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Module five: Providing behavioural support to maintain well being.

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1 Module five: Providing behavioural support to maintain well being

2 Best practice 1 The person The family The environment The staff Relationships Philosophy of care

3 This module covers: 5.1 Understanding behaviour and providing behavioural support 5.2 Team problem solving and handling crisis/urgent issues 5.3 Quality and legal issues 5. Providing behavioural support 2

4 Learning outcomes At the end of this module you will be able to: Identify and document triggers that may influence behaviour Describe ways to increase behaviours of contentment and minimise behaviours of concern Explain an orderly approach to documenting behaviour management State the value in reviewing strategies implemented Prevent and respond to abuse 3

5 5.1 Understanding behaviour and managing behaviours We all behave, and have learned to behave appropriately in given situations through the responses of others The way we behave can indicate a sense of well- 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. 4

6 What is behaviour? Q. What do you think? 5

7 … 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 … 6

8 every behaviour usually has a variety of causes sometimes the real causes/triggers of behaviour are ‘invisible’ at the time the behaviour occurs, and require further investigation we need to know the person and try to see their world through their eyes we need to be person-centred, not behaviour centred Behaviour and being person-centred 7

9 Five 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. 8 Unmet needs

10 9 Personhood & Behaviours Needs Comfort Identity Attachment Inclusion Occupation Not Met Met Behaviours of concern Anger Anxiety Depression Sadness Behaviours of contentment Happiness Enjoyment Pleasure Engaged

11 ‘any behaviour which leads to a sense of well-being and enhancing a sense of personhood for the person’ Behaviours of Contentment 10

12 ‘any behaviour which causes distress to the person…or is a manifestation of distress’ Behaviours of Concern 11

13 Always ask yourself What is this person trying to tell me? How is this person experiencing the world at the moment? What need of this person is not being ‘met’? Who is concerned by this behaviour and why? 12 Always remember behaviours are a result of the dementia and not the true character of the person.

14 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’ 13

15 Ask these questions Too noisy, bright or cold Too complicated, unfamiliar Undignified, ignored, loud, Pain, hunger, thirst, infect Life experience, habit, likes Environment? Activity/task? Communication? Health? History ? Was the Trigger caused by person’s 14

16 5.2 Team problem solving The 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 the best of our abilities, so we can improve the person’s quality of life. 15

17 Go through the steps in the creative PROBLEM SOLVING STARR with your team and use the STARR Problem Solving Sheet UNIQUE PERSON S tate & describe the specific behaviour Where When Who Look for patterns Triggers – Explore using your knowledge of the person & what was happening at the time – with whom, when and where (TEACHH and CARE) A ction Plan – decide what you will do & do it!Teamwork R esult – Is your plan working? (Case Management Team) R eport (Case Management Team & Documents) Problem Solving STARR method 16

18 STARR Problem Solving Method Remember to: State the specific behaviour of concern State where, when and who Triggers – environment, activity, communication, health, history Action strategies /plan Results – evaluate, is it working? Report and write it down – care plan 17

19 Handling crisis/difficult situations What do you do? Remain calm Follow guidelines for an immediate response to the situation Guidelines are NOT a substitute for thorough assessment and creative problem solving (which you can do later) Afterwards any incidents should be documented and reported 18

20 Guidelines If people/person in ‘tense/difficult’ situation: remain calm respectfully remove one person or gently interrupt & redirect to a more settled activity ensure the person and others are safe respond to underlying feelings and reassure If 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. 19

21 Restraints - You must be aware of and always remember to follow the restraint policies and procedures of the service where you work. 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.’ 20

22 Types of restraint Physical Chemical Punishment Environment Must have consent from legal guardian or next of kin Must be a carefully considered clinical decision Only when all other alternatives to manage behaviours have been exhausted Apply the least restrictive and temporary principle 21

23 Common myths about restraint Restraints decrease falls and prevent injuries Restraints are for the good of the client Restraints make care giving more efficient There is nothing else you can do Have you ever seen anyone happy to be restrained? 22

24 Common myths about restraint Restraints decrease falls and prevent injuries Fact: Does not prevent but may cause other types of serious injuries (e.g. strangulation or asphyxia) Restraints are for the good of the client Fact: 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 efficient Fact: dehumanizing short term effect creates greater dependence, restricts creativity and individual care. e.g. whose need is being met? 23

25 Problems with use of restraints accidents involving restraints can cause serious injury changes in body systems due to limited movement changes in quality of life due to restriction of freedom 24 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. Benefits of Restraint – Free Environments

26 Prevent and respond to abuse in line with organisation requirements 25 Abuse of older people - definitions A 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.

27 Why are people with dementia so vulnerable to abuse? societal attitudes and negative stereotyping of may lead to a lack of recognition or awareness Older people often isolated and hidden from outside scrutiny people may not be able to articulate the problem or may feel ashamed people may fear retaliation at home or in care signs of abuse and neglect may be attributed to age related changes or accidents guilty person under too much stress and scared 26

28 Remember to always follow your workplace policies and procedures 27 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?

29 Key Messages REMEMBER… to ask yourself. What is this person trying to tell me when they behave in this way? 1. How is this person feeling at the moment? 2. How am I feeling at the moment? 3. Team problem solving 4. Quality care is reflected in clear documentation 28

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