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Development of a Teaching Module to Impact Student
Nurses' Attitudes and Knowledge Toward Elders

BY
Amy M. M. Sved

A Scholarly Project
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

Master of Science in Nursing

College of Nursing

1998

ABSTRACT

Development of a Teaching Module to Impact Student
Nurses' Attitude and Knowledge Toward Elders

BY
Amy M. M. Sved

There is an increasing need for education and training
for nurses in the care for elderly persons. There are many
biological, social, and emotional facets to consider when
caring for this subgroup of the population. Current
curricula in nursing education can be strengthened in the
areas of age relations and how students' and nurses'
attitudes and knowledge affect the quality of care given to
elderly persons. Human caring is one approach that nurses
should use as their benchmark when caring for their
patients. This project presents a teaching outline with the
purpose of decreasing ageist attitudes in nursing students
along with the rationale for its development.

Rapid technological advances, the increasing number of
older people in the American population, and changes in
health care financing have resulted in a greater complexity
in the nature and scope of health care and the needs of
health care consumers. Leaders in nursing education need to
prepare student nurses to function effectively in the
delivery of health care to a society with changing needs.
This teaching outline will increase student nurses'
knowledge and assess their attitudes toward the elderly as

well as increase student's awareness of ageism and human

caring. The goal of this project is to prepare nurses to
care for and meet the diverse needs of an aging population.
Understanding the nature of attitudes toward aging and older
adults is important because the attitudes of others can have
profound influences on older adults both as individuals and

as a group (Slotterback & Saarnio, 1996).

ACKNOWLEDGMENTS

First and foremost, I'd like to thank my husband,
Michael. His love, support, and encouragement was the
stability and motivation I counted on and needed throughout
my educational endeavor. Thank you for also fulfilling the
role of house husband, and Mr. Mom to our boys, Evan and
Nolan. I appreciate all your patience.

Thank you to my extended family, especially my mom and
dad, for all the emotional, physical, and at times financial
support that you've given me.

Thank you to my chairperson, Louise Selanders, whose
reassurance and diplomatic approach in overseeing this
project was greatly appreciated. Thanks to my other

committee members, Linda Keilman and Sharon King for their

contributions as well.

iv

LIST OF FIGURES .

CHAPTER 1 . . . .

Background of the Problem
Statement of the Problem

TABLE OF CONTENTS

Project Purpose . . . .

Assumptions

CHAPTER 2 . . . .

Conceptual Definitions .

Conclusion .

Conceptual Framework . .
Conceptual Model . . . .

CHAPTER 3 . . . .

Review of the Literature

Stereotypes, Attitudes, and Aging

Effects of Clinical Experiences on

Attitudes, Knowledge, and Formal

Conclusion .

CHAPTER 4 . . . .

Project Development . .

Application of the Module
Evaluation of the Module

Seminar Objectives . . .
Seminar Outline . . . .

Seminar Overview and Requirements

Group Project

0 O 0

Student Seminar Evaluation . . .

CHAPTER 5 . . . .
Implications
Primary Care
Implications
Implications
Summary . .

for Advanced Practice

for Education .

for Research

Attit

udes

Education .

O O O O O O

Page

vii

O O C O O
miflJthd

10
15

O O O O O
\D

20
20
20
27
32
34

36
36
36
38
38
39
40
41
42

44
44
44
45
46
47

TABLE OF CONTENTS (cont.)

LIST OF REFERENCES . . . . . . . . . .

Appendix A:
Appendix B:

Appendix C:

Stereotypes Toward Older People Scale

(Chumblers, 1990) . . . .

Permission to use Palmore's Facts on Aging

QUiZ o o o o o o o o o o o
Palmore's Facts on Aging Quiz

vi

49

55

56
57

Figure 1:

Figure 2:

Figure 3:

LIST OF FIGURES

Dynamics of the Human Caring Process (Watson,
1985) O O O O O O O O O O O O O O O O O O O O 13

Adaptation of the Dynamics of the Human
Caring Process-Nurse/Patient Relationship
(Sved, 1998) . . . . . . . . . . . . . . . . . 17

Adaptation of the Dynamics of the Human
Caring Process-Teacher/Student Relationship
(Sved, 1998) . . . . . . . . . . . . . . . . . 18

vii

Chapter 1

EachQZand_Q£_Lhe_Ethlem

The population of the western world is continuing to
age. By the year 2025, there will be approximately 30
million people over the age of 65, or 20% of the population
of the U.S.A. (Lookinland & Anson, 1995). This rate of
growth is faster than the world population as a whole.
Population projections estimate the population aged 65 and
over is expected to grow by 75% to over 69 million by the
year 2030 (U.S. Bureau of Census, 1996).

This projection is significant because chronic disease,
long term illness, and disability comprise the bulk of the
health care concerns of older adults. The growth in the
number of oldest old (85 years and older) is of greater
concern and is expected to grow by 56% (Lookinland & Anson,
1995). With this dramatic increase in the elderly
population, the number of clients with chronic and long-term
illnesses will also climb (Rowland & Shoemake, 1995). More
than 80% of older persons have at least one chronic
condition such as arthritis, hypertension, or heart disease
(U.S. Senate Special Committee on Aging, 1991). Ten percent
of elderly persons reported themselves to be in poor health

(Lookinland & Anson, 1995). The number of elderly in poor

1

2
health is projected to increase sharply from 1990 to 2030,
paralleling the population increase (Bureau of Census,
1996). Yurchuk and Brower (1991) assert, “To ignore the
demographic imperative of an aging society is professionally
irresponsible" (p. 199).

Because of the immense impact of the elderly on the
nation's health care system now and in the future, it is
imperative that health care providers, and those going into
the health care field acknowledge the need for, and claim
responsibility for, an accurate understanding of the aging
process. This description needs to reflect the elderly as
they see themselves. This also includes evaluating
knowledge about the elderly and understanding the concept of
"ageism" (Lookinland & Anson, 1995).

The literature indicates that older adults are not
favorite clientele among many health care providers.

Student nurses frequently have negative attitudes about
working with the elderly, especially in long term care
settings (Morse, 1996; Philipose, Tate, & Jacob, 1991).
Nursing student's reluctance to work with the elderly is
evidenced by a study reported by Williams, Lusk, and Kline
(1986) documenting that less than 5% of this group desire to
work with the aged. The number of older persons whom are
ill and frail that require professional care has risen and
will continue to rise; yet the numbers of nurses entering

the area of geriatrics has generally been low (Treharne,

1990).

3

American societal views and understanding of the
elderly population has been influenced negatively by
stereotyping them as victims of physical, mental, and social
decline (Donahue & Alligood, 1995). Donahue and Alligood
(1995) state, "These ageist attitudes may be so ingrained in
our personal and societal views that few nurses want to care
for the elderly" (p. 12).

Nurses are not immune to these ageist attitudes
(Heliker, Brophy, Naughton, Druyan, Hunglemann, Jacobs,
LaPalio, Sabbia-Madden, & Schulte, 1993; Marte 1991; Perkins
1991; Spier, 1992). Many students do not want to work in
nursing homes because of the lower status assumed by their
peer professionals (Perkins, 1991). However, nurses who
work with the elderly act as role models through their
expressed perceptions about aging and their attitudes toward
older individuals. This has been supported by (Gillis,
1992; Lookinland & Anson, 1995; Maddox & O'Hare, 1991). The
impact of their positive or negative modeling may heighten
young, impressionable students working in the health care
environment.

The future demand for health care workers to meet the
needs of an aging population in the United States can be
expected to increase (Lookinland & Anson, 1995). At the
same time, our culture has tended to devalue the aging
individual with negative stereotypes, a state referred to as
ageism (Donahue & Alligood, 1995). Older persons may be

devalued because of these stereotypes, and health care

4

providers, as well as student's attitudes may act as a
barrier affecting the quality of care an older client
receives (Donahue & Alligood, 1995).
Statemen§_nf_the_zrnhlem

Newbern, Barba, Courts, and Malone (1994) states, "If
nursing is to produce the competent caregivers that older
adults deserve, clinical courses in gerontology must be
required for undergraduates" (p. 173). Given the
competitiveness of the current health care market and growth
of managed care, formal care providers must begin to view
their elderly clients as 'customers' who need to be
satisfied and involved in their care rather than dependent
recipients of care. Educational programs in clinical
facilities are needed which emphasize service oriented
performance and improved patient outcomes (Lookinland &
Anson, 1995).

Some nursing programs at the undergraduate level have
required clinical and lecture courses as part of the
curriculum, that focus on gerontological issues. This
attempts to ensure entry-level competence in caring for
older people. Newbern et a1. (1994) believe that a required
clinical course should be instituted in all baccalaureate
nursing programs and gerontological content should be
incorporated in associate degree nursing curricula. Items
that focus on gerontological nursing content should be
included in NCLEX examinations and formal mechanisms should

be developed to encourage faculty to provide mentorship,

5

consultation-and education to faculty assigned to teach
gerontological nursing courses. Implementation of these
recommendations would go far in providing a supply of
competent nurse caregivers for the elderly. It is
appropriate, then, to first tap into student's and nurse's
attitudes and level of knowledge toward elderly persons.
W

The purpose of this scholarly project is two-fold; to
increase awareness of ageism and human caring through a
teaching module and to increase knowledge and assess
sophomore-junior level student nurses' attitudes toward
elderly persons by having them fill out two questionnaires.
As the population continues to age, a more unified,
comprehensive, and collaborative transpersonal approach to
caring for individuals and families, especially those
persons whom are elderly, is required. This notion is based
on the following assumptions:
W5

First, by assessing knowledge and attitudes about older
persons, one can find out where nurses are in their way of
thinking about age relations, physical, and psychological
aspects of aging. This also provides a setting for self-
reflection of their own attitudes. Furthermore, by
realizing the potential effects they can make in the field
of gerontology, students may increase their openness to the
possibility of working with elders more. The anticipated

outcome would be that nurses will interact with elderly

6
persons in a non-ageist manner and utilize the concepts of
Watson's Human Care Theory.

Secondly, there are still some current educational
models that do not offer courses that specifically
concentrate on gerontological issues such as the biological,
social, and psychological aspects of aging. These courses
do not consistently investigate the knowledge and attitudes
of students toward elderly persons and promote the field of
gerontology and age relations. By developing awareness of
ageism, and supporting the positive diversity of our elders,
it will be helpful in assuring that attitudes and
stereotypes do not hinder the quality of care given to
patients.

Lookinland and Anson (1995) state that despite the
controversy surrounding the appropriateness of measuring
attitudes toward elderly people as one homogenous group,
their findings demonstrated the need for focused continued
education to combat the stereotypical perceptions about
unfavorable attitudes toward older individuals. Lookinland
and Anson (1995) also suggest that student nurses learn the
difference between the normal process of aging and

pathological conditions in elderly people.

Chapter 2

: l J E E' 'l'

The following conceptual definitions are considered
vital to understanding human caring and ageism.

Ag:nal_£azing_gggasign. Also called an event, whereby
two persons (nurse and patient) come together with their own
unique life histories and phenomenal field in a human care
transaction. It is a focal point in time and space which
has the potential to influence both the nurse and patient in
the future (Watson, 1985). It presents the two persons with
the opportunity to decide how to be in the relationship and
what to do with the present moment. If the caring occasion
is indeed transpersonal and involves the spirits of the
nurse and patient, it will present each with new
opportunities.

Ageism. A set of social practices, and its embodiment
in the aged body are central concepts for understanding the
way we treat people of different ages (Laws, 1995). Ageism
exists throughout society, but health care providers many be
especially vulnerable to ageist attitudes because of their
increased exposure to ill and feeble elderly individuals
(Adelman, 1991; Bond, 1992; Getzen, 1992; Scott, 1991).

' Watson (1988) states, "Ageism reflects the need to return to

7

8
philosophical roots of modern nursing to guide practice with
an emphasis on an intention to care and the recognition of
healing, caring, and love with medical and nursing
interventions." This is especially true as the concept of
ageism universally affects a particular subgroup of the
population, the elderly.

Aging. Global loss of abilities, a gradual loss of
energy and a phenomenon of disease (Kirk, 1992). Prior
medical labeling combined with categorization led to the
institutionalization of the concept "old" into society.
This provided the structure necessary to form stereotypes
about elderly people, encouraging prejudicial behaviors
(Bond, 1992).

gazing. The moral ideal of nursing whereby the end is
protection, enhancement, and preservation of human dignity
(Watson, 1988).

Human_§aring. Involves values, a will and a commitment
to care, knowledge, caring actions, and consequences.
Therefore, it is not just an emotion, concern, attitude, or
benevolent desire (Watson, 1988). It begins when the nurse
makes contact with the patient and enters the phenomenal
field of the patient. In order to facilitate this process,
a personal, social, moral, and spiritual commitment to care
must be made by the nurse (Watson, 1985).

Phenomena1_Eie1d. It is a person's frame of reference
or subjective reality (Watson, 1985). It is composed

entirely of human responses. Another person may never know

9

another's phenomenal field, but it is possible through
empathy to begin to know another person's reality.

T:anspgzsgna1_§aring. Is a means of progress where an
individual moves toward a higher sense of self and harmony
with his or her mind, body, and soul.

W A Special kind of
human care relationship-union with another person; high
regard for the whole person and their being in the world
(Watson, 1985). This type of care preserves human dignity
and humanity. Transpersonal caring allows the nurse's
ability to detect feelings and the inner condition of
another in accordance with the nurse's own sensitivity, life
experiences, attitudes and emotions, to the feelings of self
and others.
Conclusion

With implementation of this teaching module, it is
hoped that student's will realize the important role and
responsibility they have in providing quality health care to
our elders. The country is now on the threshold of sweeping
changes in health care delivery. Such changes in how nurses
address the health care needs of older Americans mandates,
at the very least, changes in power, faculty competencies
and attitudes, and the allocation of resources (Newbern et
al., 1994). According to Newbern et a1. (1994), it is these
changes that will shift the attitudes, practice, and

educational aspirations of students.

10
W

The theoretical framework upon which this project is
based is Watson's Theory of Caring. Watson (1988) views
caring as "becoming," a way of "being" for the nurse and the
intention of an intimate, potentially transcending, human to
human contact that is the medium for the transpersonal
caring relationship. The transpersonal caring relationship
is a specific type of professional human to human contact
with the goal of restoring the patient's experience of inner
harmony. The nurse uses and discloses self and must be
aware of his/her own beliefs and values before engaging the
phenomenal field of the other. According to Watson (1985),
the nurse approaches this patient contact, or event, with
the intention and commitment to care. The art of
transpersonal caring allows humanity to move toward greater
harmony. The evolution of human feeling can proceed by
means of the moral ideal of transpersonal caring in nursing,
where ageism can be replaced by a valuing intention and
dignity of humankind (Watson, 1990).

Human caring in nursing is not just an emotion,
concern, or attitude. Rather, it is a moral ideal, whereby
the end is protection, enhancement, and preservation of
human "valuing". The value of human caring involves a
higher sense of spirit of self, a philosophy of moral
commitment toward protecting human dignity and preserving

humanity. The beginning, then, is an attitude that becomes

11
a will or intention which manifests itself into concrete
acts (Watson, 1990).

Binstock (1985) states, one of the central challenges
in actively coping with the implications of an aging
population is to move toward a better informed perspective
on aging, age relations, stereotypes, and professional
implications. Nurses need to recognize the diversity of
older persons as well as the life course context in which
all of them will experience. This fresh perspective may
enable students to reformat issues of ageism and give care
with human dignity and valuing at its' backbone. The
process of human care for individuals and families is a
major focus for nursing (Watson, 1990).

Nurses should learn how to implement nursing
interventions in any health care setting that views the
person holistically, not as a diagnosis, or a stereotype
based solely on age. Assessment of the interaction of the
person with the environment and how this relates to their
health beliefs is needed. Nurses have done this for years,
but now is the time to extend the focus to gerontological
issues that promote the wisdom, vitality, and life work of
the elderly. Quality nursing and health care today demand a
humanistic respect for the functional unity of the human
being.

Patients are becoming more knowledgeable about their
health. They want nurses to care for them with an intent to

preserve, protect, and enhance human dignity. Nurses can

12
use 'carative' factors in their attempt to protect, enhance,
and preserve humanity by helping the person find meaning in
illness, suffering, pain, and existence and to help another
gain self-knowledge, control, and self-healing wherein inner
harmony is restored regardless of the external circumstance
(Watson, 1985). Thus, each discovers more about self, one's
own humanity, and the humanity of others. Wykle and Morris
(1994) state a belief in the humanity, dignity, and the
continued presence of the essence of the patient is the
foundation of any nursing activities or interventions in the
Human Care Model (See Figure 1).

Utilizing this model has clear advantages because of
the assumption regarding the experience of time. Time is
not linear, but it's the past, present, and future merging.
This can be helpful to the nurse who has an encounter with a
patient who's physically in the present but has inner
experiences of emotions and feelings related to past events
that are immediate to the patient (Wykle & Morris, 1994).

Watson (1990) defines illness as disharmony in the
mind, body, or soul that may be related to the person's
inner world as he or she experiences it but is not
necessarily a disease process. The nurse assists the
patient to decrease his/her anxiety which allows the patient
to free his/herself of frustrations so that healing will
take place. The empathetic nurse in an actual caring

occasion would respond to any anxiety or feelings of

13

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14
frustration so that harmony is established. This healing
and harmony focuses on an actual caring occasion.

Nurses can provide holistic transpersonal care of the
mind-body-spirit to their Clients. As a nurse, one
recognizes the biophysical, psycho-physical, and
interpersonal needs of the self and client. It also extends
to the family and community. If there is harmony with
person's mind, body, and soul, then a sense of congruence
will exist. As the student matures s/he will become more
differentiated and his/her sense of inner self will become
more developed. Establishing a state of harmony is a human
need, consisting of the need to be loved, understood, and
valued, as well as the need for positive regard and the need
to be accepted (Watson, 1990).

The underlying assumptions of Watson's conceptual model
of Human Caring is a model for all nurses, including student
nurses, to reflect upon to keep as their benchmark to how
they care for their patients. Some of these assumptions
are: 1) Often the need for love and care is overlooked, and
we often do not behave well toward each other; 2) If we are
to sustain our humanity, we need to become more caring and
nourish our humanity and evolve as a civilization; 3) We
first have to impose our will to care and love upon
ourselves and examine our values, attitudes, and beliefs,
then we can respect and care for others with gentleness and
dignity; 4) Caring is the essence of nursing; 5) Human care,

at the individual and group levels, is receiving less and

15
less emphasis in health care; 6) Nursing's social, moral,
and scientific contributions to humankind lie in its
commitment to human care ideals in theory, practice, and
research (Watson, 1985).
W

All nurses have pre-existing attitudes and beliefs from
their causal past which influences how they care for
patients. The goal of nursing based on Watson's theory is
to help persons gain a higher degree of harmony (health)
within the mind, body, and spirit, which leads to an
experience of self healing in the person (Marckx, 1995).

One can visually depict Watson's conceptual model and
understand the three pictorial views of the nurse, patient,
and the transpersonal caring interaction when two people's
phenomenal field come together. The nurse and patient both
have a causal past whereby life experiences, attitudes, and
beliefs reside, and a phenomenal field that reflects the
aura at the present moment. It is when both nurse and
patient come together in an actual caring occasion that
these components mesh in a present moment, whereby the nurse
attempts to protect, enhance, and preserve humanity by
helping the patient find meaning in their illness,
suffering, or pain. The process towards harmony, when the
patient's mind, body, and soul are in congruence, is the
actual caring occasion (See Figure 1). The ideal end result
is the preservation of dignity and the patient gains self-

knowledge, control, and healing.‘ Thus, the sense of harmony

16
is restored, regardless of external circumstances (Watson,
1990). 4

When an actual caring occasion happens it involves
action and choice both by the nurse and the patient (See
Figure 2) or the teacher and the student (See Figure 3).
This transaction helps to restore inner harmony. The two
individuals in a caring transaction are both in a process of
being and becoming. According to Watson (1990), both
individuals bring with them to the relationship a unique
life history and phenomenal field, which in turn becomes
part of the life history of each person. The end is the
protection, enhancement, and preservation of the person's
humanity, which helps to restore inner harmony and potential
healing. This such ideal is based upon a belief that we
learn from one another how to be human by identifying
ourselves with others.

According to Watson (1990), a transpersonal caring
relationship depends upon the nurse's ability to realize and
accurately detect feelings of themselves and others (within
their phenomenal fields), as well as the nurse's own life
history (causal past) (See Figure 2). Such knowledge and
sensitivity can be gained through working with other
cultures or particular subgroups of the population (the
elderly). sincerity within the transpersonal care
relationship is also important. If the nurse is sincere
he/she will be able to express the feeling as he/she

experiences or realizes it. The degree of transpersonal

17

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19
caring is increased by the degree of genuineness and
sincerity.

Figure 2 incorporates the nurse and an elderly patient
in an actual caring occasion, whereby their phenomenal
fields and causal past come together. The nurse is holding
non-ageist attitudes, is valuing the patient, and preserving
their dignity through the nurses commitment to care for that
patient. Furthermore, it is in this moment in time, that
harmony is restored within the patient's mind, body, and
spirit through the concrete acts of the nurse.

The concepts can also be applied to the teacher/student
relationship (See Figure 3). The teacher and student may
also come from different backgrounds, ages, experiences, and
attitudes. When the teacher utilizes this module, the two
can come together at a present moment and embellish the
dynamics of the human caring process. By exploring the
myths and misconceptions of the aging process, and other
gerontological issues, the teacher is trying to make a
difference by impacting the student's views and attitudes
toward elder persons. In this focal point in time, there is

potential to influence both the teacher and student in the

future.

Chapter 3

E . E ll 1'! l
i! l E!!'! i i E .

A significant number of elderly persons will suffer
some degree of disability or ill health. It has been
suggested that this age group will represent the single most
common care group for nursing (Slevin, 1991). It is
imperative, then, that the nursing profession prepare its'
students for this eventuality. Slevin (1991) supports that
educational programs for nursing give relatively little
prominence to the care of the elderly. Slevin (1991)
further states, "In the face of dominant ageist attitudes
within communities and the influence these have on young
people, including new entrants to nursing, the profession is
faced with a major problem. Where society fails to accept
the elderly in a more positive light, the profession must
attempt to succeed" (p. 1198).

Negative attitudes toward older adults are thought to
be prevalent within the American culture (Slotterback &
Saario, 1996). However, research on attitudes presents
conflicting results. According to Slotterback and Saario
(1996), there is still no clear picture of the attitudes

toward older adults. Attitudes toward elder persons are

20

21
generally thought to be negative (Hummert, 1990; Kite,
Deaux, & Miele, 1991). Attitudes lead a person to perceive
the world around him/herself in certain ways, and it is the
consequence of this, that groups of people may be judged
according to stereotypes (Perdue & Gurtman, 1990).

It is frequently suggested that younger adults are
negative in their attitudes toward elderly people (Slevin,
1991). There are also claims that such attitudes develop as
a result of the socially constructed phenomenon of ageism
(Slevin, 1991). Nurses are not immune to these ageist
attitudes (Heliker et al., 1993; Perkins, 1991; Spier,
1992).

The study by Slevin (1991) demonstrated that student
nurses did have negative attitudes, and there appeared to be
a definite gender socialization influence. The sample from
this study was a convenience sample of RN's and enrolled
nursing students from five medical geriatric units. ‘The
study set out to establish the accuracy of three
propositions: the existence of ageism in society leads to
young people developing negative attitudes toward the
elderly, gender socialization influences result in females
having more positive attitudes toward the elderly than males
because young women entering nursing are highly motivated
toward caring, and finally, professional socialization
influences, including professional education, leads to

nurses having more negative attitudes toward the elderly

than other young people.

22

Slevin (1991) utilized a purpose-designed instrument,
Wm which had been
designed to measure attitudes of medical students towards
elderly people. The questionnaire was particularly Valuable
as it included an orientation to the caring dimension. It
was easily adapted for use with nurses.

The findings supported that attitudes were found not to
be highly positive; it also suggested important gender
differences, whereby girls had significantly more positive
attitudes. It appeared to suggest that educational
experiences, exposure to professional values, and actual
work experience in elderly care situations may have
negatively influenced attitudes.

A study by Sarver and Knowles (1985) showed results
that quality of health care is linked to the preferences
which student nurses and professionals have for their
patients. Younger patients were "most preferred" by
baccalaureate nursing students. This suggests that age may
be more of a factor than gender in determining the
preferences of baccalaureate nursing students for their
patients.

A study conducted by Pursey and Luker (1995) examined
attitudes and stereotypes of nurses toward older people. A
convenience sample of 136 community nurses was obtained.
Data was collected by means of a questionnaire and an in-
depth qualitative interview. The questionnaire was designed

specifically for this study and contained forced choice and

23
open-ended questions about demographic details and
professional characteristics. Respondents were asked about
their current work involvement with people over age 65 and
asked to write about two incidents from hospital or
community settings where they had been involved with older
people; one where they felt they had been effective as a
nurse, and one where they felt they had been ineffective.
The establishment of, or failure to establish, a good
relationship with a patient was clearly reflected in
respondent's descriptions of effective and ineffective
practice. A few respondents found some older people
interesting and enlightening to talk to, and the
establishment of a good relationship facilitated the
delivery of what nurses saw as a good standard of care.
Many respondents expressed concern for frail patients and
revealed a degree of anxiety about working with them.

The findings of Pursey and Luker's study (1995) have
lead the authors to challenge the common assumption that an
identified lack of desire in nurses to work with older
people is due solely to negative attitudes which nurses hold
toward older people themselves. They concluded that the
high dependency levels of older people and the structure of
the nursing work with older people in hospitals means that
fewer nurses make this area a positive career choice. While
several subjects in this study said they enjoyed the work
they had done with individual older people, they did not

like working with the elderly. This reveals a tension

24
between a vision of older people in the collective sense as
opposed to the experience of contact with individuals.

A study by Donahue andAlligood (1995) described
attributes of how the elderly saw themselves. They selected
adjectives from a list of 300 that they would normally use
to describe themselves. It was revealed that six adjectives
were chosen by 35 of the 44 participates. These six
adjectives were cheerful, friendly, good-natured, honest,
loyal, and reliable. All of these adjectives selected were
all relational and extremely positive. According to the
authors, these six adjectives elicited two major themes-one
related to disposition and the second to moral integrity.
Interestingly, there were 46 adjectives that no one
selected, all of which were negative in nature with the
exception being the attribute, 'handsome'.

The widely accepted stereotype of older adults is that
they experience a marked deterioration of intellectual
abilities (Ryan, 1992). In the domain of personality, a
variety of stereotypes about old age are found. Such
negative stereotypes and terms used when referring to the
elderly are poor, ill, lonely, irritable, and forgetful
(Cockerham, 1991; Harris, 1990). Previously, there has been
negative perception by media representation of the elderly
(Biggs, 1993; Harris, 1990). The study by Donahue and
Alligood (1995) is important as the attributes that describe
the elderly by society is apparently not how the elderly see

themselves. This finding is consistent with those of other

25

studies (Biggs, 1993; Cockerham, 1991; Robbin, 1991).
However, the elderly are not immune to society's view.
According to Donahue and Alligood (1995), labeling can
create a self-fulfilling prophecy effect on the elderly.
Some older persons may be more susceptible to labeling and
incorporate negative attitudes into their self-perception.

Hummert (1990) gave young adults an identical list of
adjectives and told them to group those adjectives to
describe younger and older people. The respondents
clustered the adjectives differently for younger and older
persons, indicating that they held varying
conceptualizations of these groups. Slotterback and Saario
(1996) similarly found that college freshmen responded
differently toward older and young adults in terms of
overall attitudes. Negativity was found in two of the
categories, physical and cognitive, but not in the third
category, personal/expressive. In fact, older adults were
generally viewed more positively than younger adults in this
third category, indicating young persons recognized the
multidimensionality of older adults. Positive attitudes
toward aging have been found in other research as well
(Harris, Page, & Begay, 1998). It is possible that people
have different attitudes toward young and older adults
because of perceived aging effects on attributes, perceived
generational differences, or a combination of both

(Slotterback & Saario, 1996).

26

Nurses, and student nurses alike, are bound by societal
norms, but the profession can break from these and teach,
promote, and interact with an aged person in a non-ageist
manner. Slevin (1991) feels that nurses need to promote
caring and positive attitudes rather than disinterest and
intolerance. There have been many research studies on how
health care professionals and students have had a lack of
knowledge about the elderly and furthermore, hold negative
attitudes toward the elderly (Treharne, 1990; Slevin, 1991;
Dellasega & Curriero, 1991; Reuben, Fulleron, Tschann, &
Croughan-Minihane, 1995). This is particularly significant
as the majority of our professionals will be taking care of
the elderly. -

A study by Dellasega and Curriero (1991) researched the
intentions of nursing students to work with the elderly.
The results of the study indicated that with the exception
of working with persons characterized as "aging" (45-64
years of age), most of the students entering the nursing
profession indicated that they would prefer not to work with
the elderly. There was no indication that teaching
effectiveness was an inhibiting factor since 11 students
completed a course on gerontology. The reason for
preferring not to work with the elderly has been suggested
to be because of the sequencing of clinical experiences and
possibly that students early on in their professional
education find it impossible to speculate about future

career pathways (Dellasega & Curriero, 1991). Some students

27

had not yet been exposed to other specialties such as mental
health, obstetrics, and pediatrics. However, 50% of the
students indicated on their final evaluations that their
attitudes toward the elderly were becoming more positive.
EEE | E :1i . 1 E . Ell'l i

There has also been conflicting results among research
on the effects of different clinical sites and whether
students have received any formal lecture or education prior
to their clinical experience (Hartley, Bentz, & Ellis, 1995;
Heliker et al., 1993; Rowland & Shoemake, 1995; Sheffler,
1995). There are also conflicting results on whether
nursing students had more negative attitudes with an
increase in their education. Spier and Yurick (1989) and
Taft (1986) found that early educational exposure to the
elderly fostered more positive attitudes. Murray and
Chambers (1991) found that student nurses attitudes to
patient groups are indeed influenced by their experiences
during their education. Prior exposure to and experience
with the elderly exerted a positive influence on nursing
students' attitudes in studies by DeWitt and Matre (1988).
Snape (1986) found that student nurses who are two to three
years into their training held more negative attitudes
toward the elderly then students who had recently ended
their'training.

The timing of the clinical experiences of nursing
students has also been studied. Cook and Pieper (1986)

studied the effects of an intensive two week experience in a

28
nursing home. They found that twice as many negative
attitude changes emerged as did positive ones suggesting
that a two week period was not long enough to result in a
positive attitude change. Dellasega and Curriero (1991)
surveyed students three times within a course of a semester
and found the intent to work with the elderly remained low,
but 50% of the students indicated a more positive attitude
as a result of the course.

Snape (1986) conducted a study to assess the attitudes
of nursing students and nurses toward the elderly in an
acute care hospital. Findings indicated that subjects who
had not experienced the acute care clinical rotations were
more positive in their attitude towards the elderly than
those subjects who had experienced the clinical rotation.
The results also indicated that learner's attitudes to
geriatric nursing did not improve following eight weeks on
geriatric wards and up to eleven hours of lecture. The
staff nurses were also found to have more positive attitudes
than the two groups of nursing students.

Rowland and Shoemake (1995) studied how experiences in
a nursing home affect nursing student's perceptions of the
elderly. All but one of the 169 students reported having
some prior experience with elderly individuals. 0f the
students, 88.2% reported family-related contacts with
elderly persons. More than 80% rated their prior
experiences with the elderly as good, 14% rated it as fair,

and 5% rated their experiences as poor. In a physical

29
characteristics group, more students perceived that the
elderly are 'dirty' on the post test than on the pre test.
Other physical characteristics reported by the students were
"healthy, sickly, poor vision, and hard of hearing." Social
behavior descriptors reported by students were "self-
centered, pleasant, grouchy, independent, dependent,
sociable, and withdrawn" (Rowland & Shoemake, 1995). After
the clinical experience, one in four students reported more
positive feelings. One in eight expressed less positive
feelings about their practicum. A little less than two-
thirds of the students reported no change in their
experience and feelings from the beginning of their clinical
experience to the end. Students were also asked to rank
their interest in working professionally with the elderly on
a pre test and again on a post test. Close to two-thirds
had the same opinion pre and post test. One in ten stated,
"I would not like it". One third responded that it would be
"okay," and one fifth indicated they would really like
working with the elderly. A positive finding in this survey
was after the practicum, 108 students as opposed to 87
before the practicum, said they enjoyed their experience.

A study conducted by Hartley, Bentz, and Ellis (1995)
also researched the effect nursing home placement had on
student attitudes toward the elderly. This study researched
a sample size of 136 students entering an associate degree
nursing program. The researcher's used Hogan's Attitude

Scale as a means of measuring attitudes utilizing a pre/post

30
test design. Findings indicated that there was improvement
in attitudes of students following their nursing home
experience.

Heliker et a1. (1993) explored nursing student's
attitudes toward the elderly after a non-threatening
experience with "well" elders on three different occasions.
The findings in this pilot study suggest that attitudes of
students toward the elderly can be influenced by experiences
with 'well' elderly during the early phases of their
professional education.

One educator, Debbie Metzler, RN, MSN, CCRN, an
assistant professor at Bellin College in Green Bay,
Wisconsin would like to see students introduced to elderly
in a wellness center or at home rather than a nursing home.
This approach may promote a more positive attitude because
the students can work with the healthy elderly in their own
environment. Metzler (1990) believes that students who have
experience working with healthy elderly before working with
them when they are ill seem to be more sensitive to their
total needs rather than merely focusing care on the illness.

Sheffler (1995) conducted a descriptive study which
examined nursing students' attitudes toward the elderly pre-
and post-clinical experiences in the nursing home and
hospital setting. The results indicate that students'
attitudes toward the elderly improved regardless of their
clinical setting, and that there was a positive relationship

between knowledge and attitudes.

31

Treharne (1990) conducted a study to assess the effects
of a clinical experience in an acute care setting on two
groups of first year nursing students. Results indicated
that students' attitudes toward the elderly became
significantly more negative during this experience.

Smith (1992) reported on the differences between
nurse's physical workload on general wards and acute
hospital wards as perceived by different levels of student
nurses. Older patients were rated by students at the end of
training, as generating a high physical workload, and having
poor learning potential for students. Smith (1992) suggests
that the heavy physical nature of work with older people
leaves nurses with little time for considering individuals.
Furthermore, qualitative interviews demonstrated that one of
the major indicators of effective interaction with older '
people was the establishment of good relationships, and this
facilitated the delivery of what nurses show as a good
standard of care. The subjects also stated that they could
only see a future of further deterioration for the patient.
Feelings of inadequacy by the nursing students were
expressed frequently during interactions with difficult
patients. Another issue raised during the interviews was
dignified care. One subject voiced, It upset me basically.
There was so much lack of dignity...I don't believe in doing
the job by halves and that's what working with the elderly
was...It was just like they were waiting to die (Smith,

1992). Another student responded, I found care of the

32
elderly stressful...there was one nurse who would strip
people off, get them lined up on commodes... and have them
wash naked. I just found is so undignified (Smith, 1992).
Several respondents in this study said that while they
enjoyed the work they had done with the individual elder,
they did not like working with the elderly (Smith, 1992).
Ell'l i K J i i E 1 El l'

Attitudes have been noted to correlate with knowledge
(Perkins, 1991). A study by Singleton, Harbison, Melanson,
and Jackson (1993) determined the knowledge level of five
health care professionals, including nurses. Results
indicated that there was a significant relationship between
years of total contact with the elderly and professional
group. There was also a significant relationship between
whether that professional had taken courses on gerontology
and their knowledge about the elderly. Results indicated
that 71% of RN's were lacking.in knowledge about the
elderly.

Newbern, Barba, Courts, and Malone (1994) believe the
key to providing competent nurse caregivers for the elderly
is requiring a clinical course in gerontology. Johnson and
Connely (1990) also note, all nursing programs have not
elected to include gerontological content at the
undergraduate level despite more than five decades of the
nursing profession's recognition of the need. Yurchuck and

Brower (1991) furthermore assert, "to ignore the demographic

33
imperative of an aging society is professionally
irresponsible" (p.199).

Aday and Campbell (1995) conducted a study on changes
in baccalaureate nursing student's attitudes and work
preferences after a gerontology curriculum. A pre/post test
design was used. To measure attitudes they modified the
Perceptions of Aging and Elderly Inventory developed by Rich
(1983). Results indicated that students held fewer negative
stereotypical views of elderly patients at the end of their
nursing program than at the beginning of the program. When
asked to rank preference of clientele, subjects responded
that young adults were most favorable and the oldest old
(persons over age 85) was least preferred with only two of
the whole sample responding they preferred the elder
patient. It was concluded that the value of an educational
program as,a means of significantly changing preconceived
notions about the elderly was demonstrated. The results
also indicted that students' attitudes were directly
correlated with their preference for working with this
population.

Reed (1992) suggest the field experience should include
exposure to the aged with a wide range of functional
abilities. They maintained that such experiences foster an
understanding of normal aging and dispel negative
stereotypes. MacNeil (1991) suggests that future research
is needed to better define the factors that reduce age

related bias of nurses of the future.

34

Slevin's study in 1991 further indicated the need to
extend training about gerontology throughout a nurses
professional life. A lack of education may be influential
in determining how well nurses are prepared for their work
with the elderly. Treharne (1990) also states the quality
of educational studies and courses is also important.
Treharne (1990) found that student nurses during their care
of the elderly actually developed more negative attitudes.
Slevin (1991) and Treharne (1990) suggests that professional
education, both at qualifying and continuing education
levels, requires a major review. More positive attitudes
and the reflection of these in high quality of care, will
only be achieved if there is adequate educational '
preparation for meeting the needs of this age group. An
assessment of knowledge and attitudes as part of students
preparation will enable nurses to discuss vital issues on
age relations and to promote the positive diversity that
elderly people possess.
Conclusion

In conclusion, the methodologies of previous studies
haven't significantly dealt with whether attitudes are a
function of the aging process or of perceptions of
generations.

Whatever the case, society knows that the number of
elderly in America is increasing and is affecting all
aspects of health care. There is a lack of clarity in the

literature. There hasn't been any consistent tools to

35
measure attitude and knowledge.- Frequently, the tools have
not been updated, contain inaccurate information and are
judgmental. There has been a lack of instruments with
established reliability and validity for use with college
age populations (Finnerty-Fried, 1982; Wingard, 1980).
Currently, there are ten "attitudes or stereotypes toward
the elderly" instruments ranging from 16 to 137 items, and
have reported reliabilities ranging from .36-.85.
Furthermore, the validity of these scales have been
questioned by researchers (Adelman & Albert, 1987; Finnerty-
Fried, 1982). Adelman and Albert (1987) claim that most
instruments measuring attitudes are outdated. Eight out of
ten published scales were developed in the 1950's and
1960's; the other two were developed in the 1980's. This
further punctuates the lack of clarity in how knowledge and
attitudes are measured.

Negative societal attitudes toward the elderly are
often incorporated into the beliefs of health care providers
and influence behavior and the care given. Donahue and
Alligood (1995) state, "The nursing profession is challenged
to investigate and disseminate research findings related to
the aging process and health care practices for the elderly"

(p. 12).

Chapter 4

W

The purpose of this project was to develop a teaching
module for entry level nursing students with the goal of
assisting them to develop realistic attitudes related to the
elderly. Patient care could be directly effected by opening
up discussion, providing formal instruction on the concept
of ageism, and administering two questionnaires on attitude
and knowledge about the elderly. This will lead into an
open forum discussion on pertinent gerontological issues and
the concepts of Watson's Theory of Human Caring by nursing
personnel or faculty. A pilot study of nursing students
could be used to test the effectiveness of administering the
questionnaire's and the discussion of the results of the
tool on nursing students.
E J‘ l' E I] H i J

The module will act as a tool to impact student nurse's
views and attitudes toward the elderly. The tool focuses on
the philosophy and concepts of Human Caring. Physical,
mental, and social stereotypes will be identified and
student's own experiences will be shared with the class.
Furthermore, the exploration of biological, social, and

psychological components of aging will be linked to

36

37
stereotypes, attitudes, and quality of care issues. Two
questionnaires will also act as a tool within this module to
assess knowledge and measure attitudes toward the elderly.

The Stereotypes Toward Older People Scale (Chumbler,
1993) and Palmore's Facts on Aging Quiz (Palmore, 1988) is
for use by personnel or faculty to administer to entry level
nursing students. The Stereotype Toward Older People Scale
consists of 14 items that student's rate on a Likert scale
from never to always that best describes to what extent they
believe each statement is true of older persons. For
example, if they feel the adjective (i.e. are grouchy)
always describes the elderly, they would circle a 7 (always)
or a 1 (never). The development of this instrument was
undertaken to measure college students' stereotypes toward
older individuals which can be used for both research and
practical purposes, including collecting baseline data for
the design of program to educate students about older adults
and evaluating the effectiveness of such programs (Ventura-
Merkel & Doucette, 1993).

The Palmore's Facts on Aging Quiz (FAQ) is a multiple
choice version of statements about the elderly which
measures the student's knowledge about this subgroup of the
population. This FAQ was first published in 1977 and was
updated in 1988. It was designed to cover the basic
physical, mental, and social facts and the most common
misconceptions about aging. There are several uses for the

FAQ, but the simplest and main reason that it was used in

38-

this module was to act as a catalyst for group discussion
and clarification of misconceptions. It can be used by
faculty for theoretical interest or as a practical guide to
student's educational needs.
Evaluation_of_the_MQdule

The seminar focused on three areas- Watson's Theory of
Caring, concepts of ageism, attitudes, and knowledge, and
blending these concepts so that student's can apply them in
their professional role. Evaluation of the teaching module
is included and is a means to measure outcomes on how

successful the instructor was in meeting the objectives for

this seminar.

5 . : . I E . l

Seminar on Developing Awareness of Ageism and

Impacting Student Nurses' Knowledge and Attitudes
Toward the Elderly

Instructor: Amy Sved, R.N., BSN

Prerequisites: Sophomore-Junior level nursing student.

See Handouts on Watson's Theory of Caring

Lookinland, 8., & Anson, K. (1995). Perpetuation of
Ageist Attitudes Among Present and Future Health Care
Personnel: Implications for Elder Care. lgnrnal_gf_Adyanged
Nursin§1_21 47- 56-

Marckx, B. (1995). Watson' s Theory of Caring: A Model

for Implementation in Practice. 1_Nursing_sare_0ualitx1
2,(4), 43- -54.

Singleton, J., Harbison, J., Melanson, P., and Jackson,
G. (1993). A Study of the Factual Knowledge and Common
Misconceptions About Aging Held by Health Care
WWO) . 37-

39

Watson. J- (1990)- WWW
gaze: (Rev. ed.). New York: National League for Nursing.

ngrxieu: This seminar and interactive class will focus on
student's/nurse's attitudes and stereotypes associated with
aging and elderly persons. Students will also gain
understanding of Watson's Theory of Human Caring so that
they may utilize vital concepts with patients, specifically
with elderly persons. There will be an open discussion on
two questionnaires, Palmore's Facts On Aging Quiz (Palmore,
1988) and Stereotypes Toward Older Persons Scale (Chumbler,
1993), which will be used to measure knowledge and attitudes
toward the elderly. Group discussions will also encompass
student's perspective on aging, personal experiences and
attitudes toward elderly persons, and their role in

providing quality care to this subgroup of the population
using Watson's theory.

5 . :1. l'

At the completion of this seminar, students will have the
ability to:

1. Describe key concepts and components of Watson's Theory
of Human Caring as it relates to gerontological issues
and nursing practice.

2. Explicate the nature, scope, and functions of care and
caring and its relationship to providing quality care
to elderly persons.

3. Explore the concepts of an actual caring occasion,
transpersonal caring, and ageism.

4. Identify common stereotypes, myths, and misconceptions
associated with aging and elderly persons.

5. Discuss positive and negative personal and work related
experiences students have had with elderly persons.

6. Fill out two questionnaires that measure knowledge and
attitudes toward the elderly and obtain results from a
class perspective.

7. Identify interests and barriers of professional
development and employment in the field of gerontology.

8. Delineate future professional and personal applications
of human caring toward elderly persons.

4O

: A seminar, group project, and
discussion will be the methods of instruction. The seminar
is 3 % hours long and breaks will be provided. Required
readings, personal and professional experiences shared with
the class, and a group project will provide the focus for
class discussion. Results from two questionnaires that
measure knowledge and attitudes toward elderly persons will

be analyzed with a brief discussion afterwards about the
results.

W
Watson's Theory of Human Caring- 30 minutes

Objectives:

Describe the philosophy and vital components of
Watson's Theory of Human Caring and it's applicability
to aging, gerontology, and nursing practice.

- Explicate the nature, scope, and functions of care and
caring and it's relationship to providing quality care
to elderly persons.

0 Describe the concepts of transpersonal caring, an

actual caring occasion, phenomenal field, and Watson's
conceptual model.

Common stereotypes that affect the elderly and student's
experiences with elderly persons- 45 minutes

0 Identification of physical, mental, and social
stereotypes which label the elderly population.
0 Discussion of positive and negative personal and work

related experiences individual members of the class
have had with elderly persons.

The concept of Ageism and its effect on the quality of care
provided to the elderly- 45 minutes

Defining and understanding the concept of Ageism.
Explore the biological, social, and psychological
components of aging.

- Linking stereotypes, attitudes, and quality of care
issues.

Administration of two questionnaires, Palmore's Facts on

Aging Quiz and Stereotypes Toward Older People Scale-25
minutes

Analysis of results-Group summary regarding knowledge level

and whether negative attitudes exist among this group of
students-20 minutes

41

Group Project and Discussion-60 minutes

0 This assignment is to break into four groups of five.
Each group will answer one statement related to aging,
Watson's theory, nursing practice, stereotypes, or

attitudes toward the elderly and share their answers
with the whole class.

0 Identify interests and barriers of professional
development and future employment in the field of
gerontology. '

0 Delineate future professional and personal applications
of human caring toward elderly persons.

W

Group #1

1. Describe the underlying philosophy of Watson's Theory

of Human Caring and identify key components of the

theory and relate them to how you could better care for
elderly persons.

Group #2

1. Briefly discuss the concept of ageism and come up with
a group definition that reflects the member's

understanding of what ageism means. Draw a picture of
your view of ageism.

Group #3

1. Briefly discuss some biological, social, political,
economic, emotional, and/or educational
stereotypes/characteristics that have helped or
hindered society's view of elderly persons.

Group #4

1. Describe the member's of your group interest in working
with elderly persons and identify the barriers and
reasons to why student's may not want to work with this
subgroup of the population. From the seminar and
discussion today, does anyone have a change in attitude
or knowledge toward the elderly and why?

42

Wanna

This seminar fOcused on three areas. First, we
familiarized ourselves with Watson's Theory of Caring.
Second, we focused on concepts of ageism, attitudes, and
knowledge toward the elderly. Third, we attempted to blend
human caring concepts and apply her theoretical model in our
professional roles, especially when taking care of this
subgroup of the population.

Please fill out this evaluation that will provide

measurable outcome on the effectiveness of this module.

1. At the completion of this seminar, how did your
attitude change toward older people?
negatively changed 1-2-3-4-5-6-7 positively changed
2. How would you rate the length of this seminar?

too short 1--2--3--4--5--6--7 too long

3. How much new information did you learn?

no new information 1-2-3-4-5-6-7 learned a great deal
4. Are you satisfied with the overall quality of this

seminar?

not at all satisfied 1-243-4-5-6-7 very satisfied

5. How would you rate the quality of the teaching faculty
member(s)?

low quality 1--2--3—-4--5-—6--7 high quality

6. Would you recommend this seminar to other persons in
your profession?

would not recommend 1-2-3-4-5-6-7 strongly recommend

7. How useful was this seminar in applying the things you
learned to your personal and professional lives?
not at all useful 1--2--3--4--5--6--7 very useful

43

What did you like best about the seminar?

 

 

What did you like least about the seminar or what would you
like to see different?

 

 

Did you find doing the two questionnaires insightful and
were you surprised by the results?

 

 

Chapter 5

mm

Rapid technological advances in health care delivery,
changes in health care financing, and the increasing number
of elderly in the American population have resulted in
dramatic alterations in the nature and scope of health care,
the needs of health care consumers, and the practice of
nursing. Within any primary care setting, the APN can
utilize the concepts of Watson's transpersonal caring when
dealing with health care problems and achieving and
maintaining harmony among elderly person's mind, body, and
soul. The opportunity to take each encounter with a patient
and make a point to have actual caring occasions, enables
individuals and families to achieve and maintain a state of
well-being. As a practitioner, it becomes necessary to
examine one's own beliefs, values, and attitudes about
clients or particular subgroups of the population, so that
judgments and stereotypes do not inadvertently affect
quality of care.

As the new millennium approaches, it will be imperative
for health care professionals and practitioners to

holistically manage the elderly's health care problems, as

44

45

chronic illnesses will be prominent among this population,
through knowledge, valuing, commitment, and actions that
focus on quality of life and dignity. According to Walton
(1996), it is essential that nursing hold intrinsic the
belief in the value of the experience of the whole person.
Nurses examine and explore the importance of the multiple
aspects of personal values, life experience, and personal
history. Furthermore, APN's assessment, implementation,
and evaluation of the factors that influence and impact the
patient's physical condition and both short and long term
well-being. Walton (1996) agrees with Watson whereby the
nurse and patient cannot be separated from a mutual co-
constructed experience and if one is affected so too the
other. Frequently, nurses describe this experience of
knowing their patient as the essence of their caring nursing
practice and patient-centered decision making (Jenny &
Logan, 1992). APN's who wish to have an empathetic care
relationship with their patients must first acquire a
personal, social, moral, and spiritual engagement of self
and a commitment to oneself and to other's self and dignity.
The APN can use Watson's ideas to give direction to their
practice by incorporating human emotions, compassion,
wisdom, and positive intentions.
I 1' l' E E1 l'

Nursing educators are confronted with the difficult
task of preparing new nurses who are not only able to

provide health care in today's complex world, but are able

46

to adapt to constant changes and still provide quality
nursing care to a society with compelling needs.
Furthermore, faculty need to be educated in aging first
before they teach this diverse subject to students. It
would be prudent to hire educators with education in
gerontology to teach gerontology. It is frequently thought
that any member of a faculty staff can teach gerontological
issues. 3

This teaching module examines attitudes and knowledge
about the elderly and was designed for sophomore and junior
level students. Faculty_and other educational leaders,
however, might consider using the questionnaires before
student's clinical experiences and incorporate Watson's
theory into existing curricula to foster improved outcomes
of their student's professional development. APN's can
consolidate the theory of humanistic caring and
transpersonal caring as a new way of thinking about
themselves and their patients. To combine Watson's theory
into Western philosophy would mean moving away from the
scientific notion within our society and to blend the idea

of humanism (mind, body, spirit) as a core thread throughout

the educational process.
W

On a more global view, additional research on knowledge
and attitudes toward the elderly would be helpful to
extinguish the perpetuation of ageist attitudes among

present and future health care personnel. To test the whole

47
effectiveness of the module, one could develop a research
project using a pre and post test measuring attitude and
knowledge. One could formulate a hypothesis of how the
class changed in their attitudes and knowledge before and
after taking the seminar. Another research proposal would
be to test certain variables (i.e. age or sex). For
example, a researcher would question whether there is a
difference in attitudes of a 19 year old student compared to
a 29 year old student. This module also can provide the
nurse a foundation on which to research and generate new
nursing theories that are both testable and relevant to
caring.
Summer!

Care of older adults in this country has been
documented as being inadequate (Bahr, 1991). There are some
ethical and moral issues that need to be addressed within
educational curriculum regarding elder care. The nursing
profession needs to prepare nurses to become change agents
and catalysts in the health care of the older population.
Student nurses to APN's should utilize their assessment
skills and be aware of the developmental tasks, challenges,
and differences occurring within each decade of life so that
every aging person is not characterized and placed in a
category with the 85 year old aging person who may exhibit
frailness. It cannot be assumed that nursing students have
a foundation of knowledge about older adults. That

knowledge foundation must be built on research- based,

48
verifiable, and factual data. ’In this way, the many
stereotypes, biased opinions, and myths about older adults
will be replaced with excellent content that is scientific
and valid. Negative attitudes and stereotypes are not
easily replaced, so it becomes very_important that faculty

and nurses continually reinforce the positive elements of

caring for older adults.

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APPENDIX A

55
APPENDIX A
W

Read each statement below and circle the number which
best describes to what extent you believe each statement is
true of older persons. If you feel the adjective always
describes the elderly circle 7; if you feel the adjective
never describes the elderly circle 1; if you feel somewhere
in between circle any one of the numbers between 1 and 7.
If you feel neutral or undecided, the midpoint is 4.

1) Never 5) Most of the time
2) Rarely 6) Almost always
3) Occasionally 7) Always.

4) Some of the time

 

Old people... Never Always
1. are set in their ways ' 1 2 3 4 5 6 7
2. are meddlesome 1 2 3 4 5 6 7
3. are old-fashioned 1 2 3 4 5 6 7
4. think about the good old days 1 2 3 4 S 6 7
5. never fully recover from illness 1 2 3 4 5 6 7
6. are physically active 1 2 3 4 5 6 7
7. are grouchy 1 2 3 4 5 6 7
8. talk to themselves 1 2 3 4 5 6 7
9. get upset easily 1 2 3 4 5 6 7
10. are productive 1 2 3 4 5 6 7
11. are optimistic 1 2 3 4 5 6 7
12. walk slowly 1 2 3 4 5 6 7
13. have health problems 1 2 3 4 5 6 7
14. are intolerant l 2 3 4 5 6 7

Scoring: Four factors are measured within the scale. Items 7, 8, 9
measured intolerance, items 5, 12, 13 measure health, items 1, 2, 3, 4
measure personality, and items 6, 10, 11 measure activity. The range of
possible scores is from 1 to 7, a high score indicating that more
negative stereotypes toward old persons are present in the respondents.

APPENDIX B

56

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APPENDIX C

57

APPENDIX C

I. ' ' (2)

Multiple Choice Version

For each statement or question, circle the letter that
represents the correct answer.

1.

In old age, a person's height:
a. does not change

b. only appears to change

*c. tends to decline

d. depends on how active one is

As compared to younger persons, more older persons (65

or over) are limited in their activity by which type of
illnesses?

a. acute illnesses
b. colds and flu

c. infections

*d. chronic illnesses

Which type of illnesses do older persons have less
frequently than younger persons?

a. chronic illnesses

b. colds and flu

c. infections

*d. acute illnesses

Compared with younger persons, older persons have:

a. more injuries in the home

b. have about the same number of injuries in the home
*c. have less injuries in the home

d. are twice as likely to be injured in the home

Older workers:
a. have higher rates of absenteeism than younger
workers
b. cannot be depended upon
c. have about the same rates of absenteeism as younger
workers

*d. have lower rates of absenteeism than younger
workers

The life expectancy of African Americans at age 65:
a. is higher than that of whites

b. is lower than that of whites

*c. is the same as that of whites

d. has never been determined

10.

11.

12.

13.

58

Men's life expectancy at age 65 as compared to women's
life expectancy:
*a. is lower
b. tends to be returning to what it was in the 1940's
c. is about the same
d. is higher

What percent of medical expenses for the aged does
Medicare pay?

*a. nearly 50%

b. nearly 70%

c. nearly 100%

d. about 15-20%

Social Security benefits:

*a. automatically increase with inflation

b. are not subject to change

c. are not adjusted to meet inflation

d. are often cut back in times of inflation

Supplementary Security Income

*a. guarantees a minimum income for the needy elderly

b. provides extra income for all the elderly

c. supplements the income of the elderly in nursing
homes

d. pays medical expenses for the elderly

As far as the aged getting their proportionate share of
the nation's income:
a. most of the aged live below the poverty level
b. the aged are the poorest group in our society
*c. the aged do get their proportionate share of the
income
d. the income gap between the aged and other adult
groups continues to widen

Compared to persons under 65, rates of criminal
victimization among the elderly are:

a. higher

*b. lower

c. much the same

d. steadily increasing

Regarding crime and the elderly:
*a. they are more fearful of crime than are younger
persons
b. they fear crime the same as other age groups

c. they are less fearful of crime than are younger
persons

d. most elderly persons have no fear of crime

14.

15.

16.

17.

18.

19.

20.

59

The most law abiding of all adult age groups are:
a. the middle aged

b. persons in their 30's

c. young couples

*d. the elderly

Regarding the number of widows and widowers among the
aged:
a. their numbers are about equal
*b. their are nearly 5 times as many widow as widowers
c. there are about twice as many widowers as widows
d. the number of widows is rapidly increasing

When it comes to voter participation rates:
a. the aged seldom vote

b. those ages 35-44 tend to have higher rates than the

elderly

c. college students have higher rates than do the
elderly

*d. older people have higher rates than the rest of the
population

In reference to public office:

a. there is no relationship between age and public
office

b. older people are seldom found in public office

*c. there are proportionately more older persons in
public office ‘

d. there are proportionately more younger persons in
public office

The proportion of African Americans among the aged is:
*a. growing

b. declining

c. very small compared with other minority groups

d. staying the same

Participation in voluntary organizations:

*a. usually does not decline among healthy older
persons

b. drops among healthy older persons

c. rises among healthy older persons

d. is highest among the youth

The majority of old people live:
a. alone

b. in institutions

*c. with their spouses

d. with their children

21.

22.

23.

24.

25.

60

rate of poverty among the elderly

is lower than among those under 65

is higher than among those under 65

is the same as it is for other age groups

is high as a result of their having fixed incomes

rate of poverty among aged African Americans:
is less than that of whites

is about the same s that of whites

is about triple that of older whites
continues to increase

Older persons who reduce their activity tend to be:

a.
*b.
c.
d.

happier
not as happy as those who remain active

more well-adjusted than those who remain active
healthier

When the 1st child leaves home, the majority of parents

a.
*b.
c.
d.

The
*a.
b.
c.
d.

have serious problems of adjustment

have higher levels of life satisfaction

try to get their children to come back home
suffer from the "empty nest" syndrome

proportion of the widowed among the aged:

is gradually decreasing

is rapidly increasing

has remained the same in the last half century
is unrelated to increasing longevity

14mm“)~.\\\m\n\'~M»W mm

3 1293 02374 49