1. Behaviors are Unmet Needs
In-service Training Guide

2. Understanding Negative Behaviors
Staff must try to change their thinking from trying to control behavior to finding the reason behind the behavior.
Ask yourselves, what behaviors do I exhibit when I am sick ? Do you want to get out of bed, shower, get dressed and be forced to go to the dining room for a meal ? Are you grumpy or anxious when your in pain ? If so, which would you prefer, treat your illness or your pain , or just treat your behavior ? Or, everyone just assume that the behavior is your norm and do nothing .

3. Understanding Negative Behaviors
Behaviors in relation to needs:
Behaviors to obtain or meet a need (pacing = stimulation need)
Behaviors to communicate a need (repetitive questioning = help me )
Behaviors that result from an unmet need (pain /discomfort = aggression)

4. Understand Negative Behaviors
Most negative behaviors are not normal
Find the underlying cause
Focus on abilities, not limitations
Behaviors are methods of communication
As caregivers, we may assume a resident’s negative behavior is normal. Most negative behaviors have an underlying cause. The underlying cause could vary from something as serious as severe pain or infection to something medically less serious such as my pants being too tight, or I’m hungry or thirsty but I can’t tell you that. Focusing on abilities reduces frustration.

5. Sometimes…… Understand Behaviors A behavior is actually a
personality trait and not a behavior !
There are people in the world that are, by nature grumpy, angry or just down right mean. There are people out there that prefer being alone, do not enjoy group events, that’s ok too. As caregivers we need to know by investigating that this is a personality and not a negative behavior.

6. Don’t take it personally !
Many times the resident cannot control his/her negative behavior. Understand that there is usually an underlying cause to that behavior, such as pain, or frustration. Take a moment to………
…….place yourself in that resident’s situation. Imagine, a month ago you were living life as usual, one morning you woke up and the whole left side of your body stopped working and you were unable to speak. People start making decisions for you, you are unable to take care of yourself at home, so now you’re living in a nursing home……..
Just think about it for a moment. The comforts of home, gone, the ability to use your bathroom as long as you want without interruptions, no more. The option to go into your kitchen and cook up a late night snack or have your beloved pet sleep at the foot of your bed, or have your grandkids spend the night, these options are gone, and for many ,these options are gone for good.

7. Don’t take it personally cont..
Now how’s your mood ? Do you think these changes could result in negative behaviors?
I cannot even begin to imagine what my moods would consist of, can you ?

8. FUEL + MATCH = FIRE The negative behavior is the “fire”
Negative Behaviors
FUEL + MATCH = FIRE The negative behavior is the “fire”
Next slide explains this slide

9. NEGATIVE BEHAVIOR
Fire can be put out over and over again, but it will continue to rekindle, unless the “fuel” (the underlining cause of the behavior) and the “match” (the trigger that sets off the behavior) are removed.
Lets move to the next slides to see how we can work on removing the underlying causes.

10. MANAGING NEGATIVE BEHAVIORS
Step 1: Identify the behavior
Identify the behavior, and ask yourself if the behavior is affecting the resident or other residents ?
Be specific, striking out at other residents, refusing care by striking caregiver, persistent crying resident unable to eat, and so on. If we just say “aggressive behavior” or “tearfulness” does this really tell us what is going on with the resident ? Keep in mind, if the resident’s behavior is not affecting or causing a danger to himself or others how do we need to proceed? Please refer to federal regulation F329.

11. MANAGING NEGATIVE BEHAVIORS
Step 2: Note what could be
causing the problem?
Become a Detective and
Investigate the Cause.
The more you understand the cause of the behavior, the better opportunity you have to create successful interventions! There are so many variables or underlying causes that may trigger negative behavior we need to look at all of theses variables, or possible causes. Please refer to the CMS Hand in Hand training program for behavioral interventions and approaches. View video clips of how our actions can trigger a resident’s negative reaction.

12. MANAGING NEGATIVE BEHAVIORS
When does it occur?
Where does it occur?
Who is there when it occurs?
What happens before it?
Here are some investigative questions to ask yourself. Look for triggers.
When? What time of the day is it…morning, afternoon, evening?
Where? Dining room, shower room, resident’s room?
Who is present? Let’s face it some personalities clash. Is the resident responding negatively to a particular person?
Does the residents behavior only happen when she is given a shower ? Maybe this resident never took showers, instead all her life she took baths. Easy fix, right ?

13. MANAGING NEGATIVE BEHAVIORS
Is it triggered by a medical
factor?
Is it triggered by the task?
Is it triggered by an
environmental factor?
Is pain or infection a factor? Are the caregivers rushing the resident during care causing anxiety or frustration ? Does the behavior happen at a certain time of day or during a noisy time of day like shift change ?

14. MANAGING NEGATIVE BEHAVIORS
Step 3: Adapt your behavior or the environment?
Set a realistic goal, one that you have a chance of achieving. Consider alternative approaches to the behavior. As I mentioned in the previous slide.

15. MANAGING NEGATIVE BEHAVIORS
Is there a communication
breakdown?
Other causes?
What does the situation
mean to the resident?
Verbal communication can be very challenging in some cases. As caregivers, we need to listen to what signals are being given when we can’t connect with words. (The Hand in Hand Toolkit sent to all homes by CMS demonstrates communication techniques that are helpful to all staff.)

16. MANAGING NEGATIVE BEHAVIORS
Brainstorm with your team.
Select an approach or a set of approaches and give it a try, perhaps for a week.
Re-evaluate your plan.
Adjust as needed
Determine how you will
share successes with co-workers.
Investigate/assess, plan, implement, and evaluate. If that plan didn’t work , adjust or simply start over .

17. May Reduce Negative Behaviors
COMMUNICATION
May Reduce Negative Behaviors

18. COMMUNICATION
Provide simple verbal cueing. Look in the resident’s eyes when speaking to him/her to help focus attention.

19. COMMUNICATION Ask only one question at a time Wait for a response
Provide options
Always include the resident in any conversation
Ask only one question at a time. Provide options such as, “Do you want to wear the red or blue dress?”, not, “What do you want to wear?”
Supply missing words for a resident if they get lost in conversation, or just can’t find a word, this can decrease frustration for the resident as well as show the resident that you truly are listening. And always include the resident in any conversation that is in regards to that resident or the care you are giving the resident.

20. Ask the resident for permission to do a task with him/her.
COMMUNICATION
Ask the resident for permission to do a task with him/her.
Explain the task too and always consider how much assistance the resident can provide with the task you are performing.; such as offering the resident a wash cloth to assist during bath or shower.

21. COMMUNICATION Use short, simple sentences Touch Eye contact
Never argue with a resident
Speak slowly, and
clearly
Always assume the resident can understand what you are saying. The ability to express oneself does not always affect the ability to understand others. Make eye contact and place yourself in front of the resident at their level.

22. COMMUNICATION
Staff should be aware of and monitor their own body language.
Often, our words say one thing, but our bodies say another.

23. COMMUNICATION Eliminate distractions: TV Radio Environmental noise
Most of our residents have decreased hearing abilities, and many suffer with decreased cognitive abilities.
Before attempting to guide a resident through a task eliminate as many distractions as you possibly can to enable the resident to focus better on the task at hand.

24. COMMUNICATION Visual cues !
Supply visual cues, such as touching your own glasses when asking, “Where are your glasses?” or pointing at your teeth when explaining oral care.
Supply visual cues, such as touching your own glasses when asking, “Where are your glasses?” or pointing at your teeth when explaining oral care.

25. STAFF INTERACTION
Residents are very sensitive to staff feelings/ stress/ behavior and will mirror those emotions.
We all know that when someone around us is stressed or upset, we can tell. Their feelings have the ability to affect our mood. Keep in mind that our disposition and interaction has the ability to impact both negatively and positively on the behaviors of those around us.

26. Be mentally prepared each day! DON’T REACT
Prepare yourself mentally and physically
Some residents may pinch or hit you unexpectedly. Be ready for it and don’t react.
Always use a slow, calm approach
Remember that some of our resident cannot mentally come to our world, so we must go into theirs. Their world may not be moving at the same pace as yours.
We should never force a resident to participate in care. It will serve everyone best, if you stop what you are trying to do and come back later to try again. Before you try again, you need to look at the failed attempt from previously. Do not come back and do the exact same thing and expect a different reaction from the resident. There are many of our residents that may not remember who we are from one day to the next, but they will remember a negative interaction. You may need to see if there is a member of your team that the resident responds to better than you. If so, ask for help from that individual.

27. REMEMBER
Focus on abilities of our residents, not the limitations. What CAN they do? Behaviors are methods of communication.
For example, taking clothes out of a closet can be a resident’s way of conveying that they are looking for something (not necessarily clothes).
We have to get creative and find ways to determine the message behind the behavior.
Another point to remember is: Always watch for signs of pain and report it to your charge nurse.

28. “Treat people as if they were what they ought to be and you help them to become what they are capable of being” Goethe philosopher

29. Thank You for taking the time to learn about behaviors.