Knowledge, Attitude and Practice of Care of the Elderly Patients 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.
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.
Population of Study
The population of study consisted of (402) doctors, (600) nurses,(10) dentists and (11)physiotherapists that provide direct clinical health care to elderly patients making up a total of one thousand and twenty three (1023) health workers.
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%.
From Table 1data analysis of the socio demographic characteristics of the respondents revealed that age ranged from 20 >50 years with a mean age of 34 years and standard deviation of 4.8. More than half of the respondents 62% percent were females, For educational status all the health workers were educated 460 (100%) up to tertiary level.
RESEARCH QUESTION 1. What is the level of knowledge of care of the elderly among the health workers in ESUTH, Ado Ekiti
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.
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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