9/24/2012           Introduction to a DVD                                                                                 ...
9/24/2012                                                                      The kind of challenging behaviourEvaluate c...
9/24/2012              Scenarios                                                  Interactive DVD                         ...
9/24/2012                Advantages   The potential advantages of the DVD lie in its         Clip            of DVD    f...
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Andrew Brennan and Ruth Banner - DVD training package

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Description of DVD training package, ABI

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Andrew Brennan and Ruth Banner - DVD training package

  1. 1. 9/24/2012 Introduction to a DVD Aim of the presentation: training package:  Introduce the concept: A low-arousal approach for de-escalation of challenging behaviour following an Acquired Brain Injury Dilemmas  Rationale behind the concept  Evaluate current area of current practice  Development of training DVD Presented by Andrew Brennan &  How the training package is used  Clip of the DVD Ruth Banner Concept Rationale  Mobile & immobile patients – some Work on a Inpatient have cognitive deficits & challenging behaviour. Neuro Rehab Unit, more patients being admitted that have challenging Currently Minimal staff training on behaviour.  Affects on patients – unable to participate in therapy and Demand on beds increasing, not always the right challenging behaviour. Training a large amount of people mis-trust in staff if not environment for this patient group but demands on handled appropriately. service often means patients  are admitted. can be difficult & time consuming. Challenging  Research literature identifies that Staff being injured. behaviour continuity in approach is essential, Increased need to develop a training Large staff turn over and  To address lack of continuity in approach tool that will meet all agency staff on the unit the needs of the staff means that there is often on the unit. no continuity.  Overall aim was to produce a DVD that will effectively engage staff for training purposes and beneficially Trying to deliver training to this amount of staff Impact on staff – impact on risk management. currently extremely Increased sickness, difficult and time stress and burnout. consuming. Identify and justify why a Justification for change in training training tool is required approach• In an area of high staff turnover, there is a need for Styles of staff interpersonal conduct can help rolling programmes of competency-based training, avoid provoking a sense of both staff and including responding to potentially violent situations. patients’ powerlessness and depersonalisation, thus precipitating aggression.• Understanding aggression and prevention can reduce . the number of behavioural incidents reported (Allen et Itis no surprise that challenging behaviour al 2002). causes an increase in emotional exhaustion and burnout of staff members.• Training with staff, should encourage staff to use a non-aversive approach, focusing on positive Itis not only therapists who have a role in relationships to avert power struggles and avoid escalating client behaviour (Giles et al 2005). behavioural management; nurses play a pivotal role in the provision of care to people with ABI.  Nursing staff have much more face to face contact with patients. 1
  2. 2. 9/24/2012 The kind of challenging behaviourEvaluate current area of recorded on the Neuro Rehab Unit in professional practice the last 12 months (Jan 2011 - Jan 2012) An evaluation of the incident reports filed following an incident where a member of the team has been hit, punched or pinched whilst working with individuals that have had a Acquired Brain Injury. Challenging behaviour Aims of the DVD occurred when: There is no such product currently on the market. Used as a stand alone package for refresher and new staff training. Emphasise the interdisciplinary requirements of working with difficult behaviour. Empathically show the emotional impact that both staff and patients experience in heated situations. Illustrate how the low arousal approach works at the antecedent level (i.e. how someone in a high arousal, agitated, state is easily triggered by staff actions). Define the low arousal approach: an immediate non- confrontational, non-critical and positive relational approach by staff to patients’ verbal outbursts, destructive behaviours (e.g. property damage) and physical aggression. Illustrate de-escalation strategies for diffusing heated situations. Development of the DVD Content  Keeping a Cap on Staff Emotional Expression Calmness and positivity – “Like a Swan”  Treating Patients with Dignity and Respect  There is currently no video based training Core skills described that help avoid triggering patients’ package available that addresses difficult behaviours challenging behaviour for inpatient wards  Staff Beliefs About Patients’ Behaviour Illustrate that after ABI, normal levels of control over providing neurological inpatient events and rehabilitation. At the time of writing, the emotional states are far reduced. Difficult behaviour is not deliberately personal or calculated. Ex-patient invited to production of such a DVD package is nearing describe feeling states when showing aggression due to completion. confusion  This is One Discreet Part of Behavioural Management  Specific Scenarios DVD will compare good and bad examples of staff relating in situations where there is difficult patient behaviour. 2
  3. 3. 9/24/2012 Scenarios Interactive DVD  The DVD will be interactive; the viewer will be requested  The DVD features a dramatised set of to select one of two options for how best to approach a scenarios considered typical of ward based patient’s difficult behaviour and, as part of the process, events when there are patients following an will see both good and bad examples. acquired brain injury who show difficult to  The underlying themes of the DVD emphasis staff manage behaviour, including those who are in member’s need to maintain positive relations with post-traumatic amnesia, and post-traumatic patients. This includes principals of treating them with confusional and agitated states. The DVD dignity and respect, maintaining a non-aversive, non- features actors representing staff working with confrontational and non-critical approach in the face of patients showing such difficulties. They depict difficult behaviour, and encourages simple shared dramatisations of how best to approach and formulations of the reasons behind patients’ difficult relate to patients during a difficult episode, and behaviour due to acquired brain injury. also, how best not to approach patients in such circumstances. Approaches Overlapping Approaches from:  These include: the Relational Neurobehavioural The examples of good practice in Approach (Giles and Manchester; 2005); staff approaches shown by the DVD Positive Behavioural Support (e.g. Allen, 2005); are informed by several documented the Low Arousal Approach (McDonnell, 2011); approaches. Each approach has a attributional models of how staff relate to likely degree of conceptual overlap patients (e.g. Weiner, 2006); and work that with others; all promote quality highlights and manages the difficulties of high relationships of carers towards patients that are conducive to better expressed emotion between carers and patients therapeutic outcomes. (e.g. Berry, Barrowclough and Haddock, 2010). Participants in the Training DVD DVD covers The roles played by actors, the DVD is  The DVD intends to be short enough to be presented by two of the ward’s own staff, watched in a routine staff break or lunch an occupational therapist and nurse Ward time. It intends to be a non-academic Manager. It also features interviews with exercise focussing on fundamental other staff and an ex-patient who himself, relational and interpersonal aspects of a few years earlier, had shown difficult behaviour management and avoiding what behaviour whilst in a confusional state might be described as more high level following brain injury. These features all behaviour management methods, such as intend to further enhance staff behaviour analysis and modification engagement and impact of the training. 3
  4. 4. 9/24/2012 Advantages The potential advantages of the DVD lie in its  Clip of DVD flexibility and accessibility; staff do not have to book onto organised group based teaching sessions and can, instead, pick up the DVD to play on a computer or television. Furthermore, the dramatised images and associated narration intend to model ways of staff interpersonal relating to patients who are showing aggression, which isn’t normally a feature of training sessions. This method may also have advantages over written guidelines. Summary References  Adams, D. & Allen, D. (2001) assessing the need for reactive behaviour management strategies in children with learning disabilities and server challenging behaviour. Journal Intellectual Disability Res. 45 (4): 335-43  Allen, D. Doyle, T. & Kaye, N. (2002) Plenty of gain, but no pain: a systems wide initiative. Ethical approaches to physical interventions. Kidderminster, BILD publications. 219 – 32.Questions?  Benson, B. Schaub, C. Conway, J. Peters, S. Strauss, D. & Helsinger, S. (2000) Applied Behaviour Management and Acquired Brain Injury: Approaches and Assessment. Journal Head Trauma Rehabilitation. 15 (4):1041-1060  Giles, G, M. & Manchester, D. (2006) Two Approaches to Behaviour Disorder After Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. 21(2): 168-178  Giles, G, M. Wagner, J. Fong, L. & Waraich, B, S. (2005) Twenty-month effectiveness of a non-aversive, long-term, low cost programme for persons with persisting neurobehavioral disability. Brain Injury. 19(10): 753-764  Jacobson expressed emotion 2000  Jenkins, R. Rose, J. & Lovell, C. (1997) Physiological wellbeing of staff working with people who have challenging behaviour. Journal of Intellectual Disability Research. 41. 502-511  Kaye, N. & Allen, D. (2002) Over the top? Reducing staff training in physical interventions. British Journal of Learning Disabilities. 30, 129-132  Luiselli, J, K. Pace, G, M. & Dunn, E, K. (2003) Antecedent analysis of therapeutic restraint in children and adolescents with acquired brain injury: A descriptive study of four cases. Brain Injury. 17:255-264  Peters, M, D. Gluck, M. & McCormick, M (1992) Behavioural Rehabilitation of the challenging client in less restrictive setting. Brain Injury. 6:299-314  Royal College of Psychiatrists, British Psychological Society and Royal College of Speech and Language Therapists (2007) Challenging behaviour: a unified approach Clinical and service guidelines for supporting people with learning disabilities who are at risk of receiving abusive or restrictive practices. Royal College of Psychiatrists.  McDonnell, A. (2010). Managing aggressive behaviour in care settings: understanding and applying low arousal approaches. Chichester: Wiley-Blackwell  Mitchell, G. & Hastings, R, P. (2001) Coping, burnout, and emotion in staff working in community services for people with challenging behaviour. American Journal on Mental Retardation. 5, 448-459  Mott, S. Nagy, E. & O’Reilly, K. (2006) Behaviour support following acquired brain injury: An exploration of the role of the registered nurse. Journal of the Australian Rehabilitation Nurses Association. 9(4): 7-13  Toogod, S. (2009) Establishing a context to reduce challenging behaviour using procedures from active support: a clinical case example. Tizard Learning Disability Review. Volume 14 Issue 4.  Ylvisaker, M. Turkstra, L. Coehlo, C. Yorkston, K. Kennedy M. Sohlberg, M, M. & Avery J (2007) Behavioural interventions for children and adults with behavioural disorders after TBI: A systematic review of evidence. Brain Injury. 21(8): 769-805.  4

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