The Influence of an Educational Programme Upon the Attitudes of Nursing Students Toward the Care of Ill Older People: A Critical Realist Evaluation Study

The primary aim of this longitudinal study was to evaluate the effect of an educational programme upon the attitudes of nursing students toward working with ill older people, with two main objectives:

1. To explore the contextual conditions necessary for the programme mechanisms to work, and

2. To investigate how these contextual conditions may influence the success of the programme mechanisms in changing attitudes.

Critical realism provided the theoretical framework, which guided the study design, from inception through to data analysis. Katz’ (1960) functional approach to attitude change was used to develop the educational programme.

The study was quasi-experimental, using an interrupted time-series design. The attitudes of two groups of nursing students were measured over a period of 20 months, prior to and after the educational programme. A questionnaire-based tool was used to measure attitudes, selected because of its acknowledgement of the importance of contextual factors when measuring the attitudes of nursing students toward the field of older person care. One group attended the educational programme, the other did not. The attitudes of the second group were measured at identical points, to provide data for comparison.

The findings showed that the programme had no effect on the attitudes of nursing students toward working with ill older people, either immediately, or over time. Both existing and new mechanisms were identified, that appear to adversely affect the context in which nursing students learn about the practise of nursing, and make it difficult for students to experience the care of ill older people in a positive way. Detailed analysis showed that elements related to the clinical learning environment have a strong impact on students’ attitudes towards the care of ill older people; very often, this impact is negative. The reality of clinical practice, it appears, is highly influential on students’ attitudes toward working with this group.

The critical realist conception of a stratified clinical learning environment was developed in this study, informed by the work of Brown (2009). Mechanisms related to the structures and people in the clinical learning environment were identified which if addressed locally, may be pivotal in improving the contexts in which nursing students learn about the nursing care of ill older people.

The original contribution that this study makes relates to how nurse educators can begin to improve the attitudes of nursing students toward the nursing care of ill older people, by improving the contexts in which they learn, with reference to their mechanisms. In line with this study’s findings, developmental work should begin within the psychological stratum, with concurrent action in both the socio-cultural and curricular strata of the clinical learning environment, in order to provide more immediate improvements in students’ placement experiences. A number of recommendations were made that would begin this developmental process, and may result in negating the need for attitude change programmes, with the ultimate intention of improving the quality of care for ill older people.