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Attitudes toward the elderly : relationships between registered nurses’ attitudes and a set of selected… Loh, Man Yeow 1984

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ATTITUDES TOWARD THE ELDERLY: RELATIONSHIPS BETWEEN REGISTERED NURSES' ATTITUDES AND A SET OF SELECTED CHARACTERISTICS OF THE NURSES by MAN YEOW ^LOH B.Sc.(Nursing), University of Utah, 1980 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE STUDIES School of Nursing We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF A p r i l © Man Yeow BRITISH COLUMBIA 1 984 Loh, 1984 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l l m e n t of the r e q u i r e m e n t s f o r an advanced degree at the U n i v e r s i t y of B r i t i s h C olumbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g of t h i s t h e s i s f o r s c h o l a r l y purposes may be g r a n t e d by the head of my department or by h i s or her r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department of /Jut&tQ^  The U n i v e r s i t y of B r i t i s h Columbia Vancouver, Canada, V6T 1W5 i i Abstract The purpose of t h i s study is to investigate the attitudes of registered nurses toward the elderly, and to i d e n t i f y the relationships between nurses' attitudes and the nurses, age, educational l e v e l , agency of employment, length of employment in present job, amount of time spent with elderly c l i e n t s , and whether the nurses have taken a course or advanced education in Gerontological Nursing. Two hundred forty-one registered nurses from three health care settings (acute care, extended care and community) were recruited for the study. The "Opinion About People" Scale was used to measure nurses' attitudes. The results of the study suggest that registered nurses from the three health care settings a l l have positive attitudes toward the e l d e r l y . Type of health care setting, age, length of employment in present job, amount of time spent with elderly c l i e n t s , and advanced education in Gerontological Nursing a l l af f e c t attitudes of nurses to some degree. Level of nursing education is the only variable that is not correlated with nurses' attitudes. Registered nurses from the community setting show more positi v e attitudes toward the e l d e r l y . Older nurses reported more " r e a l i s t i c toughness"/cynicism but less anxiety toward aging. They are also more supportive of public r e s p o n s i b i l i t y for the elderly than younger nurses. The longer the nurses work in their present job, the less p o s i t i v e t h e i r a t t i t u d e s . Nurses who spend more time w i t h the e l d e r l y c l i e n t s r e p o r t e d s t r o n g e r support f o r f a m i l y r e s p o n s i b i l i t y toward the aged. F i n a l l y , n u r s e s who have taken a c o u r s e or advanced e d u c a t i o n i n G e r o n t o l o g i c a l N u r s i n g show more p o s i t i v e a t t i t u d e s toward the e l d e r l y than those who have not taken a c o u r s e or advanced e d u c a t i o n . i v Table of Contents Abstract i i Table of Contents iv L i s t of Tables v i L i s t of Figures v i i i Acknowledgement ix CHAPTER 1 INTRODUCTION TO THE STUDY 1 Backgroud to the study 2 Conceptual Framework 4 Purpose of the Study 10 Problem Statement 10 Def i n i t i o n of Terms 10 Operational D e f i n i t i o n 11 Assumpt ion 11 Limitat ions 11 CHAPTER 2 REVIEW OF LITERATURE 12 Demographic Data of the Elder l y Population 13 Variables Related to Attitudes Toward the E l d e r l y . . . . 14 Attitudes of Other Professionals Toward the El d e r l y . . 17 Attitudes of Registered Nurses Toward the E l d e r l y . . . . 19 Summary 2 3 CHAPTER 3 METHODOLOGY 26 Instrument 26 "Opinion About People" Scale 26 Demographic Questionnaire 29 Sample 29 Data Col l e c t i o n Procedure 30 Data Analysis 32 Human Right Protection 32 CHAPTER 4 RESULTS AND DISCUSSION 33 Description of the Total Sample and Subgroups 33 Results of the "Opinion About People" Survey 40 Type of Health Care Setting 40 Age 42 Educational Level 44 Time Spent with Elderly 47 Length of Employment 49 Advanced Education in Gerontological Nursing 52 Results of the Correlational Analysis and Discussion. 52 CHAPTER 5 SUMMARY, CONCLUSIONS, IMPLICATIONS, AND RECOMMENDATIONS 7 0 Summary and C o n c l u s i o n s 70 I m p l i c a t i o n s 75 Recommendations f o r F u r t h e r R e s e a r c h 81 REFERENCES 83 Appendix A: E x p l a n a t o r y L e t t e r 89 Appendix B: O p i n i o n About People S c a l e 91 Appendix C: Demographic Q u e s t i o n n a i r e 97 v i L i s t of Tables Table 1 Subscale and Score Range 28 Table 2 Number and Percentage of Registered Nurses Pa r t i c i p a t i n g from the Three Health Care Setting 31 Table 3 Number and Percentage of Registered Nurses in each Educational Level in each Health Care Setting 34 Table 4 Number and Percentage of Registered Nurses in each Age Group in each Health Care Setting 36 Table 5 Number and Percentage of Registered Nurses in each Subgroup by "Length of Employment in Present Job" in each Health Care Setting 37 Table 6 Number and Percentage of Registered Nurses in each Subgroup by "Amount of Time Spent with Elderly" in each Health Care Setting 39 Table 7 Mean Scores for the Total Sample and Subgroups by "Type of Health Care Setting" in the "Opinion About People" Scale 41 Table 8 Mean Scores for the Total Sample and Subgroups by "Age" in the "Opinion About People" Scale 43 Table 9 Mean Scores for the Total Sample and Subgroups by "Nursing Educational Level" in the "Opinion About People Scale 46 Table 10 Mean Scores for the Total Sample and Subgroups by "Amount of Time Spent with Elderly C l i e n t s " in the "Opinion About People" Scale 48 Table 11 Mean Scores for the Total Sample and Subgroups by "Length of Employment in Present Job" in the "Opinion About People" Scale 50 v i i Table 12 Mean Scores for the Total Sample and Subgroups by "Courses Taken in Gerontological Nursing in the "Opinion About People" Scale 53 Table 13 Summary of Spearman Rho Correlation Analysis 54 Table 14 Summary of Spearman Rho Correlation Analysis 56 Table 15 Summary of Spearman Rho Correlation Analysis 60 Table 16 Summary of Spearman Rho Correlation Analysis 63 Table 17 Summary of Spearman Rho Correlation Analysis 66 Table 18 Summary of Spearman Rho Correlation Analysis 69 L i s t of Figures v i i i Figure 1 The relationship between attitudes and nursing care 9 Acknowledgement I wish to thank my committee, Dr. Kathleen Simpson and Ms. Maureen Murphy, for their guidance and support throughout t h i s study. I am also grateful to a l l the agencies and nurses who participated in this project. Appreciation is also extended to L e s l i e and my classmates for their encouragement. 1 CHAPTER 1 Introduction to the Study The proportion of elderly people in Canada is increasing steadily and i t i s projected that by the year 2001 the elderly w i l l comprise about 11% of the population or 3.4 m i l l i o n Canadians ( S t a t i s t i c s Canada, 1980). Schewenger and Gross (1980) reported that "on any given day" in 1976, approximately 8.4% of the population 65 and over were in some kind of health care i n s t i t u t i o n . Unfortunately, the proportion of registered nurses who are interested and experienced in gerontological nursing remains quite low. This orientation is of no surprise in l i g h t of the youth-oriented nature of our society. In general our society places a high value on youth, a c t i v i t y and wealth. In contrast, old age with i t s associated loss of health, youth and income is less valued. Certainly nurses are influenced by the attitudes of the society in which they l i v e . The s t a t i s t i c a l d i s t r i b u t i o n of the population indicates that registered nurses, the single largest group of health care personnel in Canada, are encountering the elderly in their practice. Registered nurses not only provide nursing care and a s s i s t elderly patients to adapt to chronic i l l n e s s in long term care/chronic care i n s t i t u t i o n s , but also they frequently encounter the elderly in acute care 2 hospitals as the risk of serious acute i l l n e s s is greater for older people. The community too is another area in which registered nurses provide services such as health promotion, health maintenance and i l l n e s s care to the well and i l l e lderly in our society. The effectiveness and the quality of the nursing care given to the elderly is greatly affected by nurses' attitudes toward this group of the populat ion. Background to the Study Interest in and concern for the health care of the elderly has been growing in recent years. However, many elderly patients continue to receive inadequate, poor quality and depersonalized care (Anderson & Stone, 1969; Buckelew, 1982; M. E. Campbell, 1971; Epstein, 1977; Health & Welfare Canada, 1982; Lore, 1979; Seelig, 1982). In addition, Podneiks (1983) indicated that abusive care of the elderly has been a common phenomenon within health care settings but the extent of the problem has only been recognized recently. Buckelew, Epstein, Lore, Podnieks, and Seelig implied that attitudes of nurses toward aging and the eld e r l y is one of the factors that contributes to poor quality nursing care. Furthermore, according to F u t r e l l and Jones (1977), attitudes also have implications for human resource management as they have dire c t affects on funding, recruitment, and curriculum design. They maintained that i f registered nurses who serve as role models for younger 3 people do not have p o s i t i v e a t t i t u d e s toward the e l d e r l y and are not e n t h u s i a s t i c about t h e i r work, then young peop l e w i l l not be a t t r a c t e d t o t h i s f i e l d i n s u f f i c i e n t numbers, s c h o o l s w i l l not r e c e i v e f u n d i n g from government t o educate young peop l e i n t h i s s p e c i a l t y , and new g r a d u a t e s w i l l not c o n s i d e r g e r o n t o l o g i c a l n u r s i n g i n t h e i r c h o i c e of p r a c t i c e . In the l o n g r un, n u r s i n g may not have the human r e s o u r c e s t o meet the needs of the growing numbers of e l d e r l y i n the c o u n t r y . A t t i t u d e s toward the e l d e r l y have been examined i n a v a r i e t y of s t u d i e s because of i t s e f f e c t on the q u a l i t y of n u r s i n g c a r e and human r e s o u r c e management. V a r i a b l e s such as age, e d u c a t i o n l e v e l , agency of employment and l e n g t h of employment were found t o be r e l a t e d t o the n u r s e s ' a t t i t u d e s (Brower, 1981; M. E. Campbell, 1971; F u t r e l l & Jones, 1977; G i l l i s , 1973; T a y l o r & Harned, 1978; Wolk & Wolk, 1971). Most of the r e p o r t e d f i n d i n g s were c o n t r a d i c t o r y , p r e c l u d i n g the drawing of c o n c l u s i o n s from these d a t a . T h e r e f o r e , i t i s c r u c i a l t h a t a t t i t u d e s toward the e l d e r l y , and the v a r i a b l e s t h a t i n f l u e n c e t h e s e a t t i t u d e s , be i d e n t i f i e d and e x a m i n e d . c r i t i c a l l y , so t h a t s t a t e g i e s t o change or support these a t t i t u d e s can be f o r m u l a t e d and implemented where n e c e s s a r y . By u s i n g such s t r a t e g i e s , n u r s i n g can be b e t t e r equipped t o a t t r a c t q u a l i f i e d p e r s o n n e l t o the p r o f e s s i o n and t h e r e w i l l be a p r o p o r t i o n a t e d i s t r i b u t i o n of n u r s e s among needed s p e c i a l t i e s such as g e r o n t o l o g i c a l n u r s i n g . P r e s e n t l y n u r s i n g i s t r y i n g t o e s t a b l i s h i t s p r o f e s s i o n a l 4 c r e d i t a b i l i t y , t h e r e f o r e , i t i s very important that the q u a l i t y of the p r a c t i t i o n e r s be assured. By doing so, the nursing p r o f e s s i o n can b e t t e r ensure that the needs of the e l d e r l y - w i l l be met and q u a l i t y n u r s i n g care w i l l be provided to t h i s group of people. A t t i t u d e i s one of the key elements that a f f e c t s the performance of the r e g i s t e r e d nurses i n t h e i r i n t e r a c t i o n with the e l d e r l y . So, to ensure q u a l i t y n u r s i n g care, t h i s element must be i n v e s t i g a t e d thoroughly. Conceptual Framework A t t i t u d e has been d e f i n e d and c o n c e p t u a l i z e d in many d i f f e r e n t ways. The d i f f e r e n t a s p e c t s of a t t i t u d e s have a l s o been i n v e s t i g a t e d by many r e s e a r c h s t u d i e s . The d e f i n i t i o n s , c o n c e p t u a l i z a t i o n s and resear c h f i n d i n g s provide the foundation f o r dev e l o p i n g frameworks i n g u i d i n g and d i r e c t i n g f u r t h e r a t t i t u d i n a l r e s e a r c h . The most common d e f i n i t i o n views a t t i t u d e as a mul t i d i m e n s i o n a l concept that c o n s i s t s of three i n t e r r e l a t e d components: c o g n i t i v e , a f f e c t i v e , and b e h a v i o r a l ( A l l p o r t , 1935; K i e s l e r , 1969; Krech & C r u t c h f i e l d , 1948; Rosenberg & Hovland, 1960; Secord & Backman, 1964; T r i a n d i s , 1971). A t t i t u d e encompasses a person's thoughts and b e l i e f s , f e e l i n g s , and b e h a v i o r a l i n t e n t i o n s toward an a t t i t u d e o b j e c t . Behavior i s determined not only by what people l i k e to do but a l s o by s o c i a l norms, h a b i t s , other a t t i t u d e s and expected consequences of the behavior. When these f a c t o r s 5 are consistent, attitudes and behavior can be related d i r e c t l y to each other. When the four factors are inconsistent, behavior may not correspond with attitude (Ehrlich, 1969; Triandis, 1971; Wicker, 1969). For example, i f a high school student does not l i k e to smoke (attitude), i f he knows that smoking may cause lung cancer (consequence of behavior), i f he is not a regular smoker (habit), and most of his friends do not smoke (norm), then, when he is offered a cigarette, he w i l l most probably refuse the cigarette and choose not to smoke (behavior). In contrast to the multidimensional view of attitude, Ajzen and Fishbein (1980), D. T. Campbell (1963), Doob (1947), Fishbein (1967), and Thurstone (1931) viewed attitude as a r e l a t i v e l y simple unidimensional concept, defined as a learned predisposition to respond to any attitude object in a consistently favourable or unfavourable manner. Instead of considering b e l i e f s and behavioral intentions as part of attitude, Ajzen and Fishbein viewed them as concepts that are related to attitudes. In order to predict and understand behavior, one must be concerned with the four concepts: b e l i e f s , attitude , behavioral intention and behavior. Ajzen and Fishbein maintained that subjective norms (a person's b e l i e f that people who are important to him think he should or should not perform the behavior with respect to the attitude object), are related to behavioral intention and behavior. These two authors also indicated that external variables such as demographic variables, 6 p e r s o n a l t r a i t s and o t h e r a t t i t u d e s can o n l y a f f e c t b e h a v i o r i n d i r e c t l y . That i s , e x t e r n a l v a r i a b l e s w i l l be r e l a t e d to b e h a v i o r o n l y i f they are r e l a t e d t o one or more of the f o u r c o n c e p t s mentioned above. S t u d i e s done by Bekker and T a y l o r (1966), Kogan (1961), M e r r i l and Gunter (1969), and Tuckman and Lorge (1958) i n d i c a t e d t h a t age p l a y s an i m p o r t a n t r o l e i n i n f l u e n c i n g an i n d i v i d u a l ' s a t t i t u d e s toward the aged. Stevens (1976) s t a t e d t h a t b e l i e f s and a t t i t u d e s are a c q u i r e d and d etermined by e x p e r i e n c e and l e a r n i n g , which i n t u r n a f f e c t an i n d i v i d u a l ' s b e h a v i o r . F u r t h e r m o r e , Brower (1981) showed t h a t s o c i a l o r g a n i z a t i o n i s a s t r o n g d e t e r m i n a n t of a t t i t u d e s toward the e l d e r l y . Hence, t h e r e i s e v i d e n c e t o suggest t h a t e x t e r n a l v a r i a b l e s do p l a y a v i t a l r o l e i n i n f l u e n c i n g one's a t t i t u d e s and b e h a v i o r . F i s h b e i n (1965) and Rosenberg ( i 9 6 0 ) have demonstrated i n t h e i r r e s e a r c h t h a t an i n d i v i d u a l ' s a t t i t u d e toward any o b j e c t depends upon h i s b e l i e f s about the o b j e c t and the e v a l u a t i v e a s p e c t s of t h e s e b e l i e f s . I t f o l l o w s t h a t a t t i t u d e can be measured by c o n s i d e r i n g or e v a l u a t i n g the i n d i v i d u a l ' s b e l i e f s about the o b j e c t . An i n d i v i d u a l ' s b e l i e f s r e p r e s e n t the knowledge and i n f o r m a t i o n he has about h i s environment. A c c o r d i n g t o A z j e n and F i s h b e i n (1980), Doob (1947), and Thurstone (1931), when a t t i t u d e i s measured a p p r o p r i a t e l y and a c c u r a t e l y , a t t i t u d e toward an o b j e c t can p r e d i c t the o v e r a l l p a t t e r n of b e h a v i o r . In o t h e r words, any b e h a v i o r towards an o b j e c t w i l l have the same a f f e c t i v e tone as the a t t i t u d e toward the o b j e c t . 7 There are d i f f e r e n t conceptions of attitude, but the two most common conceptions have been discussed previously. Regardless of how the concept of attitude i s defined, i t is clear that attitudes toward an object a f f e c t behaviors toward that object. Thus, i t is inevitable that nurses' attitudes toward the elderly w i l l a ffect their behaviors toward this group of people. These behaviors in turn w i l l a f f e c t the effectiveness and quality of nursing care given to the e l d e r l y . Numerous studies have investigated ways in which patients respond to attitudes and behaviors (Hatton, 1977; Hulicka, 1964; M i l l e r , 1976; Soloman, 1982; White, 1977). These studies showed that i f nurses hold negative attitudes toward the e l d e r l y , subtle signs of rejection, disrespect and indifference w i l l be communicated constantly to the elderly during routine interaction. These subtle behaviors are seldom overlooked by the e l d e r l y , and they af f e c t the ego, self-esteem and feelings of adequacy and independence of the e l d e r l y . In the dependent role, some individuals may be vulnerable to the attitudes and behaviors of the nurses. Mukulic (1971) concluded in her study that elderly patients who previously were able to p a r t i c i p a t e in d a i l y bathing were unable to help themselves in t h i s a c t i v i t y shortly aft e r admission to a health care i n s t i t u t i o n because nursing personnel did not reinforce these self-care behaviors. Studies done by Lowental (1958) on incontinence in g e r i a t r i c patients reported that 80% of the incontinence had no 8 p a t h o l o g i c a l b a s i s . The auth o r c o n c l u d e d t h a t p a t i e n t s took i n c o n t i n e n c e f o r g r a n t e d because n u r s i n g p e r s o n n e l d i d not encourage t o i l e t i n g and a c c e p t e d i n c o n t i n e n c e as p a r t of r o u t i n e g e r i a t r i c c a r e . In a d d i t i o n , D a v i s (1968) m a i n t a i n e d t h a t o l d e r people a r e good d i s s e m b l e r s and they q u i c k l y t e n d t o adopt whatever r o l e i s expected of them. I f nu r s e s b e l i e v e t h a t e l d e r l y a r e l i k e c h i l d r e n and expect them t o behave a c c o r d i n g l y , then the e l d e r l y w i l l q u i c k l y adopt t h a t r o l e . D a v i s f u r t h e r s t a t e d t h a t the e x p e c t a t i o n s of o t h e r s i n s o c i e t y undoubtedly account f o r much of the e c c e n t r i c , e r r a t i c and c h i l d i s h b e h a v i o r s of o l d e r p e r s o n s . I f n u r s e s ' a t t i t u d e s toward the e l d e r l y a r e p o s i t i v e i n n a t u r e , n u r s e s ' r e s p e c t , a c c e p t a n c e and l i k e of e l d e r l y p a t i e n t s w i l l be demonstrated i n t h e i r a t t e n d i n g b e h a v i o r s . A c c o r d i n g t o Ivey (1971) and Mehrabian (1970), a t t e n d i n g b e h a v i o r s c o n s i s t of b e h a v i o r s such as i n i t i a t i n g and m a i n t a i n i n g good eye c o n t a c t , l i s t e n i n g w i t h o u t i n t e r r u p t i o n , and/or m a i n t a i n i n g n a t u r a l p h y s i c a l c o n t a c t . These a t t e n d i n g b e h a v i o r s tend t o f o s t e r a p o s i t i v e s e l f -image i n the c l i e n t s and i n t u r n w i l l i n c r e a s e and improve t h e i r response t o h e a l t h or s i c k n e s s i n t e r v e n t i o n and c a r e . The s t u d i e s of B e l l u c c i and Hoyer (1975), 1975), E r b e r , F e e l y and Botwink (1980), H a t t o n (1977), Leech and W i t t e (1971), and Rosendahl and Ross (1982) c o n f i r m e d the p o s i t i v e e f f e c t s of a t t e n d i n g b e h a v i o r on an e l d e r l y p e rson's a b i l i t y t o respond t o and improve performance. As D a v i s (1968) p u t s i t , "The human element i n our t r e a t m e n t , the a t t i t u d e toward 9 a p a t i e n t t h a t r e f l e c t s empathy t h r o u g h c a r e f u l l i s t e n i n g a n d o b s e r v a t i o n , t h e p e r c e p t i o n o f o n e ' s s e l f as a p e r s o n who s e n s e s t h e mean i n g o f h i s l i f e a r e s u r e l y a s c u r a t i v e a s a n y wonder d r u g " ( p . 8 0 4 ) . U n d o u b t e d l y n u r s e s ' a t t i t u d e s t o w a r d t h e e l d e r l y w i l l a f f e c t t h e i r b e h a v i o r s w h i c h , i n t u r n , a f f e c t t h e e f f e c t i v e n e s s and q u a l i t y of n u r s i n g c a r e d e l i v e r e d t o t h e e l d e r l y . F i g u r e 1 p r o v i d e s a s c h e m a t i c r e p r e s e n t a t i o n of t h e s e r e l a t i o n s h i p s . I t i s t h e s e r e l a t i o n s h i p s w h i c h f o r m t h e c o n c e p t u a l f r a m e w o r k t h a t g u i d e s t h i s s t u d y . E x t e r n a l V a r i a b l e 3 . Demographic v a r i a b l e s B e l i e f s A t t i t u d e s P e r s o n a l t r a i t s > about t h e — > toward the E n v i r o n m e n t a l f a c t o r s e l d e r l y e l d e r l y Other a t t i t u d e s P o s i t i v e B e h a v i o r s e.g. Acceptance L i s t e n i n g Eye c o n t a c t Q u a l i t y N u r s i n g Care B i o p s y c h o s o c l a l needs of the e l d e r l y are met N e g a t i v e B e h a v i o r s e.g. D l s r e s p e c t Tnd I f f e r e n c e ReJ ec t Ion Impaired N u r s i n g Care Decreases the ego and esteem of the e l d e r l y Promotes dependence and c h i l d i s h behav to rs F i g u r e 1 . The r e l a t i o n s h i p between a t t i t u d e s and n u r s i n g c a r e . 10 Purpose of the Study The purpose of the study is two f o l d : f i r s t , to investigate the attitudes of registered nurses toward the elder l y , and second, to identify the relationship between the nurses' attitudes and a set of selected c h a r a c t e r i s t i c s of the nurses. Problem Statement This study i s to address the following s p e c i f i c quest ions: 1 . What are the attitudes of registered nurses toward the elderly? 2. What are the relationships between registered nurses' attitudes toward the elde r l y , and the nurses' educational l e v e l , agency of employment, age, length of employment in present job, time spent with elderly c l i e n t s , and whether the nurses have taken a course or advanced education in Gerontological Nursing? D e f i n i t i o n of Terms Elderly, the aged, and the old -- a person 65 years of age and above. Attitudes -- certain r e g u l a r i t i e s of an individual's feelings, thoughts, and predispositions to act toward some aspect of his environment (Secord & Backman, 1964, p.97). Registered Nurse -- a person who is a graduate of an approved school of nursing, who is registered as a member of the Registered Nurses' Association of B r i t i s h Columbia. Operational D e f i n i t i o n Attitudes -- the registered nurses' responses to the "Opinion About People" Scale. Assumpt ion It i s assumed that attitudes of registered nurses affect their behaviors, and their behavior a f f e c t s quality of nursing care they deliver to the elderly Limi tat ions 1. Other variables which may affect the nurse's attitudes, such as so c i o - c u l t u r a l background and exposure to the elderly at early age are not considered. 2. The mood of the registered nurses when they complete the questionnaire i s not considered. 3. A paper-and pencil instrument i s limited in i t s a b i l i t y in measuring the various aspects of attitudes. 1 2 CHAPTER 2 Review of Literature The purpose of t h i s chapter i s to examine pertinent l i t e r a t u r e that i s d i r e c t l y or i n d i r e c t l y related to this study. There are numerous studies that have investigated the attitudes of registered nurses toward the elderly and the correlates of these attitudes (Brower, 1981; M. E. Campbell, 1971; Devine, 1980; G i l l i s , 1973; F u t r e l l & Jones, 1977; Nelson, 1973; Taylor & Harned, 1978; Wolk & Wolk, 1971). Research on these topics has not been conclusive, with many c o n f l i c t i n g results reported, and some studies tending to refute the findings of others. The l i t e r a t u r e review is organized into four sections. The f i r s t section discusses the demographic data of the elderly population in Canada and t h e i r u t i l i z a t i o n of health care services. Section two includes a review of studies that have attempted to ide n t i f y variables that are related to attitudes toward the e l d e r l y . The next section focuses on other professionals' attitudes toward the e l d e r l y , and the f i n a l section reviews studies that have examined the attitudes of registered nurses toward t h i s population group. A summary of the findings in the l i t e r a t u r e review concludes th i s chapter. 13 Demographic Data of the Elderly Population It i s d i f f i c u l t to appreciate the need for more and better quality care for the elderly without f i r s t revealing the s t a t i s t i c a l dimensions of elderly within the population of Canada. Canada became an "old" country when the 1971 census indicated that 8.1% of the people were older than 65 years of age. Population aging (population aging means an increase in the proportion of older people in the population) was and s t i l l i s occurring in the country (Auerback & Gerber, 1976). In 1980 there were roughly 2.3 m i l l i o n Canadians or 9.5% of the t o t a l population aged 65 and over. If S t a t i s t i c s Canada's projections are correct, by the turn of the century this age group w i l l represent 3.4 m i l l i o n people or 11% of the Canadian population. By 2025, when most of the baby boom generation reaches t h i s age group, Canada w i l l have 5.5 m i l l i o n people aged 65 or above ( S t a t i s t i c s Canada, 1980). There is a higher tendency for health impairment and d i s a b i l i t y among the elderly compared to the rest of Canada's population. This tendency i s strongly supported by the data from the 1978-79 Canada Health Survey ( S t a t i s t i c s Canada, 1981). These data showed that days of d i s a b i l i t y and percentage of population having at least one health problem are higher among those aged 65 and over. The t o t a l population as a whole experiences an average of 15.7 d i s a b i l i t y days per person compared to 35 annual d i s a b i l i t y days for the e l d e r l y . D i r e c t l y related to this pattern of 1 4 reported health impairment and d i s a b i l i t y i s the considerably higher than average use of hospital and health services by the e l d e r l y . The estimated annual hospital days per person are 5.3 for the entire population; the corresponding rate for people over 65 is 13.2. Demands on the health care system for services required by the elderly are evident from a l l the s t a t i s t i c a l data. Registered nurses who are interested and knowledgeble in gerontological nursing are not only needed in long team care and acute care f a c i l i t i e s , but also in community health. The recent changes in the provision of health care, such as long term home care, day hospitals and day care centers for the elderly require more registered nurses who are q u a l i f i e d to care for these people. However, negative and stereotypic attitudes toward the elderly by health care workers have created a barrier for t h i s group of the population in obtaining adequate personalized health services (Department of Health & Welfare, 1982). This has serious implications for nursing as nursing constitutes about two-thirds of the t o t a l health care workers in Canada. Hence, formulation of a strategy to ensure positive attitudes among registered nurses is c r u c i a l i f q u a l i t y nursing care is to be provided to the e l d e r l y population. Variables Related to Attitudes Toward the El d e r l y There are several variables which have been i d e n t i f i e d as having an influence on the attitudes of registered nurses 1 5 toward the e l d e r l y . Some of these variables are age, level of education, type of employment agency and length of employment. There is no concensus among the findings of the studies reviewed as to which d i r e c t i o n (positive or negative) these variables influence attitudes. Hence, further research is needed to increase our understanding of the existing relationship. Age has been i d e n t i f i e d as one of the variables that is related to registered nurses' attitudes toward the el d e r l y . Brown (cited in M. E. Campbell, 1971) and M. E. Campbell (1971) found that registered nurses preferred younger patients and that there was an association between the patient-age preference of the nurse and the nurse's age. The older the registered nurse, the more positive the attitudes the nurse had toward the e l d e r l y . Research by F u t r e l l and Jones (1977) and Wolk and Wolk (1971) support the findings of Brown and M. E. Campbell. But Taylor and Harned (1978) found that the older the registered nurse the more negative the attitudes were toward the e l d e r l y . Another variable i d e n t i f i e d as having an influence on a registered nurse's attitudes toward the elderly was the nurse's l e v e l of education. Brown (cited in M. E. Campbell, 1971) and M. E. Campbell (1971) found that the more extensive the educational background of the registered nurses, the more posit i v e the attitudes they had toward the eld e r l y . However, these registered nurses were also the group least w i l l i n g to work with the el d e r l y . This 16 re l a t i o n s h i p was not confirmed in the study of nursing home adminstrators conducted by G i l l i s in 1972 (cited in G i l l i s , 1973) and in the work of F u t r e l l and Jones (1977) in their study on physicians, s o c i a l workers and registered nurses' attitudes toward the el d e r l y . G i l l i s (1973) in a later study, however, found that registered nurses graduating from a baccalaureate program were less positive in their attitudes toward the elderly than diploma nurses. The type of employment agency was the t h i r d variable found to affe c t registered nurses' attitudes toward the eld e r l y . Brower (1981) in her survey of 581 registered nurses in Florida found that registered nurses working in acute care hospitals and home health agencies directed by v i s i t i n g nurse associations had more positive attitudes toward the elderly than registered nurses working in nursing homes. Studies done by G i l l i s (1973) and Taylor and Harned (1978) also found that registered nurses from d i f f e r e n t health care settings had di f f e r e n t attitudes toward the el d e r l y . They found that registered nurses from nursing homes had the least p o s i t i v e attitudes compared to those who worked in health departments or acute care hospitals. This result however was not supported by Devine (1980). Length of time spent with the elderly was also i d e n t i f i e d as being related to registered nurses' attitudes toward the eld e r l y . Length of time was interpreted d i f f e r e n t l y in the studies reviewed (M. E. Campbell, 1971; G i l l i s , 1973; Gunter, 1971; Tuckman & Lorge, 1958). Time 17 spent with the elderly was defined as: (1) number of years spent working with the elde r l y , (2) studying gerontology including the elements of time and exposure to the elderly, and (3) amount of direct contact in working with the eld e r l y . A l l the d e f i n i t i o n s addressed only the quantitative and not q u a l i t a t i v e sense of time. G i l l i s (cited in G i l l i s , 1973) and M. E. Campbell (1971) both indicated in their studies that as the number of years working with the elderly increased, positiveness in attitude decreased. However, this r e l a t i o n s h i p was found to be i n s i g n i f i c a n t by G i l l i s in her 1973 study. Gunter (1971) defined time spent with the el d e r l y as time spent in studying gerontology. Her research also showed that positiveness in attitudes decreased with time. When length of time was defined as the amount of time spent in direct contact with the elderly, the more time registered nurses spent in direct contact with the elde r l y , the more positive their attitudes toward these people became (Tuckman & Lorge, 1 958) . Attitudes of Other Professionals Toward the Elderly Mead's theory of s o c i a l behavior (Lauer & Handel, 1977) indicated that attitudes often a r i s e through interaction, and when two people interact, each influences the behavior of the other. Registered nurses are no exception to th i s phenomena because frequently registered nurses work in a mu l t i d i s c i p l i n a r y environment. Therefore, i t i s possible to 1 8 consider that the attitudes and behaviors of registered nurses toward the elderly are greatly affected by other health care professionals. The studies included in this section of the review are selected because they represent attitudes held by professionals other than nurses. Attitudes toward the elderly of various pre-professionals and professionals such as psychologists, physicians, medical students, s o c i a l workers and r e h a b i l i t a t i o n workers have been studied by many researchers. One of the f i r s t studies was i n i t i a t e d by Wilensky and Barmark (1966) to assess the interests of doctoral students in c l i n i c a l psychology in working with the e l d e r l y . The findings showed that elderly patients were the least l i k e d group and students preferred not working with the elderly i f possible. Other studies have also indicated resistance to work with the e l d e r l y . Spence, Feigenbaum, and Roth (1968), surveyed medical students preferences for s p e c i a l i z a t i o n and found that g e r i a t r i c medicine ranked below surgery, p e d i a t r i c s , o b s t e t r i c s , opthamology and psychiatry. The study also showed that medical students shared most of the general s o c i e t a l conception and misconception about the e l d e r l y . In addition, these students adhered to a set of medical stereotypes about aging and the e l d e r l y . By surveying p s y c h i a t r i s t s , Cyrus-Lutz and Gaitz (1972) found that the older p s y c h i a t r i s t s were more resistant to work with the el d e r l y than younger psychiatr i s t s. 19 Research conducted by Lowy and Archer (1974) to investigate s o c i a l workers' attitudes toward the elderly revealed that s o c i a l workers' attitudes were either close to neutral or p o s i t i v e . F u t r e l l and Jones' (1977) research findings were similar to Lowy and Archer. However, Farrar and Bloom (1967) found that students studying s o c i a l work had a high l e v e l of stereotyping before f i e l d experience with the elderly, and the l e v e l of stereotyping increased in one-third of the students surveyed after f i e l d experience. Farrar and Bloom also maintained that when the students' l e v e l of stereotyping was r e l a t i v e l y high, intensive contact with the elderly did not s i g n i f i c a n t l y reduce the stereotypes. In reviewing the a t t i t u d i n a l research done on other professionals, i t is clear that professionals such as physicians, s o c i a l workers and psychologists do hold stereotypic and negative attitudes toward the e l d e r l y . Registered nurses are not the only group that have these attitudes. There i s no attempt to determine the attitudes of other professionals. Rather, the purpose of t h i s section is to point out that registered nurses do not work in a vaccum environment. They interact with other professionals in the work settings, and their attitudes could be influenced by others. Attitudes of Registered Nurses Toward the E l d e r l y There have been several studies that have investigated 20 attitudes of nursing personnel toward the elderly (Brower, 1981; M. E. Campbell, 1971; Coe, 1967; Devine, 1980; G i l l i s , 1973; Taylor & Harned, 1978; Wolk & Wolk, 1971). Some of the studies revealed that registered nurses' attitudes toward the elderly were characterized by stereotyping, negativism and defeatism (M. E. Campbell, 1971; Coe, 1967; Nelson, 1973). However, other studies showed that registered nurses' attitudes were neutral or posi t i v e ( F u t r e l l & Jones, 1977; Taylor & Harned, 1978; Wolk & Wolk, 1971). » One of the e a r l i e s t studies on registered nurses' attitudes toward the elderly was conducted by Coe (1967). His study found that registered nurses generally had negative attitudes toward the el d e r l y , and the nurses indicated annoyances associated with caring for the elderly because the elderly were incontinent, unable to feed themselves and complain frequently. The registered nurses in the study also expressed the view that elderly patients were slow, and i t was d i f f i c u l t to deal and communicate with them. Brown (cited in M. E. Campbell, 1971) directed a three year research project to explore nursing personnel's attitudes toward the e l d e r l y . A questionnaire e n t i t l e d "Nurses Preference Schedule" was administrated to 800 registered nurses, licenced p r a c t i c a l nurses and nursing a s s i s t a n t s . The research indicated that most nursing personnel had negative attitudes toward the e l d e r l y . The 21 nursing personnel also associated the elderly with persons who had some degree of i l l n e s s and required nursing care. Additionally, the nursing personnel also associated elderly patients with dependency, physical contact and care, limited a b i l i t y to function, and need for help and work on the part of nursing personnel. Similar results were found in M. E. Campbell's North Carolina study (1971). M. E. Campbell surveyed 50 registered nurses, 48 licenced p r a c t i c a l nurses and 49 nursing assistants in two teaching i n s t i t u t i o n s in North Carolina and found that a l l three categories of nursing personnel demonstrated negative and stereotypic attitudes toward the el d e r l y . The registered nurses in the study showed less preference in working with the elderly than the other two groups of nursing personnel. Nelson (1973) reported on a study done by Stockwell to find out i f nursing care d i f f e r e d between "most l i k e d " and "least l i k e d " patients. The study was conducted in twelve d i f f e r e n t London hospitals, and 388 patients and 87 registered nurses were observed. Stockwell found that el d e r l y patients were the most l i k e l y patients to f i t the c h a r a c t e r i s t i c s of patients which registered nurses "least l i k e d " . The "least l i k e d " patients were described by the researcher as those patients who (1) did not know the names of their nurses, (2) were unable to communicate readily with the nurses, (3) did not express determination to get well, and (4) grumbled and complained, and were confined to bed. Stockwell also reported that e l d e r l y patients were also more 22 l i k e l y to receive negative responses from the registered nurses in the study. Negative responses of the nurses were refl e c t e d by (1) the amount of time taken to answer the c a l l buttons of patients, (2) the number of hypodermic injections nurses were w i l l i n g to give patients for pain, and (3) the amount of time nurses spent in verbal communication with pat ients. Not a l l studies on registered nurses' attitudes toward the elderly revealed negative r e s u l t s . A few studies did indicate that registered nurses' attitudes were somewhat po s i t i v e . For example, F u t r e l l and Jones (1977) carried out a research study to investigate and compare physicians, s o c i a l workers and registered nurses' attitudes toward the elderly in a urban community in the Eastern United States. 245 questionnaires were sent out to the potential respondents of the study and data were processed for 150 respondents: 75 registered nurses, 42 physicians and 33 so c i a l workers. The results of the study showed that physicians, registered nurses and s o c i a l workers a l l had s l i g h t l y p o s i t i v e attitudes toward the el d e r l y , and the younger physicians and s o c i a l workers and older registered nurses were the most l i k e l y persons to have posit i v e att i tudes. Taylor and Harned (1978) surveyed 71 registered nurses in the state of Oklahoma and found that attitudes of the registered nurses in the study were a l l positive or neutral toward the e l d e r l y . The study also indicated that younger 23 nurses with less experience working with the e l d e r l y , and nurses who worked in acute care hospitals or in teaching, had more positive attitudes than their counterparts. Summary The study of attitudes toward the elderly in health care professionals has been a s i g n i f i c a n t component in s o c i a l , psychological and gerontological research. This is because attitudes r e f l e c t the behavioral tendencies of their holders (Lutsky, 1980). S t a t i s t i c a l reports (Health & Welfare Canada, 1982; S t a t i s t i c s Canada, 1980) have also indicated that there w i l l be continued demand on the health care system to provide needed services for the elderly in the future. The quality of the services provided by the health care professionals such as registered nurses and physicians i s affected greatly by the attitudes of these professionals toward the e l d e r l y . This chapter has reviewed attitude l i t e r a t u r e from the mid 1960s to the present time. Major research findings related to registered nurses' attitudes toward the e l d e r l y and variables related to these attitudes were i d e n t i f i e d . Many c o n f l i c t i n g results were found as to what attitudes registered nurses have toward the e l d e r l y . Research testing of variables related to attitudes toward the e l d e r l y such as age, educational l e v e l , agency of employment and time spent with the e l d e r l y patients did not produce a clear understanding of the relationships. The review also 24 i d e n t i f i e d several factors that l i m i t the generality of the conclusions drawn from these studies. F i r s t , the sample size in a l l studies reviewed was r e l a t i v e l y small, ranging from 30 to 87 registered nurses, except Brower's study where she surveyed 581 registered nurses. Second, Tuckman and Lorge's (1953) "Attitudes Toward Old People Scale" and Kogan's (1961) "Old People Scale" were the two instruments used by most of the researchers to assess registered nurses' attitudes toward the e l d e r l y . "Attitudes Toward Old People Scale" is a r i g i d yes-no scale. Axelrod and Eisdorfer (1961) tested the construct v a l i d i t y of this scale and found that only 88 of the 137 items were v a l i d in terms of their pertinence to the e l d e r l y . Kogan's "Old People Scale" i s a seven point Likert scale which consists of 17 matched positive-negative pair items. That i s , there is a set of 17 items expressing negative sentiments about the elderly, and there i s a second set of 17 items which i s the reverse of the f i r s t set. Bader (1980) pointed out that attitude items may not always be perceived as bipolar by respondents. Agreement with p o s i t i v e l y worded items may not be comparable to disagreement with negatively worded ones. Therefore, alternate forms may not be psychologically polar even though they may be l o g i c a l l y opposite. As a result of the contradictions among findings in the past a t t i t u d i n a l research, t h i s study is designed to obtain further information about the attitudes of registered nurses toward the el d e r l y from d i f f e r e n t health care settings, and the variables affecting these attitudes. Because of the li m i t a t i o n s noted in the surveying instruments used in previous studies, a new instrument c a l l e d "Opinion About People Scale" w i l l be used in t h i s study. This scale wi be discussed in the following chapter. 26 CHAPTER 3 Methodology The research questions posed in Chapter 1 can be addressed with a descriptive research design. For this reason, a survey approach u t i l i z i n g a questionnaire was car r i e d out. Kerlinger (1964) suggests that survey research is an e f f i c i e n t and e f f e c t i v e method for c o l l e c t i n g a large amount of accurate data and id e n t i f y i n g i n t e r r e l a t i o n s among variables. Instruments Two instruments were used in thi s study: ( 1 ) the "Opinion About People"Scale, and (2) a demographic questionnaire developed by the investigator. "Opinion About People" Scale The Opinion About People" Scale, designed to measure attitudes toward the elderly was used to assess the attitudes of registered nurses toward this group of people. This scale was chosen because of i t s s p e c i f i c design in measuring attitudes toward e l d e r l y , i t s ease for the registered nurses to complete, and the short time needed to answer the questionnaire. The "Opinion About People" Scale was developed by Kapos and Smith (1972) of the Ontario Welfare Council. This scale 27 is comprised of 32 items to which registered nurses respond using a nine point Likert-type scale ranging from strongly agree to strongly disagree. A low score indicates very strong agreement with the statement in the item, and a high score implies strong disagreement. The 32 items in turn make up seven subscales which designate attitude dimensions. The seven attitude dimensions are: 1. " R e a l i s t i c toughness"/cynicism toward aging. This dimension describes some of the stigmata and t r i b u l a t i o n s of old age. An example of an item pertaining to " r e a l i s t i c toughness"/cynicism in the "Opinion About People" Scale is "You can't cope with things the way you used to i f you l i v e to be a ripe old age". The lower the score in this attitude dimension, the more " r e a l i s t i c toughness"/cynicism toward aging, and hence th i s indicates negative attitudes. 2. Denial of the effects of aging. This dimension deals with feelings about the r e a l i t y of the aging process. An example of an item dealing with denial of the effects of aging in the "Opinion About People" Scale is "Anyone could keep young i f he only t r i e d " . 3. Anxiety about aging. 4. Social distance to the old. This dimension describes the feeling of d i s l i k e and d i s t r u s t of the old. An example of an item concerning s o c i a l distance to the old is "The older people get, the more they think only of themselves". 5. Family r e s p o n s i b i l i t y toward the aged. 28 6. Public r e s p o n s i b i l i t y toward the aged. 7. Unfavourable stereotype of the elderly. The subscale items and score range are shown in Table 1. For attitude dimensions 1, 2, 3, 4 and 7, the lower the score, the more negative the attitudes. For attitude dimensions 5 and 6, the lower the score the more positive the attitudes and vice versa. Table 1 Subscale Items and Score Range Attitude Number Score Intermediary dimension of items range position 1 R e a l i s t i c toughness/ 6 16 - 144 80 cynicism toward aging 2 Denial of the effects 3 2 - 2 7 15 of aging 3 Anxiety about aging 4 13-117 65 4 Social distance toward 8 19 - 171 95 the old 5 Family r e s p o n s i b i l i t y 4 22 - 198 110 toward the aged 6 Public r e s p o n s i b i l i t y 6 17 - 153 85 for the aged 7 Unfavourable stereotype 4 9 - 8 1 45 of the aged 29 The r e l i a b i l i t y c o e f f i c i e n t of the "Opinion About People" Scale was found to be 0.63 in this study using Cronback's alpha r e l i a b i l i t y test. Kapos and Smith (1972) indicated that the v a l i d i t y of the scale has been f u l l y established as the scale had been tested vigorously and revised several times before i t was published. Kartha and Evers (1983) confirmed the v a l i d i t y of the scale via factor analysis when they conducted a study on post-course attitude change in registered nurses in the f i r s t year degree course on care of the e l d e r l y . (See Appendix B for items in the "Opinion About People" Scale.) Demographic Questionnaire The demographic questionnaire was developed to obtain additional information about the registered nurses which was not available from the "Opinion About People" Scale. The additional information obtained was : (1) age, (2) agency of employment, (3) educational l e v e l , (4)length of employment in present job, (5) average amount of time spent the elderly c l i e n t s each day, and (6) whether the registered nurse had taken a course or advanced education in gerontological nursing. (See Appendix C for items contained in the Demographic Questionnaire.) Sample The population studied was from of Vancouver, B r i t i s h Columbia. The the metropolitian area sample consisted of 30 registered nurses from three health care settings: acute care, extended care and community. Random sampling of agencies and registered nurses within the agencies was not carri e d out. Rather, agency p a r t i c i p a t i o n was on a permission basis and registered nurses p a r t i c i p a t i o n within each agency was voluntary. Both full-time and part-time registered nurses from head nurse and staff nurse levels were recruited for the study. Agencies which agreed to parti c i p a t e in the study included two extended care f a c i l i t i e s , two community health departments and two acute care hospitals. The t o t a l population of the two extended care f a c i l i t i e s , two community health departments and one of the acute care hospitals were surveyed. A s t r a t i f i e d sampling technique was used to recruit registered nurses from the other acute care h o s p i t a l . Only nurses from the medical nursing department were included in the study because t h i s group has the most contact with elderly patients among the nurses employed in this acute care h o s p i t a l . Table 2 presents the number and percentage of registered nurses recruited from each of the three health care settings. Data Collection Procedure The investigator contacted the Directors of Nursing of a l l the agencies agreeing to participate in the study. A plan to d i s t r i b u t e the questionnaire was developed according 31 Table 2 Number and Percentage of Registered Nurses Pa r t i c i p a t i n g from the Three Health Care Settings Type of- setting Number of R. N. from each setting Percantage of a l l R. N. surveyed Acute care 1 1 9 49.40% Extended care 64 26.50% Community 58 24.10% Total 241 100.00% Note. R. N. means registered nurse. to the needs and preferences of each agency. Some agencies arranged meetings between the investigator and the head nurses. The investigator explained b r i e f l y the purpose and the nature of the study, and the head nurses took the r e s p o n s i b i l i t y of d i s t r i b u t i n g the explanatory l e t t e r (see Appendix A for contents of the l e t t e r ) and questionnaire and c o l l e c t i n g them when completed. In other agencies, the investigator was asked to attend.staff meetings and the questionnaire was di s t r i b u t e d at that time. In some cases, completed questionnaires were returned to a st a f f member who took r e s p o n s i b i l i t y for c o l l e c t i n g them. The investigator then returned to the agencies on a designated date to c o l l e c t the completed questionnaires from the responsible staff members. A t o t a l of 500 questionnaires were 32 d i s t r i b u t e d , 250 (50%) q u e s t i o n n a i r e s were r e t u r n e d , and 241 (48.2%) q u e s t i o n n a i r e s were u s e a b l e ( n i n e i n c o m p l e t e q u e s t i o n n a i r e s were r e t u r n e d t o the i n v e s t i g a t o r ) . The d a t a were coded and keypunched f o r computer a n a l y s i s . Data A n a l y s i s A l l d a ta were a n a l y s e d u s i n g p r o c e d u r e s i n the U n i v e r s i t y of B r i t i s h Columbia Package f o r the S o c i a l S c i e n c e s , V e r s i o n 9.00 (Under MTS). The d a t a about a t t i t u d e s of r e g i s t e r e d n urses were a n a l y s e d u s i n g d e s c r i p t i v e s t a t i s t i c s . Spearman Rho c o r r e l a t i o n a n a l y s i s was a p p l i e d t o determine r e l a t i o n s h i p s between the a t t i t u d e s of r e g i s t e r e d n urses toward the e l d e r l y and the s e t of s e l e c t e d c h a r a c t e r i s t i c s of the n u r s e s . Human R i g h t P r o t e c t i o n A l l n u r s e s i n the study were in f o r m e d t h a t c o m p l e t i o n of the q u e s t i o n n a i r e ("Opinion About P e o p l e " S c a l e and Demographic Q u e s t i o n n a i r e ) would be taken as t h e i r consent t o p a r t i c i p a t e i n the s t u d y . The n u r s e s were t o l d t h a t p a r t i c i p a t i o n i n the study or t h e i r r e f u s a l t o do so would not j e a p o r d i z e t h e i r p r e s e n t employment. Anonymity was emphasized, the n u r s e s were informed t h a t a l l i n f o r m a t i o n was c o n f i d e n t i a l . F i n a l l y , the n u r s e s were t o l d t h a t a l l data would be d e s t r o y e d a f t e r the i n v e s t i g a t o r has completed her M a s t e r ' s t h e s i s and s c h o l a r l y paper. 33 CHAPTER 4 Results and Discussion The results of t h i s study are presented in three sections. Section one is a description of the t o t a l sample (N=241) and the subgroups formed according to type of health care setting. The second section d e t a i l s the attitudes of the registered nurses in the t o t a l sample and the subgroups toward the e l d e r l y . Results of a c o r r e l a t i o n analysis undertaken to ascertain whether relationships exist between the attitudes of the registered nurses and the set of selected c h a r a c t e r i s t i c s of the nurses are discussed in section three. Description of the Total Sample and Subgroups A t o t a l of 500 questionnaires were d i s t r i b u t e d to the registered nurses. However, only 241 nurses were recruited for t h i s study. Of these, 119 are employed in an acute care setting, 64 are from extended care f a c i l i t i e s , and 58 are working in community health departments. Of the 58 community health department nurses, 27 work in Preventive Health , 23 work in Home Care and 8 in Long Term Care. The t o t a l sample and subgroups are described according to the set of c h a r a c t e r i s t i c s outlined in Chapter 1. Table 3 presents a summary of the number and percentage of registered nurses with d i f f e r e n t educational levels in 34 the three health care settings. The majority (44.0%) of the registered nurses in the t o t a l sample are graduates from a three year diploma program. This group represents 43.7% (N=52) of a l l acute care nurses, 40.6% (N=26) of a l l extended care nurses, and 48.3% (N=28) of a l l community health nurses. It should be noted that almost 29% of the registered nurses in the survey have a baccalaureate degree in nursing. In contrast, an average of only 10% of a l l registered nurses in Canada graduate from a baccalaureate program. Table 3 Number and Percentage of Registered Nurses in each Educational Level in each Health Care Setting Acute Extended Community Total care care sample n=l99 n=64 n=58 N=241 Educational le v e l No. % No. % No. % No. % 2 Yr Diploma 27 22 .7 1 3 20. 3 0 0.0 40 1 6 .6 3 Yr Diploma 52 43 .7 26 40. 6 28 48.3 106 44 .0 Baccalaureate 32 26 .9 18 28. 1 1 9 32.8 69 28 .6 Others* 8 6 .7 7 10. .9 1 1 19.0 26 1 0 .8 *Master's degree and nursing education from foreign countries which does not f a l l into the categories defined for nursing educational l e v e l . 35 The age of registered nurses in the study has been categorized into four age groups: 21-30 years, 31-40 years, 41-50 years, and those over 50 years. Table 4 summarizes the d i s t r i b u t i o n of registered nurses in each age group in the three d i f f e r e n t health care settings. The mean age of the t o t a l sample is 34.6 years with a standard deviation of 9.8. The mean age for the acute care, extended care and community nurses are 30.6, 36.1 and 41.1, years respectively. The majority of the registered nurses f a l l into the 21-30 year age group, representing almost 45% of the t o t a l sample. The data also show that most of the registered nurses in the 21-30 year age group (69.6%) are in the acute care setting. In thi s sample, older nurses tend to work primarily in extended care or community settings. There are several reasons for thi s r e s u l t . One reason could be that i t i s d i f f i c u l t for younger nurses to obtain employment in community health. In addition, i t i s also possible that younger nurses prefer to work in acute care setting. The length of employment of the registerted nurses in their present job is presented in Table 5. The mean length of employment for the entire sample is 4.2 years. The mean length of employment for registered nurses in the acute care hospitals is well below the sample mean, averaging only 2.9 years. Extended care nurses also have a shorter length of employment when compared to the t o t a l sample. The mean length of employment for the extended care nurses is 3.8 36 years. As for the community health nurses, their mean length of employment is 7.1 years, more than one and a half times greater than the sample mean. Table 4 Number and Percentage of Registered Nurses in each Age Group in each Health Care Setting Acute Extended Community Total care care sample n=111 n=60 n=56 N=227 Age group No. % No. % No. % No. % 21 - 30 7 1 64.0 21 35.0 1 0 17.9 1 02 44.9 31 - 40 26 23.4 1 6 26.7 1 7 30.4 59 26.0 41 - 50 1 2 10.8 1 7 28.3 1 7 30.4 46 20.3 > 50 2 1 .8 6 10.0 1 2 21.4 20 8.8 Note. Fourteen registered nurses did not indicate their age, and thus were not included in the to t a l sample. Mean age for the t o t a l sample, acute care, extended care and community nursing groups are 34.6, 30.6, 36.1 and 41.1 years respectively. 37 Table 5 Number and Percentage of Registered Nurses in each Subgroup by "Length of Employment in Present Job" in each Health Care Setting Acute Extended Community Total care care sample n=l08 n=6l n=54 N=223 Length of employment No. % No. % No. % No. % < 2 years 59 54.6 30 49.2 1 2 22.2 101 45.3 2 - 5 years 38 35.2 1 6 26.2 1 4 25.9 68 30.5 5 - 8 years 4 3.7 8 13.1 1 2 22.2 24 10.8 > 8 years 7 6.5 7 11.5 1 6 29.6 30 13.5 Note. Eighteen registered nurses did not indicate their length of employment in their present job, and thus were not included in the to t a l sample. Mean length of employment for the t o t a l sample, acute care, extended care and community nursing groups are 4.2, 2.9, 3.8 and 7.1 years respectively. The majority of the registered nurses (45.3%) have worked in their present job for less .than two years, followed by those who have worked between two and five years (30.5%). From these data, i t appears that registered nurses from the community health department tend to remain in the same job for a longer period of time compared to nurses in the other two groups. A possible reason for thi s result may be that the registered nurses in the community are older, and hence more "settled". In addition, these nurses may 38 a l s o e x p e r i e n c e g r e a t e r j o b s a t i s f a c t i o n , l e a d i n g t o a lower t u r n o v e r r a t e than n u r s e s i n the a c u t e c a r e or extended c a r e s e t t i n g s . T a ble 6 shows the nurses as a t o t a l group spend an average of 5.8 hours w i t h e l d e r l y c l i e n t s each day. The r e g i s t e r e d n u r s e s from the extended c a r e h o s p i t a l s have the most c o n t a c t , a v e r a g i n g 8.1 hours each day. The a c u t e c a r e n u r s e s spend about 5.7 hours per day w i t h e l d e r l y c l i e n t s and nurses from the community spent o n l y 2.8 h o u r s . These d a t a i n d i c a t e t h a t a h i g h p e r c e n t a g e of n u r s i n g time i s spent w i t h the e l d e r l y . T h i s i s not s u r p r i s i n g when one c o n s i d e r s the number of e l d e r l y i n Canada, and t h e i r i n c r e a s e d h e a l t h needs/problems. They u t i l i z e not o n l y the extended c a r e f a c i l i t i e s , but a l s o the a c u t e c a r e h o s p i t a l s . At p r e s e n t , t h e r e are v e r y few p r e v e n t i v e h e a l t h and h e a l t h maintenance programmes i n the community t h a t a r e d e s i g n e d s p e c i a l l y f o r the e l d e r l y . T h i s f a c t o r i s r e f l e c t e d i n the average number of hours spent w i t h e l d e r l y c l i e n t s by the community n u r s e s . Only 20 r e g i s t e r e d n u r s e s (8.8%) from the e n t i r e sample have taken a c o u r s e or advanced e d u c a t i o n i n G e r o n t o l o g i c a l N u r s i n g . Of t h e s e 20 r e g i s t e r e d n u r s e s , h a l f (10) are from the community, s i x are from the extended c a r e s e t t i n g and f o u r from the a c u t e c a r e h o s p i t a l s . T h i s f i n d i n g c o u l d r e s u l t from the f a c t t h a t t h e r e a r e s t i l l v e r y few n u r s i n g programs o f f e r i n g s p e c i a l c o u r s e s i n G e r o n t o l o g i c a l N u r s i n g . 39 Table 6 Number and Percentage of Registered Nurses in each Subgroup by "Amount of Time Spent with Elderly C l i e n t s " in each Health Care Setting Time spent Acute Extended community Total care care sample n=78 n=64 n=40 N=182 No. % No. % No. % No. < 2 hours 24 30. 8 3 4 .7 1 9 47.5 46 25 .3 2 - 5 hours 18 23. 1 3 4 .7 18 45.0 39 21 .4 5 - 8 hours 22 28 . 2 27 42 .2 3 7.5 52 28 .6 > 8 hours 1 4 17. 9 31 48 .4 0 0.0 45 24 .7 Note. Fi f t y - n i n e registered nurses did not indicate the amount of time they spent with elderly c l i e n t s each day, and thus were not included in the t o t a l sample. Average amount of time spent with elderly c l i e n t s each day by the t o t a l sample, acute care, extended care and community nursing groups are 5.8, 5.7, 8.1 and 2.8 hours respectively. 40 Results of the "Opinion About People" Survey  Type of Health Care Setting The sample as a group scores p o s i t i v e l y on a l l attitude dimensions in the "Opinion About People" Scale. Registered nurses from the acute care setting, however, are consistently less positive in a l l attitude dimensions compared to the t o t a l sample. They also score less p o s i t i v e l y in attitude dimensions 2, 3, 4, 6 and 7 compared to nurses in extended care and community settings. The attitude dimensions of registered nurses from the community setting are almost the opposite of those of the acute care nurses. This group of nurses scores more p o s i t i v e l y than the t o t a l sample in five of seven attitude dimensions. This pattern is maintained when comparisons are made with the extended care and acute care nurses. The attitude dimensions in which the community nurses score less p o s i t i v e l y are attitude dimensions 1 and 5. These responses imply that registered nurses from the community have a l i t t l e more " r e a l i s t i c toughness"/cynicism toward aging than their counterparts. They are also somewhat less supportive of family r e s p o n s i b i l i t y for the e l d e r l y . The mean scores for the seven attitude dimensions for registered nurses from the extended care setting are very close to the t o t a l sample means. Their mean score for attitude dimension 2 is the only score that i s below the sample mean. However, the difference i s i n s i g n i f i c a n t . Table 7 presents the mean scores of a l l seven attitude dimensions for the t o t a l sample 41 and subgroups. Table 7 Mean Score for the Total Sample and Subgroup by "Type of Health Care Setting" in the "Opinion About People" Scale Att i tude dimension Acute Extended Community Total Inter-care care sample mediary n=119 n=64 n = 58 N=241 position M M M M 1 R e a l i s t i c toughness 97.1 97.6 96.8 97.2 80 toward aging 2 Denial of the effects of aging 16.4 17.1 19.2 17.3 15 3 Anxiety about aging 66.5 71.1 73.6 69.4 65 4 Social distance toward the old 128.1 129.0 130.9 129.1 95 5 Family r e s p o n s i b i l i t y 99.3 99.8 106.8 101.3 110 toward the aged 6 Public r e s p o n s i b i l i t y 62.3 58.4 58.9 60.5 85 for the aged 7 Unfavourable stereotype of 57.4 58.9 60.5 58.6 45 the elderly Note. For attitudes dimensions 1, 2, 3, 4, and 7, a score higher than the intermediary position indicates p o s i t i v e attitudes. For attitude dimensions 5 and 6, a score lower than the intermediary position indicates p o s i t i v e attitudes. 42 Age To further investigate the attitudes of nurses in this study, a c l a s s i f i c a t i o n was made according to age. Following the previous format, mean scores for the seven attitude dimensions are determined for each age group. The mean scores for each age group are compared with the t o t a l sample as well as among a l l the age groups. Table 8 shows the mean scores for the t o t a l sample and the age groups. Registered nurses in the 21-30 year age group score less p o s i t i v e l y in attitude dimensions 3, 5 and 6 compared to the t o t a l sample. It seems that t h i s group of nurses have more anxiety about the effects of aging than the sample as a whole. They are also less strong for both family and public r e s p o n s i b i l i t y for the e l d e r l y . When compared with other age groups, t h i s group of nurses are most positive in attitude dimensions 1, 4 and 7. They show l i t t l e " r e a l i s t i c toughness"/cynicism toward aging. They also indicate very l i t t l e s o c i a l distance toward the elderly, and they have the least unfavourable stereotypes about the aged. Registered nurses in the 31-40 year age group also score less p o s i t i v e l y in three attitude dimensions than the sample as a whole. Their mean scores in attitude dimensions 1, 4 and 7 are below the sample means, r e f l e c t i n g less positive a t titudes. Compared to other age groups, these nurses score the lowest in attitude dimension 7, meaning that they have the most unfavourable stereotypes about the e l d e r l y . In addition, they are also least positive toward 43 Table 8 Mean Scores for the Total Sample and Subgroups by "Age" in the "Opinion About People" Scale 21-30 31-40 41-50 > 50 Total Inter-years years years years sample mediary n=l02 n = 59 n=46 n=20 N=227 position Attitude dimension M M M M M 1 R e a l i s t i c toughness 100.7 95.7 95.6 93.0 97.2 80 toward aging 2 Denial of the effects of 17.3 17.5 17.7 16.9 17.3 15 aging 3 Anxiety about aging 66.8 70.9 70.3 83.0 69.4 65 4 Social distance toward the old 130.0 128.5 129.9 128.0 129.1 95 5 Family r e s p o n s i b i l i t y 103.0 99.3 97.5 105.0 101.3 110 toward the aged 6 Public r e s p o n s i b i l i t y 61.7 62.8 58.5 53.6 60.5 85 for the aged 7 Unfavourable stereotype of 59.3 57.4 58.5 59.3 58.6 45 the el d e r l y Note. For attitudes dimensions 1, 2, 3, 4 and 7, a score higher than the intermediary position indicates p o s i t i v e attitudes. For attitude dimensions 5 and 6, a score lower than the intermediary position indicates p o s i t i v e attitudes. Fourteen registered nurses did not indicate their age, and thus were not included in the t o t a l sample. 44 public r e s p o n s i b i l i t y for the e l d e r l y . Among a l l age groups, the 41-50 year age group i s the most positive group. They only score below the t o t a l sample means in two attitude dimensions, (attitude dimensions 1 and 7). However, the differences are very small, only 1.6 points for attitude dimension 1 and 0.1 points for attitude dimension 7. These differences are not s i g n i f i c a n t . Compared to other age groups, these nurses are most favourable toward family r e s p o n s i b i l i t y for the eld e r l y , and they rank second in supporting public r e s p o n s i b i l i t y for the aged. The 50 year and over age group shows a mixture of attitudes. They score more p o s i t i v e l y than the t o t a l sample in three attitude dimensions: 3, 6 and 7, and less p o s i t i v e l y in four: 1, 2, 4 and 5. Their scores in attitude dimensions 1 and 2 are the lowest among a l l age groups, indicating that the nurses in this age group have s l i g h t l y more " r e a l i s t i c toughness"/cynicisim toward aging and denial toward the effects of aging. However, they also score highest in attitude dimension 3, showing that they have the least anxiety about aging. It is interesting to note that t h i s group of nurses are most supportive of public r e s p o n s i b i l i t y for the el d e r l y . Educational Level The registered nurses' level of education i s another variable included in the study. As indicated in Table 9, registered nurses who graduated from a two year diploma 45 program score less p o s i t i v e l y than the t o t a l sample in almost a l l attitude dimensions. However, i t should be noted that the size of this group of nurses i s very small, there are only 40 nurses. The only attitude dimension for which these nurses score higher than the sample mean is attitude dimension 7. This group of nurses is also least positive in attitude dimensions 2, 5 and 6 among a l l educational groups. The responses indicate that the two year diploma graduates have more denial of the ef f e c t s of aging, and are less positive toward family and public r e s p o n s i b i l i t y for the elderly than nurses in other educational groups. The three year diploma graduates are more positive in a l l attitude dimensions compared to the t o t a l sample. Furthermore, they also score more p o s i t i v e l y in a l l attitude dimensions among a l l educational groups except attitude dimension 1. Their mean score in th i s attitude dimension is lower than the group of nurses who have a baccalaureate degree in nursing, showing more " r e a l i s t i c toughness"/ cynicism toward aging. Registered nurses who have graduated from a baccalaureate program score more p o s i t i v e l y than the t o t a l sample in attitude dimensions 1, 4 and 6. The attitude dimensions for which these nurses score less p o s i t i v e l y than the sample are attitude dimensions 2, 3, 5 and 7. Among the di f f e r e n t educational groups, these nurses score highest in attitude dimensions 3 and 7. The findings indicate that nurses who have a baccalaureate degree have the least 46 Table 9 Mean Scores for the Total Sample and Subgroups by "Nursing Educational Level" in the "Opinion About People" Scale 2 Year 3 Year Bacca- Total Inter-Diploma Diploma laureate sample mediary n=40 n=!06 n=69 N=215 position Attitude dimens ion M M M M 1 R e a l i s t i c toughness toward aging 94.3 2 Denial of the effe c t s of aging 16.9 3 Anxiety about aging 66.8 4 Social distance toward the old 128.8 5 Family r e s p o n s i b i l i t y 105.8 toward the aged 6 Public r e s p o n s i b i l i t y 63.6 for the aged 7 Unfavourable stereotype of 58.9 the el d e r l y 98.2 17.4 71.7 59.5 59.8 99. 1 17.2 66.5 60.4 97.2 80 17.3 15 69.4 65 130.2 129.3 129.1 95 98.4 103.3 101.3 110 60.5 85 57.0 58.6 45 Note. For attitude dimensions 1, 2, 3, 4 and 7, a score higher than the intermediary position indicates positive attitudes. For attitude dimensions 5 and 6, a score lower than the intermediary position indicates p o s i t i v e attitudes. Twenty-six nurses with other educational levels were not included in the t o t a l sample. 47 " r e a l i s t i c toughness"/cynicism tward aging, but they are also most anxious about aging. Additionally, they also show the least unfavourable stereotypes of the e l d e r l y . Time Spent with Elderly Table 10 presents the mean scores of the attitude dimensions among the t o t a l sample and subgroups, categorized according to the average amount of time spent with elderly c l i e n t s each day. It is noted that registered nurses who on the average spend less than two hours with elderly c l i e n t s each day score more p o s i t i v e l y than the t o t a l sample in a l l attitude dimensions except 3 and 6. Compared to other groups in the same category, they also score most p o s i t i v e l y in attitude dimensions 1, 2 and 6, and least p o s i t i v e l y in attitude dimension 5. This result shows that nurses in this group have the least " r e a l i s t i c toughness"/cynicism toward aging and denial of the effects of aging. They are most positive toward public r e s p o n s i b i l i t y for the el d e r l y and least positive for family r e s p o n s i b i l i t y for the aged. Registered nurses who spend between two and fiv e hours a day with elderly c l i e n t s only score below the sample mean in attitude dimension 1. The mean score for this dimension is also the lowest among a l l subgroups. However, th i s group scores most p o s i t i v e l y in attitude dimensions 3, 4, 5 and 7. In other words, the nurses who spend two to fiv e hours a day with e l d e r l y c l i e n t s reported the least anxiety about aging, show l i t t l e s o c i a l distance toward the elderly and indicate the greatest acceptance of the e l d e r l y . Furthermore, they 48 Table 10 Mean Scores for the Total Sample and Subgroups by "Amount of Time Spent with Elderly C l i e n t s " in the "Opinion About People" Scale < 2 2 - 5 5 - 8 >8 Total Inter-hr/day hr/day hr/day hr/day sample mediary n=46 n=39 n=52 n=45 N=182 position Att i tude dimens ion M M M M M 1 R e a l i s t i c toughness toward aging 100.1 95.1 96.1 97.2 97.2 2 Denial of the effects of aging 18.2 17.3 16.7 17.1 17.3 3 Anxiety about aging 67.2 74.0 69.1 68.8 69.4 4 Social distance toward the old 129.7 130.4 128.6 128.4 129.1 5 Famility r e s p o n s i b i l i t y 113.2 97.4 99.6 98.3 101.3 toward the aged 6 Public r e s p o n s i b i l i t y 58.1 60.2 59.2 62.3 60.5 for the aged 7 Unfavourable stereotype 58.8 59.5 57.5 58.6 58.6 of the elderly 80 1 5 65 95 1 1 0 85 45 Note. For attitude dimensions 1, 2, 3, 4 and 7, a score higher than intermediary position indicates positive attitudes. For attitude dimensions 5 and 6, a score lower than the intermediary position indicates p o s i t i v e attitudes. F i f t y - n i n e registered nurses did not indicate the amount of time they spent with elderly c l i e n t s each day, and thus were not included in the t o t a l sample. 49 are strongly favourable toward family r e s p o n s i b i l i t y for the aged. Among a l l subgroups, those registered nurses who spend between five and eight hours with elderly c l i e n t s each day show the least positive attitude. They score less p o s i t i v e l y in fiv e of seven attitude dimensions compared to the t o t a l sample. They also show the most denial toward the ef f e c t s of aging and unfavourable stereotypes of the elderly among a l l subgroups. F i n a l l y , the group of nurses who spend more than eight hours per day with the elderly c l i e n t s score less p o s i t i v e l y than the t o t a l sample in a l l attitude dimensions except one. They are more supportive of family r e s p o n s i b i l i t y for the t o t a l elderly than the sample. Among a l l subgroups, this group of nurses occupy an intermediary position, that i s , they do not score highest or lowest in any of the attitude dimensions in the "Opinion About People" Scale. Length of Employment The registered nurses in the study have also been categorized into four subgroups according to their length of employment in their present job. Table 11 presents the mean scores of the attitude dimensions for the t o t a l sample and the four subgroups. As shown in Table 11, registered nurses who have worked less than two years in their present job score higher than the t o t a l sample in attitude dimensions 1, 3, 4 and 7. When compared to other subgroups, they also 50 Table 11 Mean Scores for the Total Sample and Subgroup by "Length of Employment in Present Job" in the "Opinion About People" Scale < 2 2 - 5 5 - 8 > 8 Total Inter-years years years years sample mediary n=101 n=68 n=24 n=30 N=223 position Attitude dimension M M M M M 1 R e a l i s t i c toughness 99.9 94.6 98.0 88.3 97.2 80 toward aging 2 Denial of the effects of aging 17.1 16.7 15.5 15.5 17.3 15 3 Anxiety about aging 73.3 67.4 63.6 67.1 69.4 65 4 Social distance toward the old 132.6 122.1 128.5 114.4 129.1 95 5 Family r e s p o n s i b i l i t y 103.6 92.4 89.7 112.1 101.3 110 toward the aged 6 Public r e s p o n s i b i l i t y 61.0 61.3 58.2 62.1 . 60.5 85 for the aged 7 Unfavourable stereotype of 59.5 56.9 56.1 59.2 58.6 45 the elderly Note. For attitude dimensions 1, 2, 3, 4, and 7, a score higher than the intermediary position indicates p o s i t i v e attitudes. For attitude dimensions 5 and 6, a score lower than the intermediary position indicates positive attitudes. Eighteen registered nurses did not indicate their length of employment in present job, and thus were not included in the t o t a l sample. 51 score the highest in these attitude dimensions. In addition, this group is the only group which scores higher than the sample in attitude dimensions 3 and 4. This finding shows that this group of registered nurses has the least " r e a l i s t i c toughness"/cynicism and anxiety toward aging. They also have the least s o c i a l distance toward the elderly and have the least unfavourable stereotypes of the eld e r l y . The group of registered nurses who have worked in their present employment for two to five years and the group with more than eight years at their present employment score s i m i l a r l y . Both groups score lower than the sample mean in attitude dimensions 1, 2, 3, 4 and 6. The only difference between these two groups is that nurses who have worked between two and fiv e years in their present job score more po s i t i v e l y than the sample in attitude dimension 5 and less p o s i t i v e l y in attitude dimension 7. Nurses who have worked more than eight years score just the opposite. When compared to other subgroups, the group that has worked more than eight years score the least p o s i t i v e l y in attitude dimensions 1, 2, 4, 5 and 6. These nurses reported the most " r e a l i s t i c toughness"/cynicism toward aging and denial of the effects of aging. They have the most s o c i a l distance toward the eld e r l y and are least supportive of family or public r e s p o n s i b i l i t i e s for the e l d e r l y . Registered nurses who have worked between five and eight years in their present job score more p o s i t i v e l y than 52 the sample in attitude dimensions 1, 5 and 6. They also score the lowest in attitude dimensions 3 and 7 among a l l subgroups, r e f l e c t i n g more anxiety toward aging and more unfavourable stereotype of the e l d e r l y . However, they believe more strongly that both the family and public should have r e s p o n s i b i l i t y for the e l d e r l y . Advanced Education in Gerontological Nursing The last analysis in this section compares the mean scores of the attitude dimensions between those registered nurses who have taken a course or advanced education in Gerontological Nursing with the sample as well as with those who have not taken any course or advanced education in t h i s area. Table 12 shows the result of this analysis. It i s noted that the group of nurses who have taken a course or advanced education in Gerontological Nursing score more p o s i t i v e l y in a l l attitude dimensions except attitude dimension 5 than the t o t a l sample and the group which has not taken a course/education in Gerontological Nursing. These nurses are less supportive of family r e s p o n s i b i l i t y for the e l d e r l y . Results of the Correlational Analysis and Discussion Spearman Rho Correlation C o e f f i c i e n t s are used to describe the relationships between registered nurses' attitudes and a set of selected c h a r a c t e r i s t i c s of the nurses. Table 13 displays the results of the c o r r e l a t i o n a l analysis between nurses' attitudes and type of health care 53 Table 12 Mean Scores for the Total Sample and Subgroups by "Courses Taken in Gerontological Nursing" in the "Opinion About People" Scale Has taken Has not taken Total Inter-courses courses sample mediary n=20 n=221 N=241 position Att itude dimension M M M 1 R e a l i s t i c toughness 105.0 toward aging 2 Denial of the effe c t s of aging 19.3 3 Anxiety about aging 76.5 4 Social distance toward the old 140.0 5 Family r e s p o n s i b i l i t y 109.7 toward the aged 6 Public r e s p o n s i b i l i t y 57.5 for the aged 7 Unfavourable stereotype of 61.5 the elderly 96.4 16.9 68.4 127.6 1 00. 1 59.9 58.2 97.2 17.3 69. 4 129.1 101.3 60.5 58.6 80 1 5 65 95 1 10 85 45 Note. For attitude dimensions 1, 2, 3, 4 and 7, a score higher than the intermediary position indicates.positive attitudes. For attitude dimensions 5 and 6, a score lower than the intermediary position indicates p o s i t i v e attitude. 54 Table 13 Summary of Spearman Rho Correlation Analysis Independent variable: Type of health care setting N=241 Dependent variable: Attitude dimension 1 R e a l i s t i c toughness toward aging 0.025 2 Denial of the effects of aging 0.226** 3 Anxiety about aging 0.159* 4 Social distance toward the old 0.053 5 Family r e s p o n s i b i l i t y toward the aged 0.098 6 Public r e s p o n s i b i l i t y for the aged 0. 163* 7 Unfavourable stereotype of the elderly 0.161* *2<.01. **P_<.001 setting. The type of health care setting i s s i g n i f i c a n t l y correlated with attitude dimensions 2, 3, 6 and 7. This describes a relationship where registered nurses from the community setting display less anxiety and less denial of the e f f e c t s of aging, and they are more accepting of the el d e r l y . This group of nurses are also more positive toward 55 public r e s p o n s i b i l i t y for the e l d e r l y . This finding is similar to that of G i l l i s (1973) and Taylor and Harned (1978) who found that nurses from the community setting have a more positive attitude toward the e l d e r l y . The only difference between the results of this study and that c i t e d previously is that in t h i s study, the attitudes of the extended care nurses are more positive than nurses from the acute care setting. The other studies indicate the opposite ( G i l l i s , 1973; Taylor & Harned, 1978), that i s , acute care nurses have more positive attitudes than extended care nurses. There are several factors that could contribute to t h i s r e s u l t . For example, registered nurses in the community setting have a d i f f e r e n t working environment and working condition compared to nurses from acute care or extended care settings. . This in turn may increase their job s a t i s f a c t i o n and hence i n d i r e c t l y affect their attitudes toward the e l d e r l y . Another possible reason that registered nurses from the community setting have more po s i t i v e attitudes i s that the c h a r a c t e r i s t i c s of the e l d e r l y (degree of i l l n e s s , d i s a b i l i t y or dependency) in the community may be d i f f e r e n t from those in acute care and extended care settings. Hence, the nature of the needs of the elderly would be d i f f e r e n t , and t h i s factor may influence the attitudes of nurses toward the e l d e r l y . The result of the correlation analysis between age and nurses' attitudes is shown in Table 14. Age is found to have a s i g n i f i c a n t r e l a t i o n s h i p with attitude dimensions 1 , 56 Table 14 Summary of Spearman Rho Correlation Analysis Group Acute Extended Community Total care care sample n=111 n=60 n=56 N=227 Dependent variable: Attitude dimension Independent variable: Age 1 R e a l i s t i c toughness toward aging -0.147 -0.154 -0.066 -0.114* 2 Denial of the effects of aging -0.161* -0.191 0.141 0.026 3 Anxiety anout aging 0.080 0.116 0.365** 0.190* 4 Social distance toward the old -0.025 -0.039 -0.015 -0.008 5 Family r e s p o n s i b i l i t y toward the aged -0.257** -0.074 -0.097 -0.056 6 Public r e s p o n s i b i l i t y for the aged -0.144 -0.195 -0.012 -0.188** 7 Unfavourable stereotype of the eld e r l y - -0.060 -0.230* 0.131 0.018 Note. Fourteen registered nurses did not indicate their age, and thus were not included in the t o t a l sample. *p<.05 **p_<. 005 57 3 and 6 in the t o t a l sample. The older the registered nurses, the more " r e a l i s t i c toughness"/cynicism but less anxiety they have toward aging. However, they also feel more strongly that the r e s p o n s i b i l i t y for the elderly rests on the public. Analysis of the c o r r e l a t i o n between age and attitude dimension scores of the subgroups (subgroup by type of health care setting) reveals d i f f e r e n t relationships. Age has no relationship with attitude dimensions 1 and 6 in the acute care, extended care or community groups even though i t is s i g n i f i c a n t l y correlated in the t o t a l sample. (One possible reason for t h i s finding could be that when the t o t a l sample is divided into three subgroups according to the type of health care setting, the size of these subgroups is r e l a t i v e l y smaller than the t o t a l sample. This in turn affects the s t a t i s t i a l analysis, and thus reveals a di f f e r e n t relationship between the t o t a l sample and the subgroups.) However, age i s found to have a s i g n i f i c a n t relationship with attitude dimension 3 in the community nurses, attitude dimension 7 in the extended care nurses, and attitude dimensions 2 and 5 in the acute care nurses. This result implies that the older the community nurses, the less anxious they are toward aging. As for the acute care nurses, the older they are, the more denial of the effects of aging and the stronger their support for family r e s p o n s i b i l i t y for the e l d e r l y . In the case of the extended care nurses, the older nurses have more unfavourable stereotypes of the elderly than the younger nurses. 58 One explanation for the differences in attitudes between the older and younger nurses in the t o t a l sample is that older nurses, being closer to old age, see the real problems that they may face as they age, and thus have more " r e a l i s t i c toughness"/cynicism toward aging than the younger nurses (Thorson, Whatley & Hancock, 1974). As for the finding that nurses are less anxious about aging, this may be explained in terms of the kinds of nurses constituting the older age group. For the most part, within the t o t a l sample, registered nurses from the community setting make up the older age group. This group of nurses, as mentioned e a r l i e r , may have more job s a t i s f a c t i o n because of a d i f f e r e n t working environment. In addition, these nurses may also have d i f f e r e n t experiences with the elderly because the c h a r a c t e r i s t i c s of the elderly (degree of i l l n e s s , d i s a b i l i t y or dependency) in the community and the nature of their needs may be d i f f e r e n t from those in the acute care and extended care settings. These factors may influence the attitudes of the nurses toward the e l d e r l y . This argument (chara c t e r i s t i c s of the elderly and the nature of their needs) further supports the findings of the subgroup analysis which shows that older nurses from the acute care and extended care settings have less p o s i t i v e attitudes toward the e l d e r l y . The decrease in positiveness of attitudes again may be accounted for by the c h a r a c t e r i s t i c s of the elderly and the nature of their needs. Another c h a r a c t e r i s t i c of the registered nurses which 59 has been included in the c o r r e l a t i o n a l analysis i s the level of nursing education. Table 15 indicates the result of t h i s analysis. Level of nursing education is not correlated with any of the attitude dimensions in the "Opinion About People" Scale in the t o t a l sample. However, there i s s i g n i f i c a n t c o r r e l a t i o n between the l e v e l of education and attitudes among the subgroups (subgroup by type of health care s e t t i n g ) . The result of the analysis shows that the l e v e l of nursing education i s s i g n i f i c a n t l y associated with attitude dimensions 4 and 5 in the acute care nursing group. It i s also correlated with attitude dimensions 1 and 3 in the extended care group, and attitude dimensions 3 and 7 in the community nursing group. The baccalaureate graduates in the acute care setting indicate more soc i a l distance to the elderly and they are also more favourable toward family r e s p o n s i b i l i t y for the aged than nurses who graduated from two year or three year diploma programs. However, among the registered nurses in the extended care setting, the baccalaureate graduates are more positive and have less " r e a l i s t i c toughness/cynicism and anxiety toward aging than nurses with other educational l e v e l s . As for the community nurses, the reverse i s found. The nurses who graduated from baccalaureate programs show more anxiety toward aging and they are less accepting of the elderly than diploma graduates. These findings must be viewed with caution because of the smaller number of nurses in each subgroup compared to the t o t a l sample. 60 Table 15 Summary of Spearman Rho Correlation Analysis Group Acute Extended Community Total care care sample n=119 n=64 n=58 N=241 Independent variable: Educational l e v e l Dependent variable: Attitude dimension 1 R e a l i s t i c toughness toward aging -0.082 0.265* -0.159 0.167 2 Denial of the effects of aging 0.008 -0.084 -0.029 0.024 3 Anxiety about aging -0.073 0.243* -0.307** 0.001 4 Social distance toward the old -0.171* 0.186 -0.142 0.044 5 Family r e s p o n s i b i l i t y toward the aged 0.153* 0.187 0.026 0.014 6 Public r e s p o n s i b i l i t y for the aged -0.017 0.160 -0.007 -0.078 7 Unfavourable stereotype of the eld e r l y -0.107 0.010 -0.169* -0.166 *p_<. 05 **P_<.01 61 These results are not congruent with most of the findings reported in current l i t e r a t u r e (M. E. Campbell, 1971; Thorson, Whatley & Hancock, 1974) which indicate that better-educated groups have more positive attitudes toward the el d e r l y . It seems reasonable to expect that baccalaureate nurses may have a greater understanding of the aging process, the behaviors and needs of the elderly, and thus develop more positive attitudes. A possible reason for the lack of difference in attitudes among nurses with d i f f e r e n t nursing educational levels in the sample is that the nursing curriculum of a l l the nursing programs does not include Gerontological Nursing and experiences with elderly patients. Some of the Baccalaureate programs may have included some theory of aging and some c l i n i c a l experience with the elderly in their curriculum. However, the amount of content in Gerontological Nursing may be so small that i t does not affect the baccalaureate students' understanding of the aging process and the care of the e l d e r l y . As for the subgroup analysis, the difference in attitudes between baccalaureate graduates and diploma graduates may be explained in terms of nurses' preference in working with certain types of c l i e n t s . The baccalaureate graduates from the extended care setting have a more positive attitude toward the el d e r l y because they choose to work with the elderly. The baccalaureate graduates in the acute care and community settings have a less p o s i t i v e attitudes because they prefer to work with other types of 62 c l i e n t s than the e l d e r l y . Furthermore, these nurses' perceptions of the elderly may have an influence on their attitudes toward the e l d e r l y . The nurses may perceive that caring for the elderly is "less nursing" even though to care for the elderly in both acute care and community settings requires equal i f not more nursing knowledge and s k i l l s . This perception has been reported by several researchers in both Canada and the United States (Delora & Moses, 1969; Hnatiuk, 1981; MacDonnell, Tramer & Siemens, 1980). However, as the number of elderly in the population increases, nurses in the acute care and community settings w i l l encounter elderly c l i e n t s more frequently in their practices. Hence, i t i s c r u c i a l that these nurses develop posit i v e attitudes toward the elderly as their attitudes af f e c t the quality of care they provide to this group of populat ion. The result of the c o r r e l a t i o n analysis between length of employment in present job and attitudes of registered nurses i s shown in Table 16. Length of employment in the present job is found to be correlated with attitude dimensions 1 and 6 in the t o t a l sample. This result implies that the longer the nurses' length of employment, the more " r e a l i s t i c toughness"/cynicism they have toward aging. Add i t i o n a l l y , these nurses are more supportive of public r e s p o n s i b i l i t y for the e l d e r l y . The analysis also reveals that length of employment i s correlated with attitude dimensions 1, 2 and 5 in the acute care nursing group, 63 Table 16 Summary of Spearman Rho Correlation Analysis Group Acute Extended Community Total care care sample n=l08 n=64 n=58 N=223 Independent variable: Length of employment in present job Dependent variable: Attitude dimension 1 R e a l i s t i c toughness toward aging -0.160* -0.213* -0.084 -0.142* 2 Denial of the eff e c t s of aging -0.173* 0.211* 0.211 0.015 3 Anxiety about aging 0.052 -0.134 0.005 0.094 4 Social distance toward the old . -0.077 -0.072 -0.067 -0.056 5 Family r e s p o n s i b i l i t y toward the aged -0.220* -0.053 0.053 -0.055 6 Public r e s p o n s i b i l i t y for the aged -0.062 -0.165 -0.042 -0.119* 7 Unfavarouble stereotype of the e l d e r l y -0.026 -0.318** 0.026 -0.049 Note. Eighteen registered nurses did not indicate their length of employment in their present job, and thus were not included in the t o t a l sample. *p_<. 05 **p<.005 64 indicating that the registered nurses with longer lengths of employment in the acute care setting have more " r e a l i s t i c toughness"/cynicism toward aging. They have more denial of the effects of aging and they believe that r e s p o n s i b i l i t y for the elderly rests with the family. In the extended care group, the length of employment is s i g n i f i c a n t l y correlated with attitude dimensions 1, 2 and 7. The longer the nurse works in t h i s setting, the more " r e a l i s t i c toughness"/cynicism and denial there is toward aging. They also have more unfavourable stereotypes of the e l d e r l y . The length of employment at the present job has been included in this study for two reason. F i r s t , i t can be used to substantiate that age is correlated with attitudes toward the e l d e r l y . Length of employment to a certain extent r e f l e c t s the age of the nurses. Second, the l i t e r a t u r e indicates that i f length of employment i s interpreted in terms of years of experience in working with the elderly, then attitudes toward the elderly are influenced by t h i s variable. The results of t h i s study c e r t a i n l y support the argument that length of employment is closely associated with age as the c o r r e l a t i o n a l analysis shows i d e n t i c a l relationships in both subgroups (subgroup by age and subgroup by length of employment). When length of employment is interpreted as years of experience working with the elderly c l i e n t s , the result of the analysis i s consistent with that of M. E. Campbell (1971) and G i l l i s (1973). The results show that as the 6 5 length of employment increases, positiveness of attitudes decreases. Again, the c h a r a c t e r i s t i c s of the eld e r l y and the nature of their needs could be contributing factors to the less positive attitude toward the elderly by nurses from the acute care and community settings. Table 17 presents the results of the co r r e l a t i o n analysis between time spent with elderly c l i e n t s and attitudes. The average amount of time spent each day with elderly c l i e n t s is found to be correlated s i g n i f i c a n t l y with attitude dimension 5. The result reveals that the more time nurses spend with the elde r l y , the stronger their support for family r e s p o n s i b i l i t y for the eld e r l y . This relationship is also found to be s i g n i f i c a n t among the nurses from the community setting. For the acute care nurses, the amount of time spent with the elderly has a s i g n i f i c a n t relationship with attitude dimension 1. The more time the acute care nurses spend with the elde r l y , the more " r e a l i s t i c toughness"/cynicism they have toward aging. However, the opposite case i s found with the extended care nurses. In addition, the extended care nurses who spent more time with the elderly have less unfavourable stereotypes of the e l d e r l y . The finding that the registered nurses who spend more time with the elderly believe strongly that r e s p o n s i b i l i t y for the el d e r l y rests with the family may be explained by the idea that these nurses may s t i l l subscribe to the myth 66 Table 17 Summary of Spearman Correlation Analysis Group Acute Extended Community Total care care sample n = 78 n = 64 n = 40 N=~182 Dependent variable: Attitude dimension Independent variable: Amount of time spent with elderly c l i e n t s 1 R e a l i s t i c toughness toward aging -0.200* 0.271* -0.007 -0.039 2 Denial of the effects of aging -0.063 0.174 -0.145 -0.074 3 Anxiety about aging -0.040 -0.072 -0.141 -0.018 4 Social distance toward the old -0.068 -0.031 -0.045 -0.030 5 Family r e s p o n s i b i l i t y toward the aged -0.149 0.120 -0.263* -0.139* 6 Public r e s p o n s i b i l i t y for the aged -0.062 0.113 0.152 0.068 7 Unfavourable stereotype of the el d e r l y -0.019 0.225* -0.159 -0.028 Note. F i f t y - n i n e registered nurses did not indicate the amount of time they spent with el d e r l y c l i e n t s each day, and thus were not included in the t o t a l sample. *p_<. 05 67 that families abandon their elderly ( T r o l l , 1982). Extended care nurses, e s p e c i a l l y , may perceive that their p a t i e n t s / c l i e n t s are seldom v i s i t e d by family members, adding to the feeling that the family should take more r e s p o n s i b i l i t y in caring for the aged. As for the result of the subgroup analysis, the decrease in the positiveness of attitudes of the acute care nurses when they spend more time with the elderly may be explained in terms of their preference to work with other types of c l i e n t s than the el d e r l y . Furthermore, the attitudes of these nurses may also be influenced by the ch a r a c t e r i s t i c s of the elderly c l i e n t s (degree of i l l n e s s , d i s a b i l i t y or dependency) and the nature of their needs. The extended care nurses however show more positive attitudes toward the elderly as the amount of time spent with these people increases. This result may be explained by the argument that extended care nurses choose to care for the e l d e r l y . Furthermore, i f these nurses are able to spend more time actually caring for the elde r l y , they are better able to understand and meet the needs of these people. This in turn w i l l increase the s a t i s f a c t i o n and f u l f i l l m e n t of their job, and hence, lead to more positive attitudes toward the e l d e r l y . However, i f registered nurses are only supplying medication or carrying out treatment, they w i l l not be able to interact with the elderly intimately and to plan for their t o t a l care. When only custodial care i s provided to the el d e r l y , the nurses could be frustrated and 68 d i s s a t i s f i e d with their job, thus leading to less positive attitudes toward the el d e r l y . The f i n a l variable considered is whether the registered nurses have taken a course or advanced education in Gerontological Nursing. Table 18 shows the results of this analysis. The result indicates that in the t o t a l sample, this variable has s i g n i f i c a n t association with attitude dimensions 1, 2, 4 and 7. This result indicates that nurses who have taken a course or advanced education in Gerontological Nursing have less " r e a l i s t i c toughness"/ cynicism toward aging. They also have less denial of the effects of aging, less s o c i a l distance to the elderly and more acceptance of the aged than those nurses who have not taken a course or advanced education in Gerontological Nursing. This finding is supported in the l i t e r a t u r e which maintains that people with more knowledge of the aging process and the elderly have more positive attitude toward the elderly and they understand and accept t h i s group of people more read i l y . Another possible explanation for this finding is that nurses who take courses or advanced education in Gerontological Nursing are nurses who have positive attitudes toward the elderly in the f i r s t place. 69 Table 18 Summary of Spearman Rho Correlation Analysis Dependent variable: Attitude dimension Independent variable: Courses taken in Gerontological Nursing N=24 1 1 R e a l i s t i c toughness toward aging 0.126* 2 Denial of the eff e c t s of aging 0.147* 3 Anxiety about aging 0.104 4 Social distance toward the old 0.166** 5 Family r e s p o n s i b i l i t y toward the aged 0.094 6 Public r e s p o n s i b i l i t y for the aged 0.072 7 Unfavourable stereotype of the elderly 0.123* *p_<.05 **p<.005 70 CHAPTER 5 Summary, Conclusions, Implications and Recommendations Summary and Conclusions The purpose of this study is two f o l d : f i r s t , to investigate the attitudes of registered nurses toward the elder l y , and second, to id e n t i f y the relationships between nurses' attitudes and a set of selected c h a r a c t e r i s t i c s of the nurses. The impetus for th i s study i s based on the observation that c o n f l i c t i n g results dealing with the attitudes of registered nurses toward the elderly are found in the l i t e r a t u r e . Two hundred fourty-one registered nurses from three d i f f e r e n t health care settings (acute care, extended care and community) volunteered for p a r t i c i p a t i o n in the study. The "Opinion About People" Scale which measures attitudes toward the elderly and a demographic questionnaire were administrated to these nurses. A l l data obtained were analysed using procedures in the University of B r i t i s h Columbia S c i e n t i f i c Package for the Social Sciences, Version 9. Two s t a t i s t i c a l methods were used to describe the attitudes of registered nurses and to identif y relationships between the attitudes of nurses and a set of selected c h a r a c t e r i s t i c s of the nurses. Descriptive s t a t i s t i c s and Spearman Rho Correlation C o e f f i c i e n t s were used. 71 The following are the major findings and conclusions of the study: 1. Registered nurses from the three health care settings; that i s , acute care, extended care and community a l l show positive attitudes toward the eld e r l y . This finding is very encouraging as many past a t t i t u d i n a l research studies have indicated that registered nurses often have negative attitudes toward the eld e r l y . This finding suggests that the nurses' attitudes measured here have changed compared to those reported in the 1970's. This change i s not only timely but c r u c i a l because of the increase in the number of elderly c l i e n t s in the health care system. 2. The type of health care setting in which nurses work i s s i g n i f i c a n t l y correlated with attitudes toward the el d e r l y . Registered nurses from the community have s i g n i f i c a n t l y more positive attitudes toward the elderly than nurses from the acute care and extended care settings. This finding i s consistent with the studies conducted by G i l l i s (1973) and Taylor and Harned (1978). The c h a r a c t e r i s t i c s of the elderly (degree of i l l n e s s , d i s a b i l i t y or dependency) and the nature of their needs may be contributing factors to the differences in attitudes among registered nurses from the three health care settings. 3. A s i g n i f i c a n t c orrelation i s also found between age and attitudes toward the el d e r l y . Older nurses demonstrate more " r e a l i s t i c toughness"/cynicism but less anxiety toward 72 aging. They are also most supportive of public r e s p o n s i b i l i t y for the aged than are younger nurses. The differences in attitudes between older and younger nurses could be due to factors such as c h a r a c t e r i s t i c s of the elderly and the nature of their needs, and nurses' personal feeling toward aging (these factors have been discussed in the previous chapter). The older nurses, being closer to old age, witness the real and potential problems that they may encounter as they age, and thus are less p o s i t i v e toward the elderly (Thorson, Whatley & Hancock, 1974). 4. There is no s i g n i f i c a n t c orrelation between attitudes toward the elderly and the l e v e l of basic nursing education. The lack of differences in attitudes among nurses with d i f f e r e n t educational levels could be accounted for by the fact that Gerontological Nursing is not commonly included in nursing c u r r i c u l a (Delora & Mosses, 1969; Gunter, 1971). Furthermore, i t is noted that many programs f a i l to insure s a t i s f y i n g and rewarding exposure of students to the el d e r l y . 5. The length of employment in the nurse's present job is correlated s i g n i f i c a n t l y with attitudes toward the eld e r l y . The longer the nurses work in their present job, the less positive their attitudes toward the e l d e r l y . Again, the decrease in positiveness of attitudes could be explained in terms of the type of elderly c l i e n t s the nurses encounter while caring for them (degree of i l l n e s s , d i s a b i l i t y or dependency) and the nature of their needs, and 73 the working environment and working condition surrounding the nurses. 6. Another variable which i s correlated s i g n i f i c a n t l y with attitudes toward the elderly is the amount of time the registered nurses spend caring for the el d e r l y . The more time the nurses spend with the el d e r l y , the stronger their b e l i e f that r e s p o n s i b i l i t y for the elderly rests with the family. One possible explanation for this finding is that many nurses s t i l l hold the myth of family abandonment of the elderly ( T r o l l , 1982). This leads to the feeling that families should be more responsible for their aged parents. A s i g n i f i c a n t c o r r e l a t i o n also exists between amount of time spent with elderly c l i e n t s and attitudes of nurses in the extended care and acute care settings. In the extended care setting, the more time nurses spend with the elderly, the more po s i t i v e their attitudes. The opposite case is found for the acute care nurses. Nurses from the extended care setting who are able to spend more time actually caring for the eld e r l y may develop better understandings of the needs of the elderly, and hence develop more positive attitudes. 7. Registered nurses who have taken a course/courses or advanced education in Gerontological Nursing show s i g n i f i c a n t l y more positive attitudes than nurses who have not taken courses or advanced education in Gerontological Nursing. This finding implies that education could decrease the tendency of negative attitudes toward the e l d e r l y . 74 Additionally, extensive inservice education in Gerontology is needed to provide nurses with a forum for better understanding of the e l d e r l y . The g e n e r a l i z a b i l i t y of this study is limited by factors such as the p o s s i b i l i t y that only registered nurses with positive attitudes toward the elderly volunteered to participate in this study. The number of agencies included in the study is limited (two acute care and two extended care f a c i l i t i e s , and two community health departments). Individual agencies may have a s p e c i f i c philosophy and policy that could influence the attitudes of the registered nurses. In addition, nurses in the community setting are from three d i s t i n c t programs (preventive health, home care and long term care). A larger sample i s needed to compare attitudes between nurses from these three programs. The instrument used in t h i s study is a paper-pencil instrument which may l i m i t the accuracy in attitude testing. Thus, the findings may not correlate with behaviours pertaining to attitudes toward the el d e r l y . A d ditionally, variables such as s o c i a l norms and expected consequences of the behavior could affect the correlation between nurses' attitudes and behaviors in the c l i n i c a l setting. Others factors including working environment, working condition, c h a r a c t e r i s t i c s of the elderly and the nature of their needs which were discussed previously should be investigated more thoroughly in future a t t i t u d i n a l research as they may have an influence on nurses' attitudes toward 75 the e l d e r l y . This research w i l l increase one's knowledge and understanding of how these factors a f f e c t attitudes and behaviors, and hence quality patient care. Implications It has been estimated that by the turn of the century about 3.4 m i l l i o n people in Canada w i l l be 65 years or older. The increase in the proportion of el d e r l y in this country w i l l have far reaching e f f e c t s upon the health care delivery system, and upon those who provide services, p a r t i c u l a r l y registered nurses. Because of the demographic trend, the findings of this study have s i g n i f i c a n t implications concerning nursing service, nursing research, nursing education and governmental p o l i c i e s regarding the care of the elderly. Positive attitudes toward the elderly are needed to achieve optimal care for the e l d e r l y . It is encouraging to find that registered nurses in t h i s study do hold positive attitudes. However, strategies must be formulated by a l l health care agencies to ensure t h i s positiveness is maintained or increased. This study indicates that nurses who have taken a course or courses in Gerontological Nursing demonstrate more positive attitudes. Hence, inservice education in Gerontological Nursing could be one of the strategies which health care agencies could use to maintain or increase positive attitudes in nurses. Extensive inservice education programs should be adapted to meet the 76 needs of the registered nurses in pa r t i c u l a r organizations. Inservice education programs should be designed to increase knowledge of the aging process, especially the biopsychosociai changes that confront the aging person, and new concepts for care should be planned and implemented. Nursing service administrators can play a v i t a l role in maintaining and increasing positive attitudes as their leadership can have a wide influence on nurses. Registered nurses in management positions should be knowledgeable in and supportive of Gerontological Nursing. Nursing administrators have great influence on the d i r e c t i o n in which nursing care for the elderly is focused. Too many hospitals have for too long centered on highly technical i l l n e s s problems which are medically oriented. The medical model emphasizes disease and cure, but this model does not f i t with the philosophy of the care of the e l d e r l y . The philosophy of care of the el d e r l y focuses on quality of l i v i n g rather than treatment of disease. If nurses continue to care for the elderly under the influence of the medical model, nurses could experience great f r u s t r a t i o n as they are unable to f u l f i l l their perceived role expectations (that is to cure rather than to care for the e l d e r l y ) . However, i f nurses adhere to the nursing model which focuses on caring and qu a l i t y of l i v i n g , nurses w i l l be able to decrease or eliminate the experience of r o l e - c o n f l i c t and the feeling of f r u s t r a t i o n . This w i l l in turn enhance positive attitudes toward the e l d e r l y , and hence improve the quality of care 77 provided to them. The pattern of work organization i s another factor that could affect the maintenance and improvement of positive attitudes in nurses. Based on the investigator's personal experience, i t seems that because of limited monetary and human resources, the work pattern of nurses in extended care and long term care settings is focused on routines rather than on the needs of elderly c l i e n t s . E s s e n t i a l l y nursing care i s depersonalized, and nurses simply want to get the job done instead of meeting the needs of their c l i e n t s . Nursing must move away from t h i s pervasive pattern of work organization as i t not only a f f e c t s the attitudes of nurses toward the elderly but also the q u a l i t y of care. New methods of de l i v e r i n g care to the elderly should be developed. Primary nursing, u t i l i z i n g c l i n i c a l s p e c i a l i s t s competent in Gerontological Nursing should be encouraged i f possible. The presence of expert c l i n i c a l s p e c i a l i s t s p r a c t i c i n g in the care systems could reverse negative attitudes and support positive attitudes towards the elderly among nurses as the c l i n i c a l s p e c i a l i s t s provide leadership and role models for positive s o c i a l i z a t i o n experiences. The data of t h i s study suggest that the type of health care setting correlates with the attitudes of registered nurses. Differences in philosophies and p o l i c i e s in the health care agencies, in the type of elderly the nurses encounter (degree of i l l n e s s , d i s a b i l i t y or dependency), and in the working conditions and working environment in the 78 di f f e r e n t health care agencies may i n d i r e c t l y a f f e c t the attitudes of the nurses. These variables must be investigated more thoroughly as they may have a s i g n i f i c a n t influence on the development and maintenance of positive a t t i t u d e s . When more information i s available with regard to these variables, the nursing profession can manipulate them, and ensure that nurses w i l l have positive attitudes toward the eld e r l y . This approach w i l l enable practising nurses to be more ef f e c t i v e in whatever setting they provide care to the elderly, and to be more confident about their roles and contribution to the care. This in turn could increase the nurses' s a t i s f a c t i o n in working with the elde r l y and hence further increase their positiveness in attitudes toward th i s age group. The lack of cor r e l a t i o n between attitudes toward the elde r l y and the le v e l of basic nursing education has implications for nursing education. This result i s of concern because one might expect higher education in the u n i v e r s i t i e s would result in more positive attitudes. Baccalaureate students in general have more opportunity to care for a variety of c l i e n t s in various settings for a longer period of time. Therefore, i t would be reasonable to expect the baccalaureate programs to have a posit i v e impact on the students' attitudes. Baccalaureate graduates are future leaders and teachers in the nursing profession, they have the potential to influence the attitudes of nurses and other people. It is very important that they have positive 79 attitudes toward the el d e r l y . The lack of differences in attitudes among nurses with d i f f e r e n t educational levels could be accounted for by the fact that Gerontological Nursing i s not commonly included in nursing c u r r i c u l a (Delora & Mosses, 1969; Gunter, 1971). Therefore, to ensure future nurses do have positive attitudes toward the elderly, schools of nursing should take on more r e s p o n s i b i l i t y in promoting posi t i v e attitudes among their students at an early stage in their nursing education. Gerontological Nursing should be included in the c u r r i c u l a of nursing schools, and nursing students should be provided with c l i n i c a l experiences with the e l d e r l y . The c l i n i c a l experiences should focus on the posi t i v e but r e a l i s t i c aspects of aging. This not only w i l l acquaint the students with the eld e r l y , but also promote the development of posit i v e attitudes and increase their interest in working with the elderly after completing their nursing education. Nursing schools should also s o c i a l i z e the students toward Gerontological Nursing. Too often nursing students as well as teachers and practising nurses believe that care of the elderly in settings other than acute care hospitals requires less nursing s k i l l and knowledge. Research by Delora and Moses (1969) and writings of Hnatiuk (1981) suggest that this b e l i e f s t i l l may be operative among many nursing students. In a Manitoba study (MacDonnel, Tramer & Siemens, 1980), elderly patients were i d e n t i f i e d as the least preferred patients by diploma students in three 80 hospital schools. These data are discouraging and could present major problems for the nursing profession in the years to come when a greater percentage of the population w i l l be age 65 and over. Thus, i t i s c r u c i a l that nursing schools create a positive image of Gerontological Nursing, so that students w i l l develop more interest in working with the e l d e r l y . Nursing schools should also make available more post-basic continuing education in Gerotological Nursing. In thi s way, practicing nurses who lack knowledge in caring for the elderly w i l l be able to take courses to increase their knowledge base and become better p r a c t i t i o n e r s in this area. This study shows that the more time registered nurses in extended care setting spend caring for the eld e r l y the more positive their attitudes toward th i s group of people. This c o r r e l a t i o n has great implication for government funding policy for long term care and extended care f a c i l i t i e s . According to the Canadian Nursing S t a t i s t i c s ( S t a t i s t i c s Canada, 1978), in 1977 only 5.6 % of employed registered nurses in Canada were working in nursing homes and f a c i l i t i e s for the aged. Nearly one-half of these nurses were employed on a part-time basis. One reason for the small number of registered nurses in extended care and long term care settings is that p r o v i n c i a l governments have t r a d i t i o n a l l y provided less funding for these health care f a c i l i t i e s . This results in a l i m i t on the number of registered nurses these f a c i l i t i e s can employ. In B r i t i s h 81 Columbia, i t is noted that the government provides staff funding for a much smaller r a t i o of professionals (registered nurses) to non-professionals (aux i l i a r y workers) in extended care f a c i l i t i e s than acute care hospitals. Because of t h i s governmental funding policy, nursing hours per patient day are less than those of acute care hospitals, and the nursing s t a f f size also contains fewer professional nurses. Nurses working in these settings are unable to become involved in direct care for the elderly as they are too busy carrying out treatment and giving out medication. When only custodial care i s provided to the elde r l y , nurses can become very frustrated with their role in th i s health care setting. These factors can eventually lead to negative attitudes toward caring for the elderly as well as toward the elderly themselves. Thus, extended care f a c i l i t i e s should press the government to provide more money for hi r i n g more registered nurses, and the government should reverse i t s funding policy to the extended care and long term care f a c i l i t i e s , so that el d e r l y patients in these f a c i l i t i e s are able to receive the same quality of professional nursing care as patients in other health care settings. Recommendations for Further Research Further research i n t o the attitudes of registered nurses toward the elderly is suggested and includes the following: 1. A study should be conducted to observe registered 82 nurses behaviour toward the elderly in the c l i n i c a l setting to determine whether their attitudes are congruent with their behaviors toward the e l d e r l y . 2. A study should be conducted to investigate further how operational factors in the organizational context af f e c t attitudes and behaviors of registered nurses toward the e l d e r l y . These factors could include comparisons of variables such as c l i e n t c h a r a c t e r i s t i c s , inservice education programs, agency p o l i c i e s and leadership influences. 3. A study r e p l i c a t i n g this study should be conducted among faculty in schools of nursing and individuals functioning in administrative positions in nursing departments. 83 References Ajzen, I., & Fishbein, M. (1980). Understanding attitudes  and predicting behavior. Englewood C l i f f s , NJ: Prentice-Hall. A l l p o r t , G. W. (1935). Attitudes. In C. Murchison (Ed.), Handbook of s o c i a l psychology (pp. 798-844). Worcester: Clark University Press. Anderson, N. N., & Stone, L. B. (1969). Nursing homes: Research and public p o l i c y . Gerontologi st, 9, 214-218. Auerbach, L., & Gerber, A. (1976). Implications of the  changing age struture of the Canadian population  (perceptions 2). Ottawa: Science Council of Canada. Axelrod, S., & Eisdorfer, C. (1961). Attitudes toward old people: An empirical analysis of the stimulus-group v a l i d i t y of the Tuckman-Lorge questionnaire. Journal of  Gerontology, J_, 75-80. Bader, J. E. (1980). Attitudes toward aging, old age and old people. Aged Care & Service Review, 2(2), 5-14. Bekker, L. D., & Taylor, C. (1966). Attitudes toward the aged in a multi-generational sample. Journal of  Gerontology, 21, 115. B e l l u c c i , D., & Hoyer, W. (1975). Feedback e f f e c t s on the performance and s e l f - r e i n f o r e i n g behavior of elderly and young adult women. Journal of Gerontology, 30, 456-460. Brower, H. T. (1981). Social organization and nurses' attitudes toward older persons. Journal of  Gerontological Nursing, 7(5), 293-298. Buckelew, B. (1982). Health care professionals vs the e l d e r l y . Journal of Gerontological Nursing, 8(10), 560-564. Campbell, D. T. (1963). Social attitudes and other acquired behavioral d i s p o s i t i o n s . In S. Koch (Ed.), Psychology: A study of a science (Vol. 6, pp. 94-172). New York: Mcgraw-Hill. Campbell, M. E. (1971). Study of the attitudes of nursing personnel toward g e r i a t r i c patients. Nursing Research, 20(2), 147-151. 84 Coe, R. (1967). Professional perspectives on the aged. Gerontologist, 7, 114-119. Cyrus-Lutz, C , & Gaitz, C. M. (1972). P s y c h i a t r i s t s ' attitudes toward the aged and aging. Gerontologist, 12, 163-167. Davis. R. (1968). Psychological aspects in g e r i a t r i c nursing. American Journal of Nursing, _4, 802-804. Delora, J. R., & Moses, D. V. (1969). Specialty preferences and c h a r a c t e r i s t i c s of nursing students in baccalaureate programs. Nursing Research, _1_8(2), 137-144. Devine, B. (1980). Old age stereotyping: A comparison of nursing staff attitudes toward the e l d e r l y . Journal of  Gerontological Nursing, 6(1), 25-32. Doob, L. W. (1947). The behavior of attitudes. Psychological Review, 54, 135-156. E h r l i c h , H. J. (1969). Attitudes, behavior, and the intervening variables. American Sociologist, 4_. 29-34. Epstein, C. (1977). Learning to care for the aged. Reston, V i r g i n i a : Reston. Erber, J., Feely, C., & Botwink, J. (1980). Reward conditions and socioeconomic status in the learning of older adults. Journal of Gerontology, 35, 565-570. Farrar, M., & Bloom, M. (1967, November). Social work education and the reduction of stereotypes about the aged Paper presented at the Twentieth Annual Meeting of the Gerontological Society, St. Petersburg, FL. Fishbein, M. (1965). A consideration of b e l i e f s , attitudes, and their r e l a t i o n s h i p s . in I. D. Steiner & M. Fishbein (Eds.), Current studies in s o c i a l psychology (pp. 107-120). New York: Holt, Reinhart & Winston. Fishbein. M. (1967). Attitudes and the prediction of behavior. In M. Fishbein (Ed.), Readings in attitude  theory and measurement (pp. 477-492), New York: John Wiley. F u t r e l l , M., & 'Jones, W. (1977). Attitudes of physicians, nurses, and s o c i a l workers toward the elderly and health maintainence services for the aged: Implication for health manpower po l i c y . Journal of Gerontological  Nursing, 3(3). 42-46. 85 G i l l i s , M. (1973). Attitudes of nursing personnel toward the aged. Nursing Research, 22, 517-519. Gunter, L. (1971). Students' attitudes toward g e r i a t r i c nursing. Nursing Outlook, 19, 466-469. Hatton, J. (1977). Nurses'attitude toward the aged: Relationship to nursing care. Journal of Gerontological  Nursing, 3(3), 21-26. Health & Welfare Canada. (1982). Canadian governmental  report on aging. Ottawa: Author. Hnatiuk, R. (1981). The challenge of gerontological nursing in a nursing home. Journal of Gerontological  Nursing, 7(1), 41-43. Hulicka, I. (1964). Fostering self-respect in aged patients. American Journal of Nursing, 3_, 84-89. Ivey, A. (1971). Microcounseling: Innovations in interviewing t r a i n i n g . S p r i n g f i e l d , IL: C. C. Thomas. Kapos, A., & Smith, D. (1972). Identifying standard attitudes toward senescence. Toronto: Ontario Welfare Counc i1 . Kartha, A. A., & Evers, F. T. (1981),- Post-course Attitude  change in registered nurses in the f i r s t year degree  course on care of the e l d e r l y . Manuscripts submitted for publicat ion. Kerlinger, F. N. (1964). Foundations of behavioral  research. New York: Holt, Rinehart & Winston. K i e s l e r , C. A., C o l l i n s , B. E., & M i l l e r , N. (1969) Attitude change. New York: Wiley. Kogan. N. (1961). Attitudes toward old people in an older sample. Journal of Abnormal Social Psychology, 62, 616-632. Krech, D. , £< Cr u t c h f i e l d , R. S. (1948). Theory and problems in s o c i a l psychology. New York: Mcgraw-Hill. Lauer, R. H., & Handel, W. H. (1977). Social psychology:  The theory and application of symbolic in t e r a c t i o n . Boston: Houghton M i f f l i n . Leech, S., & Witte, K. L. (1971). Paired associated learning in elderly adults as related to pacing and incentive conditions. Developmental Psychology, 5, 180. 86 Lore, A. (1979). Supporting the hospitalized elderly person. American Journal of Nursing, 76, 496-599. Lowenthal, M. (1958). Nobody wants the incontinent. RN, 2J_, 100-103. Lowy, L., & Archer, J. (1974). Relationship of attitudes toward aging by s o c i a l workers. Gerontologi st, 14, 83. Lustsky, N. S. (1980). Attitudes toward old age and elderly person. In C. Eisdorfer (Ed.), Annual Review of  Gerontology and G e r i a t r i c s (Vol. 1, pp. 287-337) . New York: Springer, 1980. MacDonnel, J., Tramer, R., & Siemens, L. (1980) Patient age preferences of nursing students. Essence, 3_(3), 118 119. Mehrabian, A. (1970). Tactics of s o c i a l influence. Englewood C l i f f s , NJ: Prentice-Hall. M e r r i l , S. E., & Gunter, L. (1969). A study of patient's attitudes toward old people. G e r i a t r i c s , 24, 1 07-112. Mikulic, M. (1971). Reinforcing independent and dependent nursing behavior by nursing personnel. Nursing Research, 20, 162-167. M i l l e r , P. (1976). Rx for the aging person: Attitudes. Journal of Gerontological Nursing, 2(2), 22-26. Nelson, B. K. (1973). Study indicates which patients nurses don't l i k e . Modern Hospital, 8, 70-72. Podnieks, E. (1983). Abuse of the el d e r l y . The Canadian  Nurse, 79(5), 34-35. Rosenberg, M. J. (i960). A structure theory of attitude dynamics. Public Opinion Quaterly, 24, 319-340. Rosenberg, M. J., & Hovland, C. I. (1960). Cognitive, aff e c t and behavioral components of attitudes. In M. J. Rosenberg et a l . (Eds.), Attitudes organization and  change (pp. 1-14). New Haven: Yale University Press. Rosendahl, P. P., & Ross, V. (1982). Does your behavior affe c t your patient response? Journal of Gerontological  Nursing, 8(10), 572-575. Schwenger, C , & Gross, M. (1980). I n s t i t u t i o n a l care and i n s t i t u t i o n a l i z a t i o n of the el d e r l y in Canada. In V. Marshall (Ed.), Aging in Canada: Social perspectives (pp. 248-256). Don M i l l s , Ontatio: Fitzhendry & Whiteside. 87 Secord, P. F., & Backman, C. (1964). Social psychology. New York: Mcgraw-Hill. Seelig, A. (1982). Promoting changes of attitudes. Nursing Mirror, 154, 28-30. Soloman, K. (1982). Social antecedents of learned helplessness in the health care setting. Gerontologist, 22(3), 282-287. Spence, D. L., Feigenbaum, F. F., & Roth, J. (1968). Medical student attitudes toward the g e r i a t r i c patient. Journal of American G e r i a t r i c Society, _1_6 (9) , 976-983. S t a t i s t i c s Canada. (1978). Nursing in Canada: Canadian  nursing s t a t i s t i c s , 1977. Ottawa: Author. S t a t i s t i c s Canada. (1980). Population projection for  Canada and the provinces, 1976-2001. Ottawa: Author. S t a t i s t i c s Canada. (1981). The health of Canadians. A  report of the Canadian Health Survey. Ottawa: Author. Stevens, R. (1976). Attitudes. Milton Keynes, Great B r i t a i n : The Open University Press. Taylor, K. H., & Harned, T. L. (1978). Attitudes toward old people: A study of nurses who care for the elderly. Journal of Gerontological Nursing, 4(5), 43-47. Thorson, J. A., Whatley, L., & Hancock, K. (1974). Attitudes toward the aged as a function of age and education. Gerontologist, 8, 316-318. Thurstone, L. L. (1931 ) - The measurement of s o c i a l attitudes. Journal of Abnormal Psychology, 26, 249-269. Triandis, H. C. (1971). Attitude and attitude change. New York: Wiley. T r o l l , L. E. (1982). Myth and themes about elders and their families. Journal of the Western Gerontological  Society, 7(2) , 5, 42. Tuckman, J., & Lorge, I. (1953). Attitudes toward old people. Journal of Social Psychology, 37, 249-260. Tuckman, J., & Lorge, I. (1958). Attitudes toward aging individual with the aged. Journal of Genetic Psychology, 92, 199-204. Wicker, A. W. (1969). Attitudes versus actions. The relationship of verbal and overt behavioral responses to attitude objects. Journal of Social Issue, 25, 41-78. 88 Wilensky, H., & Barmark, J. E. (1966). Interests of doctoral students in c l i n i c a l psychology in work with older adults. Journal of Gerontology, 21, 410-414. White, C. M. (1977). The nurse-patient encounter. Attitudes and behaviors in action. Journal of  Gerontological Nursing, 3(3), 16-21. Wolk, R. L., & Wolk, R. B. (1971). Professional workers' attitudes toward the aged. G e r i a t r i c s , 19, 624-639. Appendix A: Explanatory Letter 90 Explanatory Letter Dear Colleague, My name is Man Yeow Loh. I am a graduate student in Nursing at the University of B r i t i s h Columbia, and I am carrying out a research project for a Master's thesis. I am requesting participants to complete a questionnaire in order to a s s i s t me in learning more about nurses' attitudes toward the e l d e r l y . This study is designed to assess nurses' attitudes toward the elderly in several health care settings. It is anticipated that the findings of this study w i l l increase nurses' awareness of their attitudes toward the elderly. With an increased awareness, the nursing profession can improve i t s quality of care for this group of the populat i on. The completion of the questionnaire w i l l be taken as your consent to participate in the study. P a r t i c i p a t i o n in the study or your refusal to do so w i l l not jeapordize your present employment. Approximately 20 minutes w i l l be required to complete the questionnaire. A l l information is confidentiai and you are not required to ide n t i f y yourself by signing your name on this l e t t e r or anywhere on the questionnaire. If you have any questions concerning the study, please contact me at for further information. Thankyou for your cooperation. Yours t r u l y , Man Yeow Loh Appendix B: "Opinion About People" Scale 92 OPINION ABOUT PEOPLE Schedule .. Answer Sheet How To Answer The Schedule, OPINION ABOUT PEOPLE The statements you are going to read are opinions. Anyone could agree with some of them, and object to some of the others. The question i s which are the opinions with which you agree or disagree, as the case may be. Please indicates your own judgement about each idea expressed by c i r c l i n g some number between 1 and 9 on the Answer Sheet. The low numbers 1,2, 3 and 4 mean some degree of agreement, and the high numbers 6, 7, 8 and 9 mean some degree of disagreement. Five then means that you have no opinion one way or another. In other words you "measure" your opinion l i k e the temperature on a gauge that looks l i k e t h i s : AGREE f> DISAGREE > strongly a l i t t l e a l i t t l e strongly 1 2 3 4 5 6 7 8 9 A b i t confusing? Perhaps a few examples w i l l help: "L i f e is a bowl of cherries" You think that would be nice, but i t just is not quite true. So you may want to c i r c l e "6". "Men are t a l l e r than women" If you think that this i s quite true you would indicate i t by c i r c l i n g perhaps "2". "The man of 2500 w i l l be much happier than man at  the present time" If you f e e l you have no way of answering that one, you w i l l have to c i r c l e "5". We think however that you w i l l not have to use the fence-s i t t i n g "5" too often. Remember please: one, and only one number between 1 and 9 should you be c i r c l e d on the Answer Sheet for each sentence in the Schedule. Do not stop to think too long about the statement. A l l that is wanted i s your f i r s t reaction. 93 OPINION ABOUT PEOPLE SCHEDULE 1. Some people stay young at heart no matter how long they l i v e . 2. Things are getting better for most people these day. 3. You have to be old yourself to enjoy the stories old people l i k e to t e l l . 4. Residences for the r e t i r e d persons should always work out their programs and routines with the old people concerned. 5. The best neighbourhoods are those where young families intermingle with r e t i r e d people. 6. You can't expect other people to take care of you when you no longer can take care of yourself. 7. No one who i s r e t i r e d and over 70 should be allowed to drive a car. 8. The older people get, the more they think only of themselves.. 9. You're further ahead i f you always assume that everybody is out for Number one. 10. Most times I feel relaxed in the company of elderly people. 11. Old age i s 0. K. for those who are f i n a n c i a l l y independent. 12. There i s no point in talking about personal matters with people who are much older or much younger than yourself. 13. You can't cope with things the way you used to i f you l i v e to be a ripe old age. 14. Retired people are happiest in the company of people who are their own age. 15. Anyone could keep young i f he only t r i e d . 16. People in high o f f i c e aren't r e a l l y interested in the troubles of the average person. 94 17. You're l i k e l y to get bogged down i f you l e t elderly people help you with your projects. 18. No matter what the community can do i t i s up to the children to see that their aging parents have every comfort. 19. I cannot help feeling depressed at the thought of getting old. 20. You can't expect old people to exert themselves. 21. On the whole, people's chances in l i f e are getting worse and not better. 22. When you r e t i r e you re a l i z e that the best years of l i f e are yet to come. 23. You'll never get old i f you don't let yourself go. 24. It is rather sad to be s t i l l a l i v e after your friends are gone. 25. Old age pensioners have a right to be taken care of in a d i g n i f i e d way even i f younger people must contribute their taxes. 26. By and large, young people don't care about anyone but themselves. 27. The future i s so uncertain that there i s l i t t l e point in thinking or planning ahead. 28. People who spend a l l they make cannot expect much when they are no longer earning a l i v i n g . 29. A l l community organizations' should have some older persons on their boards. 30. It must be quite a shock to look in the mirror and find that you are showing signs of aging. 31. One shouldn't try to involve elderly people in things; a l l they r e a l l y want i s some peace and comfort. 32. Relatives who were close to the parents in former years r i g h t l y expect the children to care about their well being i f they l i v e a very long l i f e . OPINION ABOUT PEOPLE ANSWER SHEET < AGREE i ^ ? ^  DISAGREE > strongly 1 2 a 3 l i t t l e 4 5 a l i t t l e 6 7 strongly 8 9 1. 1 2 3 4 5 6 7 8 9 2. 1 2 3 4 5 6 7 8 9 3. 1 2 3 4 5 6 7 8 9 4. 1 2 3 4 5 6 7 8 9 5. 1 2 3 4 5 6 7 8 9 6. 1 2 3 4 5 6 7 8 9 7. 1 2 3 4 5 6 7 8 9 8. 1 2 3 4 5 6 7 8 9 9. 1 2 3 4 5 6 7 8 9 10. 1 2 3 4 5 6 7 8 9 1 1 . 1 2 3 4 5 6 7 8 9 12. 1 2 3 4 5 6 7 8 9 13. 1 2 3 4 5 6 7 8 9 14. 1 2 3 4 5 6 7 8 9 15. 1 2 3 4 5 6 7 8 9 16. 1 2 3 4 5 6 7 8 9 17. 1 2 3 4 5 6 7 -8 9 18. 1 2 3 4 5 6 7 8 9 19. 1 2 3 4 5 6 7 8 9 20. 1 2 3 4 5 6 7 8 9 21 . 1 2 3 4 5 6 7 8 9 22. 1 2 3 4 5 6 7 8 9 96 2 2 . 2 3 . 2 4 . 2 5 . 2 6 . 2 7 . 2 8 . 2 9 . 3 0 . 31 . 3 2 . 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 Appendix C: Demographic Questionnaire 98 ABOUT YOURSELF I would l i k e a few facts about yourself. This information is for s t a t i s t i c a l analysis only. Please check whichever description applies to you and f i l l in requested information. 33. Age (years) 34. Nursing Education (Please check highest l e v e l completed) 1. Two year diploma program 2. Three years diploma program 3. Four year university program 4. Others (Be s p e c i f i c please) 3 5. Agency of Employment 1. Acute care hospital 2. Extended care/Long term care hospital 3. Community/Health department (Please also check area of expertise in community/ health department i f i t applies to your agency) Home care Long term care Preventive care 36. Length of Employment (Years working in present employment) (years) 99 37. Average amount of time spent with elderly c l i e n t s  each day (hours/day) 38. Have you taken a course or advanced education in  Gerontological Nursing? Yes No 

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