Although gerontologists are greatly concerned about the care of the elderly, scant attention is paid to those characteristics that induce providers to enter the field. The need for personnel in gerontology is increasing rapidly, and the problem of developing shortages must be attacked and solved, otherwise all the envisioned granthose programs for the elderly will not be operationalized effectively.
This preliminary study on nursing students at the University of Hawaii attempts to identify characteristics that are related to an expressed interest in gerontology. A future study might differentiate the characteristics of those who enter gerontology from the characteristics of those who enter other fields of nursing.
The theoretical background of the present study is derived from several theories related to career development. Roe1 proposed a relationship between early experiences and vocational choice. She hypothesized that people attracted to service occupations are people oriented and probably come from homes with loving, overprotecting environments.
Other background theories are Freud's theory of transference and the phenomenon of parataxis as coined by Harry Stack Sullivan. These concepts define the tendency of an original dyadic relationship to influence one's perception of another person. For example, if a person had a loving relationship with a grandparent, perceptions or expectations gained from that relationship would be carried over to another aged person. Anthropological studies have shown that a society's basic personality type, which includes patterns of relationships, feelings, and values, stems from child-rearing practices and common early experiences of its members. Thus, values inculcated in early childhood are carried over into adult behavior.
Attitudes support and are supported by a cognitive structure. It is theorized that attitudes are influenced by facts and information. Studies show increased knowledge accompanies attitudes supporting an issue. New information can modify attitudes through liberal education.
Review of Literature
A number of studies have been conducted on the determinants of student nurses' attitudes toward the elderly.2-5 No strong effects of age were found probably because of the restricted age range involved.4,6,7 Psychological factors of altruism and fulfillment were found to be more important than economic considerations.6,8 Geriatrics was described as dull and depressing and was rated as the least preferred specialty.8 Those that expressed an interest in working with the elderly preferred to do so in a general hospital or public health setting rather than in a nursing home.4
INTEREST IN GERONTOLCXiY VARIABLES OF BY DIFFERENCES IN PROPORTIONS
Previous work experience with the elderly was not found to be related to interest in working with elderly.4,6,7,810 Baccalaureate students were more positive about working with the aged than were associate degree nurses.6,9
Past personal experiences with the elderly did not affect their interest.3,4,10 Robb,2 however, found that those who wanted to work with the elderly reported positive relationships with grandparents.
Although much research in this area has been done, ethnicity in Pacific Asian cultures has never been studied. Conflicting data exist regarding age, education, and past relationships with the elderly. This study adds to the literature by endorsing or refuting some of these past findings.
The Undings cited in the literature suggest a number of hypotheses for the present study:
1 . Students' age and ethnicity make no difference in their interest in gerontology.
2. Work experiences with and courses on the elderly have little effect on student interest.
3. Baccalaureate students are more interested in gerontology than are associate degree students.
4. Students who have had positive relationships with grandparents or elderly friends have a greater interest in gerontology.
Study Method and Procedure
As a preliminary study, the data present a number of limitations. Although the overall data collection instrument was pretested and revised accordingly, the validity and reliability of dependent variables was not rigorously tested. However, the dependent variable, "interest in gerontology," was worded in three different ways, and these three forms do suggest a degree of reliability. Another restriction was the smallness of the sample. Finally, external validity is limited to a nonrandomized sampling from one school of nursing. Contributing to this limitation is the ethnic-racial uniqueness of the Hawaiian setting. However, this circumstance provided a unique advantage to test for ethnic factors.
Population - A total of 118 students filled out a questionnaire during a class hour in the final year of the nursing program including both two-year (associate degree) and four-year (baccalaureate) students.
The first two years of the four-year program cover arts and science courses as prerequisites for the two-year, upperdivision nursing program. Both programs offer a fundamental course in basic nursing skills, with the clinical portion taught in a long-term care facility. As a prerequisite to the baccalaureate program, students are required to take a two-semester course in human development, of which one semester is devoted to aging. The general hospitals in which the medical-surgical clinical experiences are offered have patient populations containing a large percentage of elderly. Students also care for the well elderly in community health settings. Geriatric-gerontology content is covered in several units throughout the curriculum.
Measures - An instrument included three ways of wording the dependent variable: interest in gerontology per se, interest in gerontology as shown by interest in working with the ill elderly, and interest as shown by intention of working in a long-term care facility.
Interest was defined as an expressed desire to work with the elderly, which may or may not result in working in this particular field. Elderly included anyone over 65 years of age, and ill elderly was defined by confinement in an acute hospital.
The independent variables were age, marital status, ethnicity, level of nursing education, work experience, personal relationship with the elderly, and courses taken. The measures were discrete, consisting of response options of yes, no, not at all, somewhat or very much.
The questionnaire was revised following pretesting with 20 senior baccalaureate students from a class in the final semester of their program. Pretesting clarified a number of ambiguities in the wording of the items. The results obtained from this small group were similar to that of the full study.
Analysis - The independent variables were cross-tabulated against the dependent variables and tested by chi square.
The population included 6 males and 112 females. The males were not included in the analysis since the number was too small to test for sex differences. In addition, Tuckman & Lorge7 found no significant differences in sex on attitudes toward aging in a general population.
ETHNICITY RELATIVE TO INTEREST IN GERONTOLOGY AND AGE
Fifty percent of the population fell in the 20 to 24 age group, 30% in the 25 to 29 age group, and 20% were 30 and above. In marital status, 62% were single, 28% were married, 9% were divorced, and 3% were separated. Fiftythree percent were associate degree students, and 47% were baccalaureate students. Ethnic distribution was 40% Caucasian, 28% Japanese, 11% Chinese, 11% Filipino, 2% Korean, and 8% other. This heavily Pacific Asian distribution is unique to Hawaii and, as will be seen, provided the opportunity for findings hitherto unreported.
With respect to the dependent variable, 9 (8%) indicated an interest in entering the field of gerontology, 61 (54%) were somewhat interested, and 42 (37%) were not at all interested. These findings were consistent with those of other studies, which indicate that geriatrics is a less preferred area of nursing. A similar distribution was obtained for the variable form "wanting to work with the ill elderly," and the variable form "would like to work in a long-term care facility."
The results of cross-tabulation with "interest in gerontology" are summarized in Table 1 as differences in proportions. Similar analyses were done with the two other forms of the dependent variable, but since the results were essentially the same, they need not be displayed here. Because of the small sample size, findings that do not meet the 0.05 significance level are indicated as trends.
Age - Slightly more of the younger group (20 to 24) had greater interest in working with the elderly (67.9% vs 57.1%). Although interest in gerontology is related to a favorable attitude toward the aged, two studies8,9 did find that older nurses were more positive toward the aged. Campbell,6 on the other hand, found age not to be relevant. In this study, the tendency for the younger age group to be more interested in gerontology may be due to the confounding effect of ethnicity, inasmuch as the ethnic groups who were more interested were also younger. This effect is examined under Ethnicity and Age.
Marital Status - There was no relationship between interest in gerontology and marital status. The married group was older and consisted of more Caucasians; this group expressed less interest in gerontology. However, as stated, no statistical relationship was found with marital status at this level of sample population.
Ethnicity - Cross-tabulation of interest in gerontology with Caucasian and non-Caucasian status revealed that 50% of the Caucasians were interested in gerontology, whereas 71% of the nonCaucasians were interested. This difference was significant at the 0.05 level.
PERCENT INTERESTED IN GERONTOLOGY BY ETHNICITY ANDAGE
Ethnicity and Age - Variation in interest and age by Caucasians and nonCaucasians subgroups is shown in Table 2. The Filipino students had the highest proportion of interest in gerontology (91.7%), whereas the Caucasians had the lowest proportion (50%). The ethnic differential was greatest between the Filipinos and Caucasians. It would therefore appear that the non-Caucasian finding was due primarily to Pacific Asian groups other than the Japanese and Chinese.
Twelve of the Filipino students were over 25 (33.3%) in contrast to 44 Caucasian students over age 25 (79.5%). With the exception of the Japanese, who represented 27.7% of the sample, there was a corresponding increase in age of the ethnic groups (or increase in proportion over age 25) with decreasing interest. Thus, for most of the cases the age-interest relationship may be explained by ethnicity. This was most clearly shown by the fact that Pacific Asians, particularly Filipinos, were both die youngest and had the most interest.
When analysis is done within age groups (see Table 3), the Filipino students still had the highest percentage of interest (87.8%) and the Caucasian students the lowest (44.4%) within the younger group. Within the oldest group, all of the Filipinos reported interest (N=4).
We have seen that the Caucasians are less interested in gerontology than the non-Caucasians (50% vs 71%); they are also older (79. 5% over age 25 vs 31. 8% over age 25). Again using the dichotomized ethnic variables in an analysis within two age groups, we found similar ethnic differentials in proportions interested. For the younger group, 44.4% of Caucasians and 70.2% of non-Caucasians were interested, with similar corresponding figures (45.7% and 71.4%) for the older group. These analyses suggest ethnicity to be the important variable rather than age. The negative age findings are therefore congruent with many of the studies reported in the literature. The limited age range of the population may help explain the relative unimportance of age. Campbell,6 whose sample of study included aides, LPNs, and RNs, found age not to be an influencing factor in attitudes toward the aged.
Level of Nursing Education - Returning to Table I, working status and level of education (associate degree vs baccalaureate) were not related to interest in gerontology. Campbell6 did show a relationship between baccalaureate education and interest in gerontology, but the relationship was not borne out in this study. Campbell's study showed that RNs who had the most extensive educational background preferred not to work with the aged. This study dealt, however, with working LPNs, RNs, and aides, so the findings are not comparable to the present study.
Work Experience - Most of the students (84%) had worked previously with the elderly, and Table 1 shows no significant relationship between work experience and interest in gerontology, although there was a slight trend in this direction (63.8% vs 55.5%). Work experience with the elderly occurred largely as part of the educational experience in the school of nursing. A small group had previous experience with the elderly as LPNs and RNs. None of these work roles had any systematic relationship to interest in gerontology.
Positive Personal Experience - A greater percentage of those who had a positive personal experience with the elderly were interested in gerontology (66.2% vs 47.8%). This was consistent with Robb,2 who found that students who preferred to work with the elderly had positive attitudes toward them and had positive relationships with grandparents.
Courses - There was a trend for students who were interested in working with the aged to have had previous courses in aging (66.2% vs 55.2%), although this trend was not statistically significant. Interest in gerontology not only coincided with course work in aging but with the number of courses offering clinical experiences. These clinical experiences occurred most often in hospitals, to a lesser extent in the community, and least in nursing homes. All these findings were based on smalt trends rather than statistical significance.
It was initially hypothesized that age and ethnic differences would make no difference in students' interest in gerontology. This hypothesis was not confirmed. Of the two factors, the ethnic finding seemed to be the more important, since the age finding was a function of the younger age of the nonCaucasian students.
Tiie greater interest in gerontology among the non-Caucasians was intriguing and may well be a reflection of greater reverence for the aged found in Pacific Asian cultures. This finding may be specific to Hawaii because of the mix of Pacific Asian and Caucasian groups in the state population and in the University of Hawaii School of Nursing student body.
There was a statistical trend for courses and clinical experiences in gerontology to be related to greater interest in gerontology. On the other hand, previous work experience with the elderly had no significant effect on the dependent variable. This finding deserves further investigation since Tuckman & Lorge7 reported that more direct contact with the aged generated positive attitudes, whereas Gunter4 and Gillis9 found an inverse relationship.
The level of nursing education (associate vs baccalaureate) made no difference in the students' desire to work in gerontology. Gillis9 found that the higher the educational level, the more positive the attitudes toward the aged. With increased emphasis in psychosocial areas of the baccalaureate curriculum, education should make a difference, but this was not borne out in the present study.
Students who have had a positive relationship with an elderly person had greater interest in gerontology. This suggests the importance of preserving and strengthening intergenerational solidarity and age integration in society.
With improved identification of variables that suggest students' interest in the field of aging, more will be known about which students are apt to enter the field. If these variables can be recognized, they can be taken into account in recruitment or curriculum revision. Quality nursing in gerontology will only be rhetoric until we can attract sufficient numbers of capable and wellprepared nurses to the field.
This study has identified, on a preliminary basis, some of the variables related to interest in gerontology. However, further studies are needed to investigate whether students with such characteristics actually take jobs in the field. The latter is a more valid measure of predictors and may therefore generate statistically significant predictors. The ability to produce such data would be greatly enhanced by a larger sample size.
In addition, if data regarding Pacific Asian students' greater interest in gerontology is valid, further exploration could be made into the correlation between level of acculturation and interest in gerontology among these students as well as among others of minority cultural background in other regions of the United States.
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INTEREST IN GERONTOLCXiY VARIABLES OF BY DIFFERENCES IN PROPORTIONS
ETHNICITY RELATIVE TO INTEREST IN GERONTOLOGY AND AGE
PERCENT INTERESTED IN GERONTOLOGY BY ETHNICITY ANDAGE