Independence and Dependence in Self-Care Behaviors in Nursing Home Residents: An Operant-Observational Study

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Abstract
In the present research project, an attempt is made to delineate the relationship between dependent/independent behaviors of nursing home residents and the consequent behaviors of the staff. In this context, dependence in residents is limited to self-care behaviors during morning care in the nursing home. Subjects were six staff members of one ward in a nursing home and the 48 patients they cared for. Observations of behavior sequences were recorded with the BOSS system by four observers over 11 days for one hour each morning. Interrater reliability, established during eight sessions, ranged from 0.89 to 1.00 (X= 0.946). In terms of frequencies of behaviors, elderly residents exhibited significantly more independent behaviors than dependent behaviors. Staff engaged significantly more often in 'no response', followed by dependence-supporting behavior, and lastly by independencesupporting behavior. In terms of interactive sequences, an independent response by a resident was most often followed by 'no response' from staff. In contrast, staff members almost invariably responded to the dependent behavior of the residents with dependencesupporting behavior. These temporal contingencies when interpreted within an operant paradigm should have consequences for the maintenance of dependent and independent behavior in elderly residents.