Considering the ever-increasing population of the elderly, the nurses' and nursing students' attitudes toward the elderly and how to care for them are very important. The current study aimed to investigate the nurses' and nursing students' attitudes toward the elderly. In the current study, which was of a descriptive-analytical type, a total of 160 nurses and nursing students were selected based on purpose-based sampling and investigated. The data collection tool was a two-part questionnaire including demographic information and the Kogan scale of attitude towards the elderly. SPSS version 21 statistical software and Pearson correlation tests, one-way analysis of variance, and t-tests were used for analysis. In all cases, the significance level was defined as less than 0.05. The average score of the total attitude of the research units towards old age was 110.88 out of 204. 93.1% of the samples had a neutral attitude, 5% had a positive attitude, and 1.9% had a negative attitude. A statistically significant relationship was observed between age and attitude (p<0.05), which means that the higher the age of the participants, the more positive attitude they had towards the elderly. Higher-year students also had a more positive attitude (p<0.05). There was no statistically significant relationship between sex, history of education about old age, occupation, history of caring for the elderly in the family, working years of personnel, and place of study with attitude (p>0.05). The majority of nurses and nursing students have a neutral attitude toward the elderly. Therefore, attention should be paid to their education to improve their positive attitude.
Introduction
Today, due to various reasons such as the increase in life expectancy, the significant progress of medical sciences, and the decrease in the fertility rate in the world, the average life expectancy of people has increased and old age has become a global phenomenon [1, 2]. According to the estimates of the WHO, elderly people aged 60 and over will make up 15% of the world's population in 2025, and this amount will increase to 25% in 2050 [3]. The rapid growth of elderly people and their vulnerability to different health disorders leads to an increase in the number of patients who need medical services. As members of the health care team, nurses are increasingly responsible for the care of older adults. In addition, they have a vital role in ensuring the safety of patients and acting on their behalf [4-6].
Many studies, including Alshehry et al.'s study [7], have pointed out the importance of attitude in providing medical and care services. In addition, many researches have been conducted regarding the attitude and interest of nurses and nursing students toward caring for the elderly, and the results of the studies have been different. The findings of the research conducted on nurses' attitudes toward elderly care have shown negative, positive, and neutral attitudes [8-12]. In addition, several researches have shown that the knowledge and attitude of nurses affect their outlook on ways to care for the elderly [13, 14]. Attitudes are important in nursing and relate to how we perceive the behavior of others and how we use our understanding of ourselves to provide care. Our understanding of nursing is shaped by our attitude towards different aspects of care [15].
The attitude of healthcare workers towards elderly people is influenced by various factors such as gender, age, education, workplace, and professional socialization [16]. Race and ethnicity [17], moral intelligence, and altruism [18] are also factors influencing attitude. If inexperienced and untrained nurses are assigned to care for the elderly, the quality of care for the elderly will be compromised and nurses will lose their key role in caring for the elderly [19].
The results of the studies show that awareness and efforts to change negative attitudes and beliefs about the elderly improve their care delivery [20]. During a study, Banimahdi et al. [21] evaluated nursing students' and graduates' views on aging. The results of their study showed that limited experience in caring for the elderly, age less than 25 years, and male gender were significant factors in having a more unfavorable view of the elderly. Population aging in current societies is one of the main challenges of health care systems. With age, the probability of developing health problems and chronic diseases will increase and the demand for health care will increase. This requirement will affect hospitals and care providers. Nurses will face the challenge of caring for the elderly in the future.
Studies have shown that nursing students usually have a negative attitude toward the elderly, which is influenced by personal beliefs, values, culture, experience, and observations [22, 23]. Because the issue of nurses' attitudes towards elderly patients cannot be generalized to all nurses and nursing students anywhere in the world. Therefore, the present study was conducted to investigate the attitude of nurses and nursing students towards the phenomenon of aging.
Materials and Methods
In this descriptive-analytical study, 160 nurses and nursing students working in the hospitals of the Medical Sciences University were selected. To determine the sample size, the Jersey Morgan and Karjesi sample size estimation table and the Cochran formula were used. Considering the size of the statistical population of 235 people, the sample size was estimated to be 145 people based on Morgan's table. Because of the possibility of dropping samples, the final number of samples was 165 people.
Sampling was done on a purpose-based basis and in an easily accessible and self-reporting manner. 5 distorted questionnaires where people did not answer the questions completely were excluded from the study. The inclusion criteria were nurses or nursing students between the 18 and 60 ages who were willing to participate in the study. The exclusion criterion was a failure to complete the questionnaire correctly.
To collect information in this research, a two-part questionnaire was used, the first part of which included graphic demo information and individual characteristics of the research units, including gender, gender, jackal, students' place of study, students' academic year, nurses years of service, previous training about with the elderly, and the history of caring for the elderly in the family, and the second part includes Kogan's Attitudes Toward Older People Scale to measure the attitude of caregivers towards the elderly. Kogan's attitude towards the elderly scale was designed in 1961 to measure the attitude of nurses towards the elderly. This questionnaire has 34 positive and negative statements (17 statements of positive attitude and 17 statements of negative attitude) about the phenomenon of aging, and the respondent's attitude towards aging and the phenomenon of aging is measured using a six-point Likert scale from completely opposite to (0). It measures up to completely agree (score 6) and for the statement without comment (score 3) about these statements. The negative statements scores were reversed to get the total score. The changes in the expression related to positive and negative attitudes ranged from 0 to 204. To score and determine the attitude, scores between 0 and 68 were considered as having a negative attitude, 69 to 137 as having a neutral attitude, and 138 to 204 as having a positive attitude. A high score in positive expressions indicates a more favorable attitude and a high score in negative expressions indicates a more negative attitude towards the elderly. The reliability and validity of Kogan's questionnaire have been investigated in different studies [2, 24, 25] and Cronbach's alpha coefficient has been mentioned in different studies from 0.79 to 0.87 [24].
In this study, full explanations about how to complete the questionnaire and the purpose of the study were given to the subjects, and then written permission was obtained from the volunteers. Descriptive statistics were used to prepare tables and determine the mean, standard deviation, and relative and absolute frequency of data. After testing the normality of the data with the Shapiro-Wilk test, the normality of the data was confirmed (P < 0.05) and then, according to the normality of the data, from the inferential statistics of the Pearson correlation approximation, the one-way ANOVA test was performed. ANOVA, Independent t-test, Tukey's post hoc test, and Leven's test were used to check the homogeneity of variances in the independent t-test for data analysis. In all cases, the significance level was defined as less than 0.05. Data were analyzed by SPSS version 21 software.
Results and Discussion
Based on the results, 75.6% of the participants were in the age group of less than 30 years and 4.4% were in the age group of over 40 years. 36.3% of the samples were men and 63.7% were women. 50.6% of student participants and 65.8% of nurses participating in the study had less than 10 years of service experience. 92.5% of the participants had not received training related to the elderly. In addition, the results showed that 72.5% of the participants had no history of caring for the elderly in their family.
The average score of the total scores obtained in the dimension of attitude towards the elderly was 110.88 ± 14.9 (range of scores 50-154). 1.9% had a negative attitude, 93.1% had a neutral attitude and 5% had a positive attitude towards old age (Table 1).
Table 1. Distribution of the absolute and relative frequency of the research units according to the scores obtained in the attitude dimension of the elderly.
|
The score obtained in the dimension of attitude towards the elderly |
N |
% |
|
Negative (0-68) |
3 |
1.9% |
|
Neutral (69-137) |
149 |
93.1% |
|
Positive (138-204) |
8 |
5% |
|
Total |
160 |
100% |
The results of the attitude scores of nursing students and nurses are shown separately in Table 2. The results of the study showed that 94% of nurses have a neutral attitude toward the elderly, of which 1.3% had a negative attitude and 7.4% had a positive attitude towards the elderly.
Table 2. Distribution of relative and absolute frequency of working nurses according to the scores obtained in the dimension of attitude towards the elderly.
|
The score obtained in the dimension of attitude towards the elderly |
N |
% |
|
Negative (0-68) |
1 |
1.3% |
|
Neutral (69-137) |
75 |
94% |
|
Positive (138-204) |
3 |
4.7% |
|
Total |
79 |
100% |
The results show that 95.2% of nursing students have a neutral attitude towards the elderly. Among these, 2.4% had a negative attitude and 2.4% had a positive attitude towards old age (Table 3).
Table 3. Distribution of absolute and relative frequency of students according to the scores obtained in the dimension of attitude towards the elderly.
|
The score obtained in the dimension of attitude towards the elderly |
N |
% |
|
Negative (0-68) |
2 |
2.4% |
|
Neutral (69-137) |
77 |
95.2% |
|
Positive (138-204) |
2 |
2.4% |
|
Total |
81 |
100% |
The results reveal that there is a positive and statistically significant relationship between age and attitude towards old age (p<0.001, r=0.252), which means that the older the age of the participants, the more positive attitude towards old age is seen. Also, statistical analysis showed that there is no relationship between gender, occupation (student or nurse), place of study, history of previous education about the elderly, history of caring for the elderly in the family, and working years of the personnel with the attitude towards the elderly (P>0.05). The academic year of the students and the attitude towards aging were reported to have a positive and statistically significant relationship (f = 2.328, p = 0.05), which means that students of higher years had a more positive attitude towards aging.
The analysis of the findings obtained from the present research shows that the attitude of nursing students and nurses regarding old age is at a neutral level. There are conflicting views regarding the attitude of nursing students and nurses. Many researchers have stated the relationship between age and attitude toward old age [25]. Factors such as individual beliefs and beliefs, the cultural context of the society, and the religious beliefs of the people have been involved in it. In addition, most of the nurses personally had a history of caring for the elderly in the hospital.
The results of the current study showed that there is a positive and statistically significant relationship between age and attitude towards old age; it means that the older the participants were. They had a more positive attitude towards old age. The results of this research are consistent with the study of Liu et al. They concluded that people over 40 have a better understanding of old age [26].
Doherty and colleagues of Doberty Metal consider age as one of the important factors in having a positive attitude. In addition, community health nurses have a better attitude than nurses who work in hospitals. Nurses who dealt more with elderly people in the department had more positive attitudes towards acute departments. Therefore, nurses should be equipped with geriatric knowledge [27].
It seems that community health nurses are more in touch with people and those who spend most of their time in treatment centers with the elderly have a more positive attitude. This can be due to long-term contact and adequate knowledge of the needs of the elderly. Reports from other research suggest that feelings toward the elderly may change with experience, age, and gender. Probably, the results of the current research can be due to reasons such as the young age of the participants, not having enough experience, and not giving special courses for the care of the elderly for nurses, each of these factors should be investigated in qualitative research. In the recent study, there was no statistically significant difference in the attitude score between the two groups of male and female nurses, and these findings were consistent with the results of Lui and Wong's study conducted on doctors.
Conclusion
In total, the analysis of the findings obtained from the present research shows that the general status of the attitude of nursing students and nurses regarding old age is at a neutral level. Many studies have reported important variables that influence nursing students' attitudes toward working with the elderly. These variables include having the skills and knowledge needed to care for the elderly, the influence of working nurses on the attitude of nursing students, the influence of educators on the attitude of nursing students and learning through opportunities through work and contact with the elderly, individual beliefs and beliefs, religious beliefs. Individuals, each person's family and work experiences, society's culture, and nurses' understanding of the elderly. In their plans, nursing managers can improve their attitude towards the elderly by forming classes in the field of elderly care education and distributing elderly patients to all nursing personnel. Bedside nurses who care for the elderly in hospitals should receive the necessary training for nursing these patients and have special practical courses in welfare centers and nursing homes. They have learned the psychological issues related to it and they gain clinical experience in welfare centers and nursing homes. In educational centers, the relevant professors should create interest in taking care of the elderly. In addition, through mass media training, families should be taught to respect the elderly from an early age.
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