Nurses’ Knowledge of, and Attitudes and Perceptions towards People with Dementia: A Mixed Method Study Saudi Arabia

Abstract

Historically, nurses in Saudi Arabia have not received any training in recognising or caring for people with dementia. This is likely due to the prevalent cultural views of dementia as fate and undefined pathways to its care. In fact, only in 2016 was geriatric care training introduced into domestic nursing schools’ curricula; however, specific knowledge relating to dementia was not part of the programme, meaning awareness of this disease is still lacking. Hence, nurses working in hospital settings may not have the appropriate knowledge and skills required to support people with dementia. This study investigates Saudi Arabian nurses’ knowledge of (cognitive expertise), attitudes toward (feelings and behaviours) and perceptions of (thoughts, concerns and interpretations of particular behaviours) the care of people with dementia in Saudi Arabia’s hospitals to inform the development of future training programmes. The study was conducted in six hospital settings in Jeddah, Saudi Arabia and uses a sequential explanatory mixed-method design, involving a survey, and diary-interviews. A self-administered paper survey was completed by 710 nurses in Jeddah hospitals. Of these, 17 nurses agreed to keep a diary and 18 attended a follow-up interview. The study includes the validated Dementia Attitude Scale and Dementia Knowledge Assessment Tool version 2 and a set of demographic questions. Findings from the survey and diary interviews were established using the pillar integration process. This process helped identify practice approaches, as well as the knowledge and attitudes of nurses working with people with dementia, and then corroborated these practices through the diary- interview key points.

Analysis of the survey identified five themes: (1) the positive association between knowledge and attitudes, (2) work environment implications on nurses’ knowledge and attitudes, (3) educational and cultural backgrounds’ influence on nurses’ knowledge levels and attitudes, (4) links between nurses’ low self-confidence and their comfort level when dealing with people with dementia and (5) nurses’ basic knowledge about dementia and dementia care. Analysis of the diary-interview data identified five additional themes: (1) the acquisition of knowledge and the belief systems of nurses, (2) attitudes that inform nurses’ behaviours, (3) nurses’ perceptions of living with and caring for people with dementia, (4) professional factors affecting nursing practices and (5) nurses’ ideas for enhancing dementia care. The above themes are summarised in this study, including sub-themes associated with these. Finally, the pillar integration process identified five findings. These are (1) a lack of knowledge is associated with a lack of confidence when nursing people with dementia, (2) nurses are willing to learn about dementia but information and resources are not always available, (3) nurses’ attitudes, emotions and perceived communication difficulties affect their delivery of dementia nursing care, (4) stigmas, cultural norms and perceptions associated with a dementia diagnosis can have a negative impact on nursing care for people with dementia and (5) organisational factors can negatively impact the nursing care for people with dementia. The findings are discussed in the context of socio-cultural influences, the role of emotional work and the impact of the work environment. Additionally, the study provides practical recommendations to inform healthcare organisations and nursing care in the Saudi Arabian context.