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Neuromanagment > Behavior Management > Flashcards

Behavior Management Flashcards

1
Q

Why is behavior management needed sometimes?

A
  • It is needed for inappropriate and difficult behaviors that can result from dementia, delirium, frontal lobe impairment, brain injuries, and mood disorders
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2
Q

How can behavioral problems be a burden?

A
  • Time-consuming
  • Complicate ADLs
  • Stressful for caregivers and healthcare professionals
  • Financial cost of managing behaviors
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3
Q

What is behavior?

A

Behaviors can be a normal part of the recovery process, but must be dealt with productively so they do not lead to long-term destructive patterns of interaction

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4
Q

What is the intent of the behavior?

A
  • Always look at intent of behavior
  • Is the person trying to communicate a need, desire, or wish?
  • Is the person trying to cope with a stressor (acute or chronic)
  • Is the person displaying behaviors due to sensory impairment?
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5
Q

Why is it important to consider Maslow’s Hierarchy of Needs when assessing a client with behaviors?

A
  • Are the individual’s basic needs being met?
  • What is the individual’s emotional condition and background?
  • What is the client’s baseline for communicating and coping?
  • Are safety and security measures being met?
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6
Q

What should you assess in an environment?

A
  • Where are you and the client in relation to the exit?
  • Are there any possible dangers?
  • Do you need help? If so, how do you get it?
  • Are there any objects that could potentially be used as a weapon?
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7
Q

What should a therapist assess about oneself?

A
  • What is your emotional and physical status?
  • Will you ask for help?
  • Are you capable of managing yourself?
  • This is about helping others manage themselves, not about you controlling them
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8
Q

What is behavior like following an injury?

A

1) Verbal outbursts
2) Physical outbursts - pacing, throwing objects
3) Egocentrism
4) Sexually inappropriate
5) Rigidity/inflexibility
6) Impulsivity
7) Limited self-awareness

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9
Q

What are the ABC’s of behavior?

A
  • Antecedent: occur before behavior and are under staff/caregiver control
    • Internal factors: fatigue level, sensory sensitivity, does the person have seizures?
    • External factors: are used to decrease likelihood of outbursts by changing tone of voice, changing the setting, or grading the activity
  • Behaviors: observable. Develop a program with clear and concise directions
  • Consequences: occur after behavior and make it less/more likely to happen again. Use reinforcement as opposed to punishment
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10
Q

What are signs of behaviors?

A
  • Attempt for one to remove himself from task by pushing away activity or table
  • Increase in non-purposeful body movement, fidgeting, or self-stimulating
  • Loss of eye contact
  • Verbal comments indicating that the task is too difficult or frustrating
  • Increase in respiration, skin flushing
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11
Q

What should a therapist do if their patient is demonstrating unwanted behaviors?

A
  • Remain calm and use quiet voice
  • Remain concrete in responses
  • Be consistent in responses
  • Don’t overstimulate
  • Be patient
  • Treat patient as an adult
  • Redirect the patient
  • Take path of least resistance - if they are not hurting themselves or others then let them continue with group or activity
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12
Q

What are the steps to deal with dangerous behavior?

A

Step 1: remain calm and in control
Step 2: tell someone to notify supervisor or other qualified personnel in the area to provide assistance. Make sure they understand the urgency of the situation
Step 3: continue to speak in a calm, soft voice and tone
Step 4: move patient to a quiet area. Remove stimulation. One-to-one interventions are most effective
Step 5: re-direct attention and activity away from the agitation, incident, or situation
Step 6: if agitated behavior persists or escalates, or if additional personnel are delayed, change tactics. Know the security codes at different facilities
Step 7: follow-up with an incident report for the Medical Record. Incident report is for any change that you did not expect during treatment (ex: falls)

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13
Q

What can be changed in the environment to decrease stimulation?

A
  • Keep TV and radio to minimum
  • Create a quiet environment
  • Keep conversations and number of people talking to a minimum. This is difficult when family and friends come to visit
  • Keep environment consistent - if you move furniture or items around make sure you explain why and return them to their original place
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14
Q

How can communication decrease unwanted behaviors?

A
  • Speak slowly and in a normal tone and volume
  • Give patient time to respond to conversation or command
  • Use short simple sentences and repeat if necessary
  • If patient is perseverating, remind them that they are perseverating and switch activities
  • Forced choices - give patient a limited set of options
  • Avoid sarcasm
  • Avoid putting person “on display”
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15
Q

What are non-pharmacological treatments for problem behaviors?

A
  • Relaxation techniques
  • Distraction
  • Redirection
  • Reality orientation
  • Group programs
  • Validation therapy
  • Attitude therapy
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16
Q

What is redirection?

A
  • Appearing to agree with the person but helping person go in a different direction physically or conversationally without them thinking they are being forced to do something
17
Q

What is reality orientation?

A
  • Provide client with frequent reorientation to time, place, person, and situation
18
Q

When is validation therapy appropriate?

A
  • Recognizes that “reality” is altered
  • Time - not necessarily sequential, bounces around from past to present to future
  • Memory - familiar people become strangers, past mixes with present, but the real world will not define the dementia world
  • Emotions - difficulty with interpreting spoken language but can read non-verbal communication if it is amplified
19
Q

What is validation therapy?

A
  • Non-confrontational process
  • Validates or accepts values, beliefs, and the reality of the person with dementia
  • “Agrees” with what they want but by conversation person is steered to do something else without the person realizing that they are being redirected
  • Identifies unmet needs
  • When feelings are expressed and validated, feelings lose their strength
20
Q

What are examples of validation techniques?

A
  • Rephrase - repeat the client’s key words
  • Mirror their tempo and movements
  • Reflect the look in their eye
  • Listen to their verbs and use their preferred sense
  • Ask extreme questions - “how bad” or “how often”
  • Reminisce
21
Q

What is attitude therapy?

A
  • Developed as a method to manage situational emotional disorders which focuses on relationship approaches
22
Q

What is the active friendly attitude approach?

A
  • Useful for building self-esteem. Client is actively sought out, praised for recognizable success, and dealt with in an unconditional and warm manner
23
Q

What is the passive friendly attitude approach?

A
  • Waiting for client to invite you into conversation or relationship. Once invitation is extended, you can respond with a more active and friendly approach
24
Q

What is the mechanical attitude approach?

A
  • Allowing client to experience natural consequence of behavior without praise or criticism
25
Q

What is the kind firm attitude approach?

A
  • Setting up reasonable expectations for self-care and daily living skills. Kind but firmly insist that client meet these goals
26
Q

What is the no demand attitude approach?

A
  • Therapy is not initiated as client is out of control. De-escalate the situation by placing client in safe, secure, low stimulus area
27
Q

What is the TLC attitude approach?

A
  • Gentle care and kindness is provided to add joy, comfort, and dignity to final days
28
Q

What are specific restraint reduction alternatives for someone who wanders?

A
  • Use full length mirrors at exit points to distract wanderer
  • Use bright yellow barrier strip at the end of the door for the wanderer
  • Put a stop sign on the door
29
Q

What are specific restraint reduction alternatives for someone who squirms?

A
  • Use a foam wedge seat cushion to keep resident from sliding out of chair
  • Use lazy boy
  • Occupy the resident’s time
  • Make sure bed has bed rails or an alarm
30
Q

What are specific restraint reduction alternatives for someone who falls?

A
  • Use a hi-low bed
  • Put mattress on floor
  • Use a bed bell
  • Make sure bed has rails
  • Make sure shoes and socks have traction
31
Q

How can a restraint free environment be created?

A
  • Develop an education program
  • Focus on resident’s capabilities, rather than their deficits
  • Promote resident function
  • Minimize likelihood of resident needing to get up unaided
  • Customize seating for individual postural needs
  • Make environment as home-like as possible
  • Educate staff on how to manage agitated or disruptive behavior

Neuromanagment (22 decks)

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