1. ANNUAL COMPULSORY EDUCATION RESIDENT AGGRESSION Revised April 2013

2. LEARNING OBJECTIVES: Be able to define aggression Increase your understanding of why aggression happens Become an active participant in adjusting the environment & your approach Increase your understanding of and become an active participant in identifying agitation & preventing aggression Increase your understanding of the importance of reporting agitation & aggression

3. WHAT IS AGGRESSION? Aggression is a forceful attacking action, which may be physical or verbal Aggression can be effected by environment, cognitive loss, & loss of independence

4. WHY DOES AGGRESSION OCCUR ? Aggression is the expression of anger, frustration, and/or fear It is the resident’s way of calling out for help or defending themselves All behaviors have reason(s), we just do not always know what those reason(s) are In some cases the aggressive behavior is triggered by a certain situation and/or event

5. CONTRIBUTING FACTORS Multiple losses: Loss of their home Loss of their independence Loss of loved ones & possibly children Physical losses: vision, hearing, mobility Reduced ability to communicate Dependency on staff & loved ones: This often leads to frustration, aggravation & anger Loss of control over their lives They are often left with very few choices, i.e. what time they have to get up, when they can go for lunch

6. CONTRIBUTING FACTORS Fear of dying Invasion of privacy & personal space This results in feelings of weakness and powerlessness. Residents can feel hopeless or threatened and become defensive or protective Environment : Increased noise levels, changes in temperature, loss of control over activities Being rushed may cause uneasiness & frustration Delirium: Periods of confusion, impaired judgment, confusion from pain, types of medications & other diseases

7. CONTRIBUTING FACTORS Dementia: The resident is lost in a world that makes little sense. They may have anxiety that easily leads to fear & panic. Restraint devices Cause increased levels of anxiety & agitation Disease Processes: Arthritis Diabetes Stroke Constipation Pain Infections

8. PREVENTING AGGRESSION Prevent situations that you know may contribute to agitation, which can lead to aggressive behavior Do not expect or ask more of the resident than he/she is able to do Always use a calm approach; avoid surprising the resident Check for source of distress Pain, constipation, looking for washroom, hungry, tired, cold Decrease stimulation to maintain a calm & quiet environment Know triggers & plan ahead

9. ENVIRONMENT The environment should be: Calm & Quiet Comfortable Private Good lighting No distractions Ensure resident is wearing appropriate eyeglasses & hearing aids

10. REMEMBER YOUR VOICE Tone of voice is more important that what you say Voice should be calm, soothing & low Speak slowly and clearly using short phrases rather than sentences Present one idea at a time Do not hurry, allow time for a response

11. BODY LANGUAGE Facial expression Gestures Maintain eye contact Approach slowly from front, do not surprise Use a gentle touch on the arm Do not appear threatening in any way Smile

12. KNOW YOUR RESIDENT Cognitive Resident Trust is built and maintained Reasons for aggressive behavior may be very clear Resident with Dementia Trust must be built every time you meet You must get into their world You must be willing to help Reasons for aggressive behavior can take time to figure out

13. SIGNS OF AGGRESSION Learn to identify the signs that a resident may become aggressive For example constant pacing, excessive talking, & defensive behavior may all be indications of increasing frustration & agitation Report these signs to the nurse in charge Remember that their reality is different than yours

14. LOOK FOR WARNING SIGNS Pacing Searching for something Anxiety or nervousness Raised voice Suspiciousness Isolating self Threats Throwing things

15. MANAGING AGGRESSIVE BEHAVIOUR Do : Treat residents as adults & individuals Everyone wants to be recognized & valued Remember that the resident has feelings too Gauge facial expressions & body language Empathize: Try to understand their experience, put yourself in their position Take the time & slow down Listen & be respectful

16. MANAGING AGGRESSIVE BEHAVIOUR Do : Allow them choices, but keep them to a few Know the resident; it may give you hints to their behavior Get into their reality as they cannot be in yours Confirm their feelings Your words & body language should give the same message Keep your hands visible & in the open Allow the resident to talk first Reassure the resident that you are there to help

17. MANAGING AGGRESSIVE BEHAVIOUR DO NOT : Argue, confront or correct them This is disrespectful & can cause agitation & aggression Ask questions that the resident may not remember. i.e. “How many children do you have”’ Instead ask, “Do you have any children?” Embarrass, shame, or belittle Give too many choices Take it personally, reflect on the triggers, & adjust your approach for next time

18. REPORTING AGITATION & AGGRESSION Report all acts of aggression & agitation to the Nurse Nurse will review the resident’s history, diagnosis, medications as well as complete a pain & physical assessment along with behavior mapping The goal is to find triggers to the agitation & prevent escalation to aggression It is important that all information about the aggressive behavior be given to the Nurse

19. MANAGING AGGRESSIVE SITUATIONS Remain calm Do not try to physically stop the resident Be aware of your surroundings Keep voice & body language non-threatening If possible, remove resident from the location & leave the situation/report to a Nurse Call for help if you are unable to escape the location or if others are in danger Always report incident even if no injuries occurred

20. REFERENCES Brenda Strafford Foundation LTD. Policies