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Two different strategies are possible for improving nurses’ interactions with elderly patients One is to arrange special periods, such as reality orientation, in which a high level of appropriate interaction is encouraged The other is to improve nurses’ attitudes to patients and treatment, or select nurses with better attitudes, on the grounds that poor attitudes might underly poor behaviour This study was designed to find out whether nurses’ interactions with elderly patients varied in relation to their attitudes, or differed between periods of routine care or of special activities based on reality orientation organized by the nurses Systematic observations were made of the behaviour of 27 nurses working on two psychogeriatric wards, before all nurses completed questionnaires measuring attitudes to nursing care and to elderly people A higher proportion of interactions were ‘positive’(i e involved nurses’ informing, questioning or making general conversation) during activity periods than at other times No attitudinal measure predicted the proportion of interactions which were positive, although this was greater in qualified nurses The results are consistent with the view that formal reality orientation periods can improve the quality of nurses’ interactions with elderly patients, but are inconsistent with the view that targeting nurses’ attitudes would be effective