Effect of COVID-19 Isolation on Nursing Student and Older Adult Interview Assignment.

The US population is aging. Young people may have ageist views that may deter them from careers working with older adults. Intergenerational teaching strategies in college courses offer opportunities for young and older people to interact. In a nursing course, 7 semi-structured interviews, discussion board content, and a synthesis project provide the framework for a sharing relationship to develop. The COVID-19 required alterations in the interview format, and understanding these changes from the elders' viewpoints were added to the interviews. This data identified 4 themes with positive and negative reactions.

Introduction

The number of older adults in the United States is increasing (1) while ageism and misconceptions associated with this population persists (2). According to Hayslip and associates (3), these misconceptions pose a barrier to choosing careers that include working with older adults. Educational interventions (4) have demonstrated success in decreasing ageism and increasing positive behavior toward older adults and increasing the willingness to consider a career in geriatrics. The teaching strategy of having nursing students interview 1 older adult for several weeks is an intervention used in our older adult course. The COVID-19 pandemic resulted in specific experiences for the older adult related to social distancing, access to support services, and isolation. This pandemic also resulted in the need to pivot teaching methods in a gerontology course while retaining course objectives and requirements. Healthcare policies (5) which prevented face-to-face contact, a general computer inexperience and access, and the living arrangements of some of the older adults were other challenges to conducting the interviews. Thus, the course assignments were completed virtually, with specific content added to focus specifically on the effects of the COVID-19 pandemic.

Course Content

This 14-week elective nursing course focuses on the lifestyle and health of older adults. Through scaffolded purposeful course activities, exposure and exploration of the life of an older adult, along with their life choices, and health needs are probed by the student. Completion of the course activities provides a framework for humanizing the older adult, which is purported to change the paradigm of ageism. (6) Course content includes lectures of various educational formats and theoretical foundations specific to the older adult. These provide an array of structures for the student to use as they progress through the course and process their experience. For the interview objective, each student identifies an older adult who will serve as the informant throughout the course. Criteria for this individual includes being a nonrelative, active and cognitively aware person, aged 70 years or above, and capable of responding to the requirements of the activities. For the older adult, these activities included the availability to meet with the student, and a willingness to self-disclose and describe their life experiences. For the student, course activities included conducting 7 interviews with their identified informant, participation in 5 discussion boards, and a group synthesis presentation. During the interview, each student took notes which were devoid of personal identifying information. These notes were used to complete the discussion board and presentation assignments. They also served as a reflection source for the student to document the interactions and the knowledge attained.

Methods

In response to the COVID-19 pandemic, course alterations were necessary. These included transferring all course content to an online format and restructuring the interview processes. The alterations were done to comply with the social distancing requirement as outlined by the Centers for Disease Control and Prevention (CDC). (5) While attaining the course requirements required creativity, the course objectives were not altered. The required 7 interviews, typically performed face to face, were completed using several modalities. These included phone calls, FaceTime, and/or the use of a web-based electronic platform. Despite the academic and social challenges of the COVID-19 pandemic, all course objectives were met, and all students completed the course on time.

The required 7 interviews are guided by course content focusing on a different aspect of life. Initial interviews were nonintrusive and aimed to develop a trusting relationship. Subsequent interviews provided the opportunity to probe experiences, perceptions, regrets, and plans for the future. Discussion board topics correlated to the interview focus while providing a format to compare these data to personal and familiar experiences. Access to peer discussion board posts allowed comparison and contrasting of the experience among all course participants. The group process forums summarize all content and allow the development of a personal perception of the life of an older adult. Students would share unique incidents, lessons learned, and content that was unexpected/surprising. The intergenerational relationship development with their elder interviewees is often tacit, hence the use of multiple avenues of thinking are needed. Additionally, a focus on understanding the perspective of the older adult experiencing the interviews during the COVID-19 pandemic was a late aim of the interview questions.

Results

In response to the alterations required due to the COVID-19 pandemic, 2 questions were added to the final interview content. The first question, which queried if the interaction was satisfactory despite the inability to be face-to-face, required a yes/no response. Responses to this question were overwhelmingly positive, with 92.8% of the respondents (77 of 83) responding yes; 7.2% of the respondents (6 of 83) were not satisfied with their interaction. These results are shown in Table 1. The second question was open-ended and inquired if a face-to-face interaction would have been preferred. These short answer responses underwent thematic analysis (7) to identify themes. Recognizing the validity and trustworthy challenges of qualitative analyses, this method provides a framework for identifying consistencies across informants. Four themes were identified: (1) scheduling issues, (2) varied ways for interaction, (3) a social event, and (4) health concerns, with each theme containing positive and negative data. The themes were universal and supported the initial question result. Despite the inability to provide respondent-specific responses, the analyses identified positive and negative data from most informants. Descriptive comments are provided in Table 2.

Table 1.

Satisfaction With the Course Format.

Question	Yes Responses	No Responses
Question #1 Was the interaction between you (the elder) and me (the student) satisfactory with the use of Zoom-like communication technique?	77 of 83	6 of 83
	92.8%	7.2%
Question #2 Would a face-to-face interaction have been preferable?	62 of 81	19 of 81
	76.5%	23.5%

Table 2.

Interaction Comments.

Themes	Samples From the Data
Scheduling Issues	Face to face is harder to schedule especially when we meet for weeks and both are busy Zoom or phone I thought was fine It would be nice to see each other every week but this was convenient
Varied Ways for Interaction	Some weeks met face to face, sometimes Zoom or FaceTime Phone or Zoom made interviews easy and more accessible Phone calls just as good Enjoyed face-to-face interaction
A Social Event	Will miss our weekly calls-so looked forward to them I loved to be in your company Would love to meet in person maybe over lunch
Health and Technology Issues	Would have been easier to hear if face to face but either way is fine Feel safer from pandemic on FaceTime Interacted with masks on each time we met Was skeptical to do this new Zoom but turned out to be beautiful Zoom was hard on me, phone would have been better

Discussion

Exposing college-age people to older adults remains one intervention capable of altering the misperceptions associated with older adults. (8) Teaching modalities were altered, in response to COVID-19 guidelines, yet the course objectives were met, and the experience was of value to both the student and the older adult. A trusting relationship and exposure to the life of an older adult were achieved. Unintended outcomes for the respondent included attaining the skills needed to navigate web-based communication systems, the knowledge that these formats support secure conversations, and relationships can be developed, despite the lack of face-to-face contact. Despite social distancing requirements, the interaction and relationship development that occurred as a course requirement did not change. One interviewee stated he had a more positive outlook on the interview days.

According to Burnes and associates (6) ageism has negative effects on the physical and mental health of older individuals. The conclusion from their systematic review identified education and intergenerational contact as effective interventions aimed at reducing ageism. The nursing course, which uses both interventions, appears to decrease ageism misconceptions. Ageism misconceptions can be tacit. It takes more than 1 instance of intergenerational activities to have young people view older adults toward the more positive. (9) These misconceptions must be mitigated such that interest in careers that work with older adults are considered. The physical and mental health of each of us, as we are all aging, depends on this.

Limitations

Data were collected from a small sample from 1 study site. Applicability is thus limited. Whether the respondent interacted with the students via Zoom, phone, FaceTime, or face to face while wearing facial masks, relationship building occurred. Garcia and associates reported findings from a systematic review that suggested more virtual encounters are needed in “empirically based interventions (EBI) in the field of intergenerational work” (p. 1). The results of this activity support the ability of web-based formats as an EBI.