Caring For People with Disruptive Behaviours
Caring for older people can be very complex, due to the effects that aging has on the body, add to this complex situation, dementia, and it becomes even more complex. The behavioral disturbances that are common for this group of people are, hitting, screaming, biting, resisting care, wandering, self-harm, nocturnal wakefulness, refusal to eat, frequent and unnecessary toilet requests, and intrusion (Adams, 2008). Acute care nurses are expected to deal with serious illnesses along with the behaviour issues of elderly people, which can be exacerbated by hospitalization. (Adams, 2008). This paper will examine the behaviours displayed by people with dementia in the acute setting, and strategies to provide appropriate care and manage these behaviours.
In the acute setting and some residential aged care facilities, the nursing approach to these situations is to ignore the patient or to rely on the restrictive measures, for example, physical or chemical restraints (McCloskey, 2004). Physical restraints are anything that prevents a person from free flow of moment. Chemical restraints are sedatives, antipsychotics etc (Wang&Moyle, 2004). These approaches are initiated to minimize or eliminate the particular behavior in question, thus reflecting ignorance to the needs of the older person with dementia (SullivanMarx, 2001: GP and Residential Aged Care Kit, 2006).
Nurses can no longer take a reactive approach to these issues due to the scope and complexity of the issues. Nursing staff should adopt a more proactive approach and carefully plan the care for patients who have dementia (Dewing, 2001: GP and Residential Aged Care Kit, 2006). There are models of care that can be followed, which help to reduce the stress factors for these patients, thus in turn reducing the stress, frustration and aggravation for the nursing staff. These models of care have also been proven to enhance the level of care and improve the quality of life for the individual with dementia (Brooker, 2007). One such model of care is the Progressively Lowered
Stress Threshold Model (PLST), this was introduced in Canada in 2002, another model is the Person Centered Care Model, (Brooker, 2007: Edvardsson&Nay, 2009)
Both models recognize that patients with dementia have difficulty in receiving, processing and responding to stimuli, especially environmental stimuli. These difficulties have resulted from the progressive decline in cognitive, effective and functional abilities (McCloskey, 2004). The PLST model also indicates that patients with dementia can exhibit behaviour that is baseline. This behaviour can at any given time vary due to environmental factors or the stage of disease (Brooker, 2007: Edvardsson&Nay, 2009) Generally baseline behaviour is when a patient is in a calm state and able to function accordingly to the level of cognitive impairment they may have (Bartel, Dums, & Oxam, et al, 2004). If the patient is feeling stressed or experiencing feelings of loss of control, anxious behaviour, such as avoidance may occur (McCloskey, 2004). If this anxious behaviour continues, and there are excessive stimuli present, then aggression or verbal disruption may occur. (GP and Residential Aged Care Kit, 2006). When these demands on the individual are removed or adjusted then functional behaviour will occur (Brooker, 2007).
There are six main groups of stressors that affect the patient with dementia, thus accelerating the behaviour from baseline to the anxious and dysfunctional level. The groups are changes in routine, fatigue, unfamiliar people, environment, caregiver, and demands that go beyond the functional capacity of the individual with dementia (Nordam, Sorlie, & Forde, 2003). Also, excessive stimuli, perception of loss, anger, pain and medication could be included in this category. These stressors can cause the individual to become anxious, stressed and therefore trigger the dysfunctional behavior...
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