Session 6 Understanding and responding to behaviours that challenge “Getting to Know Me”...
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Transcript of Session 6 Understanding and responding to behaviours that challenge “Getting to Know Me”...
Session 6Session 6Understanding 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
Social Built
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...
6.6
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/stimulati
onAnxiety
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 www.dtse.com.au
Alzheimer’s Australia professional, family and community education www.fightdementia.org.au
RDNS – Two day workshop ‘Dementia in focus’ Phone: 9536 5251 www.rdns.com.au
University of Wollongong Dementia Training Study Centre – Dementia education online
6.15