Working Together to Enhance Understanding of Responsive Behaviours in Long-Term Care

Transcription

1 Working Together to Enhance Understanding of Responsive Behaviours in Long-Term Care Sherry Dupuis, PhD Director, MAREP Long-Term Care Association of Manitoba Annual Conference May 29, 2007 Winnipeg, Manitoba Responsive Behaviours (RB) in Long-term Care Program Purpose: on-going program to gain a comprehensive understanding of responsive behaviours in long-term care settings Phase One examined the nature of RBs in LTC homes (e.g., frequency, triggers, interventions) Phase Two involved the development of a training tool to educate front-line staff on better ways to manage and accommodate responsive behaviours Phase Three examined the meanings and experiences of RBs for staff working in long-term care homes 1

2 What are Responsive Behaviours? reflect a response to something negative, frustrating, or confusing in the person s environment place the reasons or triggers for behaviours beyond the disease rather than only within the individual (caused by biological/disease processes) persons with dementia chose and prefer this term a behaviour is a means of communication to address behaviours need to look beyond the disease need to change the environment (physical or social aspects) Phase One To gain a comprehensive understanding of staff members perceptions of responsive behaviours in long-term care settings and the most effective strategies for managing those behaviours Objectives to identify: most frequently experienced and most disruptive responsive behaviours in LTC settings staff members perceptions of the triggers of specific types of responsive behaviours most frequently used interventions to manage specific types of responsive behaviours perceived effectiveness of interventions used to manage specific types of responsive behaviours differences between staff groups on selected aspects of responsive behaviours 2

3 Top Ten Responsive Behaviours Experienced by the Most Staff 1. Constant unwarranted request for attention or help (97.1%) 2. Pacing, aimless wandering (96.8%) 3. Complaining/whining (96.7%) 4. Repetitive sentences or questions (96.5%) 5. Trying to get to a different place (95.8%) 6. Cursing or verbal aggression (94.9%) 7. General restlessness or agitation (94.5%) 8. Negativism/sarcasm (89.8%) 9. Making strange noises (89.3%) 10. Grabbing onto people (88.9%) Other Findings non-aggressive verbal behaviours most common and most intense highlighted the need for a repertoire of interventions to draw on negative responses still used by over 30% of staff -- likely due to increasing pressures on staff and staff burnout health care aides likely to experience the most intense behaviours yet are less likely to have training in responsive behaviours compared to other staff type of intervention used differs significantly by staff group 3

4 Phase Two Development of a training tool to educate front-line staff on better ways to manage and accommodate responsive behaviours Based on P.I.E.C.E.S. TM framework Physical Intellectual Emotional health Capabilities Environmental (both physical and emotional) Social and cultural factors Understanding the Behaviour 1. What is the behaviour? 2. Who is the behaviour affecting? 3. What is the degree of risk? 4. What are the potential triggers of this behaviour? 5. What is the meaning behind the behaviour? 4

5 What are the Possible Triggers? Physical (UTI, Flu, Constipation, Pain or Discomfort, hunger) Intellectual (Frustration with lack of ability to communicate) Emotional (Need for touch, love, grief and loss, boredom) Capabilities (Match between task and remaining abilities) Environment (Lighting, noise, commotion) Social and Cultural Factors (Social interactions, care style, life history and culture) P.I.E.C.E.S

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7 The Gentle Persuasive Approaches (GPA) Project: A Standardized Curriculum to Teach Person-Centred Behaviour Management to Front-line Staff in Long Term Care Overall Goal To use a person-centred, compassionate, and gentle persuasive approach, when responding respectfully, and with confidence and skill to responsive behaviours of a more escalated nature associated with dementia 7

8 Curriculum Delivery: 2 coaches (PRCs) 7.5 hour day participants per session Multiple education strategies minilecture, reflection, video, small group, practical skill development, role play Curriculum, Cont d Course Content: Module 1: Person-centred care Meaning behind behaviour Module 2: Impact of dementia on the brain Relationship of changes in the brain to behaviour Care implications Module 3: Communication (emotional, environmental, interpersonal) Communication strategies 8

9 Curriculum, Cont d Module 4: Gentle Persuasive Approaches Protective grab Individual techniques Team techniques Role play / Case studies Phase Three To examine the meaning and experience of responsive behaviours for various long-term care staff and how these meanings and experiences influence the ways in which staff respond to behaviours Guiding Research Questions: How do staff think about responsive behaviours? What meanings do staff attach to responsive behaviours? What factors influence the way staff think about behaviours? How do various staff experience responsive behaviours in the long-term care environment? What factors influence the way behaviours are experienced? How do staff typically respond to behaviours? What factors influence the ways in which staff respond? How do the meanings and experiences of responsive behaviours influence how staff respond to behaviours? 9

10 Key Findings interactional and organizational factors more important than pathology/resident factors in the ability of staff to respond effectively to behaviours most important interactional factor for staff is: the style by which staff approach their jobs caring style necessary in responding appropriately to behaviours and in the prevention of behaviours non-caring style identified as a major trigger of behaviours A Caring Style Caring through Voice and Spoken Language providing residents with information, explaining what staff are doing simplifying language and tasks reducing amount of information given being gentle/using a calm voice and manner Caring through Body Language approaching residents from the front getting down to resident s s eye level using physical affection 10

11 A Caring Style Caring through Relational Styles building of close relationships with resident/knowing the resident seeing beyond the disease respecting and believing in autonomy/self- determination of residents believing that the person is still there knowing and respecting individual resident s preferences and routines showing interest in residents really listening to residents being patient A Caring Style Caring through Being with the Person respecting and being able to move in residents realities moving with the resident s s rhythms, slowing down being flexible in routines validating resident s s experiences being able to empathize with residents 11

12 Organizational Structure /Systemic Factors Staffing Issues staff dynamics/conflicts staff shortages lack of trained staff/preparedness to respond staff turnover = lack of consistency in staff lack of strong, supportive leadership/strong role models staff fatigue, stress, and dissatisfaction with job Organizational Structure /Systemic Factors Limitations of Traditional Service Model heavy workloads/high resident-to to-staff ratios lack of time to adopt and use caring styles focus on tasks (bed-and and-body work) and paperwork lack of flexibility in routines 12

13 Recommendations ensuring strong, supportive leadership is in place providing outlets for emotional support and the release of stress developing a culture of teamwork adopting a relationship-centred approach providing adequate training for all staff adopting a self-reflexive practice approach allowing time needed for the adoption of caring styles focusing on staff wellness Remember! Only after we understand the behaviour can we meaningfully manage or accommodate it 13

14 Thank You! Contact Information: Murray Alzheimer Research and Education Program Faculty of Applied Health Sciences University of Waterloo Waterloo, ON N2L 3G1 Telephone: , Ext Website: 14