Changing nurse aide behavior to decrease learned helplessness in nursing home elders;
A multiple-case study design with a two-group preobservation/postobservation approach was used to assess the feasibility of changing nurse aide behavior in a nursing home environment and the extent of change following an educational intervention. Subjects included 23 nurse aides, 11 experimental subjects, and 12 comparison subjects; each was assigned to groups by floor divisions. The intervention consisted of two 1 ½ -hour sessions of content on interactions intended to decrease learned helplessness in nursing home elders. Two complete feeding interactions were observed between nurse aides and residents before and after the intervention. Empathic interactions were measured by the Empathic Interaction Skills Schedule; independent-supportive, dependent-supportive, and no-response interactions were measured by the Behavioral Reinforcement Coding Schedule. A 7-point written test, given before and after the intervention, supplemented observational measures. Nurse aides in the experimental group demonstrated a positive change on all variables, except independent-supportive interactions, which showed no change. Experimental subjects were significantly more empathic (p =.025) and less supportive of residents' unnecessary dependence (p =.003) than were comparison subjects. Effects of attention were not controlled, possibly contributing to positive findings. Limited time, communication, administrative support, and involvement in resident care decisions; resident regression due to nurse aides who did not promote independence: fear of nutritional and hydrational deficits; and inflexible routines were perceived as barriers to change, given daily clinical realities of nurse aides. Study findings indicate that behavior change to decrease learned helplessness in nursing home elders is possible, at least in an empathic environment, which represented the context of this nursing home. Further research, with a focus on various resident care activities, is needed. Larger, randomized samples that control for the effects of attention are recommended in order to generalize findings. Programs promoting behavior change should be implemented on an organizational level to obtain explicit administrative support and teamwork within the institution. In addition, nurse aides suggested that content be introduced early in their careers to avoid dependent-supportive habits that are learned over time.