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Changes in students' attitudes toward aging after a gerontological nursing course

Dissertation
Author: Ann Danielle M. Buttner
Abstract:
Nurse educators are increasingly concerned about the existence of ageism in nursing students and its potential impact on the future delivery of health care to older adults. The purpose of this descriptive correlational study was to explore relationships between baccalaureate nursing students' ( N = 121) participation in a gerontological nursing course and attitudes towards older adults, personal aging anxiety, frequency and contact with older adults in five common areas of interaction, demographic variables, and likelihood of seeking a gerontological nursing practice in their careers. The Attitude Towards Elderly Scale and the Anxiety About Aging Scale were used to assess students' attitudes towards older adults, future likelihood of seeking a career in gerontological nursing, and personal aging anxiety at the beginning and end of the course. A survey form was used to obtain demographic data, e.g., age, gender, ethnicity, marital status, class, and number of prior courses on aging. Students showed significant improvement in attitudes toward the elderly, i.e., t (115) = 4.63, p < .01, by the end of the course. There was not a statistically significant difference in students' personal aging anxiety by the end of the course. The strongest significant (p < .01) relationships pertinent to students' quality and frequency of contact with older adults were found between quality of contact with older adults in students' families and pre-course attitude, r (120) = -.39, post-course attitude, r (115) = -.32, pre-course anxiety, r (120) = -.36, and post-course anxiety, r (114) = -.30. There were no significant relationships found between students' demographic data and pre-and-post course attitudes towards older adults or personal aging anxiety. Students did not indicate a significantly greater likelihood for pursuing gerontological nursing in the future by the end of the course. Implications for future research include: (a) exploring the impact of students' own anxiety about aging on ageism, and (b) developing strategies for increasing students' professional interest in gerontological nursing.

Table of Contents

Chapter One: Introduction 1

Purpose 4

Research Questions and Null Hypotheses 5

Null Hypotheses 5

Theoretical Framework: Models of Stereotype Change 6

Definition of Terms 11

Assumptions 14

Limitations 15

Delimitations 15

Significance of the Study 16

Chapter Two: Literature Review 19

Ageism and the Educational System 19

An Overview of Gerontological Nursing Education Trends 21

Ageism in Nursing Education and Research:

Problems and Historical Trends 22

Relationship Between Educational Experiences and Students’

Attitudes Toward Aging and Older Adults 26

Education Experiences and Personal Anxiety of Aging and Death 36

Summary of the Literature Review 42

Chapter Three: Methodology 46

Sample 48

Protection of Human Subjects 49

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Data Collection 49

Instruments 52

Research Questions and Null Hypotheses 56

Procedures for Data Analysis 58

Chapter Four: Results 60

Sample: Demographic Characteristics 60

Research Questions and Applicable Results 62

Null Hypotheses and Results of Testing 92

Chapter Five: Discussion 95

Limitations 108

Implications For Future Research 108

Conclusions 110

References 112

Appendix A: 129 Nurs 316 “Nursing and Gerontological Health” Course Syllabi and Reading Lists (Fall, 2007 and Spring, 2008, Semesters)

Appendix B: 151 Institutional Review Boards Approval Letters

Appendix C: Informed Consent Form 154

Appendix D: Research Instruments 158

Appendix E: Publisher’s and Author’s Permission Letters 166

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Tables Table 4.1 Sample Characteristics 62

Table 4.2 Fall, 2007 and Spring, 2008, Group Descriptive Statistics For the Pre-and-Post Course Total Scores of the Three Factors of the Attitude Towards Elderly Scale 66

Table 4.3 Group Descriptive Statistics for the Total Scores of Four Factors of the Anxiety About Aging Scale by Semester 69

Table 4.4 Bivariate Correlations Between Pre-and Post-Course Personal Aging Anxiety and Attitude Towards Elderly Scores for Entire Sample 71

Table 4.5 Bivariate Correlations Between Pre-and Post-Course Personal Aging Anxiety and Attitude Towards Elderly in the Fall, 2007, Semester Group of Students 71

Table 4.6 Bivariate Correlations Between Pre-and Post-Course Personal Aging Anxiety and Attitude Towards the Elderly in the Spring, 2008, Semester Group of Students 72

Table 4.7 Group Statistics of Students’ Frequency and Quality of Contact With Older Adults in Five Common Areas of Interaction 77

Table 4.8 Bivariate Correlations of Students’ Frequency and Quality of Contact With Older Adults (In Five Areas of Interaction) With

Pre-and Post-Course Anxiety About Aging and Attitude Towards Elderly Scores 78

Table 4.9 Intercorrelations Between Students’ Frequency and Quality of Contact in Five Common Areas of Interaction With Older Adults (N = 121) 79

Table 4.10 Bivariate Correlations Between Students’ Quality and Frequency of Contact With Older Adults and the Four Factors of the Anxiety About Aging Scale 83

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Table 4.11 Bivariate Correlations Between Students’ Quality and Frequency of Contact with Older Adults and the Three Factors of the Attitude Towards Elderly Scale 84

Table 4.12 Group Statistics Pre-and-Post Course by Semester for Likelihood of Choosing Geriatric/Gerontological Nursing in the Future 87

Table 4.13 Bivariate Correlations of Fall, 2007 Students’ Pre-and Post-Course Likelihood of Choosing Gerontological Nursing in the Future With the Total Scores of the Anxiety About Aging and Attitude Towards Elderly Scales 89

Table 4.14 Bivariate Correlations of Spring, 2008 Students’ Pre-and Post-Course Likelihood of Choosing Gerontological Nursing in the Future With the Total Scores of the Anxiety About Aging and Attitude Towards Elderly Scales 90

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Chapter One Introduction As one form of prejudice, ageism is most simply defined as negative attitudes or behaviors toward an individual solely based on that person’s age. Robert Butler first coined the word ageism in 1969 and further ascribed three distinguishable yet interconnected aspects to the term of ageism: (a) prejudicial attitudes toward older persons, old age, and the aging process (including attitudes held by older adults themselves; (b) discriminatory practices against older people; and (c) institutional practices and policies that perpetuate stereotypes about older adults, reduce their opportunity for life satisfactions, and undermine their personal dignity (Wilkinson & Ferraro, 2002). The growth in the number and proportion of older adults is unprecedented in the history of the United States. Two factors--longer life spans and aging baby boomers--will combine to double the population of Americans aged 65 and older during the next 25 years (Centers for Disease Control and Prevention and the Merck Company Foundation, 2007). Thirty-six million Americans are currently over the age of 65; by 2030, 71 million will be so. (Thornlow, Latimer, Kinsborough, & Arietta, 2006). By 2030, these 71 million American older adults will account for roughly 20% of the United States population (Centers for Disease Control and Prevention and the Merck Company Foundation, 2007). The nation’s health care spending is projected to increase by 25% due to these demographic shifts (Centers for Disease Control and Prevention and the Merck Company Foundation, 2007). Historically, older adults are the largest group of consumers of health care and this projected increase in the older adult population will continue to

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place many demands on our health care system. Therefore, the nursing profession as the largest group of health care professionals, is in an excellent position to facilitate the optimal use of health care resources by older Americans and to remove any barriers impeding this endeavor. The profession of nursing has long recognized, for example, that ageism has a decisively negative impact on opportunities for the elderly, on families of the elderly, on elders’ own social groups, and on the delivery of health care (Poirrier, 1994) but has done little beyond that of identifying the existence of ageism among nurses. In fact, the existence of ageism among health care professionals, including nurses, has been well documented (S. J. Brown, 1999; Evers & Gelder, 2003; Fox & Wold, 1996; Giardina- Roche & Black, 1990; Haight, Christ, & Dias, 1994; Helbusch, Corbin, Thorson, & Stacy, 1994; Hope, 1994; Lee, Reuben, & Ferrell, 2005; McLafferty, 2005; Rosowsky, 2005; Slevin, 1991; Wilkinson & Ferraro, 2002). The existence of negative stereotyping among students in general and students preparing for a health care career has also been well documented (Chasteen, 2000; Haight et al., 1994; Hawkins, 1996; Kalavar, 2001; Kimuna & Knox, 2005; Mosher-Ashley & Ball, 1999; Sharps, Price-Sharps, & Hanson, 1998; Speas & Obenshain, 1995; Weir, 2004; Wells, Foreman, Gething, & Petralia, 2004; K. Williams, Novack, & Scobee, 2006). Factors frequently cited in the literature as contributing to ageism in nursing include: (a) lack of faculty preparation, role models, and advanced practice nurses in gerontology (Lange, Wallace, Grossman, Lippman, & Novotny, 2006; Latimer & Thornlow, 2006; Mezey & Fulmer, 2002; Philipose, Tate, & Jacobs, 1991; Rosenfeld, Bottrell, Fulmer, & Mezey, 1999; Shoemake, Bowman, & Lester, 1998; Wallace, Lange, & Grossman,

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2005); (b) lack of gerontological content/courses and clinical experience in nursing education programs (Grocki & Fox, 2004; Joy, Carter, & Smith, 2000; Lange et al., 2006; Philipose et al., 1991; Rosenfeld et al., 1999; Shoemake et al., 1998; Wallace et al., 2005; Weaver, 1999); (c) lack of student interest in gerontological nursing (Evers & Gelder, 2003; Giardina-Roche & Black, 1990; Haight et al., 1994; Happell & Brooker, 2001; Ryan & McCauley, 2004); and (d) anxiety about own aging and death (Bernard, 1998; Harris & Dollinger, 2001; Harris & Dollinger, 2003; Laditka, Fischer, Laditka, & Segal, 2004; Lasher & Faulkender, 1993; Lynch, 2000; McConatha, Schnell, Volkwein, Riley, & Leach, 2003; Mosher-Ashley & Ball, 1999; Treharne, 1990; Wells et al., 2004). Nurses will continue to play an essential role in the provision of both acute and chronic health care to older adults. Nurses are much more likely to care for an older adult than a child or psychiatric patient in their careers, making ageism a fertile—and critical— area for nursing research. But the mere identification of ageism among nurses is insufficient towards reducing ageism in nursing education and in professional nursing practice. Although gerontological standards of care and baccalaureate competencies have been developed by professional nursing organizations, much more needs to be done to assure a competent and viable gerontological nursing work force for the future. Nurse educators are in an excellent position to contribute to the body of educational research literature by examining factors contributing to ageism and implementing and evaluating strategies to reduce ageism and positively influence students’ attitudes towards older adults and the aging process. Providing meaningful types of classroom and clinical gerontological nursing experiences may very likely improve students’ attitudes towards older adults, reduce their own anxiety about aging, and promote interest in gerontological

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nursing as a career choice. Examining the relationship between gerontological education and attitudes towards aging is the first step towards developing and implementing strategies aimed at eliminating ageism among nurses. Purpose The purpose of this study was to assess how participation in a gerontological nursing course (i.e., Nurs 316 “Nursing and Gerontological Health”) in a baccalaureate nursing program affects nursing students’ attitudes toward older adults, including one dimension of attitudes toward older adults i.e., personal anxiety about aging. More specifically, the primary investigator sought to determine if a relationship exists between nursing students’ completion of a gerontological nursing course, attitudes about older adults, the presence of anxiety about own aging, and likelihood of choosing gerontological nursing as a practice area in the future. The independent variable was the stand-alone gerontological nursing course entitled “Nursing and Gerontological Health” (Nurs 316) as part of the curriculum of Holy Family University School of Nursing. The dependent variables were: (a) attitudes towards older adults; (b) anxiety about own aging; and (c) likelihood of seeking employment in gerontological nursing in the future. Extraneous variables potentially impacting the dependent variables included: (a) age; (b) gender; (c) ethnicity; (d) marital status; (e) class; (f) completion of post-high school educational courses that primarily focused on aging; (g) frequency of contact with older adults and (h) quality of contact with older adults. This quantitative, descriptive correlational study uses a nonexperimental survey design and non-probability (convenience) sampling to address four research questions.

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Research Questions and Null Hypotheses 1. Is there a relationship between students’ participation in a Holy Family University gerontological nursing course, attitudes towards older adults, and students’ personal anxiety about aging? (a) Does participation in a gerontological nursing course improve students’ attitudes towards older adults? (b) Does participation in a gerontological nursing course lessen students’ anxiety about personal aging? 2. Is there a relationship between nursing students’ frequency and quality of contact with older adults and students’ attitudes towards older adults and personal anxiety about aging? 3. Is there a relationship between demographic variables such of age, gender, ethnicity, marital status, class, number of post-secondary education courses on aging and the attitudes toward older adults and personal anxiety about aging of students enrolled in a gerontological nursing course at Holy Family University? 4. Are nursing students enrolled in a gerontological nursing course at Holy Family University more likely to seek a gerontological nursing position in their careers? Null Hypotheses 1. There will be no difference in students’ attitude towards older adults from the beginning of the gerontological nursing course to the end of the course. 2. There will be no difference in students’ anxiety towards their own aging from the beginning of the gerontological nursing course to the end of the course.

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3. No relationship will exist between nursing students’ attitudes towards older adults and students’ anxiety about their own aging. 4. No relationship will exist between nursing students’ frequency and quality of contact with older adults and attitudes towards older adults and personal anxiety about aging. 5. No relationship will exist between demographic variables of age, gender, ethnicity, marital status, class, and number of post-secondary courses on aging and attitudes towards older adults and personal anxiety about aging of students enrolled in a gerontological nursing course at Holy Family University. 6. There will be no increase in nursing students’ likelihood to seek employment in gerontological nursing in the future as a result of enrollment in a gerontological nursing course. Theoretical Framework: Models of Stereotype Change Racism, sexism, and ageism are major concerns in our society. These “isms” are often based on stereotypes. Stereotypes have often been noted throughout the literature to be rigid and resistant to change because they are a natural consequence of our cognitive, affective, and social functioning (Weber & Crocker, 1983). Lippman (1922, p. 99) originally expressed this view when he stated “there is nothing so obdurate to education or criticism as the stereotype” (as cited by Weber & Crocker, 1983). But increasing evidence exists that stereotypes are responsive to new information, particularly ethnic stereotypes (Queller & Smith, 2002; Van Overwalle & Siebler, 2005; Weber & Crocker, 1983). It has also been increasingly discussed how perceptions are limited by personal experience, leading to the belief that one’s perceptions of older adults

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may change as experience and knowledge are gained (M. J. Lichtenstein et al., 2005). According to the prominent theory of attitudes proposed by (1963), attitudes toward a group are based upon evaluative beliefs (as cited by Zanna & Rempel, 1988). In other words, the amount of negative attitudes toward outgroups (prejudice) is based on the extent to which we endorse the stereotype of the group (Zanna, 1994). In addition to stereotypic beliefs (beliefs that typical members of the outgroup possess certain characteristics or traits), prejudice is based on symbolic beliefs (beliefs that typical members violate cherished traditions, customs, and values) as well as emotions and past and present experiences that are associated with the outgroup (Zanna & Rempel, 1988). The existence of a very fluid pattern of stereotype development throughout the life span is further supported by Social Cognitive Perspective (SCP) theory (Hummert, 1999). Given the aforementioned perspective, the premise of this research is that the instructor of gerontological content has the capacity to influence the dynamic pattern of stereotype development and promote an appreciation for aging by and within various age groups. Basic to this belief are the following two views of the author that preface a more specific discussion of the models of stereotype change at this time: (a) education provides an excellent venue for disseminating stereotype-inconsistent information and (b) negative stereotypes will weaken and change when people encounter positive (or, what is known as, stereotype-inconsistent) information about members of the stereotyped group (Queller & Smith, 2002). The bookkeeping model of stereotype change proposes a gradual modification of stereotypes by the additive influence of each piece of disconfirming information with any single piece of disconfirming information thus eliciting only a minor change in the

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stereotype (Johnston, Hewstone, Pendry, & Frankish, 1994). Substantial change only gradually occurs with the accumulation of many disconfirming instances that deviate systematically from the stereotype (Weber & Crocker, 1983). The bookkeeping model views stereotype change as an incremental process (Weber & Crocker, 1983) in which each instance of stereotype-relevant information is used to modify or build on the existing stereotype and thus, major change occurs more slowly and gradually. This model predicts a gradual modification of the stereotypes by the additive influence of each piece of disconfirming information (Van Rooy, Van Overwalle, Vanhoomissen, Labiouse, & French, 2003) with more frequent disconfirming information eliciting more changes (Weber & Crocker, 1983). The second model of stereotype change offers a different perspective of learning and stereotype change from that of the slower, more incremental process of learning purported in the bookkeeping model. The conversion model reflects a more dramatic and sudden stereotype change influenced by dramatic social events, instances, or encountering large amounts of stereotype-inconsistent information, such as in a nursing class or clinical experience. Despite limited empirical support for the conversion model (Johnston et al., 1994; Queller & Smith, 2002; Van Rooy et al., 2003), it provides a basis for understanding less gradual stereotype changes. Rothbart (1981) holds that no change whatever occurs until a threshold amount of disconfirming information has been encountered (as cited by Queller & Smith, 2002). Once the threshold is reached, the perceiver is assumed to critically reevaluate the stereotype and decide that it is incorrect (Queller & Smith, 2002).

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The subtyping model appears to have the most empirical support of the three models of stereotype change (Johnston et al., 1994; Queller & Smith, 2002; Van Rooy et al., 2003; Weber & Crocker, 1983) and proposes a hierarchical structure (s) evolving through experience, with discriminations within the group being created in response to disconfirming information (Johnston et al., 1994). Subtypes constitute exceptions (Johnston et al., 1994) and the process of subtyping appears to rely on the accumulation of instances that strongly deviate from the established stereotype (Weber & Crocker, 1983). When instances are so incongruent that they cannot be assimilated by fine tuning established stereotypes, subtypes develop (Weber & Crocker, 1983). With extreme group members being subtyped into subcategories and separated from the rest of the group, the group is insulated from dissenting members so that the content of the existing group stereotype is preserved (Van Rooy et al., 2003). Contrary to the conversion model, this model predicts that the best tactic to change group stereotypes is to distribute disconfirming information among as many group members as possible, so as to avoid subtyping of extreme discomfirmers (Johnston et al., 1994; Van Rooy et al., 2003). Subtyping may be considered to be a form of a branching out of the schema, changing from one general all-encompassing category to more and more specific and smaller subcategories (Johnston et al., 1994) and reflecting an important concept of cognitive processing i.e., schema serving as an organizing framework for the building of knowledge. This is also consistent with the view that stereotypes are natural categories, reflecting rational thinking within the primitive--yet essential--aspect of cognition (R. Brown, 1986). As intrinsic to the human organism as stereotyping appears to be, attitudes themselves should be regarded as schemas (Eagly & Chaiken, 1993). As information is

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extracted from many past experiences in the scaffolding of memory, schemas become more elaborate as we age and are integrated into the aging process itself (Hummert, 1999). Subsequently, the subtyping model (Brewer et al., 1981; Taylor, 1981) holds that the treatment of disconfirming information depends on the structure of that information (as cited by Queller & Smith, 2002). An important concept of the subtyping model is that individuals who are highly counterstereotypic are actually grouped into a new subtype that is mentally segregated from the rest of the group and, as such, their attributes do not affect the perceiver’s representation of the group as a whole (Queller & Smith, 2002). Only individuals who are slightly to moderately counterstereotypic will have an influence on the group stereotype; perceivers are assumed to regard the extreme disconfirmers as not real group members, and so their characteristics have little impact on the stereotype (Queller & Smith, 2002). Thus, learning can be facilitated in such a way to avoid students’ exposure to extreme stereotypes or extreme counterstereotypes to manage this subtyping process. Instead of structuring information to students to create only a small number of strongly disconfirming person descriptions as a concentrated condition, the same information may be better used to construct a larger number of only mildly disconfirming person descriptions, creating a more dispersed condition (Queller & Smith, 2002). According to studies of the subtyping model of stereotype change (Johnston et al., 1994; Queller & Smith, 2002; Van Rooy et al., 2003; Weber & Crocker, 1983), with increased numbers of students being exposed to stereotype-inconsistent information, greater stereotype change would most likely ensue. The basic assumption that negative stereotypes will weaken and change when people encounter positive or more stereotype-inconsistent information found in these three

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models of stereotype change is consistent with the purposes of any gerontological nursing course. Subsequently, principles of models of stereotype change can serve as a basis for developing appropriate educational interventions towards reducing negative stereotyping of older adults. Definition of Terms Geriatrics is the branch of medicine that deals with the health and care of old people (Abate, 1999). Gerontology is the scientific study of old age, the process of aging, and the special problems of old people (Abate, 1999). Gerontologic nursing is the area of nursing concerned with assessing the health and functional status of older adults, planning and implementing health care and services to meet the identified needs and evaluating the effectiveness of such care (Lueckenotte, 2000). This is the term most often used by nurses specializing in this field instead of geriatric nursing which is a synonymous term. Gerontological Health and Nursing is also synonymous term for Gerontologic Nursing. Geriatric nursing is similar to gerontologic nursing but implies a type of nursing that is more closely affiliated with the branch of medicine called geriatrics. Ageism is prejudice or discrimination on the grounds of age (Abate, 1999). Butler and Lewis (1975) defined ageism as “a process of systematic stereotyping of, and discrimination against, people because they are old” (as cited by Hope, 1994). Ageism is considered the composite of stereotypical beliefs and attitudes held by a group of people based on their advanced age (Rosowsky, 2005). Different types of ageism have been defined as personal, institutional, intentional and unintentional (International Longevity

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Center-USA, 2006). Personal ageism is defined as ideas, attitudes, and practices on the part of individuals that are biased against persons or groups based on their older age while institutional ageism refers to missions, rules, and practices that discriminate against individuals and/or groups because of their older age (International Longevity Center- USA, 2006). Intentional ageism is defined as ideas, attitudes, rules, or practices that are carried out with the knowledge that they are biased against persons or groups based on their older age whereas unintentional ageism is understood to be ideas, attitudes, rules, or practices that are carried out without the perpetrator’s awareness that they are biased against person or groups biased on their old age (International Longevity Center-USA, 2006). Ageist is the adjective for ageism. Class, as a demographic variable, is defined as the student’s current academic level i.e., Freshman (1st-year), Sophomore (2nd-year), Junior (3rd-year), or Senior (4th-year). Nursing student refers to either a full-time or part-time student having declared nursing as a major and subsequently enrolled in the baccalaureate nursing program at Holy Family University in northeast Philadelphia. The nursing student referred to in this study was eligible to take 3rd-year (junior level) courses in Holy Family University and was enrolled in the Nurs 316 “ Nursing and Gerontological Health” course in either the Fall, 2007, semester or the Spring, 2008, semester. Nurs 316 is the Holy Family University department and number assigned to the course entitled “Nursing and Gerontological Health” (see Appendix A). Older Adults is the term used in this study which refers to both male and female adults 65 years of age and older. Elderly and aged are synonymous terms but have more of a

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negative connotation attached to them. For this reason, the term older adults was used more frequently in this study. Anxiety is the state of being anxious (Abate, 1999) and anxious refers to an apprehensive uneasiness of mind (Abate, 1999) or a fearful concern or interest. Attitude is a settled opinion or behavior reflecting this opinion (Abate, 1999). Attitudes can also be defined as positive and negative predispositions toward people, objects, or ideas (Atchley, 2000). In any case, attitudes influence how information is interpreted and how behavioral dispositions are formed and are essential towards explaining human behavior (B. Williams, Anderson, & Day, 2007). Stereotype is a person or thing that conforms to an unjustifiably fixed mental picture or an impression, attitude, or trait descriptors (Abate, 1999). Stereotypes can also be considered as fixed, simplified characterizations of groups of humans, serving as devices of natural category formation that provide simplicity and order to a complex world (Lichtenstein et al., 2005). Similarly, Atchley (2000) identified stereotypes as composites of beliefs and attitudes about categories of people which are used when very little personal information about people is known. Stereotyping is therefore thought to be both universal and inevitable (R. Brown, 1986). Palmore (1999) described ageism from his perspective of a stereotyping process as taking two general but broad forms: positive and negative. Schmidt and Boland (1986) found that older people are characterized according to three separate kinds of stereotypes: physical characteristics, negative social characteristics, and positive social characteristics while Hummert et al. (1994, 1995) defined eleven different stereotypes of elderly people, six negative and five positive (as cited by Atchley, 2000). Most often, stereotypes are negative, pointing to imagined or

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assumed flaws of a group of people based on an ethnocentric or judgmental perspective (Stanley, Blair, & Beare, 2005). Bassili and Read (1981) and Field (2001) both note that descriptions of older people vary in their negative tone, ranging from inflexible or withdrawn, passive and dependent, nurturing or religious, to displaying varying degrees of physical and mental deterioration such as senility with memory loss, rigid personalities, depressed, lonely, isolated, and institutionalized by their families (as cited by M. J. Lichtenstein et al., 2005). Assumptions 1. Study participants will be truthful in reporting their perceptions. 2. Study participants wish to complete the Holy Family University baccalaureate nursing program requirements by enrolling in Nurs 316 “Nursing and Gerontological Health.” 3. Attitudes can be measured through tools such as the Attitude Towards Elderly Scale. 4. The Attitude Towards Elderly Scale includes items about aging and older adults. 5. Attitudes are shaped by various social factors, including age. 6. Attitudes toward older adults and aging could be both positive and negative and can vary within and between study participants. 7. Anxiety is a common human experience occurring in response to perceptions, events, and growth throughout the lifespan. 8. Anxiety about aging can be measured by the Anxiety About Aging Scale (AAS). 9. The personal feelings and emotions about aging and older adults of the study participants will be measured at the time of completion of the scales. 10. The terms old people, elderly, aged, older adult, and senior citizen could be used interchangeably to describe a person who is perceived by students to be 65 years of

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age or greater. Limitations 1. Due to the preponderance of females in the nursing profession, this study was not representative of the attitudes and anxiety towards aging of both genders. 2. Because participation was voluntary, participants may not have been representative of the overall population of undergraduate students or the overall population of undergraduate students with a major in nursing. 3. This study was correlational and not causal in nature. 4. Since there is limited number (60-80) of students enrolling in the Nurs 316 course in any one semester at Holy Family University, a sample size of less than 125 students was used in this study. Thus, results of this study cannot be generalized to a larger population. 5. This study was limited in time and was designed to examine only one or two cohort groups of students enrolled in the gerontological nursing course during the academic year of 2007- 2008 of Holy Family University. 6. Because this study took place at a Catholic, private, coeducational university in the northeastern area of the United States, cultural diversity within its student population is limited. Delimitations This study was delimited to nursing students enrolled either part-time or full-time in the baccalaureate program of the Holy Family University School of Nursing who were eligible to take 3 rd -year (junior level) nursing courses. The study was further delimited to only those students enrolled in the Nurs 316 “Nursing and Gerontological Health” course

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either in the Fall, 2007 and/or the Spring, 2008, semesters. Therefore, this study was not representative of all nursing students enrolled in the School of Nursing or all other undergraduate students enrolled in Holy Family University as of Fall, 2007 or Spring, 2008. It is also not representative of all nursing students enrolled in baccalaureate nursing programs in the northeastern area of the United States. Significance of the Study Ageism is a frequently ignored topic in the nursing profession. Interestingly, ageism directly conflicts with the philosophy of nursing as a caring profession and therefore should be of increasing concern to all nurses. But the issue of ageism in nursing needs to be addressed for several practical reasons. Ageism affects women more than men, the majority of nurses are women, and women lose their economic value and power as they age (Letvak, 2002). Additionally, the nursing workforce is aging rapidly and at a faster rate than the workforce as a whole (Letvak, 2002). From the mid 1980s to the end of the 1990s, the number of working nurses younger than age 30 decreased from 30% to 12% while the number of people in the US workforce younger than age 30 decreased only 1% (Letvak, 2002). The average age of RN in the United States also continued to rise from the mid 30s to the mid 40s in the same time period (Letvak, 2002). Also, ageist attitudes against older workers are prevalent in all areas of the United States workforce (Letvak, 2002), including health care providers. Concurrently, with the illness acuity of patients in hospitals increasing at the same time that the nursing shortage is increasing, older nurses will be less likely to obtain and maintain nursing positions that will clearly demand more and more physical and emotional stamina from the nursing workforce.

Full document contains 176 pages
Abstract: Nurse educators are increasingly concerned about the existence of ageism in nursing students and its potential impact on the future delivery of health care to older adults. The purpose of this descriptive correlational study was to explore relationships between baccalaureate nursing students' ( N = 121) participation in a gerontological nursing course and attitudes towards older adults, personal aging anxiety, frequency and contact with older adults in five common areas of interaction, demographic variables, and likelihood of seeking a gerontological nursing practice in their careers. The Attitude Towards Elderly Scale and the Anxiety About Aging Scale were used to assess students' attitudes towards older adults, future likelihood of seeking a career in gerontological nursing, and personal aging anxiety at the beginning and end of the course. A survey form was used to obtain demographic data, e.g., age, gender, ethnicity, marital status, class, and number of prior courses on aging. Students showed significant improvement in attitudes toward the elderly, i.e., t (115) = 4.63, p < .01, by the end of the course. There was not a statistically significant difference in students' personal aging anxiety by the end of the course. The strongest significant (p < .01) relationships pertinent to students' quality and frequency of contact with older adults were found between quality of contact with older adults in students' families and pre-course attitude, r (120) = -.39, post-course attitude, r (115) = -.32, pre-course anxiety, r (120) = -.36, and post-course anxiety, r (114) = -.30. There were no significant relationships found between students' demographic data and pre-and-post course attitudes towards older adults or personal aging anxiety. Students did not indicate a significantly greater likelihood for pursuing gerontological nursing in the future by the end of the course. Implications for future research include: (a) exploring the impact of students' own anxiety about aging on ageism, and (b) developing strategies for increasing students' professional interest in gerontological nursing.