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
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"An abnormal reaction to an abnormal situation is normal behavior."
Viktor Frankl (1946)
6.3
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6.4
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A holistic model of explanation of
challenging behaviours -
Stokes & Goudie (2002) Environment
Social Built
Behaviour
Context
Health Person
6.5
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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
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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
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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
© Greater Manchester West Mental Health NHS Foundation Trust
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
© Greater Manchester West Mental Health NHS Foundation Trust
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
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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
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6.12
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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
© Greater Manchester West Mental Health NHS Foundation Trust
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
© Greater Manchester West Mental Health NHS Foundation Trust