An Exploration of the Attitudes, Knowledge, Willingness and Future Intentions to Work with Older People among Saudi Nursing Students in Baccalaureate Nursing Schools in Saudi Arabia

Samira Alsenany

Sheffield University
Awarded 2010

The kingdom of Saudi Arabia, like the rest of the world, has a growing older population with urgent health care needs. However little prior research has been undertaken on this topic. In the light of this, the aim of this study was to explore the attitudes, knowledge, willingness and intentions to work with older people among nursing students, and to consider the effects of clinical nursing practice on such factors in the first year and the final (pre-registration) year of training in three major university hospitals. The study was underpinned by the theory of planned behaviour (Fishbein and Ajzen, 1975) which was used as a conceptual framework to explore the relationships between attitudes, subjective norms, perceived behavioural control and behavioural intentions amongst 566 nursing students. The study used a mixed methods design comprising of surveys with the nursing students and 132 faculty members and three focus groups with faculty members to explore their feelings about gerontological education in-depth. The questionnaires contained a range of previously validated instruments including Kogan’s Attitude Towards Older People Scale, Palmore’s Facts on Ageing Quiz, a measure of students’ willingness to work with older people and a measure of their perceived intention to work with them. Open-ended questions were also included. Data were analysed using both multivariate statistics and content analysis.

The results provided some interesting and important insights into the complex factors potentially shaping students intentions to work with older people. For example the 566 nursing students who participated in this study displayed a lack of basic knowledge of the physical and behavioural aspects of ageing but held largely positive attitudes towards older people. Despite such positive attitudes a majority of the participants indicated that they would prefer not to work with older people after graduation, although those students who indicated that they would prefer to work with them had the most positive attitudes and the strongest willingness and intent to take care of older people. The data also highlight the potential of clinical training experience with older adults to improve the previous variables (attitudes, willingness and intentions). The qualitative data from both students and teachers highlighted a range of complex factors that in part explained some of the quantitative findings. These related to the influence of subjective norms and perceived control. Therefore at a cultural level Saudi students are exposed to strong positive norms in relation to older people but on entering training may be exposed to negative professional norms as to the status and desirability of gerontological nursing as a career. This, together with students’ limited perceived control due to inadequate preparation for practice offer potential explanations as to the disparity between attitudes and behavioural intentions. The qualitative data also highlight the need for greater attention to the preparation of nursing students, with the provision of integrated skills and knowledge on the care of older people.

The study also provides a limited critique of the theory of planned behaviour, which whilst supported in part cannot account fully for the complex cultural and professional factors shaping students future career intentions. The thesis, the first of its kind undertaken in Saudi Arabia, concludes with some reflections and suggestions for further research and the actions needed if the preparation of students to work with older people is to improve in the future.

Building Bridges of Understanding: The Use of Embodied Practices with Older People with Dementia and their Care Staff as Mediated by Dance Movement Psychotherapy

Richard Coaten

Roehampton University
Awarded 2010

This study investigates the use of Dance Movement Psychotherapy (DMP) on people with dementia, on care-staff, on embodied practices and the author's own reflections and developing understanding about their use and importance. Embodied practices mean engaging with a person through the lived experience of their own body in relationship to self and others, thus people with dementia can be more effectively reached and communicated with. Embodied practices contributed to: improving mobility; affirming identity; supporting affective communication; increasing observed “well-being” and extending the range and quality of care relationships.

This study proposes care-staff need to be better informed psychologically about how to engage, how to “build bridges of understanding” between the “known” and the not yet “known”. Care-staff need to be more accepting that communications and behaviours expressed through “strangeness” and “otherness” can be better understood and related to as having meaning and importance. This is a paradigm shift away from biomedical
thinking, placing the onus on care-staff becoming more adept at communicating and finding
meaning in so-called “non-sense”. Embodied practices support remaining individual capacities and communication skills and by way of this, “Personhood” (Kitwood and Bredin, 1992a: 274).

The fieldwork was within a mental-health hospital ward in England. A single DMP session was studied using a qualitative and quantitative methodology, regarding impact on the patient, on care-staff, and on the use of embodied practices. It was recorded on video (VTR), mapped using Dementia Care Mapping (DCM) 2 with the impact on care-staff studied using questionnaires. Analysis of the VTR transcript yielded thirtythree linked themes leading to five further meta-themes. DCM results indicated significant effects on raising and supporting observed “well-being”, consistent with other sessions of a similar type (Crichton, 1997, Perrin, 1998).

Contribution to knowledge concerns the development of a more creative, more expressive and embodied approach to the care of people living with dementia as presented here by the development of a new approach called “Creative Care”.

Women in Old Age: An Egalitarian Analysis of the Emotional Significance of Age-based Inequalities

Loretta Crawley

University College Dublin
Awarded 2010

Drawing on egalitarian and feminist traditions, this thesis explores the emotional significance of age-based inequalities experienced by Irish women. The thesis is based on a qualitative study of twenty-one women in old age; they varied in social class, marital and family status, disability, and in regional location. In-depth interviews were employed as the most appropriate method to obtain data about women’s personal experiences and perceptions of age-based inequalities and the impact of these on their well-being. The interviews were, digitally recorded, transcribed and saved for analysis using a qualitative software package (MAXqda).

Within the area of social gerontology, gender-based approaches to the analyses of age-based inequalities are in the early stages of development. Within feminist and critical gerontology, egalitarian and emotional perspectives on the analyses of women’s experiences are under-developed. This study brought an egalitarian perspective to bear on both social and critical gerontology, and feminism, showing how age-related inequalities are gendered and how inequality also has a strong affective dimension. Injustices are experienced emotionally as well as materially and politically (Skeggs, 2004, Sayer, 2005).

The study found that older women experienced age-related inequalities as devaluation, obligations, exclusion and misrecognition, and they experienced injustices in areas of life that were largely outside of their control. Thus, while political and economic injustices experienced by people in old age are of profound importance, and these vary by social class, marital status, disability and other attributes, they are compounded by affective injustices (Lynch, Baker and Lyons, 2009).

An Investigation of Individual Recruitment Decision-making following Criminal Records Bureau Checks: The Implications for the Protection of Vulnerable Adults

Nageen Mustafa

Staffordshire University
Awarded 2010

In 2004 it was reported that an up to half a million elderly people may be victims of abuse at any one time. Studies have shown that elder abuse can have devastating effects upon service users and can often lead to long-term health problems. It is vital that health care service providers acknowledge the importance of recruitment decision-making when employing carers for work involving vulnerable adults.

In 2002 the Criminal Records Bureau (CRB) was established in the UK to ensure safer recruitment decisions could be made. The CRB check is utilised to facilitate safer recruitment decisions by providing employers with wider access to an applicant’s criminal record information through a Disclosure service. However, how these changes are impacting upon recruitment decisions and its implications for the protection of vulnerable adults is yet to be examined.

Therefore, the research presented here, sets out to explore how recruitment decisions are being made using CRB Disclosure information. The implications of these decisions for the protection of vulnerable adults and the ex-offender are examined. Organisations from the National Health Service, Social Services, Higher Education, Further Education and Care Home sectors whose employees have contact with vulnerable persons were recruited to take part in this research. A mixed methods approach was utilised to investigate research objectives.

The findings indicate that recruitment decisions are being made inconsistently both within and between organisations. Both the actual recruitment decision made and the reasons for these decisions varied. In addition, results suggested that the organisation to which an ex-offender applies to for a post could determine the success of their application based on the recruitment decision-maker/s involved in the process. Moreover, there was no general consensus on what constituted a problematic offending profile.

In order to aid data collection, a software package named Survey Software was created. This allowed the administration of a series of questionnaires, whilst recording and sorting the inputted information.