Effect of therapeutic milieu on self-care behaviors of nursing home residents

Blair, Charles E. (1985) Effect of therapeutic milieu on self-care behaviors of nursing home residents. Masters thesis, Memorial University of Newfoundland.

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Abstract

Evidence points to dependency in clients in health care institutions such as nursing homes and psychiatric hospitals. This study investigated the effects of three nursing care approaches [(a) combination of mutual goal setting, prompting, and reinforcement (b) mutual goal setting only (c) normal routine care] on selected morning self-care behaviors of nursing home residents. Subjects were four male and 11 female residents who depended on staff for 100% assistance with self-care tasks. Mean age and length of institutionalization for males were 79.2 years and 10.5 months respectively; for females 84.3 years and 16.5 months respectively. An experimental double blind design was used. Also, each subject served as his/her own control. Subjects and nurses were divided into three groups each. Nurses were assigned to subjects in a corresponding group. The study was divided into a 6 week attainment of skills period and a 16 week follow-up period. The dependent variables in the study were subjects' independent performance of selected self-care tasks and nurses' and subjects' satisfaction with care given and received respectively. Results showed that subjects in the mutual goal setting, prompting, and reinforcement group scored significantly higher on goal attainment and satisfaction, as measured by Goal Attainment Scaling and Patient Satisfaction Questionnaire respectively, than subjects in the other two groups. Nurses in the mutual goal setting, prompting, reinforcement group scored significantly higher on satisfaction, as measured by Nurse Satisfaction Questionnaire, than those in the other two groups. The .05 level of significance was used in interpreting all statistical tests. The overall conclusion of the study was that the combination of mutual goal setting, prompting, and reinforcement was significantly more effective in motivating subjects towards self-care with resultant increase in satisfaction. Details of the study are reported. Interpretation of the findings and implications of the research, for nursing practice with nursing home residents and psychiatric patients, and for clinical nursing research in general, are discussed. Suggestions for future pertinent research are made.

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