creating alternatives to medicatons and restraints … train… · creating alternatives to...

June 2012 DHS – Office of Licensing and Regulatory Oversight 1

CREATING ALTERNATIVES TO MEDICATIONS AND RESTRAINTS


PURPOSE & KEY TERMS

The purpose of this section is to assist the learner in understanding how to identify, investigate and document behaviors. This section also covers how to use the information gathered in order to create alternatives to medications and restraints.

Antecedent ABC Model Consequences Restraints Psychoactive

Medication


OBJECTIVES

The learner will be able to: Understand myths associated with the use of

psychoactive medication or physical restraints. Define the difference between behaviors associated

with dementia verses delirium. Describe why documenting behaviors can assist in

determining the underlying cause or provide information on potential alternatives in managing the behaviors.

Describe when a foster care provider needs to seek assistance from a registered nurse, physician or nurse practitioner for behavioral symptoms.


INTRODUCTION

Caring for the elderly and people with disabilities can be rewarding, but it can also be demanding and difficult due to: Unable to describe their problems; Has physical, mental or emotional disabilities; Individuals may hit, kick, throw objects, resist

care, spit, yell, argue, threaten; Have wandering behaviors or display other

challenging behaviors.


INTRODUCTION

People who display challenging behaviors are often identified as problem individuals: They are seen as a source of danger or distress to

themselves and sometimes to other people and caregivers.

Psychoactive medications and physical restraints: Can have negative side effects; Physical restraints can cause serious injuries; There are many other options available.


THE MESSAGE OF BEHAVIORS

Behavior is a form of communication just as speaking is a form of communication: A person’s actions or behaviors are ways of

communicating that can be an important and helpful tool for understanding a person and his or her thoughts and feelings;

This communication can be thought of as a behavioral message;

These messages can tell you important things about a person and the quality of his or her life.


THE MESSAGE OF BEHAVIORS CONTINUED

Challenging behaviors often result when a basic need has not been met. The person acts out or uses behavior to “say” it instead of verbally communicating a need: A person asking repeatedly to go home may be

expressing their desire to find a state of mind where they feel comfortable, secure, loved or needed, rather than a desire to go to a particular place. For this person, loneliness may be the real message.



Here are other examples of the messages a person may be communicating through behaviors:

I am lonely; I am bored; I am scared or confused; I have no power; I need choices and

control; I am in pain; I need a quiet place; I need help.



A person may obviously convey many needs with these behaviors. A single behavior can mean many things: The important point is that the behavior has

meaning. Behaviors do not occur without reason. What is your role? You need to remember that challenging behaviors

should be viewed as symptoms of an unmet need, and your job is to find out what the unmet need is.


THE INVESTIGATION

Check out physical health first when you observe a new behavior or an escalation of an old behavior: Review the resident’s medications. The person

may be experiencing a reaction to a new medication or even to one taken for a long time: Look up side effects and drug interactions in your drug

resource book or check with the doctor or pharmacist. Check to make sure the resident received the

correct medication or dosage;


THE INVESTIGATION CONTINUED

Ask questions about body systems. For example, could they: Be constipated? Have a bladder infection? Be experiencing joint pain? Having trouble breathing?

Move on to other areas. If you do not identify an immediate physical health problem, explore other possibilities;



Spend time with the person to get to know each other better: The better you know the person, the easier it will be to

understand the messages conveyed by the challenging behavior and unmet need(s).

Supporting a person with challenging behaviors requires you to know the resident as a complicated human being influenced by a complex personal history: Knowing a person’s life story and developing an honest

relationship with them can often lead to a better understanding of the reason for the behavior.



Challenging behaviors can be triggered when sad memories are unknowingly raised: Sharing pictures of a boat when the resident lost their

family members in a boating accident. It is critical to know about a person’s life story:

The simple process of collecting information to document the life story can pay off immediately. Talk to family or friends if the person allows;

The life story assists caregivers to: Tell familiar stories and paint a picture of past achievement; Honor traditions, including religious values.


LEARN HISTORY AND PATTERNS

Knowing the history and pattern of a behavior will help you understand what it means.

Understanding why it is occurring will guide what you do about it.

Keep a log or diary to record: What is the behavior? Describe clearly what the person does or says.


LEARN HISTORY AND PATTERNS

When did the behavior begin, i.e., how long has it gone on?

Where does the behavior typically happen? How often does the behavior occur? How long does it last? Is the behavior harmful/dangerous to the person or

others? What is your role? Who is present at the time the behavior is displayed?


LEARN HISTORY AND PATTERNS CONTINUED

What else is happening at the time of the behavior?

During a difficult time, what helps the resident feel better?

What makes the behavior worse? What are the situations/conditions in which the

behavior rarely occurs; and Can these be recreated or increased in number?


ABC MODEL

The more you know what happened before, during and after the behavior, the better you can determine why it happened: You may be able to identify the reason for the

behavior by determining what conditions or triggers may be causing it;

You can then figure out ways to meet the person’s needs and prevent the challenging behavior from reoccurring;

The ABC model is a tool to help you understand the challenging behavior.


ABC MODEL CONTINUED

ABC MODELA = Antecedents B = Behavior C = Consequences

The trigger The behavior Reaction or response

Thelma was in her room watching television. She had been upset for most of the day. A new caregiver (Sue) walked into her room and said, “It’s time to take a bath.”

Thelma screamed and attempted to hit Sue.

Sue walked away and Thelma stopped her behavior.


ABC MODEL CONTINUED

B – Behavior: First, focus on the B of the ABC, the Behavior.

The goal is to get a clear picture of the behavior. Clearly and objectively describe only what you see the person doing or saying. Avoid terms like tantrum or agitation.

A – Antecedent: An antecedent (sometimes referred to as a

trigger) is something that occurs before a behavior. It can be helpful to shift your attention to the antecedent of the behavior. Triggers can be internal, external or both.


ABC MODEL CONTINUED

If you can focus your attention on the antecedent or trigger, you may be more effective at changing or reducing the challenging behavior: Internal antecedent conditions or triggers refer to

what is going on inside the person. These could include: Medical and physical conditions; Mental illness; Emotional distress; Social; and Interpersonal concerns.


ABC MODEL CONTINUED

External antecedent conditions or triggers include: Factors in the physical or social environment

such as too many or too few activities; Changes in schedule or routine; Loud noises; Being too warm or too cold; Inadequate or poor lighting; Crowding, unfamiliar or confusing surroundings; Unfamiliar people or caregivers; Demands to achieve beyond the individual’s

abilities, or the feeling of no control or choices.


ABC MODEL CONTINUED

C – Consequences: Consequences are what happen to the resident

immediately after the behavior: What actions are taken by the caregiver? What behavior does the person engage in or stop

engaging in? What items or situations does the person obtain, escape

or avoid?


WHO IS TAKING CARE OF YOU?

Caregiving requires good physical health as well as strong coping skills to maintain a healthy mental attitude when providing care and services for others: While you are taking care of others and meeting

their needs you may forget your own needs. You may experience a number of difficult situations throughout the day: You may feel tired and need some rest; you may feel

frustrated and have negative thoughts; and You may need support from others.


WHO IS TAKING CARE OF YOU?

Educator Jean Clarke says: “A person’s needs are best met by people whose

needs are met.” If you don’t take care of yourself, it will be very difficult to support anyone else.

Improving your own quality of life will improve the quality of care you provide to others. Take good care of yourself by getting enough sleep, regular exercise and by eating a healthy diet.

When working with individuals with challenging behaviors, stay calm, be flexible and know when and whom to call for help when you need it.


R.E.S.P.E.C.T

A way to remember: Recognize factors that influence behavior. Empathize and understand feelings and needs. Support approach based on person’s needs. Prevent escalation by learning warning signs. Enhance the person’s abilities and potential. Care about the person’s preferences and needs. Take time to interact with the person.


DISCUSSION/QUESTIONS

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