An exploration of the attitudes, knowledge, willingness and future intentions to work with older people among Saudi nursing students in baccalaureate nursing schools in Saudi Arabia

The kingdom of Saudi Arabia, like the rest of the world, has a growing older population with urgent health care needs. However little prior research has been undertaken on this topic. In the light of this, the aim of this study was to explore the attitudes, knowledge, willingness and intentions to work with older people among nursing students, and to consider the effects of clinical nursing practice on such factors in the first year and the final (pre-registration) year of training in three major university hospitals. The study was underpinned by the theory of planned behaviour (Fishbein and Ajzen, 1975) which was used as a conceptual framework to explore the relationships between attitudes, subjective norms, perceived behavioural control and behavioural intentions amongst 566 nursing students. The study used a mixed methods design comprising of surveys with the nursing students and 132 faculty members and three focus groups with faculty members to explore their feelings about gerontological education in-depth. The questionnaires contained a range of previously validated instruments including Kogan's Attitude Towards Older People scale, Palmore's Facts on Ageing Quiz, a measure of students' willingness to work with older people and a measure of their perceived intention to work with them. Openended questions were also included. Data were analysed using both multivariate statistics and content analysis. The results provided some interesting and important insights into the complex factors potentially shaping students intentions to work with older people. For example the 566 nursing students who participated in this study displayed a lack of basic knowledge of the physical and behavioural aspects of ageing but held largely positive attitudes towards older people. Despite such positive attitudes a majority of the participants indicated that they would prefer not to work with older people after graduation, although those students who indicated that they would prefer to work with them had the most positive attitudes and the strongest willingness and intent to take care of older people. The data also highlight the potential of clinical training experience with older adults to improve the previous variables (attitudes, willingness and intentions). The qualitative data from both students and teachers highlighted a range of complex factors that in part explained some of the quantitative findings. These related to the influence of subjective norms and perceived control. Therefore at a cultural level Saudi students are exposed to strong positive norms in relation to older people but on entering training may be exposed to negative professional norms as to the status and desirability of gerontological nursing as a career. This, together with students' limited perceived control due to inadequate preparation for practice offer potential explanations as to the disparity between attitudes and behavioural intentions.The qualitative data also highlight the need for greater attention to the preparation of nursing students, with the provision of integrated skills and knowledge on the care of older people. The study also provides a limited critique of the theory of planned behaviour, which whilst supported in part cannot account fully for the complex cultural and professional factors shaping students future career intentions. The thesis, the first of its kind undertaken in Saudi Arabia, concludes with some reflections and suggestions for further research and the actions needed if the preparation of students to work with older people is to improve in the future.