experience of nursing home care: A strong influence on physical therapist students' work intentions, The

Journal of Physical Therapy Education, Spring 2002 by Tovin, Melissa Moran, Nelms, Tommie, Taylor, Leslie F

Purpose. The general population is aging rapidly, and the need for physical therapists to serve the geriatric community is significantly increasing. There is a growing concern that students hare negative attitudes toward older adults and/or toward geriatric care settings. Negalive attitudes may affect the professions' ability to meet the growing demand for qualified clinicians in geriatric settings. Previous research is limited and has centered on students' and professionals' attitudes and intentions toward geriatric employment, with a focus on factors such as personal, educational, or clinical experiences that positively or negatively influence attitudes and intentions. Yet, few studies have investigated these experiences from a qualitative perspective. This qualitative study was conducted to gain in-depth understanding of physical therapist students' educational experiences in geriatric care settings. Subjects. Fifty physical therapist students enrolled at a large southern university participated in the study. Methods and Materials. Data were gathered through focus group interviews, one-to-one interviews, and journals in which students described their educational experiences with geriatric physical therapy. Analyses. Data were analyzed using the constant comparative method and interpretive strategies to create a thick description of students' experiences. Methodological rigor was established through the trustworthiness and authenticity criteria espoused by Lincoln and Guba (1985). Two major themes, "caring" and "uncaring," were the essence of students' experiences and revealed their attitudes, beliefs, intentions, and behaviors regarding geriatric physical therapy. Findings. The most significant finding was that students' negative experiences in nursing homes greatly outweighed the positive experiences, which led to negative beliefs and attitudes toward working in nursing homes. This resulted in their intentions to seek employment in other settings. Furthermore, students felt powerless to change what they believed to be negative aspects of nursing home care. Although students had positive attitudes toward elderly clients, they failed to recognize their potential to be moral change agents in this setting. This reinforced their negative view toward employment in nursing homes. The findings of this study have serious implications for geriatric education and can inform physical therapy educators, practitioners, and researchers. Knowledge of students' experiences can assist in the development of educational interventions designed to motivate and attract physical therapists to work in nursing home settings.

Key Words: Attitudes, Geriatric physical therapy, Nursing home care, Phenomenology, Professional-patient relations.

INTRODUCTION

Entry-level physical therapist education programs aim to graduate competent physical therapists to meet the health care needs of the public. The segment of the general population over age 65 years is rapidly expanding, and the need for physical therapists and other health care professionals to serve the geriatric community, particularly in long-term care settings, is significantly increasing. There is a growing concern among health care professionals and scholars that students and practicing clinicians have negative attitudes toward older adults and/or toward geriatric care settings. Many practitioners and scholars fear that such negative attitudes may affect the profession's ability to meet the growing demand for qualified clinicians in geriatric settings. The purposes of this qualitative study were to gain an in-depth understanding of physical therapist students' educational experiences with older adults and geriatric physical therapy and to understand and interpret what meaning these experiences had for students regarding work preferences. Results inform faculty in physical therapy programs for the development of curricula that are more sensitive to the needs of an aging population and, therefore, the needs of the aging public. Based on the results, we offer educators some strategies designed to influence students' beliefs and attitudes toward working with older adults in nursing homes.

LITERATURE REVIEW

Both the number and the proportion of elderly people, those aged 65 years or older, are growing because of increased longevity and the aging of the "Baby-Boom" generation.1-3 As the number of people over age 65 years increases, so does the need for health care for the elderly population.4 In particular, there is a growing demand for long-term and chronic care services and facilities for elderly people. The impact of this growing demand is most evident in the rapid increase in the number of certified nursing homes alone.5 Because of managed care cost containment, acute care hospitals discharge patients to nursing homes earlier than in the past. As a result, residents of nursing homes have more acute levels of illness, and this trend will continue.6,7 With increasing levels of acuity, older residents need more skilled care services, including physical therapy.7