Nurse/patient dependency--a review of different approaches with particular reference to studies of the dependency of elderly patients.

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.