Bowsher J E
Medical College of Georgia.
Sch Inq Nurs Pract. 1994 Summer;8(2):207-24; discussion 225-8.
Dependence-oriented care is very much a part of nursing home care in the United States. Yet independence is a salient part of American culture and is desired by nursing home elders. Such a dichotomy sets the stage for a loss of competence, a loss of control, and a subsequent loss of well-being in nursing home elders. Potential reasons for dependence-oriented care are identified in this article, and a theoretical model of independence for frail elders is presented as a guide for professional caregivers. Findings from previous research studies related to the model suggest perceived situational expectancy of control of valued reinforcements as a mediator of the relationship between behavioral competence and psychological well-being. Findings from the literature propose the subjective environment as a mediator of the relationship between behavioral competence and perceived situational expectancy of control of valued reinforcements. Using the model, there is the potential to understand more fully the process of independence in nursing home elders and to guide professional caregivers through this process as care is delivered.
