Care Strategies for Improving Pain Management in Elderly Patients
CHAPTER ONE
PREAMBLE TO THE STUDY
Nurses are key health professionals involved in the frontline improvement of pain management of patients, including the elderly. The World Health Organization predicted that the proportion of people aged over 60 years will increase from 11% to 22% between 2000 and 2050. Aligned with this increase in the ageing population is a greater demand for nursing care. Nurses’ perceptions and challenges of working with elderly people is of global interest because of many reported negative perceptions of care and limited number of qualified nurses interested in the field of caring for elderly patients. This study aimed at exploring the nurses’ perceptions and challenges of caring for elderly patients at Federal Medical Centre, Ibadan in Oyo state. The study used a mixed methods approach. Data were obtained from 148 randomly and 18 purposively sampled nursing staffs through a structured interview schedule and Focus Group Discussions respectively. Binary Logistic Regression and content analysis of main themes were used to identify factors associated with perceptions of caring for elderly patients.
CHAPTER TWO
LITERATURE REVIEW
Introduction
Literature review is an organized written presentation of what has been published on a topic by scholars and it includes a representation of research conducted in a selected field of study. It refers to extensive, exhaustive and systematic examination of publications relevant to the research project (Burns and Groove, 2019). The purposes for analyzing or reviewing existing literature are to generate research questions, to identify what is known and not known about a particular research problem or situation. In short literature review conveys to the reader what is currently known regarding the topic of interest (Burns & Grove, 2019).
In this study literature review is intended to help to determine what is known about nurses’ perceptions and challenges of caring for elderly patients. The reviewed literature was drawn from various publications accessed from internet and other sources. An advanced search was performed using the words ‘perception’, and ‘elderly’. Only clinical research articles that stated within the objective to explore nurses’ perceptions and challenges of caring for elderly patients were evaluated and selected for inclusion in the study.
Perceptions of nurses on elderly patients
Improvement of pain management of older adults occurs in a cultural context in which the elderly in society are poorly valued. Although the concept of ageism is not fully understood. Levin and Levin (2010) suggest the term alludes to stereotypes or beliefs toward elderly people that categorize them, or attribute characteristics to them, that are not necessarily based on certain evidence. Elderly people have reported experiences of others making assumptions about their levels of illness and frailty based solely on their age, rather than on knowledge of them as individuals (Jansen and Morse, 2018). Ageist perceptions may lead to discrimination and mistreatment of elderly patients. Perceptions of elderly people are influenced by a variety of factors, including the amount of gerontological knowledge nurses possess (Baumbusch and Goldenberg, 2000), the environment in which nurses work and the workload nurses experience in diverse practice settings (McLafferty and Morrison, 2018). There are also societal views held by nurses that add to the way they perceive their elderly patients which may enhance the positive or negative treatment outcomes. Perceptions of elderly patients, at both individual and societal level can vary widely (Kite et al. 2019; Narayan 2022). Perceptions that have been reported are multi-dimensional in nature (Kite et al. 2019). In other words, ambivalent findings regarding perceptions of elderly people and ageing are indicative of the fact that most people tend to rate old age positively on some dimensions whilst rating it negatively on others (Williams et al. 2021; Gilbert and Ricketts 2022).
Whether elderly people are perceived positively or negatively is often dependent on the different dimensions they are being perceived on for instance physical appearance, health, and adaptability among others. Further, it is likely that people do not have fixed positive or fixed negative perceptions of old age, but rather they have different views of the many and varied features of ageing and elderly people.
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This chapter discusses the research design, the study setting, population, ethical consideration and sampling methods which were used to answer the research questions. The data collection tools, data collection technique and data analysis methods, validity and reliability, pre-test was also be stated. It was aimed to guide the researcher to do things in a careful, systematic and logical way. This study was exploring the nurses’ perceptions and challenges of caring for elderly patients at At Federal Medical Centre, Ibadan.
Research Design
A mixed methods approach was used in this study. A mixed methods research design involves the collection or analysis of both quantitative and/or qualitative data in a single study in which the data are collected concurrently or sequentially, are given a priority, and involve the integration of the data at one or more stages in the process of research (Creswell et al., 2017). Thus quantitative and qualitative methods were undertaken concurrently, employing a convergent parallel design. Meaning, the two strands were independent at data collection and analysis but merged at interpretation of findings. In this case, the qualitative results provided the content analysis that explains the quantitative findings (Johnson and Onwuegbuzie, 2018).
The quantitative approach is a method of research used to quantify the problem by way of generating numerical data or data that can be transformed into useable statistics. It is used to quantify attitudes, opinions, behaviours, and other defined variables and generalize results from a larger sample population (Wyse, 2011). On the other hand, the qualitative approach is used to uncover trends in thought and opinions, and dive deeper into the problem (Wyse, 2011).
CHAPTER FOUR
RESEARCH RESULTS
Introduction
This chapter deals with analysis and interpretation of data obtained during the study, the purpose is to address the findings unveiled in the study. The results describe information on nurses’ perceptions and challenges of caring for elderly patients, knowledge levels on aging and improvement of pain management of elderly patients, socio- demographic factors associated with perceptions of geriatric nursing care, availability of resources for care, staffing levels and management support. In this case both quantitative and qualitative findings are presented.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
The implications are related to the problem under study, which explored the nurses’ perceptions and knowledge of caring for elderly patients with implications for gerontological nursing training. The implications have their significance on different aspects of gerontological nursing which include, education, research, practice and administration.
More emphasis on gerontological curricula and training in various aspects of gerontological programs are strongly needed. Nurse educators should consider restructuring nursing curricula in Nigeria so that integration of aspects related to nursing elderly people takes place early in the program courses. The gerontological content which seems to be scant now need to increase so that nurses are equipped with knowledge and skill to meet the challenges of caring for elderly patients. Higher institutions of learning should provide such education to both in-service and direct nurses who will give guidance in nursing practice.
The improvement of pain management of the elderly patients is no longer the sole domain of specialist geriatric nurses and is an increasing part of the clinical workload of nurses in the medical surgical wards. Care providers require knowledge, skill and good judgment to carry out the task of caring for these patients. Therefore, there is need for capacity building in practicing nurses to improve their caring skill and knowledge which will assist in reversing the way they perceive elderly patients.
Additionally, by providing the knowledge and skills to nurses, it will help to sensitize the community also to dismiss the myths and beliefs about the elderly people such as pain being a normal part of aging and the aging process. Nurses come from these communities with these perceptions of elderly patients which impair the way they provide care to them.
It should be noted that this study is limited to a particular care setting, focusing on the perception of nursing professionals, which shows the importance of further research in other realities that also unveil the perspective of other health professionals and elderly users of health facilities.
Furthermore, it will be interesting to conduct a qualitative study to explore how the elderly people feel about the care they receive or how they perceive the nurses’ attitude towards them.
The practice of holistic care, which is the very essence of nursing, can be undermined due to cost pressures relating to nurse/patient ratios. One of the core management roles is to ensure staffing levels and knowledge bases (skill mix) are allocated appropriately to ensure provision of best practice. Nurses report that workloads are the main factor associated with negative perceptions of elderly patients. It is important for managers to understand that nurses with appropriate knowledge and skills in gerontology which are associated with positive perceptions of elderly patients will maximize benefits to both the patient and the institution. Therefore management should support gerontological nursing so that they recruit and deploy nurses who have the appropriate knowledge and skill for the core.
5.2 Conclusion
This study explored the nurses’ perceptions and knowledge of caring for elderly patients. The nurses’ descriptions of the pressing issues surrounding improvement of pain management of elderly patients provide useful information for quality improvement activity including organizational initiatives aimed at creating an enabling environment for both users.
A low awareness of ageing and ageing process was reflected in the data gathered from respondents. Educational attainment, exposure to living with aged people and working experiences helped nurses recognize the relationships between aging, common illnesses, and the required care. Results showed that more than half of the nurses (81%) had negative perceptions of caring for elderly. This means they could not offer good health care to the aged.
The study revealed that there was no statistical significance between nurses’ level of education, exposure to elderly persons, experience and the age to perceptions of caring for elderly patients. Therefore, the more a nurse is qualified, exposed, experienced and aged, the more likely he/she understood health care need for the aged and the better their perceptions about them. In terms of availability of resources for improvement of pain management of elderly patients most of the patients who indicated the inadequacy of resources had negative perceptions towards the improvement of pain management of elderly patients.
The biggest challenges were increased workload related to understaffing and lack of specialized staff and infrastructure designed for the elderly people. These findings are consistent with other studies.
The elderly population in Nigeria is growing. A major goal of nursing education should be to impact nurses’ understanding and attitudes toward improvement of pain management of the older adult patients, as well as to influence their career choices toward meeting the health care needs of this growing ageing population. An educational intervention consisting of a robust gerontological nursing content, intentional interaction with the elderly and on-going discussions and reflections of these activities can impact perceptions toward elderly patients in a more positive direction. Also positive feedback from management acknowledging nurses’ self-education and reflections about their practice could also contribute to a positive experience for older people.
5.3 Recommendations
Nurses’ perceptions toward older adults are important for several reasons which include, elderly population is increasing rapidly, elderly patients often have three or more chronic illnesses that require frequent uses of various health care institutions and perceptions toward working with elderly patients can influence career choices and the quality of care provided to elderly people.
5.3.1 General Nursing Council (GNC)
Nurses who care for this population should demonstrate an interest and willingness to work in that field. The low level of nurses’ knowledge and bad perceptions about caring for the aged in this study are associated with the lack of specific gerontological nursing training units in Nigeria. There is a need to expose nurses to a nursing curriculum that supports the development of positive perceptions and attitudes toward elderly patients. The findings of this study suggested that clinical practicum with elderly patients in pre service, and educational interventions with a rich gerontological content can positively influence the perceptions of nurses towards improvement of pain management of elderly patients.
Therefore, The GNC should also consider to introduce a nursing specialization in gerontological nursing as this will help to aid in consultation and direction of care needs of elderly people. As such, in-service training through MoH should be intensified for all nurses that are interested in improvement of pain management of elderly patients so that elderly care can be client centered. Change of nurses’ perceptions to acceptable levels begin with provision of knowledge and skill that make a difference from perspectives that are held by the general public that may devalue and stereotypes the elderly people.
Further, without education in elderly patient care, the deploying body will deploy nurses without appropriate knowledge and skill, which will counteract staff shortages without looking into the plight of the elderly people being attended to in health facilities.
5.3.2 Government through Federal Medical Centre, Ibadan
The government through MoH should establish geriatric friendly care institutions where nurses can do their practicum which in turn will begin to change the way nurses perceive caring for elderly patients. It will also give them a choice of their work environment which will reduce their stress.
5.4 Dissemination of findings
Dissemination of research findings is the diffusion or communication of research findings by presentation and publication to a variety of audiences, such as nurses, other health professionals, policy developers and consumers (Burns & Grove, 2019).
It involves the measures that would be undertaken to make known to the relevant authorities and the study participants what the study has measured. For this study the findings will be printed and bound into reports. The results of the study will be disseminated by submitting a copy of the research report each to the University of Nigeria – School Of Nursing and Medical Library for educators and students to use as reference. An executive summary will be sent to the Federal Medical Centre, Ibadan which were the selected study sites, for management and staff nurses to refer to. The general nursing council which is responsible for nursing education and curriculum development will also receive a copy and one copy will remain with the researcher.
A meeting will be arranged where presentation of research findings and recommendations will be discussed with management of the Federal Medical Centre, Ibadan. Findings will also be published in one of the nursing journals and an online presentations will be done in one of the scholarly conferences or seminars.
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