The purpose of this review is to look at how aides work with other staff, such as therapeutic recreation specialists. It is imperative that everyone works together in long-term care to make sure they are enhancing the quality of life for the residents. The main purpose of this study is to examine care aides attitudes toward the therapeutic recreation field using Ajzens Theory of Planned Behavior. Attitudes and behaviors toward therapeutic recreation were assessed and discussed. My main goal for my review is to make it clear what attitudes care aides have and why. Once it can be understood, hopefully any negative feelings can be fixed. I would like to take what I learned myself from reading this and apply it when I am in the real world dealing with aides, therapeutic recreation, and the elderly in long-term care.
As I have mentioned, “The purpose of this study was to examine special care aides attitudes toward the elderly and toward therapeutic recreation for the elderly in long-term care facilities” (Sullivan & Sharpe, 2006). It was thought that these aides should have optimistic attitudes about therapeutic recreation being used in long-term care facilities. Researchers did hypothesize that the overall attitude would be a positive one and from this, behavioral intentions could be predicted. Behavioral intentions were then hypothesized to predict therapeutic recreation behaviors.
The research conductors, Sullivan and Sharpe clued the readers in as to how large the elderly population has become in the United States. Long-term care facilities and homes provide interventions to help aide people with chronic illness and enhance their quality of life as much as possible. Therapeutic recreation was created for people with limitations. The goals of therapeutic recreation in long-term care facilities are to provide participation opportunities that promote interest and to prevent further illness and impairment. They also go on to discuss the benefits therapeutic recreation offers, development, enhancement of social relationships, reduced feelings and alienation and loneliness, and more feelings of belonging. The special care aides work with the residents daily with activities like washing, grooming, dressing, eating meals, and their morning and evening bed routines. Throughout all of this, the aides must be supportive with the residents, or it could affect the residents want to participate. Therapeutic recreation programs will not be successful if the aides do not cooperate with the specialists. Negative attitudes toward the residents or the therapeutic recreation programs can negatively affect the quality of care a client receives. The Theory of Planned Behavior, developed by Ajzen, addresses the frequent discrepancies between the attitudes we hold and our subsequent behavior. This theory has even used in many other studies revolving around attitude-behavior consistency. For example, Gardner and Hausenblas (2004) used the Theory of Planned Behavior to understand exercise and diet motivation in over- weight women.
Participants completed measures of exercise and diet behavior and constructs from the Theory of Planned Behavior. Diet adherence was predicted by behavioral intention. However, attitudes, social norm and perceived behavioral control were not predictors of exercise adherence, exercise behavioral intention, and diet behavioral intention. Courneya, Friedenreich, Arthur and Bobick (1999) evaluated the Theory of Planned Behavior to understand exercise motivation among cancer patients. Behavioral intention was a significant predictor of post-surgical exercise, and attitude was a significant predictor of behavioral intention.
There were 78 participants in this study, both full-time and part-time aides. 86% of these aides were females and their average age was 39 years old. The TRAM, Therapeutic Recreation Attitude Measure, was used. Ten questions were constructed according to instructions by Ajzen to test subjective norms, behavioral intentions, and perceived behavioral control elements of the Theory of Planned Behavior. For a behavioral intention example, “I intend to assist the residents in participating in therapeutic recreation whenever possible.” For subjective norms, “The recreation department appreciates it when I assist them in ensuring residents are attending therapeutic recreation activities.” Last, for perceived behavioral control, “It is not possible for me to make sure that the residents are attending therapeutic recreation programs.” Four recreation professionals evaluated the TRAM as a measure of attitudes and behaviors toward therapeutic recreation for the elderly. If the recreation professional agreed the item measured the stated objective, a +1 was scored. If the recreation professional was unsure, a 0 was scored. If the recreation professional believed the item clearly did not measure the stated objective, a -1 was scored. Each item had to average a 0 to stay in the TRAM, and no items wound up being dropped. The TRAM employs a five point response scale, five being often and one being never. The higher the total score, the more positive attitudes there were towards therapeutic recreation for the elderly.
Another tool used was ATOPS, Attitudes Toward Old People Scale, developed by Kogan (1961) to examine attitudes toward the elderly and has been used extensively with populations such as nurses. ATOPS is a set of seventeen negative statements about the elderly and seventeen positive statements that were a reverse of the negatives. For this study, they replaced the word “old people” with “older adults” to use proper terminology. They used another five point scale where five represented strong agreement and one represented strong disagreement. The higher the score, the more positive attitudes. A cover letter was sent along with the questionnaire package explaining the purpose of the study and providing instructions. They participants were asked to anonymously return the questionnaires. 78 of the 300 questionnaires were returned. Many aides felt they were over-worked and not compensated for it so they did not want to give their time to the questionnaire. One of the issues brought up was that only four long-term care facilities were chosen and only 78 of the 300 individuals who were contacted, replied. The aides who decided to participate may have done so because they enjoy what they do and have a positive outlook on therapeutic recreation.
The results from the TRAM and ATOPS were analyzed and it was found that special care aides held generally positive attitudes and displayed positive behaviors toward therapeutic recreation for the elderly. The questionnaires came back having the belief that therapeutic recreation was a good use of time, beneficial, important, refreshing, pleasurable and it increased happiness for the residents. The aides realized how important participation in therapeutic recreation is to the families of the residents, and how thankful the residents were when the aides assisted them to the programs. The recreation department was also so thankful to all help the aides gave. The aides felt they had some volitional control over their behaviors in regards to therapeutic recreation. This finding was surprising given the fact that many aides feel as though they are over-worked and not well compensated. I twas thought the aides would have reported not having a sufficient amount of time to complete their own responsibilities.
The perceived behavioral control component of the Theory of Planned Behavior lacks clarity and it is challenging to differentiate perceptions of control over behavior and perceptions of one’s ability to perform the behavior. For example, how much control the aides perceived they had over ensuring the residents were keeping busy and participating in therapeutic recreation programs versus how confident the aides were in regards to performing these positive behaviors toward therapeutic recreation. The cognitive component of attitudes came back the strongest. The cognitive component included the beliefs, knowledge, and ideas that participants held toward therapeutic recreation. Many participants were well-educated about the benefits of therapeutic recreation.
It was found that the longer participants worked at their facility, the less positive their attitude was toward therapeutic recreation, their behaviors toward therapeutic recreation, and their attitudes toward the elderly (Penner, Ludenia, & Mead, 1984). Negative attitudes toward the elderly in general may also have been the result of participants negative experiences in caring for the elderly. Aides that have been working longer may experience job burnout. In addition, the health care filed has recently experienced many economical cutbacks with thousands of jobs lost. For some, they know their responsibilities have increased and yet their compensation remains the same. Health care workers often work twelve hour days, skip meals, are under pressure, exhausted, and the tasks seem endless. Long-term care staff are most susceptible to back pain and injury due to heavy lifting and movement of the clients. These frustrations may be playing a role in their attitudes toward therapeutic recreation and toward the elderly.
“The cognitive and affective components of the Therapeutic Recreation Attitude Measurement displayed high reliability. The components of behavior, behavioral intention, and subjective norm exhibited lower reliability coefficients. The reliability coefficient for perceived behavioral control was below what is commonly seen as acceptable” (Mertens, 1998). The low reliability for behavioral intention, subjective norm, and perceived behavioral control may be because there are only three items assessing each component. One recommendation that was made for the future was to develop more Therapeutic Recreation Attitude Measurement items. Further use of this measurement will provide more opportunities to improve its psychometric properties (Sullivan & Sharpe, 2006).
In conclusion, aides in long-term care facilities have positive attitudes toward the elderly, and toward therapeutic recreation. Societies attitudes toward these groups have improved. Individuals are more aware that therapeutic recreation plays an important role in the lives of long-term care residents (Bocksnick & Hall, 1994). The cognitive component of attitude was the strongest which suggests investment in educating aides in the value of therapeutic recreation would provide substantial returns. Recreation staff needs to constantly educated aides and other staff members working in these facilities the benefits of therapeutic recreation. Some people do not understand the activities help in the quality of life and in providing the best care. Special care aides have many priorities but patient care should be the highest. As the elderly population continues to live longer, more long-term care facilities will be needed and therapeutic recreation is an important aspect inside the facility. This intervention supports the goal of assisting the elderly to maximize their independence in leisure, optimal health, and quality of life (Sullivan & Sharpe, 2006).
Overall, my opinion on this study is positive. I think it was extremely smart to see how the aides feel about therapeutic recreation as they are a vital part in assisting and encouraging the residents. In completing this study, it was learned was areas are the strongest and which ones need work. In addition, this study brought light to some of the issues the aides may have in terms of long hours and not enough pay. It also proved how educational lectures can truly show everyone the benefits of therapeutic recreation. When observing or working in a long-term care setting in the future, I will pay more attention to the aides role in therapeutic recreation. As it was mentioned, it takes the whole team. Once everyone is on board, therapeutic recreation can work wonders.