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.