Zhi-Dan Cao, Ying Wang, Yan-Zhen Hu, Lei Wang, Yan Wang*

1School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China; 2Nursing Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China;

Abstract Objective:To understand the real experience of nursing students majoring in geriatric nursing in learning the course of geriatric nursing, so as to provide reference for the design of this course.Methods: The semi-structured interview was used to interview 27 sophomore nursing students in the department of geriatric nursing in a a Chinese medicine college to understand their experience of learning the course of "Geriatric Nursing", and to apply a seven-step phenomenological analysis method for data analysis.Results: Refined 8 themes:Lack of cognition of physiological aging; focus on social issues and daily life care; adopting a blended teaching style to stimulate nursing students' interest in learning; understanding the life of the elderly from a professional point of view after class; reverence for life and realisation of life values; little attention is paid to the career of the elderly in China; Geriatric Nursing program expands the scope of employment; and fostering nursing students' willingness to engage with the elderly.Conclusion: The nursing students can understand and experience to the elderly and their lives through learning the course of Geriatric Nursing, but lack the motivation to learn actively.Teachers should guide nursing students to pre-study before class, enrich the course content, expand their knowledge outside of class, and adopt blended teaching to cultivate their perception of the elderly.

Keywords: Elderly care, Nursing students, Real experience, Qualitative research, Geriatric nursing

Introduction

In recent years, with the aging of the population and the miniaturization of the family structure in China, the traditional family pension model can not fully adapt to the development of the times [1].The function of family pension is single, and there is a lack of medical treatment and nursing conditions for chronic diseases in the elderly.A comparative study of various pension modes shows that the condition of the elderly with chronic diseases under the family pension mode deteriorates, the function declines, and the risk of accidents increases [2].Therefore, institutional pension is playing a more and more important role [1].As the largest output reserve of nursing talents in pension institutions in China, nursing students have the characteristics of solid professional foundation and strong plasticity.Their medical and nursing theoretical knowledge and skill level make themselves competent for the nursing service work of pension institutions [3].In order to meet the needs of the society, Tianjin University of traditional Chinese Medicine set up the major of geriatric nursing in 2010, and enrolled four-year undergraduates in the same year [4], but the nursing students had a low willingness to work in the direction of old-age nursing [5]."Geriatric Nursing" is its core course, with a total of 54 hours, including 39 hours of theoretical courses and 15 hours of practical courses.The course is offered in the fourth semester, and the pre-courses mainly include the basis of nursing, geriatric sociology and so on.The purpose of this study is to use the method of qualitative research to deeply understand the real feelings of nursing students majoring in geriatric nursing to the course of geriatric nursing and geriatric nursing, in order to train more professional geriatric nursing talents.

Methods

Participants

Purpose sampling method was adopted to select undergraduate nursing students in Tianjin University of Traditional Chinese Medicine majoring in elderly nursing as the participates in July 2019.The inclusion criteria for participates were as follows：a) Second-year nursing students with a 4-year schooling system in the national general recruitment of elderly nursing majors; b) Nursing students who have completed the course of "Geriatric Nursing"; c) Voluntary participation in this research.The exclusion criteria for participates were as follows:those who are absent from class.The interview materials are based on the principle of "saturation".Finally, 27 nursing undergraduates were enrolled, including 3 males and 24 females.

Instrument

On the basis of a large number of previous references at home and abroad, with phenomenological research methods in qualitative research as theoretical guidance,data were collected in the form of semi-structured interview, and purpose sampling of nursing students.According to the purpose of the study, the corresponding interview outline was made by referring to a large number of domestic and foreign literatures and combining with educational psychology and the characteristics.

Data collection

The interview outlines were as follows:a) Before learning the course of "Geriatric Nursing", have you ever thought about how you will get old?b) How do you feel about the elderly after taking the course of "Geriatric Nursing"? c) After taking the course of "Geriatric Nursing", how do you feel about the life of the elderly? d) Have you thought about life care before? e) What are your thoughts on life care? f) Do you know anything about the content of the course before taking the course of "Geriatric Nursing"? g) Which content of the course "Geriatric Nursing" are you most interested in? h) In the course of "Geriatric Nursing", which teaching method are you most interested in? i) Through the course of "Geriatric Nursing", will you pay attention to the elderly in your family in the future? What to focus on? j) Through the course of "Geriatric Nursing", do you want to try to approach the elderly? k) Through the course of "Geriatric Nursing", will you pay attention to the development of the cause of the elderly in my country? l) How will the study of "Geriatric Nursing" course affect your choice of elderly nursing work? Three postgraduates who have undergone uniform training and qualified will conduct face-to-face,semi-structured interviews with interviewees.

Before the interview, the interviewer explained the significance, content, and confidentiality principles of the research to the interviewee to obtain the interviewee's understanding and cooperation.The two parties agreed on the time and location of the interview, and obtained informed consent for the recording.The three interviewers were conducted in a quiet, private room with good privacy.The interviewers recorded both on-site recording and transcripts, including recording of nonverbal information, such as silence, nodding and other body language and facial expression changes.

Quality Control

Before the interview, the interviewees were trained in data collection and collation,semi-structured interviews and other qualitative researches.The interview was conducted in a relaxed and natural atmosphere without any judgment, suggestion and guidance to avoid the influence of the interviewer's personal views on the nursing students interviewed [6].

Interview information integration analysis

Claizzi phenomenological analysis method was adopted for data analysis.1) read interview information; 2) group discussion and collective summary of key points of information; 3) key information coding; 4) summarize coding information; 5) describe the detailed information; 6) general theme concept; and 7) interview subjects to check and verify.

Results

Theme 1:Lack of cognition of physiological aging

Aging is a series of degenerative changes in the morphological structure and physiological function of an organism after its growth and development reaches maturity in the course of its life.With the gradual aging of the body, the physiological functions decreased in a straight line, but there were obvious differences among different individuals [7].On the other hand, in addition to the decline of various physiological functions,there will also be psychological changes in the elderly.Most nursing students lack awareness of aging before learning the course of Geriatric Nursing.S9:"In the past, I only defined old people as old grandparents." S22:"I used to think that I just had to live to be 65 years old.Because after the age of 65, the human body will fall into a weaker situation, then I may need someone to accompany me, someone to take care of me, and I may not be able to take care of myself.If I die before the age of 65, it may be more respectable.It will also reduce a lot of burden on my child." S25:"I have considered the degradation of various physiological functions when you get old, and so on.Even if I am not willing to face the loss of my ability and self-care when I am old, I am also reluctant to face the dead."

Theme 2:Focus on social issues and daily life care

In the process of learning, nursing students pay more attention to the hot social issues and the daily life nursing of the elderly, which is consistent with the contents of the course of geriatric nursing, which involves the aging society, the physiology and psychology of the elderly.S5:"I am more concerned about hospice care, because when I watch TV dramas, some patients rely on tubes for their lives.They are also in pain, and their families are also struggling.I don't think this is what I want to see.I still hope that I can walk with dignity and respect my opinions." S6:"I am more interested in the pension model of pension institutions.".After all, in an aging society, there are a large number of elderly people, and if their children do not have the time and experience to take care of them, they will definitely have to live in nursing homes in the future.It is also helpful for them to know in advance."S7:" the principles and goals of aging.I feel that we need to know some content and knowledge at the national level, which should be of great help to our study and work." S18:"We are interested in the theory of aging.Everyone will face the problem of aging.It won't hurt to know more about it." S1, S3, S19:"I pay more attention to the psychological aspect, I think a person's mentality can play a great role, understand the psychology of the elderly, we know how to get along with them, how to care for them." S2:"in terms of medication and psychology, because the elderly will suffer from all kinds of diseases, we will be more professional when we take care of the elderly."

Theme 3:Adopting a blended teaching style to stimulate nursing students' interest in learning

At a time when the medical environment is becoming more and more complex, colleges and universities attach great importance to the cultivation of nursing students' humanistic quality, but the traditional practical teaching methods based on teachers' teaching and on-the-spot demonstration have some shortcomings, such as less class hours, nursing students do not pay enough attention to course learning, lack of interest, etc [8].The traditional practical teaching cannot meet the learning needs of nursing students and the cultivation of humanistic quality of nursing talents in this course [9].Mixed teaching can effectively alleviate the contradiction of few class hours and limited class time in nursing interpersonal communication courses, according to the various needs, characteristics, motivations and wishes of nursing students, comprehensive use of face-to-face classroom teaching, scene simulation, community internship and other ways of combination of form, reasonable design and implementation of practical teaching activities [10].S2:"scenario simulation.I think we have a strong sense of participation in the process of scenario simulation." S4:"case study, I think it is more helpful to study." S6:"I think group reporting is more interesting, and this form has aroused the thinking of each of us."

Theme 4:Understanding the life of the elderly from a professional point of view after class

In the study of geriatric nursing, nursing students, based on the physiological changes of the elderly, have a new insight into the life of the elderly from a professional point of view and have a deeper understanding of the life of the elderly.S4:"there will be some physical changes in the elderly.After learning the course of Geriatric Nursing, we know some of the reasons.The elderly are the physical changes caused by the deterioration of the function of the body and the function of the viscera when they get old." S13:"I think the elderly are rich in social experience, but they are also a group that needs to be taken care of." And an old man may not be able to do nothing when he is old.He can still learn something when he is old." S18:".Old age is a physical change, and you can still live a wonderful life as long as you admit defeat." S27:"I used to feel sorry for the elderly, but after taking this

course, I went to a lot of nursing homes and had more contact with the elderly.I found that some old people had a good mentality and were very positive."

Theme 5:Reverence for life and realisation of life values

After having a deep understanding of the elderly and their lives, nursing students pay more attention to the realization of the value of life.S3:"Life is fleeting (paused for a moment)." If you can't control this, you still live in the present." S10:"I am very calm about the issue of death.I think it is nothing.If the time of death comes, I will accept it calmly, and I will not be able to fight it.This is the best choice." S11:"the value of life is to do something meaningful." Respect life, be in awe of life, and don't waste your life casually." S22:"I used to think that the meaning of life is to reproduce, but then slowly through study, I changed my mind.Having children is only one aspect.We have to do something that we like and benefit society to realize our own value.Only in this way can it make sense."

Theme 6:Little attention is paid to the career of the elderly in China

Although they are nursing students majoring in geriatric nursing, they do not take the initiative to pay attention to the development of the cause of the elderly in our country.S3:"if I were to find this content by myself, I would feel a little at a loss." Because I am not quite sure which channels or websites to pay attention to the development of the cause of the elderly and other knowledge." S8:"I probably learned it all from what the teacher said in class, and I didn't take the initiative to pay attention to these developments." S13:"now I am thinking, Tianjin here pension institutions or pension services are doing very well, how is my city doing?" What's the problem? Or is it because there are some difficulties, so the development is not good enough? Or for some other reason." S25:"I will look at my future personal development, as well as the career prospects of the elderly, and so on.If the development is relatively good, I may go into this industry, and I may know more about it at that time."

Theme 7:Geriatric nursing program expands the scope of employment

Teaching practice has proved that students who are good at self-study have better academic performance, and students' ability of self-study is embodied in pre-class preview and after-class review.Twelve nursing students did not think about the course content before learning the course of geriatric nursing, while the other 15 nursing students only guessed the course content according to the course name but did not preview and think deeply about its content and advantages.S1:"before the course, I think the course is about how to take care of the elderly, how to treat diseases in the elderly, and how to communicate with the elderly." S2:"I think it is mainly to learn the specific measures of nursing, mainly in the aspect of nursing operation." S8:"I think the geriatric nursing course is a combination of the elderly and all aspects of nursing." Teaching practice has proved that students who are good at self-study have better academic performance, and students' ability of self-study is embodied in pre-class preview and after-class review [11].After studying the course of geriatric nursing, nursing students have a deeper understanding of their major and work direction, and think that geriatric nursing major provides them with new employment directions and opportunities.S2:"at that time, I was transferred to the nursing major, and I began to resist a little.After I learned it, I began to accept it slowly.I could pay attention to the elderly, which was also helpful to the elderly in my own family, and then I had confidence in this major.I want to continue in the future." S10:"for those who are not particularly interested in geriatric care, this job is generally not very attractive to us young people." Personally, I prefer challenging jobs.Geriatric care may be one more way, but I am still more inclined to challenging work "S14:" Geriatric care is one of my choices, not the only one."

Theme 8:Fostering nursing students' willingness to engage with the elderly

Through the infiltration of the course of geriatric nursing, nursing students pay more attention to the elderly at home after learning theoretical knowledge, and they also intend to contact other elderly people around them, so as to combine theory with practice and put what they have learned into practice.S6:"through these internships and the influence of the elderly at home, I feel that different old people will feel very different." If you have the opportunity, I still want to get in touch with some other old people and get to know them better." S9:"because after Grandpa died, there was no old man at home.I didn't know how to communicate with Grandpa before.I felt it was a pity." If you go to a community or a home for the elderly, if you can get in touch with the elderly, you still hope to get in touch with some of the elderly and communicate with them more to make up for your regrets.

Discussion

Guiding nursing students to correctly locate the course of geriatric nursing

At present, China has entered the stage of rapid development of population aging, and the construction of China's geriatric nursing service team has made considerable development and progress through the efforts of all parties.However, it is far from social development, economic growth, population aging and the diversified needs of the public for health [12].Geriatric nursing education lags behind the development and needs of the aging society.Geriatric Nursing,an introductory course for nursing students majoring in geriatric nursing,combines advanced foreign concepts with geriatric nursing practice in China by drawing on the development of geriatric nursing and geriatric nursing experience in foreign developed countries.This course aims at maintaining the health of the elderly and improving the quality of life of the elderly, combining the physical, psychological and social adaptability of the elderly, analyzing the characteristics of the elderly, paying attention to the care of the elderly and the prevention of diseases centered on daily life, increasing the content of humanistic knowledge and deepening the humanistic spirit, thus expanding the professional skills of nursing students and thus promoting their understanding of geriatric nursing knowledge.This will expand the professional skills of nursing students and promote their understanding of geriatric nursing knowledge.

Enhance nursing students' perception of the aging society

With the continuous improvement of economy, medical care and living standards, the population structure of our country is changing, and the "silver hair wave" is irresistible.According to the data of the National Bureau of Statistics, by the end of 2018, the number of people over 60 in China was 249.79 million, accounting for 17.9% of the total population, of which 166.85 million were over 65, accounting for 11.9% of the total population [13], which means that China has a large elderly population base, a rapid aging process, and many senior citizens.In the process of teaching, teachers should guide nursing students to recognize the basic national conditions of China's aging society, enhance their perception of the aging society, appropriately supplement the development trends of social hot issues, and broaden nursing students' horizons.At the same time, it can provide nursing students with a variety of channels to track the development of nursing for the elderly, help them get the latest trends independently and enhance their professional recognition.

Adopt mixed teaching to train nursing students in an all-round way

Ran Lili [14] has found that actively acquired knowledge is far superior to passively acquired knowledge in terms of quantity and quality.Therefore, in order to meet the needs of the times, a blended teaching model should be adopted to guide nursing students to learn actively and train them in all aspects.experts at home and abroad give different concepts to "blended teaching", which can be divided into:a mixture of teaching theories, a mixture of teaching methods, a mixture of learning environments, a mixture of teaching styles, a mixture of teaching resources or a mixture of teaching evaluation methods, etc.[15].By integrating different teaching methods,

the strengths of various teaching methods can be absorbed to achieve the optimization of teaching resources, which has certain promotion value.In the future, we should explore various forms of teaching models, design different training models according to different teaching contents, increase the proportion of practical courses, so that students can master theoretical knowledge more solidly through practice, in order to adapt to the development of nursing teaching, promote the advancement of higher nursing education in China, and provide reference for geriatric nursing education.

Devote yourself to the cause of nursing for the elderly and embody the professional value

The survey results of Li Xiaomei [16] show that only 40.7% of undergraduate nursing students are willing to be nurses, while those of technical secondary school nursing students and junior college nursing students are 92.0% and 82.9% respectively.Thus, it can be seen that the professional identity of undergraduate nursing students is poor.At present, it is generally believed that the old-age nursing work is "light to technology, heavy physical strength, poor treatment, narrow channel and small rising space", and its social status is not as high as that of hospital clinical nurses [17].However, the elderly in pension institutions and their families have higher requirements for professionals engaged in geriatric nursing, elderly nursing professionals need to have good professional literacy and professional ability, love the geriatric nursing profession and are willing to join the geriatric nursing work.Solid basic skills of geriatric nursing, can deal with emergencies urgently, and can carry out comprehensive and meticulous health education, disease nursing, mental health intervention and so on [18].Therefore, teachers should strengthen the guidance of nursing students in geriatric nursing, cultivate nursing students' correct professional cognition, strengthen their professional belief, and deepen their understanding of the function, nature, status and development of geriatric nursing specialty.make nursing students establish a correct professional view.Organize nursing students to visit and experience excellent nursing homes, accumulate experience, realize the prospects of their profession and work, and enhance their professional identity.

Conclusion

In this study, through a semi-structured interview with undergraduate nursing students majoring in geriatric nursing, it is clear that nursing students have different degrees of problems in learning the course of Geriatric Nursing.Therefore, the teaching of the course should start from various aspects, improve the efficiency of nursing students' pre-class preview, adopt hybrid teaching methods, enrich the course content, expand extracurricular knowledge, enhance nursing students' perception of the elderly, make them actively participate in the elderly care career, and reflect the value of the discipline, so as to achieve a more ideal teaching and learning effect.