Etiology of dependence in older nursing home residents during morning care: the role of staff behavior.
Previous findings indicate that elderly nursing home residents' dependent and independent behavior are modifiable and thus partly a function of reinforcing environmental events. The present study was an attempt to explicate such functional relationships in terms of naturally occurring resident--staff interactions. An observational-operant design was implemented with a sample of 17 staff members and 36 elderly nursing home residents. Sequential observations of resident--staff interactions were recorded daily during morning care over a 23-day period. Frequency analysis of each behavior recorded revealed that of the 1,428 observed behaviors in the presence of staff, resident behaviors constituted 563 and staff behavior 865 of the total. Residents performed independent behaviors most frequently, whereas dependence-supportive behavior was the most frequent staff behavior. As to resident--staff interactions, sequential analyses showed that independent behavior by the elderly was followed more often by dependence-supportive than by independence-supportive behavior by the staff. Staff dependence-supportive behavior was the most frequent consequence for dependent behavior by the elderly. The sequential data, with regard to resident--staff interactions in morning-care situations, allow the inference that independent behavior in self-maintenance care is not maintained by staff behavior but perhaps by intrinsic reinforcers or reinforcing agents other than staff, whereas dependent behavior is directly maintained by staff reinforcement.
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged / Q000523:psychology*; D001291:Attitude of Health Personnel; D003858:Dependency, Psychological; D006801:Humans; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009735:Nursing Homes; D010551:Personality; D012054:Reinforcement, Psychology