Difficult Behaviour Care Plan 1

Difficult Behaviour Care Plan 1

19 Comments By Solange




Case Study

Anna is a 79 year old lady suffering from the 2nd stage of dementia.

She seems to understand what staff say but is very slow to respond. She is restless most of the day, sitting for only minutes at time. As she wanders, she enters other resident’s rooms and takes possession of whatever calls her attention.

At meal times she will reach and take food from other people’s plates and offer it around. Anna walks with an unsteady gait and falls occasionally.

She enjoys good rapport with staff but she can get very resistive to pleas and requests. Staff have to employ diversionary strategies to retrieve other people’s possessions from Anna and one strategy that works well is inviting Anna to ‘help out’ with something.

Anna’s family is against giving her more medication as they claim that medication diminishes her quality of life.

Social/Emotional Care Pan

PATIENT: Anna May
DOB: 02/07/1925
Recorded by: Solange Kindermann (DT)
Date of Record: 23/05/2008
Activities Support: Requires supervision at all times.

Community Outings:

Anna requires one to one assistance. Staff will try to engage her family to accompany Anna on bus trips or make sure that there are enough volunteers.

Extra Support:

Anna will be escorted to see the hairdresser, podiatrist and all other medical appointments.

Issues/strengths:

  • Uncooperative behaviour, holding onto other people's belongings.
  • Tendency to antagonise her peers at the dining table and in the recreation area.
  • Slow to respond verbally.
  • Unsteady gait.
  • Anna is alert most of the day.
  • Good rapport with staff occasionally.

Goals:

Anna will have suitable distractions to absorb the intrusive behaviours.
Anna will feel safe and secure at all times.

Interventions:

Staff will provide Anna with daily sensory stimulation and activities suitable to her capabilities such as garden watering, walks, magazines, puzzles and serviette folding.
Staff will give Anna ample time to understand and answer questions.

When Anna is restless and upsetting others, staff will approach her in a non-directive and sensitive way offering Anna a choice of alternative activities e.g. Hand massage with essential oils, hair grooming, manicure and/or make-up, a walk in the garden. Anna responds well to kindness and this will help staff remove her from challenging situations.

Anna will attend all cooking sessions and staff will assist her to participate actively e.g. stirring, sorting, top and tailing vegetables, measuring.

Anna enjoys ball and balloon games, picture bingo and sing-along.

Staff will orient and guide Anna several times a day making sure she is safe and secure when wandering around. She will attend Music therapy, concerts, visits from children, pet therapy and special screenings of animal/nature movies.

Anna belongs to the Catholic faith and will be escorted to the monthly service in the facility.

Staff will liaise with Anna’s family regarding her well-being and offering support when needed.

Evaluation: Quarterly

Comments:

Dawn Merante 30th May 2010
very good.
Susan 3rd Sep 2010
I have found the golden carers web pages to be very informative and useful - full of great ideas - keep up the good work!
Jackie 16th Dec 2010
Yes, our Ann is very similar in behaviour, have also tried to engage her in helpful activities. Face washer & serviette folding, unwinding knitted garments, watering, washing up etc.... She looks and expresses anxiety often, walks to exhaustion, can't rest.
Lorraine Lambert 10th Jan 2011
Yes, I have found this most helpful. Thank you and look forward to more info regarding our challenging
clients.
clayton 10th Jan 2011
i have a resident who is in the 2nd stage of demensia, he has worked hard all his life and gets confused when staff wont do as he says. He likes to work with his hands and we have tried all kinds of activities with him( building activities,puzzles,workshopping, ect but he soon losses interest, any help with new activities would be appreciated. ( Ideas ) Kind regards Kelly
sally mcdonald 24th Oct 2011
great read stragities are very help full, keep up the good work
Lyndsey 11th Apr 2012
We have a John like this. Loves to torment. Pulls out all the flowers/vege in the garden, much to the sorrow of our plant lovers!!! Any ideas???
diannerudd 7th Sep 2012
You really need to know the persons Life history to work with most behaviours.
Example: We have many R.N's in our Dementia unit who are patients. They are invited to our staff meetings and training sessions if appropriate. Another resident who was also an R.N likes to sort out our linen trolley. The afternoon staff ask her to help give out the linen with them.
Another lady grew up in an orphanage in India. She likes to bring water to the back door so we can have water for the cooking/ cleaning etc. we allow this but will remove this when she is occupied with other things.
I think the main thing is being switched on to where they are currently in their minds with there dementia and how old they think they are.
Doll Therapy works well but there are lots of protocols and guidelines to follow and EVERYONE must treat the dolls as real babies .
Food activities are great for the sundowners, i find this settles most residents
Dianne Rudd 7th Sep 2012
Hi. Yes thats a hard one. i have gone outside and put fake flowers in the ground for the residents to pick. just need to keep putting them back when you find them lying around.
Could laminate some nice signs that say
please enjoy the flowers but please dont pick me, Thats if your client can read.
We do flower arranging. we have a large selection of cheap artificial flowers 1St I place a fitted bed sheet on the table then put all the flowers on the table. some men weiil also join in due to the sensory stimulation. Good luck.
Marilyn 9th Oct 2012
Love it. I will come back again and again.
Nicole 17th Oct 2012
You might like to try a raised 'weed' garden (with flowering weeds) outside for the resident gardener who likes to pull out plants or perhaps objects at waist or shoulder height for distraction, ie: rainbow flags, wind chimes, washing line etc. We have potted fake flowers/plants in plaster of paris so they can't be pulled out. Good luck.
Solange 17th Oct 2012
Great ideas Nicole, thank you for the feedback.
sandra 18th Jan 2013
Desperate for new ideas for my sundowners. I am one therapist for 45 residents and I have no assistance from other staff. i am finding the expectations unbelievable and three weeks feel like three years any ideas? the Programme I am taking over from was non existant and I am having to start from scratch and am working a full day and having to do all planning documentation etc at home. needless to say I am getting exhausted.
Regards Sandra
Filidea 18th Jan 2013
Hi Sandra.
I feel for you!!! I have been where you are now.
I look after 85 residents, and we have an excellent "sundowning" evening program which runs well and effective and our resdients are participating in meaningful activities.
I will be glad to offer you some help and ideas if you want to email me your details.
My email address is (sent privately).
Regards
Fil :)
Anne 22nd Jan 2013
Sandra, do you know anything about the sonas programme? This has proved popular/succesful in our facility, it would be great if you had a volunteer to assist you. Rgds, Anne
Michelle 8th Sep 2013
Hi there,
Great ideas here thank you very much. Similar to your situation Sandra, i too am new to a residential care setting and am in the process of setting up a programme for over 60 patients. I'll check out the sonas programme now havn't heard of it before but any other suggestions or tips are welcome!
Indeera 3rd Dec 2013
Great ideas thank you so much.
Dorothy 13th Feb 2014
Hi Sandra,
Can you help me with the following, I look after 25 residents and work 3 days a week for 6hrs struggling to put things in place without preparing things at home, with no help from nursing staff,l am told I do not need to do any documentation only exceptional reporting for accreditation? . I have 9 dementia clients in this and struggle with activities for sundowners do you have any ideas ?
Great information
row 26th Feb 2014
Hello I have found your activities very encouraging and would like to put some in to practice in the home where I work, I find music is the greatest way to promote better moods better people and a sense of peace and well being for the residents. Another thing is not to rush them, nothing worse than a staff member on there own mission, in now we are going to do this this and this it does my head in imagine what it does to them
Viktoria 27th May 2014
Hi, Anne. Tell me ,please, where are I can find The Sonas Session-training in Melbourne? Thanks, Regards, Viktoria
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