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--/H2013/01430
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This is to certify that the research work, "knowledge, attitude and practice of care of the elderly patients among health workers in university of calabar teaching hospital calabar, cross river state, nigeria" by ---, Reg. No. --/H2007/01430 submitted in partial fulfillment of the requirement award of a Higher National Diploma on --- has been approved.
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DEDICATION
This project is dedicated to Almighty God for his protection, kindness, strength over my life throughout the period and also to my --- for his financial support and moral care towards me.Also to my mentor --- for her academic advice she often gives to me. May Almighty God shield them from the peril of this world and bless their entire endeavour Amen.
ACKNOWLEDGEMENT
The successful completion of this project work could not have been a reality without the encouragement of my --- and other people. My immensely appreciation goes to my humble and able supervisor mr. --- for his kindness in supervising this project.
My warmest gratitude goes to my parents for their moral, spiritual and financial support throughout my study in this institution.
My appreciation goes to some of my lecturers among whom are Mr. ---, and Dr. ---. I also recognize the support of some of the staff of --- among whom are: The General Manager, Deputy General manager, the internal Auditor Mr. --- and the ---. Finally, my appreciation goes to my elder sister ---, my lovely friends mercy ---, ---, --- and many others who were quite helpful.
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With the global trend towards an increasing aging population, there is a corresponding increase in the health problems associated with elderly population especially in developing Countries including Nigeria. With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase, which motivated this study. The study was aimed to assess the level of knowledge, attitude and practice of care of the elderly patients among health workers in University of Calabar Teaching Hospital, Calabar, Cross River State. The specific objective were to (i) determine the level of knowledge of the physical, emotional and social care of the elderly in the University of Calabar Teaching Hospital, Calabar (ii) determine the attitude of health workers in the care of the elderly, (iii) determine the health workers practices in the provision of care of the elderly, (iv) identify factors that influence the health workers attitude towards the elderly in University of Calabar Teaching Hospital, Calabar. The hypothesis for the study tested the association between years of experience of health workers and their attitude towards care of the elderly in UCTH. Calabar. The study adopted a cross sectional descriptive design. The population of the study was 1023 health workers, which was made up of 402 Doctors, 600 Nurses, 10 Dentists and 11 Physiotherapists that provided direct clinical care of elderly patients. The sample was calculated using Taro-Yamane (1967) simplified formula for finite population giving a sample of 461 health workers. The instrument for data collection was questionnaires, the reliability of the instrument was done using test retest method and a reliability co-efficient of 0.91 was obtained. The questionnaires had five sections, section A covered socio demographic data, section B, C, D consisted of items which explored level of knowledge. Attitude, practice and section E elicited information on factors influencing the care of the elderly. The completed questionnaire was coded and analyzed using E.P.I info-7. Descriptive statistics of percentage, mean, standard deviation were used for data analysis. The criterion mean of 2.5 was also used and results of the study revealed that 95% of the health workers had good knowledge of care of the elderly. Majority of the health workers had positive attitude above rating scale of 2.5. The health workers moderately practiced care of the elderly. The factors that positively influenced health workers attitude to the care of the elderly were years of experience, age and mental state of the elderly. There was significant association (P<0.05) between attitude of Health Workers and mean years of experience. Workers with less years of experience had negative attitude, while those with more years of experience had positive attitude, towards the care of the elderly. In conclusion, health care professionals need to have the right skills to manage a more demanding role in the future. In order to offer effective services for the elderly, a skilled workforce of health professionals is therefore very necessary. The study recommended that Geriatric Nursing content in the curriculum be strengthened and also geriatric wards be established in all general hospitals.
TABLE OF CONTENTS
Title page i
Approval page ii
Certification Page iii
Dedication iv
Acknowledgement v
Table of Contents vi
List of Tables viii
List of Appendices ix
Abstract x
CHAPTER ONE: INTRODUCTION
Background to the Study 1
Statement of the Problem 3
Purpose of Study 4
Specific Objectives of the Study 4
Research Questions 4
Significance of the Study 5
Scope of the Study 5
Operational Definition of Terms used in this Study 6
CHAPTER TWO
: LITERATURE REVIEW
Conceptual Review 7
Theoretical Framework 25
Empirical Review 28
Summary of the Literature Review 33
CHAPTER THREE: RESEARCH METHOD
Research Design 34
Area of Study 34
Population of the Study 35
The Sample size for the Study 35
Sampling Procedure 35
Method of Data Collection 36
Validity of the Instrument 37
Reliability of the Instrument 37
Ethical Consideration 37
Procedure for Data Collection 38
Method of Data Analysis 38
CHAPTER FOUR: PRESENTATION OF RESULTS
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION
Discussion of the Findings 48
Implication of Findings to Nursing 51
Limitation of the Study 51
Summary 52
Conclusion 53
Recommendations 53
Suggestion for further studies 54
References Appendices Questionnaire
LIST OF TABLES
Table 1: Socio-Demographic Characteristics of the Respondents …………………… 39
Table 2a: Level of Knowledge of Health Workers towards the care of the Elderly............ 40
Table 2b: Categorization of knowledge Score....................................................................... 41
Table 2c: Proportion of health workers and their level of knowledge on the care
of the elderly patients 41
Table 3: Attitude of Health Workers towards the Care of the Elderly ………………… 42 Table 4a: Health Workers Practice of Care of the Elderly..................................................... 43
Table 4b: Categorization of Practice Score …………………………………………. 44
Table 4c: Proportion of health workers and their practice of care of the elderly patients 44
Table 5: Factors Influencing the Attitude of Health workers towards Care of the Elderly …45 Table 6a: Mean years of Experience of Health Workers and Attitude of care towards
the Elderly................................................................................................................. 46
Table 6b: Years of Experience and Attitude of Health Workers 47
Table 6b Proportion of health workers with positive and negative altitude towards
the care of the elderly patients. 47
LIST OF APPENDIXES
Appendix i: Sample Questionnaire Appendix ii: Calculation of Sample size Appendix iii: Informed Consent form
Appendix iv: Clearance before Seminar Presentation Appendix va: Ministry of Health Ethical Approval
Appendix vb University of Calabar Teaching Hospital Ethical Approval Appendix vi Clearance before Seminar Post Field
Appendix vii Calculation of Sample Size Appendix viii Letter of Identification
Appendix ix Application for Permission to Collect Data Appendix x: Letter of Introduction
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Ageing is the accumulation of changes in a person over time (Bowen and Atwood 2014). It involves a multidimensional process of physical, psychological and social change. Some dimensions of aging grow and expand over time, while others decline. Research shows that even in late life, potentials exist for physical, mental and social growth and development (Papalia, Sterns, Feldman, and Camp, 2012). It is not a disease; but phase of life where there is retrograde biological process in growth and development which leads to decreased powers for survival and adjustment. Aging is an important part of all human societies reflecting the biological changes that occur and also reflecting cultural and societal convention.
An estimated 100,000 people worldwide die each day of age related causes (Aubrey de Grey, 2017). According to National Population Commission (NPC, 2016), persons who are old enough to receive pension who are between ages of 60-65 years are regarded as the elderly. The elderly are classified by age into young old for those aged 60-74years, middle old for those aged 75-84years, old for those aged 85-94 years and oldest old for those 95years and above. (Barman, Snyder, Kozier & Erb , 2018).
Care of the elderly is the fulfillment of the special needs and requirements that are unique to senior citizens. It covers such services as assisted living, adult day care, long term care, nursing homes, hospice care and home care. Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity. The care of the elderly is multidimensional and these include physical, emotional, spiritual and social care (Ayres, 2018).
However, improvement in primary health care with focus on prevention of childhood diseases through immunization did not highlight the care of the elderly which should be one of the components of primary health care programme in most developing countries (Olise, 2011). A cursory look at the implementation of Millennium Development Goals (MDGs) by the federal government shows that there is little or no consideration of this very important segment of the population – the elderly. Also most curricula for training Health Manpower in Nigeria do not highlight the care of the elderly (Donatelle, 2011). Yet the population of this segment of the society is increasing in developing countries with their special care needs. Traditionally, in Nigeria elderly care has been the responsibility of family members and was provided within the extended family system (Ting and Woo, 2009).But with modernization, elderly care is now being provided by state or charitable institutions. This is attributable to decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home (Lee, 2019).
In most developing countries including Nigeria the population of the elderly is increasing rapidly but the government does not seem to be making any major commitments to elderly healthcare (Adio-Moses, 2011). The government is still assuming that families should take care of their elderly without recognizing that the extended family system is at the verge of collapse. Currently most families find it difficult to manage their own homes and face their challenges. This is gradually leading to neglect and abuse of the elderly (Gubrium, 2012). Care of the elderly requires adequate knowledge of the ageing process, nutrition and daily needs of the elderly. In Nigeria, marginalization of the elderly especially in their care is a common episode (Abdulraheem & Parakoyi, 205). Those involved in the provision of health care have important roles to play in programmes relating to elderly care especially in screening and detecting abuse.
Unfortunately doctors do not diagnose abuse because it is not part of their formal or professional training hence does not feature in their list of differential diagnosis (Donatelle, 2011). The health worker, according to Abdulrahem & Parakoyi (2015) plays major roles in determining and implementing desirable standards of health care, acting as a professional in developing core of professional knowledge and should have ability to impart same to others. They are often the providers of services designed to maintain health and prevent illness. Research has also shown that the quality of health care service provided to older population is strongly influenced by care givers attitude towards older people (Gallaghar, Bennet & Halford, 2016). This underscores the need to assess the knowledge, attitude and practice of care of the elderly among health workers in University of Calabar, Calabar Cross River State.
1.2 Statement of the Problem
The population of the elderly in the world is increasing rapidly (United Nations, 2014) and the rate of increase is higher in developing countries including Nigeria. Currently, Nigeria has the highest number of the elderly people in Africa estimated to be about 5.6% of the Nigeria population (NPC, 2018). With this increase in the growth of the aging population, the number of people that will need health care will undoubtedly increase. Donatelle (2011) posited that in most curricula for health professionals, little or nothing is indicated about the care of the elderly showing absolute neglect in this area Mclafferly and Morrison (2014) stated also that most health workers have very poor knowledge of mental health conditions which are common with the elderly and as such health workers come to service with deep seated, negative, diluted and superstitious belief about caring for the elderly. This lack of adequate knowledge and negative attitude towards the care of the elderly may result in serious problems in our society in the near future. In a recent study of the elderly in Ibadan by Oyetunde, Ojo & Ojewale (2013) show that
attitudinal relational gaps exist, resulting in negative patient outcome. From my clinical practice in different hospitals in Calabar, frequent misunderstanding between elderly patients and health care providers especially the young ones, was observed. Based on these, the researcher seeks to find out the knowledge, attitude and practice of care of the elderly among health workers in the only tertiary health facility in Calabar, University of Calabar Teaching hospital.
1.3 Purpose of the study
The purpose of the study is to determine the level of knowledge, attitude and practice of care of the elderly among health workers in University of Calabar Teaching Hospital, Calabar, Cross River State.
1.4 Objectives of the study
Specifically the objectives of the study include to:
- determine the health workers level of knowledge of the physical, emotional and social care of the elderly in University of Calabar Teaching Hospital ,Calabar, Cross River State
- determine the attitude of the health workers towards the care of the elderly.
- determine the health workers practices in the provision of care for the elderly.
- identify the factors that influence health workers attitude of care towards the elderly in University of Calabar Teaching Hospital, Calabar.
1.5 Research Questions
- What is the level of knowledge of the care of the elderly among health workers in a tertiary health facility in Calabar, Cross River State?
- What is the attitude of health workers towards care of the elderly in a tertiary health facility in Calabar?
- What are the health workers practices in the provision of care of the elderly in a tertiary health facility in Calabar, Cross River State?
- What are the factors that influence health workers attitude of care towards the elderly?
1.6 Hypothesis.
- There is no association between years of experience of health workers and their attitude towards care of the elderly in UCTH, Calabar.
1.7 Significance of Study
The result will help to provide basic information for designing structures and programmes for the care of the elderly in the community. It will also provide evidence based information for health education on graceful ageing. It will serve as a reference material to other researchers in the field of community health practice.
Findings of the study will help in showing the level of knowledge and attitude of the health workers towards the care of the elderly and will help improve the decision making. The result will also help in building up knowledge base on the care of the elderly patients. Improving data base on elderly health nutrition and standard of living which will help for further research, advocacy, policy dialogue and programming.
1.8 Scope of Study
The study focused on the level of knowledge, attitude and practice of the care of the elderly among health workers in University of Calabar Teaching Hospital, Calabar. The study was delimited to only health workers providing direct clinical care (hand on care to the elderly) consisting of nurses, doctors, dentists and physiotherapists in University of Calabar Teaching Hospital.
Knowledge of physical care are expressing understanding of bed bath, skin care, oral hygiene, feeding, elimination and ambulation.
Knowledge of Emotional care; refers to expressing attention, acceptance and love.
Knowledge of social care; means financial support and visitation by family members and friends (co-workers, church member’s, social club, and neighbors).
Practice of physical care expressing competence in providing skin care, oral hygiene, feeding, ambulation and elimination.
Attitude means health workers’ expression of cheerfulness, listening to patient’s complaints and prompt attention, positive attitude while negative attitude means expression of harsh words, lack of respect and “stone face”.
Health Workers refers only to Nurses, Doctors, Physiotherapists and dentists that are directly involved in the clinical care of the elderly. Elderly refers to people aged 60 years and above.
1.8
Project Organisation
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