Nurse Educators and the Care of Older Persons: A Time for Cultural Change

Abstract Background: Upon graduation, nursing students continue to be ill-prepared in gerontological nursing care and lack a desire to work with older persons. Although nurse educators are expected to facilitate students’ learning about how to provide appropriate older person care, they lack expertise to influence students’ knowledge, skills, and attitudes. There is limited empirical evidence that elucidates the barriers and supports influencing nurse educators’ development of proficiency in this area. Nursing education culture has not yet been explored for its possible influence on capacity building of educators prepared in gerontological nursing. Purpose: The purpose of this dissertation is three-fold: (1) to identify and synthesize literature about factors affecting nurse educators’ knowledge, skills or attitudes about older persons and their care; (2) to understand the culture of a university-based, pre-licensure nursing education program in a Western Canadian province in relation to nurse educators building expertise in gerontological nursing; and (3) to explore why recruitment to a focused ethnography study was successful in engaging numerous nurse educators, researchers, and administrators to volunteer within three months of study initiation. Methods: This dissertation contains three related papers with different methods used in each manuscript: (1) an integrative review to identify the factors that affect pre-licensure nurse educators’ knowledge, skills or attitudes about older persons and their care; (2) a focused ethnography to explore the cultural context of a pre-licensure nursing education program in relation to nurse educators’ expertise in gerontological nursing; and (3) a critical reflection on the successful recruitment of participants to this focused ethnographic inquiry. Findings: For the integrative review, 44 articles met the inclusion criteria. Thirteen papers reported empirical studies that addressed, in some way, factors influencing nurse educators’ preparation in older person care. The remaining articles were defined as discussion papers. More rigorous studies are necessary to expand the evidence base. The literature chronicled barriers and supports for capacity building of educators in gerontological nursing. Supports included external funding and professional regulatory frameworks. Barriers included nursing administrators’ negative attitudes toward older persons; the constrained budgets of educational institutions; ageism among educators; and a lack of awareness of gerontological nursing as a specialty and of professional development resources addressing older persons and their care. The focused ethnography offered further insight about what constrains or encourages professional development of nurse educators in older person care. Nursing education culture in one pre-licensure nursing program was characterized by a hierarchical structure among the various categories of faculty, which impeded gerontology experts’ support for undergraduate educators and for curricular revision. An integrated curriculum diminished the focus on gerontology. Limited professional development opportunities and excessive workloads constrained educators from building gerontology expertise. Valuing older persons and their care influenced the likelihood that educators would pursue preparation in gerontological nursing and affected access to gerontology resources. The critical reflection on recruitment revealed four themes contributing to successful enrollment to the focused ethnography study: laying the groundwork, recruitment plan, building rapport, and participant motivations. Understanding what motivates those who agree to participate in such research is an important contribution to the literature. Conclusions: There continues to be a lack of educators with sufficient preparation in gerontological nursing to educate future generations of nurses to deliver quality care to older persons. Further expansion of the empirical literature on the barriers and facilitators influencing nurse educators’ expertise in older person care is needed. This dissertation research suggests that nursing education culture may influence educators’ preparation in older person care. Further study of this phenomenon in other nursing academic settings is warranted. Once a robust evidence base is developed about what constrains or supports capacity building, further research could be conducted that leads to the identification and testing of strategies to prepare a nurse educator workforce adept in teaching future nurses to provide quality nursing care to older persons. There is also opportunity for future research to understand what motivates research participants to volunteer, and to identify the relative efficacy of various recruitment strategies.

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