Behaviour Management and BPSD
Published: 28 May 2020
Published: 28 May 2020
Challenging behaviours are a common symptom of many conditions, such as intellectual disability, autism and dementia.
When poorly managed, these behaviours can have far-reaching effects, including distress for the client, disruptions to the lives and comfort of other clients, and added stress and workloads to healthcare workers.
In a home or aged care setting, the behavioural and psychological symptoms of dementia (or BPSD) are common, however, still remain one of the biggest challenges to care staff. One study found that while many residential aged care staff understood the underlying causes of BPSD, they lacked the appropriate management skills and resources to deal with them appropriately (Ervin et al. 2012).
Mishandling of BPSD can lead to cases of overuse of chemical and physical restraints, which should be a last resort to care staff, but have time and time again been incorrectly used as a frontline approach to challenging behaviours.
Appropriate behavioural management is not only essential to maintaining a high quality of life and comfort for all clients, but it is also directly tied to Standard’s 1, 7 and 8 of the Aged Care Quality Standards.
The following tips will provide carers with a foundational understanding of behaviour management to ensure their clients receive effective person-centred care when displaying challenging behaviours.
There are countless ways to handle challenging behaviours, however, approaching the situation methodically with an assessment tool like the ABC approach examines the behaviour from a person-centred perspective. The aim of this type of approach is to help us understand the etiology of the behaviour and develop a suitable, consistent response for ongoing support (Crombie et al. 2007; Autism Spectrum Australia n.d.; Krishnamoorthy, A & Anderson, D n.d.).
(Bendigo Health n.d.)
The antecedent or activating event looks at direct or indirect triggers of the behaviour; the why, what, when, where and who.
These stimuli could include:
The challenging behaviour should be defined clearly. Types of BPSD commonly seen include:
(Tible et al. 2017; Health.vic 2020)
Note, simply labelling the behaviour is not sufficient. You must be able to describe what was observed. For example, did the client yell, cry, punch or use particular words?
The consequences of the behaviour are the responses from everyone involved. These could include those of the staff, family members or other residents who were witness to the behaviours.
The final and additional step to the ABC approach is to decide and debrief. This step allows the care team to come together to consider their findings and collaborate on the best way to manage the situation. Remember that in true client-directed care, the client themselves is part of the care team and should be involved in this process, or alternatively the client’s family or designated decision-makers.
Decisions on what actions to take could involve:
(Alzheimer’s Society 2020; Health.vic 2020)
Scenario: Ted is an 87-year-old resident in a secure aged care facility who is living with dementia. In his younger years, Ted was extremely active and would wake early every morning to walk to the corner milk bar to buy the newspaper.
Antecedent or Activating Event:
After waking early one morning, Ted attempts to leave through the front entrance of the facility, with the intention of walking to the shop to buy the newspaper, however, he is halted by the locked security-door, which requires a keycode to open.
Ted gets agitated and upset finding himself locked behind the door and begins to try to rattle and break the door latch. He is panicked and loudly demanding to be let out.
The staff member on shift, who has been on behaviour in a confrontational manner (‘Hey! Stop that! What are you doing?! You’ll break the door! Go back to bed!’), attempting to stop Ted from waking and disturbing other residents. The staff member forcefully grabs hold of Ted’s wrists in an attempt to stop him from breaking the door lock. The staff member’s response only makes Ted more upset, increasing his distress. His behaviour continues to escalate into yelling and physical aggression.
Decide and Debrief:
After the incident, the care team debrief with Ted’s family and learn about his history, habits and preferences of walking to get the newspaper each morning.
The team also note that the staff member on shift’s response was inappropriate and recommend they take a day away from work to de-stress and undergo further communication and de-escalation education.
The team decide that the staff member rostered on each morning should now have a newspaper ready to offer Ted when he gets up in the morning, and respectfully offer to walk with him around the facility before returning him back to his room.
The ABC approach to behavioural management works best when the challenging behaviour is clearly documented and understood. The first approach should always be non-pharmacological and should involve tweaking the personal and environmental elements that contributed to the event.
The client’s medical prescriber may consider a medications review if the behaviours are still ongoing. Many milder challenging behaviours tend to run a course and can resolve in time, and so patience and support is often the best response in these cases (Krishnamoorthy & Anderson n.d.).
Note: Always refer to your facility's policy on dealing with difficult or aggressive behaviours. If there is a real risk of danger to you or your clients, security may need to be called.
Question 1 of 4
Step ‘A’ in the ABC Approach to Behaviour Management refers to…?
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