This document introduces a training DVD that teaches a low-arousal approach for de-escalating challenging behavior in patients with acquired brain injuries. It aims to address high staff turnover, which disrupts continuity of care. Currently, minimal staff training exists for managing challenging behavior. The DVD aims to effectively train large numbers of staff and improve risk management. It evaluates the unit's incident reports over the past year to understand the types of challenging behaviors occurring and justify the need for alternative training approaches that focus on positive relationships rather than power struggles. The DVD's goals are to provide a stand-alone training package for new and current staff on an interdisciplinary approach to working with patients who exhibit challenging behaviors following brain injuries.
Three Confluence Deployments That Will Blow You AwayAtlassian
There are lots of great Confluence deployment stories. And then there are a few that are just mind-blowing. This session highlights three incredible Confluence deployments that will make your head turn.
Customer Speakers: Nate Nash of BearingPoint, Tim Colson of Cisco, Connie Taylor of Premier Inc
Key Takeaways:
* Incredible Confluence examples
* Innovative uses of a wiki and enterprise collaboration
Three Confluence Deployments That Will Blow You AwayAtlassian
There are lots of great Confluence deployment stories. And then there are a few that are just mind-blowing. This session highlights three incredible Confluence deployments that will make your head turn.
Customer Speakers: Nate Nash of BearingPoint, Tim Colson of Cisco, Connie Taylor of Premier Inc
Key Takeaways:
* Incredible Confluence examples
* Innovative uses of a wiki and enterprise collaboration
In this presentation, Peter Farrow of Randolph-Brooks Federal Credit Union shares the basics of “Lean for Credit Unions.” He also discusses some of the reasons Randolph-Brooks considered Lean and ways Lean can be beneficial to any credit union.
Peter presents three detailed case studies from Randolph-Brooks and the results they achieved:
– Branch Channel Lending
– Call Center Member Service
– Branch Workforce Management
He gives an overview of Lean in IT and a few reasons Randolph-Brooks chose to implement Lean in IT. Peter also shares some helpful tips for getting started with your own improvement initiatives.
Leveraging Lean Thinking in Credit Unions: Three Ways to Improve Member Service While Reducing Costs.
In today's competitive environment, member service is a top priority for credit unions. At the same time, there is an increased pressure to do more with less and reduce costs. The adoption of Lean principles and tools provides an opportunity for credit unions to engage employees and simultaneously improve member service and reduce costs.
Learn the basics of Lean and how it can be applied to credit unions. Hear from Randolph-Brooks Federal Credit Union about how they are leveraging Lean methods to make significant improvements in:
* Branch Channel Lending
* Call Center Member Service
* Branch Resource Management
Job Matching - Taking The Guess Work Out Of Return To Worknbirtch
Job Matching uses objective return to work tools such as Functional Abilities Evaluations and Physical Demands Descriptions to ensure that workers are safe for specific jobs. it takes the guess work out of return to work and job placement
Evidence for my ePortfolio - I designed this 8-hour training to prepare employees for the installation of a new, more automated telephone system.
http://eportfolio4mwalkerwade.wordpress.com
Driving Down Cost Through Workplace Strategies: Installment 1-The Physical SpaceGina Payne, LEED AP, ID+C
White Paper: Installment 1- The Physical Space
This paper is a first installment of three, in which we will take a look a look at cost drivers in real estate and facilities, as well as how we can keep those costs down. At a high level the drivers can be put into three categories: 1) Type of space, 2) Amount of space, and 3) Space procurement and maintenance. In the first installment, we will take a look at...
Defining high level organizational architecturesNicolay Worren
Presentation that I held October 10, 2011 at the European Organisation Design Forum meeting in Frankfurt, Germany. See my blog for more information about the meeting.
In this presentation, Peter Farrow of Randolph-Brooks Federal Credit Union shares the basics of “Lean for Credit Unions.” He also discusses some of the reasons Randolph-Brooks considered Lean and ways Lean can be beneficial to any credit union.
Peter presents three detailed case studies from Randolph-Brooks and the results they achieved:
– Branch Channel Lending
– Call Center Member Service
– Branch Workforce Management
He gives an overview of Lean in IT and a few reasons Randolph-Brooks chose to implement Lean in IT. Peter also shares some helpful tips for getting started with your own improvement initiatives.
Leveraging Lean Thinking in Credit Unions: Three Ways to Improve Member Service While Reducing Costs.
In today's competitive environment, member service is a top priority for credit unions. At the same time, there is an increased pressure to do more with less and reduce costs. The adoption of Lean principles and tools provides an opportunity for credit unions to engage employees and simultaneously improve member service and reduce costs.
Learn the basics of Lean and how it can be applied to credit unions. Hear from Randolph-Brooks Federal Credit Union about how they are leveraging Lean methods to make significant improvements in:
* Branch Channel Lending
* Call Center Member Service
* Branch Resource Management
Job Matching - Taking The Guess Work Out Of Return To Worknbirtch
Job Matching uses objective return to work tools such as Functional Abilities Evaluations and Physical Demands Descriptions to ensure that workers are safe for specific jobs. it takes the guess work out of return to work and job placement
Evidence for my ePortfolio - I designed this 8-hour training to prepare employees for the installation of a new, more automated telephone system.
http://eportfolio4mwalkerwade.wordpress.com
Driving Down Cost Through Workplace Strategies: Installment 1-The Physical SpaceGina Payne, LEED AP, ID+C
White Paper: Installment 1- The Physical Space
This paper is a first installment of three, in which we will take a look a look at cost drivers in real estate and facilities, as well as how we can keep those costs down. At a high level the drivers can be put into three categories: 1) Type of space, 2) Amount of space, and 3) Space procurement and maintenance. In the first installment, we will take a look at...
Defining high level organizational architecturesNicolay Worren
Presentation that I held October 10, 2011 at the European Organisation Design Forum meeting in Frankfurt, Germany. See my blog for more information about the meeting.
Debriefing and Cardiac Arrest Quality ImprovementDavid Hiltz
Recently, David Baumrind of East Hampton, NY and I began talking about various strategies to improve resuscitation outcomes. As part of those discussions, we talked about debriefing and how it could be used to help improve the quality of resuscitation being provided, as well as sharing our perspectives on the subject.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Andrew Brennan and Ruth Banner - DVD training package
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. 9/24/2012
The kind of challenging behaviour
Evaluate 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. 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. 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.
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