Presentation on theme: "Philosophy of care The person The environment Relationships The family"— Presentation transcript:
0 Providing behavioural support to maintain well being Module five:Providing behavioural support to maintain well being
1 Philosophy of care The person The environment Relationships The family Best practiceRelationshipsThe familyThe staffBest practiceProviding behavioural support to maintain a person’s well being is dependent on best practice.Most importantly this means being aware of the importance of ‘relationships’ between yourself and people with dementia whom you are assisting, their environment, their family and your organisation’s philosophy of care.Philosophy of care
2 5. Providing behavioural support This module covers:5.1 Understanding behaviour andproviding behavioural support5.2 Team problem solving andhandling crisis/urgent issues5.3 Quality and legal issues5. Providing behavioural support to maintain the well being of a person with dementia.This module covers ... As per PPT.
3 Identify and document triggers that may influence behaviour Learning outcomesAt the end of this module youwill be able to:Identify and document triggersthat may influence behaviourDescribe ways to increase behaviours of contentment and minimise behaviours of concernExplain an orderly approach to documenting behaviour managementState the value in reviewing strategies implementedPrevent and respond to abuseLearning outcomesExplain each Learning outcomes ... as per PPT.
4 5.1 Understanding behaviour and managing behaviours We all behave, and have learned tobehave appropriately in given situationsthrough the responses of othersThe way we behave can indicate a sense ofwell- being (satisfaction/contentment)or a sense of ill- being (suffering/discomfort).The behaviour of a person with dementia is the same. It can indicate a sense of well-being or a sense of ill-being.5.1 Understanding behaviour and managing behavioursWe all behave … as per PPT.ill-being) which we want to prevent or minimise.There are behaviours of contentment (indicating a sense of well-being) which we want to reinforce and maximise and behaviours of concern (indicating a sense ofThere is behaviour around us all the time.Behaviours and unmet needsActivity 5.1To view behaviours of people with dementia and try to understand what their need is.
5 What is behaviour? Q. What do you think? Key Question: Q. What is behaviour?Q. How is it managed?Answered by the next PPTsBe aware of countering what is usually a negative way of defining ‘behaviour’.Behaviour can be behaviours of contentment as well as behaviours of concern as outlined in next PPT.Activity 5.2What is behaviour?To explore what participants think ‘behaviour’ is and what is it means for the person with dementia.Activity 5.3Self reflection – our behaviourTo increase the awareness and empathy of participants to understand how we react and behave in given situations.
6 The behaviour of a person with dementia is no different. … is what we do (or don’t do) in response to internal or external stimulus… is what we do all of the time (we all ‘behave’), and have learned to behave appropriately in given situations through the positive or negative responses of others… can indicate a sense of well being ( contentment) or a sense of ill being (concern)The behaviour of a person with dementia is no different.Behaviour……. as per PPT.Look at summary of participant responses (written on whiteboard) from activity 5.2.Use Activity 5.2 to illustrate that we most often think of ‘behaviour’ as ‘negative’ behaviours of concern indicating ill-being and either ‘outward’ (overt) e.g. punching, scratching, wandering, shouting etc.) or and equally important as ‘inward’ (omission) e.g. withdrawal.But we should put just as much emphasis on behaviours of contentment which indicate well being e.g. happiness, enjoyment, laughing.
7 Behaviour and being person-centred every behaviour usually has a variety of causessometimes the real causes/triggers of behaviour are ‘invisible’ at the time the behaviour occurs, and require further investigationwe need to know the person and try to see their world through their eyeswe need to be person-centred, not behaviour centredBehaviour and being person centredEvery behaviour … as per PPT.We need to be creative in our thinking and approaches. It is important to ‘step into the world’ of the person with dementia and try to tune into how the person with dementia might be feeling. It is equally important for staff to recognise their own feelings and frustrations.We work in an emotional environment where we respond to people on an emotional level. This can occur without being given the emotional support required to help us practice in the best way to maintain our own sense of wellbeing. Managing our emotions and showing empathy but not feeling overwhelmed by our emotions is an important skill in aged care.
8 These needs are universal and they do not change. Unmet needsFive common unmet emotional needs are:To love and be loved (comfort)To have self-esteem boosted (identity)To have opportunity to care (attachment)To have the power to choose (inclusion)To be needed and useful (occupation)These needs are universal and they do not change.Unmet needsThe condition of dementia over time results in a multitude of losses. Five common unmet emotional needs are ... As per PPT.Comfort - family, relatives and friends may withdraw, diminishing the opportunity for the person to love and be loved and the provision of physical and emotional warmth and strength.Identity - having a sense and feeling of who one is, the person's identity changes as people begin to define them via their diagnosis resulting in low self-esteem.Attachment - the loss of one's home and pets can lead to having no one or nothing to care for i.e. lack of an opportunity to form bonds or attachmentsInclusion - the loss of control of almost every aspect of daily life and loss of being or feeling part of a group.Occupation – being or feeling involved in the process of life is lost e.g. familiar roles and jobs or the feeling of being needed and useful.Sometimes these essential needs (that we all have) are not met by our assistance and care. The behaviour of a person with dementia is trying to tell us they havean ‘unmet’ need.When social inhibitions lift and verbal communication diminishes (because of the condition of dementia), it is more likely that the person with dementia willbecome more direct in their expressions. Thus the way they express their unmet needs can be unexpected, strong, or even ‘aggressive’.We often need to change our approachour inappropriate approaches may increase behaviours of concernthe person best equipped to improve the situation is us, not the person with dementiaour attitudes and approach to the person has the power to change the emotional environment.Our actions can create both happiness (a sense of well-being) or harm (a sense of ill-being).
9 Personhood & Behaviours Behaviours of contentmentHappinessEnjoymentPleasureEngagedNeedsComfortIdentityAttachmentInclusionOccupationMetNot MetBehaviours of concernAngerAnxietyDepressionSadnessPersonhood & Behaviours... as per PPT.A person with dementia behaves in a way that tells us that their need is met (content) or not met (concern).Our aim is to meet the need of the person with dementia and trigger behaviours of contentment. We need to avoid triggers of concern.Behaviours of Concern v Behaviours of Contentment. Behaviour can be either not just behaviours of concern!The Hammond Care Group
10 Behaviours of Contentment ‘any behaviour which leads to a sense of well-being and enhancing a sense of personhood for the person’Behaviours of ContentmentDefinition ... As per PPT. (adapted from Kitwood 1997).If a person’s need is ‘met’ by our assistance and care it will lead to ‘Behaviours of Contentment’.For example, happiness, enjoyment, satisfaction, pleasure, engagement , helpfulness, usefulnessl, purposefulness, increasing comfort, decreasing anxiety, decreasing pain, leading to enhanced personhood and a sense of well-being for the person with dementia (and possibly care staff, family members or those around them)’.Encouraging and promoting triggers ‘for behaviours of contentment is a key to achieving the best quality of life for the person with dementia and may also present as an approach to address occupational health and safety concerns for all staff.’Often our approaches to promote behaviours of contentment can be a solution to preventing or avoiding behaviours of concern.
11 Behaviours of Concern‘any behaviour which causes distress to the person…or is a manifestation of distress’Behaviours of ConcernDefinition ... As per PPT.If a person’s need is not ‘met’ (i.e. an ‘unmet need’) by our assistance and care it can lead to ‘Behaviours of Concern’.For example, anger, depression, sadness, shouting, swearing, hitting, throwing, increasing anxiety, decreasing comfort, increasing pain, leading to diminished personhood and a sense of ill-being for the person with dementia (and possibly care staff, family members or those around them).Avoiding or preventing ‘triggers’ for behaviours of concern is a key to achieving the best quality of life for the person with dementia and may also present as an approach to address occupational health and safety concerns for family and all staff.Often our approaches to avoid or prevent behaviours of concern can be solution to encouraging and promoting behaviours of contentment.
12 Always ask yourselfWhat is this person trying to tell me?How is this person experiencing theworld at the moment?What need of this person is not being‘met’?Who is concerned by this behaviour and why?Always remember to ask yourself:... as per PPT.Q. How are they feeling?Q. What are they telling me by their actions?Additional questions:What concerns you might not concern the person with the behaviour!Q. Who is concerned by this behaviour and why?Connections between the person’s needs, feelings, brain impairment and behaviour.Always remember behaviours are a result of the dementia and not the true character of the person.
13 The Behaviour Chain A B C Antecedent Behaviour Consequence (Trigger) A behaviour is the response to a ‘Trigger’Look for the ‘Trigger’ and describe the ‘Behaviour’Note possible ‘Consequences’The Behaviour ChainExplain ABC as basis for providing behavioural support.A behaviour is a response to a ‘trigger’ (antecedent – ‘ante’ means preceding). Behaviour usually does not happen in a vacuum. The trigger could be outside in the environment or within the person (physical or emotional). Behaviour is ‘behaviour’ and people in the environment classify it as ‘good’ or ‘bad’.Always be specific when describing ‘behaviour’. Do not say the person is ‘aggressive’ but rather the person swore loudly i.e. what made you think the person was ‘aggressive’. What did they say or do? What did their body tell you?‘Consequences’ occur as a result of the behaviour. What happens as a result of the behaviour e.g. all staff come running to see what happened.Activity 5.4What you can and cannot changeTo explain to participants that there are ‘triggers’ that we can change and ‘triggers’ that we cannot change.
14 Was the Trigger caused by person’s Ask these questionsWas the Trigger caused by person’sToo noisy, bright or coldToo complicated, unfamiliarUndignified, ignored, loud,Pain, hunger, thirst, infectLife experience, habit, likesEnvironment? Activity/task?Communication? Health?History ?Ask these questionsThere as some things we cannot change in regards to the condition of dementia.We cannot change:the disease (there is no cure yet!).the person’s personality.a person’s biography but we can use their story.But we can change most Triggers. I’ll ‘TEACHH’ you some triggers.Ask yourself the question, ‘Was the behaviour triggered by the Environment, the Activity, the Communication or the person’s Health or History”?Was the trigger due to ... as per PPT.14
15 Individuals with behaviours of concern have unmet needs. 5.2 Team problem solvingThe goal of creative problem solving is to :“improve the quality of life for older people in need and to make a difference in their life”Individuals with behaviours of concern have unmet needs.Our goal is to identify those needs and attempt to address them to thebest of our abilities, so we canimprove the person’s quality of life.5.2 Team problem solvingThe goal ... As par PPT.No one can do it on their own.We need to work and problem-solve as a team.We need to acknowledge the strength of each team member and what they contribute to assistance and care.We need to communicate effectively.We need to support and reassure each other.
16 Problem Solving STARR method Go through the steps in the creative PROBLEM SOLVING STARR with your team and use the STARR Problem Solving SheetTriggers – Explore using your knowledge of the person & what was happening at the time – with whom, when and where(TEACHH and CARE)State & describe the specific behaviourReport(Case Management Team & Documents)Where When WhoLook for patternsProblem Solving STARR methodThis is a practical way to problem solve a situation.Use the practical example of a situation which requires the provision of behavioural support. Point to the PPT as you go through the example, highlighting the steps (each point of the STARR). DO this as a large group exercise.Activity 5.5Large group problem solving STARR Problem Solving method. To work through the STARR method of problem solving (in a step by step method) as a large group to demonstrate how to use it.State and describe the behaviour concerned. Be specific. Write only what you observe the person to do. Do not use descriptive terms. Do not guess or make assumptions. Look for patterns – where? When? Who?Triggers (what happened immediately before the behaviour occurred.) Look for patterns ask where did the behaviour occur? When did it occur? Who was involved? This is an assessment of the situation to identify the trigger.Remember Triggers – Environment, Activity, Communication, Health and History. Ask what was the behaviour due to T-E-A-C-H-H and C-A-R-E.Action Strategies that address the triggers thereby reducing the behaviour and meeting unmet needs. This becomes the action plan for your team.Result Did your strategies in the action plan work? Have you discussed it as a team and documented the resultsReport Did you report the results the findings and put your strategies from the action plan into the person’s individual care plan?You will need to use a STARR Problem Solving Sheet to complete Activity 5.6 STARR Problem Solving Sheet.UNIQUE PERSONResult – Is your plan working? (Case Management Team)Action Plan – decide what you will do & do it!Teamwork
17 STARR Problem Solving Method Remember to:State the specific behaviour of concernState where, when and whoTriggers – environment, activity, communication, health, historyAction strategies /planResults – evaluate, is it working?Report and write it down – care planSTARR Problem Solving MethodHave PPT on displayActivity 5.6Using STARR Problem Solving Sheet Case Scenario 1To introduce and work through the STARR Problem Solving Sheet (in a step by step method) in a large group to demonstrate how to use it.Activity 5.7STARR Case Scenario 2. To work through the STARR method of problem solving in a small group using the Problem Solving Sheet with a different case scenario.
18 Handling crisis/difficult situations What do you do?Remain calmFollow guidelines for an immediate response to the situationGuidelines are NOT a substitute for thorough assessment and creative problem solving (which you can do later)Afterwards any incidents should be documented and reportedHandling crisis/urgent situationsCrisis or urgent situations requiring behavioral support usually occur when we are caught off guard i.e. at short notice to replace a team member who is sick or we are unfamiliar with a person with dementia for a number of reasons or we are in an awkward situation e.g. bathroom or commencing a new area of work.The most difficult and unsettling factor is not knowing what to do. The following guidelines will help you to give an immediate response in crisis situations. They aim to diffuse situations, make the environment safe and ’buy time’ for you to read a person’s care plan or ‘take a breather’. Situations may also arise when a person develops a new behaviour that you have not experienced before or has not been observed by your team before.The guidelines are not a substitute for comprehensive assessment and creative problem solving in providing behavioural support.18
19 If people/person in ‘tense/difficult’ situation: remain calm GuidelinesIf people/person in ‘tense/difficult’ situation:remain calmrespectfully remove one person or gently interrupt & redirect to a more settled activityensure the person and others are saferespond to underlying feelings and reassureIf person is not co-operating:reschedule the task, remove yourself and try later (do not push or force)Smile, encourage and give praise for desired behaviour as soon as possible.GuidelinesIf people/ person ... As per PPT.Guidelines should only be used when a new behaviour occurs unexpectedly (a crisis situation) and there is no care plan outlining strategies for that particular situation.It is important to remember that the guidelines are not a substitute for comprehensive assessment and creative problem solving in providing behavioural support.
20 5.3 Quality and legal issues Definition of restraint: ‘Any aversive practice, device or action that interferes with a person’s ability to make a decision or which restricts their free movement.’5.3 Quality and legal issuesDefinition ... As per PPT.Restraint is the act of removing another person’s freedom. You must follow the restraint policies and procedures of the service where you work.In aged care we aim toward restraint-free care environments.Restraints - You must be aware of and always remember to follow the restraint policies and procedures of the service where you work.
21 Must have consent from legal guardian or next of kin Types of restraintMust have consent from legal guardian or next of kinMust be a carefully considered clinical decisionOnly when all other alternatives to manage behaviours have been exhaustedApply the least restrictive and temporary principleTypes of restraintPhysicalChemicalPunishmentEnvironmentTypes of restraintThere are different types of restraint.There are extreme forms of restraint, which Commonwealth guidelines state are never to be used in aged care. E.g. Posey vest, manacles/shackles, soft wrist/hand restraints, seclusion and aversive treatment.Any form of restraint must be the least restrictive form and is only to be used as a last and temporary resort. It can only be used after a comprehensive assessment, use of preventative strategies, exhaustion of all reasonable alternatives and following consultation with the person or their legal representative (guardian), family, doctor and other relevant health professionals.The risks of using restraint must be weighed up against risks of not using restraint.
22 Common myths about restraint Restraints decrease falls and prevent injuriesRestraints are for the good of the clientRestraints make care giving more efficientThere is nothing else you can doCommon myths about restraintRestraints decrease … as per PPT.Activity 5.8Restraints myths and facts To help participants to explore the myths of restraints and counter them with facts.Have you ever seen anyone happy to be restrained?
23 Common myths about restraint Restraints decrease falls and prevent injuriesFact: Does not prevent but may cause other types of serious injuries (e.g. strangulation or asphyxia)Restraints are for the good of the clientFact: Immobilisation causes other problems (e.g. pressure sores, loss of bone and muscle mass etc. Also emotional issues e.g. panic, fear, boredom, loss of dignity e.g. how does the client look?Restraints make care giving more efficientFact: dehumanizing short term effect creates greater dependence, restricts creativity and individual care.e.g. whose need is being met?Common myths about restraintDiscuss results of Activity 5.8 with this PPT.Ask the participants what they think of the above statements and their answers to Activity 5.8Clarify and highlights the evidence that contradicts these myths.
24 Problems with use of restraints accidents involving restraints can cause serious injurychanges in body systems due to limited movementchanges in quality of life due to restriction of freedomBenefits of Restraint – Free EnvironmentsProblems with use of restraintsAccidents … as per PPT.Discuss second part of Activity 5.8Q. What can we do as alternatives to avoid restraints?The benefits of restraint free are as stated in slide.Everyone is entitled to dignity and freedom Restraint - free individuals can eat, dress and move independently, maintain their muscle tone and strength, interact with others and maintain their freedom and dignity.
25 Prevent and respond to abuse in line with organisation requirements Abuse of older people - definitionsA wide range of behaviours that cause harm to an older person... a term referring to any knowing, intentional or negligent act by a caregiver, or any other person, that causes harm, or a serious risk of harm, to a vulnerable adult.Prevent and respond to abuse in line with organisation requirementsQ. What is the procedure for reporting abuse of older people in your organisation?You all need to know this because it is part of your legal obligations as a worker in aged care.The reporting responsibilities of the ‘abuse of older people’ by staff in aged care services is the same irrespective of whether the setting is in the community or residential services. The management of the ‘abuse of older people’ report is different in residential and community services. This difference occurs because in the community you are on ‘private property’ whereas in residential you are on ‘private’ property.
26 Why are people with dementia so vulnerable to abuse? societal attitudes and negative stereotyping of may lead to a lack of recognition or awarenessOlder people often isolated and hidden from outside scrutinypeople may not be able to articulate the problem or may feel ashamedpeople may fear retaliation at home or in caresigns of abuse and neglect may be attributed to age related changes or accidentsguilty person under too much stress and scaredQ. Why are people with dementia so vulnerable to elder abuse?As per PPT.In residential care ‘abuse’ could be between a staff member and a person with dementia, one person resident in the ‘home’ hitting another person resident in the ‘home’ or unusual and unexplained bruising discovered by a care worker when undressing a person with dementia.There are different forms of abuse of older people in different settings of aged care.In community care ‘abuse’ could be a care worker noticing rope ‘burn’ marks on the wrists of an older person or deliberate neglect of an older person by another person.
27 Remember to always follow your workplace policies and procedures What would I do?A care worker in a panic and extremely anxious races up to you and says, ‘Bill just hit Joan!......’ I’ve never seen that before. I’ve only been working in this organisation for a week! What do I do?Q What would I do?This PPT is deliberately phrased in a way to shock or confront participants with the reality of what could occur to them in the workplace.Activity 5.9 What do I do?To help participants remember the essential and practical steps in responding to incidents of abuse in aged services.You need to read and know your organisation’s policy and procedures on elder abuse.Abuse of older people is a crime and must be reported.Q What is your responsibility?Follow your organisation’s policy and procedures. Generic guideline:ACT - If you witness abuse and are able, diffuse the situation and offer comfort to the abused person. But do not place yourself in danger.REPORT - Immediately report to your Team Leader, Manager, SupervisorWRITE – Record all your observations and discussions with person concerned. Fill out your organisation’s documentation e.g. Incident form.Always check that all participants in the group are feeling OK after having gone through this information. Are there any other questions?Remember to always follow your workplace policies and procedures
28 Key Messages 1. How is this person feeling at the moment? 2. How am I feeling at the moment?3. Team problem solving4. Quality care is reflected in clear documentationRememberHighlight each point in turn … as per PPT.Focus again on the uniqueness of individuals with dementia; the need to focus on the skills and abilities retained by the person and the importance of changing our responses to people with dementia.Remind participants to encourage and promote triggers for behaviours of contentment and avoid or prevent triggers for behaviours of concern.Invite questions and comments regarding their understanding of the contents of the module.Ask participants to complete evaluations.Activity 5.10Module RevisionTo help participants to self assess their understanding of the content in the module.To reinforce the learning that has occurred in this module.REMEMBER… to ask yourself. What is this person trying to tell me when they behave in this way?