Many carers, nurses and employees in the aged care sector have spoken of having to navigate tricky areas when it comes to residents with challenging symptoms.
While many residents may be acting out due to circumstances out of their control, carers regularly have to deal with challenging situations with emotional and physical factors at play.
It is important to acknowledge the difficulties faced by carers so as to provide a space of transparency, affirmation and importantly solution based resources.
Rowan Harwood, Consultant Geriatrician and Professor of Geriatric Medicine and Health Care of older persons at Nottingham University Hospitals NHS Trust, has written and spoken on the topic and challenge of handling difficult symptoms and patients.
Harwood provides a reminder and comfort in the sense that no health care employee will always know what to do in any given situation, let alone a complex and high intensity one.
He says that many times difficult situations include confusing intersecting elements of medicine, psychiatry and law.
He says that oftentimes the best point of action may be really unclear.
What contributes to the difficulty in deciding what to do is that structured guidelines may be neither consistently applicable nor explicit.
Harwood explains that a person may be aggressive, violent or abusive and acting anti-socially but it is important to look below the surface.
Within a facility or before a certain task like showering, medical, mental health or emotional problems and even a combination of all may be occurring.
It is important to assess the deeper situation to find the underlying explanation of behaviour and how much of each factor is contributing to behaviour.
For example, if a resident is in a lot of pain due to a chronic illness they may be acting out of fear, believing that when it comes to showering the pain will become worse.
Harwood expresses that when looking at and attempting to manage difficult symptoms it is helpful to understand it as representing the “communication of distress or unmet need.”
This is a powerful tool when feeling overwhelmed by a resident yelling or attempting to strike you.
Our bodies naturally tense, deciding whether to fight or flight but Harwood and other experts explain that it is in centreing yourself and your mind, breathing deeply and seeking to understand the possible unmet needs that are triggering the surface loud and difficult symptoms, progress can be had.
Many psychologists and experts in this area advise that keeping your voice low, using active listening phrases like, “I hear what you are saying” and “That sounds very frustrating, how do you think we can resolve this?” can help in de-escalating a difficult situation with a resident.
Lynda Lampert explains that speaking softly, remaining neutral, keeping your distance, light eye contact and affirming that you hear their complaints go a long way in bringing down the intensity of challenging patients.
Harwood encourages that personnel can prevent and de-escalate situations through comprehending why the situation is happening, identifying the need and attempting to anticipate and meet it.
He explains that even though difficult symptoms can be overwhelming to manage, approaching it with a plan, to diagnose and treat while still maintaining safety and function can help with breakthroughs.
From asking colleagues for their input, to seeking out your boss’ opinion on the situation, and spending some quiet time brainstorming over why a resident is acting the way they are, can provide valuable insight outside of stressful situations.
Harwood encourages carers to remain person centred in their approach to figuring out challenging symptoms. Remembering a person’s humanity can have multiple benefits from providing energy to keep working at figuring out a solution and realising what is at the bottom of difficult symptoms.
It is important that if an employee is feeling overwhelmed with a resident that they feel comfortable seeking help and asking for support.
Many difficult situations are more than we can manage on our own.
It is through collaboration and coordinated approaches that many challenging situations are overcome.
Harwood advocates that “Skilled communication, non-confrontation, relationship-building and negotiation represent the best way to manage situations and avoid harm.”
It is these areas where teaching needs to occur at all levels and at consistent time intervals.
While all carers will at many points in their career have to manage difficult situations and residents, it is through support, continued learning and community that solutions can be found.
Seeking help from colleagues, superiors and other healthcare professionals coupled with asking for the training you feel you need when it comes to de-escalation, will have positive sustained impacts on work satisfaction and overall resident health.
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