Nursing is the principal healthcare profession which has major contribution towards overall wellbeing of the patient. Nurses are responsible for the well-being of the patient via delivering holistic care. However, behaviour, skills and competencies of the nursing staffs have profound impact on the well-being and tenure of hospital stay of the patient (Bodner et al., 2015). Among the patients in the hospital, one of the significant age group is the older population. According to Tremont and Davis, (2014) in the contemporary society, increases in the number of people who are in their mid-60s are gradually becoming threat for the global healthcare system. Increase in aged population is also associated with the increase in the numerous complex disease like cardiovascular disease, respiratory disease, musculoskeletal disease as well as gastro-intestinal disorders (Pleasant et al., 2017). This increase in physiological complications along with the increase in the rate of hospitalisation has increased the responsibilities of the nurses. Moreover, older population gradually tend to lose their mental and physical strength for which they require additional physical, mental, emotional and spiritual support and this further increases the challenge of the nursing staffs (Oosterom-Calo et al., 2015).
There are various evidences centring the challenging attitude of the nurses towards the elderly clients which reducess the overall well-being along with increase in the tenure of hospital stay (Davison et al., 2016). According to Davison et al. (2016), negative attitude of nursing staffs who are concerned with the elderly care are higher and there are several internal and external factors contributing towards this negative attitude. However, what exact are the factors or the underlying reason behind this negative attitude, are not elucidated. But the key concern is these kind of pessimistic attitudes of the nursing staffs is actually hampering the quality of care along with emotional and spiritual well-being of the elderly population. Chen et al. (2016) have highlighted long working hours, lack of skills and unmanageable behaviour of the patients are the major contributing factor behind the negative attitude of the nurses. However, certain internal issues behaviour of the nursing professionals is also significant in this context. Thus it is crucial to identify the actual contributing factors towards the negative attitude or challenging behaviour of the nurses treating the elderly population. The exploration of the research context will mostly be based on the identification and subsequent elimination of the factors promoting negative attitude of nurses towards older population.
The challenging behaviour of the nurses towards the elderly population has become a serious issue in the healthcare sectors throughout the world. Therefore the present study will aim to identify the factors which are the major contributors the negative behaviour of the nursing staffs. Moreover, identification of these factors will help to increase the quality of care along with health care policies like training of the nursing staffs with a special focus on the patient satisfaction (Hynnien et al. 2015). Thus alternatively it can be said that the research findings will improve the overall quality of the health care services while increasing the level of satisfaction among the care givers and the care receivers.
The aim of the research is to analyze numerous factors that modulates the attitude of the nursing professionals towards the elderlypatients and thereby giving rise of challenging behaviour.
This is the most crucial chapter of the research which is associated with the examination of the theoretical framework along with research work undertaken by other authors. In this chapter, the research will discuss numerous factors which lead to the generation of the challenging behaviour among the nurses. The critical analysis of the research papers helps the research to identify the main themes of the research (conceptual framework) along with the research limitations of the previous work followed by the choice of methodology. The chapter is important because it helped to analyse the relationship between the dependent variable (negative attitudes of the nurses towards the elderly patients) with other independent variables.
According to Borkowski (2015), nurses experience difficulty in communicating with the elderly patients. This is because, the majority of the elderly population suffers mental retardation along with certain level of dementia and thereby making them behaviourally challenged. This behaviourally challenged people demands special attention and communication standards. Finnema et al (2017), the majority of the nursing professional fails to understand this difference in the communication requirement among the elderly patients in comparison to other patients and thus generating challenging situations. Furåker and Nilsson (2009) highlighted that the nurses are required to deliver proper information of the patients to their family members. However, the majority of the nurses do not give the comprehensive information to the family members creating confusion and anger among the family members and thereby creating further challenge.
According to Wei et al., (2015), long working hours along with shortage of adequate nursing staffs creates extra pressure on the existing nursing professionals on duty. This extra work pressure increases their stress level and the impact of this stress gets expressed over the patients in terms of ill-behaviour and thereby affecting the emotional and spiritual wellbeing of the elderly patients. We et al. (2015) further highlighted that increase in the stress level among the nursing professionals cause increase in the rate of the medication errors. McCann, Baird and Muir-Cochrane (2014), highlighted a different perspective of this high level of stress, they opined that rise in stress level increases job dissatisfaction. Their survey highlighted that one out of four nurses is successful in balancing job stress and work balance and thereby satisfying patients with their therapy plan. Study conducted by Möhler and Meyer (2014), stated that elderly people demands extra care and services and this is not support by the present patient : nurse ratio and thus creating an imbalance in work followed by increase in job stress. Moreover, the majority of the elderly patients suffer from mental complications which demand extra like they are unable to take their medicines on time. This creates negative outcomes in the treatment leading to poor reputations among the nursing professionals along with negative attitude (Surr et al., 2016). Alber et al. (2014) have highlighted that the loss of adequate sleep due to extra working hours causes fatigue and drowsiness among the nurses and thereby generating cognitive behavioural problems. This rise in the cognitive behavioural problems hampers patients: nurse relationships which further increase the job stress along with negative attitudes towards the nurses.
Bing-Jonsson et al. (2016) highlighted that the lack of training is another important reason behind why the nurses fail to manage the extra work pressure along with optimal care plan for the elderly patient. Deasey, Kable, and Jeong (2014) highlighted that if nurses lack proper training, they experience problems while treating elderly care patients. Golden et al. (2015) opined that due to the lack of proper training, the nurses fail to identify the exact requirement of the patients and thereby failing to provide the appropriate care and hence increasing the tenure of hospital stay. Golden et al (2015) further opined that lack of training creates gap in knowledge. The majority of the nurses who are untrained do not have adequate knowledge about the exact communication style in the elderly care unit. Untrained nurses fail to understand the need of the patients and thus failing to provide the desired care. Samra et al. (2015) stated that elderly patients who suffer from dementia ail to express their needs, but at times execute certain body language or take help to sign language to communicate their needs. However, nurses who are inadequately trained fail to understand the sign language or the gestures of these dementia patients thus increasing lack of quality of care.
According to Hill et al. (2017) high workplace diversity along with lack of proper amenities and increase in the work load creates poor work environment for the nurses working under the elderly care unit. Hill et al. (2017) further opined that the nurses who execute their under poor working environment are bound to generate certain level of frustration which gets expressed in the form of negative attitude towards the elderly group of population. Borkowski (2015) opined the nursing profession irrespective of the ward they serve, receives less respect in comparison to the doctors. They always execute as subordinates of the doctors and this lack of job respect creates poor work environment. Moreover, in elderly care unit are critical and the family members remain over concerned. Any gap or pseudo gap in the treatment of the therapy plan as identified by the patient’s family members gets exponentially manifested in the from of anger or aggression and since the nurses are available 24X7 in the vicinity of the patients in comparison to the doctors, they become they become the main target aggression of the patient’s family members. Face and managing grievances of the patients and most importantly their family members generates tension during the working hours creating poor work environment. Borkowski (2015) further nurses who work under the poor work environment are more likely to generate negative attitude towards their patients. Scerri and Scerri (2013) highlighted that violence in workplace leads to lack of concentration thereby increasing the rate of mistakes along with negative attitudes towards the patients.
According to Hazelhof et al. (2016), elderly group of population are more likely to suffer from chronic diseases like cardiovascular disease, mucoskeletal disease, hypertension, diabetes and other mental health complications. But negative behavior or lack of proper care of the nurses towards this group of population increases their length of hospital stay along with increase in chance of getting affected with the hospital acquired infection. Vandecasteele et al. (2017), highlighted that the negative behavior of the nursing professionals results in the generation of the negative psychological issues leading to isolation, depression, anxiety and other physical issues like hypertension, low self-esteem and sudden disgust about the overall medical treatment. This decrease in the belief about the medical treatment creates a psychological gap which delays the overall outcome, further increasing their length of hospital stay. According to Hynnine et al. (2015), elderly people are lonely and seek mental assistance along with spiritual support from the healthcare professionals. Since the nursing professionals are greeting the patients round the clock, patient’s expectations from the nurses are high. However, lack of mental support and positive regards are proper help in their daily living, they become susceptible to physical breakdown along with mental stability which further increases their length within the hospital stay.
The review of literature has highlighted negative attitudes of the nurses towards the elderly group of population. The studies have presented poor staffing, long working hours, and lack of proper training along with other elderly behavioral difficulties as the major cause behind the negative attitudes of the nursing professionals towards elderly group of patients. This revelation remains a highlighted towards the immediate requirement for nurses’ geriatric training. The present study however focus on the attitude of the nursing professionals compared with the previously studied literature which is against the background of the present study, is framed to explore attitude of the nursing professionals towards the elderly care people with negative behaviours in the hospitals or nursing homes.
This chapter provides an overview of the methodological approaches under taken in order to conduct the research the organised way. According to Parahoo (2014) having a defined structure of the research helps the researcher to proceed in planned manner towards the accurate outcome.
There are different types of research philosophies like realism, positivism and interpretivism. In this research, the research has used positivism research philosophy. According to Bergh and Ketchen, (2011), positivism research philosophy helps to evaluate the information with a scientific approach along with a logical flow of the information.
There are two types of research approach, deductive and inductive. In this research, the researcher will employ deductive research approach. According to Crowther and Lancaster (2012), deductive research approach helps the researcher to select the theoretical framework first in order to analyze the hypothesis. It also helps the researcher to establish the relationship between the objectives.
There are various types of research design mainly exploratory, explanatory and descriptive research design. According to Ellis and Levy (2012), descriptive type research design helps the researcher to establish cause and effect relationship with the variables of the research. This approach helps the researcher to generalize the overall presentation while understanding the research problem. The study here used an instrument of open-ended questionnaire that has been stringently developed from taking references from review of literature. With the help of the descriptive research design, researcher is able to generate strong relationship with the proposed variables of the research.
There are two types of data collection method qualitative and quantitative. Researcher here employed qualitative data collection procedure along with qualitative data analysis.
Researcher has used random, stratified sampling method for the collection of the qualitative data. According to Bergh and Ketchen (2011), random stratified sampling help the research to easily select the focus group. 5 registered nurses working in the elderly care unit were chosen to conduct the interview with open-ended questionnaire. The selection parameter was discussed below
Copies of questionnaires were disseminated among the registered nurses of the elderly care unity of a hospital in UAE proper before initiation of the interview. After completion of the interview, the recorded interview was noted down in a transcript format and then was verified by the participants in order to avoid transcriptional bias.
As per the data per the Data Protection Act, all the selected group of participants will be signed a consent form before the initiation of the interview. This consent form will contain the purpose of the interview along with the identification of the liberty to leave the interview session at any point of time, as per their will. Moreover, the ethics form will also highlight that the time of conduction of interview will not affect their duty hours and will keep their identity confidential.
The research design will be descriptive which is popularly known as descriptive style research. For the secondary data, the researcher will mostly rely on the literary articles and for primary data, the research will conducted an interview among the five elderly care registered nurses working under hospital settings via designing open-ended questionnaires. The sampling style will be random sampling.
This chapter is designed to examine the information collected by the research as the means of primary data. Based on the analysis, the researcher will recommend suitable methods in improve the attitudes of the nurses towards the elderly group of patients.
In response to this question, all the five nurses came up with the opinion that their salary is extremely less in regards to the amount of work they do and stress they take. One nurse has been found saying, “our salary is so poor that it fails to do justice to our degrees and it becomes difficult to satisfy the daily living activities with this much of salary in the time of recessation”.
In response to this question all the five nurses came up with similar reply. According to them, though officially they have shift timings, nut in the majority of the days they work ahead of their shift timings in order to cope up with the rising number of patient and less number of nurses. One nurses coined, “we work 12 hours a day and sometimes provide support in both the shifts, day and night. We have no life”.
Four out of the five nurses opined that the physical and verbal aggression of the patients results in challenging behaviour. One nurse said, “During tight schedule and long working hours, when patients misbehaves or refuse to obey our medication instructions, we lose our patience and our outburst comes in form of negative attitude towards the patients”. Another nurses opined that, “if there were parity between the patient load and the attending nurses then it would have been easier for us to retain our patience while handling the verbal and physical aggression of our elderly patients”.
Apart from one nurses, rest 4 nurses agreed that conflict with the family members results in challenging behaviour. One nurse opined that, “when tenured nurses are there with us, it becomes easier for us to handle the aggression of the patient’s family members. However, in most of the times we are not guided by an experienced nursing professional and thus end up with a conflict with the patient’s family and the aftermath affects our behaviour with the patients”.
All of the nurses agreed that long working hours results in challenging behaviour. One of the respondents opined that, “we do not get time to enjoy with our family members and this increases stress level”. Another nurse opined that, “When I stretch my shift timing, my mental pressure increases and at this time, when a patient misbehaves or refuse to assist with the therapy plan, I get agitated and at times express anger on them”.
All the respondents said yet to this question. They said it is due to staff shortage that they are compelled to work extra which increases their stress level.
Three out of five nurses agreed that they lack proper training like communication training like other experience nurses and thus failed to manage the patients accordingly. Rest two nurses highlighted long working hours behind their challenging behaviour.
Conclusion
This chapter aims to shed light over the research outcomes while establishing relationship between previous discussed chapters. The chapter will link the objective of the research with the findings.
Objective 1: Impact of factors causing change in the attitude of the nurses towards elderly people in healthcare
Review of literature highlighted factors like prolong working hours, lack of proper adequate training, low salary and high work pressure along with aggressive behaviour of the nurses as the main reasons behind the change in attitude of the nurses towards the elderly people. The interview highlighted that increase in the work pressure along with poor working environment increases the stress level among the nurses. They fail to manage their work-life balance and their frustration gets expressed in terms of negative attitudes towards the patients. This negative attitude increases the length of the hospital stay of the nurses along with medication errors and fall injury. These kinds of attitude are hampering mental and spiritual well-being of the patients.
Objective 2: Whether this factors affects the wellbeing of elderly in healthcare
Nursing cannot work under the environment where they did not get adequate respect to display their talent. Nurses left compelled inside their working region which is in turn regarded as unfavourable. Constant ignorance in by the nursing professional towards the patients create a sense of loneliness which disrupts their emotional integrity thereby increasing the length of hospital stay.
Objective 3: Recommendation to improve the attitude of the nurses
As opined by a nurses during the interview process, one of the best process to overcome this scenario is to increases the nurse : patient ration along with increase in the experienced: newly appointed nurse ratio. This will decreases the work pressure and will also create provision for the newly appointed nurses to learn the tricks of trade from their experienced colleagues.
Three main approaches that must be used to overcome the problem include proper training of the nursing professionals in the grounds of communication skills and techniques to handle the pressure or stress management. Moreover, workplace stress are required to be reduced via recruiting more training nursing professionals along with increase in the appointment of the experienced nurses in the elderly unit. These nurses will further act as a source for communication training to the newly recruited nurses. Another recommendation include promotion of healthy workplace environment.
The research has sudden limitation, for example, for while selection of the focus group, the researcher has only chosen nurses who have equals to or less than 1 year of experience. Such that the all the responses were generated from the perspectives of untrained or novice nurses between the age group 25 to 30 years. Recruitment of experienced nurses who have more than 5 years of experience will help to elucidate the scenario under more detailed perspective. Moreover, the recording the interview of the patients who are victims of the negative responses of the nurses might have helped to get the patients perceptive of the challenging behaviour of the nurses towards patients.
References
Albers, G., Francke, A. L., de Veer, A. J., Bilsen, J., & Onwuteaka-Philipsen, B. D. (2014). Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study. Patient education and counseling, 94(1), 4-9.
Bergh, D., & Ketchen, D. J. (2011). Research methodology in Strategy and Management, 1st ed. Bingley: Emerald Group Publishing Ltd
Bing-Jonsson, P. C., Hofoss, D., Kirkevold, M., Bjørk, I. T., & Foss, C. (2016). Sufficient competence in community elderly care? Results from a competence measurement of nursing staff. BMC nursing, 15(1), 5.
Bodner, E., Cohen-Fridel, S., Mashiah, M., Segal, M., Grinshpoon, A., Fischel, T., & Iancu, I. (2015). The attitudes of psychiatric hospital staff toward hospitalization and treatment of patients with borderline personality disorder. BMC psychiatry, 15(1), 2.
Borkowski, N. (2015). Organizational behavior in health care. Jones & Bartlett Publishers.
Borkowski, N. (2015). Organizational behavior, theory, and design in health care. Jones & Bartlett Publishers.
Chen, H. M., Tsai, L. J., Chao, S. Y., & Clark, M. J. (2016). Study on the Effects of Individualized Learning Therapy on Cognitive Function and Behavioral and Psychological Symptoms of Dementia in the Institutionalized Older Adults. Journal of Nursing Research, 24(4), 300-310.
Crowther, D., & Lancaster, G. (2012). Research Methods, 2nd ed. London: Routledge.
Davison, T. E., Koder, D., Helmes, E., Doyle, C., Bhar, S., Mitchell, L., … & Pachana, N. (2017). Brief on the role of psychologists in residential and home care services for older adults. Australian Psychologist, 52(6), 397-405.
Deasey, D., Kable, A. & Jeong, S. (2014). Influence of nurses’ knowledge of ageing and attitudes towards older people on therapeutic interactions in emergency care: A literature review. Australasian journal on ageing, 33(4), pp.229-236.
Ellis, T., & Levy, Y. (2012). ‘Towards a guide for novice researchers on research methodology: Review and proposed methods’, Issues in Informing Science and Information Technology, 6, 323-337.
Finnema, E., van der Kooij, C., Dröes, R. M., & Wolter, L. (2017). Psychosocial Interventions. In Dementia in Nursing Homes (pp. 29-53). Springer, Cham.
Furåker, C., & Nilsson, A. (2009). The competence of certified nurse assistants caring for persons with dementia diseases in residential facilities. Journal of psychiatric and mental health nursing, 16(2), 146-152.
Golden, A. G., Gammonley, D., Hunt, D., Olsen, E., & Issenberg, S. B. (2014). The attitudes of graduate healthcare students toward older adults, personal aging, health care reform, and interprofessional collaboration. Journal of interprofessional care, 28(1), 40-44.
Hazelhof, T.J.G.M., Schoonhoven, L., van Gaal, B.G.I., Koopmans, R.T.C.M. & Gerritsen, D.L., (2016). Nursing staff stress from challenging behaviour of residents with dementia: a concept analysis. International nursing review, 63(3), pp.507-516.
Hill, A., Waldron, N., Francis-Coad, J., Haines, T.P., Etherton-Beer, C., Flicker, L., Ingram, K. & McPhail, S. (2017). Staff respond positively when older patients are provided with falls prevention education. Innovation in Aging, 1(suppl_1), pp.523-523.
Hynninen, N., Saarnio, R. & Isola, A. (2015). The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians. Journal of clinical nursing, 24(1-2), pp.192-201.
Hynninen, N., Saarnio, R., & Isola, A. (2015). The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians. Journal of clinical nursing, 24(1-2), 192-201.
McCann, T.V., Baird, J. & Muir-Cochrane, E. (2014). Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units. BMC psychiatry, 14(1), p.80.
Möhler, R. & Meyer, G. (2014). Attitudes of nurses towards the use of physical restraints in geriatric care: a systematic review of qualitative and quantitative studies. International journal of nursing studies, 51(2), pp.274-288.
Oosterom-Calo, R., Vice, K., & Breslow, M. (2015, August). Experiences of Older Patients with Multiple Chronic Conditions in the Intensive Ambulatory Care Home Telehealth Program. In International Conference on Human-Computer Interaction (pp. 311-316). Springer, Cham.
Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan.
Pleasant, M. L., Molinari, V., Hobday, J. V., Fazio, S., Cullen, N., & Hyer, K. (2017). An evaluation of the CARES® Dementia Basics Program among caregivers. International psychogeriatrics, 29(1), 45-56.
Samra, R., Griffiths, A., Cox, T., Conroy, S., Gordon, A. & Gladman, J.R. (2015). Medical students’ and doctors’ attitudes towards older patients and their care in hospital settings: a conceptualisation. Age and ageing, 44(5), pp.776-783.
Scerri, A. & Scerri, C. (2013). Nursing students’ knowledge and attitudes towards dementia—A questionnaire survey. Nurse Education Today, 33(9), pp.962-968.
Surr, C.A., Smith, S.J., Crossland, J. & Robins, J. (2016). Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study. International journal of nursing studies, 53, pp.144-151.
Tremont, G., & Davis, J. D. (2014). The Role of caregivers in the treatment of patients with dementia. The Neuropsychology of Cortical Dementias, 393.
Vandecasteele, T., Van Hecke, A., Duprez, V., Beeckman, D., Debyser, B., Grypdonck, M. & Verhaeghe, S. (2017). The influence of team members on nurses’ perceptions of transgressive behaviour in care relationships: a qualitative study. Journal of Advanced Nursing.
Wei, Y. P., Li, H., Chen, P., Li, J., Chen, H., & Chen, L. L. (2015). Working experiences of nursing aides in nursing homes: A qualitative study. International Journal of Nursing Sciences, 2(4), 371-377.
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