Journal of Gerontological Nursing

Feature Article 

Educational Strategies to Promote Professional Nursing in Long-Term Care: An Integrative Review

Jodie R. Fox, MSN, RN-BC

Abstract

This integrative review investigates various strategies in professional nursing education that facilitate positive attitudes toward working with older adults in long-term care (LTC) environments, including nursing homes. Nine studies contained strategies that increased positive attitudes of nurses toward older adults. The barrier most frequently identified is lack of gerontological knowledge by faculty and students, suggesting increased knowledge in faculty may ensure that older adults receive quality care. Early introduction of students to people who are aging successfully may dispel bias against older adults. Lack of current nursing role models in LTC settings may reinforce negative stereotypes.

Abstract

This integrative review investigates various strategies in professional nursing education that facilitate positive attitudes toward working with older adults in long-term care (LTC) environments, including nursing homes. Nine studies contained strategies that increased positive attitudes of nurses toward older adults. The barrier most frequently identified is lack of gerontological knowledge by faculty and students, suggesting increased knowledge in faculty may ensure that older adults receive quality care. Early introduction of students to people who are aging successfully may dispel bias against older adults. Lack of current nursing role models in LTC settings may reinforce negative stereotypes.

The number of older adults receiving care in long-term care (LTC) settings continues to rise. Older adults are living longer with chronic illnesses, therefore leading to a need for more professional nurses willing to work in LTC environments, including nursing homes (Chen, Brown, Groves, & Spezia, 2007). Currently, there is an overall lack of interest in gerontological nursing, along with a deficient number of professionally educated nurses practicing in a variety of LTC settings. Reducing this deficit is a critical factor in alleviating the disparities currently found in U.S. LTC settings.

The American Nurses Credentialing Center began recognizing gerontological nursing as a specialty just within the past 2 decades (Matzo & Goetschius, 1993). Matzo and Goetschius (1993) reported the portrayal of the nursing home nurse as the “ugly stepsister” (p. 22) of the nursing profession. The lack of respect allotted to the nursing home nurse is a persistent barrier to attracting highly educated nurses to the vocation of gerontological nursing. Enticing baccalaureate of science nursing students to choose to work in LTC environments continues to be a challenging endeavor, due in part to the poor perception of the nursing home nurse. Additionally, meager wages, lack of recognition, and negative attitudes toward older people also deter the novice professional nurse from pursuing careers in LTC settings, including nursing homes (Matzo & Goetschius, 1993; McLafferty & Morrison, 2004).

Billings and Halstead (2009) stated that “between 2000 and 2050, the number of people aged 65 and older will increase by 135% and those 85 aged years and older will increase by 350%” (p. 94). Wilson (2010) went on to state that less than 1% of all RNs currently practicing in the nation are certified gerontological nurses. This suggests a general lack of interest within the nursing population in the care of older people as a demographic group. Current studies show that nurses who attain a baccalaureate or higher education are proficient in leadership knowledge and management skills and are more likely to provide appropriate, quality nursing service to older adults living in LTC environments (Chen et al., 2007; Schrader, 2009). The paucity of professional nurses currently working in nursing homes is not congruent with the provision of excellence in caring for an increasing aging population that will continue to rely on LTC nursing services such as assisted living, adult family homes, case management, and nursing home care.

Schrader (2009) stated that nurse educators serve as role models, displaying values and norms to nursing students during both clinical and classroom instruction. Nursing instructors who harbor negative attitudes toward nursing home care may inadvertently potentiate the sense of negativity and apathy that already prevail in the students’ perceptions of the nursing home nurse. McLafferty and Morrison (2004) acknowledged that in nursing, as in any other profession, there lies the capacity to succumb to cultural stereotyping. The authors go on to state that it is the responsibility of the nurse educator to dispel insensitivity toward all vulnerable populations, including older adults living in nursing homes.

The purpose of this integrative review is to investigate various strategies in professional nursing education that facilitate positive attitudes toward working with older adults in LTC environments, including nursing homes. Both strategies and barriers conducive to positive student experiences with older adults in the LTC environment will be explored.

Method

A comprehensive search of the literature included the databases CINAHL, Sage Publications, ScienceDirect, and MEDLINE. Date parameters included articles published from 2004 to 2010. Keywords included undergraduate, education, gerontology, nursing, attitude, nursing homes, and long-term care. Although long-term care can be an umbrella term used to describe settings other than nursing homes, such as assisted living facilities and adult family homes, the term was included as part of the exploratory search. The search was limited to the fields of (a) core nursing and (b) research. Selected for review were studies that focused on baccalaureate nursing programs, attitudes nursing students and educators have toward nursing home care or care of older adults, and nursing knowledge relating to older adults. The author reviewed selected articles by title, and, if appropriate, by abstract. Both qualitative and quantitative methods pertaining to undergraduate geriatric education were incorporated for analysis. Exclusions included study locations outside of North America, within nursing homes, or any other environment outside of accredited colleges or universities. Also excluded were (a) studies that pertained to gerontological nursing involving associate degree nursing programs, (b) graduate-level nursing education, (c) education related to nursing assistants, and (d) education focused on licensed practical nurses. Twenty-seven articles received a full-text examination. Of those articles, nine met all inclusion criteria and were selected for this review (Table 1).

Studies Included In Literature ReviewStudies Included In Literature ReviewStudies Included In Literature Review

Table 1: Studies Included In Literature Review

Findings

This integrative review revealed four strategies (Table 2) that may provide a foundation for educational strategies aimed at reducing ageism and fostering positivity toward older adults by nursing students enrolled in baccalaureate nursing programs. These critical efforts are needed to develop a health care workforce that is adequately prepared to provide care to an aging America (Institute of Medicine, 2008). Strategies in the literature noted to increase interest in the nursing care of older adults included: (a) increasing gerontological knowledge among faculty and nursing students, (b) increased maturity of nursing students, (c) incorporating the meaning of healthy, successful aging into nursing curricula, and (d) a positive attitude toward older adults.

Strategies For and Barriers of Promoting Professional Nursing In Long-Term Care

Table 2: Strategies For and Barriers of Promoting Professional Nursing In Long-Term Care

Additionally, this review explored four barriers (Table 2) exposed as possible obstacles to promoting interest in the LTC of older adults by nursing students in baccalaureate programs. Noteworthy barriers included: (a) negative attitudes toward older adults in nursing student populations enrolled in baccalaureate programs and lack of enthusiasm of nursing faculty toward older people, (b) lack of appropriate nursing role models working in LTC settings, (c) lack of knowledge regarding gerontological nursing (with two studies showing that lack of regard for older adults actually increased with further gerontological knowledge [Aud et al., 2006; Holroyd et al., 2009]), and (d) poor staffing levels and lack of supplies to care for older adults in LTC settings, such as nursing homes.

One limitation of this integrative review relates to the level of evidence. According to Polit and Beck’s (2008) criteria, five of the nine studies (Chen et al., 2007; Gilje, Lacey, & Moore, 2007; Koren et al., 2008; Ryan & McCauley, 2004/2005; K.N. Williams, Nowak, & Scobee, 2006) included in this review rate as level VI (Table 2), described as single descriptive, qualitative studies, as opposed to the higher-level quantitative, randomized controlled trials not found in the current literature related to this review. However, based on criteria developed to include qualitative research—Alvarenga’s (as cited in Duvall & Andrews, 2010) quality-rating tool—eight of the nine studies rate as a Level 3, the highest possible quality rating (Aud et al., 2006; Chen et al., 2007; Ferrario, Freeman, Nellett, & Scheel (2007); Gilje et al., 2007; Holroyd et al., 2009; Koren et al., 2008; Ryan & McCauley, 2004/2005; B. Williams, Anderson, & Day, 2007).

Strategies

The literature review identified multiple actions that may be beneficial in the professional education of nurses. These strategies may lead to increasing positive attitudes and encouraging intent to work with older adults as baccalaureate educated nurses.

Each of the nine studies (Aud et al., 2006; Chen et al., 2007; Ferrario et al., 2007; Gilje et al., 2007; Holroyd et al., 2009; Koren et al., 2008; Ryan & McCauley, 2004/2005; B. Williams et al., 2007; K.N. Williams et al., 2006) included in this integrative review contained strategies that may increase the positive attitudes of baccalaureate nursing students toward older adults. Increasing the knowledge base of both nursing students as well as faculty in the specialty of gerontology was recognized in four of nine articles chosen for review (Ferrario et al., 2007; Holroyd et al., 2009; Koren et al., 2008; K.N. Williams et al., 2006). Increasing student exposure to older adults experiencing healthy and successful aging by boosting positive attitudes toward the geriatric population as a whole was a strategy identified by Aud et al. (2006), Ferrario et al. (2007), Holroyd et al. (2009), and K.N. Williams et al. (2006). Additionally, findings contained in this integrative review suggest that as the age and maturity of the nursing student increases, positive attitudes toward older adults are also enhanced (Holroyd et al., 2009; Ryan & McCauley, 2004/2005; B. Williams et al., 2007). Ferrario et al. (2007) postulated that faculty who promote a positive attitude and act as a “proaging role model” (p. 62) toward older adults increases the comfort level and receptiveness of baccalaureate nursing students to care for this population.

These positive actions, if implemented, could be instrumental in the transformation of nursing attitudes toward an aging population. Utilizing constructive affirming strategies in baccalaureate nursing education may lead to increasing a professional nursing work-force able to meet the needs of older adults living in LTC environments.

Barriers

Multiple barriers exist that dissuade novice baccalaureate prepared nurses from choosing a career in gerontological nursing. Pursuant to caring for the aging population, removal of barriers in baccalaureate nursing education may facilitate interest in gerontology. Removing barriers may lead to the incorporation of professional nurses in LTC settings with the leadership skills needed to dispel poor attitudes and promote gerontological nursing.

The barrier most commonly identified in developing positive attitudes toward caring for the aging population is lack of gerontological knowledge by both faculty and students alike (Ferrario et al., 2007; Gilje et al., 2007; Holroyd et al., 2009; Koren et al., 2008; Ryan & McCauley, 2004/2005; B. Williams et al., 2007). Negative attitudes toward older people by nursing students were the second most prominent finding within the research (Aud et al., 2006; Chen et al., 2007; Ferrario et al., 2007; Ryan & McCauley, 2004/2005). Furthermore, a barrier noted in the literature was faculty’s poor attitude regarding gerontology. This finding was substantiated by faculty members identifying lack of appropriate clinical resources, content overload, and lack of interest as barriers to gerontological nursing education (Gilje et al., 2007; Holroyd et al., 2009). Chen et al. (2007) found that a lack of professional nursing role models, coupled with student frustration toward poor staffing levels during student clinical rotations, was a barrier to nursing student intent to work with older people in nursing homes. The authors also stated that students were disappointed in the lack of available supplies to care for residents as an additional barrier to working in the nursing home environment. Holroyd et al. (2009) noted that students who have previous experience working in LTC settings could have developed a lack of interest in gerontological nursing. In contrast to the other researchers, Aud et al. (2006) and Holroyd et al. (2009) determined that students’ and faculty’s increased knowledge of gerontology based on current disease-focused nursing curricula, along with the students’ prior experiences, may be potentially creating bias against baccalaureate nursing students choosing gerontological care as a career path. Further studies are necessary to explore the effect of nursing students previously employed in LTC settings and the potential for increase in bias against gerontological nursing. Additional studies are also needed to examine the current perspective of nursing faculty in relation to ageism and stereotyping of older adults.

These findings in the literature suggest multiple barriers currently exist in baccalaureate nursing education that must be addressed to ensure the aging population will receive excellent care throughout the remainder of their life.

Discussion

Current literature suggests the existence of strategies that can spark baccalaureate nursing students’ interest in the nursing care of older adults. Having educators who are role models in support of gerontological nursing may ignite interest in nursing students. The literature suggests increasing gerontological nursing knowledge in nursing faculty may be the initial step needed to ignite the passion of care, advocacy for social justice, and leadership skills necessary to ensure the aging population receives high-quality nursing care. One possible strategy to increase the knowledge level and interest of undergraduate faculty may be to use the multiple resources available provided by the Hartford Institute for Geriatric Nursing ( http://hartfordign.org), including the e-learning center that has tools to assist faculty in integrating geriatrics into the curriculum.

Strategies that enhance nursing students’ attitudes toward caring for older adults are significant in an aging society that needs optimal professional nursing care, both now and in the future. Baccalaureate education of nurses working in nursing homes will boost professional behaviors, creating nursing leadership where in today’s society a vacuum currently exists. A possible strategy is to recruit undergraduate faculty who have experience and professional backgrounds in gerontological nursing care. This strategy may create novice professional nurses passionate about enhancing the care of older adults. Ultimately, increased nursing interest will lead to additional professionally educated nursing staff working in nursing homes and other LTC settings. Professionally educated nurses demonstrate the knowledge needed to advocate for resources nursing homes desperately need. The Institute of Medicine’s 2010 report highlighted the need for baccalaureate-level nursing education for entry level to practice. Nurses who work in LTC settings such as nursing homes, as in other disciplines, should hold a minimum of a baccalaureate education. Baccalaureate-prepared nurses possess needed leadership skills to be the change agents necessary to adapt to the uncertain future of nursing home care. Professionally educated nurses practicing in the area of gerontology will benefit older adults needing 24-hour nursing care. Additionally, adding nurse leaders who function as both managers and as bedside staff nurses in LTC settings may be a strategy to provide optimal care to this vulnerable, growing population.

Case management and nursing leadership content in professional nursing education may be the necessary catalyst that positively affects the lives of older adults in LTC settings. The American Association of Colleges of Nursing (AACN, 2007) proposed that the role of the clinical nurse leader is to address health conditions that occur most frequently using the majority of resources with a minimum cost. This is the type of nurse leader needed in LTC facilities.

The clinical experiences of baccalaureate students create the perception students will retain of gerontological nursing. The literature suggests that beginning clinical experiences with older people aging successfully early in baccalaureate programs may assist in dispelling bias against older people as a cohort. According to K.N. Williams et al. (2006), clinical nursing practice in caring for frail older adults with complex conditions is challenging and may be more appropriate in more mature senior-level students. This strategy may lead to attitudes that are more positive and raise levels of interest in baccalaureate nursing students in becoming professional gerontological nursing role models. This approach may act as the catalyst that will increase nurse leadership in LTC settings. The lack of current nursing role models in nursing homes reinforces the negative stereotype that nursing homes are bad places to live and work. Additionally, the lack of role models in LTC settings may correlate to the deficiency of baccalaureate-prepared nurses who hold leadership positions in nursing homes. Further studies are needed to explore the differences related to the educational levels of nurses holding leadership roles in nursing homes and other LTC settings.

A further strategy—adding coursework at the baccalaureate level that focuses more heavily on gerontological care—may lead to increased interest at the student level. A further rationale for increasing baccalaureate nursing education on the care of older adults was addressed succinctly by the AACN (2007):

In the past, nursing education has been dogged about assuring that every student has the opportunity to attend a birth, but has never insisted that every student have the opportunity to manage a death, even though the vast majority of nurses are more likely to practice with clients who are at the end of life. Similarly, gerontology has not been a universal curriculum requirement even though persons over 65 use the lion’s share of health resources nationally.

In addition, another strategy clearly brought forward in the literature was that the early introduction of students to people who are aging successfully is shown to create a more positive overall view of older adults in society. Negative stereotypes held by students may be reinforced by educating only to the illness and infirmity of aging as opposed to health promotion and valuing the life experience of the older adult. Knowing it is possible to age well may soften personal fears about growing older and culminate in a more realistic picture of the place older adults hold in society. Furthermore, the assertion that older, more mature students have an enhanced, more positive view of what it means to grow older further substantiates the argument that younger students may have deficient or negative life experiences as factors that prevent a positive image of successful aging, and younger students could benefit from additional education and experience. Additional studies are needed to investigate both the knowledge level and attitudes regarding the aging process by both faculty and baccalaureate nursing students.

Conclusion

As the population continues to age, professionally educated nurses will be needed to advocate for the markedly increased number of older adults in the United States. Current lack of gerontological knowledge, lack of a positive image of aging, and a lack of interest by nursing faculty are barriers to baccalaureate nursing students being prepared to care for the future health care needs of the aging population. Strategies to increase knowledge and interest in the care of older adults will increase professional nursing presence in LTC settings. Additional nursing leadership in LTC will lead to more baccalaureate-prepared gerontological nurses interested in working with older adults.

Although lack of interest in gerontological nursing is multifaceted, igniting concern for older adults at the baccalaureate level for nurses working in LTC settings may (a) address the increased levels of nursing care needed for residents in LTC settings, (b) eradicate the deficiency of nursing leadership in LTC, (c) improve the overall quality of nursing care to older adults in LTC settings, and (d) elevate the perception of gerontological nursing, leading to an influx of professional nurse leaders willing to step up and eliminate this health disparity.

References

  • American Association of Colleges of Nursing. (2007). White paper on the education and role of the clinical nurse leader. Retrieved from http://www.aacn.nche.edu/publications/white-papers/ClinicalNurseLeader.pdf
  • Aud, M.A., Bostick, J.E., Marek, K.D. & McDaniel, R.W. (2006). Introducing baccalaureate student nurses to gerontological nursing. Journal of Professional Nursing, 22, 73–78. doi:10.1016/j.profnurs.2006.01.005 [CrossRef]
  • Billings, D.M. & Halstead, J.A. (2009). Forces and issues influencing curriculum development. In Thomas, L. & Bliss, C. (Eds.), Teaching in nursing: A guide for faculty (3rd ed., p. 94). St. Louis: Saunders Elsevier.
  • Chen, S.L., Brown, J.W., Groves, M.L. & Spezia, A.M. (2007). Baccalaureate education and American nursing homes: A survey of nursing schools. Nurse Education Today, 27, 909–914. doi:10.1016/j.nedt.2007.01.004 [CrossRef]
  • Duvall, J.J. & Andrews, D.R. (2010). Using a structured review of the literature to identify key factors associated with the current nursing shortage. Journal of Professional Nursing, 26, 309–317. doi:10.1016/j.profnurs.2010.02.002 [CrossRef]
  • Ferrario, C.G., Freeman, F.J., Nellett, G. & Scheel, J. (2007). Changing nursing students’ attitudes about aging: An argument for the successful aging paradigm. Educational Gerontology, 34, 51–66. doi:10.1080/03601270701763969 [CrossRef]
  • Gilje, F., Lacey, L. & Moore, C. (2007). Gerontology and geriatric issues and trends in U.S. nursing programs: A national survey. Journal of Professional Nursing, 23, 21–29. doi:10.1016/j.profnurs.2006.12.001 [CrossRef]
  • Holroyd, A., Dahlke, S., Fehr, C., Jung, P. & Hunter, A. (2009). Attitudes toward aging: Implications for a caring profession. Journal of Nursing Education, 48, 374–380. doi:10.3928/01484834-20090615-04 [CrossRef]
  • Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Retrieved from the National Academies Press website: www.nap.edu/catalog/12089.html
  • Institute of Medicine. (2010). The future of nursing: Focus on education. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf
  • Koren, M.E., Hertz, J., Munroe, D., Rossetti, J., Robertson, J., Plonczynski, D. & Ehrlich-Jones, L. (2008). Assessing students’ learning needs and attitudes: Considerations for gerontology curriculum planning. Gerontology and Geriatrics Education, 28(4), 39–56. doi:10.1080/02701960801963029 [CrossRef]
  • Matzo, M. & Goetschius, S.K. (1993). Preparing for the gerontological nurse certification. Nursing Homes: Long Term Care Management, 42(5), 22.
  • McLafferty, I. & Morrison, F. (2004). Attitudes towards hospitalized older adults. Journal of Advanced Nursing, 47, 446–453. doi:10.1111/j.1365-2648.2004.03122.x [CrossRef]
  • Polit, D.F. & Beck, C.T. (2008). Nursing research: Generating and assessing evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins.
  • Ryan, M. & McCauley, D. (2004/2005). We built it and they did not come: Knowledge and attitudes of baccalaureate nursing students toward the elderly. Journal of the New York State Nurses’ Association, 35(2), 5–9.
  • Schrader, V. (2009). Nurse educators’ personal perspectives of long-term care settings. Journal of Gerontological Nursing, 35(10), 34–41. doi:10.3928/00989134-20090731-03 [CrossRef]
  • Williams, B., Anderson, M.C. & Day, R. (2007). Undergraduate nursing students’ knowledge of and attitudes toward aging: Comparison of context-based learning and a traditional program. Journal of Nursing Education, 46, 115–120.
  • Williams, K.N., Nowak, J. & Scobee, R.L. (2006). Fostering student interest in geriatric nursing: Impact of senior long-term care experiences. Nursing Education Perspectives, 27, 190–193.
  • Wilson, L.D. (2010). The American Association of Colleges of Nursing’s Geriatric Nursing Education Consortium. Journal of Gerontological Nursing, 36(7), 14–17. doi:10.3928/00989134-20100528-01 [CrossRef]

Studies Included In Literature Review

Citation Purpose Design/Sample Instruments Findings Recommendations
Aud, Bostick, Marek, & McDaniel (2006) Goals of gerontological coursework were to increase knowledge of gerontological nursing and promote positive attitudes toward older adults Pretest-posttest paired t test (N = 325) Health Education Systems Incorporated, Gerontological Examination, and attitudes toward older adults as measured by Facts on Aging Quiz (FAQ) Mean score on the FAQ1 was −0.072 (SD = 0.24); mean score for the FAQ2 was −0.11 (SD = 0.19), indicating an increase in negative attitude toward older adults. Academic strategies to increase knowledge do not necessarily create positive attitudes. Coursework should be revised to include diverse experiences in an aging and health continuum. Integrate evidence-based didactic content into clinical practice. Test assumptions related to stereotypes of aging.
Chen, Brown, Groves, & Spezia (2007) (a) Explore use of nursing homes in BSN programs, (b) describe factors affecting nursing faculty’s decisions to use nursing homes in BSN programs, and (c) identify advantages/ disadvantages of nursing home placement for BSN students Descriptive; content analysis and coding (N = 53 schools of nursing) Exploratory survey Advantages of nursing homes: slower pace for beginning students, stimulating for long-term care nurses; disadvantages of nursing homes: lack of available role models in long-term care, negative attitudes of long-term care nurses, and nursing assistants potentiate negative attitudes of students toward older adults. Develop partnerships between schools of nursing and nursing homes. Develop positive student perceptions of the nursing home environment, increasing interest in gerontology.
Ferrario, Freeman, Nellett, & Scheel (2007) Because health care behaviors guide attitudes and education’s role is to shape values and attitudes, what is the effect of curriculum changes on student attitudes toward aging? Two separate forms of data collection (pre- and post-curricular changes). First group: descriptive-correlational (N = 117 senior BSN students); second group: exploratory-descriptive (N = 17 nursing students who matriculated through the revised curriculum) First group: FAQ; second group: investigator-developed 12-item, open-ended questionnaire using six factors associated with successful aging First group: measures of central tendency and nonparametric statistics (Kruskal-Wallis test and Fischer’s Exact Test) found low knowledge and very negative attitudes toward older adults. More knowledge about aging was related to positive attitudes and vice versa (N = 117) (r = 0.283, p = 0.002.). Mean knowledge score = 55.9%. Second group: most frequent occurring factor scored was physical and mental health (N = 10, 30.3%). In contrast to negative views of the first group, the students emphasized goal accomplishment, family, and career. No mention was made of spirituality. Including positive aspects of aging and evidence-based organizing frameworks, such as aging, in curriculums, we may foster a paradigm shift whereby students may want to work with older adults as part of the journey toward successful aging.
Gilje, Lacey, & Moore (2007) Survey the issues and trends in gerontological curricula development since the development of Older Adults: Recommended Baccalaureate Competencies for Geriatric Nursing Care Descriptive qualitative (N = 202) Descriptive statistics were used to profile respondents, and content analysis was used to analyze textual data Lack of faculty interest in gerontology is a continuing issue. Indicates an increase of gerontological courses; however, 91% of faculty cite “curriculum overload,” 18% cite lack of interest in gerontology, 4% cite lack of qualified staff, 4% cite lack of clinical resources, and 46% choose other (data not collected) as significant barriers to increased gerontology focus in BSN programs. Nursing curricula must reflect nursing faculty’s commitment, must respond to addressing the complex health care needs of an aging society. Experiences that contribute to faculty development include: achieving credentialing, participating in regional and national conferences, involvement in centers on aging and geriatric nursing excellence, engaging in research issues related to the care of older adults, interdisciplinary practice and collaboration with gerontology programs on university campuses, and working with various foundations committed to quality care for older adults.
Holroyd, Dahlke, Fehr, Jung, & Hunter (2009) Identify whether student attitudes were influenced in a positive or negative direction by the theory and practice experiences that occurred during a 4-year BSN program Comparative cross-sectional (N = 179) Attitudes Toward Old People, a 5-point Likert-type scale given each year to BSN students Using ANOVA total negative score (p = 0.941) and total positive score (p = 0.442) is not significant with alpha level of 0.05. Kruskal-Wallis nonparametric ANOVA shows age, previous experience, and gender are related to attitude toward older adults. Unable to generalize gender due to low number of men. Regression analysis shows that as students age, attitudes toward older adults improve. Curricular revisions incorporating stand-alone geriatric classes, larger number of practical and theoretical experiences focusing on both well and unwell older adults opposed to focusing on disease process, and examination of faculty’s ageist views may improve overall nursing attitudes toward older people.
Koren et al. (2008) Prelicensure nursing students’ attitudes toward older adults; knowledge, comfort, and confidence levels; perceived learning needs; and the personal and experiential characteristics of students related to attitude toward gerontological nursing Cross-sectional needs-assessment survey (N = 200) AGED Inventory measured attitudes and stereotypical beliefs about older adults. The Undergraduate Needs Assessment Form was developed specifically for study. Increased knowledge was positively correlated to comfort and confidence. Low intent to learn more. Nurse educators should consider the perspectives of students when planning curricula related to gerontology.
Ryan & McCauley (2004/2005) Program developed for senior baccalaureate students received no interest despite recruitment efforts. Survey conducted by researchers to determine knowledge and attitudes toward older adults Nonexperimental, descriptive survey using a convenience sample of BSN students (N = 55) Kogan’s Attitudes Toward Old People Scale (KOP), along with a revised FAQ1 Senior students scored higher on the KOP than juniors. Mean scores = 145 (SD = 15.41) and 141.58 (SD = 16.27). Senior students also scored higher on the FAQ1 (mean = 12.42; SD = 3.06) than the junior students (mean = 10.42; SD = 2.42). Students’ attitudes must be identified and tested. Early content should focus on clinical assessment of healthy, functioning older adults and reinforcing geriatrics throughout the curriculum.
B. Williams, Anderson, & Day (2007) Investigate difference in attitude of students toward older adults in first and fourth year BSN program using CBL Longitudinal comparative study of first-year students, cross-sectional for fourth-year students (N = 38) Personal Details Questionnaire, FAQ, and Aging Semantic Differential Knowledge does not increase significantly in an integrated program. Independent sample t test between traditional programs (mean = 14.70) and CBL programs (mean = 15.20; t = 0.393, p = 0.693) show no significant change in attitude toward older adults from first to fourth year students. Integrated curricula may not significantly improve students’ knowledge of age-related changes nor positively influence attitudes. CBL learning may foster inner maturity toward personal aging.
K.N. Williams, Nowak, & Scobee (2006) Characterize student attitudes toward geriatric and LTC nursing and determine how the expanded clinical experience affected student attitudes and intentions to pursue nursing roles in LTC settings Focus group research during expanded LTC clinical experience (N = 32 senior-level nursing students) Eight focus group questions developed and transcribed verbatim Four primary themes emerged: LTC nurses need strong self-concept, special communication skills, culture change, and differences from prior clinical experiences in LTC. Notably, none of the students chose LTC nursing for professional positions. Expanded clinical experience in LTC may have planted the seed for future career trajectories in LTC. Consider clinical experiences outside LTC, such as senior centers and assisted living facilities. Nursing needs to focus holistically to promote positive attitudes about aging.

Strategies For and Barriers of Promoting Professional Nursing In Long-Term Care

Strategies for Developing Positive Attitudes Toward Gerontological Nursing Barriers to Positive Attitudes Toward Gerontological Nursing
Citation Increasing Gerontological Knowledge of Faculty/Students Increased Student Maturity Exposure to Healthy Aging Positive Attitude about Aging among Faculty Negative Attitudes about Aging among Faculty/Students Lack of Role Models in LTC Lack of Gerontological Knowledge among Faculty/Students Poor Staffng/Lack of Supplies in LTC Quality Ratinga Level of Evidenceb
Aud, Bostick, Marek, & McDaniel (2006) X 3 IIb
Chen, Brown, Groves, & Spezia (2007) X X 3 VI
Ferrario, Freeman, Nellett, & Scheel (2007) X X X 3 V
Gilje, Lacey, & Moore (2007) 3 VI
Holroyd, Dahlke, Fehr, Jung, & Hunter (2009) X X X ↑↓ 3 IV
Koren et al. (2008) X 3 VI
Ryan & McCauley (2004/2005) X 3 VI
B. Williams, Anderson, & Day (2007) X 3 IV
K.N. Williams, Nowak, & Scobee (2006) X X 2 VI

Keypoints

Fox, J.R. (2013). Educational Strategies to Promote Professional Nursing in Long-Term Care: An Integrative Review. Journal of Gerontological Nursing, 39(1), 52–60.

  1. Leadership skills among baccalaureate nurses are needed to ensure optimum care of older adults residing in nursing homes.

  2. Current literature describes multiple barriers that discourage baccalaureate-prepared nurses from pursuing a career in nursing homes and other long-term care environments.

  3. This literature review discusses strategies that may create student interest in older adults during baccalaureate nursing education.

  4. Implementing these initiatives during baccalaureate nursing education may lead to an increase in professional nurses who choose gerontological nursing as a career.

Authors

Ms. Fox is Assistant Professor, Viterbo University, La Crosse, Wisconsin.

The author has disclosed no potential conflicts of interest, financial or otherwise. The author thanks Patricia E. Zander, PhD, Professor Emerita, for her guidance and expertise in reviewing the manuscript.

Address correspondence to Jodie R. Fox, MSN, RN-BC, Assistant Professor, Viterbo University, 900 Viterbo Drive, La Crosse, WI 54601; e-mail: jrfox@viterbo.edu.

Received: July 29, 2011
Accepted: May 04, 2012
Posted Online: November 15, 2012

10.3928/00989134-20121107-01

Sign up to receive

Journal E-contents