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

For John and most of his classmates, the foundation of caring was compassion. They believed health care professionals should be compassionate individuals, sincerely committed to caring for others, young or old.

Students believed caring was demonstrated by taking the time to listen to patients' needs, attempting to figure out what they were trying to say, or taking time out of a busy schedule to talk with them, explain procedures, help them with a task, or simply listen to their stories. When students showed patients they cared, they noticed a positive impact on attitude, motivation, and cooperation. George shared his experience: "I had a patient who would refuse PT [physical therapy] every time we went in there. So one day, I just went in there and talked to him for 20 minutes, just to get to know him. The next day when we went in there was quite a change--he was ready to work."

Many students talked about clinical instructors (CIs) and other members of the health care team who cared for older patients, as demonstrated through their words and actions. Students were impressed by these individuals and viewed them as positive role models. Annie aspired to be like her CI: "The older people really seem to like him and respect him because of the way he treats them; he talks to them as if they're no age in particular." She offered several examples of his behavior and concluded, "There are many elements to healing, and having a physical therapist like him can make a difference."

Theme 2: The Uncaring Professional

Many students shared stories of others acting in uncaring ways toward older patients, ranging from blatant disrespect to subtle gestures. Physical therapists, physical therapist assistants, physical therapy aides, physicians, nurses, nursing assistants, transporters, and even family members demonstrated uncaring behaviors toward older patients that students had not observed with younger patients.

Students expressed shock and frustration at how older patients were treated. They told of staff who failed to attend to patients' needs. Often, students observed patients lying in their own excrement for hours or lying in bed hungry while their food tray was in view, but out of reach. They believed older patients' voices were "silenced" when staff or family members spoke about them to others in the room without caring to include them in the conversation. Students were upset by staff who spoke in front of older patients in a negative manner or blatantly showed repulsion or disgust at smell, loss of bodily function, general appearance, or wound status. Steve described staff who "would come in when we were dressing his wounds, and they'd make comments about how nasty it was."

Several students compared the treatment of older patients to handling luggage, moving furniture, or herding cattle. Staff lined patients up in wheelchairs in the hallway or sat them all together in one room with nothing to do but stare into space. Philip provided a striking example:

'They'd be there 2 to 3 hours waiting in the hall, and you'd get patients trying to move around. I remember this one lady. She tried to drag the wheelchair, and they put her against the wall and turned the chair until it was locked up against the wall, stopping her from being able to go. You know, one day she finally said, "Can you turn me in another direction so I can see something else?"