Learning Disability and Challenging Behaviour

Question: Discuss about the Learning Disability and Challenging Behaviour. Answer: Introduction: Challenging Behavior is the reoccurrence of outbursts for duration of time that the physical safety of the person or others is placed in serious danger and what the person is capable of is unpredictable (Emmerson, 2009). Challenging behavior is Aggression towards others or themselves such as Self-injurious behavior, Property destruction, non-compliant behavior, socially inappropriate behavior (Emmerson, 2009). My first four weeks of clinical placement was in a challenging behavior unit. There was eight clients with moderate intellectual disabilities and two those were is living independently with supervision and minimal assistance I am going to focus this assignment on a woman in this unit named as Katie this name is fictional due to privacy and confidentiality (Chandler and Dahlquist 2014). Katie is a 58 year old woman who has been in this service since the age of 16 she has mild to moderate intellectual disability she also has personality disorder on my first day of placement on the unit Katie was screaming and shouting at staff and was very aggressive there was other residents present and I noticed they were scared and shook so I decided to ask them to come with me to a quite side of the unit till the nurse in charge tried to deescalated the situation and to ensure their safety I brought them to a quite visitors room and reassured them everything was fine and we will go back up for breakfast shortly (Bromley and Emerson 2015). I informed the care staff where we were just in case they needed to get to us quickly I felt a little useless but I done what I thought I was capable of doing at the time as I did not know Katie and the regular staff did I thought I will leave the staff to deal with it as they should know how to calm her down (Holden and Gitlesen 2010). Behavior management is crucial when dealing with people with behaviors that challenge this refers to a set of techniques that are used to manage behaviors that challenge (CudrMauroux, A. 2009).These techniques are usually based on the topography of the behavior for example what the behavior looks like or the physical manifestation of the behavior (Grey, McClean and Barnes-Holmes 2012). On this placement I learned how nurses and care staff intervene. I observed Katie as my weeks here progressed she would scream, cry, and bang on the window attempt to strike at staff and clients around her. I had a discussion with my preceptor about management and nursing interventions for Katie. I was made aware of the incident and prevention plan in place for her. This plan was to identify the specific behavior, setting goals, being aware of early warning signs, triggers, preventative strategies, environmental accommodation. In the event of an early warning sign for example when Katie is observed to begun to be disruptive and raise her voice the response is usually supportive that is speaking to her in a low tone, reassuring her. In the event of an escalation for example when she starts screaming the response is to redirect them to her bedroom room to lie down (Holden and Gitlesen 2013). Reassurance is offered if the behavior continues PRN medication such as diazepam will be given to relax and calm her down and to control the situation and to ensure Katie dose not harm herself or others . It is vital to record the time a client has an episode of behavior that challenge to see a pattern. On my placement we use ABC recording forms: A (antecedent): where did the incident occur. B (Behavior) describes the behavior we observed and C (consequence) how did staff and others react to the behavior (Ager and OMay 2011). We also used scatter plot recording forms to describe the physical aggression we observed for example was the person crying, kicking, punching, screaming, throwing objects please find copy of both forms attached (Hastings, Remington and Hopper 2012). When a person has an episode of behavior that challenges this may mean they are in pain or distress. As nurses we must get to know clients and understand each ones communication style via their facial expressions and hand gestures. Here on my placement the staff understood the clients very well this is crucial in all their daily needs and nursing interventions (Lowe et al. 2014). Causes of Challenging Behaviors individuals with intellectual disabilities have a very high chance of also haven difficulties with behaviors that challenge and this can lead to them feeling sad after their outburst the Effects of Challenging Behavior on an individual is Danger to their self and others. It also upsets other residents and can leave the person alone and in Social isolation and impact on their social, domestic and/or employment opportunities. Individuals with intellectual disabilities will also have other health conditions and this may also impact on their behavior (Moss et al. 2010). According to Arnautovska (2016) Assessment and recording clients who are aggressive and who suffer from multiple behavior problems require a careful assessment for management of the behavior and for the safety of the client, staff and other service users a person who bites, punches, and throws objects requires an assessment called an ABC chart us as nurses must record all to ensure good communication between all staff and that all staff are aware of the clients status when they arrive on duty (Bateman and Fonagy 2012). The ABC chart records what exactly was the clients behavior like what were they doing and what intervention was put in place to reduce the frequency of the behavior. Other forms of assessment must be carried out to see is the client in pain is this why they are haven behavioral issues people with intellectual disabilities may not be capable of describing discomfort and pain (Feeley and Jones 2011). A complete mental status examination is required to exclude depression, mania, psychosis, anxiety, or delirium. Nurses should do a complete review of all medications and assess routine functions such as frequency of bowel movement, oral intake, and ensure best outcomes and interventions are put in place to enhance and improve the quality of life for the client. As a nurse it is a duty to ensure we provide the best care for our clients (Arnautovska 2016). Reference List Ager, A. and OMay, F., 2011. Issues in the definition and implementation of best practice for staff delivery of interventions for challenging behaviour. Journal of Intellectual and Developmental Disability, 26(3), pp.243-256. Arnautovska, U., Robleda, S., Jackson, J. and Pachana, N.A. (2016) the knowledge and skills assessment (KASA) tool in the Australian dementia behavior management advisory service: Development and initial testing, International Psychogeriatrics, 28(05), pp. 833 844. Bateman, A. and Fonagy, P., 2012. Psychotherapy for borderline personality disorder. Oxford: Oxford University Press. Bromley, J. and Emerson, E., 2015. Beliefs and emotional reactions of care staff working with people with challenging behaviour. Journal of Intellectual Disability Research, 39(4), pp.341-352. Chandler, L.K. and Dahlquist, C.M., 2014. Functional assessment: Strategies to prevent and remediate challenging behavior in school settings. Pearson Higher Cudr-Mauroux, A. (2009) Staff attributions about challenging behaviors of people with intellectual disabilities and transactional stress process: A qualitative study, Journal of Intellectual Disability Research, 54(1), pp. 2639. 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