In health care setting, Challenging behaviours are circumstances where a client loses their self-control and may inflict physical and emotional mischief to self and others. A person exhibits challenging behaviour in many ways and it is not considered a problem but an expression that they are not satisfied with the service rendered or as defence mechanism such as denial. These behaviours may include verbal aggression like swearing, name-calling and shouting, which is very common in elderly in care. physicalanger such as hitting, viciousness and inflicting self-injury. Sometimes challenging in a non-verbal way and can be observed as wandering, apathy and repetition.
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There are different causesthat makes a client at riskof exhibiting challenging behaviour. Mental illness is a common case of client demonstrating challenging behaviour. People who are living with little or cannot make decisions are at risk of developing challenging behaviour. Elderly who are finding it hard to communicate or unable to do so at all, clients with physical causes like urinary tract infection, constipation are examples of causes and risks. Although these are risk of challenging behaviours, there are triggers that makes them challenging and most of the time it happens during a care staff and client interaction such as when a client refuses care the care staff would insist in such a manner that would upset the client. or environmental factors such as noise or poor room lighting. The effects of drugs can also trigger some behaviours challenging to staffs.
Mr. V is an 80-year-old client in the care facility and is living with early stage of dementia. He is also a two person assist with his mobility. He is a man of routine and always wants to do things spot on. Staff are aware of him displaying challenging behaviour such as swearing and hitting carers and sometimes playing up.
One day as two carers entered ten minutes late in his room for his 7:30 morning care. He shouted for a pee bottle. Carer (1) rushes to get the bottle but he has started wetting his bed. He disappointedly told the carers that no one has come to attend on my needs. Carer (2) rather sarcastically explained that he should have rang the call bell and not wait for carers to arrive. Mr. V started closing his fists and breathes fast. He then shouted calling carer (2) stupid and started hitting him, throwing punches but somehow misses. Carer (2) moved away saying he is not there to take on his behaviour and left him along with carer (1). Nurse on duty was informed. Morning care was rendered later in the morning by different carers and broke Mr. V’s daily routine. He also refused breakfast and morning medications. He would often ring the bell just to tell someone about what has happened to him, threatening he will make a complain. Although he became settled later on the day, the incident has made it difficult for carers to provide the care he needs.
On this scenario, Mr. V’s mental illness made him at risk of challenging behaviour. the two carers coming late to his room disappointed him, but their respond triggered his anger, making him difficult to deal with. signs of beginning of challenging behaviour, based on the incident was when Mr. V started clenching his fist with heavy fast breathing. To deal with Mr. V’s behaviour, professional strategies would make the incident manageable:
- Giving the client a breather. Walking away is one of the most efficient approach in dealing with aggressive behaviours exhibited by the client. it simply means giving a break for both care provider and the client. coming back after 10-15 minutes and starting with a smile and calm approach may change the outcome of the scenario. It can also reduce the likelihood of another episode of challenging behaviour if properly executed.
- Diverting attention to something else. Rather than answering back sarcastically to Mr. V. carer (1) should have made up something else to talk about such as weather or something that can get his attention diverted from his feeling of being upset. getting rid of some factors that may contribute to such behaviour like elimination of distracting sound to divert the attention on a more manageable way.
- Using Empathetic listening makes it easier for carers to understand what really is going through the client’s mind. An effective method that results in effective communication to avert and manage challenging behaviour. As Mr. V expresses his disappointment, avoiding unnecessary response would have resolved the issue or made it more controllable. Just by acknowledging his feelings, putting yourself into his situation and understanding why he felt that way
Reporting and documenting incidents of challenging behaviour is very crucial in providing care for the client. this means that care assistants are to observe the details of the behaviour and describing as it happened rather than generalising in one or two words on the report. Failing to report or document such behaviours prevents other carers to provide health services needed. This can lead to the client’s deteriorating health condition and well-being. It can cause injury or further harm to both client and care staff. If the incident of challenging behaviour was not addressed, there will be no warning sings to watch out for, nor resolutions when it occurs that could result to harming self and others. In the long run it can damage the integrity of the organisation and the industry of care. once these challenging behaviours become worst, relatives and whanau can make a complain and the company may face legal issues.
Knowing your professional boundaries are essential in managing challenging behaviour. referring to your company’s policy and doing only what your job description asks you to will protect you and the client on incidents same as exampled above. It is being there to only provide the necessary care and not taking your personal feelings affect you from doing your job. Mocking Mr. V’s feelings is a form of crossing professional boundaries as his feelings was not taken into consideration.
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