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Answer the questions listed below after reading:
Romen, A., Zalcman, B. G., Jakubowitz, O., & Pinchas-Mizrachi, R. (2023). Knowledge and attitudes towards patients with Alzheimer’s disease across different educational levels of nursing and in different care settings: A cross-sectional study. Nurse Education in Practice, 71, 1-7. https://doi.org/10.1016/j.nepr.2023.103685
1. Describe the research design (examples include but are not limited to: experimental, quasi-experimental, or descriptive) and discuss design decisions made by the researcher.
2. Discuss steps implemented by the researcher to control for confounding variables.
3. Identify threats to internal validity in the research study.
4. Discuss the sampling design used for the research study. Describe the inclusion and exclusion criteria established by the researcher. In your opinion was the sample representative of the target population?
5. What instruments were used for data collection? What information does the researcher present regarding reliability and validity of data collection methods?
Answers must be provided using complete sentences, correct grammar and spelling. Please use APA level headings to identify the question, your response will follow as the body of that heading.
Quantitative Critique questions Week 4 assignment Rubric
Research Design
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0 points
Correctly identifies the research design. No discussion of the design decisions made by the researcher.
4 points.
Correctly identifies the research design. Vague description of the design decisions made by the researcher.
6 points
Correctly identifies the research design. Adequate description of design decision made by the researcher.
8 points.
Accurately and completely describes the research design and design decisions made by the researcher.
10 points.
Controlling confounding variables.
Not submitted unacceptable
0 points
Vague description of how the researcher controlled for confounding variables.
6 points.
Adequate description of how the researcher controlled for confounding variables.
8 points.
Accurately and completely describes how the researcher controlled for confounding variables.
10 points.
Threats to Internal Validity
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0 points
Vague description of threats to internal validity in the study.
6 points
Adequate description of threats to internal validity in the research study.
8 points.
Accurately and completely describes threats to internal validity in the research study.
10 points.
Sampling Design
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0 points
Adequate description of 1 out of 3 components of the question. (sample design, inclusion/exclusion criteria/target population)
4 points.
Adequate description of 2 out of 3 components of the question. (sample design, inclusion/exclusion criteria/target population)
6 points
Adequate description of the sample design, inclusion/exclusion criteria, and evaluates if the sample is a representative of the target population.
8 points.
Accurate and complete description of the sample design, inclusion/exclusion criteria, and evaluates if the sample is a representative of the target population.
10 points.
Reliability and validity of instrument of data collection
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0 points
Vague description of instruments for data collection and information provided by the researcher regarding reliability and validity.
3 points
Adequate description of instruments for data collection and information provided by the researcher regarding reliability and validity.
4 points
Accurate and complete description of instruments for data collection and information provided by the researcher regarding reliability and validity.
5 points
APA, Grammar and Spelling
More than 5 grammar or spelling errors
0 points
4-5 grammar or spelling errors
1 point
3-4 grammar or spelling errors
2 points
1-2 grammar or spelling errors
4 points
No errors
5 points
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Nurse Education in Practice 71 (2023) 103685
Contents lists available at ScienceDirect
Nurse Education in Practice
journal homepage: www.elsevier.com/locate/issn/14715953
Knowledge and attitudes towards patients with Alzheimer’s disease across
different educational levels of nursing and in different care settings: A
cross-sectional study
Anat Romem , Beth G. Zalcman *, Or-ly Jakubowitz , Ronit Pinchas-Mizrachi
Jerusalem College of Technology, 11 Bet Hadfus, Jerusalem, Israel
A R T I C L E I N F O
A B S T R A C T
Keywords:
Dementia
Alzheimer’s disease
Nursing students
Nurses
Attitudes
Aim: To evaluate Alzheimer’s disease (AD) knowledge and attitudes among Israeli nursing students and nurses
with different educational backgrounds working in varied geriatric settings
Background: Alzheimer’s disease (AD) management and treatment relies on multidisciplinary care, providing
comprehensive treatment to these patients. Nurses are vital to treatment provision. However, less nursing students are expressing interest to work with the geriatric population, including those with dementia.
Design: This was a cross-sectional study.
Methods: Participants were 231 nursing students and nurses of various educational backgrounds and from varied
geriatric settings. Study measures included sociodemographic characteristics, the Alzheimer’s disease Knowledge
Scale, and the Dementia Attitude Scale. Participants were recruited via social media, nursing administrations in
medical facilities, and snowballing methods. Overall scores by educational background and correlations between
the measures and select sociodemographic variables were evaluated.
Results: The overall knowledge and attitudes towards dementia among Israeli nurses is moderate to high. The
mean knowledge score was 23.32/30. The highest scores (for knowledge and attitude) were found among
geriatric nurse practitioners. The lowest knowledge scores were found among registered nurses without a degree,
while the lowest attitude scores was found among nursing students.
Conclusions: Despite relatively high scores, there is still a need to minimize the gap in specific knowledge and
attitude domains. There is a need for domain-specific training, such as risk factors related to dementia, and
providing nurses of all educational backgrounds with the tools they need to feel comfortable in caring for AD
patients.
1. Introduction
of supportive care for patients with AD. The Action Plan embraces the
treatment of dementia throughout all stages of the disease, from prevention of risk factors and early detection, through end-of-life care,
while incorporating principles of multidisciplinary work. The Geriatric
Branch of the Ministry of Health in Israel has included AD in their national plan since 2013, to enable people with AD and other dementia to
have quality of life, and the use of accessible services.
Currently, there are 50 million people worldwide with AD and other
types of dementia; by 2050, this number is expected to reach 82 million.
According to the Center for Chronic Disease Control and the Ministry of
Health the current number of dementia patients in Israel is estimated to
be approximately 100,000. In the next few years, with the aging of the
Israeli population, the number of people suffering from dementia is
expected to increase (Israel Ministry of Health, 2022).
The Global Action Plan 2017–2025 The World Health Organization
(WHO) has prioritized the topic of AD, and their overarching goals are
the prevention of AD, and improvement of quality of life with provision
1.1. Nurses’ knowledge and attitude toward AD patient care
Nurses are a critical component of these multidisciplinary teams in
all healthcare settings. Nurses treating AD and other dementia patients
* Corresponding author.
E-mail addresses: [email protected] (A. Romem), [email protected] (B.G. Zalcman), [email protected] (O.-l. Jakubowitz), [email protected]
(R. Pinchas-Mizrachi).
https://doi.org/10.1016/j.nepr.2023.103685
Received 24 April 2023; Received in revised form 15 June 2023; Accepted 21 June 2023
Available online 23 June 2023
1471-5953/© 2023 Elsevier Ltd. All rights reserved.
A. Romem et al.
Nurse Education in Practice 71 (2023) 103685
are required to have advanced knowledge of the disease and treatments,
communication skills, and adapted medical approaches, including
patient-centered care. Nurses generally need to provide treatment for
delirium and depression, neuropsychiatric treatment and other treatment methods for AD and dementia patients in order to improve the
patient’s quality of life (Kimzey et al., 2016; Alzheimer’s Disease International, 2016).
However, despite the growing need for nurses for this population,
there is a decreasing demand to work with the geriatric population, and
even less so, with geriatric patients with dementia. Therefore, understanding the factors that play a role in a nursing student’s decision to
work with older dementia patients is of utmost importance (Laura et al.,
2022). Furthermore, a number of countries examined the association
between knowledge and perception of nurses towards the dementia and
AD and the quality of treatment and attitude towards AD patients. The
findings of the studies were mixed. For the most part, the degree of
dementia-related knowledge is mediocre (Kimzey et al., 2016; Scerri and
Scerri, 2013; Wang et al., 2020).
One of the studies, conducted in China, showed that age, education,
professional group, and work experience were related to knowledge. It
was also found that the general knowledge was lacking. However, staff
attitudes were positive (Zhao et al., 2022). Other studies found that
fourth-year nursing students had a similar degree of knowledge of AD
treatment or higher than nurses already working in the healthcare system (Poreddi et al., 2015; Eccleston et al., 2015). Many nursing students
reported feeling that their knowledge on the topic of dementia was low
or lacked focus. They also reported the need for further instruction in the
fields of communication and geriatric nursing (Kimzey et al., 2016;
Scerri and Scerri, 2013). Of note, the topic of training is a central
component to the Global Action Plan 2015–2025 as well as the national
plan in Israel. However, it is not implemented in the nursing studies
programs.
Kimzey et al. (2016) and Scerri and Scerri (2013) identified the need
to increase the number of teaching hours for geriatrics, as well as create
experiential learning opportunities to enable nursing students to interact
with dementia patients. Eccleston et al. (2015) emphasize that proper
clinical guidance that follows in-class instruction improves students’
perceptions towards dementia patients. Previous studies have also
shown that when the nursing students’ knowledge in the field increases,
so does the level of empathy and sensitivity towards the patients (Laura
et al., 2022).
Blaser and Breset (2018) and Kada et al. (2009) found that nurses
tend to have a negative perception of AD patients. A number of factors
can influence this perception: workplace characteristics, sociodemographic variables, number of years with work experience, and up-to-date
knowledge of the disease. Positive perceptions were more common
among older nurses (aged 50 and older).
A study conducted in nursing homes in the Netherlands examined the
staff’s attitudes towards dementia. Findings showed differences between
the nursing homes regarding attitude, and residents experienced more
social well-being and exhibited less challenging behavior in nursing
homes where the care team had a positive attitude towards dementia
(Gerritsen et al., 2019). Further demonstrating the importance of attitude and knowledge of dementia in treating dementia patients, an Irish
study found positive attitudes towards people with dementia among
hospital and home-based teams qualified to work with dementia patients. The degree of dementia-related knowledge was more extensive
among these teams and they had a more positive attitude compared to
other teams (Keogh et al., 2020).
four year programs. Foundational courses in science, nursing theory,
physiology, and sociology are taught during the first year. The second
year focuses on medical-surgical nursing knowledge, pharmacology, and
clinical hours (Katz et al., 2010). Geriatric medicine is introduced during
the second year. The Ministry of Health’s Nursing Division regulates and
outlines mandatory nursing education requirements for eligibility to
take the national licensing exam (Israel Ministry of Health, 2019). This
division selects geriatric patient-related content based on care needs,
medical and national guidelines, and the projection of the older adult
population (Central Bureau of Statistics, 2021).
Nursing schools are mandated to integrate geriatrics-related topics
into their curricula. The content covers physiology and pathology,
geriatric syndromes, specific issues in older adult patients, mistreatment, dementia, depression, delirium, wound care, and transitions between healthcare settings (Boltz et al., 2016). Until 2021, the geriatric
nursing curriculum was credited with 39 teaching hours, which
decreased to 26 teaching hours in 2022 (Israel Ministry of Health, 2019).
However, no clinical hours or hands-on training are currently required
for the geriatric nursing curriculum.
In light of this, this study aims to evaluate the degree of AD knowledge and attitudes among nursing students and nurses working in
geriatric settings in Israel to better understand what changes may need
to be made in training and how they can be implemented.
2. Methods
2.1. Aims
The aims of this study are threefold:
1. To describe the degree of knowledge related to AD among nursing
students, registered nurses who work in geriatric medical centers
(registered nurses, registered nurses with a Bachelor’s of Science in
Nursing, or registered nurses with a Master’s of Science in Nursing),
and geriatric nurse practitioners (NPs);
2. To describe the attitudes towards AD patients among nursing students, registered nurses who work in geriatric medical centers
(registered nurses, registered nurses with a Bachelor’s of Science in
Nursing, or registered nurses with a Master’s of Science in Nursing),
and geriatric NPs; and
3. To evaluate the association between sociodemographic information
and knowledge and attitudes towards AD patients among nurses.
2.2. Study design
This was a cross-sectional, web-based study. Data collection took
place between November-December 2022.
2.3. Participants and recruitment
Participants for the study included nursing students and registered
nurses from varied geriatric settings (community, general hospital
medical center, or long-term care facility) and with varying levels of
nursing education (students, registered nurses, registered nurses with a
Bachelor’s of Science in Nursing, registered nurses with a Master’s of
Science in Nursing, and nurse practitioners). Recruitment for this study
carried out via social media, the Ministry of Health volunteer committee, student boards, and via the snowball sampling method. Information
about the research (aims, inclusion criteria) was sent to nurse administrator divisions at different medical facilities, internal social groups on
platforms such as Facebook and WhatsApp, and in other dedicated forums, such as the national Nurse Practitioner forum, and the national
student board, where the majority, if not all, of Israeli nurses are
members.
Inclusion criteria for the study included being eighteen years of age
or older, fluency in the Hebrew language, and being either a nursing
1.2. Geriatric nursing education in Israel
To be licensed as a geriatric nurse in Israel, nurses must learn
fundamental geriatric competencies through evidence-based approaches to sufficiently care for the aging population in Israel (Boltz
et al., 2016). The Bachelor of Science in Nursing (BSN) programs are
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A. Romem et al.
Nurse Education in Practice 71 (2023) 103685
student, registered nurse (RN), registered nurse with a Bachelor’s of
Science in Nursing (RN-BSN), registered nurse with a master’s of Science
in Nursing (RN-MSN), or nurse practitioner (NP) at the time of the study.
Nurses with education limited to practical nursing education were
excluded.
Participant data was anonymous and no personal data, emails, phone
numbers, or any other identifying information were collected. A total of
231 nurses with diverse nursing-related educational backgrounds who
worked in geriatric care either in hospitals, long-term geriatric facilities,
or community care were included in the study. Nursing students were
also recruited, from either the national nursing student board, from the
other groups that they may have joined for networking purposes, in
order to establish a baseline through which to determine the degree of
knowledge and attitude related to AD. A total of 59 nursing students
were recruited, who constituted approximately a quarter of all
participants.
interest. The content of the questionnaire was also evaluated by the
designated panel for content validity, construct validity, and criterion
validity. Cronbach’s Alpha for the ADKS was found to be 0.842. The DAS
showed Cronbach’s Alpha 0.798 for the social comfort factor and
Cronbach’s Alpha 0.766 for the dementia knowledge factor. Significance
level was set to 0.05.
2.6. Sample size
In order to distinguish a two-point knowledge difference for AD
between the five nursing groups on our main measure, the ADKS, with
90% power at a 5% significance level (α = 0.05), at least 115 participants were needed with 23 participants in each group. A total of 231
participants responded to the questionnaire. To facilitate the detection
of a 2-point shift (either an increase or decrease) in the ADKS among
Israeli nurses, we found that this detection is attainable at a 90% confidence level and a significance level of 0.05, considering a reduction of
16.8% and a standard deviation of 3.48. This approach aligns with the
methodology applied in the study by Poreddi et al. (2015). For the
purpose of this study, a minimum of 115 participants was required, with
each group (students, RN, RN-BSN, RN-MSN, NP) consisting of 23 participants. In response to the questionnaire, a total of 231 participants
were obtained. Within the study conducted by Poreddi et al. (2015), the
ADKS overall mean score, at 16.8 ± 3.48 out of 30, implies that the
participants possessed insufficient knowledge about Alzheimer’s
disease-related dementia. On the other hand, the DAS overall mean
score of 95.0 ± 1.47 suggests that nursing students harbor positive attitudes towards dementia.
2.4. Measures
This study explores self-reported knowledge related to AD and attitudes regarding caring for AD patients. The study explores those questions with validated measured tools: Alzheimer’s Disease Knowledge
Scale (ADKS) and the Dementia Attitude Scale (DAS).
2.4.1. Alzheimer’s Disease Knowledge Scale (ADKS)
The ADKS, by Carpenter et al. (2009), contains 30 comprehensive
questions related to nursing care and knowledge regarding patients with
AD throughout the course of the disease. The questionnaire was developed for both research and clinical evaluation purposes, and is divided
into seven domains: life impact, risk factors, symptoms, treatment and
management, caregiving, assessment and diagnosis, and the course of
the disease. The score ranges from 0 to 30, with a higher score correlated
with better knowledge related to Alzheimer disease. The ADKS scale
report Cronbach’s Alpha 0.81; and internal consistency reliability and
validity = 0.71.
2.7. Ethical approval
The research was approved by the ethical committee of the Jerusalem College of Technology (approval no. IRB 012_22). The online
questionnaire did not collect any personal information (such as emails or
any other identifying information that can compromise participant
privacy). The first question of the questionnaire asked the participant to
provide consent for participation in the study. A “yes” reply indicated
that the participant provided consent. If the participant marked “no”,
they were unable to continue to the questionnaire.
2.4.2. Dementia attitude scale
The DAS, by O’Connor, McFadden (2010), is used to assess attitude
towards AD. The scale is based on 20 items, each measured on a 7-point
Likert scale ranging from “strongly disagree” (1) to “strongly agree” (7).
The DAS is divided into two factors: “Social Comfort”, which includes
the caregiver behavioral response to AD patients, and “Dementia
Knowledge”. Cronbach’s Alpha for “Comfort” is 0.82 and for “Knowledge” is 0.75. The two factors have a strong correlation r = 0.29, p <
0.011 and both explain 38.72% of overall variance. The DAS score
ranges from 20 to 140 points, and the score reveals the provider’s attitude toward patients with AD. A higher score reflects a more positive
attitude.
Additionally, demographic information was collected for the study.
This includes age, sex, marital status, religion, nursing education,
seniority in nursing, number of years in geriatrics, work setting setting
(community, hospital, or long-care term facility), and position type (fullor part-time).
2.8. Statistical analysis
Data analysis used IBM SPSS Statistics version 26. Frequencies,
means, and standard deviations (SD) were utilized to describe sample
variables. T-Tests were used for independent samples variables, such as
sex. One-Way Analysis of Variance (ANOVA) with post-hoc tests (Tukey
test) were used to explore the different ADKS and DAS scores between
academic levels and varied healthcare settings. If the difference was
significant, post-hoc test was applied. Pearson’s correlation coefficient
was used to determine association between age, seniority in nursing,
years caring for older adults, the seven domains of the ADKS and the two
DAS factors. Cronbach’s Alpha for the ADKS was found to be 0.842. The
DAS showed Cronbach’s Alpha 0.798 for the social comfort factor and
Cronbach’s Alpha 0.766 for the dementia knowledge factor. Significance
level was set to 0.05.
2.5. Validation of the measures
The questionnaires were translated from English to Hebrew and vice
versa by two bilingual nurses who are proficient in both languages. This
process was intended to eliminate any potential confusion or inaccuracies attributable to linguistic differences. Then, these questionnaires
were subjected to further examination by an expert panel consisting of
five lecturers for the Geriatrics NP track at the Jerusalem College of
Technology, who specialize in geriatric nursing, as well as an epidemiologist. This panel had two objectives: 1. to determine whether the items
in the questionnaire were capable of accurately evaluating the intended
concepts and, 2. to assess if they could indeed inspect the domain of
3. Results
3.1. Participant demographics
There were a total number of 231 participants, with mean age of
41.03 years (SD=12.77). The majority of the respondents were females
(84%). Registered nurses with a Bachelor’s of Science in Nursing (RNBSN) had the largest proportion of participants (30.7%), followed by
nursing students (25.5%). Geriatric NPs accounted for 21.6% of participants and RN-MSNs accounted for 16% of participants. The smallest
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A. Romem et al.
Nurse Education in Practice 71 (2023) 103685
proportion of participants were RNs. Of note, according to the Israel
Ministry of Health (2022), one hundred and twelve nurses are currently
holding geriatric NP license from them fifty nurses participated anonymously in this research.
The mean seniority in the nursing profession was 16.9 years
(SD=12.2) and the number of years caring for older adults was 14.9
(SD=11.3). Almost 40% of participants worked in general hospitals,
38.1% in a community setting and 14.7% are in long-term care facilities.
The majority (77.4%) of participants reported working full-time while
22.6% reported that they work part-time. Over 36% live in northern
Israel, 6.5% are located in the south, 29% in Jerusalem and 27.3% the
central region of Israel. Over three-quarters are married. The majority of
respondents (77.1%) are Jewish, 13.4% are Muslims and 4.3% are
Christian (Table 1).
Table 2
Level of nursing education grade and association with ADKS.
3.2.1. ADKS by nursing education
The ADKS scale reflects the elements of knowledge required for the
provision of treatment to older adults with AD. The overall participants
mean knowledge score was 23.32/30. The overall score for RNs 21.931/
30 (SD=2.88), and for nursing students was 22.30/30 (SD=3.34).
Similar scores were demonstrated among RN-BSNs and RN-MSNs:
23.23/30 (SD=2.9) and 23.48/30 (SD=4.42), respectively. The overall
score for NPs was the highest: 25/30 (SD=3.47). [Table 2].
3.4. ADKS by knowledge domain
The three questions that were most often answered correctly were: a
person with AD becomes increasingly likely to fall down as the disease
progress, in the disease course domain; AD cannot be cured, in treatment
Religion
Geographic Location
Seniority in Nursing
No. of Years in Geriatrics
Position Type
Work Setting
Nursing Education
Knowledge grade%
2.88
2.93
4.42
3.47
3.34
73
77.4
78.2
83.0
74.3
3.5.2. DAS scores by factors
Examination of the first factor, “Comfort”, indicated that of all participants, nursing students are more likely to report that they feel less
safe with AD patients, are not able to imagine taking care of AD patients,
and acknowledge their frustration at not being able to provide assistance
to AD patients (Mean score=4.57/7; SD=1.07). On the other hand, NPs
were more likely to report that they feel equipped to care for AD patients, with a score of 5.9/7 (SD=0.76).
Factor 2 “Knowledge” observed the meaningful provision of care to
Table 1
Demographic and Work Experience characteristics of participant population (n
= 231).
Age
Marital Status
Std. Deviation
21.9
23.23
23.48
24.92
22.3
3.5.1. DAS by nursing education
The total DAS score among all study participants was 109.56/140
(SD=15.52). Stratified by nursing education, the mean score increased
by level of education. The overall score for attitude scores toward AD
patients was the lowest among nursing students (103.25/140,
SD=14.88); the overall attitude score of RNs towards AD patients was
104.47/140 (SD=16.53). The mean RN-BSN score was 108.52/140
(SD=15.81), while the overall RN-MSN score was 113.39/140
(SD=13.5). The mean score among NPs was the highest, with 116.70/
140 (SD=13.5). [Table 4].
The highest mean knowledge score was found among nurses in the
community setting (24.3/30, SD=3.3), followed by nurses who work in
general hospitals (23.4/30, SD=3.6). Nurses in long-term care facilities
had the lowest mean score (22.8/30, SD=3.4). The knowledge gap was
significant between settings (r = 0.050., p < 0.005).
N (%)
Male
Female
M[SD], Range
Married
Unmarried
Jewish
Muslim
Christian
Other
Central Israel
Jerusalem
North
South
M (SD), Range (Years)
M (SD), Range
Full-time
Part-time
General Hospital
Long-Term Care Facility
Community
Nursing Students
RN
RN-BSN
RN-MSN
NP
Mean
17
71
36
50
53
3.5. Dementia attitude scale
3.3. ADKS by geriatric care setting
Sex
N
RN
RN-BSN
RN-MSN
RN-NP
Nursing Student
management domain; and if trouble with memory and confused
thinking appears suddenly, it is likely due to AD, in assessment diagnosis
domain. All of these questions are directly related to the management of
patient care.
The three questions that were most often answered incorrectly were
related to the cardiovascular risk factors for Alzheimer disease: having
high cholesterol level may increase a person’s risk of developing AD;
having high blood pressure may increase a person’s risk of developing
AD; and lastly, people in their 30 s can have AD. All of these questions
were in the risk factor domain.
In all settings, nurses’ knowledge was graded as insufficient for the
risk factor domain with a mean score of 3.4/6 (SD=1.29). The highest
scores were achieved for the treatment and management (3.58/4,
SD=0.69) and assessment and diagnosis domains (3.47/4, SD=0.76)
[Table 3].
3.2. Alzheimer’s disease knowledge scores
Characteristic
Education
37 (16.01)
194 (83.9)
41.03 (12.77), 19–66
177 (76.6)
54 (23.4)
178 (77.1)
31 (13.4)
10 (4.3)
12 (5.2)
63 (27.3)
67 (29)
85 (36.8)
15 (6.5)
16.9 (12.2), 0.1–46
14.9 (11.3), 0.1–42
179 (77.4)
52 (22.6)
91 (39.4)
34 (14.7)
88 (38.1)
59 (25.5)
17 (7.4)
71 (30.7)
37 (16)
50 (21.6)
Table 3
ADKS score for each knowledge section with correlation to attitude (total score
= 30/30).
4
ADKS Domain
N
Mean
Std.
Deviation
% knowledge
section
Life Impact
231
0.69
83.54
Risk Factors
231
1.39
58.67
Symptoms
230
0.88
76.70
Treatment
Management
Assessment Diagnosis
231
0.69
90.29
0.76
87.91
Caregiving
231
1.10
77.27
Course Disease
231
2.49/
3
3.47/
6
3.05/
4
3.58/
4
3.47/
4
3.84/
5
3.41/
4
0.77
85.74
231
A. Romem et al.
Nurse Education in Practice 71 (2023) 103685
care for patients with AD, even if they are not studying towards an
advanced degree.
This is unsurprising, based on previous studies. Kimzey et al. (2016)
investigated the impact of educational experiences on nursing students’
knowledge and attitudes towards people with AD, and found that
educational interventions can positively influence knowledge and attitudes towards dementia care. Zhao et al. (2022) examined healthcare
professionals’ dementia knowledge and attitudes towards dementia
care, and found that there is a need for more education and training for
dementia care for healthcare professionals in China. This is also evident
in our study among nursing students, who were found to demonstrate
the least degree of comfort with AD patients.
Additionally, we found a correlation between seniority in nursing
and positive attitudes towards AD patients. The longer a person worked
as a nurse and in geriatrics, the higher the level of reported comfort with
AD patients. While seniority in nursing and the number of years in geriatrics are both derivatives of time, it may be possible to shorten the
amount of time needed to increase comfort. For instance, if newer nurses
were mentored by more experienced nurses, and had opportunities to
ask questions and express fears, this may foster an increased sense of
comfort among less experienced nurses.
Finally, the results of this study demonstrate that nurses who work in
long-term care facilities have the lowest level of AD-related knowledge,
compared to hospital-based nurses and community-based nurses. This
finding is in line with previous studies. Blaser and Berset (2018) found
that nurses’ attitudes towards people with dementia were influenced by
the setting in which they worked, with nurses in long-term care facilities
having more negative attitudes than those in community settings.
Similarly, Kada et al. (2009) found that staff attitudes towards institutionalized dementia residents were influenced by the level of education
and experience, with those with higher levels of education and experience having more positive attitudes towards residents.
Overall, the findings of this study add to the growing body of literature on nursing professionals’ knowledge and attitudes towards dementia care, and suggest that ongoing education and training is needed
to improve the quality of care provided to people with AD.
Table 4
Level of nursing education grade and association with to DAS.
Education
N
Mean
Std.
Deviation
Attitude
grade
Sig.
RN
17
104.47
16.535
75%
RN-BSN
71
108.52
15.818
78%
RN-MSN
36
113.39
13.53
81%
RN-NP
50
116.70
13.530
83%
Nursing
Student
53
103.25
14.881
73%
(r-0.000.,< p <
0.005)
(r-0.000.,< p <
0.005)
(r-0.000.,< p <
0.005)
(r-0.000.,< p <
0.005)
(r-0.000.,< p <
0.005)
AD patients with statements such as: it’s rewarding working with AD
patients; AD patients can enjoy life; and I appreciate the AD patient’s
coping skills with his disease. The scores of nursing students and nurse
practitioners were similar, with nursing students scoring were 5.6/7
(SD=0.69) while the nurse practitioners scored 5.79/7 (SD=0.76).
Cronbach’s Alpha for this scale was 0.842.
Pearson’s correlation coefficient was utilized to identify correlations
between the ADKS, the two DAS factors, and select sociodemographic
variables – age, seniority in nursing, and years in geriatrics.
3.5.3. Correlation between DAS and ADKS
A strong positive correlation was found between Factor 1 "Comfort"
and Factor 2 "Knowledge" (r = 0.482, p < 0.01) and the ADKS (r = 0.870,
p < 0.01). Factor 2 "Knowledge" also had a strong positive correlation
with the ADKS (r = 0.842, p < 0.01).
3.5.4. Correlation between DAS and select sociodemographic variables
Factor 1 “comfort” was significantly correlated with age (r = 0.352,
p < 0.01), seniority in nursing (r = 0.354, p < 0.01), and number of
years in geriatrics (r = 0.237, p < 0.01). Factor 2 “knowledge” showed
no significant correlation with age (r = 0.031, p = 0.644), seniority in
nursing (r = 0.011, p = 0.874), or number of years in geriatrics(r =
−0.050, p = 0.482).
4.1. Limitations
3.5.5. Correlation between ADKS and select sociodemographic variables
The ADKS was significantly correlated with age (r = 0.212, p < 0.01)
and seniority in nursing (r = 0.221, p < 0.01), but not with number of
years in geriatrics (r = .110, p = 0.123).
There are a number of limitations in this study which must be
address. First, the study was conducted only among nursing professionals in Israel and those working in geriatric settings, which may
limit its generalizability to other settings or populations. Second, the
study relied on self-reported data, which may be subject to response bias
or inaccuracies. The sample size of 231 participants may not be large
enough to draw definitive conclusions or identify more nuanced differences between subgroups. Additionally, the study only focused on
nursing professionals’ knowledge and attitudes towards Alzheimer’s
disease, and did not examine other factors that could impact care for
older adults with AD, such as organizational or cultural factors, such as
religion. We also did not collect any information regarding the participant’s personal experience with AD, such as with a close family member.
It is possible, that if a nurse had dealt with a close family member
suffering from AD, this would influence their attitudes. Furthermore, the
study did not include a comparison group of non-nursing professionals
or individuals without geriatric training, which could provide additional
context and insights into the findings. Lastly the study only captured a
snapshot of nursing professionals’ knowledge and attitudes at a single
point in time, and did not track changes in knowledge or attitudes over
time or reflect changes in the geriatric curriculum design.
4. Discussion
The findings of this study suggest that the overall knowledge and
attitudes towards AD among nursing professionals in Israel is moderate
to high, but there is still a need for an ongoing investment from nursing
educators to minimize the gap in knowledge specific domains and attitudes towards dementia patients. This moderate to high degree of
knowledge and positive attitudes towards people with AD may be
related to Israeli society, which places importance on values such as
family, respect for elders, and treating the sick. These values are also
rooted in both Jewish culture and law as important life values, as well as
in Muslim culture (Shevitz, 2005; Bergman et al., 2013).
The study also highlights the need for domain-specific training, such
as communication skills in specific settings, and risk factors and the
relationship between cardiovascular risk factors and AD. The highest
scores for both scales were demonstrated among geriatric nurse practitioners. This finding was unsurprising, given their specialization in the
field of geriatrics. It is likely that the knowledge acquired during their
advanced studies helped shape their attitudes as they came to possess a
much deeper understanding of what the patient is experiencing. Essentially, this also indicates that nurses who work with the geriatric population might need to undergo specialized training in order to better
5. Conclusion
This study provides valuable insights into the level of knowledge and
attitudes towards Alzheimer’s disease among nursing students, nurses,
and geriatric nurse practitioners in Israel. The findings suggest that
5
A. Romem et al.
Nurse Education in Practice 71 (2023) 103685
while overall knowledge and attitudes towards AD are moderate to high,
there is still a need for improvement in certain areas, such as risk factors,
caregiving, and symptoms. The study highlights the importance of
ongoing education and training for nursing professionals in this area.
The results of this
