Rajiv Gandhi University of Health Science, Karnataka

Rajiv Gandhi University of Health Science, Karnataka,

Bangalore

PERFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Address

ALPHONSA C.M.

1st YEAR M.Sc NURSING

ROYAL COLLEGE OF NURSING,

7th MAIN, 1st BLOCK,

UTTARAHALLI,
BANGALORE- 560- 061.

Name of the Institution

Royal College of Nursing

Course of study and subject

1st year M. Sc Nursing

Psychiatric Nursing

Date of admission to course

/ 30.06.2008

Title of the Topic

A Descriptive Study To Assess The Knowledge And Attitude Regarding Importance Of Geriatric Psychiatry Among Fourth Year B. Sc Nursing Students In Royal College of Nursing, Bangalore- 61 With A View To Develop An Information Booklet.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Youth is like a fresh flower in May.

Age is like a rainbow that follows the storms of life.

Each has its own beauty.” David Polis.

“Old is Gold” goes the saying “An oldwife and old wine never betrays the master”. Mankind has learned the importance and value of older population in shaping the society even when there was no medical advancements and gerontology. Some of the great men and women with their examples have proved the point that old age can be something to look forward to1.

The elderly are precious asset for any country. They have a special health and socio- economic background, which differ from those of the general population2. A significant proportion of the population in India is old. This population will go on increasing due to improved medical facilities and a reduced child mortality rate. For the past 50 years there has been a distinct change in Indian family system. Joint families are turning to nuclear families3.

Ageing is associated with a decline in physical and mental health and vigour whose severity and rate of progress in subject to much variation. Circumstances connected with retirement have often been cited as causes of unhappiness and emotional breakdown in old people. Poverty is a widespread cause of distress among the aged4. The feeling of loneliness along with the natural age- related decline in physical and psychosocial functioning, make them prone to psychological disturbances. These old persons are a great human resource and not utilize them properly may be a national waste. Hence. Elderly care is the fulfillment of the special needs and requirements that are unique to senior citizens. This broad term encompasses such services as associated living, adult day care, long- term care, nursing homes, and hospice care and in home care3.

The waste majority of outcome studies show that good geriatric care results in increased quality of life, lower morbidity and lower mortality versus traditional medical care. If nurses are able to take care of elderly patients with out any difficult, they will be able to take care of any kind of patient in any situation. It is basically because there is more legalities and decision making involve in them. Hence they need enough knowledge and a positive attitude towards geriatric psychiatry. It will start from the basic curriculum itself. So it is essential to assess the knowledge of graduate nursing students regarding the importance of geriatric psychiatric nursing5.

6.1 NEED FOR STUDY

“Today’s student nurses are tomorrow’s registered nurses”.

Touphy D.

Psychopathology increases with age. Older adults have disproportionately more psychiatric disorders, behavioral stress, and adjustment problems than younger adults at a time when their quality of life should be the best. The incidence of suicide and functional disorders increases with the age. Organic brain diseases increases after age 60 and the suicide rate is four times higher for the older Caucasian man than it is for younger adults6.

The alarming situation is that world’s elderly population is increasing monthly by about 1 million and quite often the 21st century is going to be called as “ the age of ageing” 7. The population of person aged 60 years and above comprises 7.5% of the global population. It is expected that this percentage will increase to 10.8% by 2025 8.

Geriatric population is very vulnerable to many medical and psychiatric disorders. Depressive disorder was the most common psychiatric illness and among the physical illness Hypertension (HTN) was the commonest. People living in the old age home are felt better than those who livid with their children’s family.9 The incidence rate per 1000 person per year was 7.7 for Alzheimer’s disease and 1.5 for vascular dementia. People living in the old age home felt better than those who lived with their children’s family10.

By 2030, the numbers of older adults with mental illness will strain our health care system. Sufficient advanced practice nurses with specialized knowledge to provide care will be critical. With the geriatric population increasing, so will their needs for mental health care. However, attracting nurses to work with mentally ill older adults can be challenging. The importance of supportive collaborative role with in nursing leadership staff is emphasized11.

Most health care and social service providers are routinely required to work with elderly clients and client’s aging family members. Research suggests that students entering these professions have knowledge deficits and lack positive attitudes toward older people. Few prefer to work with aging clients. Professional curricula are not providing students with adequate training to serve the current needs of this population, much less to meet projected increases in demand for services12.

Nowadays the attitude of young nursing students towards elderly mentally ill are not positive. It may be due to lack of adequate knowledge. The investigator herself felt very bad about caring of older adults during her student period. So it is necessary to provide adequate knowledge to student nurses regarding importance of geriatric psychiatric nursing. Many researches show that student nurses have no adequate knowledge & only have neutral attitude. Recently there is no much researches conducted to evaluate student’s knowledge and attitude regarding importance of geriatric psychiatry.

This is relevant as today’s student nurses are tomorrow’s registered nurses and the manner in which they currently communicate with older person may indicate how they will interact with this population in the future. So investigator thought that it is an important study to assess student’s knowledge and attitude regarding importance of geriatric psychiatry.

6.2 REVIEW OF LITERATURE

Researchers almost never conduct a study in an intellectual vacuum; their studies are usually undertaken with in the context of an existing knowledge base. A literature review helps to lay the foundation for the study, and can also inspire new research ideas13.

A qualitative study conducted to assess the attitude of elderly patients towards student rendered care in New Zealand. This study explores the perspectives of 12 older patients in long- term care hospitals who had first year nursing students involved in their care. Data were gathered using face- to- face, semi- structured interviews. The result revealed that with the exception of one patient, this group of older patients found first- year student nurses- rendered care to be a positive experience. The patients also demonstrated an interest in participating student’s learning14.

A study conducted to evaluate the quality of student nurse-older person communication in Mid- Western Regional Hospital, Ireland. Using both participant observation and semi- structured interviews collected data. Four major themes were identified from the findings. These were: - types of communication, mode of communication, factors that either hinder or enhance effective communication and student nurses approach to community with other people15.

A comparative study conducted to assess the knowledge of memory, aging and Alzheimer’s Disease in college students and mental health professionals in University of South Florida, USA. In this study, college students and mental health professionals completed the knowledge of memory aging questionnaire, Alzheimer’s Disease Knowledge Test and the Fraboni Scale of Ageism before and after a lecture on normal and pathological memory issues in adulthood. Result confirmed that professionals were more knowledgeable about memory aging and Alzheimer’s Disease (AD) and less against that of college students. Analysis of pre and post lecture response accuracy yielded comparable benefits in memory aging and Alzheimer’s disease knowledge for both group16.

A confidence interval analysis of three studies using the Alzheimer’s disease knowledge test was conducted in Queensland University of Technology. To address the question of change in awareness about AD the present study compared result from three studies that have investigated the level of AD knowledge among under graduate students, using confidence intervals. Consistent with previous findings, the result of this study suggest that more recent cohorts of undergraduate students are more knowledgeable about some aspects of AD, although to an extent that is much less marked than previously thought. Importantly, there are also a number of areas in which there appears to have been little or no change in community awareness about AD17.

A study conducted to assess the psychosocial content of the nurse- patient communication in elderly care in Department of Nursing Education, Norway. Data were collected through the use of diary notes in which nurses recorded their interaction with seven randomly selected patients. Four nursing students, eight enrolled nurses, four nursing aids and thirteen registered nurses participated with in the context in which they worked. Two main themes emerged from the analysis: time oriented and task- oriented communication18.

A study conducted to assess the attitude to and knowledge about elderly people: a comparative analysis of students of medicine, English, and computer science and their teachers. The Palmore ‘Facts about Aging Quiz 1’ measured general knowledge about elderly people and the Rosencranz and McNevin Semantic Differential Scale measured attitudes towards elderly people. A higher level of knowledge about elderly people was found both in medical students and in medical lectures compared to their counterparts in the English and computer science departments (P <0.001). Scores on the Rosencranz and McNevin Scale indicated that attitudes towards elderly people across all three groups of students and lectures were similar. A significant correlation (P<0.001) was found between high level of knowledge about elderly people, and positive attitudes towards them19.

A study conducted to evaluate ward atmosphere and satisfaction of patients and staffs in two hospitals by Aker universitetssykehus. The data were collected by using the Ward Atmosphere Scale (WAS), a self-report questionnaire that has been used in studies of treatment climate in several psychiatric wards. 22 patients and 54 staff members in four psycho geriatric wards rated the WAS. The staff perception of the working environment was also examined. In this study both patients and staff had higher scores for “order and organization” and lower scores for “anger and aggressive behavior” than mean scores of the Norwegian normative sample of wards (mainly for patients with psychosis). Three wards obtained higher patient scores for “support” and three obtained lower ones for “staff control”. The psycho geriatric patients seemed to be more satisfied with the wards in general and with the staff nurses, whereas the staff’s satisfaction and evaluation of working environment was similar to that of the Norwegian normative sample20.

A study conducted to assess nurse’s knowledge regarding recognizing Delirium Superimposed on Dementia (DSD) in Pennsylvania State University. It measured nursing identification of DSD using standardized case vignettes, and the Mary Starke Harper Aging Knowledge Exam (MSHAKE). Results revealed that the nurses in this study had a high level of general geropsychiatric nursing knowledge as measured by the MSHAKE, yet had difficulty recognizing DSD compared to dementia alone & delirium alone. Only 21% were able to correctly identified hypoactive delirium alone from of DSD, and 41% correctly identified hypoactive delirium alone in the case vignettes. Interventions and educational programs designed to increase nursing awareness of DSD symptoms could help to decrease this gap in nursing knowledge21.

A study conducted to explore the knowledge, understanding and implications for care of adult nurses working with patients who present with dementia in general hospital wards in Coventry University. Kitwood’s ‘malignant social psychology’ and ‘person- centered approach’ were used as the theoretical framework to develop a questionnaire distributed to nurses. The findings about nurses knowledge and understanding of person centered dementia care revealed that there is wide gap between knowledge and person centered care22.

A study conducted in university of Alabama to assess the knowledge about aging and Alzheimer’s disease among baccalaureate nursing students. Nursing students ability to meet the challenge of caring of patients with Alzheimer’s disease was measured using Palmer’s (1988) Facts on Aging Quiz, Version 2 (FAQ2) and Alzheimer’s Diseases Knowledge (ADK) Test developed by Dieckmann Zarit & Gatz (1988). No significant difference in ADK test score was found for students who had previous personal or educational experience with AD. However, older students, seniors and those who reported knowing more about AD had significantly better score on the ADK test and subjects as a group were found to exhibit a negative bias toward the elderly as measured by Palmoer’s FAQ223.

An investigation done to identify the aged care mental health knowledge of registered nurses (RNs) employed in long-term aged care and tests the validity and reliability of a North American tool for use in an Australian context in Griffith University, Australia. The Mary Starke Harper Ageing Knowledge Exam (MSHAKE) was sent to RNs (n = 350) in 70 Long-Term Care Facilities (LTCF) in Queensland, Australia, and 107 surveys were returned (30.5% response). Participants were found to be unprepared for the reality of caring for the mental health needs of the older population and have knowledge deficits related to suicide, prevalence of mental illness, mental health and ethnicity, and a number of issues regarding dementia24.

An investigation conducted by Department of Adult and Community Education to determine the self-perceived learning needs of nurses, both Registered Nurses (RNs) and Licensed Practical Nurses (LPNs), employed in nursing facilities in USA. Questionnaires were used to gather data from 319 nurses employed in 14 nursing facilities, representing 10% of all nursing facilities in North Carolina. A total of 164 nurses returned usable questionnaires. The nurses indicated the importance of a large number of continuing education needs, with Management Skills, Drug Therapy/ Interactions and Behavioral Problems. Night shift nurses and nurse educators had different leaning needs when compared to other subsets of nurses25.