module five provding behavioural support to maintain well being - participant guide
TRANSCRIPT
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Module five: Providing behavioural support to maintain well beingparticipant guide 1
Demystifying dementia care
Module five:
Providing behavioural support
to maintain well being
Participant guide
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Module five: Providing behavioural support to maintain well beingparticipant guide 2
About this guide
Welcome to module five of the Demystifying dementia course. This module uses thecontents of Modules one to four to develop practical strategies to prov ide behavioural
support for people with dementia using a problem solving approach.
Most importantly this means being aware of the importance of relationshipsbetween yourselfand people with dementia whom you are assisting, their environment, their family and yourorganisations philosophy of care.
This workbook has been designed to be used during the workshop, and also holds someuseful resources to refer back on after the workshop. Your facilitator will guide you through theactivities along the way. Take lots of notes, as this will become a valuable resource for youlater.
Aim
The aim of this module is to assist you to identify triggers for behaviours of concern andbehaviours of contentment and develop practical strategies to manage the consequentbehaviour. The module also addresses the importance of identifying practical strategies toprevent or avoid triggers that lead to behaviours of concern.Specifically we will be covering:
5.1 Understanding behaviour and providing behavioural support5.2 Team problem solving and handling crisis/urgent issues5.3 Quality and legal issues
Outcomes
At the end of this module, you will be able to: Identify and document triggers that may influence behaviour Describe ways to increase behaviours of contentment and minimise behaviours of
concern Explain an orderly approach to documenting behaviour management State the value in reviewing strategies implemented Prevent and respond to abuse.
The icons
At times you will see icons in this book, these prompt you to 'do' something, and are explained
below:
This icon promptsyou to answer a
question and prepareto share with the rest
of the group.
This icon promptsyou to write
something down.
This icon promptsyou to discuss
something with apartner and thennote your ideas.
This icon promptsyou to refer to theadditional notes
section at the back ofthis book.
We hope that you enjoy this module, and welcome your feedback.
Module five: Providing behavioural support tomaintain well being - overview
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Module five: Providing behavioural support to maintain well beingparticipant guide 3
We all behave, and have learned to behave appropriately in given situations through theresponses of others. The way we behave can indicate a sense of well being(satisfaction/contentment) or a sense of ill being (suffering/discomfort). The behaviour of aperson with dementia is the same. It can indicate a sense of well being or a sense of illbeing.
Let's start the module by taking a look at the behaviours of people with dementia and tryingto understand what their need is.
5.1 Understanding behaviour and managing behaviours
There is behaviour around us all the time.There are behaviours of contentment (indicating a sense of well-being)which we want to reinforce and maximise and behaviours of concern(indicating a sense of ill being) which we want to prevent or minimise.
5.1 Understanding behaviour and managing behaviours
Behaviours and unmet needs
What did you notice about the relationship between the registered nurse (Lisa) on night duty andthe nursing student (Olivia) on night duty?
What impact did the registered nurse have on the nursing student in regard to managing thebehaviour of Beryl who has a form of dementia?
What was good practice?
What was bad practice?
In the morning there were more interactions between the day senior registered nurse (Virginia) onday shift, the registered medical officer (Dr Trudy David), the night staff and Beryl.
What was good practice?
What was bad practice?
What did the junior podiatrist (Tony) do to trigger a very vocal reply and some distressed behaviourfrom Beryl?
What did the senior podiatrist (Nick) do to work effectively with Beryl?
Dvd clip 9
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Test your knowledge
Answer the questions below to gain insight into behaviours
Be aware of countering what is usually a negative way of defining behaviour.Behaviour can be behaviours of contentment as well as behaviours of concern.
Complete the activity below in relation to your own experiences.
5.1 Understanding behaviour and managing behaviours
What is behaviour?
What is behaviour?
How is it managed?
Type of behaviour that happens in youreveryday work with people withdementia
What needyou think the person withdementia is expressing through thatbehaviour(What are they trying to tell you?)
Example: They withdraw to their room Example: I feel frightened andoverwhelmed by other people around me
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Module five: Providing behavioural support to maintain well beingparticipant guide 5
Let's take a moment to explore behaviour from a personalperspective.
How do you behave when happy, sad, angry, and cranky?
Imagine you have just finished a week in which work has been really hard and exhausting. Youarrive home ready for the weekend. You have taken off your shoes and are ready to enjoy arare time when you can just relax and have a bit of time to yourself.
Your partner comes into the room from being outside and says, Ive just invited the neighboursaround for a casual dinner tonight. I promised them that you would cook your signature dish. (You know this takes at least two hours to prepare and cook).
How do you feel?
What do you say?
What would your responsive behaviour be?
5.1 Understanding behaviour and managing behaviours
What is behaviour?
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Behaviour is...
What we do(or dont do)in response to internal or external stimulus
What we do all of the time (we all behave), and have learned to behave appropriately
in given situations through thepositive or negative responsesof others
Behaviour can indicate a sense of well being ( contentment) or a sense of ill-being(concern)
The behaviour of a person with dementia is no different.
We most often think of behaviouras negativebehaviours of concern
indicating ill-being and either
outward
(overt) e.g. punching, scratching,wandering, shouting etc.) or and equally important as inward(omission)
e.g. withdrawal.
But we should put just as much emphasis on behaviours of contentmentwhich indicate well being e.g. happiness, enjoyment, laughing.
5.1 Understanding behaviour and managing behaviours
What is behaviour
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Every behaviour usually has a variety of causes.
Sometimes the real causes/triggers of behaviour are invisibleat the time the behaviour occurs, and require further investigation.
We need to know the person and try to see their world through their eyes.We need to beperson-centred, not behaviour-centred.
Behaviour and being person-centred:
We need to be creative in our thinking and approaches.
It is important to step into the worldof the person with dementia and try to tune
into how the person with dementia might be feeling.
It is equal ly impo rtant for staf f to recognise their own feelings andfrustrat ions:
We work in an emotional environment where we respond to people on an emotionallevel. This can occur without being given the emotional support required to help uspractise in the best way to maintain our own sense of well being.
Managing our emotions and showing empathy but not feeling overwhelmed by ouremotions is an important skill in aged care.
Refer to the additional notes section at the back of this guide for moreinformation on person-centred care.
5.1 Understanding behaviour and managing behaviours
Behaviour and being person-centred
In your own words describe the difference between person-centred and
behaviour-centred.
Person-centred is...
Behaviour-centred is...
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The condition of dementia over time results in a multitude of losses. Five common unmetemotional needs are listed below. Take notes as your facilitator explains each further.
Sometimes these essential needs (that we all have) are not met by our assistance and care.
The behaviour of a person with dementia is trying to tell us they have an unmetneed.
When social inhibitions lift and verbal communication diminishes (because of the condition ofdementia), it is more likely that the person with dementia will become more direct in theirexpressions. Thus the way they express their unmet needs can be unexpected, strong, oreven aggressive.
We often need to change our approach
Our inappropriate approaches may increase behaviours of concern
The person best equipped to improve the situation is us, not the person with dementia
Our attitudes and approach to the person has the power to change the emotionalenvironment.
Our actions can create both happiness (a sense of well being) or
harm (a sense of ill being).
5.1 Understanding behaviour and managing behaviours
Unmet needs
Comfort
Identity
Attachment
Inclusion
Occupation
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A person with dementia behaves in a way that tells us that their need is met (content) or notmet (concern).
Our aim is to meet the need of the person with dementia and trigger behaviours ofcontentment.
We need to avoid triggers of concern.
5.1 Understanding behaviour and managing behaviours
Personhood and behaviours
MET
NOT MET
Additional notes
Behaviour can be either not just behaviours of concern!
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Behaviours of contentment are ... 'Any behaviour which leads to asense of well-being and enhancing a sense of personhood
for the person
Behaviours of contentment
If a persons need is met by our assistance and care it will lead to behaviours ofcontentment.For example, happiness, enjoyment, satisfaction, pleasure, engagement, helpfulness,usefu lness, purposefulness, increasing comfort, decreasing anxiety, decreasing pain,leading to enhanced personhood and a sense of well-being for the person with dementia(and possibly care staff, family members or those around them).
Encouragingand promot ing triggers for behaviours of contentment is a key to achievingthe best quality of life for the person with dementia and may also present as an approach toaddress occupational health and safety concerns for all staff.Often our approaches to promote behaviours of contentment can be a solution to preventingor avoiding behaviours of concern.
5.1 Understanding behaviour and managing behaviours
Behaviours of contentment
Additional notes
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Behaviours of concern are ...'Any b ehaviour w hich causes distressto the personor is a manifestation of distress
Behaviours of concern
If a persons need is not met(i.e. an unmet need) by our assistance and care it can lead tobehaviours of concern.For example, anger, depression, sadness, shou t ing, sw earing, hi t t ing, throw ing,increasing anxiety, decreasing comfort, increasing pain, leading to diminished personhoodand a sense of ill-being for the person with dementia (and possibly care staff, familymembers or those around them).
Avoid ing or prevent ing triggers for behaviours of concern is a key to achieving the bestquality of life for the person with dementia and may also present as an approach to address
occupational health and safety concerns for family and all staff.Often our approaches to avoid or prevent behaviours of concern can be the solution toencouraging and promoting behaviours of contentment.
5.1 Understanding behaviour and managing behaviours
Behaviours of concern
Additional notes
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There are some key questions we can ask to help us betterunderstand behaviours. Fill in the blanks in the spaces belowas your facilitator introduces you to them
What concerns you, might no t concern the
person w ith the behaviour!
5.1 Understanding behaviour and managing behaviours
Key questions to ask
What is the trying to me?
How is this person the world at the ?
What of this person is being met?
Who is by this and why?
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Fill in the gaps below as your facilitator introduces you to the behaviour chain.
The behaviour chain
A behaviour is a response to a trigger(antecedent antemeans preceding). Behaviourusually does not happen in a vacuum. The trigger could be outside in the environment orwithin the person (physical or emotional). Behaviour is behaviourand people in theenvironment classify it as goodor bad.
Always be specific when describing behaviour. Do not say the person is aggressivebutrather the person swore loudly i.e. what made you think the person was aggressive. Whatdid they say or do? What did their body tell you?
Consequencesoccur as a result of the behaviour. What happens as a result of thebehaviour e.g. all staff come running to see what happened.
5.1 Understanding behaviour and managing behaviours
The behaviour chain
A B C
Additional notes
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There are triggersthat we can change and triggersthat we cannot change.
Work through the activity below, answer the questions to learn more.
Potential triggers Can you changeor use?
Place a tick or cross toindicate your answer
If you can change or use, give anexample from your everyday work
The personspersonality
The physical andsocial environmentaround the person
The way of doing theactivity or task
The type ofprogressive illnesscausing the form ofdementia
The persons state ofhealth
The persons socialhistory, andbackground e.g.culture, religion etc
.
The way peoplecommunicate to theperson
5.1 Understanding behaviour and managing behaviours
What you can and cannot change
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There as some things we cannot change in regards to the condition of dementia.We cannotchange:
the disease (there is no cure yet!).
the persons personality.
a persons biography but we can use their story.
But we canchange most triggers.Complete the TEACHH triggers below as they are introduced to you by your facilitator.
5.1 Understanding behaviour and managing behaviours
TEACHH trigger questions
Was the trigger caused by:
T
E
AC
H
H
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The goal of creative problem solving is to:
improve the quality of life for older people in need and to make a difference in their life.
Individuals with behaviours of concern have unmet needs.
Our goal is to identify those needs and attempt to addressthem to the best of our abilities
so we can improve the persons quality of life.
No one can do it on their own.
We need to work and problem-solve as a team.
We need to acknowledge the strength of each teammember and what they contribute to assistance and
care.
We need to communicate effectively.
We need to support and reassure each other.
5.2 Team problem solving
The goal of creative problem solving
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Problems can be solved in a practical way using STARR.
Take notes on this useful concept as your facilitator introduces you to STARR.
State and describe the behaviour concerned. Be specific. Write only what you observe theperson to do. Do not use descriptive terms. Do not guess or make assumptions. Look forpatterns Where? When? Who?
Triggers(what happened immediately before the behaviour occurred.) Look for patterns.Ask where did the behaviour occur? When did it occur? Who was involved? This is anassessment of the situation to identify the trigger.Remember triggers environment, activity, communication, health and history. Ask what was
the behaviour due to TEACHH and CARE.
Act ion Strategies that address the triggers thereby reducing the behaviour and meetingunmet needs. This becomes the action plan for your team.
Result Did your strategies in the action plan work? Have you discussed it as a team anddocumented the results?
Report Did you report the results of the findings and put your strategies from the action planinto the persons individual care plan?
5.2 Team problem solving
STARR problem solving method
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Let's work through an activity together to discover how STARR works. Your facilitator will
provide more instructions.
STARR PROBLEM SOLVING SHEETName: Record Number: XXX XXX XXX
Date: Time: Recorded by:
What happened? (S)[Be specific and describebehaviour of concern]
Where did ithappen? (S)
When did ithappen? (S)
Who was there? (S)
(T) Triggers[What happened before thebehaviour. Consider triggers related
to EACHH. You do not have to havea trigger for each one]
(A) Actions (R) Result
Environment
Activity
Communication
Health
History (social)
5.2 Team problem solving
Putting STARR into practice
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It's over to you... Your facilitator will provide you with a case study. With the team at your table
complete the STARR problem solving sheet as best you can.
STARR PROBLEM SOLVING SHEETName: Record Number: XXX XXX XXX
Date: Time: Recorded by:
What happened? (S)[Be specific and describebehaviour of concern]
Where did ithappen? (S)
When did ithappen? (S)
Who was there? (S)
(T) Triggers[What happened before thebehaviour? Consider triggers related
to EACHH. You do not have to havea trigger for each one]
(A) Actions (R) Result
Environment
Activity
Communication
Health
History (social)
5.2 Team problem solving
Putting STARR into practice
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STARR PROBLEM SOLVING SHEETName: Record Number: XXX XXX XXX
Date: Time: Recorded by:
What happened? (S)[Be specific and describebehaviour of concern]
Where did ithappen? (S)
When did ithappen? (S)
Who was there? (S)
(T) Triggers[What happened before thebehaviour? Consider triggers related
to EACHH. You do not have to havea trigger for each one]
(A) Actions (R) Result
Environment
Activity
Communication
Health
History (social)
5.2 Team problem solving
Putting STARR into practice
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Apply the principles of STARR for practical problem solving:
Remember to:
State the specific behaviour of concern
State where, when and who
Triggersenvironment, activity, communication,
health, history
Action strategies /plan
Resultsevaluate, is it working?
Report and write it downcare plan
5.2 Team problem solving
STARR revised
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Handling crisis difficult situationsCrisis or urgent situations requiring behavioural support usually occur when we are caughtoff guard i.e. at short notice to replace a team member who is sick or we are unfamiliar with aperson with dementia for a number of reasons or we are in an awkward situation e.g.bathroom or commencing a new area of work.
The most difficult and unsettling factor is not knowing what to do. The following guidelineswill help you to give an immediate response in crisis situations. They aim to diffusesituations, make the environment safe and buy time for you to read a person s care plan ortake a breather. Situations may also arise when a person develops a new behaviour thatyou have not experienced before or has not been observed by your team before.
The guidel ines are not a subs t i tute for comprehensive assessment and creat ive
problem so lv ing in prov id ing behav ioural support .
Guidelines should only be used when a new behaviour occurs unexpectedly (a crisissituation) and there is no care plan outlining strategies for that particular situation.
It is important to remember that the guidel ines
are no t a subst i tute for comprehensive
assessm ent and creat ive problem so lv ing
in provid ing behavioural suppor t .
5.2 Team problem solving
Handling crisis/difficult situations
Guidelines:
If people/person in tense/difficult situation:
remain calm
respectfully remove one person or gently interrupt and redirect to a more settled
activity
ensure the person and others are safe
respond to underlying feelings and reassure
If person is not co-operating:
reschedule the task, remove yourself and try later (do not push or force)
smile, encourage and give praise for desired behaviour as soon as possible.
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Restraint is the act of removing another persons freedom. You must follow the restraintpolicies and procedures of the service where you work.
In aged care we aim toward restraint-free care environments.
Types of restraint
There are extreme forms of restraint, which Commonwealth guidelines state are never to beused in aged care. e.g. Posey vest, manacles/shackles, soft wrist/hand restraints, seclusionand aversive treatment.
Any form of restraint must be the least restrictive form and is only to be used as a last andtemporary resort. It can only be used after a comprehensive assessment, use of preventativestrategies, exhaustion of all reasonable alternatives and following consultation with the personor their legal representative (guardian), family, doctor and other relevant health professionals.
The risks of using restraint must be weighed up against risks of not using restraint.
You must be aware of and always remember to follow the
restraint policies and procedures of the service where you work.
5.3 Quality and legal issues
Restraints
Definition of restraint:
What are the different types (categories) of restraints?
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To help you to explore the myths of restraints and counter them with facts, complete theactivity below with the team at your table as best you can
Reason to restrain Why is this reason a myth?
Restraints decrease falls andprevent injuries
Example: Some people have died from slippingdown and choking in a restraint
Restraints are for the good of theclient
Restraints make care giving moreefficient
There is nothing else you can do
Have you ever seen anyone happy to be restrained?
5.3 Quality and legal issues
Common myths about restraints
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The problems associated with the use of restraints include:
accidents involving restraints can cause serious injury
changes in body systems due to limited movement
changes in quality of life due to restriction of freedom
5.3 Quality and legal issues
Restraint alternatives
What are the benefits of restraint-free environments?
What can we do as alternatives to avoid restraints?
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The reporting responsibilities of the abuse of older peopleby staff in aged care services isthe same irrespective of whether the setting is in the community or residential services. Themanagement of the abuse of older peoplereport is different in residential and communityservices. This difference occurs because in the community you are on a personsprivate
propertywhereas in residential you are on
private
property.
There are different forms of abuse of older people in different settings of aged care.In residential care abusecould be between a staff member and a person with dementia,one resident in the homehitting another person/resident in the homeor unusual andunexplained bruising discovered by a care worker when undressing a person with dementia.
In community care abusecould be a care worker noticing rope burnmarks on the wristsof an older person or deliberate neglect of an older person by another person.
5.3 Quality and legal issues
Preventing and responding to abuse
Abu se of old er people - def in i t ions
'A wide range of behaviours that cause harm to an older person'
'.. a term referring to any knowing, intentional or negligent act by a caregiver,or any other person, that causes harm, or a serious risk of harm, to a
vulnerable adult'.
What is the procedure for reporting abuse of older people in yourorganisation?
You need to know this because it is part of your legal obligationsas a worker in aged care.
Why are people with dementia so vulnerable to abuse?
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Test your knowledge:
Read the scenario below and answer the questions around responding to abuse.
A care worker who is in a panic and extremely anxious races up to you andsays, Bill just hit Joan!...'Ive never seen that before. Ive only been working
in this organisation for a week! What do I do'?
5.3 Quality and legal issues
Preventing and responding to abuse
What would you advise your colleague to do?
Abuse of older people is a crime and must be reported.
Follow your organisations policy and procedures.
Generic guideline:
ACT - If you witness abuse and are able, diffuse the situation and offer comfort tothe abused person. But do not place yourself in danger. If abuse is alleged(whether the person has dementia or not) you must also REPORTand WRITE.
REPORT- Immediately report to your team leader, manager, supervisor
WRITERecord all your observations and discussions with person concerned. Fill
out your organisations documentation e.g. Incident form.
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Lets review what we have covered in this module
How is this person feeling at the moment?
How am I feeling at the moment?
Team problem solving STARR
Quality care is reflected in clear documentation
Keys to successRemember ... to ask yourself: 'What is thisperson trying to tell me when they behave inthis way?
Remember....focus again on theuniqueness of individuals with dementia; theneed to focus on the skills and abilitiesretained by the person and the importance
of changing our responses to people withdementia.
Module review
Key messages
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This activity will help you to self assess your understanding of the content in this module andto reinforce your learning that has occurred.
Multiple choice. Circle the letter of the correct answer.
1. The condition of dementia is a result of changes that take place in the brain and affectsthe persons:
A. MemoryB. MoodC. BehaviourD. All of the above
2. A persons behaviour can be in response to:A. Their environmentB. The people they are interacting withC. Their physical well beingD. All of the above
3. A person with dementia may have lost the ability to:A. Solve problemsB. Think of a rational solutionC. Respond with controlD. All of the above
4. If you can discover the trigger that influences the behaviour then you can:A. Ignore the behaviourB. Prevent or respond to the situation in the futureC. Isolate the personD. All of the above
5. For people with dementia, medical conditions which may result in behaviours of concerninclude:
A. Urinary Tract Infection (UTI)B. DehydrationC. PainD. All of the above
6. It is really important to report a change in the behaviour of a person with dementiabecause:
A. It gives you something to write in the progress notesB. The family of the person will request it
C. It may indicate a medical condition that needs treatmentD. All of the above
7. It is important to document any changes in the behaviour of a person with dementia soyou can:
A. See patterns of behaviour over certain periods of timeB. Identify triggers that influence the behaviourC. Provide clear evidence of behaviour in case review/conference meetingsD. All of the above
Module review
What did you learn?
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8. When providing assistance for a person with dementia showing behaviours of concernyou need to remember:
A. The behaviours are not deliberateB. Dont take it personallyC. The behaviours are not necessarily in the persons controlD. All of the above
9. A behaviour that indicates a sense of contentment and well-being e.g. smiling can be anexpression of:
A. HappinessB. PleasureC. EnjoymentD. All of the above
10. You need to communicate within the care team during the implementation of a strategy
or approach to meet the needs of the person with dementia so you can:A. share successes and failuresB. learn from each otherC. alert each other if there are any undesired resultsD. All of the above
11. You need to inform your colleagues and family members on a new strategy or approachto meeting the needs of a person with dementia (to overcome the behaviour of concern) sothat:
A. They are informed and involvedB. They can observeC. They can criticise
D. All of the above.
12. It is really important to document any changes of behaviour in the persons progressnotes (and specific observation charts if requested) because:
A. It may identify other triggersB. It may be used for planning a new strategy or approachC. It can prompt other care workers to report behaviour observationsD. All of the above
13. Team members involved in supporting people with dementia will need to:A. Use a consistent manner and strategy/approach outlined in the care planB. Be involved and committed to trialling a new strategy/approach
C. Be fully informedD. All of the above
14. When caring for someone whose behaviour is at times unpredictable you should:A. Plan ahead and be aware of a safe distances between yourself and the personB. Be aware of their social/lifestyle backgroundsC. Recognise the warning signs of a sense of ill-being (e.g. anxious face)D. All of the above
15. If a resident becomes aggressive you should:A. Stop what you are doing and move awayB. Keep goingC. Ignore themD. All of the above
Module review
What did you learn?
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Workplace act iv i ty modu le 5
Providing b ehavioural supp ort to maintain wel l being.
In this activity you will outline how you provide behavioural support to maintain the well-beingof a person with dementia for whom you care.
To do this activity you will need to observe a person with dementia and read their file(including their social/lifestyle history and care plan). You will need to complete workplaceactivity 5 worksheet provided in this handbook using the information you have learnt in thismodule and from your work experience.
The time required for this activity is approximately 30 minutes.
Workplace activity 5 worksheetYou will need to do the following:
1. Select a person with dementia for whom you care in your workplace and who has
displayed a behaviour of concern toward you (a sense of ill-being) e.g.refused to have ashower and for whom you have worked out a way of overcoming that behaviour and havemet their need. Your approach or strategy has resulted in leaving the person withdementia with a sense of well-being or a behaviour of contentment.
2. Locate the persons file (including the care plan)
3. Read the File (including and social / lifestyle history and Care Plan) to discoverinformation about the social history of the person and assessment of their abilities anddisabilities.
4. Complete workplace activity 5 worksheet based on your observations and experience in
supporting the person with dementia. You need to use the STARR problem solvingapproach and record your observations, search for potential triggersof the behaviour,implement a strategy or approach and discuss the results or outcome.
Completed workplace activity and feedbackWhen they have completed their workplace activity 5 worksheet, they hand it to theirfacilitator for feedback.
Workplace activities
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Providing behavioural support to maintain well-being
Name of resident: (Do not use real name)
Date
Described what happened (What is the behaviour of concern)
Where did it happen?(Location)
Example BedroomWhen did it happen?(Time)
Example: 5 00amWho was there?(People)
Example: Care worker andperson with dementia
Triggers(What happened before the behaviour. Considertriggers related to environment, activity,communication, health and history of person)
Action(Link strategies or approached to environment,activity, communication, health and history ofperson)
Environment Example: Very noisy Example: minimum noise to ease anxiety
Activity
Communication
Health
History(social background, habits, patterns)
Results (What was the outcome )Example: Person happy to be assisted in shower and happy afterwards and not anxious
Name of Care Worker (Who recorded information):
Workplace activity 5 - worksheet
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Person-centred carePerson-centred care (PCC) is a holistic approach to dementia care that focuses on theindividual, and draws on aspects such as the persons past history, routines, personalpreferences and needs.
The concept is based on meeting the needs of the whole person in order to create a feelingof well being. The foundations of PCC are based on the work of the late Professor TomKitwood, head of the Bradford Dementia Group in the UK from 1992 to 1998. He begantalking in terms of the person-centred approach to dementia care. By this, he meant seeingthe whole person, not just the disease, and the kind of care that puts the emphasis oncommunication and relationships rather than sedative medication and behaviourmanagement.
Kitwood noticed that there were many ways in which people with dementia are treated as ifthey were no longer persons and that their responses to this treatment were oftendismissed as part of their dementia. He stressed that the damage to the brain underlying
dementia is only one of many factor influencing what people say and do. To give person-centred care, we need to assume that people with dementia: are people like the rest of us,but who have disabilities in thinking, communication and memory are unique individuals,whose personality, health, life history and social relationships affect how they react to theirdisabilities tend to communicate through behaviour what they cannot express in words canmaintain well-being and have a reasonable quality of life if given good quality care.
We need to be prepared to:
use our imagination and empathy to understand how it might feel to have dementia
give people choices, and respect their individual likes and dislikes
make an effort to de-code the messages about needs and feelings in behaviour,including behaviour labelled as challenging
give them the support they need to be able to communicate, to find things to do, to copewith difficult feelings, to be socially included etc.
Kitwood found practitioners who shared his views and had ideas on how to make thingsbetter. Similar ideas about dementia were emerging in different parts of the world at aroundthe same time, and many people have recognised their value and helped to develop them.
The idea of person-centred care caught on, and appears as a standard in the NationalService Framework for older people.The four essentials of person-centred dementia care have recently been described asfollows.
V valuing people with dementia and those who care for them.I treating people as individuals.P understanding the perspective of people with dementia.S creating a positive social environment in which a person with dementia can
maintain relative well-being.
Information sourced from:Come into my World How to interact with a person who has dementia, Flinders University
of South Australia 2009. An Australian Government Initiative.
Additional notes
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Copyright
Aged Care Standards and Accreditation Agency Ltd (the Accreditation Agency) encouragesthe dissemination and exchange of information.
All material presented within this handbook and on our website is provided under a CreativeCommons Attribution 3.0 Australia, with the exception of:
this Accreditation Agencys logo, and
content supplied by third parties.
The details of the relevant licence conditions are available on the Creative Commonswebsite, as is the full legal code for the CC BY 3.0 AU license.
Attribution
Material obtained from this guide is to be attributed to the Accreditation Agency as:
Aged Care Standards and Accreditation Agency Ltd 2012.
Third party copyright
Wherever a third party holds copyright in material presented in this guide, the copyrightremains with that party. Their permission may be required to use the material.
Acknowledgement
The Aged Care Standards and Accreditation Agency acknowledges Hammond Cares
contribution to the revision of this learning package and Anglican Retirement Villages who
developed the initial version of this package in 2004.
Contact us
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EducationAged Care Standards and Accreditation Agency Ltd
PO Box 773Parramatta NSW 2124
Email: [email protected]