Recognizing the health care needs of the aging older adult population, nursing educators have been looking for the optimal method for providing gerontological clinical experiences to nursing students. Many studies have been reported using changes in students' attitudes toward older adults as the dependent variable. These studies have had mixed results with some researchers reporting positive changes in attitudes (Gunter, 1971; Wìlhite & Johnson, 1976; Heller & Walsh, 1976; Hart, Freed & Crowell, 1976; Hannon, 1980), others reporting no change (Kayser & Minnigerode, 1975), and still others having negative results (Chamberland, Rawls, Powell & Roberts, 1978). No study found that a gerontological nursing experience changed the students* career preference to working with older adults.
Some nursing educators and clinicians believe one variable affecting these mixed results is the type of clinical experience. The need to have clinical experiences with well older adults has been cited as an important factor in developing positive attitudes toward this age group (Heller & Walsh, 1976; Hannon, 1980). Others have recommended the nursing home as an excellent experience for nursing students (Barrett & Metz, 1981). No study compared students who had experiences with well older adults to those who had experiences only with institutionalized elderly.
As a part of a curriculum study, faculty at the University of Tennessee College of Nursing asked the question: Is a planned learning experience with well older adults a positive influence on a nursing student's attitude, level of gerontological knowledge, and willingness to work with older adults after graduation?
Students included in the study were seniors at the University of Tennessee Center for the Health Sciences College of Nursing enrolled concurrently in two sets of clinical and theory courses: Advanced Family Care and Long-Term Care. Thirty-seven seniors were included in fall, 1981 and 41 in fall, 1982. Both groups were approximately half of the total senior class of each year.
The 10-week course in Advanced Family Care focused on families in community settings and included a module on primary health care needs of the older adult. In laboratory settings students had experiences in clinics and home visiting. The concurrent course, Long-Term Care, focused on patients with chronic or long-term illness and included clinical experiences with older adults in nursing homes and rehabilitation settings.
The Kogan Attitude Toward Old People Scale (Kogan, 1961) was utilized to measure attitudes. This is a Likerttype scale composed of 17 negative and 17 positive statements about old people. A mean score was calculated on the negative scale, the positive scale, and the overall score for each student. The Palmore Facts on Aging (Palmore, 1977) which consists of 25 factual statements on aging was administered to measure knowledge. A researcher developed instrument provided demographic data and stated work preferences in relation to setting and age groups.
Upon entering the junior year of the curriculum and again prior to graduation, all students were given a battery of examinations including the Kogan and work preference instruments. Students were assigned to one of four clinical groups in the fall quarter of their senior year based on their Kogan mean score. Students with a negative mean score on the Kogan scale were divided into either a treatment or a control group. Those with positive mean scores were also divided into a treatment or a control group. Treatment group three that had a negative orientation toward older adults and treatment group two that had a positive orientation were placed in clinical experiences with well older adults. Control group one that had a negative orientation and control group four with a positive orientation had no planned experiences with well older adults. Faculty and students had no knowledge of the basis of assignment to clinical groups.
All students were enrolled in the Advanced Family Care course and the Long-Term Care course. As a part of the latter course, all students had 45 hours of clinical experience in a nursing home or rehabilitation center with older adults.
Clinical experiences in Advanced Family Care were divided with students in the treatment groups assigned to clinical experiences with older adults in community or noninstitutionalized settings and those in the control group working with other age groups. The 60-hour clinical experience for the treatment group was in two nursing clinics in high-rise apartment residences for the elderly, health department chronic disease clinics, and home visits to elderly clients. The Palmore quiz was administered to both the 1981 and 1982 classes the first day of the fall quarter and repeated upon completion of the course. Student assignment to clinical experiences was not manipulated based on scores on this quiz.
Mean scores on both the Palmore and Kogan tools were calculated for each of the four clinical groups of students. Differences in the pre- and post-test means were compared for each of the clinical groups by analysis of variance. Analysis of variance was used to compare differences between the four groups on the post-test. The 1981 and 1982 group means were compared by independent t test for overall means and within the four groups by a two-way analysis of variance.
FACTS ON AGING QUIZ MEANS BY CLINICAL GROUPS
MEAN ATTITUDES TOWARD ELDERLY BY CLINICAL GROUPS
No significant differences in attitudes or knowledge were found between the treatment and control groups. The total group of students demonstrated a statistically significant increase in knowledge as measured by the Palmore Facts on Aging quiz (Table 1). There was a statistically significant difference in students having negative attitudes to having more positive attitudes toward older adults, but there was no difference in students already assessed as having positive attitudes (Table 2). No change in work preference was noted for either group.
The knowledge base of nursing students on aging as measured by the Palmore quiz can be increased significantly by planned theoretical and clinical experiences. However, clinical experiences with noninstitutionalized elderly have no statistically measurable effect on knowledge over the gains made by students who did not have this clinical.
Nursing students' negative or stereotypical attitudes toward the elderly do decrease after planned learning experiences with older adults. The analysis showed, however, that those students in groups who initially had negative attitudes became more positive regardless of the clinical experiences with noninstitutionalized elderly or no experience with this population group.
The results of this study support those of other investigators reporting planned curriculum experiences related to older adults can positively influence attitudes toward this group and increase the knowledge base of nursing students on aging. What this investigation failed to support was that experiences with noninstitutionalized elderly would make a significant difference on attitude and knowledge base. Several authors have suggested that nursing programs utilizing only institutional settings, such as the nursing home, present a distorted view of the elderly and reinforce negative attitudes. In this study all of the students had clinical experiences in nursing homes and only half had planned contact with elderly in homes and primary care settings. However, both groups of students who initially had more negative attitudes improved regardless of their type of clinical contacts. Students who initially had more positive attitudes remained essentially unchanged.
This investigation suggests that knowledge and attitude change is not dependent upon the particular type of clinical learning activity. Perhaps the increased attention to the aging population in theory and in clinical regardless of the setting is sufficient to bring about desired improvement in attitudes and in knowledge.
Although this study has limitations, it has implications for nursing educators in planning curriculum experiences. Much faculty time is consumed in arranging primary care experiences. Also, only a small number of students can be scheduled at one time in most clinic settings resulting in a smaller faculty to student ratio. It may not be necessary for all students to have the same type of experiences to bring about the desired results. The important factor is the inclusion of gerontological nursing content and experiences in our curricula to produce a nursing practitioner with a positive attitude and a stronger knowledge base and ultimately provide high quality care to older adults.
- Barrett, J. & Metz, E. (1981). An SNF for BSN students. Geriatric Nursing, 2, 119-121.
- Chamberland, G., Rawls. B., Powell, C., & Roberts, M.J. (1978). Improving students' attitudes toward aging. Journal of Gerontological Nursing, 4, 44-45.
- Gunter, L.M. (1971). Students' attitudes toward geriatric nursing. Nursing Outlook, 19, 466-469.
- Hannon, J. (1980). Effect of a course on aging on a graduate nursing curriculum: A small discipline study. Journal of Gerontological Nursing, 6, 604, 611-615.
- Hart, L.K., Freed, M.I., & Crowell, C. M. (1976). Changing attitudes toward the aged and interest in caring for the aged. Journal of Gerontological Nursing, 2, 11-16.
- Heller, B., & Walsh, F. (1976). Changing nursing students' attitudes toward the aged: An experimental study. Journal of Nursing Education, 15, 9-17.
- Kayser, J.S. & Minnigerode, F.A. (1975). Increasing nursing students' interest in working with aged patients. Nursing Research, 24, 23-26.
- Kogan, N. (1961). Attitudes toward old people: The development of a scale and an examination of correlates. Journal of Abnormal Social Psychology, 62, 44-54.
- Palmore, E. (1977). Facts on aging: A short quiz. Gerontologist, 17, 315-320.
- Wilhite, M.J. & Johnson, D.M. (1976). Changes in nursing students stereotyped attitudes toward old people. Nursing Research, 25, 430-432.
FACTS ON AGING QUIZ MEANS BY CLINICAL GROUPS
MEAN ATTITUDES TOWARD ELDERLY BY CLINICAL GROUPS