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Monday, November 2, 2009: 2:20 PM
Learning Objective 1: contrast the traditional methods of addressing behaviours that challenge with a person-centred approach.
Learning Objective 2: explain the impact background factors can have on behaviour.
Challenging behaviours in dementia exceed the capability of many care home staff. Medication is traditionally the first line treatment despite evidence it is of limited benefit, may hasten cognitive decline and is associated with vascular and cardiac problems in older people. Alternatively admission to hospital occurs even though ninety percent of challenging behaviours occur as a response to care practices or environmental factors. Instead, the reasons should be addressed with a particular focus on when, where, why and with whom these behaviours manifest themselves.
In 2006, a five-month pilot study within the Northern Health and Social Services Board (NHSSB) (Antrim and Ballymena, Northern Ireland), using the Newcastle Model, a bio-psycho-social intervention received 20 referrals involving 11 care homes.
The Newcastle Model formulates challenging behaviour in terms of peoples’ needs, which are assumed to drive their behaviours. The model is a hybrid of well-established ideas from various psychological models, but its distinguishing feature lies in the unique integration of teaching, supervision and intense support provided to staff in care homes.
The NeuroPsychiatric Inventory Caregiver Distress (NPI-D) measures frequency and severity of behaviours and level of distress this causes staff. This was administered pre and post intervention. Staff were asked to complete an anonymous satisfaction questionnaire at discharge.
Findings indicated that as a result of interventions four hospital admissions were averted which, based on the average length of stay, would have cost an estimated £81,500. NPI-D scores decreased following interventions and staff questionnaires were positive. The potential of this pilot study was noted by the Institute of Healthcare Management Quality Awards scheme prompting the NHSSB to provide funding for the care components in the form of three behaviour sciences nurses. This preliminary study will form the basis of a study that will evaluate the service using a quasi-experimental intervention – comparison non-equivalent design.
In 2006, a five-month pilot study within the Northern Health and Social Services Board (NHSSB) (Antrim and Ballymena, Northern Ireland), using the Newcastle Model, a bio-psycho-social intervention received 20 referrals involving 11 care homes.
The Newcastle Model formulates challenging behaviour in terms of peoples’ needs, which are assumed to drive their behaviours. The model is a hybrid of well-established ideas from various psychological models, but its distinguishing feature lies in the unique integration of teaching, supervision and intense support provided to staff in care homes.
The NeuroPsychiatric Inventory Caregiver Distress (NPI-D) measures frequency and severity of behaviours and level of distress this causes staff. This was administered pre and post intervention. Staff were asked to complete an anonymous satisfaction questionnaire at discharge.
Findings indicated that as a result of interventions four hospital admissions were averted which, based on the average length of stay, would have cost an estimated £81,500. NPI-D scores decreased following interventions and staff questionnaires were positive. The potential of this pilot study was noted by the Institute of Healthcare Management Quality Awards scheme prompting the NHSSB to provide funding for the care components in the form of three behaviour sciences nurses. This preliminary study will form the basis of a study that will evaluate the service using a quasi-experimental intervention – comparison non-equivalent design.