Abstract
Introduction: Promoting independence among the elderly is an important issue in Japan's super-aged society. However, because of the priority on treatments caused by shortened hospital stays and the demands of complicated nursing duties, support for elderly patients' activities of daily living independence have tended to be overlooked. Objective: To clarify the characteristics of nursing support for activities of daily living based on the content of nurses' actions and verbal support, and the reasons for performing them, as well as to examine the ideal nursing support necessary for maintaining and improving independent living, based on reinforcement theory. Methods: Areas where activities of daily living care for elderly patients were provided were observed according to the natural observation method, and nurses’ actions and verbal support as well as patients' behaviors were recorded. Thirty observations were categorized into “no support,” “support,” and “full support.” Nurses' actions and verbal support that appeared to affect patients’ activities of daily living were extracted and categorized based on similarities and assigned names. Results: Support for “full support” patients who were unable to perform activities of daily living was ‘ambiguous’ and ‘hurried,’ and nurses’ speech was strong and quick. Support for patients unable to perform activities of daily living was “obedient” and “unilateral,” and nurses were often silent. Conclusions: In the case of “full support” patients, the nurse's ‘ambiguous’ and ‘hurried’ support with strong and fast speech served as aversive stimuli and reduced the patient's motivation to perform the action. ‘Obedient’ and ‘unilateral’ are habitual supportive actions of nurses, suggesting that patients learn this pattern and do not perform the action. Nursing support that involves pleasant stimuli is important to maintain and improve independent living in elderly patients.
