Week 7 - Approach to Challenging Behaviours Flashcards
Risk
‘refers to the possibility of a (usually) adverse outcome occurring when a person engages in destructive behaviour’
Behaviours related to risk include:
- risk of violence - reckless behaviour
- risk of aggression - financial vulnerability
- risk of self-harm - non-adherence to treatment
- risk of suicide - substance use
- risk of emotional trauma - risk of physical injury
Risk assessment and management
- comprehensive, collaborative and holistic assessment
- therapeutic communication and the therapeutic relationship
- de-escalation
- multi-disciplinary approach
- mindfulness of, and implementation of appropriate policy/policies
- consumer focus and family awareness
- respect and dignity
- safety
Anger
an emotion aroused because of a real or perceived threat to self, others or possession(s)
Aggression
a disposition that may lead to constructive or destructive actions but that usually has long-term negative consequences
Violence
the harmful and unlawful use of force or strength. The violent person is generally understood to refer to someone who attacks a
Anger can be categorised into 3 categories, which are:
- Physiological arousal
- Cognitive arousal
- Behavioural arousal
Psychoanalytic perspective of aggression
- Aggression as a response to frustration and/or pain
- conceptualised as an instinct, balanced by Thanatos and Eros
Behavioural and Cognitive perspective of aggression
Aggression is learned
Neurophysiological
- damage to the amygdaloid nucleus associated with violence
- temporal lobe epilepsy associated with episodic aggression and violence
- trauma to brain resulting in cerebral changes
- encephalitis
- brain tumour(s) especially in the limbic system and temporal lobes
Medical conditions linked with aggression
- COPD
- stroke
- dementia
- polypharmacy
- UTIs
Socioeconomic factors and environmental factors of aggression
Lack of infrastructure in communities Lack of employment Experience(s) of alienation amongst individuals -family break up / issues Inequality -race, culture, discrimination Poverty Substances: alcohol, other drugs
PREVENTION of aggression
Maintain a quiet and calm demeanour • Increase staff presence in the area (especially in the patient areas within the ward) to imbue calm • Regulate interaction patterns • Separate groups or individuals that ‘do not get along’ or may heighten the situation • Divide large groups into smaller groups • Reduce noise • Dim bright lights • Limit choices and create environmental cues • Allow most effective staff to take the lead • Identify and suppress trigger events • Maintain activity schedules that include diversional, physical, intellectual and relaxation activities for patients to engage in
DE-ESCALATE“Communicate & Act but do not React”
Take a deep breath (don’t just jump in; prepare yourself)
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Approach the person calmly
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Demonstrate control over the situation
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Continuously assess your safety and that of others
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Speak clearly, concisely, and slowly in short sentences; avoiding repetition
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Be respectful
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Listen actively and acknowledge the person’s concerns
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Identify the person’s needs and feelings
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Do not argue and do not tell the patient that you know how they feel (because you don’t)
Restraint
The use of manual/mechanical/chemical restraint should only e considered (used only as the last resort) when the patient or the person is at immediate risk of self-harm or harm to others and all reasonable steps have failed to seek resolution without physical contact
