1. Preventing Aggressive Resident Injuries Facility Name

2. Introduction to Aggressive Behavior Half of staff injuries caused by aggression Injuries may be severe Stressful and confusing to caregiver Can be frightening

3. Types Of Aggressive Behavior Verbal Physical Emotional

4. Causes Of Aggressive Behavior Pleasantly confused; can’t understand Fear: of us, their environment, their future Difficulty communicating: feel anxious and frustrated Underlying medical problems such as pain or infection Toilet-related problems Damage to the brain, Alzheimer's, etc. (con’t)‏

5. Causes Of Aggressive Behavior (con’t) Approach and attitude of caregivers Changes resulting in loss of control of their lives Over-reaction to simple things such as noise, glare, commotion, routine, rushing Social and moral values Losses resulting from aging

6. Some Characteristics of Aggressive Behavior Aggressive behavior is usually progressive Can usually predict behavior Most likely times for aggression: Bathing and toileting ADL care Passing meds There are good days and bad days

7. Avoiding & Preventing Aggression Avoid: Reality orientation or reasoning Approaching from the rear Calling out after the resident Talking too loudly Shouting at or among staff members Using slang (“take a hike”)‏ Arguing, scolding, or being negative Talking about other residents

8. Avoiding & Preventing Aggression Evaluate as you approach, looking for clues Stay out of their space until sure of your safety Approach from the front; smile Establish eye contact Give resident time to respond or “warm up” Use touch if appropriate

9. Avoiding & Preventing Aggression Your face should match your words Watch your body language: they will tend to mirror your moods and actions Keep your voice at normal tone Remove distractions before communicating Don’t rush Watch for warning signs

10. Avoiding & Preventing Aggression Validation matches your mood to your message Redirection distracts them from frustration Remember: concentration is difficult for them Limit choices to two (2)‏ Break tasks into small steps Demonstrate what you want One short instruction at a time Give them time to do the tasks

11. Be A STAR  S top  T hink  A ssess  R espond

12. Responding To Aggressive Behavior Warning Signs Changes in normal patterns Body language: Gestures Clenched fists Grating teeth Rapid breathing Red face or eyes

13. Responding To Aggressive Behavior Do not take it personally May help to stay close to them, to reduce force Remain calm; stop the care briefly Use a gentle approach Redirect If necessary, leave and get help

14. Gentle Responses To Aggressive Behavior Yell their name, or clap to divert their attention Tell them they are hurting you Sing something calming, like “You Are My Sunshine” or “Jesus Loves Me” Never turn your back Keep an exit available

15. Specific, Gentle Defenses For Aggressive Behavior Hair pulling: Push their hands into your scalp Biting: Gently pinch their nose shut Gently push your hand into their mouth Wear a towel or jacket Grabbing: Gently pull their thumb loose Turn and pull away

16. Other Preventive Measures Delay activity if appropriate Evaluate ABC’s Antecedents Behaviors Consequences Document and evaluate problems Communicate, but don’t label or condemn

17. TIPS FOR CAREGIVERS 1. Singing softly sometimes calms the patient 2. Safeguard the environment: remove dangerous objects their from reach 3. Ask permission for all tasks that require you to approach them 4. Communicate non-verbally in a reassuring manner: use eye contact, or a non-threatening physical position 5. Join the patient in their world (their reality)‏ 6. Walk away from verbal assaults (con’t))‏

18. 7. Recognize and heed the warning signs 8. Keep the patient covered and warm while undressing and/or bathing them 9. Don’t force them into doing tasks 1.Avoid abrupt approaches 11. Approach slowly; approach calmly Gain their trust, don’t demand it 12. Create a comfortable, fun atmosphere as much as possible

19. Questions? Thank you for your time!