Josefina Flores-Carrasco,1 Martha Guadalupe Gastelum-Ruiz,1 Mario Verdugo-Orduño,2 Ramón Emiliano Medina-Zazueta,1 Rosalba de Jesús Corral-Quiroz1
1Subjefatura de Enfermería y Técnicos, Hospital General Regional 1, Culiacán, Sinaloa.
2Jefatura de Enfermería, Hospital General Regional 49, Los Mochis, Sinaloa.
Instituto Mexicano del Seguro Social, México.
Correspondence: Josefina Flores-Carrasco
Received: March 12th 2013
Judged: September 26th 2013
Accepted: November 18th 2013
Introduction: Elder care is higher quality when it is performed by nurses with knowledges about geriatric syndromes, ergo, about the conjunction of high prevalence illnesses on seniors and often causes functional or social disability.
Objective: To describe the knowledge level about geriatric syndromes in the nursing staff on a social security hospital of Culiacan Sinaloa Mexico.
Methodology: A descriptive, observational, prospective, cross-sectional study was conducted, through the application of a survey to 105 nurses of internal medicine and surgery services. It was marked as a good level of knowledge if they were obtained between 80 and 100 % of items, as regular between 60 and 79 % and low less than 60 %.
Results: Knowledge level of the nursing staff about geriatric syndromes was good in 1 %, regular in 19 % and low in 80 %. In carrying out the inference, statistically significant association was not found.
Conclusions: From the hospital analyzed, the knowledge level of the nurses about geriatric syndromes was low.
Keywords: Aged; Nursing care; Health of the elderly
In 1950, only 8% of the world population was aged 60 or older; in 2000 this group represented 11%, and by 2050 it is expected to amount to 22%.1
In developed countries, the population aged 60 years or more is a fifth of the general population, which predicts that in 2050 in less developed countries it will be in the same proportion as in developed countries. Therefore, if the trend of this group is on the rise, the impact on existing resources and access to health services intended for the care of older adults is imminent.2
In 1974, the World Health Organization recommended how to "fully develop health services in inpatient was well as outpatient, based on the current needs of people in this age group, and how to have the necessary infrastructure and specialized personnel to carry out a complete and comprehensive practice of care".3
To update and strengthen the training of professionals in this area, the Sociedad de Geriatría y Gerontología was established in Mexico in 1977, which brings together health professionals to take a specialized and interdisciplinary approach to the problem of an aging population.4
In this context, to meet the demands resulting from the demographic and epidemiological changes of the population, health professionals who care for older adults must base their clinical judgments and interventions in the evaluation of states of health, illness, or disability of this population. The aim is to preserve or restore the autonomy of the older adult and control the comorbidity inherent to hospitalization.5,6
The practice of geriatric medicine is concerned with the diagnosis, treatment, and functional recovery of older adults. Comprehensive geriatric assessment is a multidimensional and interdisciplinary diagnostic process designed to identify and quantify the physical, functional, psychological, and social problems that older adults can present, in order to develop a plan to treatment and monitor these issues, as well as optimal use of resources to address them.
Usually geriatric syndromes are caused by a combination of diseases of high prevalence, and they are determinants of the origin of functional and social disability of older adults; they are the beginning of other problems to be taken into account starting with evaluation to prevent future complications.7,8
Myra Estrin Levine, in her theory of conservation, describes the way complex systems are able to continue working in difficult circumstances. Through conservation, individuals are able to face the obstacles, adapt, and maintain their integrity; "the goal of conservation is the health and strength to cope with disabilities" and "standards of conservation and integrity are involved" in all situations in which nursing care is necessary. "The main goal of conservation is to keep the individual intact in their entirety."
Although nursing interventions are limited to a specific principle, it is necessary for nurses to also know the influence of other concepts of conservation. Levine's model emphasizes the interactions and nursing interventions that seek to maintain integrity and promote adaptation. The interactions are based on the scientific knowledge prior to the principles of conservation. Conservation seeks to achieve a balance between energy supply and demand with respect to the unique biological reality of the individual.9,10
The program GeriatrIMSS emerged as an institutional response organized before the aging of the insured population, which seeks to promote healthy aging, implement comprehensive care of older adults in medical units, according to the needs and requirements proper to the age, train the different health professionals in the area of geriatrics involved in the care of the older adult, develop clinical research in this area, and transition to a differentiated service.
The institutional geriatric plan includes identifying risk factors, associated comorbidity, and geriatric syndromes, a fundamental task in the first level of care, with the aim of providing older adults with preventative measures and treatment for prevalent diseases, for timely referral to second-level services.11
For these reasons it became necessary to describe the level of knowledge of nurses about the most common geriatric syndromes in the geriatric population.
A cross-sectional descriptive study was carried out at Hospital Regional General 1, in Culiacan, Sinaloa. It used a convenience sample of 105 nurses in internal medicine and surgery, of all categories and shifts. The measuring instrument, comprised of sections of items and multiple-choice answers, was previously validated by a specialist responsible for the GeriatrIMSS program and evaluated in a pilot test. To determine the level of knowledge, three cutoff points were considered: good, 80-100% correct; fair, 60-79%; and poor, less than 60%.11-13 Descriptive statistics was applied with simple frequencies and percentages, measures of central tendency, and dispersion. To determine significant differences chi-squared was used with a value of p ≤ 0.05. To calculate these parameters the statistical program Stata version 10.0 was used.
Of the 105 nurses, 75.2% (79) were female and 24.8% (26) male; the average age was 39.5 ± 7 years and the range was 22 to 57 years. As for the service, 66.7% (70) worked in internal medicine and 33.3% (35) in surgery. As for shift, 36.2% (38) worked in the morning, 43.8% (46) in the evening and 20% (21) at night.
Regarding employment status, 2.9% (3) was deputy head of nursing, 12.4% (13) floor manager, 58.1% (61) nurse general, and 26.6% (28), nursing assistant. Regarding schooling, 17.1% (18) had a college degree, 40% (42) high school, and 42.9% (45) secondary school. Regarding time of service, 26.7% (28) had less than 10 years, 38.1% (40) between 10 and 19 years of service, and 35.2% (37) over 20 years (Table 1).
|Table I. Characteristics of nurses working in internal medicine and surgery services (n = 105)|
|Deputy head of nursing||3||3|
|Years of service|
80% of nurses obtained a minimal level of knowledge of geriatric syndromes, 19% (20) fair, and only 1% (1) good. No significant association was found (p < 0.05) (Figure 1).
Figure 1. Nursing staff knowledge of geriatric syndromes (n = 105).
Undoubtedly, while the knowledge level of nurses on geriatric syndromes was poor, there are remedies that can be implemented using training and continuing education. Another crucial element is staff motivation, for training to be utilized to the maximum and for it to influence the quality of life not only of the staff itself, but of the people they care for.14
Once theoretical learning is obtained, it is a priority to develop skills for assessment, a critical element for diagnostic reasoning and decision-making in choosing the best nursing interventions and the creation of individualized care plans for the patient and their family.15-17
The authors declared that there is no personal or institutional conflict of interest of a professional, financial, or commercial nature, during the planning, execution, writing of this article.