Assessment and Management of Challenging Behaviours - Essay Example

Name Professor Course Date Assessment and Management of Challenging Behaviours Introduction Many scholars have presented different definition over the years, but Emerson (95) defined the term challenging behaviour as a culturally strange conduct of such an intensity, frequency or duration that the physical safety of the individual or others is likely to be placed in serious jeopardy, or conduct which is expected to limit the use of, or result in the person being denied access to, ordinary community facilities. It has been found to interfere with people’s comfort, security and service just to name a few. Although, most people may say that someone has a disturbing behaviour, it all depends on the eyes and judgment of the person with whom the deed is done to. Some may take some acts normal while other may not; it entirely depends on your liking and sobriety. Most patients/people who have this challenging behaviour normally do not notice any anomalies, so their change in behaviour majorly relies on the people around him/her who will be able to observe the change in behaviour and immediately act on it. One surprising fact from my own experience, is that most people who live in the same house with the person with the challenging behaviour will not take action until the person affected does things that will get into their nerves’ (irritate or provoke them). The people around a person with the challenging behaviour are mostly affected by his/her behaviour both either in the short or the long run period. In all the consequences varies and this depends on the level that behaviour has escalated to and whether any action/care was given to the one suffering. The responses got from the people experiencing this behaviour may either relieve the patient or escalate the behaviour. Stokes G (20) supports this by saying that the treatment of such behaviours has traditionally been led by institutional policies of government and containment, consisting of combinations of environmental, mechanical or chemical restraint. Dementia as my case study, is the medical cause of a variety of challenging behaviours exhibited by my grandmother, these behaviours ranged from agitation to memory loss which is accompanied by other challenging behaviours caused by psychological factors such as loneliness, sense of anger, poor self-control, need of reassurance and attention from others, need to understand the surroundings which with time seemed strange to her. Kitwood (97) argues that, there can be positive as well as negative sides to the experience of living with dementia. Other internal factors that influenced her behaviour are like want to eat and drink which led to wastage of food and increase in energy bill while cooking because she would forget that food was cooking in the oven leading to burn. All the measures we had in place to cut down on the budget were thwarted due to her forgetfulness. Schulz R & Martire LM (4) confirms by saying that family caregiver remain the primary persons providing care, having to face much emotional, practical and financial burdens in the process. My grandmother’s illness came when I was still young but old enough to see what was wrong with her, she started forgetting the common house routines and everybody in the house was not in good terms with her. Nobody realized that she had a medical condition, with her too confessing and blaming her mistakes on old age. I remember she used to forget it was time to prepare food for my younger siblings and all of us would be mad at her. Before my family members realized that the loss of memory condition had been serious, the environment around her was not conducive, everybody had issues with her until she developed some challenging behaviours which as from my views then, seemed like a coping mechanism. She started being hostile just by the sight of anybody, she became more secluded and never wanted to talk to anyone in the house. This behaviour made us change our approach toward her and try to understand what was happening that is when we learnt that she has dementia.as the immediate and automatic caregivers we had to learn more of her condition, as Beauchamp N, et al. (25) and Czaja SJ & Rubert MP (52) researched that caregivers can access disease-related information, join web based multimedia learning, participate in online discussions and support groups, communicate with each other or other family members, and even with health care professionals. As part of the family, I was part of the care giving team, which after realizing that all she did was not meant, we decided to help her cope with the loss of memory and more so to guide her through the whole journey (Dementia Research Group 36). I knew that the type of care that I contribute will either change her behaviour positively or negatively. Though the challenging behaviour proved difficult to deal with, something had to be done. I had to change my attitude from responding to the behaviour negatively positively. My earlier negative responses included being irritable, anger, disapproval, frustration, shame and humiliation and verbal aggression. But after understanding what was wrong and how to go about it, I started showing her positive responses were like smiling, clapping wherever she made some improvement, rewarding her, watching my language tone and creating a favourable environment where she may proceed with her life freely. Own response to the challenging behaviour Some of my responses to the difficult behaviour shown were like: I made sure that I create an enabling environment for her to live in and even went ahead to briefing those who did not know of her condition so that they could be prepared of what comes their way. Wherever she would shout and scream, I responded in quiet and reassuring voice, Feliciano, Steers, Elite-Marcandonatou, McLane, & Arean (9) adds that the person should have a deep breath and given enough space and time is an effective technique. Whenever I saw signs that she needed something by shaking her head or stare at something, I would continue and give it to her. When her behaviour would get out of hand, I used to call for assistance and sometimes go out of her way instead of locking her in her room as we previously did. Wherever she had difficulty processing information, I would ask her a few questions; give her more time to think and not to harass her. I tried to remind her of the things she used to know and even made labels on things such as doors, which made her manoeuvring around the house easier. Wherever she felt lonely, I would engage her in games, talk to her, and even engage her in ordinary tasks such as maintaining the flower and folding clothes. Response to the person with the challenging behaviour I decided to give my grandmother the love she deserved; I revived my relationship by not scolding her in any way wherever she did something that affected me directly. I majorly relied on correcting her and reminding her to call me in to assist wherever she wanted to do something. I kept on reminding her of the things she had started to forget like visitors who were not frequent to our home. When she experienced sleeping disturbances which came as a result of joint stiffness, I would create an enabling environment for her to sleep and even have a soothing music play all night. When she exhibited signs of wondering caused by pacing linked to agitation, I would enquire from her what they want or where she wants to go, sometimes I would involve her in house chores to ease her. Other’s response to those with challenging behaviour Other people living close to my grandmother apartment had different responses to both the challenging behaviour itself and the person with the challenging behaviour. These other people referred to, might include carers, other family members and the people sharing the same apartment as her. Their responses to the challenging behaviour came about when their individual safety was threatened, when their social functioning was disrupted, and their relationships. All these people were affected in some ways, because some of the physical aggression she showed such as shouting could easily attract the attention of those not involved (Kim 89). Some of the neighbours' response to the challenging behaviour were like; in the apartment, we lived, some neighbours got used to playing loud music but when we approached them and informed them that the loud music had effects on my grandmother, they responded by reducing noise, as Kim (12) confirms that environmental is a crucial issue with the person in dementia, noise, unwanted things in their room, loud music and so on. At the grocery stores they supported her and showed her directions. Wherever she went into depression, some of the elderly women in the block would take her out to exercises and engage in activities such as knitting. With time, the neighbours together with us learnt and assisted us to avoid triggers which would lead to challenging behaviour. Whenever they felt she experienced anxiety, they became concerned to the extent of asking her what was wrong, giving her reassurance, supporting and socializing with her. They would also create a diversion and reduce the excess stimuli. Other’s response to the person with the challenging behaviour The people living around us also responded to her in a remarkably accommodating manner, whenever my grandmother was outside the house, the neighbours did not shy away from her, they showed her love, socialised with her and maintained a peaceful environment for her. My other family members gave her emotional support and avoided fatigues in her by introducing rest periods. All these were done when she experienced paranoid ideation and hallucination due to physical illness. Effectiveness of the responses According to Teri L, Logsdon RG, & Uomoto J (19) he researched that teaching carers to use behavioural techniques, emphasizing either pleasant events with patients or problem-solving skills, reduced depressive symptoms in both patients and carers. I support this scholar, because before we knew what was wrong with our grandmother, we gave her negative responses which led to her challenging behaviour worsening. From behaviour response cycle which is one of interventions for dementia related challenging behaviour McClean & Walsh (99) with time we found that these responses given out by both the caregivers and the other people around her really had an impact, though she did not come out of her condition (dementia) the responses made her adjust and her challenging behaviour declined tremendously making her life with others smooth and enjoyable. Before even the responses had an impact on her, we, mainly the caregivers had to identify the triggers which usually provoked her to behave unpleasantly, these include voice tones, anger towards her, segregation, scolding and lack of attention. So by taking care of the triggers, a change in her behaviour was seen. The responses from us and some community members especially those who understood her condition, made her drop her behaviours because she felt important, loved and needed. We were able to device routine activities which she adhered to properly through the responses, she was encouraged to develop new tasks and skills which made her feel part of the community. Through the cooperation and support from the neighbours and the community members, a favourable environment was created which led to very minimal triggers of her challenging behaviours. The regular chores I asked her to assist me, distracted her from the external stimuli which would trigger the behaviours. Through the low tones people talked to her in, made her realize that no one way against her and more so we understood her. Through interacting with her and even encouraging she to socialize made her not to be depressed. Creating regular activities which she was to do made her feel part of us. The labels put on objects created a contributing environment for her to learn and thus resulted in massive improvement in her behaviours. Through paying keen attention to her and addressing the issues at hand, she no longer had disturbances in sleeping and never felt like wondering. Conclusion Challenging behaviour always result to mix feeling especially those in direct contact with the person showing the behaviour. It is therefore, necessary to understand where the behaviour originates from and not to judge the person. As you view the behaviour it is necessary to separate the behaviour from the person so that the feeling can be associated to the behaviour, but not the person. This view will foster the relationship between you and the person with the behaviour. Hall GR (19) adds that the goals of dementia care are to maximize the potential for safe function by controlling for excess disability and providing appropriate levels of assistance, to encourage participation in activities as desired by the client, minimize discomfort caused by physical and emotional stressors and maximize expression of comfort. Therefore, we should appreciate the long uphill battle they face taking into consideration other people’s needs. Lastly for a quality dementia care, the patient’s social, psychological and spiritual well-being is fundamental. Works Cited Beauchamp N, et al. "Worksite-Based Internet Multimedia Programme for Family Caregivers of Persons with Dementia." Gerontologist 45 (2005): 793–801. Print. Czaja SJ, and Rubert MP. "Telecommunications Technology as an Aid to Family Caregivers of Persons with Dementia." Psychosom Med 64 (2002): 469–76. Print. Dementia Research Group. "Care Arrangements for People with Dementia in Developing Countries." Int J Geriatr Psychiatry 19 (2004): 170–77. Print. Emerson, E. Challenging Behaviour. Analysis and Intervention in People with Learning Difficulties. Cambridge: Cambridge University Press, 1995. Print. Feliciano, L, et al. "Applications of Preference Assessment Procedures in Depression and Agitation Management in Elders with Dementia." Clinical Gerontologist 32.3 (2009): 239-59. Print. Hall GR. Altered Thought Processes: Dementia. In: Mass M, Buckwalter Kc, Hardy M Eds. Nursing Diagnosis and Interventions for the Elderly. Redwood City: Addison-Wesley, 1991. Print. Kim, Y. "Korean-American Family Postcaregivers on Dementia Caregiving: A Phenomenological Inquiry." Journal of Gerontological Social Work 52.6 (2009): 600-17. Print. Kitwood, T. Dementia Reconsidered : The Person Comes First. Buckingham: Open University Press, 1997. Print. McClean, B, and P Walsh. "Positive Programming - an Organisational Response to Challenging Behavior." Positive Practices 1 (1995): 6-18. Print. Schulz R, and Martire LM. "Family Caregiving of Persons with Dementia." Am J Geriatr Psychiatry 12 (2004): 240–49. Print. Stokes G. "Challenging Behavior in Dementia: A Person Centred Approach " Bicesser.Speechmark 3 (2000): 53-55. Print. Teri L, Logsdon RG, and Uomoto J. "Behavioural Treatment of Depression in Dementia Patients: A Controlled Clinical Trial." J Gerontol B Psychol Sci Soc Sci 52 (1997): 159–66. Print.  Read More