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How to Manage Resident Behaviors!
Tia Stevens- Hovatter MPH, NHA, ACC, AC-BC, CDP Director of Education Health Consultants Plus Clarksburg, WV
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Top 5 behaviors Resistance to Care Wondering Short Attention Span
Examples: Refusing medications, showers, wound treatment, ect. Wondering Examples: Exit Seeking, purposeful wondering Short Attention Span Examples: Repetitive questions, ect. Socially Inappropriate Yelling, screaming, hitting, kicking, biting, pinching, ect. Sexually Inappropriate Example: Public displays, between residents, ect.
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ABC’s of Behavior Management
A – Antecedent What happened before the behavior to trigger the behavior? Did anyone or anything trigger the behavior? B – Behavior What is the current behavior? What is happening? What did the person do? C – Consequence What happens immediately after as a result of the behavior? What are the changes in the behavior of other people or the environment as a result of the behavior?
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ABC – The Hill Method B C A
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Survey Focus - Psychotropic Medications
Antipsychotic Sedatives/Hypnotics Anti-Depressant Haldol Risperdal Seroquel Zyprexa Ambien Atarax Ativian Xanax Elavil Paxil Prozac Wellbutrin Zoloft
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“We are NOT Babysitters!”
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Our Time vs. There Time If behaviors happen during “our time” (activity time), then the behavior must be documented and care planned by activities. Also reported to the Interdisciplinary Team Social Services and Nursing usually document behaviors Don’t get caught!!!!!! If nursing and/or social services is documenting resident screaming during activities and your documentation does not indicate such behavior……….the surveyors will find you !!
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Most Common Behaviors During Activities
Resident to Resident Altercations Throwing items Taking items from others Putting items in their mouths Sexual behaviors Yelling, screaming, pinching
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Stop Behaviors Before They Start!!
Keys to success Short Segmented Sentences 6 Words or less Establishing eye contact Eye Level Become Familiar Handshake Smiling Seating Know interest/likes, history
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Activity Documentation - Behaviors
Example - Resident who does not have behaviors during activities Resident quarterly care plan conference completed this date. Resident continues to attend morning activities of choice, but often prefers to not attend afternoon activities. She often enjoy sitting at the nursing station in the afternoon and talks with staff and other residents. At times the resident does yell and throw items in the afternoon, however this behavior does not occur during scheduled activities she attends. She enjoys exercise, morning bible study, watching TV and has frequent visitors. Staff continue to encourage. Care plan reviewed this date.
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Activity Documentation - Behaviors
Example – Resident who does exhibit behaviors during activities. Resident annual care plan conference completed this date. Resident continues to attend most OOR activities daily. She spends most of her day in the dinning room/activity room sitting in a rocker chair near the back of the room , per her preference. Resident does attend activities such as crafts or socials and is an active participant at times, however most of the time resident passively observes most activities. Resident has dx of schizophrenia, dementia, bipolar disorder. At times resident will scream, yell and curse during activities, she is not easily redirected at times. At times resident is redirected and will go to her room to take a “nap”. Staff continue to encourage, praise and invite to groups. Care plan reviewed this date.
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Activity Behavior Care Plan - Sample
Problem Goal Intervention Resident screams and curses during group activities. Resident will have decreased episodes of screaming and cursing during OOR group activities weekly thru next review. -Redirect -Reassure -Provide beverages during activities -Sit with resident as needed -Enjoys talking about purses and jewelry -Enjoys sitting in her rocker chair in back of room per her preference -At times passively observes during activities, at times is active (social, crafts)
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?? Questions ??
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