Resident aggression

1. Resident aggression Annual compulsory education Revised April 2013

2. Learning Objectives: • Be able to define aggression • Increase your understanding of why aggression happens, and become and active participant in adjusting the environment and your approach • Increase your understanding of and become an active participant in identifying agitation and preventing aggression • Increase your understand of the importance of reporting agitation and aggression Revised April 2013

3. What is Aggression? Aggression is a forceful attacking action, which may be physical or verbal Aggression can be effected by environment, cognitive loss and loss of independence Revised April 2013

4. Why Does Aggression Occur? • Aggression is the expression of anger, frustration or fear • It is the resident’s way of calling out for help or defending themselves • All behaviors have reasons, we just don’t always know what that the reasons are • In some cases the aggressive behavior is triggered by a certain situation or event Revised April 2013

5. Contributing Factors Multiple losses: • Loss of their home • Loss of their independence • Loss of loved ones and possibly children • Physical losses: vision, hearing, mobility • Reduced ability to communicate • Dependency on staff and loved ones: This often leads to frustration, aggravation and anger • Loss of control over their lives • They are often left with very few choices, i.e. what time they have to get up, when they can go for lunch Revised April 2013

6. Contributing Factors • Fear of dying • Invasion of privacy and personal space: • This results in feelings of weakness and powerlessness. Residents can feel hopeless or threatened and become defensive or protective • Environment: Increased noise, changes in temperature, loss of control over activity • Being rushed may cause uneasiness and frustration • Delirium: Periods of confusion, impaired judgment, confusion from pain, types of medications and other diseases Revised April 2013

7. Contributing Factors • Dementia: • The resident is lost in a world that makes little sense. They may have anxiety that easily leads to fear and panic • Restraint devices cause increased levels of anxiety and agitation • Disease Processes: • Arthritis • Diabetes • Stroke • Constipation • Pain • Infections Revised April 2013

8. Preventing Aggression • Prevent situations that you know may contribute to agitation, which can lead to aggressive behavior • Do not expect or ask more of the resident than he or she is able to do • Always use a calm approach and avoid surprising the resident • Check for source of distress • Pain, constipation, looking for washroom • Decrease stimulation • Maintain a calm, quiet environment • Know triggers and plan ahead Revised April 2013

9. Environment • The environment should be: • Calm • Quiet • Comfortable • Private • Good lighting • No distractions • Ensure resident is wearing eyeglasses and hearing aids (if applicable) Revised April 2013

10. Remember your Voice Tone of voice is more important that what you say Voice should be calm, soothing and low Speak slowly and clearly using short phrases rather than sentences Present only one idea at a time Do not hurry, allow time for a response Revised April 2013

11. Body Language Facial expression Gestures Maintain eye contact Approach slowly from front, don’t surprise Use a gentle touch on the arm Do not appear threatening in any way Smile Revised April 2013

12. Know your Resident • Cognitive Resident • Trust is built and maintained • Reasons for aggressive behavior may be very clear • Resident with Dementia • Trust must be built every time you meet • You must get into their world • You must be willing to help • Reasons for aggressive behavior can take time to figure out Revised April 2013

13. Signs of Aggression • Learn to identify the signs that a resident may become aggressive • For example constant pacing, excessive talking, and defensive behavior may all be indications of increasing frustration and agitation • Report these signs to the nurse in charge • Remember that their reality is different than yours Revised April 2013

14. Look for Warning Signs Pacing Searching for something Anxiety or nervousness Raised voice Suspiciousness Isolating self Threats Throwing things Revised April 2013

15. Managing Aggressive Behaviour Do: • Treat residents as adults and individuals • Everyone wants to be recognized and valued • Remember the resident’s feelings are intact • Read facial expressions and body language • Sympathize: Try to understand their experience, put yourself in their shoes • Take time and slow down • Listen and be respectful Revised April 2013

16. Managing Aggressive Behaviour Allow them choices but keep them to a few Know the resident; it may clue you on their behavior Get into their reality as they cannot be in yours Confirm their feelings Your words and body language should give the same message Keep your hands in the open and keep them visible Allow the resident to talk first Reassure the resident that you are there to help Revised April 2013

17. Managing Aggressive Behaviour DON’T: • Argue, confront or correct • This is not only disrespectful it can cause agitation and aggression • Ask questions that the resident may not remember. Don’t ask questions such as ‘How many children do you have?’ Instead ask, ‘Do you have any children?’ • Embarrass, shame or belittle • Give too many choices • Take it personally, reflect on the triggers and adjust your approach for next time Revised April 2013

18. Reporting Agitation and Aggression Report all acts of aggression and agitation to the Nurse Nurse will review the resident’s history, diagnosis, medications as well as complete a pain and physical assessment along with behavior mapping The goal is to find triggers to the agitation and prevent escalation to aggression It is important that all information about the aggressive behavior be given to the Nurse Revised April 2013

19. Managing Aggressive Situations • Remain calm • Do not try to physically stop the resident • Be aware of your surroundings • Keep voice and body language non-threatening • If possible, remove resident from the location and leave the situation/ report to a Nurse • Call for help if unable to escape the location or if others are in danger • Always report incident even if no injuries occurred Revised April 2013