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