Journal of Gerontological Nursing

PERCEPTIONS OF LEARNED HELPLESSNESS

Lynda W Slimmer, PhD, RN; Martha Lopez, PhD; Joan LeSage, PhD, RN; Janet R Ellor, MS, RN

Abstract

Depression is the most common functional psychiatric disorder of the elderly.1 Most psychological theories concerning depression in the elderly focus on the losses inherent with aging as an etiological factor in depression. In addition, because exposure to these losses decreases an elderly person's perception of control, perceived loss of control is cited as a major precipitating event leading to depression in the aged.2-4

The theoretical model that is most widely utilized to explain the elderly's reaction to perceived lack of control is the learned helplessness theory.5·6 This theory submits that the degree of helplessness and subsequent depression varies with the type of attributions individuals make about the cause of the uncontrollable events. A person who attributes lack of control to personal, stable, and global factors is more vulnerable to depression than one who attributes such helplessness to universal, unstable, specific factors. Three areas of dysfunction that characterize the learned helplessness condition are motivational, cognitive, and emotional/ affective deficits.

When an individual is convinced that there is no use in responding, he/she experiences motivational deficits as demonstrated by apathy, listlessness, a decreased incentive to initiate action, and a "giving-up syndrome."7·8 Cognitive deficits are reflected in reduced decision-making abilities, failure to perceive success when it does occur, and decreased ability to learn new responses.8,9 Emotional/affective deficits accompanying learned helplessness include feelings of hopelessness and loneliness, social withdrawal, irritability, insomnia, prolonged crying episodes, and sexual dysfunction.4-5,10

Several research studies of the institutionalized elderly have demonstrated that healthcare professionals may contribute to elderly residents' perceptions of lack of control and subsequent learned helplessness.11-13 Responding to this research, nurses and others have derived implications for practice and have designed studies to test the efficacy of specific interventions to counteract the institutionalized elderly's perception of loss of control.3,4,14-15 Although these intervention studies resulted in immediate enhanced psychological well-being in the subjects, follow-up studies indicated that when institutional limitations prohibited the continued use of the experimental interventions, the positive effects were reversed and the experimental subjects had significantly greater decline in well-being than the control group.16

White and Janson caution that interventions which artificially alter institutional contingencies are of greater danger to the elderly than no intervention.17 They maintain that often the dependency and passivity demonstrated by the institutionalized elderly are not evidence of decreased autonomy and learned helplessness, but rather are instrumental, adaptive behaviors representing an effort to control environmental contingencies. Rothbaum, Weiss, and Snyder likewise suggest that a sense of autonomy can be realized not only through active control of the environment (primary control), but also through acceptance of the environment and the adoption of a secondary control strategy which is characterized by an external locus of control orientation.18

Table

Twenty-eight observation recording sheets were completed by the nurse subjects. Content analysis of the sheets demonstrated that the only subjective evidence of learned helplessness cited by the subjects on all 28 sheets was a resident's request for assistance in a task that the resident was physically capable of performing. On the 28 sheets, the nurses recorded only two objective signs of learned helplessness: 1) resident does not perform ADLs (activities of daily living) that he/she has been observed to perform previously, and 2) resident does not attempt a new skill that he/she is physically capable of learning and performing.

Finally, the observation recording sheet content analysis resulted in the identification of three categories of reasons cited by the nurse subjects for why teamed helplessness was present. Thirteen nurses indicated that learned helplessness behaviors were a means of decreasing loneliness, getting staff's attention , or controlling staff or circumstances. Eleven nurses indicated that learned helplessness behaviors…

Depression is the most common functional psychiatric disorder of the elderly.1 Most psychological theories concerning depression in the elderly focus on the losses inherent with aging as an etiological factor in depression. In addition, because exposure to these losses decreases an elderly person's perception of control, perceived loss of control is cited as a major precipitating event leading to depression in the aged.2-4

The theoretical model that is most widely utilized to explain the elderly's reaction to perceived lack of control is the learned helplessness theory.5·6 This theory submits that the degree of helplessness and subsequent depression varies with the type of attributions individuals make about the cause of the uncontrollable events. A person who attributes lack of control to personal, stable, and global factors is more vulnerable to depression than one who attributes such helplessness to universal, unstable, specific factors. Three areas of dysfunction that characterize the learned helplessness condition are motivational, cognitive, and emotional/ affective deficits.

When an individual is convinced that there is no use in responding, he/she experiences motivational deficits as demonstrated by apathy, listlessness, a decreased incentive to initiate action, and a "giving-up syndrome."7·8 Cognitive deficits are reflected in reduced decision-making abilities, failure to perceive success when it does occur, and decreased ability to learn new responses.8,9 Emotional/affective deficits accompanying learned helplessness include feelings of hopelessness and loneliness, social withdrawal, irritability, insomnia, prolonged crying episodes, and sexual dysfunction.4-5,10

Several research studies of the institutionalized elderly have demonstrated that healthcare professionals may contribute to elderly residents' perceptions of lack of control and subsequent learned helplessness.11-13 Responding to this research, nurses and others have derived implications for practice and have designed studies to test the efficacy of specific interventions to counteract the institutionalized elderly's perception of loss of control.3,4,14-15 Although these intervention studies resulted in immediate enhanced psychological well-being in the subjects, follow-up studies indicated that when institutional limitations prohibited the continued use of the experimental interventions, the positive effects were reversed and the experimental subjects had significantly greater decline in well-being than the control group.16

White and Janson caution that interventions which artificially alter institutional contingencies are of greater danger to the elderly than no intervention.17 They maintain that often the dependency and passivity demonstrated by the institutionalized elderly are not evidence of decreased autonomy and learned helplessness, but rather are instrumental, adaptive behaviors representing an effort to control environmental contingencies. Rothbaum, Weiss, and Snyder likewise suggest that a sense of autonomy can be realized not only through active control of the environment (primary control), but also through acceptance of the environment and the adoption of a secondary control strategy which is characterized by an external locus of control orientation.18

Table

TABLE 1NURSE SAMPLE CHARACTERISTICS n = 44

TABLE 1

NURSE SAMPLE CHARACTERISTICS n = 44

Thus, before nurses can plan and implement practical strategies for enhancing autonomy in institutionalized elderly, they must be able to accurately identify what behaviors represent adaptive mechanisms and what behaviors are indicative of learned helplessness. Therefore, as part of a research project investigating the occurrence of learned helplessness in the institutionalized elderly, the purpose of this study was to describe nurses' present perceptions of learned helplessness.

Method

A qualitative, descriptive design was employed in this study. The sample included 28 registered nurses employed at a large metropolitan teaching hospital's center for the elderly and 16 registered nurses employed at a midwestern Veterans Administration hospital's extended care units and rehabilitation unit. Table 1 summarizes the sample's characteristics.

Two instruments were used to collect data concerning staff perceptions of learned helplessness: a semantic differential and an observation recording sheet. The semantic differential was titled, "My Feelings About Learned Helplessness in the Elderly," and included 24 scales. Each scale was composed of a pair of antonyms and seven evenly divided spaces between each antonym.

The evaluative component (first eight scales) of the semantic differential was used to measure a nurse's belief about the desirability of the learned helplessness condition. The activity component (second eight scales) of the semantic differential was used to measure a nurse's expectations for behaviors associated with learned helplessness. The potency component (last eight scales) was used to measure a nurse's feelings about the overall importance of the learned helplessness concept. Positive ratings were scored 5, 6, 7; negative ratings as 1, 2, 3; and neutral ratings were scored as 4.

The observation recording sheet was used for nurses to document the signs and symptoms that they identified as evidence of learned helplessness in residents. The form allowed a nurse to record subjective and objective data indicating that learned helplessness was observed, to describe why learned helplessness was present in the situation and to identify an appropriate nursing intervention. In addition, the nurses were asked to complete a demographic information sheet.

Data Collection Procedure

The investigators conducted meetings with the nursing staff at each institution to explain the study, invite the staff to participate, administer the semantic differential, and to provide instructions on how to complete the observation recording sheet. The nurses were instructed to complete an observation recording sheet each time they observed an incident of learned helplessness and to place it in a box at the nursing station. The nurses were given no theoretical definition of learned helplessness, but were told to rely on their own perceptions of what characterizes learned helplessness when identifying such behaviors in residents.

They were also informed that their participation in the study was voluntary. To assure anonymity and confidentiality, subjects' names were not placed on the semantic differentials and they were instructed not to sign the observation recording sheet.

Data Analysis

The means, modes, and standard deviations for each of the 24 semantic differential scales and for each of the three main components were calculated. In addition, a stepwise multiple regression analysis was used to analyze the semantic differential data. Content analysis of the observation recording sheet data was used to develop a categorization system describing the following: 1) subjective statements that nurses identified as evidence of learned helplessness; 2) observed behaviors identified as evidence of learned helplessness; and 3) stated reasons nurses recorded for why learned helplessness was present.

Table

TABLE 2SEMANTIC DIFFERENTIAL MEANS, MODES, AND STANDARD DEVIATIONS n = 44

TABLE 2

SEMANTIC DIFFERENTIAL MEANS, MODES, AND STANDARD DEVIATIONS n = 44

After the categorization system was developed, another member of the research team placed a random sample of data into the given category system. Interrater reliability of the system was 86%. Finally, the results of the activity component of the semantic differential were compared to the subjective and objective behaviors that the subjects identified as evidence of learned helplessness on the observation recording sheet.

Results

Table 2 presents the semantic differential means, modes, and standard deviations. The results of the evaluation component indicate that the sample generally believes that learned helplessness is an undesirable condition. However, the subjects are unsure whether or not learned helplessness is an expected or convenient condition. The results of the activity component indicate that the subjects believe that learned helplessness is characterized most by dependent, passive, and rigid behaviors.

In addition, the subjects rated learned helplessness as a set of behaviors that controls others, rather than behaviors resulting from being controlled. The results of the potency component indicate that the subjects demonstrate moderate concern about learned helplessness in the elderly. Table 3 presents the stepwise multiple regression data. This analysis demonstrates that the semantic differential ratings by the subjects were not significantly explained by any of the demographic variables except age. The data demonstrate a positive relationship between age and the potency component (p < .05).

Table

TABLE 3MULTIPLE REGRESSION ANALYSIS FOR SEMANTIC DIFFERENTIAL n = 44

TABLE 3

MULTIPLE REGRESSION ANALYSIS FOR SEMANTIC DIFFERENTIAL n = 44

Twenty-eight observation recording sheets were completed by the nurse subjects. Content analysis of the sheets demonstrated that the only subjective evidence of learned helplessness cited by the subjects on all 28 sheets was a resident's request for assistance in a task that the resident was physically capable of performing. On the 28 sheets, the nurses recorded only two objective signs of learned helplessness: 1) resident does not perform ADLs (activities of daily living) that he/she has been observed to perform previously, and 2) resident does not attempt a new skill that he/she is physically capable of learning and performing.

Finally, the observation recording sheet content analysis resulted in the identification of three categories of reasons cited by the nurse subjects for why teamed helplessness was present. Thirteen nurses indicated that learned helplessness behaviors were a means of decreasing loneliness, getting staff's attention , or controlling staff or circumstances. Eleven nurses indicated that learned helplessness behaviors resulted from "giving up," lack of motivation, fear, or a negative attitude toward having a chronic illness. Five nurses attributed the learned helplessness behaviors to family members' reinforcement or encouragement of dependency.

A comparison of the semantic differential activity component results and the observation recording sheet content analysis demonstrated similar findings. First, on the semantic differential, subjects depicted learned helplessness as a set of behaviors that control others rather than behaviors resulting from being controlled. Likewise, on the observation recording sheets, the most frequently cited reason for the presence of learned helplessness behaviors was to get staff attention or to control staff or circumstances.

Second, the semantic differential results rated dependent, rigid, and passive behaviors as more characteristic of learned helplessness than independent, flexible, and active behaviors. These ratings parallel the subjects' recorded subjective and objective evidence of learned helplessness on the observation sheets (ie, refusal to do ADLs or attempt a new skill). Third, the semantic differential results indicated that the subjects were evenly divided on whether or not learned helplessness behaviors were self-induced or otherinduced.

On the observation recording sheets, five subjects specifically indicated that the residents' learned helplessness was associated with behaviors by family members which encouraged or reinforced dependency.

Discussion

The most signficant finding of this study was that nurses rated learned helplessness as a set of behaviors that control others rather than behaviors resulting from being controlled. This finding is important to note in light of the fact that the theory of learned helplessness is based on the premise that it occurs due to perceived loss of control. The fact that the philosophy and treatment goals of the study's nursing units are to promote independent, active behaviors by the residents provides a partial explanation for why the nurses were sensitive to dependent, passive behaviors.

However, many of the nurses were not able to differentiate between dependent, passive behaviors motivated by a need for attention and within the control of the residents, (and therefore not evidence of the theoretical construct, learned helplessness), and dependent, passive behaviors associated with perceived lack of contro! and learned helplessness.

It is not possible to conclude from this study whether the identified resident behaviors represented primary or secondary control as described by Rothbaum, Weiss, and Snyder.18 However, the study results do indicate that nursing knowledge is not yet adequate to provide a basis for accurately identifying what behaviors represent adaptive mechanisms and what behaviors were indicative of learned helplessness. Therefore, these investigators recommend that further nursing research be conducted to generate an operational definition of learned helplessness. Toward this end, the investigators are presently conducting a study to describe the subjective experiences of elderly residents in long-term care settings that are associated with the behaviors that nurses identify as representative of learned helplessness.

References

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TABLE 1

NURSE SAMPLE CHARACTERISTICS n = 44

TABLE 2

SEMANTIC DIFFERENTIAL MEANS, MODES, AND STANDARD DEVIATIONS n = 44

TABLE 3

MULTIPLE REGRESSION ANALYSIS FOR SEMANTIC DIFFERENTIAL n = 44

10.3928/0098-9134-19870501-09

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