Article Text
PDF
Abstract
Introduction In the context of global population ageing, there is a continuous and significant increase in the average age of nursing professionals. However, evidence indicates that age bias may hinder older workers’ access to the necessary support to remain active in the workforce.
Method and analysis This scoping review aims to map and characterise the scientific literature on age bias directed at older nursing professionals in the workplace, conducted using the Joanna Briggs Institute methodology for scoping reviews and aligned with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Databases include MEDLINE (PubMed), CINAHL (EBSCOhost), LILACS, Scopus, APA PsycInfo and grey literature in Google Scholar. Two independent reviewers will screen titles and abstracts, followed by a full-text review of potentially relevant articles. Another reviewer will reconcile discrepancies. Two independent reviewers will extract data from the included articles using a data extraction tool developed for this review. The results will be tabulated and presented in a diagram and/or tables and summarised to explicitly address the review’s objective.
Ethics and dissemination Findings will be disseminated through professional networks, conference presentations and publication in a scientific journal.
Registration details https://doi-org.ezproxy.u-pec.fr/10.17605/OSF.IO/TR5ZK.
- Aging
- Health Workforce
- Nurses
- Review
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
STRENGTHS AND LIMITATIONS OF THIS STUDY
The search strategy includes studies without restrictions on study design, year of publication or language. This will ensure access to a wide range of literature relevant to the review questions and that the results can be widely applied to policies and practices.
The search strategy includes a Latin American database, as the research is being developed in a Brazilian graduate programme.
Due to the nature of scoping reviews, a critical assessment of the literature will not be included in our analysis and discussion.
Introduction
Global population ageing brings with it numerous challenges, including the increasing participation of older workers in the labour market. Notably, the population of nursing workers has been identified as a category that has seen a constant and significant increase in the average age in recent decades.1
The average age of registered nurses in the USA increased from 37.4 years in 1983 to 41.9 years in 1996, 44.5 years in 2000 and 47.9 years in 2022.2 A similar trend can be observed in the nursing workforce in New Zealand, Australia, Canada and the UK.3–6
The definition of an ‘older nurse’ is diverse and not clearly established in the literature, varying according to cultural and national context. The WHO considers an older worker to be one who is 45 years or older based on functional capacity. However, some studies define older nurses as those aged 50 or over,5 or 60 years.7
Despite early retirement being a common practice in the nursing profession, older nurses remain working beyond retirement age not only due to factors such as well-being, job satisfaction and opportunities for professional development but also due to financial instability and changes in retirement policies that alter the mandatory retirement age.8 9 However, evidence indicates that age bias can hinder older workers’ access to the necessary support to remain active in the labour market.9
The term ‘ageism’ was first identified in a text published by gerontologist Robert Butler (1969), who defined it as a form of intolerance related to age.10 Currently, the expanded concept defines ageism as stereotypes, prejudice and discrimination directed against others or oneself based on age […] it has three dimensions—stereotypes (thoughts), prejudice (feelings) and discrimination (actions or behaviours); three levels of manifestation—institutional, interpersonal and self-directed and two forms of expression—explicit (conscious) and implicit (unconscious).11
At the institutional level, ageism refers to laws, rules, social norms, policies and practices that unfairly restrict opportunities and systematically harm individuals based on age.12 13 It is also linked to the ideologies that institutions promote to justify this prejudice, such as discriminatory hiring practices or the imposition of mandatory retirement ages.14
Combating ageism is part of the action plan, as a priority issue, for ‘The Decade of Healthy Ageing 2021–2030’,15 which is part of the ‘Global Strategy and Action Plan on Ageing and Health: 2016–2030’ of the WHO. Furthermore, addressing this issue remains essential at the heart of the 2030 Agenda for Sustainable Development, which has among its objectives, based on equality, dignity, respect and protection, decent work and the guarantee of broad participation of all in society.16
Considering the aforementioned, the present study may serve as a basis for future research on institutional ageism directed at nursing professionals, identify tools used to measure the phenomenon and support prevention policies and interventions to mitigate ageism in health services.
For this purpose, a preliminary search of review protocols was conducted in May 2024 in Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Database of Systematic Reviews, Prospero and the Joanna Briggs Institute (JBI) Evidence Synthesis, and two ongoing reviews on the topic were identified. The first focuses on establishing the impact of age prejudice on the health and well-being of older nurses,17 and the second centres on the perceptions and experiences of late-career nurses regarding age discrimination, stereotypes or prejudice from colleagues in the workplace.18 Therefore, the present study is justified, aiming to map and characterise scientific productions on age prejudice directed at nursing professionals in the workplace.
Methods
The proposed scoping review will be conducted according to the Joanna Briggs Institute methodology for scoping reviews19 and aligned with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).20
The research question was developed as a broad framing of the population, the concept and the context to be explored (table 1). Thus, this scoping review asks:
How is age prejudice portrayed in the workplace environment of older nursing professionals?
Population, Concept and Context (PCC) criteria used in the scoping review
The following subquestions will be examined:
What instruments have been used to measure age prejudice in the workplace?
What strategies or interventions have been proposed to mitigate age prejudice against older nurses in the workplace?
Type of sources
This scoping review will consider primary and secondary studies that address age prejudice directed at nursing professionals in the workplace, without restrictions regarding study design, year of publication or language. From the grey literature, theses and dissertations will be included, while abstracts of scientific events, undergraduate theses and opinion articles will be excluded.
Search strategy
As recommended by JBI, a three-step search strategy will be used. The first stage included an initial basic search conducted in May 2024 using a combination of keywords and medical subject headings in MEDLINE/PubMed (table 2). An analysis of the titles and abstracts of each article will be performed to identify common keywords and indexing terms. After this analysis, a second search using all keywords, indexing terms, synonyms and concepts related to the review’s objectives and questions will be conducted in the following databases: MEDLINE (PubMed), Scopus, CINAHL (EBSCOhost), APA PsycInfo and LILACS. Grey literature will be searched on Google Scholar. The complete database search strategy is available in the online supplemental file.
Supplemental material
Search strategy (MEDLINE/PubMed)
As the review question is broad, to achieve greater search sensitivity, the same search strategy, when possible, will be conducted in search engines. If additional keywords and potentially useful search terms are discovered during the initial searches, they will be incorporated. Finally, to ensure that all studies have been identified, the reference list of the studies included in the review will be examined for other relevant studies.
Study selection
The screening of titles and abstracts and the reading of full texts will be conducted by two independent reviewers using the Rayyan platform, with duplicates removed by the software. The reasons for the exclusion of full-text studies that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the study selection process will be resolved by a third reviewer. The results of the selection will be presented in a PRISMA-ScR flowchart.
Data extraction
Data will be extracted from the articles included in the scoping review by two independent reviewers using a data extraction tool developed by the reviewers (table 3). The tool will be pilot-tested using a representative sample of the studies to be reviewed. The extracted data will include specific details about the title, authors, year of publication, type of evidence, participants, context and concepts (ie, factors related to prejudice, tools used to measure prejudice and interventions used to reduce prejudice). The draft data extraction tool will be modified and revised as necessary during the data extraction process of each included article. The modifications will be detailed in the full scoping review. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Two attempts will be made to contact the authors to request missing or additional data, when necessary.
Data extraction and charting for empirical and grey literature sources
Analysis and presentation of data
The extracted data will be presented in tables and diagrams that align with the objectives of this scoping review. The data will inform the characteristics of age prejudice directed at older nursing professionals in the workplace, instruments used to measure it, as well as strategies or interventions proposed for prevention and addressing the phenomenon. A descriptive and narrative analysis will accompany the tabulated and mapped results, describing how the findings relate to the review’s objective and question.
Ethics and dissemination
This study involves neither human participants nor unpublished secondary data. As such, approval from a human research ethics committee is not required. Findings of the scoping review will be disseminated through professional networks, conference presentations and publication in a scientific journal.
Ethics statements
Patient consent for publication
Footnotes
Correction notice This article has been corrected since it was published. Affiliation of one of the authors has been corrected.
Contributors LCP (review guarantor) led the design and conceptualisation of this review and drafted the protocol with primary support from ACSS and CSF. ECdCVGdC and MGdAF contributed to refining the search strategy, including keywords. REdLF-R and CHG were involved in establishing eligibility criteria and developing data extraction forms. All authors provided feedback on the manuscript and approved the publication of this protocol manuscript.
Funding This research was funded in part by the Coordination for the Improvement of Higher Education Personnel – Brazil (CAPES) - Funding Code 001.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.