From Dementia Skilled Improving Practice NES/SSSC 2011 Module 4 April 2015 Dementia skilled – Improving Practice Module 4 : Meeting the Needs of the Person with Dementia who is Distressed Trainers Names April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Learning outcomes Understand that when a person is expressing stress and distress they can be communicating their unmet needs Identify the common types, causes and triggers for distressed behaviour Contribute to recording and understanding distressed behaviours using an antecedent, behaviour and consequences approach April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Learning outcomes Describe how to respond when a person with dementia is expressing stress and distress Recognise the importance of gaining access to professional support and interventions to alleviate stress and distress April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Distress When someone is distressed it is useful to ask Is it really a problem? Who is it that finds the distressed behaviour problematic? Are there external factors that are challenging to the person with dementia? Is the behaviour compromising the safety of the person or others? April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Distressed behaviour Distressed behaviour can be seen as an attempt to communicate unmet need Cohen-Mansfield (2000) April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

Using the unmet need model Read through the descriptions on page 76 of the unmet need model then discuss the following What do you think of this model? Do you agree in the solution offered? Could there be other possible solutions? April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Activity Look at the activity on page 77 that you were asked to complete. Share your answers in pairs Time allowed 15 mins Now as a group Did you find this a useful exercise April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Differentiation James (2011) suggests it is useful to consider Non active forms of behaviour Active forms of behaviour Reactions to stressful situations Walking and interfering activities Failures to inhibit actions Thoughts and emotion A mismatch between the person and the environment April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

Triggers of distressed behaviours As a group brainstorm the Biological Psychological Social and environmental April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

Possible causes of distressed behaviour Many things may interact Physical environment Personality Cognitive and neurological difficulties Mental health Care and cultural environment Perceptual difficulties Physical health problems Biological changes Medication Beliefs The distressed behaviour is the “tip of the iceberg” April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Activity Look at page 81 can you identify similarities and differences? April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 What are ABC charts? Help assess the situation surrounding the distressed behaviour They give time to reflect and consider what is happening Before During After an episode of stress or distress April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Aims of the ABC chart Sheds light on the emotion that the person may be experiencing Helps us understand what they might be thinking Helps us understand what they may be trying to communicate Is a method for analysing what happened Is a method to consider clues and triggers April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 The ABC chart A – Antecedent B – Actual behaviour C – Consequences April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

How to complete ABC charts Only include what you observe Be factual Be objective Record all sections Fill in straight away Fill in every time the person is distressed April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Why ABC charts? Individual approach Replaces working on ‘hunches’ Person centred Leading to individually tailored support plans based on outcomes Uses a team approach April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 What happens next? ABC Analysis Develop a shared understanding of the individual’s distress Understanding of thoughts and emotions that may have triggered the person’s distress Develop an understanding of what can be done to reduce the person’s distress April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Using Person Centred Approaches to support people with dementia who are communicating distress Use helpful communication approaches Encourage people’s choice and independence Make sure the person is not in pain Make sure the person’s fundamental care needs are being met Make sure the person has opportunities to engage in meaningful activities Always shoe respect for the person April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 Responding positively to people with dementia who are communicating distress Verbal Communication Non verbal communication Distraction Individualised plan based on the outcome of the ABC analysis April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

How people may communicate distress Shouting Verbal aggression Repetitive questioning Repetitive phrases or movements Suspicion April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

Self assessment quick quiz If you have not done so already complete the self assessment on Pages 95 and 96 Then identify the most important things you have learned in this module April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

From Dementia Skilled Improving Practice NES/SSSC 2011 For next time Write down any questions that arise between now and next session Read Module 5 Complete activities on page 103 April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011

Thank you and we will see you on ………….. Contact Details April 2015 From Dementia Skilled Improving Practice NES/SSSC 2011