Possible causes and preventive measures concerning presenting behaviour which is difficult to manage
- Boredom and lack of environmental stimulation and distraction.
- An unsuitable mix of residents/inappropriate placements.
- Antagonism, aggression or provocation on the part of others (staff or residents).
- Too much stimulation, noise and general disruption.
- The need for attention, and feeling or being ignored.
- Lack of, or inappropriate, supervision.
- Invasion of personal space and privacy.
- Lack of consultation and informed choice.
- Lack of control over one's own life.
- Inability to communicate effectively.
- Medical condition.
- Mental health problems including dementia, Alzheimer's disease, depression and anxiety.
- Drug or alcohol abuse.
- Accidental misuse of prescribed medicines.
General preventive measures
These will include:
- Adequate and appropriate staffing for the resident group concerned.
- Staff on duty in sufficient numbers and with enough experience and training to meet needs of the residents.
- Appropriate placements / admission procedures.
- An initial assessment made prior to a person being admitted to a Home to ensure that appropriate care can be provided consistently. The assessment must include accurate historical background and a list of individual specific needs.
- Individual Care Plans which are regularly reviewed and updated. All staff should be aware of and follow consistently the requirements of the Care Plan.
- Provision of appropriate activities and involvement of individuals in planning their daily living schedule.
- Provision of adequate facilities for residents, including access to a variety of open spaces and a defined personal space with the ability to safe keep personal possessions.
- Access to a telephone.
- A system for ensuring that complaints are dealt with quickly and fairly.
- A system for monitoring the mixed and changing needs of residents.
- An appropriate staff training programme that is reviewed and updated as required to reflect changing professional practice, legislative requirements and so on.
- Staff trained in the management of challenging behaviour and ready access to advice, support and supervision from experienced senior staff.
There are often identifiable, early warning signs prior to an aggressive outburst. It must be stressed that managers and staff should have a good understanding of their residents and therefore the capacity to take effective action before an escalation of dangerous behaviour, that is, to identify the cause or causes of the problem and to resolve it / them. Examples of these indicators include:
- Restless behaviour - pushing, noisiness, jostling.
- Provocative conduct - name-calling, hiding property.
- A noticeable behaviour change from the norm.
- Over reaction to correction/instruction.
- A feeling of heightened tension.
- Tense and agitated behaviour.
- Voice pitch and volume increasing.
- Dilation of pupils.
- Closing of hands to make a fist.
It is recognised and accepted that people who display high risk behaviour require skilled and effective management. If there is a risk of physical injury to the individual concerned or others, staff should attempt to control the situation in the least restrictive way possible based on the circumstances pertaining at the time. The use of non-physical strategies to deflect and diffuse the situation should be attempted as a priority whenever possible. These approaches include:
- Clear, calm speech.
- Maintaining eye contact on the same level as the resident if possible by either sitting or standing.
- Listening carefully and respectfully, allowing plenty of time for people with communication difficulties.
- Avoiding sudden movements.
- Reassuring the person that they will not be threatened or attacked.
- A relaxed, non-threatening, body posture adopted by the staff involved.
- Diverting the person into constructive activity and reinforcing positive behaviour.
If these strategies are not successful, the minimal level of physical control required might have to be used as a last resort to safeguard the well being of all concerned. The timing of any action will always be a subjective decision; there is a very fine balance between anticipating likely trouble and positively acting or reacting to trouble. Staff need to refer to the Use of Physical Interventions policy for guidance on using physical interventions. The decision to use physical interventions needs to be defensible.