Health assignment essay help: Challenging behavior & problems-Disabilities & Disorders
Introduction:
Challenging behavior is defined as display of culturally abnormal behavior of such frequency, behavior and intensity that places the physical safety of other people in jeopardy. This kind of challenging behavior is usually exhibited by people having disabilities such as dementia, Alzheimer’s, developmental disorders, psychosis or when patients are admitted in the operation theatre. The challenging behavior includes self-injurious behavior such as biting and hitting, aggressive behavior (Kaiser, Rasminsky 2006).Thus, one of the serious and vital problems faced by nurses and health care professionals is management of disturbed individuals portraying various kinds of disturbed behavior after hospitalization. This assignment explains challenging behavior depicted by patients in hospital theatre. Moreover, the effective management of challenging behavior is discussed followed by conclusion.
Challenging Behavior:
Challenging behavior could be self-injurious behavior such as hitting or biting, aggressive behavior and stereotyped behavior. Challenging behavior could arise due to many factors such as biological factors which arises due to pain, need for sensory stimulation and medication. Social factor includes lack of knowledge, boredom, seeking social interaction, insensitivity to staff and services to the person’s needs and wishes. Environmental factors include physical aspects of lighting, noise and gaining access to the preferred activities and objects whereas the psychological factors include negative attitude such as loneliness, feeling devalued and excluded. Challenging behavior is a means of communicating dissatisfaction of the patients with the nurses and health care professionals. Research studies indicate that challenging behavior is viewed as occurrence in a circle which contains trigger, escalation, crisis and recovery. Thus cycle analysis gives a basic foundation for using various strategies for minimizing the triggers for various challenging reaction (Alzheimer’s society 2013). Commonly challenging behavior is exhibited by patients struggling with Alzheimer’s, dementia, old-age residents, hospitalized patients and disturbed children and individuals.
Understanding Challenging Behavior in Hospital Theatre:
The health care team and the nurses needs to understand that the patients who display challenging behavior are not intentionally exhibiting such kind of mental behavior and such behavior is not targeted intentionally to anyone. Patients who exhibit challenging behavior do so in order to have their expectations and their needs understood. Behavioral outbursts usually follow the pattern of de-escalation and escalation. Moreover, understanding the challenging behavior pattern can assist the staff and the nurse in supporting the patients during and prior to the behavioural incident. The pattern includes triggers, which are those events that initiate the behavioral outburst, thus knowing and understanding the triggers will help in effective planning for alleviating and diffusing the situation. Escalation is the time period where the anxiety of the person starts to increase, the patients starts exhibiting physical signs of becoming anxious. In this situation the nurses needs to be familiar with various physical signs as to have a clear understanding and knowledge on calming, redirecting and directing the patient in order to avoid any behavioral situation(CLASS n.d). The next pattern is termed as peak which is an extreme behavioural outburst where the staff needs to already have emergency strategies to deal with the patient effectively in order to reduce the risk of harm to other people and maintain safety in patients. After the peak pattern is escalation, where the people starts to calm down. Here the caretaker or the nurse needs to identify the signs for de-escalation and support the outburst .This should be documented effectively in the behavior intervention plan. Commonly, many patients starts to feel shameful and remorse after a behavioral outburst where in this phase the staff needs to comfort and encourage the person and become more involved in pursuing various activities. After the stage of escalation, where the portrayal of such challenging behavior is over, the patient starts to calm down (Xeniditis et.al. 2001) At this phase the nurses or the health care team needs to educate the patient in teaching more appropriate ways for effective communication of various needs and initiation of more positive programs, which need to be incorporated in the behavior intervention plan.
Apart from the patient factors, the other components also play a vital role for difficult clinical encounter in patients. These factors include characteristics of a physician and situational issues. The physician’s own behavior and attitude such as defensive or angry physician, fatigued and dogmatic physician bring about sleep-deprived, frustrated health care professionals who further react negatively with the patients and disempower the patients in providing adequate information and care. The situational factors include literacy and language issues due to diverse patient population. This can create miscommunication between the patient and the nurses. So the requirement of the health care team to be culturally competent and sensitive is a must as patients may have diverse beliefs on illness and health, gender and religious issues. Other situational factors includes many people present with the patient which requires being mindful of the needs of the patient and the thoughtful assessment of the situation (Hull, S, Broquet, K 2007). Environmental factors are also important as chaotic, noisy surrounding cannot provide privacy to the staff and the patient. Additionally health care factors include increase in patient mistrust in healthcare team, pressure in reducing the health care costs, lack of continuity in care and easy access to the diverse ranging and also confusion exists in provision of information through modern technology (Medical protection society 2013).
Diagram indicating the components of a difficult clinical encounter:
(Source: Adams J, Murray R. 1998)
Nurses needs to understand the patients exhibiting aggressive behavior. The vital skill for nurses is the capability of the nurses to identify various distress signals which are the root cause for challenging behavior, recognition of the trigger or distress signals aid in better understanding of the patient’s situation and behavior. Consequently, the challenges faced by the nurses includes discovering the trigger, understanding the emotions and behavior behind the challenging behavior and also understanding the meaning of what is being conveyed by the patient is vital in alleviating the challenging behavior of the.( Cunningham 2006).
Management of Challenging Behavior in hospital theatre:
In the event of emergency situation where the patients displays challenging behavior, the nurse or caretaker needs to ensure the safety of all people and individuals in various risk situations. Every client exhibiting challenging and harmful behavior needs to have an individualized action plan during emergency situations. The staff needs to protect other people by proper handling of the disturbed patient by using of physical restraints. Commonly it is not legally or ethically advisable to use any physical restraints. Despite this, use of other restraints and anti-psychotic drugs and medications are the initial and easy responses for the challenging behavior (Kirkevold et al 2004; MWCS 2002).Use of restraints includes potential and hazardous interventions which needs to be resorted as last measure. It is essential to consider the situation of the patient, time and risks involved and then only further decision needs to be made for usage if restraints. Furthermore, few principles to be considered while using restraints .First, is considering the benefits versus risks, where the prospective benefits needs to be measured of an individual person and this should outweigh the negative effects. Second is considering the family view of and other people’s views and consideration of various other alternatives of restraint to prevent any imminent harm and risks (Carlisle 1997).Third, the health care service provider’s needs to understand the attitude of the patient and need to have a good understanding for the interpretation of various disruptive behavior(hiqa.ie n.d).
Diagram indicating the assessment and response to challenging behavior:
(Source: NSW 2006)
Moreover, the objective of protective strategies is to enable the client’s and staff to remove any sort of immediate threat. Few techniques the health care provider can use includes remaining calm and not over-reacting, use of protective stance, providing the patient with personal space, communicating well with the patient by keeping the voice calm, cool and having an effective psychosocial therapeutic communication. The staff needs to assist clients through provision of support and counseling groups when coping with the emotional and physical impact when depicting challenging behavior.
Other techniques for managing and assisting the client in includes first, use of diversion, where the interruption of challenging behavior through directing and redirecting the person to undertake various hobbies or activities for reinforcing the person. Secondly, maintaining non-contingent reinforcing events throughout the day would aid in keeping the challenging behavior to a minimum otherwise the patients will not act properly to reinforce any sort of inappropriate behavior (Vella, M n.d). Third, introducing humor and laughter can diffuse frustration and anger. The health care professionals can attempt this behavior if they know the clients well. Forth, the patients need to follow directions and instructions of the nurse and this would help in diverting the person to undertake more useful activities to reduce the escalating behavior. Active listening helps in acknowledging the emotions and feeling of the person and should be non-judgmental. This will help in analysis and reflecting the underlying emotions and can further assist the person in regaining control and help in de-escalation. Additionally, in early stages of escalation, it is vital to determine the cause of the problem and thus, the nurse needs to assist the people in communicating the needs of the patient. Fifth, the nurse or the caretaker needs to facilitate relaxation when the patient feels angry, upset and agitated. Use of any novel stimulus when the escalating behavior is shown by the patient is imperative. Thus the change of stimulus can change the course of escalation (classinc.com.au 2010).
Following the nurse needs to strengthen the implementation of appropriate behavior through reinforcement. This needs to be contingent and consistent. The main goal is to address safety and reduce stress and distractions which the patient is experiencing (American Medical Directors Assoc n.d).In sum, individualized approach to the care process is the vital for establishment of appropriate interventions and behavior assessment. Provision of patient centered-care services promotes higher life-experiences, linguistic, religious and cultural understanding (Cummings, J.L. et al. 2002) in effectively alleviating the patient’s challenging behavior in operation theatre.
Limitation in the management of challenging behavior:
Lack of awareness and knowledge regarding the situation of the patient and the patient’s needs in emergency situation such as operation theatre still exists. The nurses need to acquire the required competencies and be trained adequately to support the patients to brig about improvement in care services. Till the perspectives of care are thoroughly known, the challenging behavior cannot be alleviated and will still continue to prevail during the patient-nurse clinical encounter. Moreover, the nurses need to foresee various problems for effective and efficient management of challenging behavior (Cunningham 2006). Additionally, knowledge and information needs to be imparted in nurses to implement during various patient circumstances.
Conclusion:
Challenging behavior could be self-injurious behavior such as hitting or biting, aggressive behavior and stereotyped behavior. Challenging behavior could arise due to many factors such as environmental, physician, situational and health care factors. The health care team and the nurses needs to understand that the patients who display challenging behavior are not intentionally exhibiting such kind of mental behavior and such behavior is not targeted intentionally to anyone. Patients who exhibit challenging behavior do so in order to have their expectations and their needs understood (Hawken, S 2005). Nurses needs to understand the patients exhibiting aggressive behavior. The vital skill for nurses is the capability of the nurses to identify various distress signals which are the root cause for challenging behavior, recognition of the trigger or distress signals aid in better understanding of the patient’s situation and behavior. The main goal is to address safety and reduce stress and distractions which the patient is facing. Thus, individualized approach to the care process is the vital for establishment of appropriate interventions and behavior assessment for alleviating challenging behavior in patients.
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