Nursing home residents' dependence and independence

Background. Entering an institution constitutes one of the most difficult developmental challenges for older people, and may lead to increased dependency because of reinforcing environmental events such as the interaction pattern of the staff. Aims and objective. The aim of this paper was to describe the pattern of social interaction between nursing home residents and the nursing staff during mealtimes. Design and methods. Six residents of a nursing home in a suburb of Oslo were observed. Data were collected during 120 systematic observations. Different types of behaviour relating to the residents' level of independence when interacting with the staff were examined using a structured observational scheme developed by Baltes. Results. Data showed that the residents' maintenance of independent self-care was the most predominant behaviour. Residents were rarely socially active. The behaviour of one resident varied among meals. Observations of independent self-care maintenance during interactions between the residents and the staff were sometimes consistent and sometimes inconsistent. The response of the nursing staff to the residents' social engagement was variable. Generally, however, they did not respond at all and seldom displayed engagement-supportive behaviour. Conclusions. The results represent a challenge to the nursing staff to increase social interaction during mealtimes, and also to examine their inconsistent behaviour towards the residents. Relevance to clinical practice. Mealtime appears to be a good opportunity to foster the independence of the residents as well as to enhance social activity in the form of informal conversation. Greater consistency of staff behaviour is required, based on ethical values such as consideration of the residents' self-esteem and autonomy, thereby stimulating independent self-care at mealtimes. Inconsistent behaviour, often based on values that are not clarified, may, on the contrary, lead to increased dependence of the residents.