Autonomy for nursing home residents: the role of regulations

The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.     

A meta-analytic review of gender variations in children's language use: talkativeness, affiliative speech, and assertive speech

Three sets of meta-analyses examined gender effects on children's language use. Each set of analyses considered an aspect of speech that is considered to be gender typed: talkativeness, affiliative speech, and assertive speech. Statistically significant average effect sizes were obtained with all three language constructs. On average, girls were slightly more talkative and used more affiliative speech than did boys, whereas boys used more assertive speech than did girls. However, the average effect sizes were either negligible (talkativeness, d=0.11; assertive speech, d=0.11) or small (affiliative speech, d=0.26). Larger effect sizes were indicated for some language constructs depending on either the operational definition of the language measure, the method of recording, the child's age level, the interaction partner (adult or peer), group size, gender composition, observational setting, or type of activity. The results are interpreted in relation to social-developmental and social-constructionist approaches to gender; these views are presented as complementary--rather than competing--meta-theoretical viewpoints.     

A meta-analytic review of gender variations in adults' language use: talkativeness, affiliative speech, and assertive speech.

Three separate sets of meta-analyses were conducted of studies testing for gender differences in adults' talkativeness, affiliative speech, and assertive speech. Across independent samples, statistically significant but negligible average effects sizes were obtained with all three language constructs: Contrary to the prediction, men were more talkative (d = -.14) than were women. As expected, men used more assertive speech (d = .09), whereas women used more affiliative speech (d = .12). In addition, 17 moderator variables were tested that included aspects of the interactive context (e.g., familiarity, gender composition, activity), measurement qualities (e.g., operational definition, observation length), and publication characteristics (e.g., author gender, publication source). Depending on particular moderators, more meaningful effect sizes (d > .2) occurred for each language construct. In addition, the direction of some gender differences was significantly reversed under particular conditions. The results are interpreted in relation to social-constructionist, socialization, and biological interpretations of gender-related variations in social behavior.     

Development of assertive responses: Clinical, measurement and research considerations

The development of assertive responses in unassertive individuals is surveyed in terms of clinical application, measurement techniques and experimental study. Case reports indicate that assertive training is an effective technique for a large variety of disorders as it enables patients to overcome deficits in inter-personal functioning. Some of the effective elements in assertive training have been identified by using analogue research designs. In most of these investigations the major focus has been on expressing hostile feelings and thoughts. However, more efforts at instigating positive responses (clinically and experimentally) are warranted. In addition, there is a need to assess the effects on ‘clinically’ unassertive subjects of techniques in which the transfer of training is programmed rather than expected.     

Effects of a forced institutional relocation on the mortality and morbidity of nursing home residents

Residents of a county nursing home underwent a forced, mass relocation. Gerontologists advised on preparation of staff and residents. No increase in residents' mortality or morbidity was found after the relocation. The highest death rate was in the anticipatory period, the year prior to the move.     

The effect of home or novel environment on the facilitation of passive avoidance by post-training ethanol

Passive avoidance behavior of mice is improved when mice are injected with ethanol immediately after footshock training. Further study has shown that avoidance can be affected by ethanol injections given within 1 h, but not at 90 or 180 min, after training. The present study was conducted to investigate the possibility that events which occur in the homecage during this sensitive period may influence the effect of ethanol on subsequent avoidance. Male Swiss-Webster mice were housed either singly in a novel environment for 90 min or returned to their (group) homecage following one-trial, step-through, passive avoidance training (0.1 mA footshock) and intraperitoneal injection of 3.0 g/kg ethanol (15% v/v) or saline. As in previous studies, when ethanol-treated mice were returned to their homecage, avoidance was significantly increased at 24 h compared to the behavior of saline-treated mice. However, when mice were isolated in the novel environment for 90 min immediately following treatment, the memory facilitating effects of ethanol were not observed. The avoidance behavior of mice injected with saline was the same regardless of their post-training environment. Also, the number of mice (6 or 10) housed per homecage did not significantly influence the effects of ethanol or post-training environment on avoidance. These findings indicate that environmental factors may interact with the effects of ethanol to modify avoidance behavior. The possible influence of variables such as aggression, thermoregulation, and behavioral arousal on the effects of ethanol in this paradigm are discussed.     

Longitudinal reliability of the Life Satisfaction Index (Short Form) with nursing home residents: a cautionary note.

We administered the Life Satisfaction Index (Short Form) 18 times over a 39-wk. period to an initial sample of 76 old, frail, multiply impaired, and depressed nursing home residents participating in a longitudinal quasi-experimental study of the effects of cognitive group interventions on cognition and depression. As no changes over time were observed on the outcome variable of life satisfaction, the stability of the instrument's internal consistency could be examined. Kuder-Richardson KR-20 coefficients ranged from .11 to .60, with a mean of .42 (SD = .11). We conclude that caution should be used when applying this instrument to measure life satisfaction in frail nursing home residents.     

Aspects of a dilemma of middle age: whether or not to place aged, failing parents in a nursing home

A middle-aged person's involvement in making a decision about whether or not to institutionalize an aged parent whose physical and/or mental capacities have failed inevitably arouses intense feelings, memories, fantasies, and conflicts. Fantasies that equate putting the parent in a nursing home with abandonment and murder, as well as the narcissistic threat posed by seeing one's own future in a parent's deterioration, are common. The conflicts aroused may upset long-standing psychological balances. This paper explores ego, superego, id, and reality issues that are aroused as they were seen in the psychoanalysis and psychotherapy of several patients involved in making this decision. The importance of looking for the unique aspects of the conflicts set off in each individual facing this dilemma is stressed, as is the potential for countertransference responses.     

Living with support in a home in the community: predictors of behavioral development and household and community activity

The purpose of this article was to review studies of behavioral development and household and community activity among adults with mental retardation living in community residential services and to distill knowledge about the factors that influence outcome. Research points to behavioral development occurring across the full spectrum of disability but influenced by mental retardation syndrome and the acquisition of pivotal skills. However, engagement in household and community activities has been found to be strongly related to individual adaptive behavior. People with more severe mental retardation are vulnerable to leading lives characterized by underoccupation and lack of community involvement. Moving from institutional to community-based residential services may be accompanied by significant increases in adaptive behavior, but a plateau effect on subsequent development has also been reported. There is substantial evidence to suggest that key aspects of effective teaching technology may be absent in community-based residential environments. Community settings support greater engagement in household and community activities than institutions. Ordinary housing stock and normative architecture and standards of material enrichment are to be preferred. The use of normative housing constrains group living to relatively small scale, but there is little evidence that smaller size within this range is to be preferred to larger size. There is little evidence to suggest that higher staff-to-resident ratios lead to uniformly better outcomes, but staff orientation, working methods, and performance are important influences. Little is known about what precise characteristics of community location give rise to greater community integration. MRDD Research Reviews 7:75-83, 2001.     

Japanese social workers' healthy behaviours as related to masculinity: Focus on mental health workers and caregivers of children and nursing home residents

Due to the rapid ageing of the Japanese population, the demand for social services is increasing. However, these professions are not generally recognized yet. According to the report by Kawata (1984, 1986), social workers were distressed by low pay and low recognition for the profession, an inflexible, hierarchical administration system, and staff shortages. However, few studies have focused on social workers' healthy behaviours. The present study focused on the healthy behaviours of Japanese social workers and examined the relationship of these habits to masculinity and femininity, in addition to gender differences. To identify the healthy behaviours of social workers, we compared the behaviours of 32 mental health workers and 63 caregivers to those of 91 members of the general public who attended a summer course. Four questionnaires were administered: health locus of control (Watanabe, 1985), healthy behaviours (Munakata, 1996), health state, and Masculinity‐Humanity‐Femininity scale (Ito, 1978). The results revealed that females scored higher in masculinity than males, and females tended to assess their health state as poorer and were more active in preventive health than males. Social workers practice preventive healthy behaviours more than the general public. Between the two types of social workers, mental health workers tend to rely on medical services and believe that health and sickness are matters of luck, whereas caregivers tend to believe they can control their health by themselves. In the health locus of control, external control was more closely associated with poor health than internal control, and it was negatively correlated with masculinity. As masculinity is related to healthy behaviours, it may be an important factor influencing them. Both masculinity and femininity could be desirable, not for only better caregiving but also for the social workers' own health.     

Order in the home: Family routines moderate the impact of financial hardship

The study examined whether frequency of adolescent reported family routines moderated the relation between caregivers' perceptions of financial resources and adolescents' behavioral and academic outcomes among a sample of inner-city African American families. The sample consisted of 115 adolescents (average age = 15.95) and their female caregivers participating in a large scale study on African American family life. The results revealed a significant main effect of financial resources and family routine on adolescent outcomes, such that an increase in both was related to less delinquency and more favorable academic outcomes. Family routines moderated the relation between financial resources and adolescent outcomes. Specifically, the study revealed that the link between lack of financial resources and negative adolescent outcomes was diminished for youth in high-routine homes. Alternatively, family routines did not have a significant impact on youth from high-resource homes. Results highlight the importance of organization and predictability for economically disadvantaged youth and families.     

Audit responses: responses maintained by access to existing self or coactor scores during non-social, parallel work, and cooperation procedures

Human subjects, mostly between 11 and 16 yr old, matched to sample for points that were exchangeable for money. An audit response was defined as a response maintained by allowing a subject access to an existing score on his own (self audit) or a coactor's (coactor audit) performance. In Experiment I, changes from non-social procedures (no coactor) to social procedures (coactor present) increased self and coactor audits. Since both types of audits occurred at about the same rates during cooperation and parallel work procedures, the increases did not depend on the subjects' response interactions. Although Experiment I did not demonstrate that subjects were comparing scores, the frequent occurrence of each kind of audit within a brief time period (interpersonal audit) did indicate that it was reinforcing to have both scores at the same time. These interpersonal audits suggested that the coactor's score increased self audits during social procedures. Experiment II supported this notion: relative to a non-social procedure, self audits increased more during a parallel work procedure when the coactor's score was accessible than when it was not accessible. Thus, increases in other behaviors that occur in the presence of a coactor, i.e., social facilitation, may also result from or be increased by providing a coactor's score.     

"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home

Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.