Factors Affecting Staff Attitude towards Elderly Patients in Healthcare: A Critical Study

This research aims to analyze the factors affecting the behavior of nurses towards elderly patients in healthcare. The study will conduct a literature review and interview registered nurses to validate the research objective and answer research questions. The conceptual framework includes conflict and aggression with patients and their family members, long working hours and shortage of staff, lack of proper training, and poor working environment. The study will recommend ways to refine the attitude of nurses towards elderly patients.

0Running head: RESEARCH PROPOSAL
A Critical Study of the Factors that Affect Staff Attitude towards Elderly Patients
Exhibiting
Name of the Student
Name of University
Author’s note

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Abstract
The rise in the elderly group of people is the main concern in the healthcare system. In
this research the main aim is to analyze numerous factors that affect the behaviour of the nurses
towards the aged group of population and thereby resulting in challenging behaviour. In order to
elucidate the research aim, the research will conduct the literature review followed by an
interview with the registered nurses with open-ended questionnaire. Their responses will be used
to validate the objective of the research while answering the research questions.

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Table of Contents
1. Introduction..................................................................................................................................5
1.1. Background of research........................................................................................................5
1.2. Problem Statement................................................................................................................5
1.3. Rationale...............................................................................................................................6
1.4. Aims and Objectives.............................................................................................................6
1.5. Research objectives..............................................................................................................7
1.6. Research questions................................................................................................................7
1.7. Structure of the dissertation......................................................................................................8
2.1 Literature Review......................................................................................................................9
2.2 Introduction............................................................................................................................9
2.3 Conceptual framework.........................................................................................................10
2.3.1 Conflict and aggression with the patient and their family members............................10
2.3.2. Long working hours and storage of staffs...................................................................11
2.3.3. Lack of proper training................................................................................................12
2.3.4. Poor working environment..........................................................................................12
2.3.5. Impact on health and well-being of the elderly patients..............................................13
2.4. Summary.............................................................................................................................14
3. Methodology..............................................................................................................................15
3.1. Introduction.........................................................................................................................15

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3.2. Research philosophy...........................................................................................................15
3.3. Research approach..............................................................................................................15
3.4. Research Design.................................................................................................................15
3.5. Data collection and analysis...............................................................................................16
3.6. Sampling method................................................................................................................16
3.10. Measures...........................................................................................................................17
3.11. List of questionnaire.........................................................................................................17
3.12. Ethical consideration........................................................................................................17
3.13. Summary...........................................................................................................................17
3.14. Time schedule (Gantt chart).............................................................................................17
4. Data Analysis.............................................................................................................................18
4.1. Introduction.........................................................................................................................18
4.2. Qualitative Data analysis of Interview Question................................................................18
5. Conclusion and Recommendation.............................................................................................21
5.1. Conclusion..........................................................................................................................21
5.2. Linking objectives with the findings..................................................................................21
5.3. Recommendation................................................................................................................22
6. Research limitations...................................................................................................................23
7. References..................................................................................................................................24
Appendix........................................................................................................................................28

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Appendix A................................................................................................................................28
List of questionnaires.............................................................................................................28
Appendix B................................................................................................................................29
Time plan of the research......................................................................................................29

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1. Introduction
1.1. Background of research
Nursing is the principal healthcare profession which has major contribution towards
overall wellbeing of the patient. Nurses are responsible for the well-being of the patient via
delivering holistic care. However, behaviour, skills and competencies of the nursing staffs have
profound impact on the well-being and tenure of hospital stay of the patient (Bodner et al.,
2015). Among the patients in the hospital, one of the significant age group is the older
population. According to Tremont and Davis, (2014) in the contemporary society, increases in
the number of people who are in their mid-60s are gradually becoming threat for the global
healthcare system. Increase in aged population is also associated with the increase in the
numerous complex disease like cardiovascular disease, respiratory disease, musculoskeletal
disease as well as gastro-intestinal disorders (Pleasant et al., 2017). This increase in
physiological complications along with the increase in the rate of hospitalisation has increased
the responsibilities of the nurses. Moreover, older population gradually tend to lose their mental
and physical strength for which they require additional physical, mental, emotional and spiritual
support and this further increases the challenge of the nursing staffs (Oosterom-Calo et al.,
2015).
1.2. Problem Statement
There are various evidences centring the challenging attitude of the nurses towards the
elderly clients which reducess the overall well-being along with increase in the tenure of hospital
stay (Davison et al., 2016). According to Davison et al. (2016), negative attitude of nursing staffs
who are concerned with the elderly care are higher and there are several internal and external

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factors contributing towards this negative attitude. However, what exact are the factors or the
underlying reason behind this negative attitude, are not elucidated. But the key concern is these
kind of pessimistic attitudes of the nursing staffs is actually hampering the quality of care along
with emotional and spiritual well-being of the elderly population. Chen et al. (2016) have
highlighted long working hours, lack of skills and unmanageable behaviour of the patients are
the major contributing factor behind the negative attitude of the nurses. However, certain internal
issues behaviour of the nursing professionals is also significant in this context. Thus it is crucial
to identify the actual contributing factors towards the negative attitude or challenging behaviour
of the nurses treating the elderly population. The exploration of the research context will mostly
be based on the identification and subsequent elimination of the factors promoting negative
attitude of nurses towards older population.
1.3. Rationale
The challenging behaviour of the nurses towards the elderly population has become a
serious issue in the healthcare sectors throughout the world. Therefore the present study will aim
to identify the factors which are the major contributors the negative behaviour of the nursing
staffs. Moreover, identification of these factors will help to increase the quality of care along
with health care policies like training of the nursing staffs with a special focus on the patient
satisfaction (Hynnien et al. 2015). Thus alternatively it can be said that the research findings will
improve the overall quality of the health care services while increasing the level of satisfaction
among the care givers and the care receivers.
1.4. Aims and Objectives

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The aim of the research is to analyze numerous factors that modulates the attitude of the
nursing professionals towards the elderlypatients and thereby giving rise of challenging
behaviour.
1.5. Research objectives
1. To examine the impact of numerous factors that cause change in the overall attitude of
the nurses towards the elderly people
2. To analyse whether these factors affects the mental and physical well-being of the elderly
person who is receiving the care
3. To recommend the best ways to refine the attitude of the nurses towards elderly people
1.6. Research questions
 What are the attitudes of the nurses towards the elderly group of patients?
 What is the impact of the ratio of nursing professional staffing on elderly care?
 What factors influence the attitudes of the nurses in elderly care?

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1.7. Structure of the dissertation
Source: Created by Author

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2.1 Literature Review
2.2 Introduction
This is the most crucial chapter of the research which is associated with the examination
of the theoretical framework along with research work undertaken by other authors. In this
chapter, the research will discuss numerous factors which lead to the generation of the
challenging behaviour among the nurses. The critical analysis of the research papers helps the
research to identify the main themes of the research (conceptual framework) along with the
research limitations of the previous work followed by the choice of methodology. The chapter is
important because it helped to analyse the relationship between the dependent variable (negative
attitudes of the nurses towards the elderly patients) with other independent variables.

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Verbal along with
physical aggression of the
elderly patients and
problem with the patient’s
family members
Lack of proper nursing
training and experience
nurses
Shortage of staff and
Long working hours
Challenging or
negative
behavior of
nurses
Impact upon
mental and
physical well
being of elderly
patients
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2.3 Conceptual framework
Source: Created by author
2.3.1 Conflict and aggression with the patient and their family members
According to Borkowski (2015), nurses experience difficulty in communicating with
the elderly patients. This is because, the majority of the elderly population suffers mental
retardation along with certain level of dementia and thereby making them behaviourally
challenged. This behaviourally challenged people demands special attention and communication
standards. Finnema et al (2017), the majority of the nursing professional fails to understand this
difference in the communication requirement among the elderly patients in comparison to other

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patients and thus generating challenging situations. Furåker and Nilsson (2009) highlighted that
the nurses are required to deliver proper information of the patients to their family members.
However, the majority of the nurses do not give the comprehensive information to the family
members creating confusion and anger among the family members and thereby creating further
challenge.
2.3.2. Long working hours and storage of staffs
According to Wei et al., (2015), long working hours along with shortage of adequate
nursing staffs creates extra pressure on the existing nursing professionals on duty. This extra
work pressure increases their stress level and the impact of this stress gets expressed over the
patients in terms of ill-behaviour and thereby affecting the emotional and spiritual wellbeing of
the elderly patients. We et al. (2015) further highlighted that increase in the stress level among
the nursing professionals cause increase in the rate of the medication errors. McCann, Baird and
Muir-Cochrane (2014), highlighted a different perspective of this high level of stress, they
opined that rise in stress level increases job dissatisfaction. Their survey highlighted that one out
of four nurses is successful in balancing job stress and work balance and thereby satisfying
patients with their therapy plan. Study conducted by Möhler and Meyer (2014), stated that
elderly people demands extra care and services and this is not support by the present patient :
nurse ratio and thus creating an imbalance in work followed by increase in job stress. Moreover,
the majority of the elderly patients suffer from mental complications which demand extra like
they are unable to take their medicines on time. This creates negative outcomes in the treatment
leading to poor reputations among the nursing professionals along with negative attitude (Surr et
al., 2016). Alber et al. (2014) have highlighted that the loss of adequate sleep due to extra
working hours causes fatigue and drowsiness among the nurses and thereby generating cognitive

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behavioural problems. This rise in the cognitive behavioural problems hampers patients: nurse
relationships which further increase the job stress along with negative attitudes towards the
nurses.
2.3.3. Lack of proper training
Bing-Jonsson et al. (2016) highlighted that the lack of training is another important
reason behind why the nurses fail to manage the extra work pressure along with optimal care
plan for the elderly patient. Deasey, Kable, and Jeong (2014) highlighted that if nurses lack
proper training, they experience problems while treating elderly care patients. Golden et al.
(2015) opined that due to the lack of proper training, the nurses fail to identify the exact
requirement of the patients and thereby failing to provide the appropriate care and hence
increasing the tenure of hospital stay. Golden et al (2015) further opined that lack of training
creates gap in knowledge. The majority of the nurses who are untrained do not have adequate
knowledge about the exact communication style in the elderly care unit. Untrained nurses fail to
understand the need of the patients and thus failing to provide the desired care. Samra et al.
(2015) stated that elderly patients who suffer from dementia ail to express their needs, but at
times execute certain body language or take help to sign language to communicate their needs.
However, nurses who are inadequately trained fail to understand the sign language or the
gestures of these dementia patients thus increasing lack of quality of care.
2.3.4. Poor working environment
According to Hill et al. (2017) high workplace diversity along with lack of proper
amenities and increase in the work load creates poor work environment for the nurses working
under the elderly care unit. Hill et al. (2017) further opined that the nurses who execute their
under poor working environment are bound to generate certain level of frustration which gets

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expressed in the form of negative attitude towards the elderly group of population. Borkowski
(2015) opined the nursing profession irrespective of the ward they serve, receives less respect in
comparison to the doctors. They always execute as subordinates of the doctors and this lack of
job respect creates poor work environment. Moreover, in elderly care unit are critical and the
family members remain over concerned. Any gap or pseudo gap in the treatment of the therapy
plan as identified by the patient’s family members gets exponentially manifested in the from of
anger or aggression and since the nurses are available 24X7 in the vicinity of the patients in
comparison to the doctors, they become they become the main target aggression of the patient’s
family members. Face and managing grievances of the patients and most importantly their family
members generates tension during the working hours creating poor work environment.
Borkowski (2015) further nurses who work under the poor work environment are more likely to
generate negative attitude towards their patients. Scerri and Scerri (2013) highlighted that
violence in workplace leads to lack of concentration thereby increasing the rate of mistakes along
with negative attitudes towards the patients.
2.3.5. Impact on health and well-being of the elderly patients
According to Hazelhof et al. (2016), elderly group of population are more likely to suffer
from chronic diseases like cardiovascular disease, mucoskeletal disease, hypertension, diabetes
and other mental health complications. But negative behavior or lack of proper care of the nurses
towards this group of population increases their length of hospital stay along with increase in
chance of getting affected with the hospital acquired infection. Vandecasteele et al. (2017),
highlighted that the negative behavior of the nursing professionals results in the generation of the
negative psychological issues leading to isolation, depression, anxiety and other physical issues
like hypertension, low self-esteem and sudden disgust about the overall medical treatment. This

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decrease in the belief about the medical treatment creates a psychological gap which delays the
overall outcome, further increasing their length of hospital stay. According to Hynnine et al.
(2015), elderly people are lonely and seek mental assistance along with spiritual support from the
healthcare professionals. Since the nursing professionals are greeting the patients round the
clock, patient’s expectations from the nurses are high. However, lack of mental support and
positive regards are proper help in their daily living, they become susceptible to physical
breakdown along with mental stability which further increases their length within the hospital
stay.
2.4. Summary
The review of literature has highlighted negative attitudes of the nurses towards the
elderly group of population. The studies have presented poor staffing, long working hours, and
lack of proper training along with other elderly behavioral difficulties as the major cause behind
the negative attitudes of the nursing professionals towards elderly group of patients. This
revelation remains a highlighted towards the immediate requirement for nurses’ geriatric
training. The present study however focus on the attitude of the nursing professionals compared
with the previously studied literature which is against the background of the present study, is
framed to explore attitude of the nursing professionals towards the elderly care people with
negative behaviours in the hospitals or nursing homes.

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3. Methodology
3.1. Introduction
This chapter provides an overview of the methodological approaches under taken in
order to conduct the research the organised way. According to Parahoo (2014) having a defined
structure of the research helps the researcher to proceed in planned manner towards the accurate
outcome.
3.2. Research philosophy
There are different types of research philosophies like realism, positivism and
interpretivism. In this research, the research has used positivism research philosophy. According
to Bergh and Ketchen, (2011), positivism research philosophy helps to evaluate the information
with a scientific approach along with a logical flow of the information.
3.3. Research approach
There are two types of research approach, deductive and inductive. In this research, the
researcher will employ deductive research approach. According to Crowther and Lancaster
(2012), deductive research approach helps the researcher to select the theoretical framework first
in order to analyze the hypothesis. It also helps the researcher to establish the relationship
between the objectives.
3.4. Research Design
There are various types of research design mainly exploratory, explanatory and
descriptive research design. According to Ellis and Levy (2012), descriptive type research design
helps the researcher to establish cause and effect relationship with the variables of the research.

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This approach helps the researcher to generalize the overall presentation while understanding the
research problem. The study here used an instrument of open-ended questionnaire that has been
stringently developed from taking references from review of literature. With the help of the
descriptive research design, researcher is able to generate strong relationship with the proposed
variables of the research.
3.5. Data collection and analysis
There are two types of data collection method qualitative and quantitative. Researcher
here employed qualitative data collection procedure along with qualitative data analysis.
3.6. Sampling method
Researcher has used random, stratified sampling method for the collection of the
qualitative data. According to Bergh and Ketchen (2011), random stratified sampling help the
research to easily select the focus group. 5 registered nurses working in the elderly care unit were
chosen to conduct the interview with open-ended questionnaire. The selection parameter was
discussed below
1. Participants must be women
2. Highest educational qualification: graduation
3. Designation: registered nurses
4. Working unit: elderly care
5. Age: 25 to 30 years
6. Experience: not more than 1 year

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3.10. Measures
Copies of questionnaires were disseminated among the registered nurses of the elderly
care unity of a hospital in UAE proper before initiation of the interview. After completion of the
interview, the recorded interview was noted down in a transcript format and then was verified by
the participants in order to avoid transcriptional bias.
3.11. List of questionnaire
Please refer to Appendix A
3.12. Ethical consideration
As per the data per the Data Protection Act, all the selected group of participants will
be signed a consent form before the initiation of the interview. This consent form will contain the
purpose of the interview along with the identification of the liberty to leave the interview session
at any point of time, as per their will. Moreover, the ethics form will also highlight that the time
of conduction of interview will not affect their duty hours and will keep their identity
confidential.
3.13. Summary
The research design will be descriptive which is popularly known as descriptive style
research. For the secondary data, the researcher will mostly rely on the literary articles and for
primary data, the research will conducted an interview among the five elderly care registered
nurses working under hospital settings via designing open-ended questionnaires. The sampling
style will be random sampling.
3.14. Time schedule (Gantt chart)
Please refer to Appendix B

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4. Data Analysis
4.1. Introduction
This chapter is designed to examine the information collected by the research as the
means of primary data. Based on the analysis, the researcher will recommend suitable methods in
improve the attitudes of the nurses towards the elderly group of patients.
4.2. Qualitative Data analysis of Interview Question
Question 1
In response to this question, all the five nurses came up with the opinion that their salary
is extremely less in regards to the amount of work they do and stress they take. One nurse has
been found saying, “our salary is so poor that it fails to do justice to our degrees and it becomes
difficult to satisfy the daily living activities with this much of salary in the time of recessation”.
Question 2
In response to this question all the five nurses came up with similar reply. According to
them, though officially they have shift timings, nut in the majority of the days they work ahead
of their shift timings in order to cope up with the rising number of patient and less number of
nurses. One nurses coined, “we work 12 hours a day and sometimes provide support in both the
shifts, day and night. We have no life”.
Question 3
Four out of the five nurses opined that the physical and verbal aggression of the patients results
in challenging behaviour. One nurse said, “During tight schedule and long working hours, when
patients misbehaves or refuse to obey our medication instructions, we lose our patience and our

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outburst comes in form of negative attitude towards the patients”. Another nurses opined that,
“if there were parity between the patient load and the attending nurses then it would have been
easier for us to retain our patience while handling the verbal and physical aggression of our
elderly patients”.
Question 4
Apart from one nurses, rest 4 nurses agreed that conflict with the family members results
in challenging behaviour. One nurse opined that, “when tenured nurses are there with us, it
becomes easier for us to handle the aggression of the patient’s family members. However, in
most of the times we are not guided by an experienced nursing professional and thus end up with
a conflict with the patient’s family and the aftermath affects our behaviour with the patients”.
Question 5
All of the nurses agreed that long working hours results in challenging behaviour. One of
the respondents opined that, “we do not get time to enjoy with our family members and this
increases stress level”. Another nurse opined that, “When I stretch my shift timing, my mental
pressure increases and at this time, when a patient misbehaves or refuse to assist with the
therapy plan, I get agitated and at times express anger on them”.
Question 6
All the respondents said yet to this question. They said it is due to staff shortage that they
are compelled to work extra which increases their stress level.
Question 7

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Three out of five nurses agreed that they lack proper training like communication training
like other experience nurses and thus failed to manage the patients accordingly. Rest two nurses
highlighted long working hours behind their challenging behaviour.

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5. Conclusion and Recommendation
5.1. Conclusion
This chapter aims to shed light over the research outcomes while establishing relationship
between previous discussed chapters. The chapter will link the objective of the research with the
findings.
5.2. Linking objectives with the findings
Objective 1: Impact of factors causing change in the attitude of the nurses towards elderly people
in healthcare
Review of literature highlighted factors like prolong working hours, lack of proper
adequate training, low salary and high work pressure along with aggressive behaviour of the
nurses as the main reasons behind the change in attitude of the nurses towards the elderly people.
The interview highlighted that increase in the work pressure along with poor working
environment increases the stress level among the nurses. They fail to manage their work-life
balance and their frustration gets expressed in terms of negative attitudes towards the patients.
This negative attitude increases the length of the hospital stay of the nurses along with
medication errors and fall injury. These kinds of attitude are hampering mental and spiritual
well-being of the patients.
Objective 2: Whether this factors affects the wellbeing of elderly in healthcare
Nursing cannot work under the environment where they did not get adequate respect to
display their talent. Nurses left compelled inside their working region which is in turn regarded
as unfavourable. Constant ignorance in by the nursing professional towards the patients create a

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sense of loneliness which disrupts their emotional integrity thereby increasing the length of
hospital stay.
Objective 3: Recommendation to improve the attitude of the nurses
As opined by a nurses during the interview process, one of the best process to overcome
this scenario is to increases the nurse : patient ration along with increase in the experienced:
newly appointed nurse ratio. This will decreases the work pressure and will also create provision
for the newly appointed nurses to learn the tricks of trade from their experienced colleagues.
5.3. Recommendation
Three main approaches that must be used to overcome the problem include proper
training of the nursing professionals in the grounds of communication skills and techniques to
handle the pressure or stress management. Moreover, workplace stress are required to be reduced
via recruiting more training nursing professionals along with increase in the appointment of the
experienced nurses in the elderly unit. These nurses will further act as a source for
communication training to the newly recruited nurses. Another recommendation include
promotion of healthy workplace environment.

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6. Research limitations
The research has sudden limitation, for example, for while selection of the focus group,
the researcher has only chosen nurses who have equals to or less than 1 year of experience. Such
that the all the responses were generated from the perspectives of untrained or novice nurses
between the age group 25 to 30 years. Recruitment of experienced nurses who have more than 5
years of experience will help to elucidate the scenario under more detailed perspective.
Moreover, the recording the interview of the patients who are victims of the negative responses
of the nurses might have helped to get the patients perceptive of the challenging behaviour of the
nurses towards patients.

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nursing aides in nursing homes: A qualitative study. International Journal of Nursing
Sciences, 2(4), 371-377.

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Appendix
Appendix A

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Appendix B
Time plan of the research

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