1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

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