An exploration of knowledge of students and staff at residential aged care facilities and implications for nursing education

Highlights

• Misconceptions of the older adult were related to sociological aspects of ageing.

• Stereotyping older adults devalues care and affects the quality of practice.

• Education should focus on learning strategies that promote a positive view of the older adult.

Abstract

Background

Advances in healthcare have contributed to population longevity with many older adults living with complex comorbidities, including those in residential aged care facilities (RACFs). Nursing staff require knowledge of gerontology, normal ageing processes and expected physiological, psychosocial, function and cognitive changes in addition to health promotion in order to provide individualised care. The complexity inherent in the medical, palliative and basic care needs of the residents makes RACFs excellent places for learning for undergraduate student nurses who undertake clinical placement as part of a Bachelor of Nursing course. Previous research has identified that knowledge of care staff is relatively poor.

Objectives

To explore the knowledge and misconceptions of ageing among first year undergraduate nursing students and aged care staff facilitating a placement during a clinical learning experience.

Design

Descriptive cross-sectional design.

Setting

Three clinical RACFs in Australia.

Participants

First year nursing students and staff of three different RACFs.

Method

Pre and post-test clinical placement surveys. Students and staff completed Palmore's Facts on Ageing Quiz, a 25-item tool to assess knowledge and attitudes of ageing, before commencing the clinical placement and on the last day of a two week placement.

Results

Physiological questions were answered correctly. A knowledge deficit was evident from a sociological perspective. Negative attitudes have been found to devalue care and can directly affect the quality of practice in an undesirable way, forming a barrier to effective and therapeutic relationships with older adults, potentially impacting on patient care.

Conclusions

From an education provider perspective, the inclusion of activities to enrich the learning activities of nurses within RACF- inclusive of reflective activities and guidance from an expert clinical facilitator - may assist in dispelling negative attitudes and stereotypes of the older adult and increase recognition of the value of working with older adults.

Introduction

Globally the older population continues to grow at an unprecedented rate and Australia shares the reality as most post-industrial societies do, of a rapidly ageing population. Throughout the world the number of people aged 65 years or over has increased from 6% in 1990, to 9% in 2019 (703 million), and this is projected to increase to 16% by 2050 (1.5 billion) (United Nations Department of Economic and Social Affairs Population Division, 2019). Eastern and South-Eastern Asia have the largest number of the globe's 65 years and over population (260 million), with North America and Europe second (over 200 million) (United Nations Department of Economic and Social Affairs Population Division, 2019). In 2017, 3.8 million (15%) of Australians were aged 65 years and over, with this number expected to grow to a projected 8.8 million older Australians by 2057 (Australian Institute of Health and Welfare, 2018a). Advances in healthcare have contributed to population longevity and many of these older adults live with complex comorbidities necessitating admission to residential aged care. With the average age of a person entering a Residential Aged Care Facility (RACF) in Australia being 80.2 years (Australian Institute of Health and Welfare, 2018b), there is an urgent need to prepare for increased demands on aged care services and to prepare an aged care workforce that has good levels of knowledge and skills related to gerontology, normal ageing processes and expected physiological, psychosocial, function and cognitive changes in addition to health promotion in order to provide high quality and individualised care (Hanson, 2014; Lea et al., 2015). To this end, the inclusion of gerontology content in undergraduate Bachelor of Nursing degrees and ensuring opportunities for student nurses to practice with expert role models in the aged care environment has been recommended (Lea et al., 2015; Carlson and Bengtsson, 2014; Hovey et al., 2017).

The complexity inherent in the medical, palliative and basic care needs of older people in RACFs makes this care setting an excellent learning place for undergraduate student nurses who undertake clinical placement as part of a Bachelor of Nursing course. During clinical placement, student nurses should work alongside expert role models, gaining experience in applying theoretical content to practice in caring for the older adult. Nurses in RACFs have the opportunity to demonstrate their knowledge of ageing and level of clinical expertise to meet the needs of an ageing population, to ensure appropriate care is provided. This model of learning ensures that appropriately trained nurses are imparting their knowledge to undergraduate nurses who undertake clinical placements (Hodgkin et al., 2017). However, balancing the appropriate mix of gerontology curriculum content and ensuring the clinical placement exposes the student nurse to meaningful experiences with expert role models with good knowledge and skills in aged care can be challenging.