Minimizing and Preventing Negative Behaviors. Presented by: Chris Ebell

Transcription

1 Minimizing and Preventing Negative Behaviors Presented by: Chris Ebell

2 Meet Your Presenter Chris Ebell, OT/L, DCCT DCS Lead Trainer Dementia Care Specialists, a CPI specialized offering

3 Objectives 1. Define negative behaviors. 2. Discuss possible causes of negative behaviors. 3. Identify methods to prevent/minimize negative behaviors. 4. List the steps for implementing a plan to address negative behaviors. 3

4 What Are Negative Behaviors? Behaviors are communication As ADRD progresses, the person: Begins to lose his/her ability to communicate verbally. Depends more on gestures, facial expressions, body language, and behaviors to communicate. 4

5 Physical Causes for Behaviors Pain Illness, fatigue, hunger, thirst Side effects of medications Confinement or barriers Uncomfortable beds, chairs leading to pain Inaccessible bathroom 5

6 A Positive Physical Environment Medically address illness or injury. Review medications for side effects. Assess for pain; treat pain proactively. Anticipate the person s needs. 6

7 Social Causes for Behavior Unfamiliar environment resulting in a feeling of insecurity or fear. Loss of sense of self. Excessive noise; over stimulation. Lack of stimulation/purpose. Feelings of abandonment, non-personhood, or lack of respect. Lack of touch; companionship. 7

8 A Positive Social Environment 1. Know the person. 2. Provide dignity and respect for the person. 3. Decrease fear by providing routine, a consistent and familiar environment, and a sense of love, acceptance, and security. 4. Decrease boredom by involving the person in meaningful, valued activities. 5. Reduce distractions; make the environment inviting. crisisprevention.com/cpi/media/media/specialties/dcs/life-history-questionnaire.pdf 8

9 How Might the Care Partner Approach Result in Negative Behaviors? Disrespect, or failing to gain trust and agreement. Unrealistic expectations of the care partner. Excess disability placed on the person. Ineffective communication techniques. 9

10 Positive Care Partner Approaches Gain trust and agreement. Establish rapport. Gain the person s attention. Treat the person with respect and provide the person with a sense of control/choices. Be patient, never rush the person. Focus on abilities and find the just right challenge. 10

11 More Positive Care Partner Approaches? Maintain consistency in schedules and care partners. Recreate routines and environments to match LTM. Maintain the person s privacy. Focus on the process of doing versus quality. Use appropriate communication techniques. 11

12 Attempt to Discover What the Person Is Communicating Look for a pattern in the negative behavior; every time answer these questions: 1. Who was there? 2. What happened? 3. Where did it happen? 4. When did it happen? 5. Why might it have happened? 12

13 Dr. NO D= Describe; answer the W questions. R= Reason; identify possible reasons for the behavior Consider the person s cognitive level and life story. N= Try a Non-pharmacological approach to address the behavior. O= Observe for positive change and share with others. 13

14 In Order to Find the Just Right Challenge Consider: Can Do Will Do May Do Realistic Abilities ACL, BATF Theory of Retrogenesis Relevant Activities Motivating Factors Likes/dislikes Possible Abilities Care Partner Approach Environment 14

15 Communication Techniques Be patient and calm. Gain eye contact and attention. Lead with the person s name. Speak slowly allowing extra time for the person to respond. Avoid using pronouns. 15

16 More Communication Techniques Use validation and enter the person s reality. Speak in short sentences; add visual and tactile cues as needed. Provide one-step directions. Never criticize; refrain from trying to reason with the person. 16

17 Implement a Plan 1. Determine the appropriate approaches and environment that are the just right match for the individual. 2. Try out these approaches/environmental adaptations. 3. Train others in the appropriate approaches and adaptations. 4. Create a system to maintain the plan. 17

18 Case Study ACL 3 Jack is 92. He has macular degeneration with visual loss, and has a diagnosis of Alzheimer s disease. He is a resident in the memory disorder unit. He has no children. After serving in the military during the war, he worked as a supervisor/manager in an auto plant until retirement. He has outlived two wives and had lived alone for 15 years before moving to the community living center. He enjoyed socializing with neighbors, watching baseball, and playing poker. Jack walks independently, mildly unsteady, with no recent falls. His appetite is good. Recently, he has demonstrated signs of paranoia, stating that people were hiding in corners and planning to get him. At the residence, he has been refusing to bathe or change his clothes, becoming verbally abusive and physically threatening with care partners. 18

19 Poll Question What might be happening in the environment that is triggering a feeling of fear in Jack? a. Low vision causing him to misinterpret objects/persons in his environment. b. Environmental distractions, loud noises. c. Inappropriate care partner approaches (e.g., approaching Jack from behind him). d. All of the above. 19

20 Poll Question What might he be communicating when resistive to care? a. He has always been argumentative. b. He does not like to bathe. c. He feels helpless because he is not provided with opportunities to do part of the tasks. d. He is upset because the Cubs lost the ball game. 20

21 Care Approaches to Address Fear/Paranoia Provide adequate lighting. Provide eye contact; speak directly to the person. Speak with a calming voice. Provide touch. Allow for slow processing. Eliminate sounds or sights that could be frightening. Assess the environment; check noise level, temperature. Maintain a consistent environment. Provide striking color contrasts for objects. 21

22 Care Approaches to Address Excess Disability 1. Discover the person s cognitive level. 2. Identify the amount and type of cues needed to sequence through a basic task. 3. Identify needed environmental adaptations. 4. Teach care partners how to provide these cues and adaptations. 5. Monitor the care approaches and the person s response. 6. Celebrate success. 22

23 Customized Plan for Jack 1. Gain attention, trust and agreement by: Making eye contact, leading with Jack s name, and talking to him about the military or about baseball. 2. Allow Jack control and choices by: Asking him to choose when he wants to take a shower (i.e., morning or night). Asking him to pick from two choices of clothing. 3. Provide one-step directions such as: Wet your washcloth, rub soap on your washcloth, and wash your arm. 23

24 Customized Plan for Jack 4. Create a consistent, safe, and loving environment by: Providing adequate lighting, familiar objects, and furniture, such as his easy chair and his own brand of products. Keep care partners consistent and avoid changing the environment. Maintain a consistent routine based on his life history. Always greet Jack and provide 1-to-1 assistance to engage him in social events. 24

25 Customized Plan for Jack 5. Use verbal, visual, and tactile cues when providing directions, such as: Demonstrate putting your arm through a sleeve as part of your directions for Jack. 6. Allow for slow processing by: Waiting for his response to questions or directions. Anticipating that activities will take longer and allow for that time. 25

26 Negative Behaviors Remember that negative behaviors are communication. We need to listen and respond to the communication/emotion that the person is expressing. Often that communication is a request for a basic human need such as: dignity, purpose, love. 26

27 Thank You Thank you for making a difference in everything you do W. Park Place, Suite 600 Milwaukee, WI instructor@crisisprevention.com crisisprevention.com 27