1. Annual compulsory education
Resident aggression
Annual compulsory education
Revised April 2013

2. Learning Objectives: Be able to define aggression
Increase your understanding of why aggression happens
Become an active participant in adjusting the environment & your approach
Increase your understanding of and become an active participant in identifying agitation & preventing aggression
Increase your understanding of the importance of reporting agitation & aggression

3. What is Aggression?
Aggression is a forceful attacking action, which may be physical or verbal
Aggression can be effected by environment, cognitive loss, & loss of independence

4. Why Does Aggression Occur?
Aggression is the expression of anger, frustration, and/or fear
It is the resident’s way of calling for help or defending themselves
All behaviors have reasons, we just do not always know what those reasons are
In some cases the aggressive behavior is triggered by a certain situation and/or event

5. Contributing Factors Multiple losses: Loss of control over their lives
Loss of their home
Loss of their independence
Loss of loved ones & possibly children
Physical losses: vision, hearing, mobility
Reduced ability to communicate
Dependency on staff & loved ones: This often leads to frustration, aggravation & anger
Loss of control over their lives
They are often left with very few choices, i.e. what time they have to get up, when they can go for lunch

6. Contributing Factors Fear of dying
Invasion of privacy & personal space:
This results in feelings of weakness and powerlessness. Residents can feel hopeless or threatened and become defensive or protective
Environment: Increased noise levels, changes in temperature, loss of control over activities
Being rushed may cause uneasiness & frustration
Delirium: Periods of confusion, impaired judgment, confusion from pain, types of medication & other diseases

7. Contributing Factors Dementia: Restraint devices Disease Processes:
The resident is lost in a world that makes little sense. They may have anxiety that easily leads to fear & panic.
Restraint devices
Cause increased levels of anxiety & agitation
Disease Processes:
Arthritis Pain
Diabetes Infections
Stroke Constipation

8. Preventing Aggression
Prevent situations that you know may contribute to agitation, which can lead to aggressive behavior
Do not expect or ask more of the resident than he/she is able to do
Always use a calm approach; avoid surprising the resident
Check for the source of distress
Pain, constipation, looking for a washroom, hungry, tired, cold
Decrease stimulation to maintain a calm & quiet environment
Know triggers & plan ahead

9. Environment The environment should be: Calm & Quiet Comfortable
Private
Good lighting
No distractions
Ensure resident is wearing appropriate eyeglasses & hearing aids

10. Remember your Voice Tone of voice is more important that what you say
Voice should be calm, soothing & low
Speak slowly and clearly using short phrases
Present one idea at a time
Do not hurry, allow time for a response

11. Body Language Facial expression Gestures Maintain eye contact
Approach slowly from front, do not surprise
Use a gentle touch on the arm
Do not appear threatening in any way
Smile

12. Know your Resident Cognitive Resident Resident with Dementia vs.
Trust is built and maintained
Reasons for aggressive behavior may be very clear
vs.
Resident with Dementia
Trust must be built every time you meet
You must get into their world
You must be willing to help
Reasons for aggressive behavior can take time to figure out

13. Signs of Aggression
Learn to identify the signs that a resident may become aggressive
For example constant pacing, excessive talking, & defensive behavior may all be indications of increasing frustration & agitation
Report these signs to the nurse in charge
Remember that their reality is different than yours

14. Look for Warning Signs Pacing Searching for something
Anxiety or nervousness
Raised voice
Suspiciousness
Isolating self
Threats
Throwing things

15. Managing Aggressive Behaviour
Do:
Treat residents as adults & individuals: Everyone wants to be recognized & valued
Remember that the resident has feelings too
Empathize: Try to understand their experience, put yourself in their position
Gauge facial expressions & body language
Take the time & slow down
Listen & be respectful

16. Managing Aggressive Behaviour
Do:
Allow them choices, but keep them to a few
Know the resident; it may give you hints to their behavior
Get into their reality as they cannot be in yours
Confirm their feelings
Your words & body language should give the same message
Keep your hands visible & in the open
Allow the resident to talk first
Reassure the resident that you are there to help

17. Managing Aggressive Behaviour
DO NOT:
Argue, confront or correct them
This is disrespectful & can cause agitation & aggression
Ask questions that the resident may not remember.
i.e. “How many children do you have”’ Instead ask, “Do
you have any children?”
Embarrass, shame, or belittle
Give too many choices
Take it personally. Reflect on the triggers, & adjust your approach

18. Reporting Agitation & Aggression
Report all acts of aggression & agitation to the Nurse
Nurse will review the resident’s history, diagnosis, medications as well as complete a pain & physical assessment, along with behavior mapping
The goal is to find triggers to the agitation & prevent escalation to aggression
It is important that all information
about the aggressive behavior be
given to the Nurse

19. Managing Aggressive Situations
Remain calm: Do not try to physically stop the resident
Be aware of your surroundings
Keep voice & body language non-threatening
If possible, remove resident from the location & leave the situation/report to a Nurse
Call for help if you are unable to escape the location or if others are in danger
Always report incident even if no injuries occurred

20. Brenda Strafford Foundation LTD. Policies
references
Brenda Strafford Foundation LTD. Policies