Who's Challenging who in Challenging Behaviours

Talking to a colleague the other night about a residents "challenging behaviour" got me to thinking that maybe it is time we addressed this topic again.

For those of you who know me, or have had me in to do training on Challenging Behaviours in-house, will know my philosophy on this topic. Firstly, a caregiver has to ask, "Why is the behaviour Challenging Me, because I can guarantee the behaviour discussed doesn't challenge every caregiver in the facility, including RN's. In fact, often when I go in to do training we focus on a particular behaviour that is challenging and problem solve to get answers as well as the understanding behvaiours. It becomes a very enlightening and rewarding experience for everyone.

While I understand repeatative behaviour can be very distracting and annoying, the fact is, the person is trying to tell you something. We don't have to always answer them in words either. Our actions and our love can often be sufficient to distract them even momentarily.

I am vehmently against the use of medication to try and modify behaviour. It really just doesn't work. I came to realise this when I was a Charge Nurse at Greenlane Hospital, but I battled with a Geriatritian who would not listen the what we said and saw and insisted we give the anti-psychoitcs she charted. It wasn't till I had my own rest home I was in a position to offer more respect for clients in my care. I was fortunate to have a GP who had a similar philosophy saying he could only prescirbe on the information we gave him. I suggested we have a trial on taking everyone off sedation and anti-psychotic drugs and he agreed. With his support we were able to offer a better quality of life for the residents. I replaced this with Reike, Holistic Pulsing, Aromatherapy & flower essence and I spent my time on educating the caregivers. I probably was one of the first Rest Homes to have a policy of this nature, and that was in the early 1990's! For 5 years, before I sold the Rest Home, not one sedative or anti-psychotic drug was used at all.

What happened when the caregivers changed their attitude, behaviour and reaction to a person was the residents behaviour became much less of a problem. We were solution based. We talked to the families to find out their background and gleamed some possible answers to their behaviour. Don't underestimate the information families give you and it's relevance in understanding the person and don't ignore what the person is saying either. The result we got , was a group of residents who were more responsive and staff that were solution based.

While it is a help to understand the condition the person has, at the end of the day it is the behaviour that has to be addressed. This can usually be managed well with love and understanding. One thing that people know and respond to is how safe, or unsafe, they feel around the caregiver.

With the introduction of so many different ethnic groups looking after our people, if is more difficult for them to understand the Kiwi culture. Many of these ethnic groups do not provide residential care for the elderly or disabled in their own country. Nor do they do not understand who a Kiwi is. What our culture is. Who we are as a "people" or the lifestyle the residents have lived.

For example, It is only of recent years there has been a wide variety of ethnicities living in NZ. It used to be Maori and Pakeha. That was it. With the failing brain, spare a thought to how the person may feel when they wake up to a person from India, Philippines, China, Korea, Africa or where ever coming into their room in the morning. Is it just possible they may feel they are living in another country rather than their country of birth?

Now I am not saying any of this is wrong, what I am saying is, UNDERSTAND THE WAY THE PERSON YOU ARE GIVING CARE TO MAY FEEL when faced with these situations or challenges. Find out about the person and see how they would like to be cared for. Don't assume they want to be treated as the culture you were brought up in. They won't. Like you, they only know what they know, and, after all, they are paying your wages. They are your client. At the end of the day it boils down to a training issue. HOW SKILLED ARE YOUR STAFF IN WORKING WITH PEOPLE AND THEIR BEHAVIOURS?

What is Kiwi Culture

Talking to friend today about Kiwi's, I was saying that we are not very good at saying what we want or don't want. However if we don't get what we want or expect, rather than confront the issue, we will skirt around it and tell 25 other people about how bad we were treated or whatever the complaint it.

Contrasting this with European people, for example people from Germany, who will tell you exactly what they want or don't want. If they dont want to talk to you, they will say "I don't want to talk to you now".

As Kiwi's we are most offended by such comments where as it is normal practice for other nationalities to express themselves honestly.

Something we all need to understand about each other, especially other cultures coming in to care for New Zealanders/

Cultural Sensitivity

There is little doubt that in New Zealand now we have a blend of cultures. This is very evident in health care and here lies the challenge. The way of life for many people from these countries, especially the eastern cultures, if frequently one of survivial. That is quite foreign to us Kiwi's. We have been privileged to receive a handup to help us through the tough times. We are essentially a fairly laid back culture. Rarely have we had to fight for anything in our lives. So fundementally those giving care have a totally different focus on care to those receiving care i.e. task verses understanding the person. This makes person centred care very challenging for some cultures who have a very analytical based learning system. Are you more focused on the task or the person? They both have equal value. Doing task only is very disrespectful to those in your care.