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research-article2013

TCNXXX10.1177/1043659613515527Journal of Transcultural NursingAyoğlu et al.

Research Department

Attitudes of Turkish Nursing and Medical Students Toward Elderly People

Journal of Transcultural Nursing 2014, Vol. 25(3) 241­–248 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043659613515527 tcn.sagepub.com

Ferruh Niyazi Ayog˘lu, PhD1, Hülya Kulakçı, PhD, BSN2, Tülay Kuzlu Ayyıldız, PhD, BSN3, Gülbahar Korkmaz Aslan, PhD, BSN4, and Funda Veren, MSc, BSN5

Abstract Purpose: The purpose of this study was to evaluate the attitudes of nursing and medical students toward older people in Turkey. Method: This was a cross-sectional and comparative descriptive study. The Turkish version of Kogan’s Old People Scale was used to evaluate attitudes toward older people among 618 students. Results: Medical students showed more positive attitudes toward older people than nursing students. Students who were females, whose economic income was less than expenditure, and who were not interested in working with older people after graduation showed less positive attitudes. Conclusion: The results suggested that positive attitudes toward older people exist; despite this, it is obvious that more efforts are required to enhance these attitudes. Implications for Practice: Revision and improvement in curricula are needed to enhance the attitudes of students toward older people, and lecturers in schools should further consider the need to prepare students for their roles as caregivers for this particular group. Keywords gerontology, older people, attitudes, nursing students, medical students Due to improvements in health and social fields within the last 25 to 30 years, the life span has increased (Kucukguclu, Mert, & Akpinar, 2011). This has led to an increase in the older population throughout the world (International Data Base, 2010). It has also increased in Turkey, where the proportion of people age 65 years and older reached 7.5% in 2012 (Turkish Statistical Institute, 2012). As the older population continues to increase exponentially, the demand for health care services also increases (Kucukguclu et al., 2011). The increase in the older population requires the configuration of health service planning for older people in Turkey as well as worldwide. Since the quality of health care services that are provided to older people is directly influenced by the attitudes of health care professionals (Cankurtaran et al., 2006; Celik, Kapucu, Tuna, & Akkuş, 2010; Kucukguclu et al., 2011; Ugurlu et al., 2011), their attitudes should be determined to ensure efficient planning and implementation at a national level (Kulakci, 2010). Nurses and doctors, as part of an interdisciplinary team, have a pivotal role as providers of health care services for older people and are uniquely positioned to influence the quality of their care (Cankurtaran et al., 2006; Celik et al., 2010; Holtkamp, Kerkstra, & Ribbe, 2000; Kucukguclu et al., 2011). Attitudes of nursing and medical students will also play an important role in providing health care services in the future (Cankurtaran et al., 2006; Kucukguclu et al., 2011). Therefore, the present study was conducted to evaluate the

attitudes of nursing and medical students toward older people in Turkey. This study also sought to evaluate possible relationships between students’ attitudes and other variables such as age, sex, class level, family type, family’s living place, family’s economic situation, having a family member who is 65 years of age or older, living with someone who is 65 years of age or older, and interest in working with older people. This first known study regarding the attitudes of nursing and medical students toward older people (they were evaluated together) was carried out in Turkey. Therefore, it is thought that the results of this study will make an important contribution to geriatrics/gerontology training for nursing and medical students. 1

Department of Public Health Medical, Bulent Ecevit University, Zonguldak, Turkey 2 Department of Public Health Nursing, Bulent Ecevit University, Zonguldak, Turkey 3 Department of Child Health and Illness Nursing, Bulent Ecevit University, Zonguldak, Turkey 4 Department of Public Health Nursing, Pamukkale University, Denizli, Turkey 5 Department of Surgical Nursing, Bulent Ecevit University, Zonguldak, Turkey Corresponding Author: Hülya Kulakçı, Department of Public Health Nursing, Bulent Ecevit University, Zonguldak, Turkey. Email: [email protected]

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Literature Review Health care services for older people will have an increasingly important part in the practice of health care professionals (Lambrinou, Sourtzi, Kalokerinou, & Lemonidou, 2009). Different attitudes are adopted by health care professionals for different age groups, and these attitudes are mostly negative in terms of older people (Akin, Sevig, & Karataş, 2001; Gething et al., 2004; Kulakci, 2010). These negative attitudes toward older people have a detrimental effect on the quality of health care services and care (Gething et al., 2004). Since today’s nursing and medical students are the health care professionals of tomorrow, development and cultivation of positive attitudes toward older people are crucial (Celik et al., 2010; Lambrinou et al., 2009). Therefore, several studies have been conducted to evaluate the attitudes of students toward older people, and these studies have reported conflicting results. Although some studies have reported that students have positive attitudes toward older people (Burbank, Dowling-Castronovo, Crowther, & Capezuti, 2006; Cheong, Wong, & Koh, 2009; Hweidi & Al-Obeisat, 2006; Lambrinou et al., 2009; McKinlay & Cowan, 2003; Menz, Stewart, & Oates, 2003; Wang et al., 2009), other studies have shown that students have negative attitudes (Aud, Bostick, Marek, & McDaniel, 2006; Happell & Broker, 2001; Soderhamn, Lindencrona, & Gustavsson 2001). However, several factors such as age (Hweidi & Al-Obeisat, 2006; Soderhamn et al., 2001; Vefikulucay-Yilmaz & Terzioglu, 2011), sex (Hweidi & Al-Obeisat, 2006; Lambrinou et al., 2009; Pan, Edwards, & Chang, 2009; Sheikh et al., 2013; Wang et al., 2009; Zambrini, Moraru, Hanna, Kalache, & Nunez, 2008), class level (Bleijenberg, Jansen, & Schuurmans, 2012; Hughes et al., 2008; Hweidi & Al-Obeisat, 2006; Lambrinou et al., 2009; Shen & Xiao, 2012; Soderhamn et al. 2001), income (Hweidi & Al-Obeisat, 2006), and interest in working with older people after graduation (Adibelli, Turkoglu, & Kilic, 2013; Hughes et al., 2008; Hweidi & Al-Obeisat, 2006; Wang et al., 2009) have been also studied and seem to affect the attitudes of nursing and medical students. Several studies have indicated that gerontological education and clinical experiences are the keys to having positive attitudes toward older people (Bernard, McAuley, Belzer, & Neal, 2003; Eskildsen & Flacker, 2009; Ryan, Melby, & Mitchell, 2007; Sheffler, 1995; Shen & Xiao, 2012). For example, Scheffler (1995) evaluated the attitudes of nursing students toward older people by pre- and post-clinical experiences in two health care settings (nursing home and hospital) and assessed the relationship between the students’ knowledge about older people and attitudes toward them. The findings indicated that students’ attitudes toward older people were improved regardless of the clinical setting, and there was a positive relationship between their knowledge and attitudes. In a similar study, Bernard et al. (2003) have conducted a controlled, prospective longitudinal trial of an intervention to introduce medical students to healthy older

people. The attitudes of the students in the intervention group were first determined in the beginning of the first year and then at the end of the second year. The results showed a significant difference between the attitudinal scores of the intervention group and the control group. The students in the intervention group showed more positive attitudes compared with the control group. A later study by Ryan et al. (2007) evaluated the effectiveness of an educational and experiential intervention on the attitudes of nursing students toward older people. The attitudes of nursing students were tested in the beginning of a degree program for adult nursing and during 1 year of the program through a series of visits to a wellknown older person in the community. The results indicated that nursing students reported positive attitudes and these were retained throughout the first year of their nurse training. Eskildsen and Flacker (2009) compared the attitudes and knowledge of first-year medical students about aging issues before and after a course on aging. Findings suggested that the course on aging improved students’ attitudes toward older people and knowledge about aging. As seen in the previous studies, gerontological education and clinical experiences are the best ways to improve nursing and medical students’ knowledge about older people and attitudes toward them. The institutions that provide nursing and medical education play an important role in this regard (Scheffler, 1995; Williams, Anderson, & Day, 2007).

Methods Design and Sample This was a cross-sectional and comparative descriptive study. The study was conducted at a university in the Western Black Sea region of Turkey. The study population included a total of 848 nursing and medical students (nursing students = 403, medical students = 445) during the 2011-2012 academic term. The students who were studying during the dates of data collection and who agreed to participate in the study were included. In accordance with these criteria, 618 students (nursing students = 339, medical students = 279) participated in the study.

Instruments Student Information Form. The form included 10 questions evaluating students’ personal and family characteristics (department, class level, age, sex, family type, family’s living place, family’s economic situation, having a ≥65-yearold family member, living with a ≥65-year-old person, and interest in working with older people). Kogan’s Old People Scale. Kogan’s Old People Scale (KOPS) was developed by Kogan in 1961. KOPS is one of the most commonly used tools that was developed to evaluate attitudes toward older people. It does not contain medical terms but rather has a social context. As well as

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Ayog˘lu et al. being used for health care providers, it is also used to determine the attitudes of society (Kilic & Adibelli, 2011). KOPS is a self-administered scale consisting of 17 paired statements, each having one positive and one negative version. Odd-numbered items contain a negative statement, whereas even-numbered items contain a positive statement. The scores for every item are added together to give a total score; 34 is the lowest score, and 204 is the highest score that can be obtained from the scale. The score indicating a neutral attitude is 102. Therefore, a score below 102 indicates a negative attitude toward older people and a score above 102 indicates a positive attitude. A high score obtained from the total scale indicates a positive attitude toward older people (Ugurlu et al., 2011; Zverev, 2013). Validity and reliability of the original scale were evaluated with two different populations. The first group was composed of psychology students; Cronbach’s alpha was .77 for the positive scale and .76 for the negative scale. The second group was composed of elder care center staff; Cronbach’s alpha was .73 for the positive scale and .83 for the negative scale (Adibelli et al., 2013). Hilt (1999) assessed the scale as a whole and found a Cronbach’s alpha of .81. This scale has been translated into many languages and is used as a valid and reliable tool in many countries (Bleijenberg et al., 2012; Lambrinou et al., 2009; Soderhamn et al., 2001; Ugurlu et al., 2011; Wang et al., 2009; Yen et al., 2009). KOPS was translated into Turkish, and its validity and reliability were studied. Psychometric analysis of the Turkish version of KOPS has indicated high reliability (internal consistency) and good content and construct validity (Erdemir, Kav, Citak, Hanoglu, & Karahan, 2011; Kilic & Adibelli, 2011; Kucukguclu et al., 2011; Ugurlu et al., 2011). Ugurlu et al. (2011) reported a Cronbach’s alpha of .64, Kilic and Adibelli (2011) reported .81, Kucukguclu et al. (2011) reported .89, and Erdemir et al. (2011) reported .84. Ugurlu et al. (2011) stated that the scale could be used with students who were studying in health departments. Therefore, the Turkish version with validity and reliability as determined by Ugurlu et al. was used in our study, and the scale was assessed as a whole. Cronbach’s alpha was calculated as .82 in the current study.

Procedure To use KOPS in this research, written approval was received from Ugurlu et al. (2011), who conducted a validity and reliability study of the Turkish scale. To conduct the research, written approval was received from the Department of Nursing and Faculty of Medicine. The most appropriate days and hours for the collection of data were determined through discussions with the supervisors of the departments. The classes were visited at these predetermined times. Students were informed about the purpose and significance of the study and were reminded that they were not obliged to participate in the study. Data collection tools were distributed to

the students who agreed to participate in the study. Students were asked to respond to the statements as honestly as possible and were reminded not to sign the data collection tools, to maintain anonymity.

Ethical Considerations We obtained approval from the Department of Nursing and Faculty of Medicine of the university overseeing the research. We explained the study to the students in the classrooms and obtained verbal consent from all who participated in the study.

Statistical Analysis We analyzed the data by using SPSS 11.5 for Windows (SPSS Inc., Chicago, IL). Numerical and percentage values were used for categorical variables. Compliance with the normal distribution for numerical variables was assessed by Shapiro-Wilk test. Nonparametric inferential tests were used for the data that were not normally distributed. To test for statistical significance, Mann-Whitney U test and the Kruskal-Wallis test were used for independent samples. Mann-Whitney U tests with Bonferroni correction was used for the comparison of subgroups that were determined to have statistically significant difference by Kruskal-Wallis test. The correlation between age and KOPS score was assessed by Spearman’s correlation analysis. Results were evaluated within 95% confidence interval, and p < .05 was considered statistically significant.

Results A total of 618 students participated in this study evaluating the attitudes of nursing and medical students toward older people. The mean age of the students was 22.50 ± 2.02 years. Three hundred and thirty-nine students (54.9%) were nursing students, and 279 (45.1%) were medical students. Two hundred and seventy-three nursing students (80.5%) and 162 medical students (58.1%) were females. Four hundred and thirty-five students (70.4%) participating in this study were females, 82.8% (n = 512) had a nuclear family type, 60.8% (n = 375) were from a family that lived in a city, 66.0% (n = 407) had an income that was equal to expenditure, 25.7% (n = 156) had a family member who was 65 years of age or older, 45.1% (n = 275) were living with a person who was 65 years of age or older, and 66.6% (n = 406) stated that they were interested in working with older people. Other findings related to the students are summarized in Tables 1 through 3. The mean total KOPS score of the students was 126.98 ± 14.34. This was higher than the neutral score of 102, which suggests an overall positive attitude toward older people in the study sample. Comparative results of the students’ attitudes toward older people based on their education characteristics are

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Table 1.  Kogan’s Old People Scale (KOPS) Scores Based on Education. Variables

n

%

Department (n = 618)   Nursing students 339 54.9   Medical students 279 45.1 Class level of nursing students (n = 339)   First year 85 25.1   Second year 81 23.9   Third year 67 19.8   Fourth year 106 31.3 Class level of medical students (n = 279)   First year 91 32.6   Second year 16 5.7   Third year 41 14.7   Fourth year 53 19.0   Fifth year 44 15.8   Sixth year 34 12.2

KOPS, M ± SD

p

125.70 ± 15.13 128.54 ± 13.18

Attitudes of Turkish Nursing and Medical Students Toward Elderly People.

The purpose of this study was to evaluate the attitudes of nursing and medical students toward older people in Turkey...
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