KNOWLEDGE ATTITUDE AND PRACTICE OF CARE OF ELDERLY PATIENT AMONG HEALTH WORKERS
CHAPTER ONE
Objectives of the study
Specifically the objectives of the study include to:
- determine the health workers level of knowledge of the physical, emotional and social care of the elderly in Ekiti State University Teaching Hospital ,Ado Ekiti, Ekiti State
- determine the attitude of the health workers towards the care of the elderly.
- determine the health workers practices in the provision of care for the elderly.
- identify the factors that influence health workers attitude of care towards the elderly in Ekiti State University Teaching Hospital, Ado Ekiti.
CHAPTER TWO
LITERATURE REVIEW
This chapter presents the review of literature related to the work, from books, Journals,
Abstracts, and internet materials, under the following subheadings:
Conceptual Review,(Concept of ageing, Biopsychosocial challenges of the care of the elderly, Knowledge of care of the elderly amongst health workers, Attitude / practice of health workers on the care of the elderly, Problems associated with the care of the elderly, Factors influencing health workers practice of care towards the elderly), Theoretical Review, Empirical Review and Summary of review.
Conceptual Review
Concept of Ageing
Aging is a universal phenomenon that is obvious as well as inevitable. Old age is a significant stage in life and normally related to life expectancy of given area, hence the conditions and the needs of the aged becomes imperative. Preparation for old age cannot be over emphasized. Aging can be observed as a consistent pattern of change that every human being undergoes, starting at a very slow rate at around age 30, and progressing at a more rapid rate beyond age 65 (Olowookere, 2003). Aging is a sensitive and seriously regarded issue and it is a process of becoming older. The aged in Nigeria are highly revered, respected and often held in high esteem. The aged constitute a repository of wisdom and experiences.
The aged are often seen as the custodians of knowledge due to their experience in life.
The population of old people throughout the world is increasing at a very rapid rate (Population
Reference Bureau, 2011). The most rapid increase is taking place in the developing world with
Africa alone projected to have between 204 and 210 million old people by the year 2050. This unprecedented rise in the number old people presents fundamental socio-economic difficulties (Olaleye, 2011). Nigeria with a population of 140.8 million people (NPC 2006) is the most populated nation in Africa and the ninth in the world (UN, 2005). Life expectancy at birth stands at 57.6 years (NPC, 2008). The population growth rate (2000 – 2005) is 2.5% with 5.6% of the total population aged 60 and above. As the most populous country in Africa, Nigeria currently has the highest number of aged or elderly people in Africa Population Reference Bureau(PRB, 2011) with the largest population in Africa and the ninth in the world, it is estimated that by year 2025, the population of Nigeria aged 60 and above will constitute 6 percent of the entire population as projected by (UN population Division, 2005)
Old age is not a disease; it is the phase of retrograde biological process in growth and development which leads to decreased powers of survival and adjustment. The World Health Organization has always designated as “Elderly” people aged 65 years and above. In 1980, the United Nations defined 60 years as the age of transition of people. (U N 2004). Older people make up an increasing proportion of the population in developed world and this demographic transition also affects some developing countries. Generally older people are at increased risk of disease, disability, social and financial deprivation compared to the younger generation in the same population (National Council on Ageing and older people (NCAOP) , 2005). An increase in the number of older people will lead to increased demands on health and support services including aged care residential services and acute health service (Mccormacks, 2004).
Mcmurdo (2000) also stated that the elderly have reduced ability to generate resources; they lack the basic needs that affect their health status. Where one finds well developed Maternal and Child Health Services, a vacuum exists in the elderly health policy. Population growth combined with ageing will mean that greater number of older people will need health and community care services, more older people in the hospital mean more people with dementia needing appropriate care. Varice (2010) indicated that society where the elderly population is expanding and cultural values are changing, the needs of the elderly become increasing by entwined with appropriate health care needs. Death of older people both in institutional settings and the community have often been attributed to natural, accidental or undetermined causes when in fact they were consequences of abusive or neglectful behavior. As long as older people are devalued and marginalized by society they will suffer from loss of self identity and remain highly susceptible to discrimination and all forms of abuse (Szucs, 2001)
The concept of aging is multifaceted. This is because its in-depth description or explanation covers diverse areas of human development. There are chronological, biological, psychological and social, functional dimensions of aging (Papalia, Feldman and Camp, 2002; Hoyer and Roodin, 2003). The chronological dimension describes the number of years that have slipped away since one’s birth while the biological explains the status of vital organs of the body as an individual advances in age. The psychological dimension focuses on individuals’ ability to adapt to environmental demands/challenges while social dimension sheds light on how an individual conforms to written and unwritten norms, roles expected of him/her by the society in which he/she operates. The functional dimension measures how effective an individual is in physical and social environment when compared with other people within his/ her age bracket (Hoyer and Rodin, 2003). The concept of aging to some scholars is not a single or one-way process, Berger, Dev, Mutrie & Hannah (2005) posits that there are three distinct but interrelated processes of ageing. These are primary, secondary and tertiary aging. The primary ageing represents the inevitable age – related changes, which all human beings are expected to pass through. The period is characterized by inability of human organism to replace damaged parts of the body. The secondary aging involves all the age related changes, which are consequences of individual and societal failure to eradicate unhealthy conditions. It is at this period that certain diseases such as Cancer, diabetes, arthritis, visit the elderly. The tertiary ageing on the other hand, deals with numerous losses or unpleasant experiences associated with old age. Most developed world countries have accepted the chronological age of 65years as a definition of ‘elderly’ or older person, but like many westernized concepts, this does not become accustomed to the situation in Africa, while this definition is somewhat arbitrary, it is associated with the age at which one can begin to receive pension benefits. At the moment, there is no United Nations standard numerical criterion, but the UN agreed cut –off is 60+ years to refer to the older population (UN, 2004)
Bio-psychosocial challenges of the elderly in Nigeria
Physical changes
According to Berger Dev, Mutrie and Hannah (2005) the first sign of ageing begins with the skin which becomes drier, thinner and has elastic wrinkles, visible blood vessels and pocket of fat under the skin appear as irrefutable evidence of the passage of time. Merrill and verbrugge (2001) also revealed that with time pockets of fat settle on various parts of the body most noticeable around the abdomen, but also on the upper arms, the buttocks, eyelids and double chin, bones become fragile and more easily broken and difficult to heal. The Muscles loose power and become atrophy while joints stiffen or wear out, circulation slows down, blood pressure rises and because the lungs hold less oxygen the aged has less energy, reaction to stimuli is slower and there is less resistance to illness. There are difficulties to fall asleep and remaining asleep and vision, hearing and sense of smell became less acute (Nur et al, 2009). Disability significantly affects quality of life in old age though it is considered to be consequences of the normal ageing process; they are often caused by chronic diseases which the elderly are at risk (Szucs, 2001). There seems to be a problem with providing the appropriate care for these disabilities for this segment of the population yet the population is growing rapidly in both developed and developing countries (Vitalianie, Zhang and Scsarian, 2003).
Accessibility to Care
The lack of health care for senior citizens is a crucial problem with the assumption that Provision of healthcare services has always been adequate. This assumption is wrong as recent research has shown that Medical care is not easily accessible. This is because the geographical distance to get to these services makes it difficult, if not impossible for many older people to access, particularly in the rural areas (Nussbaum, 2003). Hence, their health needs still has to be met by visiting traditional medical men and herbalists. At the family level care services provided do not adequately meet the needs of the old persons. Diminishing economic power has hindered the willing family members. However these changes demand that governments, the private sector, nongovernmental organizations and the civil society in general be prepared to deal with them, bearing in mind the special needs of the people.
CHAPTER THREE
RESEARCH METHOD
This chapter presents research design, area of study, population of study, sample, sampling procedure, research instrument, validation of the instrument, reliability testing, ethical consideration, procedure for data collection and method of data analysis.
Research Design
A Cross sectional descriptive study design was used to determine the level of knowledge, attitude and practice of care of elderly among health workers in Ekiti State University Teaching Hospital Ado Ekiti Ekiti State. According to Isangedihi, Joshua, Asim & Ekuri (2004), the descriptive study survey allows orderly collection of data. The cross sectional approach involves the collection of data at a point in time and considered suitable for the phenomenon being studied (Polit & Beck, 2006).
Area of the Study
The area of study was Ekiti State University Teaching Hospital (ESUTH). It is a tertiary institution located in Ado Ekiti, Ekiti State. ESUTH Ado Ekiti is a research, training and service centre for health professionals and health care needs of all age groups are met At inception, the Teaching Hospital inherited 1 consultant, 34 general duty doctors, 250 nurses and 6 pharmacists. At present, the hospital can boast of 29 Consultants, 2 Senior Registrars, 65 general duty doctors, 288 nurses, 14 Pharmacists, 4 Pharmacy Technicians, 18 Laboratory Scientists and 125 Hospital Attendants. The transition involved the posting of staff from HMB (Hospital Management Board) to the Teaching Hospital and transfer of some of the staff of the State Specialist Hospital to the Hospitals Management Board. It consists of so many units namely casualty, Outpatient Department, Medical, Surgical, Theatre, orthopedic, Pediatric, Maternity, community Health, E.N.T and Administration to mention but few. It has 600 beds for inpatients and is headed by a Chief Medical Director and other subordinates in sub units.
CHAPTER FOUR
PRESENTATION OF RESULTS
The results are presented in Tables and figures according to the research questions. Out of 461 questionnaires that were administered 460 questionnaires were returned giving a returned rate of 99.9%.
CHAPTER FIVE
DISCUSSION OF FINDINGS
This chapter presents discussion of major findings; conclusion, implication of findings to nursing, recommendations, suggestions for further studies and summary as well as limitation of the study.
Research Question 1
What is the level of knowledge of care of the elderly among health workers in ESUTH, Ado Ekiti. The findings in this study indicate that majority(95%) of the health workers had adequate knowledge on the basic needs and care of the elderly. The findings also revealed that health workers who had sufficient knowledge on the nutrition and personal hygiene of the elderly were also in the majority. The explanation for this may be because all the health workers have tertiary education and are already in specialized areas. This agrees with the finding of Okoye and Asa (2011) that knowledge on the basic needs of the elderly will help care givers to assist the elderly to meet their needs without compromising their health and safety. It is also in agreement with Mandy, Mitehell and Oneil , (2011) that higher level of education increases health workers knowledge of care of the elderly. However, this findings disagrees with Donatelle (2001) and Mcfarely and Morrison(2004) that posits that most curricula of health professionals have little or nothing to do about the elderly and as such most health workers have very poor knowledge on the care of the elderly.
Research Question 2
What is the attitude of health workers towards the care of the elderly in ESUTH Ado Ekiti
The study reveals that the positive attitude of the health workers was higher than the negative attitude that they like taking care of the elderly; they called the patient by name and created a relationship with the elderly. This agrees with Mandy, Mitchel and Oniel (2011) that reported health workers have positive attitude towards the care of the elderly. It is also in line with the Oyetunde, Ojo and Ojewale (2013) opinion that there is positive attitude of health workers towards the care of the elderly. The positive attitude of health workers towards the care of the elderly in the study is probably due to high level of education and well trained health workers. This is in accordance with Nelson (2004) who concluded that trained health workers are more likely to develop positive attitude to the care of the elderly. And also agrees with Kaempfer, Wellam & Himburg, (2002) that opines that the higher the level of education the more positive the attitude towards the care of elderly among health workers.
However the findings also revealed that a large proportion of health workers also (68%) agreed that caring for the elderly is difficult and stressful so they prefer to take care of younger patients, than elderly people. Also the fact that taking care of the elderly is time consuming, and that the mental state of the elderly affects their response to care. This agrees with Lee, (2007) and Weiss (2005), that reported negative attitude of health workers towards the care of the elderly could be due to the inability of the health workers to identify those conditions that can be treated effectively as well as inadequate resource to treat. It also agrees with Okoye & Asa, (2011) that concluded that health workers experience stress when caring for the elderly greatly because it is time consuming and emotionally, physically and psychologically draining.
Findings from the study also revealed that majority of the health workers prefer taking care of younger people. This could be because taking care of the elderly is time consuming and stressful. This agrees with Weiss (2005) and Lee (2007) that reported that health workers show negative attitude towards the elderly by using physical restrictions to disrespect the patient autonomy and dignity and discriminate against them.
Research Question 3
What are the health workers practices in the provision of care towards the elderly.
The findings revealed that majority of health workers (81%) provided adequate care for the elderly. The practices included nutritional assessment, thorough assessment during emergency, evaluation and effective care, calling patient by name and creating a relationship. These findings are due to the high level of education and specialization of the health workers. This is in accordance with Lecovich (2008) that concluded that calling patient by their name is one of the good behavioral practices of care of the elderly. It is also in line with Oyetunde, Ojo and Ojewale (2013) that also concluded that nutritional assessment is an integral part of clinical assessment for the elderly. However this finding disagrees with Sulaimen et al (2010) who still emphasizes on the preservation of the family and value of taking care of their parents at home.
Research Question 4
What are the factors that influence health workers attitude towards the care of the elderly?
These findings revealed that most of the respondents (97%) agreed that taking care of the elderly requires special training and those special wards should be created for the elderly (geriatric wards). This finding is probably because the elderly have some peculiarities that would require special care and also a cordoned area. The study also reveals that most of the health workers would not prefer this area of specialization except when they are being forced to. This agrees with Happel (2002), alliance for ageing research, (2003) and Bowen et al, (2008), whose findings showed that identification of geriatrics as a career choice amongst health workers and social care workers appear to be a long standing theme in literature.
HYPOTHESIS 1. There is no association between the years of experience of the health workers and their attitude towards the care of the elderly.
The findings reveal that negative attitudes of health workers with mean years of experience are statistically significant. With the item that health worker neglects themselves when taking care of the elderly. Health workers with less years of experience strongly agreed that they will neglect themselves while those with many years of experience disagreed. This shows that there is association of attitude with many years of experience therefore rejects the null hypothesis. There is association of mean years of experience with attitude of health workers towards the care of the elderly. This may be due to the fact that the health workers with lesser years of experience have not had enough experience of caring for the elderly. With increased years of experience there may be improved attitude towards the care of the elderly.
Implication of Findings to Nursing
- Geriatric Nursing content in the curriculum to be strengthened.
- Consistent and frequent education programmes need to be implemented to address knowledge gaps in contemporary Geriatric Nursing.
Limitation of the study
The study was conducted in Ekiti State University Teaching Hospital, Ado Ekiti. This means that there may not be much room for generalization because health workers in other institutions may have different knowledge, attitude and practice of the care of the elderly. Also only selected health workers in special professions were considered therefore the knowledge of health workers in other disciplines of health were left out. Information was based on the respondent’s perception which could have been influenced by other factors such as the time, schedule, etc. Practice of health workers care was assessed by their knowledge on practice of care, not by the process-outcome approach.
Summary
The study focused on the knowledge, Attitude and practice of care of the elderly patients among health workers in Ekiti State University Teaching Hospital, Ado Ekiti. The specific objectives were to (i) determine the level of knowledge, the physical, emotional and social care of the elderly patients in the Ekiti State University Teaching Hospital, Ado Ekiti (ii) determine the attitude of health workers in the care of the elderly patients, (iii) determine the level of health workers practices in the provision of care of the elderly patients, (iv) identify factors that influence the health workers attitude towards the elderly patients in Ekiti State University Teaching Hospital, Ado Ekiti. The hypothesis for the study tested the association between years of experience of health workers and their attitude towards care of the elderly patients in ESUTH. Ado Ekiti. The study adopted a cross sectional descriptive design. The population of the study was 1023 health workers, made up of 402 Doctors, 600 Nurses, 10 Dentists and 11 Physiotherapists that provided direct clinical care to elderly patients. The sample was calculated using Taro-Yamane simplified formula for finite population giving a sample of 461 health workers. The instrument for data collection was questionnaire, the reliability of the instrument was done using test retest method and a reliability co-efficient of 0.91 was obtained. The questionnaire had five sections, section A covered socio demographic data, section B, C, D consisted of items which explored level of knowledge. Attitude, practice and section E elicited information on factors influencing the care of the elderly patients. The completed questionnaire was coded and analyzed using E.P.I info-7. Descriptive statistics of percentage, mean, standard deviation were used for data analysis. The criterion mean of 2.5 was also used and results the study revealed that 95% of the health workers had good knowledge of care of the elderly patients. Majority of the health workers had positive attitude above rating scale of 2.5. The health workers moderately practiced care of the elderly patients. The factors that positively influenced health workers attitude to the care of the elderly were years of experience, age and mental state of the elderly. There was significant association (P<0.05) between attitude of Health Workers and mean years of experience. Workers with less years of experience had negative attitude, while those with more years of experience had positive attitude, towards the care of the elderly patients.
Conclusion
In conclusion, health care professionals need to have the right skills to manage a more demanding role in the future. In order to offer effective services for the elderly patients, a skilled workforce of health professionals is therefore very necessary.
Recommendations
Although the findings of the study show that health workers have good knowledge on the care of the elderly, the attitude of the health workers was statistically significant with mean years of experience i.e. the years of experience is associated with attitude of health workers. There is need to provide more resources and also training of personnel in area of elderly care.
- Special wards / department should be created for the elderly in the hospitals with well trained staff in the area of specialization.
The researcher also suggested that the government should develop a health policy for the elderly that will capture the care of the elderly.
- Develop a system of periodical health workers evaluation to determine strategies of upgrading their knowledge and enhancing practice.
- Development of follow up courses and in service training programs should be conducted to maintain efficient performance of individuals previously trained in the care of the elderly
- Encouraging health workers to attend national and international congresses, seminars symposiums and workshops on care of the elderly.
Suggestion for further studies
The researcher suggests that similar study on the knowledge of care of the elderly should be done in other health facilities in other States. Other studies that include the problems associated with health workers attitude towards the care of the elderly.
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