[Objectives of the study]
Many universities in Japan, where nursing education is offered, have been adopting the curriculum in which Basic Subjects (liberal arts such as humanities, social science, natural science) and Foundation Education Subjects (anatomy, physiology, biochemistry, etc.) are learned in lower grades before Nursing Education Subjects. Majority of the universities split Nursing Education Subjects by fields (adult nursing, geriatric nursing, pediatric nursing, etc.), offering the corresponding lectures and clinical practices for each field, after “Fundamental Nursing” is completed. The students must attend lectures and pass examination before going out for clinical practices. Many universities set one-year clinical practice opportunity for the third-year (junior) or the fourth-year (senior) students Due to the aged society in Japan, the possibility of encountering older adults is quite high for the students in clinical practice. Especially in Japan, there are many students who are not sure about how to deal with older patients due to their inexperience of living with older adults, which has become a problem to be solved.
Therefore, in this study, the focus was on the “images toward older adults”. As it may decide one’s attitude for nursing, it could be used as an indicator to evaluate the effect of the education. The purpose of this study was to work out appropriate education contents of geriatric nursing based on the data obtained through the investigation on the ageism and views on & images toward older adults for the students of the university with which the researcher is affiliated, for the period between the students’ entry in and just before their graduation from the university.
1. Subject of the study
Questionnaire surveys were carried out among the nursing students enrolled in April 2013 for three times in total when they were in their first year (in 2013 at the time of enrollment, 110 students), in their third year (in 2015 before commencing their practical training, 92students) and in their fourth year (in 2016 after the completion of all practical nursing training and immediately before graduation, 103 students). Any special contents of education on ageism or images toward older adults are not currently adopted in the geriatric nursing classes of the university where the study was conducted.
2. Surveyed items
The students were asked if they have any experience of living with older adults (“living-together experience”) and from what age they feel the person is an older adult (“minimum age regarded as an older adult”) with the basic items of self-administered questionnaire,
Facts on Aging Quiz (FAQ) of E.B.Palmore (1986) was used for the measurement of the degree of ageism, “Attitudes Toward the Aged” developed by Nakano, et al. (1997) for the view of older adults and eighteen adjective pairs developed by Nakano, et al. (1997) with reference to “The Children’s Attitude Toward The Elderly (CATE)” scale created by Jantz, R.K., et al. (1976) for students’ impression of older adults.
3. Analysis method
Simple totaling was applied to the basic attributes as well as “minimum age regarded as an older adult”. The latter was divided into 2 groups based on whether they have “living-together experience” or not. Comparison is done between the students of each academic year with Mann-Whitney U test.
In FAQ, the score ratios of correct answers were simply tabulated and multiple comparisons were carried out. In the measurement of the view of older adults, multiple comparisons were carried out by calculating the concordance rate among answers to positive items. The SD method was used for the measurement of students’ impression of older adults, and multiple comparisons were carried out using the five-point rating scale with three points as a neutral point. Multiple comparisons were also conducted for each adjective pair. In multiple comparisons, Mann-Whitney U test was used to adjust significance level (0.05/3).
With approval of the medical research ethics review board of the university to which the researcher belongs, the study was conducted after explaining to students verbally and in writing the purpose of the study, protection of their privacy, the fact that the participation in the study was non-obligatory and it would not affect their evaluation in classes.
[Results and discussion]
1. Basic items
1) Whether there is any “living-together experience” or not
The number of the students who have “living-together experience” with older adults are 37 (34%) for students of all first, third and fourth academic years.
2) The age they consider to be older adults
Among the first year students, 60–64 year old was selected by 44 students (40%), 65–69 by 29 (26%), 70–74 by 23 (21%), 50–59 by 8 (7%), 75–79 by 4 (4%) and one answered over 80 (1%). Among the third year students, 65–69 year old was selected by 46 students (50%), 60–64 by 20 (22%), 70–74 by 16 (17%), 75–79 by 5 (6%), over 80 by 3 (3%) and 50–59 by 2 (2%). Among the fourth year students, 65–69 year old was selected by 58 students (56%), 70–74 by 17 (16%), 75–79 by 13 (13%), 60–64 by 19 (10%), over 80 by 5 (5%) and none selected 50–59 (0%).As a result of the comparison based on whether there is any “living-together experience” or not, no significant difference was recognized between the students of each academic year.
3) Discussion of the basic items
47% of the first year students who just enrolled the course considered under 64 year old to be older adults although the ratio became about 10% after the fourth year. This could be mostly due to the fact that they had gained knowledge by leaning older adults was defined as the aged 65 and older by the WHO.
The average score ratio was 56.0% (SD=9.9) for the first year students, 59.0% (SD=7.2) for the third year students and 57.9 % (SD=8.8) for the fourth year students. Although the score ratio was slightly higher in the third year when students completed attending lectures in geriatric nursing studies compared to the time of their enrollment, the result of multiple comparisons did not show significant difference among respective years. This revealed that regular lectures and experience of practical training alone would not reduce students’ prejudice against older adults.
3. View of older adults
The average value of the concordance rate among answers to positive items was 62.8% (SD=16.7) for the first year students, 63.7% (SD=17.4) for the third year students, and 66.9% (SD=15.3) for the fourth year students. Compared to the time of enrollment, positive answers increased as the year progressed, however, the result of multiple comparisons did not show significant difference among respective years.
4. Impression of older adults
The average score was 3.13 (SD=0.5) for the first year students, 3.05 (SD=0.4) for the third year students, and 3.03 (SD=0.5) for the fourth year students. The result of multiple comparisons showed the score of the third year students was significantly lower (p<0.05/3) compared to the first year students. Also, in the multiple comparisons of each adjective, the score of “sad―happy” significantly shifted towards “sad” and the score of “untidy―tidy” towards “untidy”, respectively, in the third year when compared to the first year. When comparing the first year to the fourth year, the score of “week and ill―healthy” significantly shifted towards “week and ill” and the score of “slow―quick” towards “slow”. The Spearman’s correlation coefficient was 0.452 (p=0.000) for the first year students, 0.392 (p=0.012) for the third year students, and 0.398 (p=0.000) for the fourth year students; all presented significant moderate positive correlation.
Analysis of adjective pairs revealed that students’ impression of older adults shifted negatively when compared to the time of their enrollment. This could be due to negative changes in their feeling towards older adults after gaining knowledge during lectures and actually coming in contact with patients with illness. It is important that lectures will teach students older adult’s “strength” as well as the aspect of declining health due to diseases and aging in order to help them carry out nursing duties feeling positive.
5. Differences based on whether there is any “living-together experience” or not
For views on older adults, the matching rate of the affirmed items is significantly higher in the first-year students who have “living-together experience” than in those who don’t have it (p=0.003). The grandparents who are living with students would be relatively healthy because they are not residing in a hospital or facility. It may be the reason for the differences in images toward older adults between the students who have “living-together experience” and those who don’t have it.
It is believed that caregiver’s impression and view of older adults will influence their attitude and elements of provided care. The result of this study indicated that it would be difficult to provide students knowledge of ageism or positive impression regarding the elderly during regular lectures, exercises, and practical training. It suggested the necessity of incorporating elements to create an impression of older adults without prejudice and help students understand the strength of older adults into lectures and exercises of geriatric nursing.