The onset and alleviation of learned helplessness in older hospitalised people
The purpose of this study was to extend the current understanding of relational links between disempowering care and dependence, and empowering care and independence by assessing the extent to which the theories of Learned Helplessness (LH), (Seligman, 1975) and Learned Mastery (LM), (Peterson, Maier & Seligman, 1993) are relevant to these links. This involved investigating the onset of Learned Helplessness induced dependence and Learned Mastery induced independence. It also involved evaluating the alleviation of LH induced dependence using a LM intervention. The study used a two-staged design consistent with the LH paradigm. During the first stage a sample of older hospitalised people were randomly assigned to experimental and control conditions. Interventions included exposing participants to disempowering (non-contingent) and empowering (contingent) circumstances during a mealtime event as a means of inducing LH and LM respectively. Findings showed that disempowering interventions led to LH effects within the mealtime event akin to patient dependence. These effects were alleviated in the second stage through exposing patients to empowering circumstances consistent with the development of LM. The exploratory phase involved developing a valid and reliable measure of empowerment and disempowerment in hospital settings, the Patient Empowerment Scale (PES). This scale evaluated the extent to which hospital environments exposed older hospitalised people to circumstances consistent with the development of LM and LH. Having developed the PES it was submitted to a sample of 102 hospitalised elders situated on one of five hospital wards. This involved patients judging the extent to which they had been exposed to a series of consensually valid prototypical empowering and disempowering acts. All wards evaluated showed a tendency towards delivering empowering care although there were significant variations between sites. Moreover, some wards were found to show a negative relationship between empowerment and age. A factor analysis was also conducted on the PES yielding the principle components of empowering and disempowering care. From these components relevant models of these concepts were constructed. Finally, alpha reliability ratings for the PES ranged from 0.74 to 0.87 for empowerment and 0.65 to 0.87 for disempowerment. Study limitations and directions for future research are considered.
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