Respond to BoC Flashcards
Respond effectively to behaviours of concern
Behaviours of concern may be described as:
negative behaviours
often erratic and unpredictable behaviour
may be difficult to control.
The behaviour may also threaten the physical safety of that person or others.
(9) Examples of behaviours of concern:
Aggression
Confusion or other congnitive impairment
Noisiness
Manipulation
Wandering
Self-destructive actions
Intoxication
Verbal offensiveness/abuse
Intrusive behaviour(12) Background factors that might contribute to behaviours of concern:
Environmental factors:
The less choice a person has about how they spend their time and arrange their personal affairs, the more the environment will impact on their level of frustration. Competition for space, company, belongings, jealousy, too much noise and not enough stimulation.
Health and medical issues:
Feelings of discomfort.
Side effects from medications, uncontrolled pain, insomnia, depression and fatigue are common factors in altering mood and judgment. Some people may have panic/anxiety attacks at particular noises or a change in routine.
Emotional factors:
Anxiety, depression and loss of abilities or control.
Loss of privacy, intimacy and a sense of coming and going when you want.
Interpersonal issues:
People receiving healthcare may feel that they are being treated differently by their friends and family. Through their inability to communicate effectively, for example from dementia, or a stroke, many families do not know how to communicate or relate with their loved one. In turn, this is a trigger for aggressive behaviour. Frustration and confusion are very common triggers.
Routine and Consistency:
Disruption to regular routines can be upsetting for residents - many feel as this is one of the few things that they have control over. People can become anxious and angry over simple disruptions to their daily routine if no feasible explanation is offered.
Lack of stimulation:
Might resort to drastic measures to make life ‘interesting’. The creation of a disruptive incident can break the boredom cycle.
Disturbing stimulation:
Loud TVs or radios and confusing sounds from other people’s conversations can lead people to try escape to a more peaceful environment. If a person is unable to find a more peaceful environment, they may take out their frustrations on other residents or objects.
Pain:
Aggressive and challenging behaviour can be caused by pain. If a person is unable to express pain verbally or through gesture, they may express their discomfort through agitated behaviour.
Diet:
Clients may not like what they are having for lunch, or just may not like the cooking at the facility.
Fear:
Unfamiliar surroundings and people, unpredictable demands, rejection by family, fear of bodily harm, feelings of helplessness or a loss of self-control.
Grief:
A person’s grief needs to be addressed and supported. Patients can become disruptive and incredibly angry — a trigger for challenging behaviour.
Mental illness:
Mental illness is very diverse, so various stimuli can cause challenging behaviour. Seek specialised intervention to determine possible triggers for residents with mental illness.
Drugs with links to challenging behaviours:
Alcohol = violence
Psychostimulants (meth/ice, speed, cocaine, dexamphetamine [prescribed] ) = anxiety, fear, aggression, anger and psychosis.
Also, Withdrawal after drugs/alcohol.
Signs of recent psychostimulant abuse:
Fast, loud, difficult-to-interrupt speech; Agitation (pacing, fidgeting); Impulsive/reckless behaviour; Sweaty; Clenched jaw or grinding teeth; Large pupils.
A policy for managing behaviour of concern includes:
Assessment of the client to develop an individual behaviour plan;
Consent of client relating to behaviour support practices;
Behaviour plans, including risk assessment, client history and management guidelines for identified behaviours;
A crisis management plan individual to the client
Monitoring behaviour of concern:
helps identify the trigger for behaviour and formulate an intervention to reduce the likelihood of a critical incident
Things to record:
Detailed description of the behaviour;
Analysis of the context in which the behaviours occur - where/when;
Strategies for managing the behaviours;
Interventions that can be used effectively;
Client’s mental capacity;
Client’s health;
Circumstances surrounding the incident observed;
What leads up to the behaviour;
The setting – equipment organisation, group dynamics, staff changes etc;
Responses by others – staff and clients – toward the behaviour.
Developing a plan of action:
The cyclical process of observing, analysing, interpreting and planning positive guidance strategies is basic to good care and best outcomes for clients who display difficult and challenging behaviour.
After observing and identifying the behaviour and its possible triggers in consultation with others, consider how the behaviour can be prevented or responded to appropriately in the future by developing a plan of action.
3 factors in responding to Behaviours of Concern:
Develop an understanding of the client’s needs by:
having a thorough knowledge of the person displaying the challenging behaviour;
being aware of possible causes of that behaviour for that client.
Liaise closely with your work colleagues and be open to ideas that come up during discussions.
If the behaviour is ongoing and of concern, involve other appropriate staff in developing a plan to deal with the situation. Professional resource personnel and referral bodies might be brought in to advise a course of action. Ideally, a partnership will evolve in which the best outcome for the client is ensured.
Employers’ duty of care in regards to preventing or minimising harm that may occur as a result of challenging behaviours:
Ensure access to suitable communication systems/alarms;
Provide support when needed;
Have relevant & up-to-date procedures and guidelines;
Ensure mandatory reporting of incidents
When not to approach a client displaying behaviour of concern:
You do not feel confident or are in doubt;
They are enclosed in a small space with no exit;
They have a weapon;
They are making treats to harm others;
They are already too hostile, fearful or intoxicated to respond.
Behaviours of concern should be managed:
Promptly, firmly and diplomatically and in accordance with your organisation’s policies and procedures.
Promptly: can often prevent the escalation of certain situations
Firmly: you display confidence and assertiveness and the ability to effectively deal with the situation.
Diplomatically: being sensitive and tactful toward the individual is more likely to achieve a positive result.
Three times to manage behaviours of concern in the workplace:
Before: Implement preventative measures to minimise the possibility of negative behaviour occurring.
During: It is not always possible to anticipate inconsiderate or aggressive actions. If prevention has not been successful, use strategies that have been identified for that client. These must allow the client to regain control and prevent injury to the client or staff.
After: Debrief the client to assist them in addressing underlying issues that might have contributed to the incident
By far the best outcome for both client and staff is achieved if preventative measures are successfully implemented. However if this has not occurred, strategies must be used during an incident that will quickly bring the incident to a successful conclusion.
If nothing else is attempted the situation will become a critical incident. If an incident has occurred, a report will be made and the relevant people/agencies notified.
Selecting a strategy/response for a BoC incident:
The client perception that a basic need has not been met is often the trigger for behaviours of concern. Selecting the appropriate strategy for dealing with behaviours of concern will depend on:
The nature of the incident;
The potential effect on different persons involved (clients, staff and others);
Established procedures and guidelines.
three responses to challenging behaviour:
Reaction
Planned intervention
Prevention
Reacting to challenging behaviour:
Sometimes urgent action is required to ensure everyone’s safety. Organisations will have policies and procedures in place covering this.
The general rules are to:
Protect people and property;
Try to distract the person or calm them down;
Do not crowd the person;
Try to work out what triggered the behaviour;
See if it can be resolved immediately;
Use minimal force or confinement.
Examples of reactive strategies are removing everyone from the place where the behaviour is occurring and directing the person to a quiet area, such as a backyard.
