An Investigation into the efficacy of nursing curriculum on elderly health problems via Delphi's method.

INTRODUCTION AND
OBJECTIVE: Elderly people are a vulnerable group of society. Today, health authorities of the country pay a great deal of attention to the issue of aging. Given the fact that nurses are have direct contact with patients referring to health centers, it is necessary to develop a comprehensive and practical training program for future nurses. This can help provide adequate care for the elderly. The present study aimed to investigate the efficacy of nursing students' undergraduate curriculum on the elderly health problems via Delphi's method.
MATERIALS AND METHODS: This futuristic study was carried out at Iran Medical Sciences Universities between December 2016 and November 2017. The research sample consisted of 63 faculty members and non-faculty members who were randomly selected. The final document and data were collected using a researcher-made questionnaire. Descriptive statistics and SPSS (version 24) were used to analyze the data.
FINDINGS: In the first step, according to 70 percent of participants, the allocated time on providing "Elderly Care" content, as well as providing actual content by the professors of each credit is not sufficient. The findings of the second step revealed that 79 percent of participants indicated, adding the topic of "Elderly Care" to the mentioned syllabus, greatly contributes to improving the capabilities of graduates.
CONCLUSION: The studies suggest that the curriculums of "Bachelor of Nursing" (BN) does not have an operational approach toward the problems of elderly period, and the necessity of some variations, such as increasing the number of credits and allocating distinct syllabus to the topic of aging, employing the faculty member in the major specialties of elderly, and involving them in teaching, seems critical.

Introduction

As a natural process, aging is one of the stages of human development and evolution. The age 65 is usually regarded as the beginning of aging.[12] The aging phenomenon has roots in the improvement of living standards, health, socioeconomic status, mortality, increased life expectancy, and the implementation of birth control policies. One of the largest population changes in the twentieth century is aging of the population. This will increase the number of the elderly from 600 million in 2000 to 2 billion by 2050.[345] According to the general population census in 2006, about 7.3% of Iran's population, that is, more than 5 million people, are older than 60 years old.[6] The phenomenon of aging makes the country's policymakers pay more attention to the elderly. They need to plan, identify, and prioritize the factors affecting healthcare of the elderly.[789] It is clear that in each and every society, doctors, nurses, managers, and policymakers have different roles to play in the health section.[1011] Given the fact that nurses are have direct contact with patients referring to health centers, it is necessary to develop a comprehensive and practical training program for future nurses. This can help provide adequate care for the elderly.[12131415]

Nursing education at the undergraduate level is also the basis for professional nurse education. A public nurse should be able to examine health status, provide services, and coordinate care for individuals, family, and society.[1617] In order to educate nurses who can efficiently implement healthcare programs and strategies for elderly people, it is necessary to review the type of educational programs of nurses, especially at undergraduate level.[181920]

The curricula at universities and higher education play a crucial role in the success or failure of these institutions.[21] Unfortunately, despite the importance of curriculum in higher education institutions, they are not paid much attention. Accordingly, not much attempts have been made to review, evaluate, modify, and change them.[2223] Some issues and themes in the curriculum need to be documented and reviewed; including methods and techniques for measuring educational needs, sources of choice of objectives, sources of content selection for the program, criteria and principles for selecting the content of the program, content organization principles, content organization methods based on learning activities, community, and subject matter, written presentation methods and oral teaching, principles for selecting appropriate teaching methods and paying attention to their advantages and disadvantages, timing, duration of the content, position of the course and the proper selection of educational technology, developmental and computational evaluations and appropriate evaluation methods and techniques.[2425] Although the problem of aging has not yet drawn much attention in Iran due to the young population structure, in the coming years, the healthcare system will be dealing with this issue. Thus, there is a need for comprehensive planning to effectively address the issue of aging.[262728] Given the lack of information in this area and the importance of this issue, the present study aimed to assess the efficacy of undergraduate nursing curriculum on the health problems of the elderly. It also attempts to find the strengths and weaknesses of the curriculum and provide remedial measures in order to design and develop undergraduate nursing curriculum. In this regard, it is believed that in order for the nursing major to succeed and to identify the strengths and weaknesses of its curriculum, it is essential to review the undergraduate nursing curriculum and use the results in the formulation and modification of the curriculum. Furthermore, the results obtained from this study can help developers of nursing curriculum by providing practical suggestions so that they will have a broader view to develop or change the curricula, set more appropriate goals and content, design proper teaching methods, create a comprehensive, and practical curriculum. These measures can help future nurses provide adequate care for the elderly.

Materials and Methods

The present study was conducted using modified Delphi's technique via face-to-face interviews and e-mail from December 2017 to November 2018. This study aimed to investigate the efficacy of undergraduate nursing curriculum on the health problems of the elderly. The faculty members in Iranian medical sciences universities have provided their opinions on this issue. After selecting a list of the names of state medical science universities based on type 1, 2, and 3, and selecting three universities through a simple random sampling method, a total of nine universities were selected which can be classified as follows: the first type (Iran University of Medical Sciences; Tabriz University of Medical Sciences; Isfahan University of Medical Sciences), Type 2 (Hamedan University of Medical Sciences; Ilam University of Medical Sciences; Ardabil University of Medical Sciences) Type 3 (Kurdistan University of Medical Sciences; Dezful University of Medical Sciences; Bushehr University of Medical Sciences). The research population of this study includes commentators and experts in the field of nursing and elderly people. For each course (Physiology, Nutrition/Nutrition Therapy, Pharmacology, Nursing Principles and Skills, Adult/Senior Nursing (1-2-3), Mental Health Nursing and Community Health Nursing), one person was selected by simple random sampling from each of the universities; a total of 63 individuals were selected and invited to participate in this study. The inclusion criteria included having expertise (e.g. teaching undergraduate nursing courses), having BA degree and above in the field of nursing. This research has been done in two stages. Firstly, an invitation, which included a summary of the Delphi's method, was sent to the all participants. Those who accepted the terms were finally included in the study. In the first stage, a researcher-made questionnaire was used to collect the data; this questionnaire consisted of two parts. The first part examines some of the personal and social characteristics of the commentators and experts. The second part contains six questions. The first two questions of the questionnaire indicate the current status and how the program is implemented from the perspective of the participants. These two questions include: (1) Is the content per hour in the course sufficient for a nursing bachelor's degree regarding the aging care? (2) In your opinion, is the content provided by the professors in the course of nursing bachelor's degree sufficient for the elderly care? The next four questions of the questionnaire provide the suggestions for improving the situation from the perspectives of the participants: (1) What kind of model do you recommend for optimizing the issues of the elderly care in terms of content, the adequacy and layout of the course? (2) What kind of teaching methods do you think are efficient in the nursing bachelor's degree course for the elderly care? (3) In your opinion, what infrastructure facilities are required for training undergraduate nursing students for the elderly care? (4) What do you think are the qualifications and requirements for choosing instructors to train undergraduate nursing students? According the respondents, the second-phase questionnaire was developed for each lesson individually. In the second stage, the questionnaire of each lesson was provided to the attending members of the courses by face-to-face interviews and e-mails. The participants were requested to submit their ideas and suggestions to improve the curriculum. After extracting comments, receiving responses and calculating the frequency and average of the responses, items that had earned more than 70% were retained as the final items. Meanwhile, items with 70% opposing ideas were rejected.[2930] Of all the accepted items, the strategic document was extracted.

Data were analyzed by SPSS (version 24) and descriptive statistics. Prior to the study, all participants were informed about the study and its objectives, as well as the rights of the participants in the study, including the right to withdraw from the study and confidentiality of the data. Obtaining oral and informed consent from all participants in the study was in accordance with the principles of publication ethics of the Iranian Ministry of Health.

Findings

In the first stage, a total of 50 (79%) responses were used to extract the findings. Concerning the first two questions, the first questionnaire was designed to answer the question about the adequacy of the time allocated to present the content of the care program for the elderly. Accordingly, 70% of participants stated that the time allocated for the content and the presentation of content by professors is not enough [Table 1]. The next four questions of the first stage questionnaire give suggestions for improving the status quo from the viewpoints of the participants. The majority of the proposed suggestions include increasing the number of units, increasing the number of teaching hours, increasing courses and workshops, using appropriate teaching methods, work experience of teachers and specialist teachers [Table 2].

Table 1

Participants’ responses to the first two questions of the first questionnaire

Courses	The number of individuals selected in each course	The rejected questionnaires	Item 1		Item 2
			No	Yes	No	Yes
Adults - Aging (1, 2, 3)	9	7 (%78)	6 (86%)	1 (14%)	6 (86%)	1 (14%)
Principles of Nursing	9	8 (%89)	8 (100%)	-	8 (100%)	-
Mental Health/Mental Diseases	9	7 (%78)	6 (86%)	1 (14%)	6 (86%)	1 (14%)
Community Health Nursing	9	8 (%89)	8 (100%)	-	8 (100%)	-
Nutrition	9	6 (%67)	5 (83%)	1 (17%)	5 (83%)	1 (17%)
Physiology	9	7 (%78)	5 (71%)	2 (29%)	5 (71%)	2 (29%)
Pharmacology	9	7 (%78)	7 (100%)	-	7 (100%)	-

Table 2

Participants’ answers to the third, fourth, fifth and sixth questions of the questionnaire in the first stage

Courses	Common Recommendations
Adults - Aging Principles of Nursing Mental Health/Mental Diseases	Increasing the units and the teaching time, allocating separate units to the course of aging, highlighting the topics of aging as titles in the syllabus, recruiting experienced educators and clinical educators, adding courses and workshops for instructors, having specialized degrees for training the teachers, engaging with experts in the field of epidemiology to change the pattern of curriculum, using new teaching methods (conference, group discussion, lecture, problem solving, etc.), holding apprenticeships in nursing homes, health centers, hospitals, etc.).
Courses	Exclusive Recommendations
Adults - Aging	Separating elderly clinical units at educational hospitals for training
Principles of Nursing	Practical section equipped to educate trainees and hold training seminars for instructors
Mental Health/Mental Diseases	Creating counseling centers for seniors
Nutrition & Nutrition Therapy	Establishing adult counseling centers and providing advice to the elderly

In the second stage, a total of 39 (78%) responses were extracted from the participants. According to the findings, 83% of the participants believed that the most appropriate expertise to present elderly courses in nursing is surgical nursing, elderly nursing and mental health nursing. Besides, 71% of the participants stated that the most appropriate expertise to present elderly courses in the community health course is elderly nursing. Moreover, 80% of the participants stated that the most appropriate people to present physiology courses are physiology professionals. According to the findings, 83% of the participants argued that the most appropriate environment for passing the adult education curriculum is nursing home and hospital. Other items and responses which were agreed upon more than 70% were inserted in the final document [Table 3].

Table 3

The selected constructs in the final document

Courses	Common Constructs
	Final Constructs	The number of people who agreed
Adults - Aging Principles of Nursing Mental Health/Mental Diseases, Nutrition, Pharmacology	Adding the subject of aging	38 (97%)
	Assigning 0.25 units to the course of the elderly	29 (74%)
	The most appropriate teaching methods (lecturing method with questions and answers)	28 (72%)
	Having work experience for instructors	30 (77%)
	Having a work experience of 1-5 years	28 (72%)
	Adding the course of the elderly of the undergraduate nursing curriculum to improve social responsiveness	33 (85%)
	Adding the course of the elderly helps to greatly enhance the skills of the graduates.	31 (79%)
Courses	Exclusive Constructs
	Final Constructs	The number of people who agreed
Adults - Aging	Separating the elderly’s departments in hospitals improves the quality of internship.	5 (83%)
Mental Health	The need to create mentally oriented counseling centers for the elderly, to give nursing students an opportunity to provide counseling and visits to elderly people.	5 (83%)
Community Health	Urban and rural health centers are the environment needed to attend an internship for elderly care.	5 (71%)
Nutrition & Nutrition Therapy	Nutritionists are the most appropriate specialist for providing nutritional counseling	5 (100%)
	The need to create counseling centers for nutrition, for the elderly, to give nursing students an opportunity to provide counseling and visits to elderly people.	4 (80%)
Pharmacology	Pharmacologists are the most competent specialists in teaching the courses on the elderly.	3 (75%)
	Hospitals are the right environment for the internship on the elderly care.	3 (75%)

Discussion

The present study aimed to investigate the efficacy of nursing undergraduate curriculum on health problems of the elderly. It should be noted that similar studies have not been found; therefore, we will focus on studies that are consistent with the objectives of this study. According to the findings, most participants stated that the hours devoted for the elderly care and the actual content provided by the professors are not sufficient. Choi-Kwon et al. found that it was necessary to increase the time and number of specialized units of basic science courses in order to enhance this knowledge in nurses.[31] Vartanosian et al. showed that they agree with the increase in the time allocated to the departments of physiology, especially by offering these courses with more units and applying them to specialized nursing and clinical courses.[32] Pourghane et al. argued that the units and presentation of the course in the pharmacology clinical internship is inadequate.[33] Allan et al., Sharafi et al. and Valizadeh et al. highlighted the inadequate time devoted for the course.[343536] According to the results, it can be stated that increasing the hours of training can improve the performance of the nursing students for the elderly care. Findings showed that lecturing method along with question-answer sessions can help provide nursing undergraduate course more effectively. Existing surveys and evidence show that the lecturing method is very likely to be one of the most commonly used educational methods in the 21st century. According to the suggestion of the professors, it is better to address the most important disadvantages of this method, which is the inactivity of learners and one-way learning process. Therefore, the best way to engage students is question-answer sessions and the group discussion.[3738] Charlton believes that if the lecturing method is combined with active teaching methods, such as questioning, it helps to acquire knowledge.[39] Concerning elderly care skills training for undergraduate nursing students, the experts believe that there is a lack of proper network infrastructure and educational facilities. The direct relationship between the student and the elderly needs to be expanded. For example, a nutrition consultancy center in a hospital and health centers may allow the students to be active. The results showed that half of the students did not feel satisfied with the facilities and equipment in the clinical education environment.[40] Pourghane stated that educational problems from nursing students’ point of view include lack of suitable educational environment and lack of educational aids in the clinical setting.[41] According to the findings and the opinions of the professors, it is necessary to develop elderly care skills in undergraduate nursing students in order to establish a link between theoretical and practical education. However, in order to learn the minimum requirements, it is necessary to provide resources and information on the patients and disease. In examining the qualifications required to select instructors on the basis of expertise, the participants voted for the specialists. As the next priority, they voted for the experts in fields of the elderly. It can be said that one of the most important responsibilities of medical universities, especially in the field of nursing, is to train specialists and professional forces. In fact, the university as an educational, research and technology center is interacting with the community, and students should find ways to treat and care for patients through professional training by professors and specialists. Khorsandi argued that an ideal professor is the one who has professional competence.[42] Fahlah et al. highlighted the professors’ scientific competence and specialty and the ability to provide scientific information as the most important characteristics of a university professor.[43] Findings indicated that participants need work experience. Work experience is one of the important pillars in recruiting the forces of various organs and organizations. One of the main reasons for this is the person's recognition of the ups and downs of the work and the establishment of the relationship between theoretical and practical training. The reason why professors highlighted the higher work experience in recruiting lecturers is that a professional instructor has learned to provide information in an empirical way and is more successful in transmitting information.[4445]

Conclusion

Studies show that the nursing curriculum lacks an active approach to aging issues. that there is a lack of proper network infrastructure and educational facilities. The direct relationship between the student and the elderly needs to be expanded. Given the fact that the present study has examined the efficacy to the curriculum from different angles, the following recommendations may be considered: observing and analyzing the problems and challenges of aging in different groups of the medical education system of the country, explaining nursing curriculum standards based on health, and medical priorities of the country and so on.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.