This is Learning Module #1. It provides you with the P-R-I-D-E
Method of positive reinforcement to increase your residents' independence.
A note here about terminology: for the sake of brevity, I will
use the term resident; however, you may use the word tenant,
client, consumer, customer, or a similar term. So don't let the
difference in terminology side-track you from hearing the content
of the learning module.
Activities of Daily Living
The abbreviation ADL stands for Activities of Daily Living. If
you have never had a job in health care before, the term ADL is
probably foreign to you. Actually, the term itself says it all:
Activities... of Daily... Living...
Question #1: What does ADL stand for? To select and enter
your answer go to .
Some examples of activities of daily living are... bathing,.
showering, eating, washing your face and hands, brushing your
teeth, and combing or brushing your hair.
Question #2: Give three examples of ADLs? See above
Why is Activities
of Daily Living independence important? You may be thinking "here
is an entire course that focuses on increasing ADL independence...
why is independence so important?" The three basic goals
of an Assisted Living Facility are to maintain a resident's independence,
dignity and choice.
Question #3: The three basic goals of an Assisted Living Facility
are to maintain a resident's what? See above
independence and what it means to you. Think about how your life
would be if you had to depend on someone to wash your face, brush
your hair, or even to eat. When you got ready for work this morning,
you did all of the these on your own. However, say you had fallen
the day before, your arm is stiff, and you can't move it above
your shoulder. Now you have to go to work. How are you going to
get your hair brushed? Who is going to do it? How would you ask
them? What would be their attitude? Don't they have responsibilities
and tasks to do in the morning as well?
you live alone, would you have to ask a neighbor to brush your
hair? Now, your lack of independence to do this one simple Activity
of Daily Living, brush your hair, suddenly affects the start of
your whole day. How do you feel? Frustrated? Angry? Sad? Depressed?
You probably wouldn't feel much like going to work. Maybe you'd
opt to stay in bed, withdraw, sulk, and feel sorry for yourself.
Now place yourself
in one of your resident's shoes for a minute. Let's say you have
a resident, Effie, down the hall in room 201. She's had a stroke
and she cannot raise her hand above her shoulder. She cannot brush
her hair. How do you think Effie feels? Frustrated? Angry? Sad?
Depressed? Maybe she feels like staying in her room and withdrawing,
sulking, and feeling sorry for herself, and doing less and less...
Question #4: What are two common reactions to loss of ADL independence? .
If there were
something you could do to help Effie not only use, but increase
the use of the abilities she has, how do you think that would
make her feel? Well, just think back a minute about your sore
arm... lets say you move your arm a certain way and the soreness
is magically gone. Now you're able to brush your hair independently
and are no longer dependent upon others. How do you feel? Happy? Elated? Confident? Competent? Good about yourself? Successful?
Well, the same applies to Effie. The more she is able to do for
herself independently, the better she feels about herself, and
the more things she feels like doing for herself. So, increasing
ADL independence becomes an upward spiral of independence resulting
in a general positive outlook on life. That is one reason why
your Assisted Living facility focuses so much on staff not doing
for residents, but helping residents do for themselves. They want
to create this upward spiral of independence.
that you understand what ADLs are and why independence is so important,
let's spend the remainder of this tape giving you a tool to increase
resident independence. This tool is called positive reinforcement.
What is positive reinforcement? Well, a simple definition of positive
reinforcement is something that you say or do to get a certain
behavior to increase.
Question #5: Positive reinforcement is something that you say
or do to get a certain behavior to do what? See above
The PRIDE Method of Positive Reinforcement
Now let's get
back to Effie. If she has mentioned to you that the doctor wants
her to try to use her arm as much as possible, you might encourage
her to brush her hair. You might use what I am going to outline
for you, the pride (PRIDE) method of positive reinforcement.
this particular module, you're not only learning a technique for
on-the-job, but a technique to use at home too. If you have children
or a significant other at home, and you want them to continue
doing something that they are doing right, washing the dish or
picking up after themselves, this technique works here too.
essence of the technique is, when someone is doing something that you want them
to continue doing, whether it be a resident in the facility, or someone at home,
to encourage or reinforce that behavior, you say something like "good, great,
good job, or thank you." Of course, I know you've done this in the past,
but sometimes your positive reinforcement backfires, and the receiver ends up
doing less, rather than more. Why? Well, you're about to find out. Here's part
of the answer:
go back to Effie's hair brushing for a minute. How do you think
she would feel if she had been brushing her hair for the last
month independently, and you walk into her room this afternoon
and say, "I'm glad to see you are brushing your hair without
any trouble." Or, what if Effie never has had a problem brushing
her hair since being admitted to your facility?
What kind of message does your comment give to her? What do you think she would say
to you out loud or to her self? Probably something like, "Gee,
I've been brushing my hair all along. Why is it so special now?
Didn't she notice before that I'm able to brush my hair myself?
I guess this staff member has me confused with someone else and
really doesn't know me." So, now how does Effie feel? Happy
and confident to do more? Or sad, confused, and unimportant? As
a result, your positive reinforcement, which was intended to increase
independent behavior, may become a negative reinforcement and
actually decrease the behavior.
same holds true for your children or significant others. If for
the past week, by some miracle, they've been doing an extra special
job of washing the dishes or picking up their room, hoping you'll
reward them. Then one day they decide to slough off and do a half-way
job. Today when you get home, you decide to try positive reinforcement
and say, "Gee, your room (or the dishes) look great."
Chances are they, like Effie, will be confused, perhaps feel unimportant,
and feel like you really don't know what is going on with them.
P = Personalized
let's establish some ground rules for your positive reinforcement.
There will be five steps or rules to this method. To help you
remember all five, just remember the word pride. PRIDE: Each letter
will help you to recall one of 5 techniques to make positive reinforcement
work for you. The "P" stands for personalized.
first rule is: Your reinforcement or compliment needs to be personal
or individualized to the receiver, whether it is a resident in
the facility, or a child or significant other at home.
Question #6: "P" in the PRIDE method stands for what?
do I mean by personalize? Let's go back to Effie before you
have said anything to her. It's obvious to you by now that you
need to observe over a period of time to see what is worthy
of commenting on or reinforcing. Observation is the key to personalizing
or individualizing your compliment. For Effie, the best way
to do this is to place Effie's ADL skills mentally into two
categories: ADLs Effie can easily perform, and ADLs that she
is struggling with and may even need some assistance from you.
For Effie, let's say she can easily brush her hair but is struggling
and has some difficulty buttoning her dress. Or for a resident,
Henry, regarding mobility, he can easily walk. But he has some
difficulty with rising from a chair. For another resident, Maude,
she can easily wash her hands, but has some difficulty with
washing her face.
Question #7: What is the key to personalizing or individualizing
your compliment? .
Question #8: Place your resident's ADLs into what two categories
of assistance with personalizing your compliment? See above
in order to personalize or individualize your compliment or
positive reinforcement, you need to observe first.
are three examples of how this works to provide an environment
Compliment Effie's buttoning her dress; Henry's rising from
a chair; and Maude's washing her face when they seem to be doing
a better job then in the past. Maybe Effie slides the button
through the hole with less shakiness. You might say, "good
job Effie, you got that right though there." With Henry
you might say, "Henry, that's great that you got up from
the chair without your cane. And that's a low seat, those are
harder." With Maude you might say, "Oh you've already
washed your face. Yesterday I had to help you I'm glad to see
you can do that on your own."
incidentally, with your children you might say, "Wow, you
even put the casserole dish to soak. Thank you. That makes it
easier for me later on."
R = Real
summary, the P stands for personalize or individualize your comments
or compliments. The second key to making the PRIDE method work
for you is the R in Pride. The R stands for real. You have to
be real or sincere. In other words, you have to believe that Effie
is doing a better job of buttoning, Henry rising from the chair,
or Maude washing her face. Or, as in the case of your children
or significant other, doing the dish. If you don't really believe
your compliment yourself, chances are it will be reflected in
your tone of voice, your facial expression, and even in the way
you stand or move your body.
Question #9: The "R" in the pride method stands for
what? See above
Question #10: If you are not sincere, it will be reflected or
show in what three areas? .
or being real, you'll know exactly what I am talking about when
you watch a poorly produced TV commercial, usually the ones done
by local businesses. A good example in my area are car and appliance
sales ads. They say that their cars or appliances are great, and
that they have the best prices in town, but there is just something
about the way that they say it which makes it not believable.
The whole commercial comes across like a bunch of phony, insincere,
hype. So, in the past, if your compliments have backfired, maybe
they were personalized, but you were not sincere.
your compliment as a means to increase your resident's ADL independence,
find a piece or a part inside of you that really believes your
you can't feel good or right about what you are saying or if it just doesn't seem
right to you, to provide and environment for resident success, keep looking and
observing the resident until you find an ADL accomplishment that really strikes
you as deserving. Then, make your comment genuinely enthusiastic because it's
motivated by being real, and is not artificial or manipulative.
I = Immediate
P stands for personalize or individualize, the R stands for being
real or sincere, the I in our PRIDE method to increase ADL independence
stands for immediate. I think this one is pretty self- explanatory.
When you see a resident or your children doing something worthy
of a compliment or positive comment, give it immediately. Can
you think of a time in your childhood or adult life when you have
really worked for something and the compliment came much later
after the fact or not at all?
Question #11: The I in our PRIDE method to increase ADL independence
stands for what? See above
Now that you
have your situation in mind when your accomplishment went unnoticed,
how did you feel? Unhappy, unimportant, frustrated? Now let's
think about the Effie, Henry, or Maude in your facility. Let's
take Effie for example with her button. She really has been struggling
with her stiff fingers lately. You walk into her room and just
before this she figured out the knack of getting it through the
hole. This time she pushes the button through with little effort.
You observe this, and are aware that this is a major accomplishment
So you say, "Wow, Effie, that's great! You did that
button in nothing flat!" How does Effie feel? Well, she probably
feels the way you would have felt if after making a special meal,
someone would have said, "What a great meal! Thanks for the
effort!" You feel on top of the world. Like a winner, good
about yourself. So the "I" in PRIDE stands for immediate.
When you compliment or reinforce immediately, it has much more
impact at the time.
D = Direct
is for personalize, "R" is for real, and "I"
is for immediate. The "D" in the PRIDE method of increasing
ADL independence is the word "direct." Be very direct
or specific with your comments, rather than being vague or general,
rather than just saying, "good or great." It means much
more if you use the person's name and state specifically what
it is you are complimenting. The resident needs to know exactly
why he or she is receiving the compliment. Here's how this works.
Let's look at a different set of ADLs and how the "D"
of being direct would apply.
a resident that needs assistance in and out of the shower, you
might say, "Mary, good job! I barely had to help steadying
you at all getting into the shower." For a resident who needs
hygiene assistance you might say, "Ernie, great, your hands
seem much steadier brushing your dentures today." For a resident
that needs structuring and setup help with dressing, you might
say, "Elizabeth, oh great, you have already chosen the dress
you want to wear today."
Question #12: The "D" in our pride method of increasing
ADL independence stands for what? See above
Question #13: Your resident needs to know exactly what? .
E = Express Frequently
is for personalize; "R" is for real; "I" is
for immediate; and "D" is for direct in our PRIDE method
of using positive reinforcement to increase ADL independence.
So what does the "E" stand for? Express frequently.
Don't be stingy with your positive reinforcement. It doesn't cost
anything. Think about how good you feel when you get recognized
for your effort. There is a saying, "What goes around comes
around." By putting a smile on one of your residents' faces,
by expressing to him or her frequent compliments that are personalized,
real, immediate and direct, you end up returning their smile with
one of yours. As you interact with other residents and give more
PRIDE positive reinforcements, it becomes kind of like a chain
reaction. So the "E" stands for "express positive
Question #14: What does the "E" stand for? See above
is "why don't we give positive reinforcement more often?"
We become busy, and so focused upon doing things for our residents
that we forget to notice what they do for themselves, and don't
take time to compliment, encourage and reinforce the abilities
they do have.
remember, in Assisted Living the goal is to maintain a resident's
independence in as many areas as possible, for as long as possible.
Don't do something for a resident that he or she could do for
themselves. Yes, it is quicker to put the soap in their hand rather
than stand there and wait while you watch them fumble. However,
by doing this for them, you deprive the resident of the opportunity
to experience a feeling of accomplishment, success, and raised
self-esteem. When you say, "Great! You got the soap in the
clothes yourself. I knew you could do it," this gives them
confidence in their own independence.
Question #15: What is one reason that staff do not use positive
reinforcement more? See above
So slow down,
watch and see what the resident truly needs assistance with before
When you see
a behavior, whether it be a resident zipping a zipper independently
or your child doing his school work without being told, positive
reinforcement will increase the chance that the behavior will
continue, especially if you use the method outlined here by thinking
of the word "pride."
"P" stands for personalize. Observe first, then make
sure your compliment is given for a behavior which the receiver
may view as worthy of a compliment. "R"stands for real.
Be real. It's important that you mean what you say, and are sincere.
"I" stands for immediate. Give the compliment at the
time you observe the behavior. Better late than never is fine,
but complimenting at the time is much better. "D" stands
for direct. Be direct with the resident and very specific about
what you are complimenting. Don't leave him or her guessing as
to what you mean by "great job." "E" stands
for express. Express praise and compliment frequently.
stated at the beginning of this tape, you need to have a working
knowledge of the techniques presented on positive reinforcement.
This is necessary in order to take action on improving the quality
of your residents' lives. That is what this Learning Module and
entire series is all about --taking action. You now have what
you need to be successful. You have just been provided with very
concrete, specific examples of how to use positive reinforcement
to increase your residents' ADL independence ... the rest is up
to you. The next Staff Training Module, two, deals with instruction.
Peer-Reviewed Journal Article References:
Abramson, L., Petranker, R., Marom, I., & Aviezer, H. (2020). Social interaction context shapes emotion recognition through body language, not facial expressions. Emotion
Bordne, S., Rietz, C., Schulz, R.-J., & Zank, S. (2020). Behavioral and emotional quality of life of patients undergoing inpatient geriatric rehabilitation. Rehabilitation Psychology, 65(3), 299–310.
Harris, J. A., Kwok, D. W. S., & Gottlieb, D. A. (2019). The partial reinforcement extinction effect depends on learning about nonreinforced trials rather than reinforcement rate. Journal of Experimental Psychology: Animal Learning and Cognition, 45(4), 485–501.
van Haaren, F. (2015). Automatic negative reinforcement: Its possible role in problem behavior with treatment implications. Behavior Analysis: Research and Practice, 15(3-4), 161–170.
Differential versus differentiated reinforcement. Behavior Analysis: Research and Practice, 17(1), 98–100.