An exploration of the attitudes, knowledge, willingness and future intentions to work with older people among Saudi nursing students in baccalaureate nursing schools in Saudi Arabia

Abstract

The kingdom of Saudi Arabia, like the rest of the world, has a growing older population \nwith urgent health care needs. However little prior research has been undertaken on this \ntopic. In the light of this, the aim of this study was to explore the attitudes, knowledge, \nwillingness and intentions to work with older people among nursing students, and to \nconsider the effects of clinical nursing practice on such factors in the first year and the \nfinal (pre-registration) year of training in three major university hospitals. The study was \nunderpinned by the theory of planned behaviour (Fishbein and Ajzen, 1975) which was \nused as a conceptual framework to explore the relationships between attitudes, subjective \nnorms, perceived behavioural control and behavioural intentions amongst 566 nursing \nstudents. The study used a mixed methods design comprising of surveys with the nursing \nstudents and 132 faculty members and three focus groups with faculty members to explore \ntheir feelings about gerontological education in-depth. The questionnaires contained a \nrange of previously validated instruments including Kogan's Attitude Towards Older \nPeople scale, Palmore's Facts on Ageing Quiz, a measure of students' willingness to work \nwith older people and a measure of their perceived intention to work with them. Openended \nquestions were also included. Data were analysed using both multivariate statistics \nand content analysis. \nThe results provided some interesting and important insights into the complex factors \npotentially shaping students intentions to work with older people. For example the 566 \nnursing students who participated in this study displayed a lack of basic knowledge of the \nphysical and behavioural aspects of ageing but held largely positive attitudes towards older \npeople. Despite such positive attitudes a majority of the participants indicated that they \nwould prefer not to work with older people after graduation, although those students who \nindicated that they would prefer to work with them had the most positive attitudes and the \nstrongest willingness and intent to take care of older people. The data also highlight the \npotential of clinical training experience with older adults to improve the previous variables \n(attitudes, willingness and intentions). The qualitative data from both students and teachers \nhighlighted a range of complex factors that in part explained some of the quantitative \nfindings. These related to the influence of subjective norms and perceived control. \nTherefore at a cultural level Saudi students are exposed to strong positive norms in relation \nto older people but on entering training may be exposed to negative professional norms as \nto the status and desirability of gerontological nursing as a career. This, together with \nstudents' limited perceived control due to inadequate preparation for practice offer \npotential explanations as to the disparity between attitudes and behavioural intentions.The \nqualitative data also highlight the need for greater attention to the preparation of nursing \nstudents, with the provision of integrated skills and knowledge on the care of older people. \nThe study also provides a limited critique of the theory of planned behaviour, which whilst \nsupported in part cannot account fully for the complex cultural and professional factors \nshaping students future career intentions. The thesis, the first of its kind undertaken in \nSaudi Arabia, concludes with some reflections and suggestions for further research and the \nactions needed if the preparation of students to work with older people is to improve in the \nfuture.

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