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ATTITUDE OF HEALTHCARE PROFESSIONALS TOWARDS THE CARE OF THE AGED ATTENDING UNIVERSITY TEACHING HOSPITALS

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CHAPTER ONE

 Introduction

 

Background to the study

With the global trend towards an increasingly ageing population, health care professionals (HCPs) are considered to be at risk of developing ageist attitudes. This may arise due to their exposure to disproportionate percentage of ill or dependent older people. This rapidly increasingly ageing population with their declining health poses a great challenge to the health care professionals. The obvious implication of this is that healthcare professionals need to have appropriate attitude to play significant roles in responding to healthcare supports and needs of the elderly patients.  Recent researches demonstrate that the world population is rapidly ageing. For instance, according to the Central Agency for Public Mobilization and Statistics (2010), the number of elderly in Egypt was 3.3 million, that is 4.2% of the total population and this percentage is expected to increase to 8% by the year 2030.  World Health Organization (WHO, 2012) reported that between 2000 and 2050, the proportion of those over 60 years worldwide will double from about 11% to 22%. It further inferred that the absolute number of persons aged 60 years and above is expected to increase from 605 million to 2 billion over the same period. As a result, Okafor (2010) asserted that HCPs are to ensure adequate well-being of individuals, including the aged. The aged care should comprise of physical, mental/emotional and social healthcare dimensions, without discriminating and stigmatizing attitude and behaviour by HCPs. Kapungwe, Cooper, Meyeya, Mwanza, Mwape, Sikwese and Lund (2011) reported that there are widespread stigmatizing and discriminatory attitudes among health care professionals towards mental illness and those with emotional related cases, especially the aged whose population is rapidly increasing.

This increasing elderly population with its physical, social and emotional health implications increases the demands on the HCPs in the hospitals, especially general and university teaching hospitals. According to Okafor (2010), health care professionals are very important health workers with obligation of disease prevention, treatment, rehabilitation and preservation of health. This responsibility poses great challenges to HCPs. Hassan (2013) explained that HCPs must be prepared to meet the healthcare challenges of the rapidly increasing segments of population including the elderly. As a result, acquisition of proper gerontological knowledge and holding positive attitude are relevant for health care professionals for proper management of the elderly patients. However, when attitude of HCPs relates to the aged patients, it is called attitude towards the aged patients attending the hospital.

Health Care Professionals’ attitude towards the aged patients seems to depend on their perception of life, type of orientation received and attitude inculcated during training, among other factors. Obioha (2004) defined attitude as a state of readiness organized through experiences upon individuals’ response to all objects and situations. This is because every attitude, positive or negative, acceptable or unacceptable, is formed for a purpose. Each attitude serves some functions to individual, group or society that holds it, particularly when it translates to behaviour. Ademuwugan and Adekunle (2002) stated that attitude is a set of effective reactions towards an object that predisposes the individual to behave in a certain manner towards the object. This is in line with Pearson (2001) who affirmed that attitudes are the opinions and feelings that people usually have about something. This means that individuals’ behaviours or actions are triggered off by attitude towards the object. An attitude is a hypothetical construct that represents an individual’s degree of like or dislike for an object or item. Attitudes are generally positive or negative views of a person about a place, thing or event. In this study, attitude is perceived as a set of effective reactions, opinions and feelings that healthcare professionals hold towards the aged attending university teaching hospitals in Enugu State. This means that attitude is formed either positively or negatively when one comes in contact with the attitude object, in this case HCPs attitudes towards the aged patients, which are also referred to as elderly or older patients in the study.

Healthcare professionals (HCPs), according to Park (2007) are group of practitioners who render healthcare services to different categories of persons including the elderly for the purpose of prevention of diseases or infections, treatment, promotion, maintenance and restoration of health. Probably, as a result of the challenges associated with their roles, Alsenanry (2007) pointed out that in the past 30 years, HCPs have developed stereotypes and misconceptions about old people, and students in the areas of health care professions tended to have minimal interest in working at old people’s wards. He further observed that they preferred to work with children and adult patients. In this study, HCPs are individuals or group of people such as doctors, nurses, medical laboratory scientists, physiotherapists, pharmacists who are well trained in the field of health to render adequate healthcare services to ensure optimum well-being of the young, the ageing and aged. Therefore, attitude of health care professionals in the context of this study is perceived as a set of effective reactions, opinions and feelings that health care professionals hold towards the aged attending the university teaching hospitals in Enugu State.

According to World Health Organization (WHO, 2012), ageing is the process of growing old, while the aged are generally referred to as old people or elderly people among the population groups. They are those who have reached an advanced age of 60 and over. The way the aged are perceived varies across cultures. In traditional primitive culture, elderly people command respect because their memories are storehouses where cultures and traditions are kept and retrieved. In some contemporary societies, following the discovery of information technology, the elderly people are less revered giving rise to ageism.

Ageism has become a global issue that demands urgent attention. Ageism, according to Mandy, Mitchell and O’Neil (2013) is a systematic stereotyping of discrimination against people because they are old. Ageism is perpetuated by the portrayal of older people as frail, ill, physically declining, suffering mental deterioration, poor and dependent. This societal notion may influence the attitudes of health care professionals towards the elderly patients depending on their orientation and background. Roush (2003) affirmed that ageing is a natural process consisting of irreversible biological change that occurs in all living things with the passage of time, which eventually leads to death. This means that ageing process brings about the wearing down of organs in the body as well as the functions of the brain in the ageing individual. Though, there are individual differences in the rate of ageing, with time most people respond almost the same way to ageing. In most people, the hair turns white and becomes sparse, the skin loses moisture and elasticity and becomes more and more wrinkled. Changes in skeletal structure cause people to become shorter in there sixties and above. Samuel (2006) summarized the ageing process as a period of decline physically and psychologically. It can only be delayed but it must surely come with its signs and symptoms. In this study, ageing is referred to as a natural process which involves biological, mental, social, and physiological growth and development, followed by decline which occur in people as they live towards death. The aged patients in the context of this study are perceived as all those who have attained an advanced age of 60 and above who seek medicare at University Teaching Hospitals in Enugu State.

Ageing process predisposes the aged to numerous physical, social and mental health problems and increases their contact with HCPs who may display positive or negative attitude towards them, depending on the background and characteristics of the HCP. This study is therefore poised to determine the attitudes of HCPs towards the care of aged patients attending University Teaching Hospitals in Enugu State. In order to properly determine the attitudes of these HCPs, this study needs to be rooted in some theories.

Therefore, this study will be anchored on two theories: theory of reasoned action (TRA) propounded by Ajzen (1991), and theory of programmed ageing (TPA) propounded by Prinzinger (2005), appear relevant in determining the attitudes of HCPs towards elderly patients. The theory of reasoned action (TRA) looks at a person’s attitude towards stages of life as very influential to the person’s behaviour or action. It means that one’s attitudes towards a particular behaviour are influenced by the believed outcome of the behaviour and one’s evaluation of the potential outcome. Theory of programmed ageing (TPA) believes that ageing and death are necessary parts of evolution. If any specie does not have genetic capacity for ageing and death, then it will not be forced to replicate to survive. These two theories guided this study which was carried out among health care professionals at University Teaching Hospitals in Enugu State.

Enugu state is in the South-Eastern Nigeria, and with estimated population density of 3,257,298.  It was created on 27th August 1991, with its capital and the seat of government at Enugu (Ministry of Information, Enugu State, 2013). Its boundaries are formed by Anambra State to the East, Kogi and Benue States to the North, Imo and Abia States to the West and Ebonyi State to the South. It is made up of 17 Local Government Areas. The economy is based on agriculture, commerce, and education. It has a total of seventeen owned general hospitals. It has one state teachings hospital (Enugu State Teaching Hospital Parklane, Enugu (ESUTHP) and federal government owned teaching hospital (University of Nigeria Teaching Hospital, Ituku/Ozala (UNTH). The two teaching hospitals have fairly large population of HCPs of diverse characters. Moreover, the elderly and other age groups do visit these hospitals for their routine health checks and treatment of different ill-health, and HCPs hold different attitudes towards them, especially the elderly patients. This study intends to determine their attitudes towards the aged patients considering the diverse characters of the HCPs.

There are certain demographic characteristics or factors that may affect attitude of HCPs towards the elderly patients. Such factors include gender, age, marital status and profession (jobtype) of the HCPs. Specifically, studies outside the setting of this study suggest that HCPs respond differently to elderly patients. For instance, Mandy, Mitchell & O’Neil (2013) conducted a study to investigate the attitude of healthcare workers towards older patients in Ireland. The result indicated that more nurses hold positive attitudes towards older people because of their training and orientation. The researcher is uncertain whether area of professions affects the attitude of HCPs towards the aged attending university teaching hospitals in Enugu State.

Marital status is another factor that may influences the attitude of healthcare professionals towards ageing and the elderly. A study carried out by Saude (2012) to investigate the influence of marital status on attitudes of Community Health Workers (CHWs) indicated that married CHWs have positive attitudes towards the elderly, maybe as a result of the fact that most of the CHWs were married, and have had experience working with elderly people, lived with elderly people or were trained with courses that have implications for elderly health.

Besides, age has been identifies as another factor that influence the attitude of healthcare workers towards the older patients. Thus, Luo, Shu-Fang and Ying-Hui (2013) indicated that older healthcare workers in Taiwan possessed positive attitudes towards ageing, aged patients than those of the younger age group without much gender differentiation. Knowledge of ageing also influences the attitudes of HCPs towards aged patients. Saude (2012) in a study found that community health workers’ attitude towards the elderly patients in the city of Marília, state of São Paulo, Southeastern Brazil, in 2010 was negative.

However, there is dearth of literature on attitudes of HCPs towards the care of the aged patients attending university teaching hospitals in Nigeria in general and Enugu State in particular. This is the gap this study is poised to fill.

 

Statement of the Problem

With rapidly increasing number of the aged population worldwide, older peoples’ healthcare services are expected to be manned by well gerontologically trained HCPs who hold positive attitudes towards the elderly. This is because the aged who seek medicare in the hospitals do display diverse characters in approaching the healthcare professionals attending to them who may develop positive or negative attitude towards them.  Samuel (2006) maintained that ageing is a natural process and an inevitable part of life, and can affect the totality of the individual’s life and well-being. Moreover, due to the situation and conditions of ageing, some elderly people become inactive or passive because of the fact that they have no control over some events that come along with ageing. As a result, HCPs are expected to demonstrate positive attitude towards ageing and the elderly patients attending the hospitals especially in the university teaching hospitals in Enugu state under study.

Regrettably, Okafor (2009) acknowledged that people’s attitudes towards ageing and the aged have been so negative that people who pray for long life receive it, but reject the features of the answered prayer, such as dying of gray hairs or physically pulling them out, loss of teeth replaced by artificial ones, wrinkling of skin suppressed with plastic surgery, and so on. Apart from the elderly’s unacceptance of features of old age, HCPs in hospitals seem to see old age as a sick condition. They refer physical, social and emotional health problems of the elderly as “just old age”, a phrase that seems to suggest disregard. In the face of all these, Hassan (2013) revealed that the number of HCPs interested in working with aged patients appears to be decreasing as a result of lack of knowledge of ageing or ageing conditions. Evidence provided by Minichiello, Brown and Kendig (2000) indicated that elderly patients in hospitals were being neglected or treated as not important by HCPs, and were commonly denied access to needed medicare that could alleviate their health conditions. Okafor (2010) showed that HCPs exhibited discriminating attitude towards people affected with epidemic who attended the hospitals for medicare, including the aged. Moreover, there is dearth of literature on attitude of HCPs towards the aged attending the university teaching hospitals in Enugu State.

This situation is very worrisome. Consequently, the researcher is uncertain whether such attitude exists among HCPs in University Teaching Hospitals in Enugu State. This study, therefore, is necessary to determine the attitude of HCPs towards the aged attending the University Teaching Hospitals in Enugu State. The situation poses this question: What is the attitude of HCPs towards the aged attending University Teaching Hospitals in Enugu State? The answer to this question is the main interest of this research. However, to the knowledge of this researcher, no research work has been conducted on this topic in this area.

 

Purpose of the Study

           The purpose of the study is to determine the attitudes of HCPs towards the care of the aged attending university teaching hospitals in Enugu State. Specifically, the study is to determine the;

  1. Attitude of HCPs towards the physical healthcare of the aged;
  2. Attitude of HCPs towards the mental/emotional healthcare of the aged;
  3. Attitude of HCPs towards the social healthcare of the aged;
  4. Attitude of HCPs towards the aged based on the marital status;
  5. Attitude of HCPs towards the aged by the age of the HCPs;
  6. Attitude of HCPs towards the aged by gender of HCPs;
  7. Attitude of HCPs towards the aged by profession (doctors, nurses, medical laboratory scientists, physiotherapists and pharmacists).

Research Question

  1. What is the attitude of HCPs towards the physical care of the aged?
  2. What is the attitude of HCPs towards the mental/emotional care of the aged?
  3. What is the attitude of HCPs towards the social care of the aged?
  4. What is the attitude of HCPs towards the aged based on the marital status?
  5. What is the attitude of HCPs towards the aged by the age of the HCPs?
  6. What is the attitude of HCPs towards the aged by gender of HCPs?
  7. What is the attitude of HCPs towards the aged by profession (doctors, nurses, medical laboratory scientists, physiotherapists and pharmacists)?

Hypotheses

The following hypotheses are postulated to guide the study and each will be tested at .05 level of significance at appropriate degree of freedom.

  1. There is no significance difference in the attitude of male and female HCPs towards the aged patients in University Teaching Hospitals in Enugu State.
  2. There is no significance difference in the attitude of different categories of HCPs towards the aged patients in University Teaching Hospitals in Enugu State.
  3. There is no significant difference in the attitude of HCPs towards the aged patients based on age differences of HCPs in University Teaching Hospitals in Enugu State.
  4. Marital status makes no significant difference in attitudes of HCPs towards the aged patients in University Teaching Hospitals in Enugu State.

 

Significance of the Study

The findings of this study showed that HCPs in university teaching hospitals in Enugu State demonstrated negative attitude towards the care of the aged. Specifically, the data that were generated on the attitude of HCPs towards the physical care of the aged patients will be beneficial to HCPs, the elderly patients, community health workers, management of old people’s homes and the general public. Positive attitude will be encouraged and motivated as it will spur HCPs to develop more interest on ageing education, and it will help older people visit hospitals regularly without fear of ageist attitudes from HCPs.

Data generated on the attitude of HCPs towards the emotional/mental care of the aged patients will be beneficial to government and health workers in general. This will help health workers to always demonstrate positive attitude towards the aged patients attending hospitals for healthcare services.

Data generated on the attitude of HCPs towards the social care of the aged patients will be useful to HCPs, community health workers, anthropologists and social workers in demonstrating positive attitude towards the social care of the aged in hospitals and old people’s homes.

The result on the attitude of HCPs towards the care of the aged patients based on marital status of the HCPs revealed how the single, married and divorced HCPs care for the aged attending the university teaching hospitals. This will be useful to all health workers to know that the aged attending the hospitals need adequate attention and care from single, married or divorced health workers.

Findings on the attitude of HCPs towards the care of the aged patients based on age differences of HCPs will be beneficial to both young and adult HCPs, health workers and the aged. Positive attitude will be encouraged as it helps to reduce old age stigmatization, abuse and disregard from HCPs in the hospitals. On the other hand, negative attitude will be corrected through more gerontorogic continuing education and seminars.

Data generated on the attitude of HCPs towards the care of the aged patients based on gender will be useful. The result will be useful to both male and female HCPs and the elderly patients. As a result, positive attitude will be encouraged and motivated in order to improve psychosocial relationship between HCPs and the elderly without gender differentiation.

Data generated on the attitude of HCPs towards the care of the aged patients by profession of HCP (doctors, nurses, medical laboratory scientists, physiotherapists, pharmacist) will be useful to the different categories of HCPs, health educators and community health workers. Negative attitude will be discouraged and avoided by HCPs to reduce or stop the impression that older people are frail, troublesome, always complaining and not important. The result will be beneficial to health educators who will utilize it in attitudinal and behavioural modification of the HCPs and the aged. The result will also be of immense benefit to the hospitals’ management who may decide to send HCPs for more gerontological training.

Finally, the result of the study is intended to help verify the relevance of the two theories of anchor: theory of reason action (TRA) and theory of programmed ageing (TPA) to the attitude of HCPs towards the aged in Enugu State Teaching Hospitals.

 

Scope of the Study

The study will be conducted in Enugu State. The study will cover the two University Teaching Hospitals in Enugu State: Enugu State University Teaching Hospital Parklane and University of Nigeria Teaching Hospital, Ituku/Ozala, which are the only two university teaching hospitals in Enugu with adequate healthcare facilities for both the ageing and older people. The study will concentrate in finding out the attitude of HCPs towards the aged patients attending University Teaching Hospitals in Enugu State (ESUTHP AND UNTH). This is because the teaching hospitals are big and with large proportion of different categories of HCPs, and

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