1. SPECIFIC BEHAVIORAL PROBLEMS

2. CONSIDERATIONS FOR CARE 1. All behavior has a purpose 2. Experts believe: purpose of behavior is to satisfy unmet needs 3. Patterns of behavior are developed throughout a lifetime based on heredity and environment (life experiences) 4. Most older adults continue to use the same behavioral responses that they learned throughout their life

3. Challenges  Meet the patient’s needs to the best of your ability  Set standards of excellence for yourself  Sometimes only you will know (I.e., sterile field)  Let your conscience be your guide  Anything less than 100% is not acceptable

4. BEHAVIOR MANAGEMENT  ABC’s –A=Antecedent (cause) of behavior –B=behavior –C=Consequences of behavior

5. THREE STEPS OF BEHAVIOR MANAGEMENT 1. Determine cause of behavior 2. Eliminate cause 3. Sometimes the consequences of behavior may also need to be eliminated in order to stop behavior

6. ROLE OF CNA IN BEHAVIOR MANAGEMENT PLANS  Initial observations needed to describe behavior problem; identify possible causes of problem  Report objective observations to nurse  Be aware of management plan  Understand role and responsibilities  Request information & assistance from nurse prn

7. ROLE OF CNA IN BEHAVIOR MANAGEMENT PLANS  Increase resident’s good behavior by rewards specified in care plan –Verbal reinforcement may include positive feedback (praise, compliments, congratulations) –Nonverbal reinforcement may include acceptable touch (pat, hug, handshake) or smile, snack

8. ROLE OF CNA IN BEHAVIOR MANAGEMENT PLANS  Reduce resident’s inappropriate behavior by: –Ignoring it; if you can safely do so –Continuously reinforcing appropriate behavior –Other non-punitive responses as per care plan

9. Complaining/Demanding  Report complaint or demand  If demand or c/o justified, correct it  If not justified: –Assure resident that c/o heard & reported –Be good supportive listener –If c/o relates to care, be neutral, not defensive, do not take sides or argue with resident –Allow resident as much control over daily life as possible –Distract resident with favorite object/activity –c/o due to boredom? Attention seeking? Anger?

10. Yelling or Screaming  Distraction methods: snacks, discussing favorite topics (difficult to yell while eating or talking)  Causes: under-stimulation? Boredom? Fear? Pain? Unmet needs (hunger, thirst, toileting)?  Provide care to eliminate cause (if trained)

11. Verbal or Physical Aggression  Remain calm, reassuring, non-threatening body language  Do not become defensive, argue or try to reason with resident  Try distraction or have favorite caregiver calm resident  Look for causes: fear, anger, stress, feeling helpless, lack of privacy, misunderstanding, personality conflicts, unmet needs

12. Reporting  Report to charge nurse: –Changes in behavior –Possible causes of behavior –Effective comfort/diversional measures –Depressed or sad residents –Threats of suicide or threats to harm other people or property

13. Remember….. Behavior is a form of communication……. What is your resident/patient really trying to tell you……