1. 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

2.  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 Aims 6.2 © Greater Manchester West Mental Health NHS Foundation Trust

3. "An abnormal reaction to an abnormal situation is normal behavior." Viktor Frankl (1946) 6.3 © Greater Manchester West Mental Health NHS Foundation Trust

4. What behaviours do you find most challenging? 6.4 © Greater Manchester West Mental Health NHS Foundation Trust

5. A holistic model of explanation of challenging behaviours - Stokes & Goudie (2002) Environment SocialBuilt Behaviour Context Health Person 6.5 © Greater Manchester West Mental Health NHS Foundation Trust

6.  Try to think of as many possible explanations for the following behaviours a patient who has dementia may exhibit on a hospital ward... Commonplace explanations for behaviours that challenge... 6.6 © Greater Manchester West Mental Health NHS Foundation Trust

7. 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 © Greater Manchester West Mental Health NHS Foundation Trust Perseveration

8. 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 © Greater Manchester West Mental Health NHS Foundation Trust Aggression

9.  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 Behaviour we find challenging: Hints and tips... 6.9 © Greater Manchester West Mental Health NHS Foundation Trust

10.  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 © Greater Manchester West Mental Health NHS Foundation Trust

11.  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 Summary of key themes 6.11 © Greater Manchester West Mental Health NHS Foundation Trust

12. Look out for… 6.12 © Greater Manchester West Mental Health NHS Foundation Trust

13. 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? Improving dementia care: What next? 6.13 © Greater Manchester West Mental Health NHS Foundation Trust

14. 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 References 6.14 © Greater Manchester West Mental Health NHS Foundation Trust