understanding dealing with aggressive residents in nursing home

1. Understanding & Dealing with Aggressive Residents in Nursing Home For Health Care Provider

3. Understanding a resident with aggressive behaviors Aggressive behavior is often associated with some form of moderate dementia. Due to cognitive impairment, the resident tends to misinterpret, misidentify and be confused, especially by intimate caregiving. Usually, the aggression is a method of gaining control and a "fight or flight" stress response leading to resistance and reactance. Most of workplace violence by aggressive residents in nursing home is unpredictable, and sudden. It is most frequent when assisting residents with feeding, bathing and dressing. The violence occurs with demented and non-demented residents and seems to increase during the evening and night shifts.

4. Causes of Aggressive Behavior of the residents in nursing home The residents with aggressive behaviors have often had severe factors combine to trigger their outburst. Ex: The phenomenon of �sundowning� in which resident with early dementia becomes agitated as the sun sets, may be the result of several combination of diminished eyesight and hearing, feelings of hunger, adverse effects of medications for his illness, and disorientation caused by staff shift changes.

5. The 19 Tips to deal with aggressive behaviors

6. 1. Asking for pain or physical discomfort before assistance Approximately 20 % of residents with agitation, particularly verbally aggressive behavior, had pain which can cause screaming and other types of agitation.

7. 2. Active listening & effective verbal responding Take time to really hear what a resident is saying, remain honest, calm, clear and concise during interactions. Not jumping to conclusions. Ensure appropriate eye contact and facial expressions

8. Case Study An elderly resident was very upset and began angrily pacing the floor. When a CNA started to walk with him and listen to his concerns, he confided in her that his wife was late in coming to visit him that day. When the CNA checked the day�s schedule, she was able to reassure him in a clam, caring voice that his wife would arrive in 2 hours. It made him relieved and his pacing ceased.

9. 3. Don�t rush the resident or overly structure the environment Tension commonly results from feelings of being forced or pushed to act in a certain way.

10. 4. Using redirection and �Fiblets� in residents with memory impairments You can simply draw the resident�s attention to another subject and take her mind off of whatever she is focusing on. Fiblets are often called �little white lies.� They address the subject the resident is dwelling on, provide some comfort, and allow the resident to mentally move on to another subject.

11. Case Study A retired resident with dementia became agitated at 4 p.m. that her factory shift was up and she had to catch the bus to go home. She paced the floor and wanted to catch the bus. Staff recognized her distress, and each afternoon at 3:55 p.m. would give her a ticket for her bus and tell her to wait for it. The �ticket,� as a fiblet, redirect her. After a few minutes, she became interested in her supper and forgot about her bus.

12. 5. Physical Stance & position Maintain a non-confrontational stance Use non-threatening postures

13. Your Position with a aggressive resident Standing with feet about 18 inches apart and put one foot forward toward the resident and the other foot a step back at a 45 degree angle. Keep your hands and arms at your sides. You position yourself to the side rather than directly in front. Maintain a distance of approximately six feet. You should bend from the knees, kneel or sit down so that you are at the resident�s eye level.

14. Your Position with a aggressive resident (cont.) Don�t standing over a resident who is seated or in bed can be frightening and may provoke anger. Don�t cross your arms in front of you because this can be interpreted as menacing.

15. 6.Eye contact with an aggressive resident. Approaching slowly & calmly from the front. Telling the resident what you are going to do and try not to startle him/her. Don�t stare or scowl because these expressions may be interpreted as a challenge. Watching the resident�s eye movement. You may be given an advance warning that a resident is preparing to strike you.

16. 7. �Tincture� of time Allowing the resident to have time and space to let his/her outburst dissipate.

17. 8. Controlling the Environment Moving other residents and staff out harm�s way. Removing objects that could be used by the resident to hurt him/herself or others. Blocking routes by which he/she could leave the facility. Making sure the aggresive resident is not alone and is always kept in view.

18. 9. Reinforce non-violent behaviors Rewarding positive behaviors discourages negative outbursts.

19. 10. Using touch judiciously A touch or a hug can be comforting to an agitated person, but for another if could be provoking.

20. 11. Encourage the resident to do as much as possible.

21. 12. Promote regular exercise

22. Be careful 13. Avoid arguing or trying to reason with the resident. 14. Don�t use aggression or make threats when dealing with the resident. 15. Avoid physical restraint wherever possible. 16. You should always get help immediately if they are in danger.

23. 17. Please tell the supervisors when a resident is aggressive.

24. 18. How to release from a aggressive resident resisting to catch you Release from a one-handed grip Pull out of an arm grip is to first make a fist. Twist your arm toward the gripping thumb until the side of your wrist is between the resident�s thumb and fingers.

25. Release from a hair pull: Clasping your hands over your head. Pressing down with your knuckles on your attacker�s hand. This relieves the pain cause by the grasp & provides leverage for the release of the release of the hold. Maintaining this pressure, when you feel the resident�s hold loosen, bend at the waist and turn away.

26. Release from a bite: Avoid the urge to pull away. Pushing toward the bite. Use your free hand to place your index finger in the pressure point just below the ear at the upper point of the jaw bone. Extenting the thumb of the same hand to the lower jaw. The jaw will loosen and you can remove the injured area. Note: Human bites need special medical attention. Report the bite immediately to a supervisor.

27. 19.Recreational adjunctive and social therapies for aggressive resident Physical environment Music, voice and language Massage and Aroma Light Therapy

28. Physical environment For agitation and aggression during bathing, bathrooms were enhanced with tape recordings of birdsong, flowing water and small animals and large bright picture. Moreover, residents were offered pudding and soft drinks. : Meals were provided in day room for the residents with aggression during elevator transfer to meal room.

29. Music, voice and language: For agitation and aggression, audiotapes of preferred music played during bath times. Classical music played for 1 and � hours in the dining room during the noon meal during alternating weeks. Music played from five minutes before dinner until last person left dining room.

30. Massage and Aroma: 30-minute hand massage twice a day. Aromatherapy & massage showed greatest reduction in agitation between 3-4 p.m. 2% lavender oil via aromatherapy stream daily. Melissa oil (10% by weight combined with base lotion) via cream applied to hands twice daily.

31. Light Therapy: For agitation: 2 hours morning exposures to 2500 white fluorescent light to reduce agitation in the evening.

32. Conclusions Aggression encompasses a range of behaviors, from verbally non-aggressive outbursts to physical assaults. Often, what appears to be aggressive behaviors may be the residents� way of expressing needs they cannot communicate verbally. Therefore, health care providers should carefully evaluate, understand and tailor interventions to the residents� needs.