Högskolan i Skövde

Nursing students are important future health care providers to the growing number of older persons in society. However, two barriers are their common ageist attitudes and lack of interest in geriatrics. This is a concern in light of the global demand for nurses and a challenge that need to be addressed in nurse education. Age suit simulation has been shown to affect the attitudes of students toward older persons, but the important context of home is often missing from studies. Accordingly, the present study employed a quantitative approach with the goal of investigating the effects of aging simulation with an age suit in a home context as a part of experiential learning among second-year nursing students. The age simulation allowed the students to experience both specific and common health problems from the patient’s point of view in a controlled environment and a relevant context: the home. Data were collected using a questionnaire in a quasi-experimental pretest – posttest design with a control group. Results showed that the intervention had a positive effect on various aspects of the nursing students’ perspectives on caring for older persons. Work experience was associated with more positive attitudes. The control group was more negative toward geriatrics as a career choice than the intervention group. In conclusion, age suit simulation can be an innovative part of nurse education because it raises awareness and understanding of the health challenges of older persons, which are important in combating ageism among future nurses.

Background

Older persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults.

Methods

A qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis.

Results

The analysis generated three main themes; “It’s like walking in a bubble”, “An eye opener” and “Concerns about ageing and the current structure of geriatric care”. The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability.

Conclusions

Age suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons.

Background

Nursing students are important future health care providers to the growing number of older persons in society (World Health Organization [WHO], 2015). However, two barriers are their common ageist attitudes and lack of interest in geriatrics (Kalogirou et al.,2021; Koskinen et al., 2022) which make this an important issue in nursing education. Students may respond more positively towards caring for older persons if the education in gerontology and geriatrics is well structured, innovative, stimulating and interesting (Burbank et al., 2006; Garbrah et al., 2020) and combining theory and experiential learning has been effective in combating ageist attitudes (Gallo, 2019). By contrast, focusing on pathology and basic skills training made students feel that they were not prepared for the complexity of care of older persons (Burbank et al., 2006; Garbrah et al., 2020). Nursing faculty must engage students in student-centred activities, such as simulations (Dahlke et al., 2020) and age suit simulations have been reported to increase empathy and reduce negative attitudes towards older persons (Bearman et al., 2015; Sari et al., 2020). There is however scarce contemporary research on age suit simulations over different cycles in nursing programmes (Coelho etal., 2017).

Participants

Students in the nursing programme at Skövde University during their second year.

Method

Data is collected over three years at different points in the programme however the education intervention takes place during their second year. During the intervention, data were collected using a questionnaire in a quasi-experimental pretest posttest design with a control group, as well as group interviews and video recordings.

The GERonTologic simulator (GERT) age suit

The GERT suit is designed to simulate the sensation of an older person by restricting and impairing psychical and cognitive functions. The suit is composed of various parts such as special shoes, straps, gloves, headphones, eye glasses and weights. These parts can be assembled to simulate specific consequences of aging (age-simulation-suit.com). For example, stiff and aching joints, impaired vision, reduced range of motion, tremor, reduced breathing capacity (lung disease) reduced hearing as well as tinnitus.

Simulations at Skaraborg Health Technology Center (SHC) University of Skövde

Age suit simulation provides the opportunity to equip young persons with age related health problems and are typically used to increase the understanding of living with acertain health problem (Timm et al., 2020). The simulations are carried out in the collaboration arena, knowledge center and testbed of Skaraborg Health Technology Center (SHC). The arena provides a unique opportunity to simulate age related health problems in a highly accessible home context and carry out daily chores in an arena equipped with welfare technologies and other aids in the both digital and manual.

Pedagogical framework

The framework used is experiential learning theory. Kolb (1984) defines experiential learning as the process whereby knowledge is created through the transformation of experience and learning is a continuous process. Kolb and Kolb (2018) describe that the brain is adapted to learn by experience and the process is illustrated as a cycle of; experiencing, reflecting, thinking and acting. Students learn differently, meaning they have different learning styles and by consequence students take different ways in the learning cycle. The age suit simulations in the controlled environment give the nursings tudents a chance to reflect upon needs, possibilities and hindrances in relation to welfare technology and other aids as they experience specific and common health problems from the patient's point of view. The activities in SHC can be related to the learning cycle described by Kolb, resulting in knowledge becomes ingrained in the body of the learner.

Results

The statistical analysis showed that the intervention group responded more positively to caring for older persons as a career choice than the control group. That is, the participants in the intervention group had more positive scores for caring for older persons after the intervention than before the intervention. The scores for the items that described frustration with caring for older persons were higher in the intervention group post-intervention and when compared to the control group. There was no statistically significant difference between the male and female students. More years in the work force was associated with more positive attitudes to caring for older persons, but the students with less experience were more positively influenced by the intervention. In the preliminary results of the qualitative analysis students reported a deeper understanding for older persons and the challenges of living with health problems. The knowledge from partaking in the simulations experience was described as something other than that of theoretical knowledge. The simulations affected them physically but also mentally. This was referred to as a feeling of walking in a bubble, being disconnected from others. Interestingly, impaired vision and hearing was described as worse than physical pain. There were multiple aspects of frustration for example adapting to a heavy body and trying to complete ordinary tasks with limited vision, which became very time consuming. In addition, they saw a need to implement this new knowledge in their clinical practise. They spoke of being patient, to give enough time, provide safe care and focus on what is important. Another aspect was awareness of the barriers and facilitators of providing care in a home environment. They saw opportunities as well as ethical dilemmas and pragmatic issues of interacting with health and welfare technologies. They also become increasingly aware of ethical aspects of health care provision and the vulnerability that older persons can experience. The students also reflected on their own aging process and what they could do to promote healthy ageing in themselves.

References:

Bearman, M., Palermo, C., Allen, L. M., & Williams, B. (2015). Learning empathy throughsimulation: A systematic literature review. Simulation in Healthcare, 10(5), 308–319.

Burbank, P. M., Dowling-Castronovo, A., Crowther, M. R., & Capezuti, E. A. (2006). Improving knowledge and attitudes toward older persons through innovative educationalstrategies. Journal of Professional Nursing, 22(2), 91–97.

Coelho, A., Parola, V., Cardoso, D., Duarte, S., Almeida, M., & Apóstolo, J. (2017). The use of the aged simulation suit in nursing students: a scoping review. Journal of Nursing Referência (Revista de Enfermagem Referência), 4(Nº14), 147–158.

Dahlke, S., Davidson, S., Kalogirou, M. R., Swoboda, N. L., Hunter, K. F., Fox, M. T., ... & Salyers, V. (2020). Nursing faculty and students' perspectives of how students learn to work with older people. Nurse Education Today, 93, 104537.

Gallo, V. (2019). Ageism in nursing education: A review of the literature. Teaching andLearning in Nursing, 14(3), 208–215.

Garbrah, W., Kankkunen, P., & Välimäki, T. (2020). Gerontological nurse teachersabilities and influence on students' willingness in older people nursing: A cross-sectional, correlational survey. Nurse Education Today, 90, 104461.

Kalogirou, M. R., Dahlke, S., Davidson, S., Hunter, K. F., Pollard, C., Salyers, V., ... & Fox, M. (2021). Working with older people: Beginning or end of a nurse's career? International Journal of Older People Nursing, 16(6), e12407.

Kolb, D.A. (1984). Experiential Learning: Experience As The Source Of Learning And Development. http://www.learningfromexperience.com/images/uploads/process-ofexperiential-learning.pdf

Kolb, A., & Kolb, D. (2018). Eight important things to know about the experiential learning cycle. Australian educational leader, 40(3), 8–14.

Koskinen, S., Burke, E., Fatkulina, N., Fuster, P., Löyttyniemi, E., Salminen, L., ...& ProCompNurse Consortium. (2022). Graduating nurse students' interest in older peoplenursing A cross sectional survey in six European countries. International Journal of Older People Nursing, 17(3), e12446.

Sari, D., Taskiran, N., Baysal, E., Acar, E., & Cevik Akyil, R. (2020). Effect of an aged simulation suit on nursing students' attitudes and empathy. European Geriatric Medicine, 11(4), 667–675.

Timm, I. J., Spaderna, H., Rodermund, S. C., Lohr, C., Buettner, R., & Berndt, J. O. (2020, December). Designing a randomized trial with an age simulation suit representing people with health impairments. In Healthcare (Vol. 9, No. 1, p. 27). MDPI.

World Health Organization. (2015). World report on aging and health. World Health Organization. https://apps.who.int/iris/handle/10665/186463

Background

In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

Question

The focus of this study was to explore expecting parents’ use of digital sources and how this influences their health during pregnancy.

Methods

A systematic review covered the thematic analysis of 39 articles.

Findings

The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents’ health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

Conclusion

Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

Världshälsoorganisationen, [1] belyser utmaningen att ge en vård som stödjer ett hälsosamt åldrande. Ett centralt hinder är den höga förekomsten av negativa attityder gentemot åldrandet, äldre personer och vård av äldre, särskilt bland vårdpersonal [2-4]. Vidare påvisas att sjuksköterskestudenter kan bära på negativa attityder till att vårda äldre och därför inte ser arbete inom äldrevård som ett önskvärt och framtida arbetsfält [5, 6]. Otillräcklig forskning avseende ålderism tillsammans med bristande utbildning inom området äldre, det normala åldrandet samt åldrandets hälsoproblem beskrivs som en bidragande faktor till ålderism [4]. Trots att interventioner kontinuerligt genomförs för att ändra attityder och minska ålderism i vården kvarstår dessa i betydande omfattning [3]. Det finns således ett behov av att skapa innovativa lösningar som bidrar till en ökad och hållbar förståelse för åldrandet, äldre och åldersrelaterade hälsoproblem. Detta adresseras i en ny utbildningsintervention med simulering i äldredräkt som utformats och genomförs i Skaraborgs Hälsoteknikcentrum (SHC), Högskolan i Skövde. Forskning [7] lyfter fram att simulering i utbildning, särskilt genom användande av utrustning som äldredräkt, är en framgångsrik väg att ändra studenters attityder gentemot äldre. Simulering i SHC ger även möjlighet att testa hälso- och välfärdsteknik vilket ytterligare kan inverka positivt på uppfattningar om dess nytta vid implementering av teknik i vården [8].

Pågående utbildningsmoment i utbildning till sjuksköterska och distriktssköterska

Under läsåret 2019-2020 har grupper av studerande inom omvårdnad deltagit i simulering i SHC. Vid denna simulering har äldredräkt använts för att återspegla upplevelsen av normalt åldrande och vanligt förekommande hälsoproblem. De studerande tilldelas en personas och genomför olika scenarier i SHC. I samband med detta besvaras enkät [9], före simulering samt efter simulering för att ta del av synen på åldrandet och att vårda äldre samt eventuell förändring efter genomgången simulering. Efter simuleringen reflekterar studenterna i grupp över upplevelsen av simuleringen, åldrandet och den vård som ges. Reflektionerna relateras sedan till centrala begrepp i omvårdnad samt sjuksköterskans kärnkompetenser. Vidare reflekterar de studerande över hur simuleringen påverkat deras insikt och förståelse samt hur det kommer att visa sig i den vård som ges.

Forskningsprojekt

Utbildningsinterventionen beforskas som en del i ett longitudinellt projekt med övergripande syfte att studera hur en utbildningsintervention med simulering i äldredräkt inverkar på insikt och förståelse för åldrandet, att vara äldre och att leva med åldersrelaterade hälsoproblem i kontexten samt vård av äldre personer. Vidare är syftet att longitudinellt studera studenters syn på åldrandet, äldre och att vårda äldre personer. De hittills genomförda simuleringarna visar tecken på att studenters insikt och förståelse avseende åldrandet, att åldras och att leva med åldersrelaterade hälsoproblem förändras på ett positivt sätt. Det finns därför ett behov av att systematiskt utvärdera effekten och nyttan av den intervention som nu genomförs i SHC. Externa medel söktes hos Familjen Kamprads stiftelse och 3,5 miljoner erhölls för att genomföra projektet och att anställa en doktorand.

Referenser

1. WHO, Integrated care for older people (ICOPE) implementation framework: guidance for systems and services. 2019, Geneva: World Health Organization.

2. Wyman, M.F., S. Shiovitz-Ezra, and J. Bengel, Ageism in the Health Care System: Providers, Patients, and Systems, in Contemporary Perspectives on Ageism, L. Ayalon and C. Tesch-Römer, Editors. 2018, Springer International Publishing: Cham. p. 193-212.

3. Burnes, D., et al., Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis.American Journal of Public Health, 2019. 109(8): p. e1-e9.

4. Wilson, D.M., et al., A critical review of published research literature reviews on nursing and healthcare ageism. Journal of Clinical Nursing, 2017. 26(23-24): p. 3881-3892.

5. Szadowska-Szlachetka, Z., et al., Attitudes of students of nursing major towards people of geriatric age. Polish Journal of Public Health, 2019. 129(3): p. 95.

6. Naughton, C., K.L. O’Shea, and N. Hayes, Incentivising a career in older adult nursing: The views of student nurses. International Journal of Older People Nursing, 2019. 14(4): p. e12256.

7. Giner Perot, J., et al., Aging-simulation experience: impact on health professionals’ social representations. BMC Geriatrics, 2020. 20(1): p. 14.

8. Frennert, S. and K. Baudin, The concept of welfare technology in Swedish municipal eldercare. Disability and Rehabilitation, 2019: p. 1-8.

9. Burbank, P.M., G.J. Burkholder, and J. Dugas, Development of the Perspectives on Caring for Older Patients scale: Psychometric analyses. Applied Nursing Research, 2018. 43: p. 98-104