbell found nurses with Associate Degrees or diplomas had the most positive attitudes. Campbell 16 explained this was because those with Associate Degrees or diplomas had more direct contact with old people than did the RNs, whose work may be more administrative. On the other hand, certain researchers (McCabe, 1989; Brower, 1985; Taylor & Harned, 1978) have demonstrated more positive attitudes toward the elderly among nurses who held administrative or nursing faculty positions. McCabe (1989) found nurses in such positions would be more likely to have attained higher levels of education than nurses in staff positions. Thus, the liberalizing effect of higher education may partially account for the more positive appraisal of older people. In addition, nurses who function as faculty members or administrators may interact with the older client differently than do staff nurses. Not having to face the challenge of dealing with the needs of older people on a day-to-day basis may allow these nurses to maintain a more positive attitude. Gillis (1973) suggested that one reason for Bachelor Degree nurses not having more positive attitudes might be that their curriculum did not include specialized gerontol ogy nursing theory or experience. Thus, these findings show a lack of association between formal education level and attitudes towards old people. Including gerontological nursing theory or experience might increase positive attitudes toward the aged (Gillis, 1973). 17 Race/Ethnicity There are very few studies that have investigated attitudes toward the elderly among different races and ethnic groups. Burge (1978) examined the possible influ ence of race, sex, and religion on nurses' attitudes. Burge reported that race was significantly related to stereotype acceptance, whereas sex and religion were not. However, the study lacked credibility in that there was no numerical data to support the findings; the levels of statistical significance were not reported and the measure of race might have been confounded with socioeconomic status which was not controlled. Gomez et al. (1985) examined the influence of race on nurses' attitudes by employing tests before and after the clinical practicum. Ethnicity had two levels— black and white. Three Hispanic and two East Indian students were excluded from the sample. Gomez et al. (1985) found that the white students had a more positive attitudinal score than did the black students. No pre- to post-differ- ences in attitude indicated stability. Thus, while the Gomez et al. (1985) studies showed an association between race and attitude toward old people, the Burge (1978) study lacked credibility to supporting this finding due to no report of statistical significance and no control of variables such as socioeconomic status. 18 Family Background Intergenerational relationships have been studied for decades. One seemingly unilateral conclusion emerges: relationships between grandparents or significant elders and youth have positive potential. These relationships have been documented to be beneficial in counteracting stereotypes younger people have about old age (Corbin, Kagan, & Metal-Corbin, 1987) , providing youth with histori cal awareness and perspective (Peacock & Talley, 1984; Tice, 1985), and providing friendship and preventing isolation of the elderly (Aday, Rice, & Evans, 1991). Kennedy (1990) investigated college students’ perceptions of relationships between grandparents and grandchildren and found them generallly positive, indicating affection and respect for grandparents. The female tendency toward nurturance often recognized in gender studies was distinc tive in this study. Also, black students saw the grandpar ent role as more active in their family life than did white students. This was consistent with findings that black grandmothers were more likely to retain authority over rearing of grandchildren (Cherlin & Furstenberg, 1985). Kennedy suggested further research was needed to relate attitudes and experiences of students of other races between childhood and young adult years to examine changes in grandparent contact between childhood and young adult years. Job Satisfaction Nurses' high turnover rates have plagued the profession for many years. Therefore, many empirical studies of nurses' job satisfaction and its causes and its outcomes have been conducted. The search for the causes of satisfaction has been extensive and fruitful; however, the relative importance of the many identified factors remains unclear. Blegen (1993) suggested job satisfaction was a complicated phenomenon, influenced by many variables. Therefore, it is important to identify the variables which have the largest and most consistent effects. Blegen (1993) performed a study to identify variables which had the largest and most consistent effects on nurses' job satisfaction. Blegen found thirteen variables that are associated with nurses satisfaction (stress, commitment, communication with supervisor, autonomy, recognition, routinization, communication with peers, fairness, locus of control, age, years experience, education, professional ism) . Blegen found that job satisfaction for nurses was most strongly related with stress (negatively) and commit ment (positively). Thus, stress was identified as a variable which has been strongly related to human service workers (Maslach, 1982). Nurses who were older were more satisfied and those with more education were less satisfied 20 with their work. No relationship between years of experi ence and satisfaction was found (Blegen, 1993). Nurses' Preferences for Work with the Elderly The elderly are often perceived as physically disabled, mentally deteriorating, socially withdrawn, and economically nonproductive (Williams, Lusk, & Kline, 1986) . Such negative stereotyping, common in American society, is also found among other professionals and students. A number of studies have shown that attitudes of student nurses and nursing-care providers are generally rather negative (Benson, 1982), they prefer not to work with older patients (Kayser & Minnigerode, 1975; Williams, Lusk, & Kline, 1986) , and they have a lack of knowledge about old people (Reed et al., 1992). Therefore, Reed suggested developing didactic and experiential learning opportunities for students in nursing professions. However, according to the studies of Gomez et al. (1985) and Carmel et al. (1992), advanced education in gerontology appears to increase knowledge and positive attitude toward the elderly, but does not increase the preference for working with the aged. 21 CHAPTER III STUDY QUESTIONS AND HYPOTHESES This study was designed to answer the following questions: 1. What are the variables which are associated with nurses preferring to work with elderly patients? 2. What are the variables associated with nurses1 positive attitudes toward working with elderly patients? 3. What is the relationship between attitudes toward working with the elderly and perceived career commitment and job satisfaction among registered nurses: The following hypotheses were tested. 1. There will be significant differences in attitudes toward and preferences for work with elderly patients by degree, age, education, and experience. Specifically, (a) Nurses with master's degrees will show more positive attitudes and preferences for work with elderly patients. (b) Nurses who are older will have more positive attitudes and stronger preferences for work with elderly patients. (c) Nurses who have completed gerontology education will have more positive attitudes and stronger preferences for work with elderly patients. <d) Nurses with clinical experience with elderly patients will have more positive attitudes and stronger preferences for work with elderly patients. (e) Nurses who have had personal experience with the elderly will have more positive attitudes and stronger preferences for work with elderly patients. 2. There will be differences in career commitment and job satisfaction among registered nurses by education, age, gerontology education, and clinical and personal experience. Specifically, (a) Nurses with higher education will show more positive scores on career commitment and job satisfaction. (b) Nurses who are older will have more positive scores on career commitment and job satisfaction. (c) Nurses who have completed gerontology education will have more positive scores on career commitment and job- satisfaction. (d) Nurses with more clinical experience with elderly patients will have more positive scores on career commitment and job satisfaction. (e) Nurses who have had personal experience with the elderly will have more positive scores on career commitment and job satisfaction. 23 Methods Sample The population sampled was all registered nurses who were working full-time at St. Vincent Medical Center in 1994. Among 75 respondents, 10 were from the night shift and 65 were from the day shift. Ages ranged from 23 years old to 70 years old and the sample was ethnically diverse. Participants were 7.0% Hispanic, 22.0% white, 7.0% black, 3 0.0% Asian, 2.9% Pacific Islander, 29.0% Filipino, 1.0% other. Females were predominant (97%). Of the partici pants 22.0% were reported living with elderly relatives at home. Registered nurses were selected randomly from each unit such as medical intensive care unit, coronary care unit, and medical unit. There were 120 questionnaires distributed and 75 were returned. No follow-up was performed for those registered nurses who did not respond. While nothing is known about nonrespondents it is possible that nurses who did not respond might have had negative attitudes toward the elderly. Data Collection A structured questionnaire was used for data collection. The study employed two methods of data collec tion: by mail and personal collection. Seventy-five questionnaires were send out by mail and only 30 returned. Because of this low mail response rate the researcher chose 24 personal distribution. The handing out 45 questionnaires to the available sample and picking up all 45 in person on the same day. All data collection was conducted in March and April of 1994. Measurement The Kogan Old People Scale was used to measure the attitudes of registered nurses toward the elderly. The reliability and validity of the scale was presented by Kogan (1961). The nurses were asked to circle the answers on a series of questions (11-26 in the questionnaire in the Appendix) indicating whether they strongly disagreed, disagreed, slightly disagreed, slightly agreed, agreed, or strongly agreed with a number of statements. These 17 questions were selected from the Kogan Old People Scale. Nine of these questions were worded in the negative mode and eight questions were worded in the positive mode. The responses were scored 6, 5, 4, 3, 2, l or 1, 2, 3, 4, 5, 6, respectively, depending upon whether the statement favored old people or was negative towards the elderly (strongly disagree=l, disagree=2, slightly disagree=3, agree=4, slightly agree=5, strongly agree=6). The scores for the 17 questions were computed for each nurse. The scores for all 17 answers were summed and mean scores for each individual were obtained by dividing by 17. Average scores on the scale were computed for categories of each independent 25 variable (education, year of graduation, location of nursing program, education in gerontology, year of licen sure, years of experience, elderly relatives living at home, age, racial background. Table 2 provides the mean scores for these categories of each independent variable. Registered nurses' satisfaction for working with the elderly was ranked on a scale of 1 to 3 (1-very satisfying, 2-somewhat satisfying, 3-not so satisfying). This was scaled so that lower scores represent high satisfaction from working with the elderly. The distribution of responses for each category of independent variable (education, year of graduation, location of nursing, education in gerontology, year of licensure, years of experience, elderly relative living at home, age, ra cial/ethnic background) is reported in Table 1. Registered nurses' commitment for work with the elderly was answered with yes or no to one question: I am planning to stay in my present job for 5 years or more. The assumption was made that nurses' commitment to say in their present job represents nurses' commitment to work with the elderly, because more than 90% of patients with whom nurses in his study worked were over 65 years old. The percent saying yes for each category of each indepen dent variable is reported in Table 3. 26 CHAPTER IV RESEARCH FINDINGS Nurses' Preferences for Work with the Elderly The questionnaire was returned by 75 nurses, giving a response rate of 62.5%, but 6 did not answer the question about their preferences for work with the elderly. There fore, this section was based on 69 respondents with the following education: 24 with diplomas, 18 with associate degrees, 26 with baccalaureate degrees, and 1 with a master of science in nursing degree. The respondents ranged from 23 to 7 0 years of age, with the mean age being 40.5. Graduates from the U.S.A. numbered 34; 21 were graduates from the Philippines; 1 was a graduate from Canada; 3 were graduates from England; 5 were graduates from Korea; 4 were graduates from Hong Kong; and 1 was a graduate from Israel. About 22% of them reported never having had a course that dealt specifically with aging. About 55% of them reported from 8 to 21 years of experience on average. Table 1 shows the number and percentage in each response category variable as well as the distribution of preferences of registered nurses for work with the elderly. As can be seen, respondents' scores for preferences for 27 work with the elderly were rather low. Only 31.88% of the respondents preferred to work with the elderly. Table 1 Characteristics of the Sample and Preferences for Work with the Elderly Preference Variable Number Percentage (% of yes) Degree Diploma 24 34.78 33.30 Associate 18 26.09 22.20 Baccalaureate 26 37.68 38.46 Master 1 1.45 0 Year of Graduation 1959-1965 4 5.80 25.00 1966-1975 23 33.33 34.78 1976-1985 26 37.68 26.92 1986-1992 16 23.19 31.25 Location of Nursing Program U.S.A. 34 49.28 41.18 Philippine 21 30.42 28.57 Canada 1 1.45 0 England 3 4.35 0 Hong-Kong 4 5.80 50.00 Korea 5 7.25 0 Israel 1 1.45 0 Gerontology None 15 21.74 13.3 3 Workshop 18 26.09 44.44 Less than half a course 13 18.84 38.46 Whole course without clinical experience 2 2.90 0 Whole course with clinical exper ience 21 30.43 33.33 28 Table 1— continued Variable Number Percentage Preference (% of yes) Year of Licensure 1959-1965 3 4.35 0 1966-1975 19 27. 54 42.10 1976-1985 31 44.93 29.03 1986-1993 16 23 .18 31.25 Years of Experience 1-7 years 23 33.33 26. 09 8-14 years 22 31.88 27.27 15-21 years 15 21.74 40.00 22-28 years 7 10.15 42.86 29-35 years 2 2 .90 50.00 Elderly relatives living at home Yes 15 21.74 26.67 No 54 78.26 33.33 Age 21-30 14 20.29 35.71 31-40 24 34.78 25. 00 41-50 22 31.88 36.36 51-60 6 8.70 16. 67 61-70 3 4.35 66. 67 Racial/ethnic background Hispanic 5 7.25 80. 00 White 15 21.74 33.33 Black/African 5 7.25 40. 00 Asian 21 30.43 28 .57 Pacific Islander 2 2.90 0 Filipino 20 28.99 25.00 Other 1 1.45 0 N=69 Total : Prefer Not prefer Mean Number : 32 47 Mean Percentage : 31.88 68.12 29 Education Degree The expectation was that registered nurses who had higher education or more direct contact with the elderly would express a greater preference for work with the elderly. But, the result did not show what was expected. About 38% of the 26 subjects who had baccalaureate degrees showed a preference to work with the elderly, and this was the group with the highest preference rate among the four groups. Actually, the registered nurses who had master's degrees showed the lowest preference rate among the four groups. However, the result which represents registered nurses' preference rate with a master's degree is seriously troubled by the sample size. Among the 69 respondents, only 1 respondent had a master's degree. Therefore, the result which represents nurses' preference rate who had master's degree is not presenting an accurate assessment of their group. Year of Graduation The effect of year of graduation on nurses' prefer ences for work with the elderly was also examined. The expectation was that registered nurses who graduated earlier would express a higher preference rate. However, the result shows those who graduated earlier tended to have less preference for work with the elderly than those who graduated more recently. The result shows that year of graduation was not significantly related to nurses' 30 preferences for work with the elderly as 25% of 1959-1965 graduates preferred to work with the elderly, 35% of 1966- 1975 graduates preferred to work with the elderly, 27% of 1976-1985 graduates preferred to work with the elderly, and 31% of 1986-1992 graduates preferred to work with the elderly. Notably, the group of 1966-1975 graduates showed the highest preference rate among all groups. This might be due to cohort differences or confounded with other vari ables. Again, this study was limited due to the method sampling (accidental sampling) and the lack of control for third variables. Location of Nursing Program The effect of the location of the nursing program on nurses' preferences for work with the elderly was examined. No prior studies were found which investigated the rela tionship between these two variables. Seven locations were included in this study: United States of America, Philip pines, Canada, England, Korea, Hong Kong, and Israel. The finding was that those who graduated the from United States tended to have a higher preference rate than those who graduated from outside the United States. Again, this study was limited due to sample size (N=69) and unequal sample distribution across locations. (United States=34, Philippines=21, Canada=*3, England=3, Hong-Kong=4, Korea=5, Israel=l). Therefore, it is hard to generalize this finding to describe the relationship 31 between location of nursing program and nurses' work preference. Education in Gerontology The effect of education in gerontology on nurses' preferences for work with the elderly was examined. Numerous studies have been done to evaluate the effects of courses in gerontology on changes in knowledge, attitudes, and work preferences among nurses. The expectation was that a combination of didactic and experiential educational opportunities in gerontology could improve attitudes toward the elderly in a positive direction among nurses (Gomez et al., 1985); although it does not seem to increase prefer ence for working with the elderly (Campbell, 1971). This study shows (Table 2) that 22% of nurses had no education in gerontology, and 13% of them showed a preference for work with the elderly, whereas among those nurses who had taken a workshop, less than half a course, or a whole course with clinical experience more than 30% expressed a preference for work with the elderly. No one preferred to work with the elderly among nurses who had whole courses without clinical experience. Thus, this study showed more work preference among nurses who had a combination of didactic and experiential educational opportunities than for those who had educational opportunities only. This finding is similar to that of the previous study done by Gomez et al. (1985). 32 Year of Licensure The effect of year of licensure in nurses' prefer ences for work with the elderly was examined. As can be seen in Table 1, those who graduated and received a license between 1966-1975 showed the highest preference score relative to the other three groups (42%). Those who received a license between 1959-1965 had the lowest preference in comparison to the other three groups (0%). However, comparisons of data are limited by the small sample size (N=69) and unequal sample distribution (1959- 1965=3). Years of Experience The effect of years of experience on nurses' preferences for work with the elderly was examined. There are numerous studies that have been conducted to examine the relationship between years of experience and nurses' preferences for work with the elderly. Consistency between attitude and experience has been difficult to demonstrate in previous studies. However, many previous studies show that nurses with more positive past experience indicated more positive attitudes toward elders. Table 1 shows a steadly increasing preference rate with more experience. But, comparisons of these data are limited by unequal sample distribution and the small samples in the two highest categories (29-35 years=2, 22-28 years=7). Elderly Relatives Living at Home The effect of elderly relatives living at home on nurses' preferences for work with the elderly was also examined. Relationships between grandparents and other intergenerational relationships have been studied for decades. Previous studies showed relationships between grandparents or significant elders and youth have positive potential. Therefore, the expectation was that the registered nurses who lived with elderly relatives would express a higher preference rate. But, the result of this study did not show what was expected. Table 1 shows 27% of nurses who lived with elderly relatives and 33% of nurses who did not live with the elderly preferred to work with the elderly. Thus, this study indicated an inconsistent and weak relationship between these two variables. Age The effect of age on nurses' preferences for work with the elderly was examined. Several studies have been conducted to examine relationships between age and nurses' preferences for work with the elderly. While some studies showed older subjects had higher knowledge and more positive scores than did younger subjects, other studies have failed to demonstrate an association between age and attitudes toward old people. As can be seen in Table 1, there was an inconsistent relationship between age and nurses' preferences for work with the elderly. This study 34 was limited due to the unequal sample distribution by age (51-60=6; 61-70=3) and the fact that third variables (education, experience, and so on) were not controlled. Racial/Ethnic Background The effect of racial background on nurses' prefer ences for work with the elderly was examined. There are very few studies that have investigated attitudes toward the elderly among different races. As seen in Table 1, Hispanics had the highest preference rate (N=5, 80%), Black/Africans had a 40% preference rate (N=5) , whites had a 33% preference rate (N=15), Asians had a 29% preference rate (N=21), Pacific Islanders had a 3% preference rate (N=2) , and Filipinos had a 25% preference rate (N=2 0) . This study showed Hispanic, black, and white nurses with higher preferences than Asian or Filipino nurses. But, this study was limited due to sample size (N=69) and the unequal sample distribution by race. Also, third variables (education, age, experience, and so on) were not controlled in this study. Therefore, it is difficult to generalize this finding to describe the relationship between race and nurses' preferences for work with the elderly. Results This study examined the relationship between nine independent variables and nurses' preferences for work with the elderly (Table 1). Among nine independent variables, experience was the only independent variable which was 35 related to nurses' preferences for work with the elderly. Table 1 shows a steadily increasing preference rate with more experience. But, this study was limited due to sample size (^69) , unequal sample population and lack of control for third variables. Therefore, it is difficult to generalize from these findings to describe the relationship between these nine independent variables and nurses1 preferences for work with the elderly. Nurses' Attitude Toward the Elderly The higher the resulting mean attitude score, the more positive the attitude toward the elderly expressed by the subject. As discussed in the preceding chapter, there were 17 questions selected from the Kogan Old People scale; nine questions were in the negative mode and eight ques tions were in the positive mode. Table 2 Mean Score of Nurses' Attitude Toward the Elderly Variables Number Mean score Degree Diploma 26 3.8 3 Associate 19 3.78 Baccalaureate 28 3.51 Master 2 3.44 36 Table 2— continued Variables Number Mean score Year of Graduation 1959-1965 1966-1975 1976-1985 1986-1992 Location of Nursing Program U.S.A. Philippine Canada England Korea Hong Kong Israel Gerontology in Education None Workshop or contin uing education Less than half a course Whole course without clinical experience Whole course with clinical experience Year of licensure 1959-1965 1966-1975 1976-1985 1986-1993 Years of experience 1-7 years 8-14 years 15-21 years 22-28 years 29-35 years Elderly relatives living at home Yes No 5 3.48 24 3.77 27 3.82 19 3.69 36 3.92 23 3.54 2 3.68 3 3.68 6 3.21 4 3.44 1 3.00 15 3.64 20 3.72 13 3.75 2 3.35 25 3.72 4 3.54 19 3.66 34 3.77 18 3.72 26 3.63 24 3.34 15 3.71 7 3.65 3 3 . 94 17 3.73 58 3.70 37 Table 2— continued Variables Number Mean score Age 21-30 16 3.64 31-40 25 3.63 41-50 22 3 .57 51-60 7 3 .71 61-70 5 3.72 Racial/ethnic background Hispanic 5 4.27 White 17 3.91 Black/African American 5 3.65 Asian 22 3.51 Pacific Islander 2 4.00 Filipino 23 3.55 Other 1 4.71 N=75; scoring: strongly disagree=l, disagree=2, slightly disagree=3. slightly agree=4, agree=5, strongly agree=6 This study was designed to investigate the consis tency of nurses1 attitudes and their preferences for working with the elderly. Educational degree of nurses was not consistently related to these two measures. Nurses who had a baccalau reate degree showed the highest preference rate (38.46%), but nurses who had a diploma showed the most positive (M=3.83) attitude toward the elderly. Nurses who had master's degrees showed the lowest preference rate (0%) for work with the elderly and attitudes (M=3.44) toward the elderly. 38 Year of graduation did not show consistency. While nurses who graduated in 19 66-1975 showed the highest preference rate (34.78%); nurses who graduated 1976-1985 showed the most positive attitude (M=3.82) toward the elderly. The nurses who graduated in 1959-1965 showed the lowest preference rate (25%) for work with the elderly and the most negative attitude (M=3.48). The location of the nursing program was relatively consistently related to these two variables. Since most of population was from the U.S.A. (N=34-36) and the Philip pines (21-23), this study compared these two countries. The sample representing the other countries was not analyzed due to scanty numbers. The nurses who finished their nursing education in the U.S.A. showed a higher preference rate (41.18%) and more positive attitudes (3.92) then nurses who finished their nursing education in the Philippines (preference rate=28.57%, attitude mean score=3.54). Education in gerontology was also relatively consis tently related to these variables. The nurses who had taken workshops or continuing education (preference rate=44.44%, attitude mean score=3.72), less than half a course (preference rate=38.46%, attitude mean score=3.75) and a whole course with clinical experience (preference rate=33.33%, attitude mean score=3.72) had higher prefer ence and attitude scores than nurses who had no education 39 in gerontology (preference rate=13.3 3%, attitude mean score=3.64) or nurses who had a whole course without clinical experience (preference rate=0%, attitude mean score=3.35). Thus, this result showed clinical experience was a crucial factor affecting nurses1 preferences for work with the elderly and nurses' attitudes toward the elderly. Year of licensure was not consistently related to scores indicating nurses' preferences for work with the elderly and nurses' attitudes toward the elderly. But, the nurses who received their license between 1959-1965 had both the lowest preference (0%) and attitude scores (3.54) . This result was consistent with the result of year of graduation. Thus, the nurses who graduated and got a license between 1959-1965 showed the lowest preference and attitude scores among the four groups. Years of experience were not consistently related to these. But, nurses who had 29-35 years of experience showed the highest score in preference (50%) and attitude (3.94) scores among the five groups. Elderly relatives living at home did not consistent ly relate to these variables either. Nor was age consis tently related to preferences and attitudes. But, the nurses 61-70 years old showed both the highest in prefer ence (66.67%) and attitude scores (3.72) relative to other age groups. 40 Racial/ethnic background was relatively consistently related to these variables. Hispanic nurses showed the highest preference (80%) and attitude score (4.27), followed by white nurses (preference=33.33%, attitude score=3.91), and black nurses (preference=40%, attitude score=3.65). Asian nurses (preference=2 8.75%, attitude score = 3.51) and Filipino nurses (preference=25%, attitude score=3.55) had lower scores than Hispanic, white, and black nurses. Among the nine independent variables, for three— location of nursing program, education in gerontology and racial/ethnic background— there was a positive tendency for scores nurses' preference rate and nurses' attitudes to go together. Other variables such as educational degree, year of graduation, year of licensure, years of experience, and age did not show consistent scores between nurses' preferences for work with the elderly and nurses' attitudes toward the elderly. However, there was consistency among some groups such as nurses who had master's degrees (N=2) and nurses who graduated (N=5) or got a license (N=4) between 1959- 1965. They showed the lowest level of preference for work and attitudes toward the elderly. The nurses who were 61- 70 years old (N=5) or had 29-35 (N=3) years of experience had the highest preferences and most positive attitudes toward the elderly. But, the samples representing these 41 groups were small, and therefore, there are limitations to their generalizability. Table 3 shows that mean score of nurses' attitude toward the elderly for all groups were in the range of 3.0- 5.0. Thus, the analysis of this study shows that in general nurses1 average attitudes toward the elderly were slightly positive. Nurses' Job Commitment and the Relationship with Attitude Nurses' job commitment was measured by asking whether they planned to stay in their present job for 5 years or more. Among 75 participants, 2 participants did not answer. Therefore, this analysis is based upon 73 responses. Among 73 participants, 59 participants respond ed yes to staying in their present job for 5 years or more. Thus, about 81% of participants wanted to stay in their present job. Table 3 shows the percentage of the nurses' inten ding to stay in their job for five years for each category of the independent variables. 42 Table 3 Nurses’ Career Commitment to Work with Elderly Patients Variable No. Planned to Stay in Their Job (Number and % of Yes) Degree Diploma 25 18 (72%) Associate 19 15 (79% ( Bacalaureate 28 25 (89%) Master 1 1 (100%) Year of Graduation 1959-1965 5 5 (100%) 1966-1975 24 23 (96%) 1976-1985 25 21 (84%) 1986-1992 19 10 (53%) Location of Nursing Program U.S.A. 36 31 (86%) Philippine 22 20 (91%) Canada 2 1 (50%) England 3 3 (100%) Korea 6 1 (17%) Hong Kong 3 3 (100%) Israel 1 0 (0%) Gerontology in Education None 15 12 (80%) Workshop or continuing education 19 17 (89%) Less than half a course 13 9 (69%) Whole course without clinical experience 2 1 (50%) Whole course with clinical experience 24 20 (83%) Year of Licensure 1959-1965 4 3 (75%) 1966-1975 19 19 (100%) 1976-1985 33 28 (85%) 1986-1993 17 9 (53%) 43 Table 3— continued Variable No. Planned to Stay in Their Job (Number and % of Yes) Years of Experience 1-7 24 16 (67%) 8-14 24 23 (96%) 15-21 15 14 (93%) 22-28 7 4 (57%) 29-35 3 2 (67%) Elderly Relatives Living at Home Yes 16 14 (88%) No 57 45 (79%) Age 21-30 15 10 (67%) 31-40 24 19 (79%) 41-50 22 21 (95%) 51-60 7 5 (71%) 61-70 5 4 (80%) Racial/Ethnic Background Hispanic 5 5 (100%) White 17 14 (82%) Black/African American 5 3 (60%) Asian 21 16 (76%) Pacific Islander 2 1 (50%) Filipino 22 19 (86%) Other 1 1 (100%) N=73 Total :yes no Number 59 14 Percentage 81% 19% Educational degree of nurses was related to their plans for the future. Nurses who had higher education were more likely to intend to stay in their present job. Nurses who had a master's degree had the highest intent (100%) of staying in their present job for five years or more. Thus, 44 the hypothesis was supported. But this result is limited in generalizability due to the unequal sample distribution by degree (master degree N-l). Year of graduation was also related to future plans. Nurses who graduated in 1959-1965 had the highest rate (100%) of intention to stay in their present job five years or more. And, nurses who graduated 1986-1992 showed the lowest percentage (53%) among the four groups. The location of nursing programs was not related to job intent. Since most of the population was from the U.S.A. (N=31-36) and the Philippines (N=20-22), these two countries were compared. The nurses who finished their nursing education in the Philippines indicated a greater intent to stay in their present job (91%) than did the nurses who finished their nursing education in the U.S.A. (86%). Thus, this result opposite to the result of the nurses' preference rate and attitudes toward elderly patients. Gerontology education did not relate to job intent and did not support the hypothesis. The nurses who had taken workshops or continuing education (89%) or a whole course with clinical experience (83%) were more likely than nurses who did not have gerontology education with clinical experience to intend to stay on the job. However, nurses who did not have any education in gerontology showed a higher rate (80%) than nurses who had less than half a 45 course (69%) or a whole course without clinical experience (50%). Probably, nurses who did not have education in gerontology were older or had more experience. This result requires further study. Year of licensure was not related to job intent nor was years of experience. Nurses who had 8-14 years of experience showed the highest intent (96%) to stay in their present job five years or more. The relationship between elderly relatives living at home and job intent supported the hypothesis (88%) , but the relationship with age did not support the hypothesis. The nurses up to 50 years old had higher scores with age; but after 50 years of age they had a lower score. Probably, as nurses became closer to retirement age themselves they were less likely to intend to stay on the job for five years This result requires more study. Hispanic nurses showed the highest intent to stay with their present job. (199%). Black/African nurses showed the lowest score. Pacific Islander nurses (N=2) and Others (N=l) were not analyzed due to the sample size. Among the nine independent variables, the relationships among four (degree, year of graduation, education in gerontology, elderly relatives living at home, and age) and job intent supported the hypothesis. Even though the relationships with these variables supported the hypothe 46 sis, the size of some of the samples were small, and thus the generalibability is limited. Nurses' Satisfaction in Working with the Elderly Nurses' satisfaction in working with the elderly was measured by asking about their satisfaction in working with children, middle-aged adults, and the elderly. Among 75 participants, 5 participants did not answer. Therefore, this analysis was based upon 70 sample members. Among the 70 participants, 41% (N=29) responded that it was very satisfying to work with the elderly and 49% (N-34) respond ed that they were somewhat satisfied in working with the elderly. Only 10% of the participants (N=7) responded not so satisfied in work with the elderly. Thus, this study shows a high rate of nurses' job commitment and nurses' satisfaction in working with the elderly despite a low peference rate for work with the elderly. Table 4 shows the distribution of responses to the question of nurses' satisfaction in working with the elderly for each category of each variable. The nurses who had baccalaureate degrees showed higher satisfaction (very satisfying=48%, somewhat satisfy- ing=44%) than nurses who had diploma degrees (very satisfy- ing=42%, somewhat satisfying=46%). Thus, the hypothesis is supported. But this study eliminated nurses who had 47 Table 4 Nurses' Satisfaction in Working with Elderly Patients Variables No. Percent Responding Very Somewhat Satisfying Satisfying Not So Satisfying Degree Diploma 26 Associate 16 Baccalaureate 27 Master 1 42 32 48 0 46 50 44 100 12 13 8 0 Year of Graduation 1959-1965 4 1966-1975 24 1976-1985 25 1986-1992 17 Location of Nursing Program USA 35 Philippines 20 Canada 2 England 3 Korea 5 Hong Kong 4 Israel 1 Gerontology in Education None 13 Workshop or Continuing Education 19 Less than Half a course 13 Whole Course without Clinical Experience 2 Whole Course with Clinical Education 23 75 46 36 35 54 25 50 33 0 25 0 31 47 54 50 35 25 50 60 47 37 65 50 33 80 75 100 61 47 23 50 57 0 4 4 18 9 10 0 33 20 0 0 8 6 23 8 48 Table 4— continued Variables No. Percent Responding Very Somewhat Satisfying Satisfying Not So Satisfying Year of Licensure 1959-1965 3 67 33 0 1966-1975 19 53 42 5 1976-1985 32 41 50 9 1986-1993 16 31 50 19 Years of Experience 1-7 22 23 59 18 8-14 23 52 39 9 15-21 15 33 60 7 22-28 7 86 14 0 29-35 3 33 67 0 Elderly- Relative Living at Home Yes 16 38 62 0 No 54 43 44 13 Age 21-30 13 38 31 31 31-40 24 38 50 12 41-50 22 50 50 0 51-60 6 50 50 0 61-70 5 40 60 0 Racial/Ethnic Background Hxspanxc 5 80 0 20 White 17 53 41 6 Black 5 40 40 20 Asian 19 32 63 5 Pacific Islander 2 50 50 0 Filippino 21 33 57 10 Other 1 100 0 0 Total 70 41 49 10 49 associate (N=16) or master's degrees (N=l) due to sample size. Therefore, the result has limited generalizability. Higher satisfaction rate was linked to earlier year of graduation. While 46% of nurses who graduated in 1966- 1975 indicated that working with the elderly was very satisfying and 50% said it was somewhat satisfying, 35% of the nurses who graduated in 1986-1992 indicated that working with the elderly was very satisfying and 47% said somewhat satisfying. The location of the nursing program was not related to the rate of satisfaction in working with elderly patients. Since most of the population was from the U.S.A. (N=35) and the Philippines (N=2 0), this study compared these two countries. The nurses' satisfaction rate from these two countries was over 90%. The relationship between satisfaction and Gerontolo gy in education did not support the hypothesis. There was not much difference among nurses who took gerontology education or who did not, except the group of nurses who took less than half a course. Those with earlier year of licensure showed higher satisfaction from working with the elderly. While 67% of the nurses who received licensure in 1959-19 65 indicated that working with the elderly was very satisfying and 33% said somewhat satisfying, nurses who got licensure in 1986- 50 1993 31% said it was very satisfying and 50% said it was somewhat satisfying. Nurses who had more experience had consistently higher satisfaction rates. Thus, the hypothesis is supported. Nurses who lived with elderly relatives expressed a higher satisfaction rate (very satisfying=38%, somewhat satisfying=62%) than nurses who did not live with elderly relatives (very satisfying=42%, somewhat satisfying=44%). Thus, the hypothesis is supported. Older nurses indicated higher satisfaction rates from working with the elderly patients. The nurses who were 61-70 years of age indicated a higher satisfaction rate (very satisfying=40%, somewhat satisfying=60%) than nurses who were 21-30 years of age (very satisfying=38%, somewhat satisfying=31%) . Thus, the hypothesis is support ed. The highest satisfaction rate (N=19 very satisfy- ing=32%, somewhat satisfying=63%) was among Asian nurses, followed by white nurses (N=5, very satisfying=53%, somewhat satisfying=41% and Filippino nurses (N=21, very satisfying=33%, somewhat satisfying=57%). Hispanic nurses (N=5, very satisfying=80%, somewhat satisfying=0% and black nurses (N=5, very satisfying=40%, somewhat satisfying=40%) showed lower satisfaction than Asian, white, and Filippino nurses. But, Hispanic nurses showed the highest very 51 satisfying rate (80%), followed by white nurses (very satisfying=52%). Among the nine independent variables, education degree, year of graduation, year of licensure, years of experience, elderly relatives living at home, and age were related to satisfaction rates in working with the elderly patients so that they supported the hypotheses. 52 CHAPTER V DISCUSSION The problem facing health care is that the number and proportion of elderly persons will rapidly increase in the next few decades, and there will be increased demands for professionals to work with older clients. Therefore, it is reasonable to suppose that attitudes, preferences, satisfaction, and career commitment held by professional workers will help to determine the quality of care given to old people. As Robert Butler, M.D. (1968) pointed out, ageism means that the elderly are devalued simply because they are old. Previous researchers suggest that attitudes of student nurses and nursing-care providers are generally negative (Benson, 1982) and nurses, as a group, prefer not to work with older clients (Kayser & Minnigerode, 1975; Williams, Lusk, & Kline, 1986). It is disturbing to think that health care professionals have a negative bias in caring for elderly clients. The study reveals that 81% of nurses (N=59) wanted to stay in their present job five years or more and 90% of nurses (N=63) indicated satisfaction in working with elderly patients. But, only 32% of nurses (N=i47) prefered working with elderly patients. Thus, this study shows a 53 low rate in nurses' preferences for working with the elderly despite high rates of nurses' career commitment and satisfaction rate. The average score of nurses' attitudes toward the elderly was in the range of 3.0-5.0. Thus, this study shows nurses' attitudes toward the elderly are somewhat positive. It is surprising that nurses with a master's degree, graduate, or who got a license in 1959-1965 had low rates of preference and more negative attitude toward the elderly, while they had the highest satisfaction rate from the most. Another surprising finding was that nurses who obtained nursing education in the U.S.A., rather than a foreign country, Hispanic, Black, or White nurses, rather than Filipino or Asian nurses, scored more positively in both attitudes and preferences for work with the elderly. Asian nurses showed the highest satisfaction rate. However the location of nursing education was not related to satis faction from work with the elderly patients. Those who were 61-70 years old or had 29-35 years experience had more positive attitudse, preferences, and satisfaction from working with the elderly. Educational attainment, year of graduation, elderly relatives living at home, experience, and age were related to higher rates of nurses' career commitment and greater satisfaction from work with the elderly. These findings support the initial hypotheses. But, experience was the only independent 54 variable which was related to nurses 1 preferences for work with the elderly. Location of nursing program, education in gerontology, and racial/ethnic background were related to nurses' preference rates and nurses' attitudes. But, this study had several limitations due to small sample size, because of the univariate methods employed. This study was not able to isolate potentially confounding variables. Thus, the results of this study are limited in generalizability. Suggestions for Further Study Health care leaders are asking for a commitment by the profession to improve the care of the aged. An increasing population in the U.S.A., and an increasing percentage of this population consisting of the aged, underlines the importance of this commitment. Therefore, nurses' attitudes towards theelderly have been the subject of much research in recent years. This study represents an attempt to understand nurses' attitudes, job satisfaction, nurses' preferences for work with the elderly and how these related to level of education, experience, race, age, education in gerontology, and family background. Future studies should continue to examine nurses' attitudes, job satisfaction and preferences for work with the elderly. The impact of variables on nurses' attitudes, satisfaction, and preferences for work with the elderly needs to be explored using a representative sample and controlling for confusing variables to find the independent effect of each of the variables. Another purpose of future studies might be to document health care outcome— specifi cally, quality health care for the elderly. Thus, further study should examine these two issues and the effects of nursing care for the elderly in health care settings. REFERENCES 57 REFERENCES Aday, R. H., Rice, C., & Evans, E. (1991). Inter- generational partners project: A model linking elementary students with senior center volunteers. The Gerontologist. 31(2), 263-266. American Association of Retired Persons & Adminis tration on Aging. (1987). A profile of older Americans. Washington, DC: Author. Bagshaw, M., & Adams, M. (1986). Nursing home nurses' attitudes: Empathy and ideologic orientation. International Journal of Ageing and Human Develop ment. 22.(3), 235-246. Benson, E. R. (1982). Attitudes toward the elderly: A survey of recent nursing literature. Journal of Gerontological Nursincr. 8, 279-281. Blegan, M. A. (1993). Nurses' job satisfaction: A meta-analysis of related variables. Nursing Research. 42.(1), 36-40. Brower, H. (1981). Teaching gerontological nursing in Florida: Where we stand. Nursing and Health Care. 11(10), 543-547. Brower, H. T. (1985). Do nurses stereotype the aged? Journal of Gerontological Nursing. 11, 17-28. Brown, M. I. (1971). Patient variables associated with nurses' preferences among elderly patients. Pre sented at Fifth Nursing Research Conference, New Orleans, LA. Burge, J. M. (1978). Stereotyped attitudes toward the aged in nursing homes. Issues in Mental Health Nursing. 1, 53-61. Butler, R. (1969). Ageism: Another form of bigotry. The Gerontologist. 9, 243-246. Butler, R. N. (1980). Why survive: Being old in America. New York: Harper & Row. Campbell, M. (1975). Study of the attitudes of nursing personnel toward the geriatric patient. Nursing Research. 20(2), 147-151. 58 Carmel, A., Cwikel, J., & Galinsky, D. (1992). Changes in knowledge, attitudes, and work preferences following courses in gerontology among medical, nursing, and social work students. Educational Gerontology. 18, 329-342. Cherlin, A., & Furstenberg, F. F. (1985). Styles and strategies of aging. In V. L. Bengtson & J. F. Robertson (Eds.), Grandparenthood. Beverly Hills: Sage. Corbin, D. E., Kagan, D. M., & Metal-Corbin, J. (1987). Content analysis of an intergenerational unit in aging in a sixth-grade classroom. Educational Gerontology. 13. 403-410. Dye, C. J., & Sassenrath, D. (1979). Identification of normal aging and disease-related processes by health care professionals. Journal of the American Geriatric Society. 27., 472-475. Elmore, M. J. (1964). Proposals relating to the selec tion and organization of learning experiences for nursing students in the care of older patients. Unpublished doctoral dissertation, Columbia Univer sity. Ferrini, A. F., & Ferrini, R. L. (1989). Health in the later years. Dubuque, IA: William C. Brown. Fielding, P. (1979). An exploratory investigating self- concept in the institutionalized elderly, and a comparison with nurses' conceptions and attitudes. International Journal of Nursing Study. 16. 345- 354. Fisher, D. H. (1977). Growing old in America. New York: Oxford University. Giardina-Roche, C., & Black, M. E. A. (1990). Attitude of diploma student nurses toward adult clients. Journal of Nursing Education. 29(3), 208-213. Gillis, M. (1973). Attitudes of nursing personnel toward the aged. Nursing Research. 22., 517-520. Gioiella, E. C., & Bevil, C. W. (1985). Nursing care of the aging client. Norwalk, CT: Appleton- Century-Crofts. 59 Gomez, G. E., Blattstein, 0. D., & Gomez, E. A. (1985). Beginning nursing students can change attitudes about the aged. Journal of Gerontological Nursing. 11(1), 6-10. Gunter, L. M. (1971). Students' attitude towards geriatric nursing. Nursing Outlook. 19, 466-469. Hart, L. K., and others. (1976, July-Aug.). Changing attitudes toward the aged and interest in caring for the aged. Journal of Gerontological Nursing, 2, 10-16. Hatton, J. (1977). Nurse's attitude toward the aged: Relationship to nursing care. Journal of Geron tological Nursing. 3.(3) , 21-26. Heller, B. R., & Walsh, F. J. (1976). Changing nursing student's attitudes toward the aged: An experi mental study. Journal of Nursing Education. 15(5), 9-17. Holtzman, J. M., & Beck, J. D. (1979). Palmore's facts on aging quiz: A reappraisal. The Gerontologist. 19. 116-120. Hucksadt, A. A. (1983). Do nurses know enough about gerontology? Journal of Gerontological Nursing. 9, 392-396. Institute for Health and Aging. (1985). Impact of an aging population on health care needs: State projections. San Francisco, CA: University of California. Joel, L. A., Baldwin, B., & Stevens, G. (1989). Report from the American Nurses' Association Council on psychiatric and mental health nursing. Gerontology and Geriatrics Education. 9.(3) , 17-25. Johnson, M. A., & Connelly, J. R. (1990a). Nursing and gerontology: Status report. Washington, DC: Association for Gerontology in Higher Education. Johnson, M. A., & Connelly, J. R. (1990b). Strategies for increasing gerontology content in nursing education. Washington, DC: Association for Gerontology in Higher Education. 60 Kayser, J. s., & Minnigerode, F. A. (1975). Increasing nursing students1 interest in working with aged patients. Nursing Research. 24. 23-26. Kennedy, G. E. (1990). College student's expectations of grandparent and grandchild role behaviors. The Gerontological Society of America. ^0(1), 43-48. Kermis, M. D. (1987). Equity and policy issues in mental health care of the elderly: Dilemmas, deinstitutionalization and DRGs. The Journal of Applied Gerontology. 6(3), 268-283. Kogan, N. (1961). Attitudes towards old people: The development of scale and examination of correlates. Journal of Abnormal and Social Psychology. 62., 44-54 Maddox, M. A., & Tillery, B. J. (1988). Elderly image seen by health-care professions. Journal of Gerontological Nursing. 14(11), 21-24. Maslach, C. (1982). Burnout— the cost of caring. Englewood Cliffs, NJ: Prentice-Hall. McCabe, B. W. (1989) . Ego defensiveness and its relationship to attitude of registered nurses toward older people. Research in Nursing and Health. 12, 85-91. Meyer, M. M., Hassanein, R. S., & Bahr, Sr. R. T. (1980). A comparison of attitude of the aged held by professional nurses. Image. 12, 62-66. Nolan, M., & Grant, G. (1993). Rust out and the thera peutic reciprocity: Concepts to advance the nursing care of older people. Journal of Advanced Nursing. 18, 1305-1314. O'Hanlon, A. M., Cameron, J., & Osofsky, J. (1993). Knowledge of and attitudes toward aging in young middle-aged, and older college students: A com parison of two measures of knowledge of aging. Educational Gerontology. 19. 753-766. Owen, D. (1976). In sickness and in health. London:Quartet Books. Palmore, E. B. (1980). The facts on aging quiz: Part two. The Gerontologist. 20f 669-672. 61 Peacock, W. E. , & Talley, W. H. (1984). Intergenera- tional contact: A way to counteract ageism. Educational Gerontology. .10, 13-24. Reed, C. C., Beall, S. C., & Baumhover, L. A. (1992). Gerontological education for students in nursing and social work: Knowledge, attitudes, and per ceived barriers. Educational Gerontology. 18. 625-636. Schoen, D. C. (1993). Nursing student attitudes after an experience with independent elderly. Gerontology & Geriatrics Education. 14(1), 47-55. Tappen, R. M., & Brower, H. T. (1985). Integrating gerontology into the nursing curriculum: Process and content. Journal of Nursing Education. 24, 80-82. Taylor, H. K., & Harned, T. L. (1978). Attitudes toward old people. Journal of Gerontological Nursing. 4(5), 43-47. Tibbitts, c. (1979). Can we invalidate negative stereotypes in aging? The Gerontologist. 19, 10-20. Tollett, S. M., Thornby, J. J. (1982, June). Geriatric and gerontology nursing curricula trends. The Gerontologist. .21(6), 16-23. Ward, R. A. (1984). The aging experience (2nd ed.). New York: Harper and Row Publishers. Wilhite, M. J., & Johnson, D. M. (1976). Changes in nursing students' stereotypic attitudes toward old people. Nursing Research. 2J5(6) , 430-432. Williams, R. A., Lusk, S. L., & Kline, N. W. (1986). Knowledge of aging and cognitive styles in bac calaureate nursing students. The Gerontologist. 26. 545-550. Winger, J. M., & Smith-Staruch, K. (1986). Your patient is older, what leads to job satisfaction? Journal of Gerontological Nursing. 12(1)# 31-35. APPENDIX 63 COPY Dear Nurse, I am completing my master's project and need your assistance. Please consider each question and answer by filling in the blank or circling the appropriate number. This study is about your opinion toward elderly patients. Your opinion provides a valuable factor for the completion of this project. Your assistance in completing this project is appreciated. Sung Ja, KHO 5th floor staff nurse St. Vincent Medical Center 64 SURVEY OF LICENSED REGISTERED NURSES' ATTITUDES TOWARD ELDERLY PATIENTS MARCH, 1994 Section 1- Education 1. In what kind of program did you receive your registered nursing education? 1. Diploma program 2. Associate degree program 3. Baccalaureate degree program 4. Master's degree program 2. What year did you graduate from your nursing program? Year___________________ 3. What was the location of your basic nursing program? U.S.A. = 1 Philippine = 2 Canada = 3 England = 4 Korea = 5 Hong Kong = 6 Israel = 7 Write in state and country_____________________ 4. How much education in gerontology did you complete? 1. None 2. Workshop or continuing education 3. Less than half a course 4. Whole course without clinical experience 5. Whole course with clinical experience Section 2- Licensure and personal information 5. In what year were you first licensed as a registered nurse? Year 6. How many years of experience do you have caring for elderly patients? Number of years______________________ 65 7. Do you have elderly relatives living at home? Yes____________ No_____________ 8. How old are you? Age____________ 9. Circle the word that best describes your racial/ ethnic background 1. Hispanic 2. White 3. Black/African American 4. Asian 5. Pacific Islander 6. Filipino 7. Other Section 3 In the following questions, I am interested in your idea about aging. Circle the appropriate number which reflects your opinion to the following questions. Strongly disagree-1, Disagree-2, Slightly disagree-3 Slightly agree-4, Agree-5, Strongly agree-6 10. It would probably be better if most old people lived in residential units with people of their own age. 6 5 4 3 2 1 11. Most old people are really no different from anybody else; they're as easy to understand as younger people. 6 5 4 3 2 1 12. Most old people get set in their ways and are unable to change. 6 5 4 3 2 1 13 . 14. 15. 16. 17. 18. 19. 20. 21. 66 Most old people would prefer to continue working just as long as they possibly can rather than be dependent on anybody. 6 5 4 3 2 1 Most old people tend to let their homes become shabby and unattractive. 6 5 4 3 2 1 People grow wiser with the coming of old age. 6 5 4 3 2 1 Old people have too much power in business and politics. 6 5 4 3 2 1 Most old people are very relaxing to be with. 6 5 4 3 2 1 Most old people bore others by their insistence on talking about the "good old days." 6 5 4 3 2 1 Most old people tend to keep to themselves and give advice only when asked. 6 5 4 3 2 1 If old people expect to be liked, their first step is to try to get rid of their irritating faults. 6 5 4 3 2 1 You can count on finding a nice residential neigh borhood when there is a sizeable number of old people living in it. 6 5 4 3 2 1 There are a few exceptions, but in general most people are pretty much alike. 6 5 4 3 2 1 67 23. Most old people seem to be quite clean and neat in their personal appearance. 6 5 4 3 2 1 24. Most old people are irritable, grouchy, and unpleasant. 6 5 4 3 2 1 25. Most old people are constantly complaining about the behavior of the younger generation. 6 5 4 3 2 1 26. Most old people need no more love and reassurance than anyone else. 6 5 4 3 2 1 SECTION-4 USE YOUR NURSING EXPERIENCES AND EDUCATION IN GENERAL TO RATE THE FOLLOWING ITEMS 27. I am planning to stay in my present job for 5 years or more. Yes_________ No _________ 28. It is satisfying for me to work with the following age groups of patients. Very Somewhat Not so Satisfying Satisfying Satisfying Children Middle-Aged Adults Elderly 29. I would prefer to work with elderly patients rather than children or middle aged adults. Yes No 68 Thank you very much for your cooperation in completing this questionnaire. IN FORM A TION TO U SER S This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality o f the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleed through, substandard margins, and improper alignment can adversely afreet reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand com er and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6" x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. A Bell & Howell Information Company 300 North Zeeb Road, Ann Arbor. M l 48106-1346 USA 313.'761-4700 800/521-0600 DMI Number: 1376468 UMI Microform 1376468 Copyright 1995, by UMI Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. UMI 300 North Zeeb Road Ann Arbor, MI 48103

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Asset Metadata

Creator Kho, Sung Ja (author)

Core Title Survey of registered nurses' attitudes toward elderly patients

School Leonard Davis School of Gerontology

Degree Master of Science

Degree Program Gerontology

Degree Conferral Date 1994-12

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag gerontology,health sciences, nursing,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Peterson, David A. (committee chair), Crimmins, Eileen M. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-2248

Unique identifier UC11357857

Identifier 1376468.pdf (filename),usctheses-c18-2248 (legacy record id)

Legacy Identifier 1376468-0.pdf

Dmrecord 2248

Document Type Thesis

Rights Kho, Sung Ja

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA