Jordanian nursing students’ attitudes toward the elderly

Abstract

The purpose of this study was to identify Jordanian nursing students' attitudes towards older people and to consider whether the attitudes of the selected sample had any bearing on the care provided for this client group. A descriptive correlational design was employed and Kogan's [Kogan, N., 1961. Attitudes toward old people: the development of a scale and examination of correlates. Journal of Abnormal and Social Psychology, 62, 44-54.] attitudes toward older people scale was administered to a convenience sample of 250 nursing students enrolled in the BSN program at a governmental university in the northern region of Jordan. Students' attitudes were identified using descriptive and inferential statistics. The Jordanian nursing students who participated in this study displayed marginally positive attitudes toward older people. Age and the socio-economic status of the students correlated significantly with their attitudes. Senior and male nursing students had more positive attitudes toward this client group than their counterparts. Students who prefer to work with older people following graduation reported more positive attitudes toward older people than students who did not. The results of this study suggest that positive attitudes exist towards older people; despite this, it is clear that efforts are required to enhance them further. In addition, the Jordanian lecturers in schools of nursing should further consider the need to prepare the students for their roles as caregivers for this particular client group.

Full text

Jordanian nursing students’ attitudes toward
the elderly
Issa M. Hweidi
a,
*, Salwa M. Al-Obeisat
b,1
a
Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and
Technology, PO Box 3030, Irbid 22110, Jordan
b
Faculty of Nursing, Dean, The Hashemite University, Zarqa, Jordan
Accepted 2 June 2005
Summary The purpose of this study was to identify Jordanian nursing students’
attitudes towards older people and to consider whether the attitudes of the
selected sample had any bearing on the care provided for this client group. A
descriptive correlational design was employed and Kogan’s [Kogan, N., 1961. Atti-
tudes toward old people: the development of a scale and examination of correlates.
Journal of Abnormal and Social Psychology, 62, 44–54.] attitudes toward older peo-
ple scale was administered to a convenience sample of 250 nursing students enrolled
in the BSN program at a governmental university in the northern region of Jordan.
Students’ attitudes were identified using descriptive and inferential statistics. The
Jordanian nursing students who participated in this study displayed marginally posi-
tive attitudes toward older people. Age and the socio-economic status of the stu-
dents correlated significantly with their attitudes. Senior and male nursing
students had more positive attitudes toward this client group than their counter-
parts. Students who prefer to work with older people following graduation reported
more positive attitudes toward older people than students who did not. The results
of this study suggest that positive attitudes exist towards older people; despite this,
it is clear that efforts are required to enhance them further. In addition, the Jorda-
nian lecturers in schools of nursing should further consider the need to prepare the
students for their roles as caregivers for this particular client group.

c2005 Elsevier Ltd. All rights reserved.
KEYWORDS
Jordan;
Nursing;
Older people;
Students’ attitudes
Introduction
One of the more challenging health care issues for
nursing is providing quality care for older people
(Bliesmer and Earle, 1993); particularly those older
people that have multiple health-related problems
0260-6917/$ - see front matter 
c2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2005.06.003
*Corresponding author. Tel.: +962 2 7201000x23621.
E-mail addresses: hweidi@just.edu.jo (I.M. Hweidi), Obeisat
@hu.edu.jo (S.M. Al-Obeisat).
1
Tel.: +962 5 3826600x4382.
Nurse Education Today (2006) 26, 23–30
intl.elsevierhealth.com/journals/nedt
Nurse
Education
Today

(Ebersol and Hess, 1997) and are major recipients
of health services (Sheffler, 1998). In Jordan, older
people (those aged 65+ years old) constitute
around 5% of the total population. Although, this
may seem relatively low it is projected that this fig-
ure will increase to more than 10% within the next
15 years (Primary Health Care Initiatives Report,
2003). This increase will create a requirement for
skilled and experienced nurses in many health care
settings that can address and meet the needs of
older people (Fagerberg and Ekman, 1998).
Nurses have a pivotal role as providers of care for
older people and are uniquely positioned to influ-
ence the quality of aged care (Stevens and Herbert,
1997). The majority of nurses are currently provid-
ing health care services to older clients or will pro-
vide services at sometime in the future. Nurse
educators are aware of the changing demographics
and are striving to prepare their students to be
knowledgeable health care professionals who are
able to meet the needs of this growing population
of health care consumers (Sheffler, 1998).
The literature suggests the existence of exten-
sive negative attitudes among nursing students to-
ward older people. These attitudes are based on
myth and stereotype and contribute to a further
lack of understanding of the aging process and
the potential of older people (Williams and Blunk,
1999; Mosher-Ashley and Pamilee, 1999). At the
same time the number of students that are inter-
ested in working with older people has also
declined (Stevens and Crouch, 1998; So
¨derhamn
et al., 2001; Herdman, 2002; Ebersol and Hess,
1997). According to Jacelon (2002) the quality of
care provided for older people is directly related
to the attitudes of health care professionals.
Therefore, it is essential to consider adopting
strategies that promote and enhance students’
attitudes toward older people (So
¨derhamn et al.,
2001; Herdman, 2002).
Literature review
Research investigating nursing students’ attitudes
toward older people suggests the presence of
conflicting views. Literature that addressed stu-
dents’ attitudes toward older people has focused
on the characteristics of students as a significant
determinant of their attitudes (Sheffler, 1998;
Mosher-Ashley and Pamilee, 1999; Kwan and
Law, 1994; Rogan and Wyllie, 2003; So
¨derhamn
et al., 2001). The most frequently reported
students’ characteristics are ‘‘age’’ (Sheffler,
1998; McCracken et al., 1995; So
¨derhamn et al.,
2001; Mosher-Ashley and Pamilee, 1999), gender
(So
¨derhamn et al., 2001; Sheffler, 1998; Kwan and
Law, 1994; McCracken et al., 1995), educational
attainment (McCracken et al., 1995; Stevens and
Crouch, 1998; So
¨derhamn et al., 2001; Herdman,
2002), gerontological education (Hope, 1994;
So
¨derhamn et al., 2001), experience with older
people (Rogan and Wyllie, 2003; So
¨derhamn
et al., 2001; McCracken et al., 1995; Sheffler,
1998; Shoemake and Bowman, 1998) contact/liv-
ing with older adults (Mosher-Ashley and Pamilee,
1999; Hartley et al., 1995; Kwan and Law, 1994;
McCracken et al., 1995), and work preference
(McCracken et al., 1995; Fox and Wold, 1996;
Happell, 1999; Pursey and Luker, 1995).
Studies that investigated the effect of age on
nursing students’ attitudes towards older people
reported conflicting findings. In a comparative
study conducted in Sweden, So
¨derhamn et al.
(2001) found that many factors were influential to-
wards students’ attitudes particularly their age,
gender, and previous experience with older peo-
ple. In a smaller study, Sheffler (1998) reported
contradictory findings regarding nursing students’
attitudes where age, gender, race, and previous
work experience with older people, did not corre-
late with their attitudes towards older people.
McCracken et al. (1995) compared Norwegian and
American nursing students’ attitudes toward older
people and reported that age was not significant
among the total sample. However, younger Ameri-
can students reported more positive attitudes than
their Norwegian counterparts.
Mosher-Ashley and Pamilee (1999) used a conve-
nience sample to study attitudes of students in four
faculties, including nursing, toward older people.
The findings indicated that no significant differ-
ences were found for the effect of either age or
major on students’ attitudes.
In Hong Kong, Kwan and Law (1994) investigated
nursing students’ attitudes toward older patients
and found gender to be an influencing factor; fe-
male students revealed more negative attitudes
than male students. In contrast, Sheffler (1998)
and McCracken et al. (1995) indicated that gender
was not statistically significant factor in attitude
to older people among American and Norwegian
nursing students (F= 0.439) (p= 0.509) and Slevin
(1991) found that female students have more posi-
tive attitudes toward older people than male
students.
Nursing education is identified as a major factor
that influences nurses’ negativity towards older
people. Stevens and Crouch (1998) suggested that
the nursing education process includes a message
that devalues fundamental nursing in favor of
specialization and the promotion of a scientific
24 I.M. Hweidi, S.M. Al-Obeisat

knowledge base. Older patients, that need care
outside of the more scientific speciality areas of
care, are frequently devalued. In contrast, Rogan
and Wyllie (2003) conducted a qualitative research
approach and indicated that students’ early con-
tact with older people, supported by a structured
educational program, created a positive learning
experience that engaged students in quality care
of older people.
So
¨derhamn et al. (2001) found differences
between the groups of first-year students and
third-year students in their attitudes towards older
people. More negative feelings were presented in
the group of first-year students (mean score 37.8)
(p= 0.001) as compared with the group of third-
year students (mean score 32.2) (p= 0.001). These
authors recommended nurse education programs
that are goal-directed and should focused on
engendering positive attitudes and an interest in
older people. They also argued that special atten-
tion should be given to young students. In contrast,
Herdman (2002) contended that as student nurses
become more senior, their interest in working with
older people decreased. In a comparative study
between Norwegian and American nursing students
in terms of their attitudes towards older people,
McCracken et al. (1995) reported that among the
Norwegian subjects, the highest average score
were found among first-year students. Among the
American subjects, second-years had the lowest
mean score. An earlier study conducted by Robb
(1979) found a similar attitudinal pattern among
nursing students that had taken a course in geron-
tology. Rogan and Wyllie (2003) concluded that
students’ attitudes towards older people were
influenced by previous experience with the elderly.
Moreover, McCracken et al. (1995) and Shoemake
and Bowman (1998) found that past experience
with older people positively correlated with
students’ attitudes. These results contradicted
Sheffler’s findings (1998) which contended that a
statistically significant relationship did not exist
between students’ previous experience with older
people and positive attitudes.
Many research studies concluded that the longer
the time the nursing students spend with older peo-
ple, the more positive their attitudes become
(Hartley et al., 1995; Kwan and Law, 1994).
McCracken et al. (1995) reported that the greater
the experience with older people, the more
positive the experiences were rated among
students. However, Mosher-Ashley and Pamilee
(1999) did not find any important difference be-
tween students that had lived with an older adult
and students who did not have this experience.
Moreover, Wright (1988) argued that an increase
in the amount of contact with older people leads
to less positive attitudes toward them.
Students’ attitudes toward older people are ex-
pected to influence their decision to work with this
client group (McCracken et al., 1995). Four factors
have been identified that influence students’ deci-
sions to work in gerontological nursing. These in-
clude: genuine interest in older people; a solid
gerontological nursing knowledge base; good role
models; and more exposure to older people in a
variety of settings (Fox and Wold, 1996; Happell,
1999). However, Pursey and Luker (1995) argued
that the lack of desire to work with older people
is related to higher dependency levels associated
with older care and the structure of nursing work
in older care settings rather than any negative atti-
tudes towards older people.
Purpose
The purpose of this study was to identify and de-
scribe the attitudes of a group of Jordanian nursing
students toward older people and examine the
relationship between their personal characteristics
and their attitudes. Two research questions were
proposed:
(1) What are the attitudes Jordanian nursing stu-
dents at one governmental university toward
older people?
(2) Are personal characteristics of this group
influential in aecting their attitudes towards
older people?
Methodology
Design and sample
A descriptive correlational design was used to de-
scribe Jordanian nursing students’ attitudes to-
ward older people. Potential participants were
nursing students registered in the BSN program
at the School of Nursing at a governmental univer-
sity. The total number of BSN students in this
school, excluding diploma students, is approxi-
mately 1000 students. There are 16 PhD and 20
Master’s degrees holders. There are also 14 BSN-
prepared clinical instructors. Two baccalaureate
degree programs are offered: a four-year program
for undergraduate students and a two-year com-
pletion program for diploma-prepared nurses.
Two master degree programs prepare clinical
nurse specialists in acute care and community
health nursing.
Jordanian nursing students’ attitudes toward the elderly 25

The sample for this study was selected from
four different classes. Two were 1st and 2nd year
classes (junior nursing students) and the other
two were 3rd and 4th year classes (senior nursing
students). During a three-week period, May 9th
2004 to May 28th 2004, questionnaires were dis-
tributed to a convenience sample of 250 stu-
dents. Two-hundred and forty three students
returned the questionnaire, reflecting a response
rate of 95.2%. Approximately two thirds of the
students (61.8%) was residents from urban areas
and 65.5% reported having no previous experi-
ence in working with older people either in acute
care or long-term care settings. The monthly in-
come of approximately two thirds of the sample
(68.1%) was greater than 430 Jordanian Dinars
(620 US Dollars) indicating a moderate level of in-
come. Finally, 62.2% of the sample preferred not
to work in acute or long-term older people care
settings after graduation and half of the students
(50.4%) reported living with one or more older
individuals.
Ethical considerations
The Jordan University of Science and Technology
research and ethical committee approved the
study. Permission to gain access to potential
participants was facilitated by nursing course
instructors and gained from the school adminis-
tration. Informed consent was obtained from all
participants. Student nurses’ participation was
completely voluntary and students were assured
that their responses would be confidential, and
only aggregated data would be communicated.
Data collection process
Once permission to use the questionnaire was se-
cured, a panel of experts of four doctoral-prepared
nurses and four lay persons who are competent in
both Arabic and English were asked to translate
and ‘‘back translate’’ the questionnaire – de-
scribed below. Back translation is a standard proce-
dure for translating a research questionnaire from
English to other languages (Kim et al., 1995). Any
discrepancies between the original and translated
versions were discussed and resolved based on
the panels’ suggestions.
Following approval of the study, the primary
researcher provided the instructor of each partici-
pating class with an adequate number of question-
naires. The questionnaires included a cover letter
that addressed the purpose and significance of
the study. It advised the participants to complete
and place the questionnaires in a designated box.
The questionnaire did not include any identifying
data.
Research instrument
The study’s questionnaire has a demographic sec-
tion that consists of a checklist including the le-
vel of educational attainment, monthly income,
age, gender, previous experiences of working
with older people, and preference of work with
older people after graduation. Students’ attitudes
toward the older were measured using Kogan’s
Scale (1961). This instrument contained 34 state-
ments regarding older people. Half of these were
negative attitudes and half positive toward older
people. The responses are on a six-point Likert
scale that ranged from ‘‘strongly disagree,’’ to
‘‘strongly agree’’. Scores on the negatively
worded items were reversed to obtain the total
scores.
Internal consistency and reliability of the scale
ranged from 0.66 to 0.85. In the original research,
criterion validity has been supported by the posi-
tive correlation of this scale with measurements
of attitudes toward other groups such as ethnic
minorities. In this study, an internal consistency
reliability of 0.83 was demonstrated. Participants
were asked to select the appropriate response that
represented their opinions or perceptions about
each of the statements presented in the scale.
Analysis
Data were analyzed using SPSS at a significance le-
vel of 0.05. Student nurses’ attitudes were identi-
fied using descriptive statistics. The effects of
nursing students’ characteristics and their atti-
tudes towards older people were examined using
the ttest for variables measured on dichotomous
level of measurement and Pearson correlation for
variables that measured on continuous level.
Findings
The sample reported slight positive attitudes
(M= 110.6, SD = 21.79, CI = 107.78–113.35), with
approximately half of the subjects (46.2%) scoring
more than the mean, 24.5% of the sample demon-
strated greater positive attitudes (one standard
deviation or greater above the mean). The effects
of nursing students’ characteristics on their atti-
tudes toward older are presented in Tables 1 and 2.
As Table 1 highlights, the age of the students sig-
nificantly correlated with their attitudes toward
older people (r= 0.436) (p= 0.000). That is, as
the age of the students increased, there was a ten-
dency towards more positive attitudes. In contrast,
the monthly income of the students negatively cor-
related with their attitudes toward older people
(r=0.200) (p= 0.002). In that, income was
reported to be higher among the participants who
26 I.M. Hweidi, S.M. Al-Obeisat

reported more negative attitudes toward older
individuals.
Table 2 shows the influence of selected nursing
students’ characteristics on their attitudes toward
older people. Three students’ characteristics af-
fected their attitudes toward older people to a de-
gree that was statistically significant: gender
(t= 3.824) (p= 0.000), students’ educational level
(t=16.245) (p= 0.000), and preference to work
with older people after graduation (t= 3.747)
(p= 0.000). Male nursing students noticeably re-
ported more positive attitudes (M= 115.12) toward
older people than female students (M= 104.50).
Senior nursing students reported more positive
attitudes (M= 125.47) toward older people than
did their counterparts (M= 93.80). Furthermore,
students who indicated a preference to work with
older individuals after completing the BSN program
reported more positive attitudes (M= 117.18)
toward older people than those who did not
(M= 106.55). Residency area (t=0.338) (p=
0.736), past experience of working with older peo-
ple (t= 1.725) (P= 0.086), and past experience of
living with older relatives (t= 1.914) (P= 0.057)
did not noticeably affect nursing students’ atti-
tudes toward older people.
Discussion
Nursing students’ attitudes toward older people
have frequently been found to be negative (Fager-
berg and Ekman, 1998; So
¨derhamn et al., 2001)in
Western culture. By way of contrast, Jordanian stu-
dents that participated in this study reported slight
positive attitudes which contrasts with how Jorda-
nian society now view older adults. Traditionally,
Jordanians view older adults as a source of wisdom
and guidance based on their experience in various
aspects of life as urged by religion and cultural
norms and traditions. As Jordan moves towards a
western lifestyle, Jordanian society has undergone
major social changes that impacted on peoples’
attitudes toward elderly, in terms of rejection of
the principles of the past and adoption of the man-
ifestations of recent modernization. This contra-
diction in students’ attitudes can be attributed
primarily to socio-cultural differences between
Table 2 Effects of the nursing students’ characteristics and selected sociodemographics on their attitudes toward
elderly people (N= 238)
Students’ characteristics M(SD) df tp
Gender 236 3.824 0.000
*
Male 115.12 (22.68)
Female 104.50 (19.04)
Residency area 236 0.338 0.736
Village 110.01 (21.188)
City 111.00 (22.272)
Past experience working with elderly people 236 1.725 0.086
Had experience 113.91 (25.14)
Had no experience 108.80 (19.68)
Living with elderly 236 1.914 0.057
Yes 113.28 (22.65)
No 107.90 (20.68)
Preference of work with elderly after graduation 236 3.747 0.000
*
Yes 117.18 (23.61)
No 106.55 (19.63)
Educational level 236 16.245 0.000
*
Junior 93.80 (11.45)
Senior 125.47 (17.57)
*
P< 005.
Table 1 Relationships between nursing Students’
characteristics and their attitudes towards elderly
people (N= 238)
Students’ characteristics 1 2 3
Age 0.101 0.436
*
Monthly income 0.200
*
Attitudes
*
P< 0.05.
Jordanian nursing students’ attitudes toward the elderly 27

Western and Eastern cultures. For example, reli-
gion affects the ways in which older people are
perceived (Tripp-Reimer et al., 1999). Further-
more, people’s attitudes are greatly influenced by
cultural values, norms, and social structures of
the community (Andrews, 1991). In Jordan, Islam
is the state religion. Like many other religions, Is-
lam urges its believers to respect and value older
adults as demonstrated in many verses in the Holy
Koran. In the Holy Koran, ‘‘God’’ says ‘‘And your
lord has recommended that you shall not serve
‘‘any’’ but him, and goodness to your parents. If
either or both of them reached old age with you,
say them neither so much as ‘‘Ugh’’ nor chide,
and speak to them generous word. And make your-
self submissively gentle to them with compassion
and say: oh my lord! Have compassion on them,
as they brought me up (when I was little).’’ (The
Holy Koran, Surah XVII, 23–24, 1985).
Socially, the extended family system predomi-
nates in Jordan where a vast majority of older peo-
ple are living in households of four or more people.
In addition, norms and traditions predominate in
Mediterranean culture encourages strong family
ties, where living in multigenerational households
is dominant (Andrews, 1991; Zunzunegui et al.,
2001).
Five students’ characteristics investigated were
found to affect their attitudes toward older peo-
ple. These characteristics include, age, monthly in-
come, gender, students’ educational level, and
preference to work with older people after gradu-
ation. Students’ age was positively associated with
their attitudes toward older people; as the age of
the students increased the students develop more
positive attitudes. This result is congruent with
So
¨derhamn et al. (2001) who indicated that young
students have more negative attitudes toward the
older than their counterparts. A possible explana-
tion is that the young nursing students have less
knowledge and educational experience with old
age, since addressing health-related issues in
course work and nursing clinical practice at the
governmental university where data were col-
lected, started in the second year of their course
of study, during which students are still susceptible
to social stereotypes of the old.
Nursing education and educational past experi-
ence with old age are considered major factors in
shaping students’ attitudes towards the elders
(So
¨derhamn et al., 2001; Herdman, 2002; Rogan
and Wyllie, 2003; Shoemake and Bowman, 1998).
In this study, senior nursing students who tended
to have more knowledge and educational experi-
ence with older people yielded the more positive
attitudes among this layer of students. Further-
more, older-aged group of students may have par-
ents closer in age to the elders which might affect
positively their attitudes. However, Sheffler (1998)
and McCracken et al. (1995) did not find a correla-
tion between students’ age and Kogan’s score.
The difference in mean of Kogan’s score be-
tween males and females nursing students would
appear to suggest important gender differences.
The results indicated that male students
(M= 115.12) (p= 0.000) have more positive atti-
tudes than females (M= 104.50) (p= 0.000). This
result is consistent with Kwan and Law (1994)
who indicated that female students have more neg-
ative attitudes toward older people than male stu-
dents. The following tentative hypothesis might
rationalize this result. As the extended family sys-
tem is dominant in Jordan, males, as a result of re-
cent economical difficulties, started moving long
distance looking for jobs to improve their families’
economic status since they are, culturally, the
family bread-winners. Consequently, females are
left home alone taking care of the older person
which is considered an extra burden on women.
This extra burden in responsibilities might nega-
tively influences female students’ attitudes toward
older people. This result is inconsistent with the
literature that suggests that females fulfill the
caregiver role because they are socialized to enact
caring and nurturing roles (Slevin, 1991; So
¨der-
hamn et al., 2001). Moreover, other research stud-
ies (Sheffler, 1998; McCracken et al., 1995)
indicated that gender differences were not found
to be important in affecting students’ attitudes to-
ward older people.
A majority of the participants (62.2%) preferred
not to work with older people after graduation.
However, students who preferred to work with
older people after graduation (37.8%) have more
positive attitudes toward them. This result is con-
gruent with Herdman (2002) and McCracken et al.
(1995) who indicated that working with the older
among nursing students was not a priority but they
did not rule it out. In contrast, acute care settings
was chosen as first priority among the selected
nursing students since it was perceived as exciting
and challenging. The results of this study can be re-
lated directly to the fact that older care is a spe-
cialized area that requires advanced preparation
because it is more demanding. In addition, the cur-
riculum of the nursing school, from which data
were collected, did not focus early on gerontology,
which might make the junior students feels that
they are not skilled enough to consider working in
such settings.
Students’ level of educational attainment ap-
peared to affect nursing students’ attitudes toward
28 I.M. Hweidi, S.M. Al-Obeisat

older people; senior nursing students reported
more positive attitudes toward the older more than
junior students. This result is similar to that of
So
¨derhamn et al. (2001). These researchers indi-
cated that senior nursing students have more
positive attitudes than the juniors. Unfortunately,
the BSN program curriculum in Jordan does not
appropriately consider and address the gerontolo-
gical aspects of nursing in the courses. If so, this
experience starts late in their 2nd year of study.
Moreover, junior students usually assigned for
young patients and simple cases since they are
viewed by their instructors as novices in clinical
practice.
The gerontological considerations are addressed
and considered in both lectures and clinical prac-
tice late in the 3rd and 4th year of the BSN pro-
gram. In contrast, other research studies found
that nursing education process fosters the develop-
ment of negative attitudes towards older patients
and decrease their interest in working with the
older (McCracken et al., 1995; Stevens and Crouch,
1998; Herdman, 2002).
Limitations of the study
One of the major limitations of this study is re-
lated to the instrument used for the purpose of
measuring nursing students’ attitudes. Although,
the Kogan’s scale is a valid measure of attitudes
toward older people in the Western culture, it
may lack the sensitivity to measure the same con-
struct in the Eastern culture like the Jordanian. In
addition the sample was one of convenience, rel-
atively small, and did not include nursing students
from other governmental universities, private or
military sectors. Using random sampling tech-
nique, increasing sample size, and including nurs-
ing students from other sectors might improve the
generalizability of the findings to the general pop-
ulation of students at universities in Jordan. By
using a self-reporting questionnaire, people may
report what they think the researcher wants to
know, rather than what they actually feel (Waltz
et al., 1991). Caution should also be exercised in
generalizing the findings. The findings are only
limited to the participating nursing students in
this study.
Conclusions and implications
In order to maintain and enhance Jordanian nursing
students’ attitudes toward older people, it is
important for nurse educators to address the fac-
tors that have been shown to have an impact on
the care of older people. The findings of this and
other studies highlight the need to adopt educa-
tional strategies that focus on meeting the needs
of older people (So
¨derhamn et al., 2001; Stevens
and Crouch, 1998). Thus, more emphasis on geron-
tological curricula and training in BSN programs is
strongly needed. Nurse educators should consider
restructuring the nursing curricula so that integra-
tion of aspects related to nursing older people take
place early in the BSN program. This emphasis will
be of great value to maintain and enhance nursing
students’ attitudes up to the standards of the
norms of Jordanian society.
Recommendations for further research
This research demonstrates similarities with other
research exploring nursing students’ attitudes to-
ward the older people. Further research is, how-
ever, needed to more clearly identify Jordanian
nursing students’ attitudes by replicating this
study using a random and larger sample size to
improve the external validity of the findings. It
is also recommended to study nursing faculty
members’ attitudes toward the older since their
attitudes found to affect their students’ atti-
tudes. Finally, using qualitative research ap-
proach is the appropriate method to study a
qualitative concept (Phillips, 1995) such as atti-
tudes. This qualitative study should be conducted
to investigate the essence of attitudes among
Jordanian nursing students.
References
Andrews, G., 1991. World Health Organization Collaborative
Study on Social and Health Aspects of Aging in Bahrain,
Egypt, Jordan and Tunisia. Center for Aging Studies, Finders
University of South Australia, Adelaide, Australia.
Bliesmer, M., Earle, P., 1993. Research considerations: nursing
home quality perceptions. Journal of Gerontological Nursing
9 (6), 27–34.
Ebersol, P., Hess, P., 1997. Toward Healthy Aging, fifth ed. C.V.
Mosby Company, St. Louis.
Fagerberg, I., Ekman, S.-L., 1998. Caring for elderly patients: a
longitudinal study of Swedish nursing students’ narratives.
Health Care in Later Life 3, 258–271.
Fox, S.D., Wold, J.E., 1996. Baccalaureate student gerontolog-
ical nursing experiences: raising consciousness levels and
affecting attitudes. Journal of Nursing Education 35 (8),
348–355.
Happell, B., 1999. When I grow up I want to be a...? where
undergraduate student nurses want to work after graduation.
Journal of Advanced Nursing 29 (2), 499–505.
Hartley, C.L., Bentz, P.M., Ellis, J.R., 1995. The effect of early
nursing home placement on student attitudes toward the
elderly. Journal of Nursing Education 34, 128–130.
Herdman, E., 2002. Challenging the discourses of nursing ageism.
International Journal of Nursing Studies 39, 105–114.
Jordanian nursing students’ attitudes toward the elderly 29

Hope, K.W., 1994. Nurses attitudes toward older people: a
comparison between nurses working in acute medical and
acute care of elderly patients settings. Journal of Advanced
Nursing 20, 605–612.
Jacelon, C.S., 2002. Attitudes and behaviors of hospital staff
toward elders in an acute care settings. Applied Nursing
Research 15 (4), 227–234.
Kim, H.S., Schwartz-Barcott, D., Holter, I.M., Lorensen,
M., 1995. Developing a translation of the McGill pain
questionnaire for cross-cultural comparison: an example
from Norway. Journal of Advanced Nursing 21, 421–
426.
Kogan, N., 1961. Attitudes toward old people: the development
of a scale and examination of correlates. Journal of Abnor-
mal and Social Psychology 62, 44–54.
Kwan, A.Y., Law, B.K., 1994. Attitudes of student/pupil
nurse toward the aged in Hong Kong: implications for
nursing education. Hong Kong Journal of Gerontology 8
(1), 43–51.
McCracken, A., Fitzwater, E., Lockwood, M., Bjork, T., 1995.
Comparison of nursing students’ attitudes toward the elderly
in Norway and the United States. Educational Gerontology
21, 167–180.
Mosher-Ashley, P.M., Pamilee, B., 1999. Attitudes of college
students toward elderly persons and their perceptions of
themselves at age 75. Educational Gerontology 25 (1), 89–
102.
Phillips, P., 1995. A deconstruction of caring. Journal of
Advanced Nursing 18, 1554–1558.
Primary Health Care Initiatives. PHCI year 5 Progress Report.
February, 2003.
Pursey, A., Luker, K., 1995. Attitudes and stereotypes: nurses’
work with older people. Journal of Advanced Nursing 22 (3),
547–555.
Robb, S., 1979. Attitudes and intentions of baccalaureate
nursing students toward the elderly. Nursing Research 28,
43–50.
Rogan, F., Wyllie, A., 2003. Engaging undergraduate nursing
students in the care of elderly residents in Australian nursing
homes. Nurse Education in Practice 3, 95–103. doi:10.1016/
s1471-5953(02)00085-9.
Sheffler, S.J., 1998. Clinical placement and correlates affecting
student attitudes toward the elderly. Journal of Nursing
Education 37 (5), 216–218.
Shoemake, A.F., Bowman, S.S., 1998. Gerontological nursing
education: a professional and personal challenge for future
baccalaureate faculty and students. Educational Gerontology
24 (5), 491–507.
Slevin, O.D’.A., 1991. Ageist attitudes among young adults:
implications for a caring profession. Journal of Advanced
Nursing 16, 1197–1205.
So
¨derhamn, O., Lindencrona, C., Gustavsson, S.M., 2001.
Attitudes toward older people among nursing students and
registered nurses in Sweden. Nursing Education Today 21,
225–229. doi:10.1054/nedt.2000.0546.
Stevens, J., Crouch, M., 1998. Care – the guiding principle of
nursing? In: Keleher, H., McInerney, F. (Eds.), Nursing
Matters: Critical Sociological Perspectives. Churchill Living-
stone, Australia.
Stevens, J., Herbert, M., 1997. Ageism and nursing practice in
Australia. Royal College of Nursing, Australia’s Discussion
Document No. 3.
The Holy Koran, Surah XVII, 23–24, 1985. The Holy Koran (M.H.
Shaker, Trans.). Surah XVII, The Israelites, (Bani-Israel),
Verse 23–24. Tahrike Tavsile Koran INC, Elmhurst, NY.
Tripp-Reimer, T., Johnson, R., Sorofman, B., 1999. Cultural
dimensions in gerontological nursing. In: Stanley, M., Beare,
P.G. (Eds.), Gerontological Nursing: A health Promotion/
Protection Approach. Davis Company, Philadelphia, pp. 21–
36.
Waltz, C.F., Stickland, O.L., Lenz, E.R., 1991. Measurement in
the Nursing Research. F.A. Davis, Philadelphia.
Williams, S.W., Blunk, E.M., 1999. Comparison of Swedish and
American preschool children’s attitudes toward elderly
persons. Psychological Reports 84, 899–903.
Wright, L.K., 1988. A reconceptualization of the negative staff
attitudes and poor care in nursing homes. The Gerontologist
28 (6), 813–820.
Zunzunegui, M.V., Beland, F., Otero, A., 2001. Support from
children, living arrangements, self-rated health and depres-
sive symptoms of older people in Spain. International Journal
of Epidemiology 30, 1090–1099.
30 I.M. Hweidi, S.M. Al-Obeisat