Journal of Gerontological Nursing

Attitudes Affect QUALITY CARE

Lois N Knowles, PhD, RN, C, FAAN; Vernon T Sarver, Jr, MA


Tomorrow's gerontological nurses are being groomed in today's baccalaureate nursing programs. What can be done to encourage interest in the growing specialty of gerontology?


Tomorrow's gerontological nurses are being groomed in today's baccalaureate nursing programs. What can be done to encourage interest in the growing specialty of gerontology?

The quality of health care provided has been linked to the preferences which nursing students and professionals have for their patients.1-7 While many types of preferences merit attention in this connection, none seem to draw upon any more basic characteristics of the patient than those relating to age and sex. Yet, while many studies have documented age preferences of nursing students and professionals, few have explored sex preferences, and none could be found which explore the interaction of these variables.

With respect to age, the preferences of nursing students and professionals for younger patients are well known. In their study of nursing students in baccalaureate programs, DeLora and Moses reported that patients who were most frequently "most desired" were children under twelve, followed by young adults (ages 22-35). Those patients least frequently "most desired" were the elderly (60 and over), who were also the most frequently "least desired."8 Gunter surveyed senior nursing students at a major university and found that mature and young adults were preferred as patients, with the preschool child, school child, adolescent, aging adult, and the aged adult, followed in that order.9 After surveying nursing students at all levels of a baccalaureate program, Kay ser and Minnigerode found that most students were more interested in working with child and adult patients than with the elderly.10 Others who have examined age preferences of nursing professionals have reported similar results."·1

With respect to sex preferences, only two studies could be found and these report conflicting results. On the basis of unstructured interviews with 182 nurses in several hospital settings, Habenstein and Christ identified an "overwhelming preference" among their respondents for male patients.12 More recently, though, in a study of 72 nursing students, Coulon and Tay 1er found that their subjects "did not state a definite preference towards nursing male or female patients."13 The results of both of these studies, however, should be interpreted cautiously: Coulon and Tay 1er 's, because they relied on a small sample (N = 72) and their design failed to control for subjects' gender (11 males, 61 females); and Habenstein and Christ's, because they depended entirely on data culled from unstructured interviews.

These methodological limitations have been recognized and specifically addressed by the present study, which relies on a questionnaire (instead of unstructured interviews), draws data from a large sample (N = 252), and controls for subjects' gender (252 females, no males). Also, in contrast with the work of these and other researchers, who have reported either age or sex preferences (but not both), the present study examines the interaction of these variables.

The Study

A questionnaire was given to 252 students in a baccalaureate nursing program at a state university. The ages of those in the sample ranged from 17 to 56, with a mean age of 20.62. Two hundred twenty-five (89.3%) were included within a range of 18 to 24; three (1.2%) were younger; fifteen (6.0%), older; and nine (3.6%) failed to indicate an age on the questionnaire. All of the respondents were female. Criteria for inclusion were:





1. Gender - female;

2. Attendance on the day the questionnaire was administered; and

3. Willingness to participate in the study.

Employment of these criteria resulted in the exclusion of one student, a male.

The questionnaire was divided into three parts. The first part consisted of 35 forced-choice items, which in each case required students to express a preference for one type of patient over another. The students were asked to assume, in all cases, that the choices involved white, middle-class residents of the local community, hospitalized for a fracture of the right leg. Each item consisted of a pair of descriptive phrases conjoined by the word "or." Each of these phrases included both a sex designation and one of five age designations (eg, "5-year-old boy," and "35year-old woman"). Thus, examples of pairings would be "5-year-old boy or 50-year-old woman," "19-year-old boy or 75-year-old man," etc.

Responses to only five of the 35 forced-choices items have been analyzed for this study, ie, specifically, those pairings for which age was held constant (eg, "5-year-old boy or 5-yearold girl," "19-year-old boy or 19-yearold girl"). These pairings were scattered among the remaining 30 on the questionnaire. From this use of the data will be gleaned an indication of the sex preferences of nursing students for each of the five age designations.

In the second part of the questionnaire, students were asked to identify the patient for whom they would "most prefer" and "least prefer" to provide nursing care. Selections were made from the following list, which consists of all combinations of age and sex designations from the first part of the questionnaire: 5-year-old boy, 50-year-old woman, 75-year-old man, 35-year-old woman, 19-year-old boy, 50-year-old man, 19- year-old girl, 35-year-old man, 5-year-old girl, and 75-year-old woman.

In addition to identifying type of patient most and least preferred, students were asked to provide specific reasons for their preferences. Reasons given by students were subjected to a content analysis by the investigators. This data will be presented and evaluated in a later study.

In the third and final part of the questionnaire, students were asked to supply answers to questions of a demographic nature. However, for purposes of this study, only data indicating students ages have been utilized.


The first part of the questionnaire yields data in which frequency of preference for male patients exceeds that for female patients in four of the five categories of age designation (see Table).

The female is preferred with greater frequency only in the 19-year-old category. In two of the categories, differences in frequencies of preference are statistically significant. However, when frequencies of the five age designations are combined for each sex, the percentages of the totals of frequencies are nearly equal (50.5% for the male patient, and 49.6% for the female patient).

Similar results are obtained in the second part of the questionnaire. Here, students were asked to identify "most preferred" and "least preferred" patients from a list of ten in which age and sex designations were combined. When compared to the female patient within four of the five age designations, the male patient is "most preferred" with a greater percentage of responses. However, once again, the 19-year-old female receives a greater percentage of responses than the male of the same age.

Regarding age preferences, a comparison of the five age designations suggests that, in general, the younger the patient, the more often he or she is "most preferred" (see Figure 1). The only exception to this occurs with respect to the 19-year-old male, who is "most preferred" less often than the 35year-old male. However, even here, the 19-year-old male is more popular than the 35-year-old female and 50-year-old and 75-year-old patients of both sexes.

When comparing youngest and oldest patients of the same sex among age designations, the 5-year-old male is "most preferred" nearly fifteen times as often as the 75-year-old male; and the 5year-old female, more than thirteen times as often as the 75-year-old female. These disparities are statistically confirmed when frequency data for the ten age and sex designations are analyzed for "goodness of fit."

For "least preferred" patient, the 75year-old patient receives 34.5% of all responses; the 75-year-old male is next with 24.2%, followed by the 19-yearold male with 10.2% (see Figure 2). The patient least often "least preferred" is the 50-year-old male (1.0%) followed by the 35-year-old male (1.7%) and the 19-year-old female (2.2%). When comparing youngest and oldest patients among the age designations, the 75year-old male is "least preferred" nearly seven times as often as the 5year-old male; and the 75-year-old female, more than 14 times as often as the 5-year-old female. Again, statistical evidence of these disparities is obtained when frequency data for the ten age and sex designations are analyzed for "goodness of fit."


An important feature of this study has been the analysis of sex preferences as a function of patients' ages. It will be remembered that when the former were considered independently of the latter, no appreciable differences could be detected in students' preferences, (ie, 50.5% preferred the male; 49.6%, the female). However, when these same preferences were examined as a function of patients' ages, not only were differences apparent, they were in two instances statistically significant. In view of this, it would appear that the conflicting sex preference data of earlier studies may be distorted by analyses which fail to take account of the interaction of these variables.12·13

Regarding the statistically significant differences, some conjectures may be offered. In the case of 19-year-olds, it may be that female baccalaureate nursing students tend to identify psychologically with patients of the same sex and approximately the same age. On the other hand, they may tend to be wary of a professional relationship with those of approximately the same age but of the opposite sex. Both of these reactions would seem consistent with the behavior of young women who have recently attained the traditional age of courtship and intimacy.

Accounting for the popularity of the 50-year-old man over the woman of the same age would appear more difficult, though perhaps it is possible that patients of this age represent "parental figures" for nursing students in their late teens and early twenties. Accordingly, or at least from a psychoanalytic perspective, it would not be at all surprising to find that female students view a "father figure" in a favorable and benign light, while they tend to be more critical of a "mother figure." In this vein, it is noteworthy that the 50-yearold man is the least often "least preferred" of all the age and sex designations, while the 50-year-old woman is the second most often "least preferred" among females for all age designations. Both of these findings appear to warrant further study and consideration for inclusion as a topic of discussion in courses dealing with the psychological aspects of nursing practice.







With respect to age preferences, in general, the data of this study indicate that the younger the patient, the more likely he or she will be "most preferred" by nursing students. Conversely, the older, the more likely he or she will be "least preferred." Especially striking are the comparative findings relative to the youngest (5-year-old) and oldest (75-year-old) age designations.

Another implication of this study is that age may be more of a factor than sex in determining preferences of baccalaureate nursing students for their patients. For example, even though the 19-year-old girl is "most preferred" twice as frequently as the 19-year-old boy, the latter is still three times more popular than the 75-year-old patient of either sex. In general, younger patients of either sex are "most preferred" more often than older patients, regardless of sex, the only exception being the case of the 19-year-old boy who is "most preferred" less frequently than the 35year-old man.

Finally, some mention should be made of the findings of Dodge and later of Brown, both of whom report in their studies of nursing professionals that as nurses themselves become older they tend to become more receptive to working with older patients.14·15 A possible sequel to the present study might be to explore age and sex preferences of experienced nurses, perhaps of 10 or 15 years standing in the profession, to see whether their preferences differ from those of baccalaureate nursing students, and if so, to what extent.

Other research options include the possibility of expanding the questionnaire to include additional age designations, (in this regard, the 1-year-old and the 42-year-old may prove interesting). Another possibility would be that of administering the instrument to a group of male nursing students. Here, on psychoanalytic theory at least, a reversal of preference would be a plausible conjecture with respect to the 50-year-olds (íe, it would be expected that the female would be preferred over the male). Also, in a study of this kind, it would be interesting to see whether there would be a preference reversal with respect to the 19-year-olds (ie, where the male would be preferred over the female). Finally, in further research, there may be some merit in varying the nature of the illness which is presupposed. That is, a much more serious illness such as terminal cancer might be substituted for the "fracture of the right leg" of the present study. In this case, other values may come into play and preferences for younger patients may not be nearly as strong.


  • 1 . Campbell ME: Study of the attitudes of nursing personnel toward the geriatric patient. Nurs Res 1971;20:147-151.
  • 2. Elmore M: Proposals relating to the selection and organization of learning experiences for nursing students in the care of older patients. Unpublished doctoral dissertation, Columbia University, 1964.
  • 3. Hatton J: Nurse's attitudes toward the aged: Relationship to nursing care. J Gerontol Nurs 1977; 3(3):21-26.
  • 4. Heller BR, Walsh FJ: Changing nursing students attitudes toward the aged: An experimental study. Journal of Nursing Education 1976; 15(5):9-17.
  • 5 . LaMonica EL·. The nurse and the aging client: Positive attitude formation. Nursing Educator November/December, 1979; 23-26.
  • 6 . Schmelzer MO: Nursing Preferences for Clientele, ANA Publication (NP-59), Division on Practice, 63-87, 1979.
  • 7. White CM: The nurse-patient encounter: Attitudes and behaviors in action. J Gerontol Nurs 1977; 3(3): 16-20.
  • 8. DeLora JR, Moses D: Specialty preferences and characteristics of nursing students in baccalaureate programs. Nurs Res 1969; 18(2): 137- 144.
  • 9. Gunter LM: Students' attitudes toward geriatric nursing. Nurs Outlook 1971; 19(7):466-469.
  • 10. Kayser JS, Minnigerode FA: Increasing nursing students' interests on working with aged patients. Nurs Research 1975; 24(I):23-26.
  • 11. Brown MI: Nurses AttitudesToward the Aged and Their Care, Annual Report to Gerontology Branch, USPHS (contract PH 108-64-122), July 1, 1967.
  • 12. Habenstein RW, Christ EA: Prqfessionalizer, Traditional ìzer and Utilizer, ed 2. Columbia, Missouri, University of Missouri, 1963 (originally published, 1955).
  • 13. Coulon L, Tay 1er J: Sexual bias in nursing practice. The Lamp 1977; (September): 13- 15.
  • 14. Dodge JS: Age of nurse helps determine her attitude toward patients. Modern Hospital 1960; 95:5.
  • 15. Brown Ml: Nursing care of the aged. In Jeffers F (ed): Proceedings of Seminars. 1965-69. Duke University Council of Aging & Human Development. Durham, North Carolina. Duke University Medical Center.




Sign up to receive

Journal E-contents