Orem (1995) described three systems of nursing care: (1) wholly compensatory, (2) partially compensatory, and (3) the educative-supportive system of care (ESSC). The ESSC is recommended when clients are intact enough to independently perform self-care. The ESSC is the best system of care to support intact nursing home residents' independence of daily living. The major goal of this study is to assess the effectiveness of four intervention conditions in producing a therapeutic, ESSC milieu supportive of residents' ADL abilities. The interventions are staff education programs: (1) a combination of instruction on both Orem's Principles of Nursing Care (OPNC) and Skinner's (1953) principles and methods of Applied Behavioral Analysis (ABA); (2) ABA-only; (3) OPNC-only; and (4) regular in-service-education (RISE). The objectives are to provide nursing staff with the knowledge and methods to foster independent activities of daily living (ADL) of residents and to maintain the independence of ADLs performed by residents. The two specific aims to this study are:
Aim 1 : To compare, among treatment conditions, the following outcomes: (a) nursing staffs knowledge of behavioral principles and behavioral skills; (b) changes in residents' specifically targeted ADLs, mood (anxiety and depression), self-esteem, and satisfaction with care received; and (c) nursing staffs turnover rates; and, Aim 2: To track the development (promotion, maintenance, decline) of a range of initially intact nursing home residents' ADLs over 24 months post admission. When tracking residents' ADL activity, comparisons between the control condition (RISE intervention only) residents' skill performance and the other three groups will allow documentation of potential for the three intervention conditions to foster or maintain intact residents' independent ADL following admission. A quasi-experimental, 4-comparison, repeated measures design with 12 nursing homes will be used. There will be random assignment of homes to treatment condition with three homes and approximately 38 residents' and 81 NAs' complete data available in each of the four conditions. Data will be collected longitudinally starting at baseline and being repeated every 6 months for 24 months. Analysis of variance (ANOVA) will provide the basic statistical analyses to address the research hypotheses. If shown effective, these educational interventions could potentially improve the quality of care provided by nursing staff, improve the quality of life for nursing home residents by maintaining independence, and result in affective benefits for residents.
