PERSONAL BEHAVIOURAL SUPPORT PLAN Personal care elderly functional

Transcription

1 PERSONAL BEHAVIOURAL SUPPORT PLAN Personal care elderly functional NAME NHS NUMBER D.O.B WARD CONSULTANT A /05/1947 Green ward Dr bob How I present on a good day: I will be quiet in volume I will attempt to communicate to staff using incomprehensible speech. I may mobilise communal areas. I will sit and listen to radio two and sometimes classic FM. What helps to keep me calm? I like to have cups of tea and have the company of others listening to radio stations I like; it helps me to stay relaxed. I have painful arthritis in my wrists the staff help me with this by offering me hand and arm massage with essential oils. The staff prompt me with my regular liquid medication for pain relief. I find tablets difficult to swallow. When staff give me simple instructions and use positive friendly body language and facial expressions to help me feel safe. Things that make me feel; Upset/ Sad: when I am not able to listen to my radio or when staff change the channel. If Staff don t prompt me to have diet and fluids. Angry/Agitated: If staff do not stay on top of my pain relief medication I will be in pain however find this hard to communicate. I will become agitated and angry and attempt to assault staff. When staff want to help me with my personal care, I feel vulnerable and scared at this time. I do not allow staff to help me and will hit out to keep them away from me. Physical Health risks: Deterioration in skin condition & physical health due to staff not completing A s personal care, Risk of infection. Historical compaction risk due to pain relief medication, proactive monitoring, high fibre diet and use of anti-constipation medication

2 THINGS I DO IF I START TO FEEL anxious, upset, agitated, angry: I may become louder in volume and my incomprehensible verbal comments may begin to increase in frequency and duration. I may be observed to walk with purpose more. My facial expression may change to that of a concerned expression furrowed brow and down turned mouth. When staff complete all of my primary interventions I am more likely to allow staff to help me with strip washing myself. With support of two staff. PRIMARY INTERVENTIONS Encourage A s to have adequate diet and fluids Staff to support A to accept her liquid pain relief medication. Staff to monitor A s output to ensure pain relief is not causing any constipation, historical risk of compaction. Which may lead to increased agitation. Staff to support A to engage in music groups and to spend time with peers whom enjoy listening to the radio to promote inclusion and positive engagement with others. A s favourite drink is tea with no sugar please ensure that she is prompted with these in line with her daily fluid requirements. Staff to proactively offer A, a hand and arm massage to help with relaxation techniques. It has been noted that A responds better to personal care after 09:30 she responds better if she has been in receipt of relaxation session prior to personal care. Staff to use calming gentle tone of voice and have bright and positive facial expressions. A communicates through incomprehensible speech however her tone of voice and volume of voice are clearly communicative of her current mood. Staff to consider use of strip washing allowing A to clean herself with verbal and visual prompts. Separate cloth and bowel for genital areas. Allow A to keep her clothing on and remain covered in areas she is not washing If A does not allow regular strip washing of whole body consider secondary interventions. THINGS I DO IF I HAVE MISSED USING MY PRIMARY INTERVENTIONS; If all of my primary interventions are either not successful or unable to be applied I may begin to present with increased agitation which historically could lead to a risk of assaultive behaviour towards others. SECONDARY INTERVENTIONS. To undertake any personal care when risk has escalated past primary interventions A will need the minimum of three staffs support. A should be encouraged to be in a seated position during personal care with staff supporting her arms in either level two or level 4. The third member of staff will complete the

3 I can be physically aggressive towards staff during having personal care. Personal care needs may include; Strip Wash Continence Care Nail care - hands and Feet Assisting with diet and fluid intake I may warrant a physical intervention due to the risk I pose to myself and others. This may include; Hitting others Scratching Staff spitting Holding on with my nails embedding them in others skin. I can be verbally aggressive towards staff, swearing, and Shouting out any inappropriate words which may come to mind. I may ignore staffs direction. For all personal care to be carried out to minimise the risk of injury to A and the staff team THINGS I DO IF I HAVE MISSED USING MY SECONDARY INTERVENTIONS. If staff have ensured that there are no underlying physical health concerns and I have continued to refuse intervention for personal care and there remains a significant risk to myself. Staff will need to intervene and support me in my best interests as per the decisions made during my best interest meeting. Risks to myself include; Injury to self Potential sprains and bruising to hand from hitting out, digging nails into staff and personal care required. All items required for assisting personal care should be set up within the room prior to A entering. The room should be of an appropriate temperature to complete personal care so that A is comfortable. Efforts must be made to understand the cause of physical aggression/hostile behaviours and meaning of any gestures or body language that A may display. There may be a need for physical health investigation to rule out infection which may increase agitation and difficulties with orientation to time and place or person. Staff to be mindful of invasive nature of personal care and A s need to be verbally reassured throughout. Consideration of her listening to her favourite music during as A likes to sing with staff to help distract and calm. One staff member to give direction to A when completing personal care to not increase confusion. Staff to utilize communication skills described in primary interventions to prevent the escalation of situations wherever possible. Endeavour to administer medication regularly as prescribed. To help prevent increased pain due to arthritis. The attitudes, interactions and actions of staff members should at all times demonstrate a duty of care towards A. Every effort must be made to verbally de-escalate by offering reassurance and supportive comments. TERIARY INTERVENTIONS: Nursing staff to continue attempt to conduct a full AMEWS monitoring and physical investigations. Tell Ann what you are doing at each stage. Ann can become aggressive and resistive a minimum of 2 staff may be required to assist Ann utilizing proactive holding/support. Personal Care Strip washing and continence care. A minimum of two staff are required to support A, there will be two members of staff one on

4 scratching. Injury to staff bruising from hitting/slapping. Scratch marks/open wounds from scratching. Infection risk from spitting. Psychological distress A may be anxious and upset when being held Deterioration in skin condition & physical health due to staff not completing my personal care. Risk of infection and ultimately risk of death. Psychological distress to client or staff members Unpredictability of behaviour may lead to anxiety of A and fellow patients. each arm holding A. A 3rd person may be required to work from the side and to undertake A s personal hygiene needs. A will be in a seated or Semi Recumbent position while on a bed. The 3rd member of staff will be the lead in the intervention and maintain all communication. Even if A appears calm staff should maintain the level of hold until all personal care has been attended too and the team are told directly by the lead that they can reduce/let go of A. Staff should consider the possible need to remain with A. or offer supportive interventions after personal care event to regain A s trust of staff and ensure no further escalation of physical or verbal assaultive behaviours. POST INCIDENT SUPPORT: WHAT MADE YOU FEEL; UPSET, ANGRY, AGGIATED? Staff have observed that personal care interventions cause A to become distressed, anxious and upset which is described in the above primary, secondary and tertiary interventions. WHAT HELPED YOU TO CALM? Staff have observed that when staff talk calmly to A and used positive and reassuring language this helps her to calm more quickly. A has responded well to appropriate use of touch during hand and arm massage. When personal care has been approached after this intervention A has appeared to respond better to staffs interventions of personal care. WHAT COULD YOU HAVE DONE TO HELP US HELP YOU? Proactive use of identified primary interventions to help promote dignity and minimise distress caused by intervening during personal care. Staff are to be mindful of what works well and document any interventions that have help A to calm. HOW DO YOU FEEL? Are you PHYSICALLY WELL? A is currently physically well Staff to offer post incident support and reassurance after need for physical interventions.

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