Understanding and responding to behaviours that challenge 6.1 “Getting to Know Me” Enhancing...

Understanding and responding to behaviours that challenge

6.1

“Getting to Know Me”Enhancing Skills in the Care of People with Dementia in General Hospitals

© Greater Manchester West Mental Health NHS Foundation Trust

To discuss what people find challenging To consider meanings of behaviours and

ways of responding appropriately Reflections of the programme and to

consider changes to practice / further training needs

6.2


"An abnormal reaction to an abnormal situation is normal behavior."

Viktor Frankl (1946)

6.3


6.4


A holistic model of explanation of

challenging behaviours -

Stokes & Goudie (2002) Environment

Social Built

Behaviour

Context

Health Person

6.5


Try to think of as many possible explanations for the following behaviours a patient who has dementia may exhibit on a hospital ward...

6.6


Fragmentation of experience -

/ forgetting purpose

Looking for a friendly face

Coping with stress

Routines and habits

A purpose connected

with the past

Feeling lost

A task to accomplish or

a need

Physical discomfort

Adapted from Stokes (2001)6.7

Exploring, or searching for the familiar

Avoidance of noise/stimulation Anxiety

Failing to find the way (poor

singage)

Walking / Pacing


Perseveration

Approaching the person abruptly, or approaching from behind

Delivering hands-on intimate care in a

personal space to a person who is not

aware of their dependency needs

Entering a person’s personal space

without invitation / explanation

A reaction to attempts by

others to deny / confine control

A response to delusional ideation /

hallucinations

An unexpected change or losing

something of value...

Confronting the reality of a person

whose present reality might not be similar to our own

Pain / discomfort

Adapted from Stokes (2001) 6.8


Aggression

As a team, utilise all your knowledge of the person to consider what might be the cause of their behaviour. Pool your ideas and begin to eliminate those that can be disproven.

Consider using a behaviour monitoring chart to observe for patterns that may be clues to the triggers

Talk to relatives, they are likely to know the person the best

Always consider delirium/underlying physical illness

Try to put yourself in the person’s shoes to consider their perspective, remember their view of reality in time, place and person may be different from your own

Be aware that aggressive behaviour is often a resistance to the actions of others that are mistakenly perceived as threats

6.9


Be aware that sometimes the cause of the behaviour may be the unlikeliest of causes (eg a person not recognising their own reflection in a mirror when alone in a bathroom and becoming frightened and agitated)

If aggressive, avoid – where possible - invading a patient’s personal space

Where possible give the person space and opportunity to calm down

Seek support but avoid crowding the person

Use a calm and even tone of voice.

Maintain your own safety and that of others.

6.10


See the person not the dementia Empathy – focus on feelings and put yourself in the

person’s shoes Improve communication skills See behaviour as having “meaning” Consider the impact of the physical and social

environment Where possible provide opportunities for

meaningful activity Recognise the importance of the need for

familiarity to Support for relatives

6.11


6.12


1.What changes will you make personally?

2.What changes can the ward/department make?

3.What wider/bigger changes would you like to see happening to improve care in hospital and the community?

6.13


Frankl, V 1946 Man’s search for meaning Simon & Schuster

Stokes, G 2001 Challenging behaviour Speechmark

Stokes, G and Goudie, F 2002 The essential dementia care handbook Speechmark

6.14


Understanding and responding to behaviours that challenge 6.1 “Getting to Know Me” Enhancing...

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