Session 6 Understanding and responding to behaviours that challenge “Getting to Know Me” Enhancing Skills in the Care of People with Dementia 6.1
Aims 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
What behaviours do you find most challenging? 6.4
A holistic model of explanation of challenging behaviours - Stokes & Goudie (2002) Environment SocialBuilt Behaviour Context Health Person 6.5
Commonplace explanations for behaviours that challenge... Try to think of as many possible explanations for the following behaviours a person who has dementia may exhibit
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) Exploring, or searching for the familiar Avoidance of noise/stimulation Anxiety Failing to find the way (poor singage) Walking / Pacing Perseveration 6.7
Approaching the person abruptly, or approaching from behind 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) Aggression 6.8
Behaviour we find challenging: Hints and tips... 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 person’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
Summary of key themes 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
Look out for 6.12
Improving dementia care: What next? 1.What changes will you make personally? 2.What changes can be made to the environment? 3.What wider/bigger changes would you like to see happening to improve care in hospital and the community? 6.13
References 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
Additional training Dementia Training Study Centres – Vic & Tas Training, Innovation, Mentoring and Education (TIME) for Dementia: an overview Alzheimer’s Australia professional, family and community education RDNS – Two day workshop ‘Dementia in focus’ Phone: University of Wollongong Dementia Training Study Centre – Dementia education online 6.15