Aging Clinical and Experimental Research

, Volume 30, Issue 2, pp 183–191 | Cite as

Comparison of nurses and general caregivers’ knowledge, attitude, and practice on medication administration process and their distress level in long-term care facilities across Penang, Kuala Lumpur, and Selangor of Malaysia

  • Balamurugan Tangiisuran
  • Sok Cin Tye
  • May Yen Leow
  • Rahmat Awang
Original Article



Comparing nurses and general caregivers’ knowledge, attitude, and practices (KAP) on medication administration process in long-term care (LTC) setting and an assessment of their stress, anxiety, and depression (SAD) level.


A cross-sectional survey was conducted among nurses and general caregivers working in LTC using a validated questionnaire. Consisting of demographic characteristics (Section 1); 40 questions on KAP (Section 2); and assessment of Depression, Anxiety, and Stress Scale (DASS-21) (Section 3).


155 formally paid staffs in 26 LTC facilities were recruited. Nurses scored significantly higher in the knowledge section compared to caregivers (12.4 ± 1.7 vs. 4.5 ± 3.8; P < 0.001); better attitude (41.5 ± 4.8 vs. 30.8 ± 7.3; P < 0.001); and better practice (65.2 ± 8.5 vs. 40.3 ± 10.9; P < 0.001), respectively. SAD scores reveal that caregivers had significantly higher level of stress, anxiety, and depression compared to the nurses.


General caregivers exhibit poorer knowledge on aspects pertaining to posology, appropriate methods of drug administration, and side effects of common drugs used by the elderly. Compared to nurses, the general caregivers also reported poorer medication administration practices; including not checking labels and expiry dates prior to administration, and not providing basic information about medication therapy to the residents. However, both nurses and general caregivers reported positive attitudes in their role as caregivers. They take pride and satisfaction in their occupation providing support to the elderly.


General caregivers demonstrated lesser knowledge, poorer attitude, and practices towards medication administration processes, in addition to higher SAD score in LTC facilities.


Caregivers Knowledge Attitude Medication administration Nursing homes 



We would like to thank all individuals involved in this study and C Lucie from the National Poison Centre for her assistance in editing this manuscript.

Compliance with ethical standards

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


This research is not supported by any fund.

Impact statement

This study has shown that general caregivers have poorer knowledge, attitude, and practice on the medication administration process and more stressed compared to nurses. The findings highlight the necessity for caregivers to be trained adequately to provide optimum care for the elderly.


  1. 1.
    Polivka L, Zayac H (2008) The aging network and managed long-term care. Gerontologist 48:564–572CrossRefPubMedGoogle Scholar
  2. 2.
    Home | Nursing Homes and Assisted Living (Long-term Care Facilities | CDC.
  3. 3.
    Khairani AN (2016) Finance: addressing Malaysia’s long-term care needs. The Edge. Accessed 10 Nov 2016
  4. 4.
    Harrington C, Kovner C, Mezey M, Kayser-Jones J, Burger S, Mohler M et al (2000) Experts recommend minimum nurse staffing standards for nursing facilities in the United States. Gerontologist 40:5–16CrossRefPubMedGoogle Scholar
  5. 5.
    Department of Health and Human Services, USA (2015) Nursing Home Data Compendium 2015 Edition. Centers for Medicare and Medicaid Services.  Accessed 10 Nov 2016
  6. 6.
    Patterson SM, Hughes C, Kerse N et al (2012) Interventions to improve the appropriate use of polypharmacy for older people. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester: Wiley. doi: 10.1002/14651858.CD008165.pub2 Google Scholar
  7. 7.
    Szczepura A, Wild D, Nelson S (2011) Medication administration errors for older people in long-term residential care. BMC Geriatr 11:82CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Aqqad SMA, Chen LL, Shafie AA et al (2014) The use of potentially inappropriate medications and changes in quality of life among older nursing home residents. Clin Interv Aging 9:201–207PubMedPubMedCentralGoogle Scholar
  9. 9.
    Tjia J, Mazor KM, Field T, Meterko V, Spenard A, Gurwitz JH (2009) Nurse–physician communication in the long-term care setting: perceived barriers and impact on patient safety. J Patient Saf 5:145–152CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Nursing Homes & Aged Care (2016)  Dondangsayangcom. Available at: Accessed 16 June 2016
  11. 11.
    The Kap Survey model - Knowledge attitude and practices (2012) Medecinsdumondeorg. Available at: Accessed 16 June 2016
  12. 12.
    Henry JD, Crawford JR (2005) The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol Br Psychol Soc 44:227–239CrossRefGoogle Scholar
  13. 13.
    Medicines Act 1968 (2016) Legislationdatagovuk. Available at: Accessed 16 June 2016
  14. 14.
    Wright D (2002) Medication administration in nursing homes. Nurs Stand 16:33–38CrossRefPubMedGoogle Scholar
  15. 15.
    MSD Manual Professional Edition. (2016). Drug Bioavailability - Clinical Pharmacology - MSD Manual Professional Edition. [online] Available at: Accessed 20 June 2016
  16. 16.
    Lau DT, Masin-Peters J, Berdes C, Ong M (2010) Perceived barriers that impede provider relations and medication delivery: hospice providers’ experiences in nursing homes and private homes. J Palliat Med 13:305–310CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rathnayake S, Athukorala Y, Siop S (2016) Attitudes toward and willingness to work with older people among undergraduate nursing students in a public university in Sri Lanka: a cross sectional study. Nurse Educ Today 36:439–444CrossRefPubMedGoogle Scholar
  18. 18.
    Higgins I, Van Der Riet P, Slater L, Peek C (2007) The negative attitudes of nurses towards older patients in the acute hospital setting: a qualitative descriptive study. Contemp Nurse 26:225–237CrossRefPubMedGoogle Scholar
  19. 19.
    Liu Y, Norman I, While A (2013) Nurses’ attitudes towards older people: a systematic review. Int J Nurs Stud 50:1271–1282CrossRefPubMedGoogle Scholar
  20. 20.
    Flotta D, Rizza P, Bianco A, Pileggi C, Pavia M (2012) Patient safety and medical errors: knowledge, attitudes and behavior among Italian hospital physicians. Int J Qual Health Care 24:258–265CrossRefPubMedGoogle Scholar
  21. 21.
    Pierson S, Hansen R, Greene S et al (2007) Preventing medication errors in long-term care: results and evaluation of a large scale web-based error reporting system. Qual Saf Health Care 16:297–302CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cocco E, Gatti M, de Mendonça Lima CA, Camus V (2003) A comparative study of stress and burnout among staff caregivers in nursing homes and acute geriatric wards. Int J Geriatr Psychiatry 18:78–85CrossRefPubMedGoogle Scholar
  23. 23.
    Perlick DA, Berk L, Kaczynski R, Gonzalez J, Link B, Dixon L et al (2016) Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder. Bipolar Disord 18:183–191CrossRefPubMedGoogle Scholar
  24. 24.
    Ho SC, Chan A, Woo J, Chong P, Sham A (2009) Impact of caregiving on health and quality of life: a comparative population-based study of caregivers for elderly persons and noncaregivers. J Gerontol A Biol Sci Med Sci 64:873–879CrossRefPubMedGoogle Scholar
  25. 25.
    Gallant MP, Connell CM (1997) Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses. J Aging Health 9:373–395CrossRefPubMedGoogle Scholar
  26. 26.
    McCullagh E, Brigstocke G, Donaldson N, Kalra L (2005) Determinants of caregiving burden and quality of life in caregivers of stroke patients. Stroke J Cereb Circ 36:2181–2186CrossRefGoogle Scholar
  27. 27.
    Han K, Trinkoff AM, Storr CL, Lerner N, Johantgen M, Gartrell K (2014 Aug) Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: cross-sectional secondary data analysis. Int J Nurs Stud 51:1135–1141CrossRefPubMedGoogle Scholar
  28. 28.
    Wallin AO, Jakobsson U, Edberg A-K (2012) Job satisfaction and associated variables among nurse assistants working in residential care. Int Psychogeriatr IPA 24:1904–1918CrossRefGoogle Scholar
  29. 29.
    Schwendimann R, Dhaini S, Ausserhofer D et al (2016) Factors associated with high job satisfaction among care workers in Swiss nursing homes – a cross sectional survey study. BMC Nurs 15. doi: 10.1186/s12912-016-0160-8
  30. 30.
    Saeed SA, Antonacci DJ, Bloch RM (2010) Exercise, yoga, and meditation for depressive and anxiety disorders. Am Fam Physician 81:987Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Discipline of Clinical Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaPenangMalaysia
  2. 2.WHO Collaborating Centre for Drug Information, National Poison CentreUniversiti Sains MalaysiaPenangMalaysia

Personalised recommendations