Commitment to Nursing: Elderly in Intensive Care

Introduction

This section presents the review of literature related to the care of elderly patients admitted to intensive care and nurses' commitment to nursing. Specifically, the literature is categorized into three themes; nurses’ knowledge on the care of elderly patients admitted to intensive care, nurses’ attitudes toward the care of elderly patients admitted in intensive care, and nurses’ practices toward the care of elderly patients admitted to intensive care. A conceptual framework is also presented.

Nursing Knowledge of Elderly Patients in Intensive Care

Caring for older people needs specific skills and knowledge. Ferreira and Ruiz (2012) are of the opinion that there is a lack of educational training for registered nurses as well as for all other groups of nurses working with older people. This was further supported by Doherty, Mitchell, and O'Neill (2011) who reported that over the years, the healthcare provided for older adults has been severely threatened by the negative stereotypic attitudes and misconceptions by nurses with 63% of elders expressing an unmet health need.

Topaz and Doron (2013) explored a group of Israeli nurses’ knowledge of aging and attitudes toward older people in an acute care setting and analyzed the relationship between these variables using a descriptive, correlational design method. In the study, there was no significant correlation between the level of nurses’ education and knowledge of ageing, probably because until recently, nursing education in Israel lacked old-age-related content. According to the findings, there is a difference in the levels of knowledge of ageing among nurses from different ethnic groups. Faronbi et al. (2017) found that most of the respondents have a good knowledge about the care of the older adults. They recognized causes and prevention of complications when providing care to older adults. This they viewed will improve the well-being of the older adults. The complexity of caring for older people and the necessity of special knowledge and specialization in this field is recognized by the majority of nursing students.

Bing-Jonsson et al. (2016) investigated the sufficiency of nursing staff competence in Norwegian community elderly care. They found that nursing staff have competence in all areas measured, but that the level of competence was insufficient in the areas of nursing measures, advanced procedures, and nursing documentation. Nursing staff in nursing homes scored higher than staff in-home care services, and older nursing staff scored lower than younger nursing staff. Mahieu et al. (2016) investigated nursing staff’s knowledge and attitudes toward aged sexuality, to determine whether certain sociodemographic factors of the nursing staff relate to their knowledge and attitudes toward later-life sexuality, and to examine the relationship between knowledge and attitudes. The nursing staff appeared to be moderately knowledgeable about aged sexuality and displayed a rather positive attitude toward sexuality in older people. Significant relationships between various variables were found both at univariable and multivariable levels. Knowledge and attitudes proved to be positively related, indicating that a higher level of knowledge of aged sexuality is associated with a more positive attitude toward sexuality in later life.

Nurses’ Attitudes Towards Elderly Patients in Intensive Care

According to Abreu and Caldevilla (2015), the attitudes of nurses about aging and older people are of utmost importance, particularly as they are reflected in the way nurses perceive and interact with their patients and in how they provide nursing care. Studies on the attitudes of nursing students, staff and other health care professionals towards older people and their care have identified negative attitudes towards geriatric nursing (Oyetunde et al., 2013). Rush et al. (2017) examined hospital nurses' attitudes towards caring for older adults and delineate associated factors contributing to their attitudes. Nurses' held coexisting positive and negative attitudes towards generic and specific aspects of older adult care. Negative attitudes, in particular, were directed at the characteristics of older adults, their care demands or reflected in nurses' approaches to care. Across jurisdictions, work environment, education, experience and demographics emerged as influences on nurses' attitudes.

A study by Liu, Norman and While (2015) found that registered nurses expressed positive attitudes towards older people and 89.7% reported positive attitudes towards working with older patients. The variables of self-ageing anxiety, attitudes towards health-care resource allocation, knowledge of ageing, ethnic group, job title, attitudes towards older patients and interaction between ethnic group and attitudes towards working with older patients explained 42.6% of the variance in attitudes towards older people. Factors, including attitudes towards older people, self-ageing anxiety, commitment to nursing, attitudes towards health-care resources allocation among older people and clinical specialty explained 16.7-34.3% of the variance in attitudes towards older patients.

Hagerling (2015) study found that most participants were fond of older patients and had passion for providing good care to older adults. However, even though the desire to provide care was strong, various negative personal impacts were experienced by participants. Open-ended responses from participants, further reflected empathy for patients, while at the same time participants’ feelings of frustration at being unable to provide the desired care because of the lack of time, resources and support. Deasey, Kable and Jeong (2014) to determine nurses' knowledge and understanding of the ageing process and attitudes towards older people in emergency care settings. Emergency department nurses' attitudes towards and knowledge about ageing processes may affect therapeutic interactions between nurses and their older patients. Issues such as managerial style, past experiences and the medical model used for health-care delivery were secondary factors shown to influence emergency nurses' negativity towards their older patients.

Courtney et al. (2010) paper reviewed recent research on positive and negative attitudes of acute care nurses toward older people. Many negative attitudes reflect ageist stereotypes and knowledge deficits that significantly influence registered nurses’ practice and older patients’ quality of care. In the acute setting, older patients experience reduced independence, limited decision making opportunities, increased probability of developing complications, little consideration of their ageing related needs, limited health education and social isolation. Findings from Faronbi et al. (2017) study showed that respondents have positive perception toward the older adults and their care. For example, they perceived that older adults as experienced people, who have accomplished all things (marriage, birth, duties). They also believed that sickness is not part of the normal ageing process. They reported that it is possible for an individual to go through the course of aging without a disease. This good perception displayed by respondents may be associated with the fact that the study setting is a similitude of true African society which holds the older adults in high esteem.

In Abreu and Caldevilla (2015) study, the mean score on the Inventory of Attitudes toward Aging was = 2.05 (SD = 0.32), suggesting negative attitudes toward aging, particularly as identified by scores in factor 1 and factor 3. Difference across gender was not significant for factors 1, 2, 3, and 4, respectively (p= 0.423), (p= 0.668), (p= 0.377), (p= 0.067).No differences were found across mean attitude scores and gender or across attitudes and living with older people. No correlation was found between nursing students’ attitudes and age groups, in the majority of the studied factors. Arani, Aazami, Azami and Borji (2017) assessed nurses' attitude toward elderly in the city of Ilam. More than half (54.3%) of the nurses had negative attitudes toward the elderly. The results of ANOVA analysis showed significant differences (P

Oyetunde, Ojo and Ojewale (2011) study aimed at exploring the attitude of nurses towards the care of the elderly in two selected hospitals (University College Hospital and Ring Road State hospital) in Ibadan, Oyo state. This study shows that 73.0% of the respondents agreed that elderly is difficult to care for. Over 80% agreed that effective care of the elderly requires special training. Also, more than 90% believed hospitals should have special wards (geriatric ward) for effective care of the elderly. Respondents showed positive attitude towards the care of the elderly and good knowledge of aging process.

Nursing Commitment to Elderly Patients in Intensive Care

Although nurses are the primary caregivers for hospitalized and vulnerable elders living in the community, most aren’t prepared in geriatric, family-centered, or culturally competent care. Also, many nurses have little formal preparation in culturally appropriate and culturally sensitive care, including attention to patient and family values and cultural differences—despite increasing evidence of the interactions between culture and health (Smith & Fitzpatrick, 2013). Geriatrics health care providers who function as family caregivers undergo a unique, highly emotional experience. It is made more complex by an in-depth knowledge of geriatric medicine, nursing, social work and an inside understanding of the health care system. The combined expectations of their own and family expectations to positively affect their family member’s care heightened the stress of the entire experience (Wohlgemuth, Auerbach & Parker, 2015).

Milton‑Wildey and O’Brien (2010) study investigated how nurses managed the care of acutely ill older patients in acute hospital settings. Three themes were identified from the data analysis: being informed about care; limiting care; and rationalising actions. Nurses articulated they understood that quality care was important, but care was limited and interventions were prioritised. The participants blamed health services, lack of clinical leadership, patients, other nurses, and themselves. Kazerooni et al. (2019) results show a relatively good level of satisfaction of the elderly with services provided in the Kahrizak nursing home, while there is a significant difference with the expectations of the elderly from the health care system from their point of view.

The aim of Hvalvik and Dale (2013) study was to obtain insight into nurses' experiences and perceptions of caring for patients in transition to receive homecare. The results from this study indicate that the nurses endeavoured to provide person-oriented and individualized care for older persons in transition to receive homecare. The type of care they aimed to provide was in accordance with national and international health related goals, as well as with theories of healthy transitions. Their efforts and ambitions to provide excellent care were, however, challenged and threatened by various circumstances in the caring context. The cooperation across organizational levels was pointed out as a critical factor with potential for improvement. In addition, the need for greater consciousness regarding time, competence, and continuity in the care was emphasized.

Ahmadabad et al. (2016) examined the satisfaction status of elderly patients admitted in different wards in Yazd Shahid Sadoughi Hospital of provided services in winter 2015.The mean score of total satisfaction from hospital services of Yazd Shahid Sadoughi Hospital was 65.4 (range 0-100). There was a significant positive relation between the different domains of satisfactions. It was only the financial aspects which was not in relation with other domains. The highest score of the patient satisfaction belonged to the technical quality (73.7) and nursing services (69.6) and the lowest score was in the communication domain (48.7). The score of satisfaction in financial aspects was lower in men than women (p

Shady et al. (2018) assessed elderly cancer patient's satisfaction with nursing care quality in day care unit at oncology center Mansoura University. Nearly three quarters of patients were unsatisfied with nursing care quality. Most of nurses had poor knowledge about cancer. Moreover, they didn’t follow quality of nursing care standard related to cancer. Furthermore, most of resources were unavailable in the day care unit. Chumbler, Otani , Desai, Herrmann and Kurz (2016) found that older female patients reported substantially more positive global evaluations than their male counterparts. However, for older male patients, Communication with Doctors was more influential in their ratings of overall satisfaction than for older female patients. For older female patients, Communication with Nurses was more influential in their ratings of overall satisfaction than for older male patients.

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