Miller A
J Adv Nurs. 1984 Sep;9(5):479-86. doi: 10.1111/j.1365-2648.1984.tb00400.x.
The dependency of elderly patients is the outcome of interaction effects between the patient and his or her environment, and over a protracted stay in hospital, environmental factors can be as influential in determining a patient's dependency as the patient's medical or physical condition. Rigid institutional regimes and inadvertent reinforcement of dependent behaviours by nursing staff appear to play an important part in the development of institutionally induced dependency. Studies of patient dependency which assume that dependency arises largely from the physical or mental condition of the patient lack validity because the major source of variation in nursing activity is seen as an almost mechanistic response to patients' dependency. It is argued that, rather than patient dependency 'causing' nursing actions, nursing actions can cause patients to become more or less dependent.
老年患者的依赖是患者与其环境之间相互作用的结果，在长期住院期间，环境因素在决定患者的依赖程度方面可能与患者的医疗或身体状况一样具有影响力。严格的制度管理以及护理人员对依赖行为的无意强化似乎在机构性依赖的形成中起重要作用。那些认为依赖主要源于患者身体或精神状况的患者依赖研究缺乏有效性，因为护理活动变化的主要来源被视为对患者依赖的几乎机械性的反应。有人认为，不是患者的依赖“导致”护理行为，而是护理行为会使患者或多或少地变得依赖。
