Purpose: The purpose of this integrative review was to synthesize the literature describing teaching strategies that have been utilized to improve student perceptions and attitudes toward older adults in baccalaureate nursing programs, and to examine the outcomes of these teaching strategies. The integrative review was guided by the following questions: (a) what educational strategies are used to promote positive attitudes toward older adults in baccalaureate nursing students and (b) what are the outcomes of educational strategies used to promote positive attitudes toward older adults in baccalaureate nursing programs?
Methods: A modification of Cooper’s (1998) framework described by Whittemore and Knafl (2005) was utilized to conduct an integrative review of the literature. A literature search was conducted using the Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE, and Education Resources Information Center (ERIC) databases. Ancestry searching was also performed. Articles met the criteria for inclusion in the review if they: (a) were published in English, (b) reported on qualitative or quantitative research of educational strategies used in baccalaureate nursing education for the purpose of promoting positive attitudes and perceptions of older adults, (c) were a primary source, (d) were peer-reviewed, and (e) were published between 2000 and 2016. The final sample included 22 articles. The quality of the accepted empirical data was ranked using a revised protocol designed by Hawker, Payne, Kerr, Hardey, and Powell (2002). The articles ranked as “high” were most influential in directing theme development during data analysis, while the articles rated as “low” played a supportive role in theme development.
Results: The educational strategies were categorized into five distinct approaches: clinical, didactic, combined didactic and clinical, creative, and reflective. There was no evidence to support greater quantities of time spent in long term care settings, creative approaches, or combined didactic and clinical teaching as strategies for improving students’ attitudes toward the elderly. The evidence suggested that the use of high-quality, supportive clinical placements, the introduction of aging concepts and gerontological clinical learning during the first year of study, reflective strategies, and the partnering of nursing students with older adults in long term care and the community were most efficacious in cultivating positive attitudes toward older adults in baccalaureate nursing students.
Conclusion: Implications for nursing education include: early exposure to gerontology coursework and clinical settings during the nursing curriculum, ideally during the first year of study; regular, consistent reflective activities throughout the gerontological nursing curriculum as either a primary or adjuvant strategy; the addition of extended student-elder partnerships, with a reflective component in the form of either journaling or group reflection, to nursing curriculums; and high-quality, supportive clinical placements for nursing students. Implications for future research include the development of gerontological educational programs for nursing faculty, the exploration of the attitudes and perceptions of nursing faculty toward the elderly, the development of valid instruments to measure students' attitudes toward older adults, and replication of the included studies with larger sample sizes to improve generalizability.