RESEARCH ARTICLES

The perception of nursing students on aging

Ana Luiza Barreto de Oliveira^I; Mavy Batista Dourado^II; Tânia Maria Oliva de Menezes^III

^INurse. Master degree student in the Graduate Program in Nursing. Nursing School. Federal University of Bahia. E-mail: annabarreto12@yahoo.com.br
^IINurse. Master degree student in the Graduate Program in Nursing. Nursing School. Federal University of Bahia.. E-mail:
^IIINurse. PhD in Nursing. Associated Professor I of the Nursing School at the Federal University of Bahia. Leader of the Studies Core and Elderly Research. Salvador, Bahia, Brazil. E-mail: tomenezes50@gmail.com  

DOI: http://dx.doi.org/10.12957/reuerj.2014.3771

ABSTRACT: Study aimed to analyze the perception of nursing students about aging. Qualitative study, conducted in August and September 2011, with 18 nursing students of a public university in Salvador / Bahia. The interviews were analyzed through content analysis. The core theme was: The vision of graduating on aging, with their respective subcategories: Learning and maturing acquired; Stigma and vision of the old and the new; The feelings, limitations and losses in the process aging; the proximity of death. The undergraduates reported that aging is a natural process, seen as another stage of human development, linked to biological changes, psychological and genetic and environmental factors, together with the maturation and learning. The negative aspects of vision were also present, represented by losses, limitations, disabilities and proximity to death.

Keywords: Geriatric nursing; students nursing; aging; learning.

INTRODUCTION

Over the past 60 years, Brazilian population over 60 years old has increased very fast. This population will more than triple over the next forty years, from less than 20 million in 2010, for approximately 65 million in 2050¹.

This process can be influenced by different factors: biological, economic, psychological, social, cultural, environmental and spiritual, beyond the existence of morphological, functional and biochemical changes, which can interfere with social adaptation and provide individuals a greater vulnerability to diseases and illness².

However, even in front of the phenomenon of population aging, being old still means being excluded from many contexts. In these days, the perception that the society has of the old age, has a negative emphasis, since they reflect the issue of stigma having of the other³.

In this panorama, it is noticed a contradiction observed in modern society, because, on the other hand, it faces the growing population of elderly and, on the other hand, it is adopted prejudicial attitudes in relation to these and the aging process.

In this scenario, there are the training of nurses and the image that the graduated student has in relation to the elderly person and the ageing. Study found that the nursing graduates show that the assistance provided to those who are in the process of aging is directly related to the image that they have about this process⁴.

In this point of view, graduate students in nursing have concepts based on common sense, and that aging is associated with negative images, for example, stereotypes of dependency, abandonment and sadness^5-8.

It is believed that the perception of nursing graduates about the aging process is important both for specific and qualified care facing people who experience this process, but also enhancing knowledge and promoting the production on this subject, enabling the implementation of differentiated assistance. In this context, the study had as objective to analyze the perceptions of undergraduate students of nursing on aging.

LITERATURE REVIEW

In view of the demographic phenomenon lived in the country, it is essential to the formation of future qualification nursing professionals of all Brazil, allowing undergraduate students to develop, during the learning phase, the care directed to the elderly, and in this way, ensuring a quality assistance to that portion of the population⁶.

Study reveals that the nursing graduate students have a closed vision and pejorative with stereotypes, created by society, family relationships and thus refer not like old age, arousing feelings of fear, financial weakness, limitations and dependency, among other characteristics⁷. The assistance to the elderly must emphasize the maintenance of quality of life and the possibilities of prevention, rehabilitation and maintenance of their state of health, with the losses of aging⁸. In this sense, the process of formation of the student and their perception about aging will reflect in their actions to take care when they become professionals.

METHODOLOGY

Descriptive research, of qualitative approach held with students of a Nursing School at the Federal University of Bahia (EEUFBA), during the period from August to September 2011. The students were invited to participate in the research, through an invitation letter and/or visits, during the undergraduate classes, for subsequent scheduling of interview according to availability.

The research population was composed by 18 students enrolled in the Undergraduate Program in Nursing, being selected two students per semester randomly and voluntarily. As a criteria of exhaustion, there was initially the interview with one student each semester and, later, another student of each semester, which reached through the testimonials, the purposes of the guiding question.

In data collection, it was applied the technique of data saturation, ending the interviews when the responses started to repeat.

The inclusion criteria used were: students over 18 years old; being a student of the Undergraduate Program in Nursing at the Federal University of Bahia; being enrolled in the undergraduate collegiate in 2011.1 and 2011.2 semesters; two students each semester; accepting to participate in the research, after signing the Informed consent term (TFCC).

The exclusion criteria from the research were: students under 18 years old; any other graduate students, other than nursing and who were not students of UFBA; students not enrolled in the undergraduate collegiate; students who refused to participate in the research.

The data were collected through semi-structured interview, guided by the following question: How do you see the aging process? The interviews were recorded on audio and performed in rooms reserved at EEUFBA, through face to face. The study subjects were identified by fictitious names of gods. The gods of Greek Mythology had influence on culture, arts and literature of western civilization, and thus the speech of the undergraduates students have relevance to society with regard to the scenario of Brazilian ageing.

After conducting the interviews, they were transcribed and subjected to the technique of content analysis, in a thematic mode. Content analysis consists of the set of techniques of analysis of communications, through the clarification and systematization of the content of the messages and content expression, attributed to quantitative indicators or not, allowing inference and a reasoned final interpretation⁹.

The operationalization of the thematic analysis was in three phases: pre-analysis, with briefing and thorough reading of the interviews, that is the corpus; on the exploration of the material, by enumerating units of records; and the treatment of the data, in the grouping into categories with the referential interpretation and thematic literature. The project was approved by the Ethics Committee in Research – School of Nursing UFBA (Protocol 16/2011 FR 329293).

As a result, the thematic core emerged - the vision of graduating students on aging - and their respective subcategories: learning and maturing acquired; the stigma and the vision of the old and the young in society; The feelings, limitations and loss in the aging process and the proximity to death.

RESULT AND DISCUSSION

Of the 18 students of nursing, 15 (83.3%) were female and 3 (16.7%) were male. Regarding the age, there was a predominance of the group of 20 to 27 years old, and for 18, 19, 31 and 33 years old there was a delegate for each one.

With regard to religion, 10 (55.6%) reported being of the Catholic religion, 3 (16.7%) of the Christian religion, (11.1%) stated not having any religion and finally, 1 (5.5%) representative, respectively, to evangelical religions, spiritual and Adventist. With regard to marital status, all 18 (100%) in the study were single.

The results were described as mentioned previously and are explored below.

The vision of graduating students on aging

In this category, the conceptions of undergraduate students about the aging process are presented with characteristics of a natural process, accompanied or not of disease, as the testimonials:

Well, I see that aging is a natural law of life. (Athena)

A natural process that all human beings [...] are subject to the natural process of life. We grow, develop, grow old and dies. (Demeter)

Is something progressive [...] and it is something necessary [...] for the cycle of life. (Maia)

The students mention the same perception described in the literature, in which aging is a natural process, irreversible and inherent in the condition of the humanity10.It occurs the generation of life until death, characterizing a series of intrinsic changes to be aging^{5- 7-16.11}.

A study has showed the aging as a response of life to which all pass and that is associated with the installation and the accumulation of disease. However, it cannot be seen only as a disease, but a stage of life with features and values, in which they occur in the individual modifications, both in organizational structure, such as in the metabolism, biochemical balance in immunity, nutrition, functional mechanisms, emotional conditions, intellectuals, and in the communication12.

The process is intrinsic to all human beings and for socializing with the elderly person in the various contexts of everyday life. For students of nursing, contact with the aging process can be accentuated during the graduation practice and in the discussions during the academic trajectory. In this sense, it becomes important that the discussions be expanded about this process, in order to improve the knowledge, assistance and elderly´s vision.

Thinking about getting older was also reported as the degradation of all the body itself, resulting from genetic and environmental factors that lead to the decline of the functions and culminates in the death process.

So, I think it's a normal process, is inherent to all without exception, white, black, rich and poor. Everyone will grow old one day. [...] you are aging, the cells are aging and, consequently, the systems aren't working. They will stop. (Hygeia)

[...] Because you have both the deterioration of organs, as a whole [...] The body, the biological part. So, you have cells dying, some of them aging [...] but also it has the psychological and emotional part of being human. (Hera)

Study of nursing graduates reveals that there is still a perception in aging association with the negative phase of life, mainly related to physiological processes phase. The fact that associate old age to wear and to dysfunctions and linked to the idea of social space detracts behavioral incompetence¹³.

However, the prejudice regarding old age leads to a perception that this phase is marked by decline of health and, in this way, the existence of a strong design in the social imaginary that there is an association to deficit, involution and decadence^14-20.

A study has revealed that aging is a stage of life that everyone comes in and that is associated with the installation and the accumulation of illnesses, as well as being related to an exhausting stage, conflicting, full of prejudice, which causes addiction, physical and mental disability, limitation of walking, autonomy and requiring attention¹².

Learning and maturing acquired

Development and aging are processes in the construction of the life cycle of each one, which are influenced by patterns of behavior and existence of situations experienced in a network of shared social relationships.

Through the maturation and learning as fundamental elements of the human being, the aging possessed for undergraduates this positive aspect, as in the following statements:

[...] I hope my aging process with enough maturity to be able to pass [...] I hope to have a lot of wisdom in my aging. (Athena)

[...] as we aged, we're maturing a few ideas. (Iris)

[...] that brings experience for those who experience [...]. (Maia)

The findings from this study corroborate the literature, so that the students´ perception about the elderly person are the positive aspects of the experience and wisdom that guarantee them the years of life^11-13.15-18.

The beliefs are declared by everyday behaviors that trigger the assistance to the elderly person. Understanding that health professionals have the elderly interfere in the way they care and treat them. Only knowing this perception and understanding, it is possible to develop training programs and review paternalistic/authoritarian postures that inhibit the autonomy and independence of the elderly12. The same happens with the graduate, who will deal with the elderly person according to the image that gives to aging.

Therefore, recognizing positive aspects in the aging process, following the example of experience, wisdom, maturity, concreteness of life, is linked to the fact of accepting the aging process and see it as a tool for development, through learning acquired over time.

On the phenomenon of population ageing in the near future, the vision of the elderly as synonymous with decadence and disability tends to be deprived, perceiving it as an individual with autonomy, experiencing a stage full of gains acquired by knowledge and experiences accumulated over a lifetime¹⁵.

Stigma and vision of the old and the new

Some students presented the stereotype that the elderly has no value to the current society, which is only valued what is new, as in the following lines:

We're always used to the new. We don't have that preparation to deal with the aging [...] in old age is also used to leave behind what's old. (Aphrodite)

The prejudice against the elderly, so the elderly, they don't have a place in society, they are not recognized for their values, he has difficulty to live in various spaces [...]. (Hera)

So, I think the population has to change this concept that old is not good, that old there's nothing else to do, because we live in consumerism. If we use the shirt and is a little faded, [...] is old, no longer pays. Sometimes even the blouse is beautiful and everything is old, and want to throw away. (Hebe)

Today's society contributes to this distorted view of the aging process, because values increasingly young's image as a model to be followed, devaluing the old image⁷.

In this overview, aging is part of social organization and fulfillment of social roles of individuals. The society we live in is many times called disposable, because if they value the characteristics of youth and makes the individual segregated from aging. Stigma causes the social identity of individuals as lost or transformed. This scenario is the product of social construction over the years, in which it is necessary to adopt and follow standards to feel accepted in the context of social relationships¹⁶.

In this view, the structure created by the capitalist mode of production, which requires that social relations should happen only through those inserted in the labor market, many who experience the aging process will avoid social relations, leading to direct consequences on the life and personality of the aging person¹⁷.

The social mark of aging is to be in opposition to the youth. In most cultures and at different historical times, there is strong association between age, dependence, withdrawal, disability, incapacity, social decline and death¹⁸.

The feelings, limitations and losses in the process of aging

Aging comes as a process that brings many losses, limitations and disability, thus arousing feelings of fear, anxiety and depression. The negative image of ageing still accompanies the human being, in particular young people.

[...] I confess that I'm a little afraid of my aging, fear of loss. It is a period of heavy losses of the people you like or that you liked [...]. (Athena)

Yes, I see the aging process as a complex process. Because it brings a lot of fear to people. Me too, because it is a process in which the person's debilitating physical state [...] I see it as a fear process. (Hestia)

I think the process of aging is exhausting, it's as if it were a sacrifice. [...] I think nowadays the aging is something depressing. (Hebe)

In the social imaginary, aging is associated with the end of a stage, it is difficult to take pleasure in living it. This negative vision reflects the historical construction within a society, which can be revealed by feelings associated with suffering and illness¹⁹.

Some students also mentioned that the fear brought by limitations and losses, gives students the fear of being dependent on other people.

 [...] It is important as well, I have, and I could be on the care of someone, for that whether we like it or not, you're more debilitated [...] I hope you're not giving hart time [...] a person. (Demeter)

I can find that person life drawing, say I have a son, for example, will be that my son will take care of me? [...]. (Hygeia)

I have fear of being dependent on others, not being able to do my things.(Eos)

Nursing students study shows aging related to addiction and abandonment. The damage and losses incurred in this process are linked to the fact that these students do not accept even the aging process²⁰.

Thus, the society gives visibility to the process of aging by predominance of negative aspects attached to losses²¹. In addition, the conceptions that the subjects have of this process is one of the important items to address losses arising from the aging²².

In this scenario, it is realized that the loss of autonomy for self-care afflict the nursing graduates, since, imagine dependent is to be in front of the determinations elaborated by the other, which makes the ageing considerations with reliance on costly and form as something fearful.

The proximity of death

Thinking about the process of ageing is to be closer to death, as in the following lines:

[...] I think we have a revulsion by aging. I think it's normal to anyone thinking about it. I think aging is close to death. It's boring! (Hecate)

[...] It is a phase that is more enough to reach the next moment of death [...]. (Dyonisos)

Another perception by students was the arrival of aging with the proximity of death. The changes resulting from the aging process must be accompanied with rites of passage and reorganization of the meaning of life, since they highlight how transitory and fragile human existence is. The reality of death accompanies each person throughout life and losses are marked by a feeling of symbolic death²³. Before that, aging happens to be dreaded, because it brings the idea of finitude⁷.

The actions of the nurse's care permeates acting with competence and by the attitudes of professionals, which are mediated by their experiences in the daily work with the elderly²⁴, so, assistance to the elderly person is a challenge, as it requires a resolutive planning, added the necessary professional training to assist the clients²⁵.

In this way, the perception of the nursing student should be observed by the teacher, which will help in building the positive image of aging, if not already present, consolidating the principles of geriatric and gerontological nursing in the training of nurses.

CONCLUSIONS

The present study allowed to analyze the perceptions of nursing graduates about the aging process, both as a natural process, seen as another stage of human development, as a phase that can provide, for whom the experience, maturity and learning.

This step inevitable of existence is perceived as vital wear, prejudices and limitations that require attention. However, in the manner of today's society, the images of people that age are stereotyped as being incapable and useless. In this perspective, aging is seen as a process that brings many losses and limitations, awakening in the imagination of the students´ feelings of fear, anguish, and proximity to death.

The study showed how limitations that have been held in a single public nursing school and with only two graduates each semester of the Bachelor's degree course in Nursing. However, it is recommended that further studies should be carried out in other public and/or private institutions to deepen the analysis of this phenomenon.

It is important to seek the knowledge and improvement of issues related to subjects that is aging, in order to be rethought concepts and attitudes, especially with regard to aging, so that, in future, the nurses, can provide qualified and specialized attention for those who experience this process.