Organized in 1870 as the "Home for Aged and In firm Hebrews of New York, " The Jewish Home and Hospital for Aged has grown from a simple residence for four aged people to a geriatric center serving over 1,900 elderly men and women through a variety of facilities aiid programs that coyer the entire spectrum of care. Beginning in the 1940s, JHHA instituted an ongoing research program ih medical problems associated with aging and established one of the nation's first teaching centers in geriatrics for medical nursing, social service, and administrative personnel.
Utilizing the principles of the holistic approach to providing health care, the administration of JHHA conceived an inservice education program that would assist ancillary staff members to identify their emotional and educational needs in caring fdr geriatric patients. Our goals for the program were to increase communication between relatives of residents and the ancillary nursing staff, and to enhance the high standard ol care for the 514 elderly residents at The Homes Central House-the major inpatient facility.
Workshops were felt to be the desired mode fox the training progiam, but first it was important to develop a system foi measuring four catcgories of attitudes to focus on the areas of concern In order to identify staff problems a 30 item Likert type Questionnaire Wa~ onsiiuded to evaluate the following atututhnal categories:
1 Feelmgs of autQnomy
2 Job satisfaction,
3 Feelings of self esteem and
4 Feelings ibout geriatric patients and their farni lies.
In developing the qtiesttons we based our appxoach on the assumption thai attitudes can be measured by scaling verbal responses they dueuly influence overt bchavior and they can be changed b) (hanging the knowledge base of the individual The questionnaire was submitted t?ail 190 members of the ancillary nursing staff. A summary of results follows.
The staff, which is predominantly black and hispanic, reflected a mean age of 40.7 years, with an average length of employment of 10 years.
There were no significant differences in attitudes among the day, evening, and night shifts. While no identical sets of responses were found, respondents tended to select answers as a group at either extreme end of the scale for each question, so they were generally in agreement. For example, most aides either disagreed or strongly disagreed with the statement reflecting concern of the families for the hospitalized geriatric resident.
It was originally speculated that ratings toward administration and ratings toward the patients' families would both be significantly low. Although the respondents did indicate extremely poor ratings for the families of patients, the ratings for patients themselves and the professional nursing staff were extremely high. In addition, the desire to participate in teaching programs to advance their capability of dealing with concerns on the job was also high. The overall job satisfaction score was 18.44, out of a potential score of 25.
A correlation number represents the degree of association between two or more variables, ie, years of experience and job satisfaction, or age and fear of becoming elderly. We were able to compute correlations among 11 separate variables and found some expected and some totally unexpected results. For example, as number of years of aides' employment increased, so did their ratings of the nursing staff. This result is consistent with other similar job satisfaction studies and might suggest that only people who are successfully socialized into the nursing system remain, while others leave.
We also found that some aides who indicated feelings of servitude, also scored lower job satisfaction ratings. They, in turn, were less likely to hospitalize their own parents.
There were two particularly strong negative correlations that reached the level of significance (r=0.9, p=0.01). As the years of experience increased, positive feelings toward patients' families decreased. The age of the respondent was irrelevant in this finding.
The most perplexing result for us to interpret was that as aides gave increased ratings to the nursing staff, their ratings for the patients' families decreased. This might indicate an appreciation fox professional authority. Having completed the survey and established our goals, we felt we could start the workshops.
A group of 20 aides were randomly selected from the entire ancillary staff to participate in 12 periodic workshops conducted by the hospital administrator the researcher).
At the first workshop, employees were asked to use free association with words that describe "responsibilities" and "problems" of geriatric health care workers. The elicited words were then grouped into common areas of concern, and formed the basis for the 11 future workshops.
One area identified by the staff was "hostility," "selfcontrol," and "understanding" in relation to patients' families. Therefore, a workshop was planned with the staff psychiatrist to help aides examine the feelings of guilt experienced by many patients' families, and to understand how that guilt might be translated into hostility toward the staff.
Other workshops were structured around mutually identified areas of concern - ancillary staff participation in curative aspects of patient care, eliminating the dehu mañiza tion process of patients and staff within the institution, the aging process, and the establishment of appropriate communication patterns. In addition, another technique was utilized in a subsequent series of interdisciplinary workshops. The heuristic teaching strategy of "learning by discovery" was employed to enhance the aides' appreciation of patients' feelings due to their age and physical conditions. All levels of staff, including aides, were provided factual, emotional, and experiential learning experiences in the process of aging. This included touch and dexterity, vision and hearing, taste and smell. This was accomplished through the use of specialized equipment, so that staff members could experience simulation. In addition to this, panel discussions were held to discuss psychological and general physiological changes experienced by the elderly. It was felt that the quality of social interaction between staff and residents was enhanced by this cooperative undertaking by various departments, such as administration, activities, medical, nursing, nutrition, occupational therapy, physical therapy, and social service.
After the 12 original workshops, the attitude questionnaire was again submitted to the participating aides. Statistical analysis of the responses showed that all of the original correlations discussed had been nullified.
While some of the positive and negative relationships still existed, the· numerical value was reduced to insignificance.
One new correlation was noted: as positive feelings about working with geriatric patients increased, the fear of becoming elderly decreased (r=0.8, p=0.05). Since this correlation was not evident in the first survey, it might be attributed to effective participation in the workshops when fear of aging was explored.
Other changes in descriptive data were noted:
1. A 25% increase in reported overall job satisfaction;
2. A 28% increase in positive feelings about placing one's own parents in a nursing home;
3. A 30% increase in responses indicating positive feelings of parental concern by the children of patients; and
4. The proportion of people who strongly desired regular participation in inservice programs increased from 10% to 50%. No respondents disagreed with the need for more teaching.
The workshops, repeated subsequently with different groups of ancillary staff, were modified whenever "felt needs" of the groups varied in intensity of concern, as measured by our questionnaire.
Complaints from patients' families concerning ancillary staff members have been noticeably reduced since implementing this inservice program. Following a suggestion made by one nurses aide, families of patients were asked to participate in their own sessions exploring the responsibilities and problems of geriatric health care workers. Similar family groups have since become a part of the ongoing program within the institution.
It is believed that the measurement and consideration of "felt needs" of staff in developing a model inservice program helped to make significant changes in the attitudes of aides. In the areas of personal feelings about aging, attitudes concerning the children of geriatric patients, improved self-concept, job satisfaction, and teaching interaction with administrative personnel there was distinct positive movement. The training program goals were achieved and attitudinal changes were manifested in a more positive behavioral approach by the ancillary staff toward patients and relatives.
It is suggested that quantification of attitudes concerning job satisfaction and self-esteem might also serve as a tool to select out staff members who might benefit from this type of in servi ce model.
Another important outgrowth of the development of this educational program was that it was the first of several cooperative efforts by an administrator and nurse researcher to plan and achieve educational staff goals. Historically, procedure and policy changes within nursing have been based on the results of studies conducted solely by non-nursing personnel due to the lack of nursing research. Too frequently, nursing research has dealt with problems that are not subject to manipulation, and, therefore, leave problems described but unsolved. We hope that this model for inservice education, based on a cooperative administration and nursing endeavor, will inspire others in leadership positions to draw upon the knowledge and expertise that most likely exists right within their own institutions in order to evaluate and enhance health care.