ORIGINAL ARTICLE The Journal of Nursing Research ▪ VOL. 29, NO.
4, AUGUST 2021
Exploration of Geriatric Care Competencies
in Registered Nurses in Hospitals
Fang-Wen HU1* • Huan-Fang LEE2 • Yueh-Ping LI3
ABSTRACT
Downloaded from http://journals.lww.com/jnr-twna by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 10/22/2021
Background: Older adults occupy one third of acute care hospi-
tal beds, and the regular duties of many nurses include caring
for older patients. A working knowledge of geriatric care com-
petencies is necessary for nurses to provide high-quality care
to older patients and their families. It is unclear how nurses
who work in acute care hospitals self-evaluate their geriatric
care competencies and how these self-evaluated abilities differ
from the objective abilities of these nurses.
Purposes: This study was designed to explore the geriatric care
competencies of nurses in hospitals and to identify the factors
associated with these competencies.
Methods: This was a cross-sectional study. Nurses who were
employed and directly caring for patients aged 65 years and older
in any of the adult wards of a medical center located in southern
Taiwan were recruited as participants. A structured questionnaire
was developed based on a review of the relevant literature and
validated using expert consensus. This questionnaire included a
demographic datasheet, knowledge of geriatric care scale, attitude
of geriatric care scale, self-evaluation of geriatric care competency,
and geriatric care competency test. Descriptive and inferential sta-
tistics were used to analyze the geriatric care competencies of the
participants and related factors.
Results: One hundred seventy nurses were enrolled as partici-
pants. The average self-evaluation score for geriatric care compe-
tency was 67.74 (SD = 0.84). However, the average percentage
of correct answers given on the geriatric care competency test
was much lower (17.6%). The self-evaluation score was found
to be significantly associated with job satisfaction and having re-
ceived continuing education in geriatric care. In addition, age was
shown to significantly affect the percentage of correct answers
given on the geriatric care competency test.
Conclusions/Implications for Practice: A significant gap was
found between the self-perceived and actual competencies of
nurses in terms of providing geriatric care. Appropriate policies
are necessary to improve the geriatric care competencies of
nurses working in hospitals and to oversee the implementation
of effective educational methods in Taiwan.
KEY WORDS:
competency, geriatric, hospital, nurses, related factors.
Introduction
At the end of 2019, Taiwan had 3,607,127 citizens and resi-
dents aged 65 years and above, accounting for 15.28% of
the country's total population (Ministry of Interior, Taiwan,
ROC, 2020). In 2019, older adults occupied over one third
(37.2%) of acute care hospital beds and accounted for
45.9% (roughly USD$30 billion) of all inpatient expenses
covered by Taiwan's national health insurance program
(Ministry of Health and Welfare, Taiwan, ROC, 2021). Older
adults have unique and complex care needs that span the med-
ical, cognitive, emotional, social, and environmental domains.
Moreover, their signs and symptoms for various illnesses may
differ markedly from those of other age groups, requiring
nurses to have specialized training and education (St. Pierre
& Conley, 2018).
Observing the rapid increase in the world's aging popula-
tion, leaders in geriatrics/gerontology nursing recognize the
unique need to ensure that nurses have sufficient capabilities
in geriatric care. Therefore, specific core competencies have
been identified for gerontological nursing in addition to those
required for the general nursing profession. The American As-
sociation of Colleges of Nursing (AACN) and the John A.
Hartford Foundation Institute for Geriatric Nursing at New
York University assembled inputs from qualified gerontologi-
cal nursing experts into the Recommended Baccalaureate
Competencies and Curricular Guidelines for Geriatric Nurs-
ing Care in 2008 (AACN, 2008). These geriatric care compe-
tencies were updated in 2010 to include 19 statements that are
important in ensuring accessible, quality nursing care for
older adult populations (AACN, 2010).
The acute care hospital is often the point of entry into the
healthcare system for older adults. Nurses make up the largest
1
PhD, RN, Department of Nursing, National Cheng Kung University
Hospital, and Clinical Assistant Professor, Department of Nursing,
College of Medicine, National Cheng Kung University, Taiwan, ROC •
2
PhD, RN, Assistant Professor, Department of Nursing, College of
Medicine, National Cheng Kung University, Taiwan, ROC • 3PhD,
RN, Assistant Professor, Department of Nursing, National Tainan
Junior College of Nursing, Taiwan, ROC.
Copyright © 2021 The Authors. Published by Wolters Kluwer Health,
Inc.
This is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use, distri-
bution, and reproduction in any medium, provided the original work is
properly cited.
1
The Journal of Nursing Research
contingent within healthcare teams, and working in hospitals
is likely to include care for older patients even if a nurse is not
assigned to a geriatrics unit. A working knowledge of geriatric
care competencies is necessary for nurses to provide high-quality
care to older patients and their families. Still unclear are how
nurses working in acute care hospitals self-evaluate their geriatric
care competencies and how significant is the difference between
their self-evaluation and their objective ability in these competen-
cies. Therefore, the aim of this study was to explore the geriatric
care competencies of nurses in hospitals and to identify the
associated factors.
Methods
Setting and Participants
Between April 1 and December 31, 2016, a descriptive corre-
lational study was conducted in all of the adult wards of a
1,135-bed tertiary care medical center in southern Taiwan.
Inclusion criteria were nurses employed at the hospitals and
directly caring for patients aged 65 years and older. Nurses
who had been employed less than 3 months or were holding
administrative positions were excluded. The sample num-
bers were calculated using G*Power 3.1.9.2. Estimation
was based on the Cheng et al. (1996) study, in which all var-
iables explained 11.6% of the ability of public health nurses
to perform gerontological care. Other estimating parameters
included the number of predictors (14), the probability of
Type I error (0.05), and a power of 0.8. It was estimated that
at least 152 nurses were required for this study. An addi-
tional 10% margin was added to this number to account
for the possibility that some nurses would not complete the
questionnaire, increasing the total sample needed to 170.
Using quota sampling, 170 nurses from adult wards were
enrolled as participants. The number of nurses in each ward
was separately measured by considering the number of the
required sample for this study (170) and comparing the ratio
of the number of older patients in the ward with the total
number of older patients in the hospital (the number of nurses
in the ward was 170 multiplied by the number of older pa-
tients in the ward divided by the total number of older patients
in the hospital). The study was approved by the medical
center's institutional review board (B-ER-104-274). Informed
consent was obtained from each participant before enrollment.
Measurements
Self-Report Questionnaire
The questionnaire included four parts: demographic charac-
teristics, knowledge of geriatric care scale, attitude of geriat-
ric care scale, and self-evaluation of competencies to provide
geriatric care (SCG).
1. Demographic characteristics: The demographic data collected
consisted of age, highest level of education, years of experi-
ence as a registered nurse, work unit, job satisfaction (1 = very
2
Fang-Wen HU et al.
dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and
5 = very satisfied), perception of importance of work
(1 = not important at all, 2 = not very important, 3 = neu-
tral, 4 = important, and 5 = very important), perception of
comfort in the work environment (1 = very uncomfort-
able, 2 = uncomfortable, 3 = neutral, 4 = comfortable,
and 5 = very comfortable), family support (1 = strongly
disagree, 2 = disagree, 3 = neutral, 4 = agree, and
5 = strongly agree), having received geriatric-related edu-
cation in school, and having received continuing educa-
tion on geriatric care.
2. Knowledge of geriatric care scale: This scale was devel-
oped and published in Chinese in 2009. It comprises 50
items and addresses four domains: aging-related statistics
and management of biological aging, physiological aging,
and psychosocial aging. The total possible score range is
from 0 to 50, with incorrect and “do not know” responses
earning 0 points and each correct response earning 1 point.
The Cronbach's alpha coefficient, representing the
questionnaire's internal consistency reliability, was .62. The
questionnaire's content validity index was .92 (Ho, 2009).
3. Attitude of geriatric care scale: This scale was also developed
in Chinese in 2009. The questionnaire comprises 23 items
(12 positive and 11 negative), rated on a 4-point Likert scale
ranging from 1 (strongly disagree) to 4 (strongly agree). The
11 negatively worded items are reverse scored. The total
possible score range is from 23 to 92, with higher scores
indicating more positive attitudes. The Cronbach's alpha
coefficient was .84, and content validity index was .79 for
this scale (Ho, 2009).
4. SCG: The SCG was developed by the research team based
on the AACN statements of geriatric care competencies
and Roethler et al. (2011). This scale consists of 25 state-
ments scored using a 4-point Likert scale ranging from 1
(not at all confident) to 4 (very confident). The total pos-
sible SCG score range is from 25 to 100, with higher
scores indicating more confidence in providing geriatric
care. For this study, tests of content validity and jury opin-
ion were performed with five experts, including two ge-
rontological nursing professors, two gerontological clinical
nurse specialists, and one geriatrician. The overall Cronbach's
alpha coefficient was .87, indicating good reliability and
validity.
Dichotomous Problem Checklist
A dichotomous (yes/no) problem checklist was designed by
the research team from the SCG items used to assess the oc-
currence of common health problems, including activities
of daily living (ADL) impairment, gait and balance disorder,
delirium, depressive symptoms, cognitive impairment, pain,
sensory deficit, polypharmacy, malnutrition, urinary inconti-
nence, insomnia, and caregiver burden. ADL impairment
was defined as dependence in any the items (i.e., bathing,
dressing, visiting the toilet, getting up out of a chair, eating,
use of incontinence materials) of the Katz ADL (Katz et al.,
Geriatric Care Competencies VOL. 29, NO. 4, AUGUST 2021

1963). The Timed Up and Go test is a validated and reliable
measure of functional capacity incorporating aspects of mo-
bility, strength, and balance and involves measuring the time
taken (in seconds) for the patient to rise from a chair, walk a
distance of 3 m, turn, and walk back to the chair. Patients
who complete the test in more than 20 seconds are rated as
having “gait and balance disorder” (Podsiadlo &
Richardson, 1991). The Diagnostic and Statistical Manual
of Mental Disorders criteria were used to describe “delirium”
(American Psychiatric Association, 2013), which includes inat-
tention, impaired consciousness, disturbance of cognition, and
acute onset and a fluctuating course of symptoms. If two or
more of these symptoms are reported, a determination of delir-
ium is considered. Depressive symptom was defined as earn-
ing a total score of more than 8 on the Geriatric Depression Scale
Short-Form (Yesavage & Sheikh, 1986). Cognitive impair-
ment was defined as performing two or more errors after
adjusting for educational level on the Short Portable Mental
Status Questionnaire (Pfeiffer, 1975). For patients who were
incompetent in responding, the Short Portable Mental Status
Questionnaire was automatically coded as cognitive impair-
ment. Sensory deficit was defined as the inability to read bet-
ter than 20/40 on a Snellen chart or the inability to hear 1000
or 2000 Hz in both ears or either frequency in one ear
(Moore & Siu, 1996). Polypharmacy was defined as the
concomitant use of more than five medications (Rollason
& Vogt, 2003). The mini-nutritional assessment is composed
of 18 simple and rapid-to-measure items (anthropometric as-
sessment, general assessment, dietary assessment, and subjec-
tive assessment), with scoring on each part categorizing the
respondent as one of the following: well nourished, at risk
for malnutrition, and malnourished (Guigoz et al., 1999).
Urinary incontinence was considered in the affirmative if the
respondent reported wetting themselves within the previous 2
weeks (Abrams et al., 2003). Insomnia was considered in the
affirmative if the respondent reported experiencing persistent
difficulties with sleep initiation, duration, consolidation, or
quality resulting in daytime impairment (American Academy
of Sleep Medicine, 2014). Caregiver burden was considered
in the affirmative if the caregiver reported feeling overly
strained or burdened by caring for older patients (Stucki &
Mulvey, 2000).
Data Collection
The first author and two research nurses collected the data
for this study. The consistency between these researchers was
examined before data collection, and the interrater reliability

Table 1
Characteristics of All Participants (N = 170)
Variable n % Mean SD

Age (years) 27.64 7.28

Highest level of education
Diploma 3 1.8
Bachelor's degree 166 97.6
Master's degree 1 0.6
Years of experience as a registered nurse
<5 125 74.4
5–10 19 11.3
11–15 6 3.6
16–20 5 3.0
> 20 13 7.7
Work unit
Medical ward 82 48.2
Surgical ward 48 28.2
General ward 40 23.5
Job satisfaction 3.18 0.72
Nurses' perception of importance of work 3.49 0.66
Nurses' perception of comfort in the work environment 3.29 0.71
Family support 3.40 0.73
Received geriatric curriculum in school 97 57.1
Received continuing education on geriatric care 67 39.4
Knowledge of geriatric care score 36.07 4.44
Attitude of geriatric care score 62.44 5.28
Self-evaluation of competencies to provide geriatric care 67.74 8.84

3
The Journal of Nursing Research Fang-Wen HU et al.

was .98. The researchers visited the study wards Monday
through Friday during the study period to recruit eligible
nurses. After consent was obtained, phase I data collection used
a self-report questionnaire (demographic characteristics, knowl-
edge of geriatric care scale, attitude of geriatric care scale,
and SCG), copies of which the researchers delivered to the
participants.
After phase I data collection, the research nurses turned
from subjective participant evaluation of their own knowledge
and skills to objective evaluation of the health problems faced
by older patients who received direct care from the partici-
pants. The researchers first evaluated the health problems of
an older patient cared for by each nurse participant. Next,
the researchers consulted the geriatrician or geriatric clinical
nurse specialist to confirm those health problem evaluations.
In the meantime, the researchers also provided a blank dichot-
omous (yes/no) problem checklist to each nurse participant
with instructions to select/tick the health problems of that
older patient. Using the results of the researchers' yes/no prob-
lem checklist as the gold standard, the geriatric care compe-
tency test (GCCT) compared the yes/no problem checklist of
the research nurses with that of each participant. If the re-
searchers had ticked an item as one of the older patient's
health problems but the participant had not, the item was
treated as “incorrect.” Similarly, if the researchers had not
ticked a certain health problem item but the participant ticked
that item, the item was treated as “incorrect.” All other situa-
tions were treated in this study as “correct.”

Table 2
Self-Evaluation of Competencies to Provide Geriatric Care (SCG; N = 170)
Statement Very Confident Slightly Not at All Mean SD
Confident Confident Confident
n % n % n % n %

The total mean score of SCG 67.74 8.84

Assessing ADL 8 4.7 119 70.0 40 23.5 3 1.8 2.78 0.55
Managing ADL impairment 8 4.7 111 65.3 48 28.2 3 1.8 2.73 0.57
Assessing insomnia 5 2.9 120 70.6 43 25.3 2 1.2 2.75 0.52
Managing insomnia 4 2.4 102 60.4 59 34.8 4 2.4 2.63 0.57
Assessing vision loss or other sensory deficit 7 4.1 115 68.1 45 26.6 2 1.2 2.75 0.54
Providing appropriate care for sensory deficit 5 2.9 108 63.5 56 32.9 1 0.6 2.69 0.53
Assessing dementia 4 2.4 109 64.1 54 31.7 3 1.8 2.67 0.55
Providing dementia care 3 1.8 92 54.1 69 40.6 6 3.5 2.54 0.59
Assessing pain 6 3.5 130 76.5 33 19.4 1 0.6 2.83 0.47
Providing appropriate pain control 8 4.7 127 74.7 33 19.4 2 1.2 2.83 0.51
Recognizing depressive symptoms 3 1.8 65 38.2 90 52.9 12 7.1 2.35 0.63
Managing depressive symptoms 3 1.8 62 36.5 95 55.9 10 5.9 2.34 0.61
Diagnosing delirium 5 2.9 87 51.2 74 43.5 4 2.4 2.55 0.59
Managing delirium 4 2.4 93 54.7 71 41.8 2 1.2 2.58 0.56
Assessing urinary incontinence 7 4.1 126 74.1 35 20.6 2 1.2 2.81 0.51
Providing urinary-incontinence care 8 4.7 122 72.2 37 21.9 2 1.2 2.80 0.52
Conducting risk-of-fall assessment 21 12.4 131 77.1 17 10.0 1 0.6 3.01 0.49
Providing fall prevention 20 11.8 124 72.9 24 14.1 2 1.2 2.95 0.55
Assessing polypharmacy 7 4.1 100 58.8 59 34.7 4 2.4 2.65 0.60
Providing appropriate care for polypharmacy 5 2.9 97 57.1 65 38.2 3 1.8 2.61 0.57
Assessing nutrition 8 4.7 94 55.3 64 37.6 4 2.4 2.62 0.61
Managing malnutrition 6 3.5 100 58.8 62 36.5 2 1.2 2.65 0.57
Assessing care quality and burden from caregiver 8 4.7 123 72.4 38 22.4 1 0.6 2.81 0.51
Providing appropriate referrals for services (e.g., homecare, 11 6.5 126 74.5 32 19 0 0.0 2.88 0.49
daycare, nursing home; n = 169)
Providing age-appropriate discharge instructions; n = 169) 11 6.5 129 76.3 29 17.2 0 0.0 2.89 0.47

Note. ADL = activities of daily living.

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Geriatric Care Competencies VOL. 29, NO. 4, AUGUST 2021

Statistical Analysis care (adjusted β = 2.81, 95% CI [0.13, 5.49]) earned signif-
Statistical analyses were performed using SPSS for Windows, icantly higher scores on the SCG. Other related variables,
Version 20.0 (IBM Inc., Armonk, NY, USA). All p values perception of importance of work, and comfort in the work
were two-tailed, and p < .05 was considered statistically sig- environment and family support were not found to be signif-
nificant. Descriptive analyses were carried out to evaluate the icantly associated with SCG score.
demographic characteristics and geriatric care competencies The independent samples t test and chi-square test were
of the nurse participants. The associations between partici- also used to analyze the data. The findings revealed that only
pants' characteristics and geriatric care competencies were age significantly affected the number of correct answers given
assessed as appropriate using Pearson's correlation analysis, on the GCCT.
independent samples t test, one-way analysis of variance, and
chi-square test. Multiple regression analysis was performed to
measure the variables associated with geriatric care competen- Discussion
cies. Variables that were present in > 10% of the patients with This study was designed to explore the geriatric care compe-
p < .05 on univariate analysis were entered into the model for tencies of nurses in hospitals. The influence of personal char-
adjustment. acteristics on geriatric care competencies was also examined.
The participants self-evaluated as having a medium–high level
of competency in providing geriatric care (SCG). However,
Results the average percentage of correct answers on the GCCT was
only 17.6%. These findings are consistent with other studies
Participants' Characteristics and Geriatric (De Almeida Tavares et al., 2015; Roethler et al., 2011).
Care Competencies Roethler et al. showed a lack of congruency between nurses'
Themeanageoftheparticipantswas27.64years(SD=7.28years). knowledge about geriatric care and their self-perceived compe-
Most (97.6%) held a bachelor's degree, and approximately three tency. All of the nurses rated themselves in their self-assessment
quarters (74.4%) had worked in the hospital for fewer than as “very good” or “good” in their ability to provide geriatric
5 years. Of this sample, the largest share (48.2%) worked in care. However, only 32% answered 60% or more of the
a medical ward, followed by surgical ward (28.2%) and gen- knowledge questions correctly. This may be because the com-
eral ward (23.5%). The participant characteristics are sum- petency information was self-reported. One dilemma inherent
marized in Table 1. Furthermore, 57.1% of the participants to this type of data collection is participant bias. The partic-
had received geriatric-related education in school, and 39.4% ipants may have adjusted their ratings to what they thought
had received continuing education on geriatric care. The total the researcher wanted to hear. Moreover, they may have be-
mean score for knowledge about geriatric care was high, at lieved incorrectly that the study results would change or cre-
36.07 (SD = 4.44), and the mean score for attitude was ate new department policies concerning geriatric care and
medium–high, at 62.44 (SD = 5.28). The results for SCG are
presented in Table 2. The mean score for participants was Table 3
67.74 (SD = 8.84), and the three categories with the lowest rat-
ings were recognizing depressive symptoms, managing de- Rate of Correct Responses on the Geriatric
pressive symptoms, and providing dementia care. Care Competency Test (GCCT; N = 170)
In total, only 17.6% of the participants assessed all of the
Item n %
items on the GCCT correctly. The four items with the lowest
correct rates were caregiver burden and insomnia (62.4%) Score of 100% (perfect score) on the GCCT 30 17.6
and urinary incontinence and malnutrition (62.9%). The GCCT ADL impairment 141 82.9
results are summarized in Table 3. Gait and balance disorder 136 80.0
Delirium 132 77.6
Relationship Between Nurse
Depressive symptoms 127 74.7
Characteristics and Geriatric Care
Cognitive impairment 111 65.3
Competencies
Pain 111 65.3
As shown in Table 4, the SCG score was shown to be signif-
Sensory deficit 110 64.7
icantly associated with job satisfaction (r = .300, p < .001),
perception of importance of work (r = .181, p = .019), com- Polypharmacy 108 63.5
fort in the work environment (r = .260, p = .001), family sup- Malnutrition 107 62.9
port (r = .190, p = .015), and having received continuing Urinary incontinence 107 62.9
education on geriatric care (t = 1.949, p = .048). Moreover, Insomnia 106 62.4
multiple regression analysis showed that nurses with in-
Caregiver burden 106 62.4
creased job satisfaction (adjusted β = 3.35, 95% CI [0.28,
6.43]) who had received continuing education on geriatric Note. ADL = activities of daily living.

5
The Journal of Nursing Research Fang-Wen HU et al.

Table 4
Relationship Between Participant Characteristics and Self-Evaluation of Competencies to Provide
Geriatric Care (N = 170)
Variable Mean SD F/t/r p
Age (years) a
– – −.140 .076
Highest level of education b
– – 0.856 .393
Diploma 73.00 1.41 – –
Bachelor's degree or above 67.61 8.87 – –
Years of experience as a registered nurse c 0.775 .509
<5 68.37 8.67 – –
5–10 65.58 11.43 – –
11–20 65.91 9.06 – –
> 20 66.85 6.38 – –
Work unit c – – 2.589 .078
Medical ward 69.05 7.77 – –
Surgical ward 65.37 7.88 – –
General ward 67.82 11.33 – –
Job satisfaction a – – .300 < .001
Nurses' perception of importance of work a – – .181 .019
Nurses' perception of comfort in the work environment a
– – .260 .001
Family support a – – .190 .015
Received geriatric curriculum in school b
– – 1.942 .054
Yes 68.88 8.27 – –
No 66.21 9.39 – –
Received continuing education in geriatric care b – – 1.949 .048
Yes 69.43 7.73 – –
No 66.65 9.37 – –
Knowledge of geriatric care score a – – .050 .520
Attitude of geriatric care score a – – .110 .160
a
Pearson's correlation analysis. b Independent samples t test. c One-way analysis of variance.

thus adjusted their responses accordingly. The findings em-
phasize that nurses may overrate their perception of their ge-
riatric care competencies and thus require awareness of these
discrepancies to enhance their competencies accordingly.
As no prior study has similarly applied an objective instru-
ment of geriatric care competencies, no comparisons of the
results may be made with previous studies. However, on
the basis of the correct-answer rate of the GCCT, the partic-
ipants scored particularly low for assessing caregiver burden
and for distinguishing symptom differences among various
types of insomnia. Wolf et al. (2019) reported that, whereas
50%–70% of older patients are screened routinely for cogni-
tive impairment, depression, fall risk, malnutrition risk, and
compromised ADL, far fewer (16.8%) are screened routinely
for caregiver stress. De Almeida Tavares et al. (2015) also
found that the knowledge scores and attitudes of nurses to-
ward the management of sleep disorders were negative. An
important barrier in assessing caregiver burden and insom-
nia is the level of related knowledge held by the nurse. The
results presented here were not completely unexpected be-
cause of the lack of related continuing education and available
specialization in geriatric care. Another barrier noted by the
participants in this study was that lack of access to resources
impedes providing related care for caregiver burden and in-
somnia, which are critical to providing appropriate care to
older patients. Multicomponent interventions are suggested,
including supplementing education with consultation (a clini-
cal nurse specialist or an interdisciplinary team) and making
more resources and support available from leadership to intro-
duce interdisciplinary collaborators such as social workers or
a sleep team.
This study found that increased job satisfaction and hav-
ing received continuing education on geriatric care were sig-
nificantly associated with earning a higher score on the SCG.
These findings agree with the results of previous studies
(Dahlke et al., 2019; Tzeng, 2004). Geriatric care education
in the clinical setting is necessary and widely practiced. How-
ever, Dahlke et al. (2019) examined nurses' learning needs
related to working with hospitalized older patients and
found that nurses reported gaps in their clinical practice de-
spite scoring moderately high on knowledge of geriatric care.
It seems that having a moderately strong knowledge base

6
Geriatric Care Competencies
from continuing education is not sufficient for nurses to pro-
vide high-quality care. Therefore, a systematic approach to
improving nurses' geriatric care competencies is necessary
to meet the demands of Taiwan's growing population of
older adults. Currently, Taiwan has no certified geriatric
nurses. Thus, appropriate policies are needed to improve
the geriatric care competencies of nurses in hospitals, imple-
ment effective educational methods and structures, and real-
ize an evidence-based, geriatric clinical practice. With the
exception of nurse age, this study did not find any significant
association between participant demographic characteristics
and GCCT scores. Nurse age does not explain the nurses' ob-
jective test of geriatric care competencies. Further research is
warranted to explore the factors associated with the GCCT.
This study was affected by several limitations. First, the
research was conducted at one hospital only, which prevents
generalizing the results to the larger population of hospital
nurses. Second, the GCCT compared the dichotomous prob-
lem checklist between the research nurses and the participant
nurses, which may have affected the accuracy of problem
identification. The authors attempted to address this limita-
tion by consulting the geriatrician or geriatric clinical nurse
specialist to confirm the health problems of each older pa-
tient addressed in this study.
Conclusions
The number of older patients treated in hospitals is expected
to increase dramatically in the future. Nurses who work in
hospital settings should have solid geriatric care competen-
cies to improve their practice and to impact positively on
the healthcare outcomes of their older patients. The subjec-
tive and objective evaluations of the geriatric care competen-
cies of nurses in hospitals is an issue that has been rarely
addressed in previous studies. The findings of this study pro-
vide evidence that nurses are insufficiently aware of their lim-
itations in terms of knowing how to provide appropriate
care to older patients. These findings suggest that policies
to improve the geriatric care competencies of nurses in hospi-
tals and to oversee the implementation of effective educa-
tional methods are needed in Taiwan. Furthermore, more
research is needed to evaluate geriatric care competencies
using patient outcomes (e.g., incidence of mortality, func-
tional decline, hospitalization hazards).
Acknowledgments
This study was supported by National Cheng Kung Univer-
sity Hospital (NCKUH-10501004). The funding source had
no involvement in the research process.
Author Contributions
Study conception and design: FWH, FAL
Data collection: FWH, FAL
Data analysis and interpretation: FWH, YPL
Drafting of the article: FWH
Critical revision of the article: FAL, YPL
VOL. 29, NO. 4, AUGUST 2021
Accepted for publication: November 11, 2020
*Address correspondence to: Fang-Wen HU, PhD, RN, No. 138, Shengli
Rd., North District, Tainan City 70403, Taiwan, ROC. Tel: +886-6-235-3535
ext. 3709; E-mail: kokojhlin@gmail.com
The authors declare no conflicts of interest.
Cite this article as:
Hu, F.-W., Lee, H.-F., & Li, Y.-P. (2021). Exploration of geriatric care
competencies in RNs hospitals. The Journal of Nursing Research,
29(4), Article e159. https://doi.org/10.1097/jnr.0000000000000441
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