Preventing Stress-Related Behaviours in Care of Older People
The best vantage point for understanding behaviour is from the internal reference frame of the individual himself.
— Rogers (1951)
When caring for a person with dementia who is having difficulty communicating, staff are encouraged to remember that residents will pick up on negative body language such as sighs and raised eyebrows. There is evidence that non-verbal influences on communication are magnified by the effects of some types of brain damage and brain injury.
Practical Prevention Strategies
The following de-escalation techniques help staff prevent situations from escalating into stress-related behaviours:
- Stop. Plan & explain!
- Smile!
- Go Slow!
- Go Away!
- Give them space!
- Stand aside!
- Distract them!
- Keep it quiet!
- Don’t argue!
- Brainstorm & debrief!
I don’t think we can ever truly say what a person is experiencing when they are dementing but I suspect it is a world most unlike our own, it is a world of unremitting not knowing, increasing mystery, perpetual insecurity. They misunderstand many things, they misunderstand why somebody might come up to them and say let’s get those clothes off you — I mean, who is this person who is saying that?
— Graham Stokes, BUPA Director of Care
Legal Duties and Staff Safety
Standard 4 (2) of the National Minimum Standards for Care Homes for Older People states that: “You can expect that the home is run in a way that protects you from any avoidable risk or harm, including physical harm and infection.”
This positive statement has the same general meaning as the direction in the Health and Safety at Work Act 1974, section 3 (1), which underlines the employer’s duty of care to service users. Employees should be supervised competently and should be advised to avoid practices which are unsafe — including being made aware of procedures for dealing with serious and imminent danger and for entering dangerous areas.
The regulations also make it clear that employees must be authorised to stop work and withdraw from circumstances where it would be unsafe to continue or stay. They may also be prevented from resuming work where that serious or imminent danger persists.
Finally, there is an obligation to monitor staff for signs or symptoms of harm they may be sustaining through their work. This may include stress or trauma suffered through incidents of aggression or violence which the person is involved in at the workplace.
✅ Action: When these regulations are followed properly, they form a vital part of preventing stress-related behaviours.
Where violent incidents are foreseeable, employers have a duty under section 2 to identify the nature and extent of the risk and to devise measures which provide a safe workplace and a system of work.
— Lord Skelmersdale, DHSS Advisory Committee on Violence to Staff
The Role of Care Planning
Staff teams are encouraged to consider the importance of post-incident debriefing, recording and reporting obligations, and review of risk assessments and care plans. These procedures are even more important following high-risk incidents, near-misses, or sentinel events — but may be just as important for any incident which could offer the team an opportunity to plan and avoid a re-occurrence of challenging behaviour in the future.
Care plans should contain all the relevant information staff need in order to adequately plan and carry out the routine tasks which the resident they are looking after needs assistance with. These plans therefore play a large part in preventing stress-related behaviours.
Questions every care plan should answer
- How does the client prefer this task to be done?
- How much time should be allocated for this task?
- How many care assistants might be needed to safely and professionally complete the task?
- Are there certain prompt words, gestures, sounds, or things which would assist the person’s comprehension of the task?
- What can the staff team do to ease the tension of a particular task?
📊 Key statistic: Only 24% of people had an adequate record of their life history. The majority did not have enough information about their personal preferences recorded in the personal plan. — Care Commission and Mental Welfare Commission joint report (2009)
Person-Centred Care: The Foundation
All of our programmes for the Care of Older People encourage staff to move towards person-centred and person-directed care models. This is the best way to ensure that they treat people with dignity and show people respect — reducing the risk of aggression and violence in their services.
Preventing stress-related behaviours is all about treating people with dignity by showing them respect in every way we reasonably can.
Gerard O’Dea is a conflict management, personal safety and physical interventions training consultant. He is the training director for Dynamis, a specialist provider of personal safety and violence management programmes and the European Adviser for ‘Verbal Defense and Influence’, a global programme which addresses the spectrum of human conflict.