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Geriatric nurses assess their educational needs
Geriatric Nurses Assess Their Educational Needs Community health and nursing home nurses identify gaps in their basic preparation and their present needs. ILSE J. V O L I N N How do currently employed registered nurses perceive their needs for continuing education in the field of geriatric nursing? And how could their basic nursing preparation have contributed more than it did to their effective functioning in this field? These were the two main issues explored in a study carried out in 1979 by the University of Washington's department of physiological nursing. In view of the constantly increasing numbers of elderly in our society and nursing's expanding commitment to meeting their health needs, the answers to these questions might well provide guidelines for basic, continuing, a n d inservice education in geriatric and gerontological nursing. Questionnaires were Sent to 148 registered nurses employed, in nursing homes, home health care agencies, or public health departments in the state. These nurses were seilsr J. Volinn, Ph.D., is a clinical associate professor, Department of Physiological Nursing, University of Washington School of Nursing, Seattle. The author extends appreciation" to Maxine Patrick, R.N., Ph.D., and Pauline Bruno, R.N., Ph.D., for their assistance with the study reported here.
lected according to a sampling design that took into consideration both the size and location of the agency, so that urban, suburban, and rural work settings could be differentiated. The total yield of usable questionnaires was 77, representing a good cross section of inand outpatient agencies in different geographical locations.
Two-thirds of the nurses said that more experience with the aged, well a n d sick, would have been "of great advantage" during their initial nursing education.
Of the 77 respondents, 46.8 percent held diplomas from hospital programs, 16.9 percent held associate degrees, and the remaining 36.3 percent held bachelors or higher degrees. Their age distribution was assumed to correspond with that revealed by a 1970 study, also in Washington, which indicated a trend for older nurses (above 54 years) to work in nursing homes(l). (In that study, a third of all nurses
emPloyed in nursing homes in the state were in the 45- to 54-y.ear-old bracket, and an additional onefourth were over 55.) Several respondents in the present study emphasized that they had been taking care of older persons for over 30 years or that their basic education dated back about 30 years. More than half of them (57.1 percent) were providing direct patient care, 14.3 percent reported administrative and supervisory responsibilities exclusivelyl and 28.6 percent reported a combination of both.
Continuing Education Needs Malcolm Knowles states that adult learners are essentially selfdirecting;.their reservoir of experience serves as a resource; and their educational expectations are characterized by their desire for immediate application of problem-centered information(2). The questions in this study took Knowles's observations into consideration and also yielded some answers to questions raised by Peterson relative to the content and focus of continuing education programs(3). T w o issues were explored in that respect: (a) the "nurses' confidence in their ability to provide the best possible nursing care to the elderly, and (b) potential means to increase that confidence. Their assessment of their basic education added another dimension. Most respondents (88 percent) were quite self-assured about their
Gerontological changes
14.3
Nummg interventions
11.7
respondents had no comments. That broad approach was followed by more specificity as to the desired content of continuing education. There was considerable diversity in the nurses' recommendations, as reflected in the table that shows the suggested topics and percentage of respondents desiring each one.
Geriatric medicine
10.4
Basic Education Assessment
I"OPICS FOR CONTINUING EDUCATION SUGGESTED BY 77 RESPONDENTS Topics
Percent of
Respondents Drug uae and effects
14.3
Geriatric mental functioning
7.8
New techniques in geriatric care
7.8
Rehabilitation
6.5
Management of chronic iflnessea, including diabetes and malnutrition
5.2
Medical economics
3.9
Death and dying, terminal i~lneaa
2.6
ability to provide optimum geriatric nursing care. Only 12 percent seemed doubtful or distrustful of their abilities. Nevertheless, their responses provided ample information about potential educational self-improvement. Almost half (42 percent) mentioned "education"--either broadly defined or in combination with other factors. The latter included some specific suggestions such as the need for increased professional experience (referring to more cooperation between nurses and physicians, particularly those with a background in geriatric medicine); assignment to different work shifts; and structural changes such as increased support by physicians, clearer definitions of skilled nursing care, updating of licensing and institutional laws and regulations, coordination of community resources and, finally, more personnel to share in the provision of care 9 to older persons. About one-third (36 percent) were precise in evaluating how their professional self-confidence might be enhanced. They perceived one broad nee~as predominant: increased experlence or more professional cooperation or changes in the health care system. The remaining
What clinical or theoretical preparation in their basic education would have contributed to the qual!ty of their geriatric nursing care? Almost two-thirds (66.2 percent) stated that more clinical experience would have been of great advantage and they specified the following areas in which experience as students would have been helpful: more exposure to geriatric nursing (16.9 percent); rotation to geriatric care facilities (14.3 percent); as-
" M u c h could be learned if students could follow a nursing h o m e patient for one or two years or even longer," said a nurse with broad exposure to geriatric patients.
sessment experience with geriatric patients (11.7 percent); community contact with elderly (9.1 percent); care for geriatric patients in the acute care setting (5.2 percent); and rehabilitation experience (3.9 percent). The same percentage--almost two-thirds of the respondents--said that more gerontology theory in their initial education would also have been helpful. They specified such areas as gerontology (28.6 percent), death and dying (9.1 percent), social and economic aspects
(9.1 percent), knowledge of community resources and relations (7.8 percent), and methods of teaching (2.6 percent). Among their individual comments, cited verbatim, were: 9 "There could be much learned if students could follow a nursing home patient, one or two years, or even longer." 9 "It would help to learn how to relate to the elderly." 9 "There should be a separate course for geriatric nursing like OB, med, etc." 9 "Clinical experience should be especially in rehabilitation area." 9 "More exposure to healthy elderly." 9 "Experience to work closely with geriatric nurse practitioners." 9 "Exposure to current geriatric nursing theory and techniques." 9 "Physiology of aging, ethics, and legal background." In summary, the most favored topics for continuing education were gerontological changes, drug use and effects, and nursing intervention. The respondents also said that there should be more emphasis on gerontology in basic nursing education, including broader and more intensive clinical experience in geriatric nursing in both longterm and acute-care settings. At a time when the certification of geriatric nurse practitioners is rapidly gaining impetus, it is relevant to explore the opinions of nurses now providing care to older persons. Many of our respondents had been engaged in such care for a long time and were able to crystallize what they perceived as their deficiencies and how they could improve their professional effectiveness. References I. Volinn, 1. J. Professional Nurses in Washington State. Olympia, Division of Health, Washington (State) Department of Social and Health Services, 1971. (Available at State Library, Olympia) 2. Knowles, M. S. The Modern Practice of Adult Education. New York, Association Press, 1970. 3. PetersOn, C. J. Issues in allied health education. IN The Nursing Profession." Views Through the Mist, ed. by Norma L. Chaska. New York, McGraw Hill Book Co., 1978, pp. 135-151.
lected according to a sampling design that took into consideration both the size and location of the agency, so that urban, suburban, and rural work settings could be differentiated. The total yield of usable questionnaires was 77, representing a good cross section of inand outpatient agencies in different geographical locations.
Two-thirds of the nurses said that more experience with the aged, well a n d sick, would have been "of great advantage" during their initial nursing education.
Of the 77 respondents, 46.8 percent held diplomas from hospital programs, 16.9 percent held associate degrees, and the remaining 36.3 percent held bachelors or higher degrees. Their age distribution was assumed to correspond with that revealed by a 1970 study, also in Washington, which indicated a trend for older nurses (above 54 years) to work in nursing homes(l). (In that study, a third of all nurses
emPloyed in nursing homes in the state were in the 45- to 54-y.ear-old bracket, and an additional onefourth were over 55.) Several respondents in the present study emphasized that they had been taking care of older persons for over 30 years or that their basic education dated back about 30 years. More than half of them (57.1 percent) were providing direct patient care, 14.3 percent reported administrative and supervisory responsibilities exclusivelyl and 28.6 percent reported a combination of both.
Continuing Education Needs Malcolm Knowles states that adult learners are essentially selfdirecting;.their reservoir of experience serves as a resource; and their educational expectations are characterized by their desire for immediate application of problem-centered information(2). The questions in this study took Knowles's observations into consideration and also yielded some answers to questions raised by Peterson relative to the content and focus of continuing education programs(3). T w o issues were explored in that respect: (a) the "nurses' confidence in their ability to provide the best possible nursing care to the elderly, and (b) potential means to increase that confidence. Their assessment of their basic education added another dimension. Most respondents (88 percent) were quite self-assured about their
Gerontological changes
14.3
Nummg interventions
11.7
respondents had no comments. That broad approach was followed by more specificity as to the desired content of continuing education. There was considerable diversity in the nurses' recommendations, as reflected in the table that shows the suggested topics and percentage of respondents desiring each one.
Geriatric medicine
10.4
Basic Education Assessment
I"OPICS FOR CONTINUING EDUCATION SUGGESTED BY 77 RESPONDENTS Topics
Percent of
Respondents Drug uae and effects
14.3
Geriatric mental functioning
7.8
New techniques in geriatric care
7.8
Rehabilitation
6.5
Management of chronic iflnessea, including diabetes and malnutrition
5.2
Medical economics
3.9
Death and dying, terminal i~lneaa
2.6
ability to provide optimum geriatric nursing care. Only 12 percent seemed doubtful or distrustful of their abilities. Nevertheless, their responses provided ample information about potential educational self-improvement. Almost half (42 percent) mentioned "education"--either broadly defined or in combination with other factors. The latter included some specific suggestions such as the need for increased professional experience (referring to more cooperation between nurses and physicians, particularly those with a background in geriatric medicine); assignment to different work shifts; and structural changes such as increased support by physicians, clearer definitions of skilled nursing care, updating of licensing and institutional laws and regulations, coordination of community resources and, finally, more personnel to share in the provision of care 9 to older persons. About one-third (36 percent) were precise in evaluating how their professional self-confidence might be enhanced. They perceived one broad nee~as predominant: increased experlence or more professional cooperation or changes in the health care system. The remaining
What clinical or theoretical preparation in their basic education would have contributed to the qual!ty of their geriatric nursing care? Almost two-thirds (66.2 percent) stated that more clinical experience would have been of great advantage and they specified the following areas in which experience as students would have been helpful: more exposure to geriatric nursing (16.9 percent); rotation to geriatric care facilities (14.3 percent); as-
" M u c h could be learned if students could follow a nursing h o m e patient for one or two years or even longer," said a nurse with broad exposure to geriatric patients.
sessment experience with geriatric patients (11.7 percent); community contact with elderly (9.1 percent); care for geriatric patients in the acute care setting (5.2 percent); and rehabilitation experience (3.9 percent). The same percentage--almost two-thirds of the respondents--said that more gerontology theory in their initial education would also have been helpful. They specified such areas as gerontology (28.6 percent), death and dying (9.1 percent), social and economic aspects
(9.1 percent), knowledge of community resources and relations (7.8 percent), and methods of teaching (2.6 percent). Among their individual comments, cited verbatim, were: 9 "There could be much learned if students could follow a nursing home patient, one or two years, or even longer." 9 "It would help to learn how to relate to the elderly." 9 "There should be a separate course for geriatric nursing like OB, med, etc." 9 "Clinical experience should be especially in rehabilitation area." 9 "More exposure to healthy elderly." 9 "Experience to work closely with geriatric nurse practitioners." 9 "Exposure to current geriatric nursing theory and techniques." 9 "Physiology of aging, ethics, and legal background." In summary, the most favored topics for continuing education were gerontological changes, drug use and effects, and nursing intervention. The respondents also said that there should be more emphasis on gerontology in basic nursing education, including broader and more intensive clinical experience in geriatric nursing in both longterm and acute-care settings. At a time when the certification of geriatric nurse practitioners is rapidly gaining impetus, it is relevant to explore the opinions of nurses now providing care to older persons. Many of our respondents had been engaged in such care for a long time and were able to crystallize what they perceived as their deficiencies and how they could improve their professional effectiveness. References I. Volinn, 1. J. Professional Nurses in Washington State. Olympia, Division of Health, Washington (State) Department of Social and Health Services, 1971. (Available at State Library, Olympia) 2. Knowles, M. S. The Modern Practice of Adult Education. New York, Association Press, 1970. 3. PetersOn, C. J. Issues in allied health education. IN The Nursing Profession." Views Through the Mist, ed. by Norma L. Chaska. New York, McGraw Hill Book Co., 1978, pp. 135-151.