Problem-solving orientation in nursing home residents: An intervention featuring the recognition of choice and perceived control

David Judd Mellinger (1989)

This study serves as an attempt to contribute to the movement on successful aging in which relatively minor psychological interventions have been seen as capable of reversing "mindless" (unquestioning) and passive behaviors in nursing home residents. These behaviors are often attributed to living in a constraining environment such as a nursing home, however, even constraining environments offer opportunities for choice and control. This investigator viewed problem-solving orientation as a promising variable for affecting change with this population. A shift toward a more active problem-solving orientation was seen as desirable. It was hypothesized that a group intervention in which subjects would respond in a "think aloud" format to vignettes containing problems typical for their environment would increase both the recognition of choice and perceived control, which in turn would generate a more active problem-solving orientation. In addition, it was hypothesized that this group would achieve the above results more effectively than a group focused on current events and a no treatment control group. A total of 27 subjects in two nursing homes were randomly assigned to one of the three groups and were tested at Pre and Post using self-report questionnaires. Empirical results were not conclusive: (a) there were no significant results on problem-solving orientation; (b) beliefs in Chance control (an aspect of perceived control) were significantly decreased in the two treatment groups but more so in the current events group than the "think aloud" one; and (c) a significant change on Control of Basic Life Routine (a factor of recognition of choice) was recorded in the current events and no treatment groups. Qualitative data, however, suggest changes in problem-solving orientation subsequent to the study (e.g., residents in one home reported that the "think aloud" group had inspired them to revive a residents' council). In addition, confounding variables (e.g., major events that occurred in the subjects' lives during the course of the study) and flaws in the methodology (e.g., the groups met for too few number of sessions) may have mitigated against support of the hypotheses.