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

It was also emotionally draining to work with patients who were confused, verbally or physically abusive, or combative. It was hard to not take patients' words or actions personally or to work with people with short-term memory loss who needed constant reminders and repeated instructions. Students became frustrated and found working with cognitively impaired older patients mentally exhausting. While cognitive issues and goals moved to the forefront of treatment planning and implementation, the students failed to see the therapists' role in addressing cognition. Instead, they viewed impaired cognition as interfering with their ability to perform physical therapy services. This left students feeling inadequate and less likely to seek work in nursing home settings. This coincides with findings from previous studies.30,32,33

Theme 5: Caring for the Unmotivated Patient

Students encountered older patients who refused treatment, did not cooperate, or lacked motivation. They struggled with their desire to help the patient and the inclination to respect the patient's feelings. Scott expressed this struggle: "They just want to be left alone. I find that frustrating. They just want to be left alone. I can respect that." This struggle negatively affected some students' views and motivation to work with older patients. Scott believed it would be hard to deal with his feelings on a daily basis and was concerned that it would affect his motivation to treat older patients and ultimately his effectiveness as a therapist. Like many of his classmates, this concern weighed heavily against seeking employment in a geriatric setting.

Theme 6: Caring Makes a Difference

While caring was emotionally difficult for students, it was also uplifting. Students cared to talk to older patients and get to know them on a personal level. Caring to know older patients was meaningful because they had so much knowledge and wisdom to share about their lives. Justin represented many of his classmates when he talked about his older patients: "When I see an older person, I think about how much history this person has, how much I can learn from them, and not only will I be able to help them gain back some function, but I think of myself, too: what I can get out of this experience. There's always something to learn from them." Students' recognition of the ability to learn from older patients was echoed in previous research.19)

Students cared to make a difference in the lives of older patients, no matter how small. To students, making a difference in a patient's life meant improv-ing their quality of life by making them more com-fortable or more independent with some aspect of life. Marianne talked about her experience of cre-ating an exercise program on video for the residents at one nursing home: "They were so into it, it made me feel like, Oh, I can make a difference!'"

Theme 7: A Caring Curriculum?

Curriculum is deRned as all the students' school-related experiences, both formal and infor-mal, while enrolled in a program of stud)'. For the students in this study, school-related experiences included interactions with peers, faculty, and clini-cians in both the didactic and clinical components of the curriculum. Based on these interactions, stu-dents perceived many of these people as negative toward geriatric care or employment in geriatric settings. Students believed academic faculty and cli-nicians should be professional role models. Many of these role models, however, explicitly devalued geriatric care. They spoke about geriatric care and nursing home settings in a derogatory manner, dis-credited those who chose to work in nursing homes, or dismissed such work as easy or mindless. Christine, for example, quoted one professor as say-ing. "Are you gonna go hide in a comer somewhere in acute care or a nursing home, or are you gonna he where it's at and he in orthopedics." According to Ellie, this same faculty member referred to phys-ical therapy in geriatric settings as "poop and pee patrol." Megan agreed, "1 get a very strong impres-sion from some faculty that they think if you're smart and you're going to be a good PT [physical therapist], you should be in ortho !orthopedics]." Many students shared similar stones about CIs who devalued geriatric physical therapy. Cail said her Cl assigned the older patients on his schedule because he did not want to treat them. Such statements and actions caused students to reflect on their beliefs and work interests. They did not want to he per-ceived in a negative light by professional peers and role models, and this desire caused some students to consider employment in other settings. John, a student interested in geriatric care, reported. "It's made me second-guess what I want to do." This finding correlates with previous findings that stu-dents believed colleagues would accord them infe-rior status if they worked in geriatric settings.32