Journal of Nursing Education

We Need to Know More: Nurse Educators' Interest and Expertise in Gerontology

Muriel B Ryden, PHD, RN, FAAN; Julie A Johnson, PhD, RN

Abstract

ABSTRACT

An assessment was made of 129 faculty who teach nursing students about the care of aged clients to determine their level of interest and expertise in 21 content areas related to gerontology. Faculty rated their expertise consistently lower than the relevance of, and their interest in, each of the content areas. Areas identified as most important for their professional growth tended to be areas where faculty ranked their expertise as already being high. The mean self-rated expertise of faculty who taught a course in gerontological nursing was significantly higher than those who did not. Most respondents lacked formal education in gerontology: 9% of respondents had gerontology in their undergraduate program; 27% in their graduate program. Only 4% were certified as gerontological nurses or gerontological nurse practitioners.

Abstract

ABSTRACT

An assessment was made of 129 faculty who teach nursing students about the care of aged clients to determine their level of interest and expertise in 21 content areas related to gerontology. Faculty rated their expertise consistently lower than the relevance of, and their interest in, each of the content areas. Areas identified as most important for their professional growth tended to be areas where faculty ranked their expertise as already being high. The mean self-rated expertise of faculty who taught a course in gerontological nursing was significantly higher than those who did not. Most respondents lacked formal education in gerontology: 9% of respondents had gerontology in their undergraduate program; 27% in their graduate program. Only 4% were certified as gerontological nurses or gerontological nurse practitioners.

Introduction

The handwriting is on the wall. The script is large enough for all to see. The "Geriatric Imperative" (Somers, 1983) is a summons to action, not an option. Nurse educators have a social obligation to prepare nurses who have the knowledge and skills needed to care for a client population increasingly composed of frail elders. Growing awareness of this responsibility in the profession of nursing is reflected in a resolution (f6) passed by the National League for Nursing at their 1989 convention, calling for activities to increase gerontological content (Johnson & Connelly, 1990).

A report from the Health Resources and Services Administration (1980) projected a future need for about 2,000 faculty with expertise in gerontological nursing; at that time, only 420 faculty were listed. This dearth of faculty with preparation in gerontology is one of the many barriers to effective gerontological education for entering practitioners. In the recent status report on nursing and gerontology published by the Association for Gerontology in Higher Education, Johnson & Connelly (1990) point out that both academic faculty and clinical preceptors prepared in gerontology continue to be in short supply, and that this interferes with curriculum development, creative clinical placement, and recruitment, as well as basic and clinical research in the field. In listing strategies that schools of nursing should employ to enhance the education of nursing students in the care of the elderly, one dean (Prock, 1983, p. 41) asserts:

... no other single remedy is as important in stimulating the interest of both undergraduate and graduate students as having knowledgeable, clinically competent faculty members with graduate education for teaching, research, and service in gerontology and geriatrics.

There has been a growth in programs that offer specialization in gerontology at the master's and doctoral level American Nurses Association [ANA], 1986; Connelly, 1988). Encouraging promising students to seek a career track in gerontology is one approach to developing a cadre of well-prepared faculty for the future. However, nursing as well as other health disciplines will continue to experience a shortage of educators with preparation in gerontology. Health care professions must have educators who can take the lead and change the curriculum to improve the knowledge and skill of entering practitioners in the care of elderly people. Responding to this need, the Health Resources and Services Administration has provided funding for Geriatric Education Centers across the country. As one means to address this need, the Minnesota Area Geriatric Education Center (MAGEC) has instituted a program for faculty fellows to upgrade the skills of health sciences educators in the care of the aged.

Table

TABLE 1Characteristics of Respondents (N=129)

TABLE 1

Characteristics of Respondents (N=129)

Continuing education programs are another means of increasing the competencies of nurse educators in the field of gerontology. However, a survey conducted by the ANA Council on Gerontological Nursing (1986) suggested that continuing education courses in gerontology appeared to be more relevant to the needs of practicing nurses than those of faculty members. In order to target professional education programs that MAGEC might offer to nursing faculty who teach about the care of aged clients, a survey of faculty teaching in regional nursing programs was conducted in April 1990.

Institutional and Faculty Sample

Eighty-three nursing programs were contacted, including 50 Minnesota programs and 33 additional programs in bordering cities in Wisconsin, Iowa, and South Dakota. Of the programs surveyed, 30.1% were baccalaureate, 3.6% were diploma, 34.9% were associate degree, and 31.3% were practical nursing programs.

The director of each school of nursing received a packet of information, including a description of the study and three faculty needs assessment surveys. The director was asked to distribute the surveys to faculty who teach about the care of aged clients, record the number of surveys distributed on a form provided, and return this form to the investigator with any requests for additional copies.

The initial return rate was less than 45%; therefore, a second mailing was sent to the directors who had not yet returned the form. At the completion of the study, responses had been received from 67 directors (81%). The response rate varied among the types of programs surveyed: 84% (n = 21) for the baccalaureate programs, 100% (n = 3) for the diploma programs, 69% (n = 20) for the associate degree programs, and 81% (n = 21) for the practical nursing programs.

Directors indicated that they had distributed surveys to 195 faculty who teach the care of the aged. The numbers of surveys given out per school ranged from zero (directors of one practical and two associate degree programs indicated that, in their institutions, no one was currently teaching this content) to 24 (the director of one baccalaureate program indicated that all faculty integrated gerontologicai content in their courses). The mean number of surveys distributed per school was 2.9. Completed questionnaires were returned by 129 faculty, providing a 66% return rate. Table 1 summarizes the characteristics of the faculty sample.

Instrument

The faculty needs assessment had two sections. The first section usted 21 content areas in gerontology (Table 2). The content areas were determined through consultation with experts in the field of gerontology and a review of the literature. For each content area, respondents rated their current level of expertise, the relevance of the topic to their teaching responsibilities, and their level of interest in learning more about the topic. Ratings were made using a four-point Likert-type scale that ranged from O (none) to 3 (high). This survey technique, which was developed by Misanchuk (1984), was used to assess the educational needs of nurses in long-term care (Krichbaum, Johnson, & Ryden, 1992). Respondents identified the three content areas that they believed were most important to their professional continuing education. The second section of the needs assessment dealt with demographics, respondents' education in gerontology, gerontological teaching experience, and experience in gerontological research and publishing.

Table

TABLE 2Nurse Educators' (N= 129) Mean Ratings* of Expertise, Relevance, and Interest in Content Areas in Gerontology

TABLE 2

Nurse Educators' (N= 129) Mean Ratings* of Expertise, Relevance, and Interest in Content Areas in Gerontology

Results

Mean ratings of the respondents' current expertise in each content area, the relevance of the content area to their teaching responsibilities, and their interest in learning more about the content area are shown in Table 2. Respondents' current expertise ranged from low in leadership/management in long-term care (a: =1.27) to moderate in normal aging (x = 2.20). The respondents rated the relevance of every one of the content areas as moderately high. Ratings of expertise were consistently lower than ratings of relevance. Respondents' mean level of interest in learning more about the content area ranged from moderate in leadership/management in long-term care (x= 1.90) to very high in the ethical concerns related to the care of the aged (x = 2.83). The top 10 content areas ranked as most important to respondents' continuing education are denoted in the last column of Table 2.

To determine if the responses of faculty who had taught a course in gerontology differed significantly from those who had less involvement in gerontological education, a grand mean was computed for expertise, relevance, and interest for both subgroups (Table 3). T tests comparing the grand means showed no significant differences between the two groups in the relevance of the gerontological content or their interest in the content. There was a significant difference in their current expertise. Individuals who had taught a course in gerontology had a significantly higher level of perceived expertise than those who had not taught a course (i = 2.48, p = 0.008).

Table

TABLE 3Comparison of Grand Means of Ratings of Faculty Groups

TABLE 3

Comparison of Grand Means of Ratings of Faculty Groups

To determine if the responses of faculty who taught in programs preparing practical nurses differed from faculty teaching in other programs, t tests comparing the grand means of expertise, relevance, and interest were computed. No significant differences were noted between the two groups. In similar comparisons, responses of faculty teaching in baccalaureate and higher degree programs were not significantly different from those of faculty teaching in other programs (practical nursing or associate degree).

Respondents rated the extent to which their reading material focused on gerontology on a scale of 1 (not at all) to! (a very great extent). The mean was 4.75 and the mode was 5. Only 28 faculty (20.8%) subscribed to a gerontological journal. Thirty respondents (23.3%) stated that they had conducted research relevant to gerontology and 17 individuals (13.2%) reported one or more publications relevant to gerontology. Only 4% of the respondents were certified as gerontological nurses or geriatric nurse practitioners.

Discussion

The 66% response rate suggests that the findings are fairly representative of the population of educators in nursing programs hi Minnesota and border cities. No data are available on nonrespondents. The findings support other research that indicates most nurse educators lack formal education hi gerontology (Edel, 1986). They appear to be adult learners who have developed then* knowledge and skill through their own reading and attendance at conferences and workshops. The fact that as a group they focused their reading on gerontological literature to a considerable degree is encouraging. However, with only 20% subscribing to a gerontological journal and less than 4% certified in gerontology, they seem to have weak identification with gerontology as a specialty. Only a small proportion (17.1%) of the respondents were senior faculty, with rank at the level of associate professor or above. The lack of status of most of these nurse educators may be a factor in their power to advocate for gerontology within the nursing curriculum.

Respondents indicated that each of the 21 content areas was relevant to their teaching, validating the selection of content areas in the instrument. The wide range in the ratings of current expertise suggests that this instrument may be useful in assessing faculty needs for continuing education.

Leadership/management in long-term care was rated lowest in level of interest, relevance, and expertise by nurse educators. Yet a recent survey of nurse managers in long-term care (Krichbaum et al., 1991) showed a great need for leadership/management skills in this setting. Interestingly, in contrast to this low ranking of leadership/ management in long-term care, nurse educators ranked coordination of care/case management as one of the 10 most important content areas. Management skills in the community or acute care apparently are valued; management in nursing homes is not. This suggests the "stepchild" status of nursing homes. While we currently need to provide "remedial" education for nurse managers practicing in long-term care, the payoff in the future may he in convincing nurse educators of the importance of professional leadership in this setting and the responsibility of schools of nursing to provide educational experiences that will change the status quo.

A comparison of the areas ranked most important to professional development by the nurse educators with the areas in which they perceived their expertise to be lowest suggests, not surprisingly, that faculty are somewhat more interested in increasing knowledge in areas where they already have some competence than on focusing on areas where they have little expertise. The fact that health enhancement and disease prevention had one of the highest mean ratings for both level of interest and relevance reflects the value that the nursing profession places on this aspect of health care. Although faculty already saw themselves as quite expert in this area (ranked third highest in expertise), they selected it as second most important for their professional development.

Aside from the absence of concern for long-term care management, there is a fair degree of balance among the top 10 content areas, with both acute and chronic illness included, as well as mental illness and dementia, ethics, and research. Considering the need to raise the consciousness of nurses about the importance of including more than the individual as a focus of care, it is interesting to note that social policy issues are seen as relevant and of interest, but are not included in the 10 content areas rated most important.

In light of the arguments regarding the merits of integrating gerontological content versus offering a discrete course in a preservice curriculum, it is interesting to note that faculty who taught a course in gerontology had higher mean ratings of current expertise than did those who had not taught a course. The need for specialization of faculty in a content area is more clearly recognized by both administration and faculty when responsibility for a course is at stake than when content is integrated. One of the risks of integration, whatever the content area, is that if everybody is expected to do "it," nobody does "it" well.

All faculty responsible for clinical teaching need to be knowledgeable in gerontology if their students care for elderly clients. However, whether gerontology is integrated within a curriculum or taught in a discrete course, every nursing faculty should include individuals whose identified area of expertise is gerontology. Leadership by well-prepared faculty is critical in identifying the essential knowledge and skills to be transmitted to students.

Until we have adequate numbers of faculty whose undergraduate and graduate education have prepared them in gerontology, it is vital that efforts be made to support "learning in place" by faculty who find themselves responsible for teaching gerontological content, but lacking in expertise. Awareness of the need and motivation to do something about it appear to be the sine qua non for effective response to the geriatric imperative. Faculty need to take the initiative to seek out experiences that will augment their knowledge and skill. Opportunities for fellowships, single-quarter leaves, and sabbaticals; support for attendance at workshops and conferences; and the fostering of networking groups are institutional strategies that can nourish faculty growth in gerontological nursing. Findings from this study suggest that we are making progress, but we have a long way to go before faculty expertise in gerontological nursing is comparable to that in other specialty areas within the discipline.

References

  • American Nurses Association. (1986). Gerontological nursing curriculum: Survey analysis and recommendations. Kansas City, MO: Author.
  • Connelly, J.R. (1988). Geriatrics I gerontology and health professions: Manpower projections and educational considerations. Paper presented at University of Kansas Medical Center School of Nursing, Kansas City, MO.
  • DHHS, Health Resources and Services Administration, Division of Nursing. (1980). National sample of registered nurses, 1980. Washington, DC: U.S. Government Printing Office.
  • Edel, M.K. (1986). Recognize gerontological content: It is time that nursing education faced reality. Journal of Gerontological Nursing, 12( 10), 28-32.
  • Johnson, M.A., & Connelly, J.R. (1990). Nursing and gerontology status report. Washington, DC: Association for Gerontology in Higher Education.
  • Krichbaum, K., Johnson, J.A., & Ryden, M.B. (1992). The needs of nurses in long-term care facilities for education in leadership and management. Geriatric Nursing, 23, 170-174.
  • Misanchuk, E.R. (1984). Analysis of multi-component educational and training needs. Journal of Instructional Development, 7, 28-33.
  • Prock, V.N. (1983). Promoting meaningful long-term care experiences: One dean's view. In National League for Nursing (Ed-X Creating a career choice for nurses: Long-term care (NLN Publication No. 20-1917, pp. 35-44). New York: NLN.
  • Somers, A.R. (1983). The geriatric imperative: Long-term care policy must change to fit new geriatric care needs. Hospitals, 77-81.

TABLE 1

Characteristics of Respondents (N=129)

TABLE 2

Nurse Educators' (N= 129) Mean Ratings* of Expertise, Relevance, and Interest in Content Areas in Gerontology

TABLE 3

Comparison of Grand Means of Ratings of Faculty Groups

10.3928/0148-4834-19921001-05

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