nursing students' perceptions of elderly and elderliness

Anatol J Clin Investig 2015;9(1):1-5

NURSING STUDENTS’ PERCEPTIONS OF ELDERLY AND ELDERLINESS HEMŞİRELİK ÖĞRENCİLERİNİN YAŞLI VE YAŞLILIK ALGISI Gülendam HAKVERDİOĞLU YÖNT1, Esra AKIN KORHAN 2, Berna DIZER1 1 2

Sifa University, Faculty of Health Science, Turkey, Nursing Science,İzmir. İzmir Kâtip Çelebi University,Faculty of Health Science,Nursing Science,İzmir.

Abstract The elderly are generally known as people who are aged more than 65, walk with a walking stick and with difficulty, are humpbacked, have a hoarse voice. Students who are also responsible of providing care to the elderly should know the life periods and their properties and plan the care in accordance with these information. Behaviors of students in the health care environments and their perceptions concerning the elderlines are also of great importance. To determine perceptions of students concerning the elderly and elderliness. A qualitative and phenomenological study. This study was conducted with 58 1st grade students studying at the department of nursing of the faculty of medical sciences of a university. The data collection instruments used the sociodemographic form and semi-structured interview form. Number and percentage distributions were used in the analysis of sociodemographic data. Students’ perceptions of elderly and elderliness were evaluated by using the qualified analysis method of Colaizzi. Age average of the students was 18.44±0.7 years. 98.3 % of them were male, 63.8 % of them were graduates of an Anatolian high school. Examining the interviews conducted with the students, researchers classified the interviews into three categories and eleven themes. These categories were named as physiological/biological elderly, psychological elderly and sociological elderly. In conclusion we found that nursing students evaluate the elderly with an integrated approach and they do not only focus on the physiological outcomes of elderliness but also consider its psycho-social dimension. However, it was found out that students have negative opinions about elderly people. Key words: Elderly, nursing students, perception, qualitative study. Özet Yaşlı insanlar çoğunlukla bastonla ve zorlanarak yürüyen, beli kambur, sesi kısılmış, 65 yas üstü insanlar olarak bilinmektedir. Öğrenciler yaşlıların yaşam dönemlerini, özelliklerini bilerek ve bu bilgilerle birlikte yaşlılara bakımı planlamaktan sorumludur. Sağlık bakım ortamlarında öğrencilerin davranışları ve yaşlılar hakkındaki algılamaları da oldukça önemlidir. Çalışmanın amacı, öğrencilerin yaşlı ve yaşlılık algısını belirlemektir. Niteliksel ve fenomonolojik çalışmadır. Bu çalışma bir üniversitenin sağlık bilimleri fakültesi hemşirelik bölümü birinci sınıfta okuyan 58 öğrenciyle yapıldı. Verilerin toplanmasında yarı-yapılandırılmış görüşme formu ve sosyodemografik form kullanıldı. Sosyodemografik verilerin analizinde sayı ve yüzde dağılımı kullanıldı. Öğrencilerin yaşlı ve yaşlılık algıları ise, Colaizzi’nin niteliksel araştırma analiz metodu kullanılarak değerlendirildi. Öğrencilerin yaş ortalaması 18.44±0.70 yıl, %98.3’ü kız, %63.8’i anadolu lisesi mezunudur. Araştırmacılar tarafından öğrencilerle yapılan görüşmeler incelenerek, görüşmeler üç kategori ve on bir tema altında sınıflandırıldı. Bu kategoriler “fizyolojik/biyolojik, psikolojik ve sosyolojik yaşlı” olarak adlandırıldı. Hemşirelik öğrencilerinin yaşlıyı ve yaşlılığı bütüncül bir gözle değerlendirdikleri, yaşlılığın sadece fizyolojik sonuçlarına odaklanmadıkları aynı zamanda psiko-sosyal boyutta da yaşlıyı bir bütün olarak algıladıkları belirlendi. Fakat öğrencilerin yaşlı bireyler hakkında negatif görüşlerinin de olduğu bulundu. Anahtar Kelimeler: Yaşlılık, hemşirelik öğrencileri, algı, niteliksel çalışma.

Introduction The number of elderly people is rapidly increasing throughout the world. While there was 600 million people aged 60 and more in 2000, it is expected that this number will reach to 1.2 billion in 2025 and to 2 billion in 2050 [1]. According to data of Turkish Statistical Institute (TSI), 7.1% of the population is 65 and over. It is estimated that it will increase to 9.9% by 2025 [23]. In parallel to the estimations concerning the whole world of the 21st century, it is thought that it will be the century of the elderly in Turkey, as well. It is estimated that there will be around 16 million elderly people in the Turkish population [4].

Elderliness is a period that is defined differently by the people. While some historians emphasize the experiences and wisdom of the elderly, they also underline that they have an aggressive and irritable personality. On the other hand, there are some people who define “disease” as an untimely elderliness and “elderliness” as a natural disease. Elderliness was also identified as a calm period at which experiences allowing the realisation of facts are more intense and peace is dominant [5]. The elderly are generally known as people who are aged more than 65, walk with a walking stick and with difficulty, are humpbacked, have a hoarse voice. Besides, this period is associated

Berna DIZER Sifa University, Faculty of Health Science, Turkey, Nursing Science,İzmir. E-posta: [email protected] Makalenin gönderilme tarihi: 15.10.2011

Makalenin kabul edilme tarihi: 13.09.2013


Nursing students’ perceptions of elderly and elderliness

with an increase in the diseases, addiction, confusion, loneliness, helplessness, wrinkles, stop of balding and greying hair (5). Other people have a conviction that the elderly pose a burden on the society. This is because of the fact that the elderly are viewed as unproductive and weak individuals who have a reduced capacity of performing the daily activities and generally experience incompetence in the mobility [6].

Materials and Methods Participants This is a qualitative and phenomenological study conducted on 58 1st grade students studying at the department of nursing of the faculty of medical sciences of a university. 97% of students participated in this study. Instrument Data form containing the sociodemographic attributes of the students and semi-structured interview form developed by the researchers in line with the literature to determine the perceptions of elderly and elderliness were used in collecting the data. The latter consists of two open questions “Who is called as elderly?” and “How do you perceive the elderliness?” and two closed questions. Interviews were recorded by the researchers through face-to-face in-depth interview technique. Each interview lasts for 20 minutes.

Elderliness is not a disease but it is a period at which the intensity and frequency of health problems increase and functional competences reduce with the changes caused by the elderliness. Thus, the need of the elderly for health care shows an increase. It is thought that experienced health care professionals may affect the provision of the needed care to the elderly and the quality of the care [7]. Depending on health problems of the elderly, they constitute the major receiver of health services. As to the nurses, the most difficult aspect of the health care is providing a quality care to the elderly [8].

Ethical considerations Written approval was obtained from the University’s Medical Researches Ethics Committee. In addition, permissions of the students were taken after the objective and method of the research were explained.

Behaviors of students in the health care environments and their perceptions concerning the elderlines are also of great importance [3,9]. It was detected in a previously conducted study that negative behaviors of nurses towards the elderly cause worse memory performance, reduction in the self-sufficiency and increase in the heart rate and blood pressure in the elderly [10].

Data Analysis Number and percentage distributions were used in the analysis of sociodemographic data. Students’ perceptions of elderly and elderliness were evaluated by using the qualified analysis method of Colaizzi [19]. Interviews conducted by the researchers were read, coded and grouped once more. We classified meanings into categories and themesas described by Colaizzi.

In parallel to the increase of the elderly population, it is a necessity to increase the geriatrics and gerontology trainings in the nursing education [11]. Students who are also responsible of providing care to the elderly should know the life periods and their properties and plan the care in accordance with these information. Nursing students usually work with the elderly at clinical practices, nursing homes and in the health trainings related to the society and provide care to them. The literature reveals that nursing students are negatively inclined towards the elderly and have negative opinions about them [12-14]. Thus, many nursing students do not prefer working with the elderly at the period following their graduation [13,15,16]. There is a limited number of studies related to this issue in our country [3,17,18]. Our aim at this study is to determine the nursing students’ perceptions of the elderly and elderliness. It is also aimed at regulating the content of undergradute educations in accordance with the determination of perceptions of students concerning the elderly and elderliness.

Results Age average of the students was 18.44±0.7 years. 98.3 % of them were male, 63.8 % of them were graduates of an Anatolian high school. While 36.2 % of them live at districts with their families, 29.3 % of them live in the big cities. 55.2 % of the students selected the department of nursing at will. 20.7 % of them stated that there was an elderly person who lived at their family houses and needed care. Examining the interviews conducted with the students, researchers classified the interviews into three categories and eleven themes. Students’s perceptions of elderly and elderliness were classified into three categories. These categories were named as “physiological/biological elderly, psychological elderly and sociological elderly”. The category of physiological/biological elderliness included such themes as “physical ageing, reduction in immunity, health problems and need for care”,

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the psychological elderliness category included “maturity in behaviors, lack of expectation and being experienced and wise” while the sociological elderliness category included “childhood period, approaching death and increase of spiritual breakdown” (Table 1). Table 1. Categories and Themes Elderly and Elderliness Category Physiological/ Biological Elderliness

Psychological elderliness

Sociological elderliness

want to perform many things”, “The elderly assume the burden of years”. The perception of a student concerning the elderly is as follows: “My grandmum comes to my mind (95 years old). I see how impotent she is when I look at her. She does not want to do many things. She sleeps less and she eats less, she thinks constantly and she can not meet most of her needs”.

of Students’ Perceptions of Themes Physical ageing Reduction in immunity Health problems Need for care Maturity in behaviors Lack of expectation Experienced Wisdom Childhood period Approaching death Increase of spiritual breakdown

Discussion Learning the nursing students’ perceptions of the elderly will shed light on the practices to be conducted concerning the care of the elderly and the nursing education. Nurses who will provide care to the elderly at nursing homes, hospitals and the other care environments should plan the care in consideration of the characteristics of this period. After we learn their perceptions of the elderly, we can help students re-shape their misperceptions through education and change the value given by them to the elderly.

Expression examples of students for the category of physiological/biological elderly; “Person with an advanced age”, “People aged 60 and over are in the elderliness period.”, “The elderly perform their actions with difficulty or slowly”, “The elderly have gray hair and beard”, “Facial wrinkles increase during the elderliness”, “Their movements slow down”, “Metabolism slows down with ageing”, “The elderly can not run fast”, “Immune system of the elderly slows down”, “They become susceptible to the diseases”, “People whose recovery times elongate are the elderly”, “Elderliness is the period of weakness and fatigue”, “The elderly can not perform their own works”.

In our study, students defined the elderly physiologically as individuals who perform their works with difficulty or slowly, have gray hair and beard, have increased facial wrinkles, move more slowly, can not run fast, are weak and tired. Moyle [20] asked the following the question to the students in a study: “Describe the Picture you have in your head of an old person?”. Students responded by saying: “gray hair and wirnkles, stooped over, walking with mobility aids and using such devices as glasses and hearing aids.”. Students specified the physical characteristics of elderliness as disabilities, tiredness, reduced fitness, slow speech patterns, incontinence. Paulter [21] expressed in his study that students identified the elderly with wrinkly skin, gray hair, weakening bones as well as the other factors.

Expression examplesof students for the category of psychological elderly; “The elderly behave maturely”, “Elderly people always give advice”, “People who generally have an opinion about everything are the elderly”, “Elderly people are experienced”, “Elderly people are forgetful”, “Carelessness dominates the elderliness period”, “The elderly suffer from intense depressive emotions”, “Elderly people constantly think about the past and love talking of the past”, “The elderly think that the death is approaching”.

In our study, students described elderly people psychologically as people who are forgetful, experienced, wise, depressive and think that the death is approaching. It was also stated in the study of Paulter [21] that psychological effects of elderliness were depression, sharpness lose in the memory and slow brain activity. The study of Çelik et al. [17] revealed such opinions of students concerning ageing: “Ageing is to be the eldest person at home, to be an adviser”, “Ageing is a preparation period for death”. At the same time, students expressed that elderliness means an increased number of diseases and negative opinions, an increasing need for care and the occurence of cellular ageing. It was expressed in the study of Rogan and Wyllie [22] that behaviors of students towards the elderly result from their previous experiences with the elderly. In the study of McCracken et al. [23] and Shoemake

Expression examples of students for the category of sociological elderly; “Those beliving that they lived good and in full are the elderly”, “The most precious element of the society is the elderly”, “Elderliness is the period of childhood”, “Most of the elderly people do not expect too much from the life”, “Those who have already consume their aims are generally elderly people”, “The elderly do not

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and Bowman [24], it was detected that behaviors of students and previous experiences with the elderly have a positive correlation. It is thought in our study that participants’ perceptions of the elderly result from the elderly relative (grandmother) that they live together at the family home.

participating in the research do not contain a course related to the elderliness. Thus, students’ perceptions of elderliness are based on elderly people that they live together at home or see in the society. Conclusion It was determined that nursing students evaluate the elderly with an integrated approach and they do not only focus on the physiological outcomes of elderliness but also consider its psycho-social dimension. However, it was found out that students have negative opinions about elderly people, feel pity for them and consider them as people who are weak and approach to death. It is necessary to include courses related to elderliness and elderly people into the instructional programs of the nursing departments and to help students develop positive opinions about elderliness/elderly people. In this manner, it is envisaged that students working at nursing homes or providing care to the elderly at other places after graduation can provide a quality care to them. Finally, it is recommended that the research should be conducted with a larger sample including the students studying at the other departments related to the health.

Working rates of the elderly is relatively low in the Turkish society. With ageing, elderly people prefer isolating themselves from the social life and remaining at home. Especially, elderly women spend most of their time at home while elderly men spend at the coffe houses. In the countryside where a large family structure is dominant, elderly people live together with their sons, daughters-in-low and grandchildren and all of their needs are met by the daughter-in-lowdaughter, son or grandchildren. In such families, the elderly are people to be greatly respected. They embrace the elderly people and oppose to their stay at nursing homes. This situation results from the respect and fidelity felt towards the elderly. When the elderly go to the nursing home, families can feel guilty. In the nuclear family structure seen in the big cities, this situation shows a slight difference and the elderly people can stay at nursing homes. It was found out that sociocultural factors, religion, cultural values, norms and social norm of the society can change the perception concerning the elderly [8]. It is seen in our study that perceptions of students concerning the elderly reflect the elderly profile of the Turkish society.

Implications for practice • It was determined that nursing students have negative opinions about elderly people. • It is necessary to include courses related to elderliness and elderly people into the instructional programs of the nursing departments. More primary research is needed that focuses on the different grade nursing students’ perceptions.

One of the constraints of our research is that it was conducted among the first grade nursing students of a university and did not include other students studying in the field of health. Besides, instructional programs of the first grade students

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