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UNDERSTANDINGthe causes of behaviours that challenge
Sean PageConsultant Nurse - Dementia
A reductionist model of explanation
BehaviourD
MNE
I
A
E
T
• Changes in behaviour are as a direct consequence of dementia
• Most changes in behaviour are a problem
• That problem rests with the patient
• The solution to that problem rests with us
History
Premorbid personality
Physical health
Mental health
Environment
Cognitive status Lived experience
A broader explanatory approach
Lived experience
Filtered through Cognitive Abilities
Unmet need
Cohen-Mansfield’s Unmet Needs Model
Behaviour as an attempt to fulfil a need
Behaviour as means of communicating a need
Behaviour as outcome of frustration
Unmet need
Cohen-Mansfield’s Unmet Needs Model
Behaviour as an attempt to fulfil a need
Behaviour as means of communicating a need
Behaviour as outcome of frustration
Unmet need
A holistic model of explanation - Stokes & Goudie (2002)
Environment
Social Built
Behaviour
Context
HealthPerson
A holistic model of explanation - Stokes & Goudie (2002)
Environment
Built
Behaviour
Context
Built Environment
• ‘It is naïve to propose a deterministic view of the relationship between buildings and people who live in them. ….. Buildings can hinder or help the provision of quality care: in extreme cases they can prevent it but buildings by themselves can never provide it’
• ‘Quality of care depends upon staff morale, motivation and training. Hence it can be confidently argued that the quality of the social environment is of greater importance than the physical, for negative staff attitudes will negate the effects of even the best architectural design’.
A holistic model of explanation - Stokes & Goudie (2002)
Environment
Social
Behaviour
Context
Social Environment
• ‘Quality of care depends upon staff morale, motivation and training. Hence it can be confidently argued that the quality of the social environment is of greater importance than the built for negative staff attitudes will negate the effects of even the best architectural design’.
Aspects of MSP
• Accusation.• Banishment.• Disempowerment.• Disparagement.• Disruption.• Ignoring.• Imposition.• Infantalisation.
• Intimidation.• Invalidation.• Labelling.• Mockery.• Objectification.• Outpacing.• Stigmatisation.• Treachery.• Witholding.
From Kitwood (1991)
A holistic model of explanation - Stokes & Goudie (2002)
Behaviour
Context
Health
Physical health
A holistic model of explanation - Stokes & Goudie (2002)
Behaviour
Context
Person
The person
CBT cycle – understanding a person’s experience
Thoughts
Actions Feelings
What people say/shout
Observations & CT themes (anxiety, depression, anger)
What people do/don’t do
NEED
From Ian James public seminar 2005
TRIGGERS
Behaviour
Need & possible thoughts
Conversations or vocalisations
Mental health
Life story
Personality Social
environment
Physical health
Appearance
Neurological impairment
Medication
A holistic model of explanation - Stokes & Goudie (2002)
Environment
Social Built
Behaviour
Context
HealthPerson
