DEMONSTRATED BEHAVIOURName: _________________________________________________ DOB: _______________________ UR No: ________________________________
DEMONSTRATED BEHAVIOUR
|
screaming for no actual / apparent reason |
1 |
withdrawal (staying in room, in corner) |
8 |
self mutilating |
15 |
impaired attention (not concentrating) |
22 |
|
inappropriate language (swearing, abusing) |
2 |
undressing (where, why – wet, cold, tired) |
9 |
Resistive - hygiene care |
16 |
Smoking dangerously |
23 |
|
only talking to staff (isolating self from others) |
3 |
Biting, scratching, hitting, spitting, kicking |
10 |
absconding |
17 |
inappropriate sexual behaviour |
24 |
|
Walking without a frame |
4 |
Moves furniture noisily |
11 |
Excessive anxiety / fear |
18 |
wandering aimlessly, in other rooms |
25 |
|
Restlessness (twitching, fidgeting, not sitting still, moving continually, wriggling off chair) |
5 |
Being loud without insight re effect on others : speech, radio, TV, stereo |
12 |
Stating hurtful comments without caring what is said |
19 |
Resistive when being attended for no actual reason (eg. not cold or hungry) |
26 |
|
repeating words or noises |
6 |
Speaking aggressively without apparent control |
13 |
intruding - where |
20 |
voiding in inappropriate places |
27 |
|
contradicts statements of needs between staff |
7 |
Seeking attention when doesn’t need assistance |
14 |
Other dangerous actions, write specific action: |
21 |
Other (please describe) : |
28 |
CURRENT CIRCUMSTANCES / POSSIBLE TRIGGERS
|
memory loss |
1 |
disorientated |
7 |
dislikes procedure |
14 |
not being understood by staff |
20 |
incontinence |
27 |
Seeing door, wanting to go out |
33 |
|
Too hot, too cold |
2 |
too light, too dark |
8 |
too busy / chaotic / fast |
15 |
too many instructions |
21 |
too noisy / loud |
28 |
too many staff attending at once |
34 |
|
Upset after relative visits and leaves |
3 |
does not understand procedures |
9 |
Confusion about time of day |
16 |
not understanding other’s comments |
22 |
medication effects |
29 |
resident doesn’t want to live in residential aged care |
35 |
|
routine disruption |
4 |
other resident upsetting |
10 |
uncomfortable |
17 |
inability to express needs |
23 |
Embarrassed |
30 |
Unable to tell day from night |
36 |
|
Outdoor clothes seen |
5 |
Other sat in ‘their spot’ |
11 |
lonely, depressed |
18 |
boredom, lack of stimulation |
24 |
frightened |
31 |
short attention span for task |
37 |
|
Agitation from witnessed events |
6 |
brain damage with disease progression |
12 |
searching for home or people from past |
19 |
Internal reason eg,thirst, pain, hunger,constipation,infection |
25 |
unfamiliar place, people, sounds |
32 |
Looking for a fictional item which cannot be found |
38 |
|
Other (please describe) : |
13 |
Other (please describe) : |
26 |
Other (please describe) : |
39 |
|
|||||
EXAMPLE INTERVENTIONS
|
Use diversional activity |
1 |
Attend to needs slowly, touch gently. |
9 |
Stay with and talk. |
17 |
Say one thing at a time. |
25 |
Alert other staff |
33 |
|
Engage in useful activity |
2 |
Provide positive encouragement. |
10 |
Use short sentences. |
18 |
Speak clearly with patience. |
26 |
Remove environment trigger objects. |
34 |
|
Remove stimulation. |
3 |
Listen actively, acknowledge feelings. |
11 |
Ask resident to repeat. |
19 |
Return to familiar area. |
27 |
Introduce self, approach from front |
35 |
|
Calm the environment. |
4 |
Keep promises, engender trust. |
12 |
Repeat instructions. |
20 |
Reinforce independence. |
28 |
Be calm, gentle, reassuring, supportive. |
36 |
|
Provide regular routine. |
5 |
State firmly eg “stop harming yourself” |
13 |
Address by name. |
21 |
Take for walk/ to quiet place |
29 |
Be firm but kind, refrain from arguing. |
37 |
|
Only discuss plans just prior events, activities. |
6 |
Respond to the emotion and not the question. |
14 |
Use memory aids-signs, clocks, calendars/schedules |
22 |
Don't remind that they've already asked this-upsetting. |
30 |
Simple written reminders for those who can read, use pictures for communication |
38 |
|
Distract, occupy person. |
7 |
Gently point to next event if stuck |
15 |
Gentle touch. Calm voice |
23 |
Use family via phone or in person |
31 |
Get them to reminisce, express feelings. |
39 |
|
Answer their questions each time they comment |
8 |
Walk away, return later |
16 |
Validate / agree with them |
24 |
Ignore behaviour, give time out |
32 |
Talk to find out why, where resident going |
40 |
|
DATE |
TIME |
BEHAVIOUR/S DEMONSTRATED |
LOCATION (specify) 1. Bedroom 2. Dining Rm 3. Dayroom 4. Corridor 5. Other (specify) |
CIRCUMSTANCES / POSSIBLE TRIGGERS / ENVIRONMENTAL ISSUES ie. any issues contributing to behaviour |
INTERVENTIONS
|
RESIDENT’S RESPONSE TO ACTION TAKEN (if not resolved, continue assessment) |
Sign |
|
|
|
12/4/12 |
1000 |
2 |
1 |
inability to express needs |
26, 37, 7, remove resident from the environment |
Resident stopping swearing after 5 minutes |
|
|
|
|
12/4/12 |
1200 |
19 |
2 |
23 and lacks insight into painful messages |
Remove from area |
Ceased comments after removed from Mary |
|
|
|
|
12/4/12 |
1230 |
12 -Yelling very loudly |
2 and 5 (lounge areas) |
15, 21, 28 |
Remove from area |
Ceased yelling after 5 minutes |
|
|
|
|
12/4/12 |
1600 |
12 |
2 |
15, 21, 28 |
Remove from area |
Resident stopping swearing after 5 minutes |
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