I was interested in reading a small article featured in this month’s Australian Nursing & Midwifery Journal (ANMJ), (Vol) 21; No. 7- Feb 2014 on page 35 called “Impact of aggression” by Jean Booth.
Summary of Jeans research
Jean states that in 2008 she completed a PhD that looked at the experiences of aged care nurses caring for dementia residents displaying aggressive behaviour. What Jean discovered in her research was that the nurses she observed tended to be quick in delivering their care towards aggressive residents so they could get out quick and escape the possibility of being injured themselves. This observation by Jean indicated to her that there needs to be a better method of nursing residents with aggressive behaviour as their long-term health care would be compromised due to only receiving minimal nursing care all the time. Jean goes onto say that if this is not dealt with it could further exacerbate the aggression of the residents. Some of the ideas presented by Jean to manage this problem are well known such as employing more staff and providing more education to the nurses working with aggressive dementia residents. (End of summary)
My experience of nursing dementia patients and mentally impaired clients
Working with dementia residents or mentally impaired clients requires tolerant nurses and also an educated management team. In the past I had nursed four years in a dementia unit which consisted of low to high care dementia residents. Some of the high care residents were hard to manage at times as their behaviour could fluctuate at the drop of a hat if something triggered them off. One of the views I came to learn overtime was that dementia residents responded better to the same staff that looked after them on a daily basis compared to new staff rotating through the system. This ensured continuity of care that the dementia residents become used to and felt more at ease with and also build up a rapport with the nurses caring for them. However that being said it is a fine act of care all the same as something small can rock their boat and set them off requiring intervention from the nurses to prevent them from becoming too aggressive.
I recall one afternoon shift of signing on duty and I had to let some visiting family members out of the dementia unit through a locked security door. While I was doing this an elderly dementia man approached and was about to walk out with the people leaving to which I had to stop him from leaving. Well the sky almost fell in and was he mad at me. He said, “you lot are nothing more prison officers locking us all in here…what have we done wrong to be locked up”? I responded in a nice tone back but that didn’t help much as that made him all the more aggressive swearing all these choice words at me and almost to the point of wanting to punch me out. Anyway it all worked out fine as there were other staff around to assist and we were able to help calm the resident down. This was a learning experience to me as in future I took any family members leaving the ward through another exit door away from where the gentlemen was which meant there were no future occurrences of that incident repeating itself again. As time progressed over the next few weeks I was able to build up a rapport with this gentleman that allowed me to provide person centred care.
During my time working shifts with disabled clients on a casual basis I had to at times care for mentally impaired clients. This field of nursing or caring also requires specific nursing care specific to the care needs of the client. If the nurses or care-staff fails to understand the client’s identity profile (IP) and protocols it can lead to aggressive and uncontrolled behaviour by the client towards the staff which can be a challenge to deal with at times. Even some of the best trained nurses or care staff will have incidents or issues that arise when providing care towards challenging dementia residents or mentally impaired clients. This can be exacerbated especially if there is a shift that is short staffed placing more care load on to the staff dealing with challenging behaviours.
The role of management
I am going to suggest from personal experience that corporate boards of some health facilities can seem to be somewhat distant to the front line of their business. I’m saying this due to the fact that profits can sometimes be their main goals and not the purpose of the health care they are trying to deliver. This view is often shared by those working on the front lines (clinical care) especially when working short staffed which seems to be the ongoing strategy by management to reduce operational costs. One of my nursing textbooks called “managing clinical processes in health services” by Roslyn Sorensen and Rick Iedema (2008) illustrate from their research that management can often focus on financial management, people management, organisational management and customer orientation, but little in terms of managing the clinical aspect of care. In recent times I think some health facilities have taken steps to manage their clinical areas better such as providing better staff ratios to patients or clients but much more needs to be done yet.
The other problem confronting management is lack of available funding especially in aged care as in the last few months the Liberal Australian Government have cut back some of the promised funds that the former Australian Labor Party had endorsed for aged care. When issues like this arise it can have an impact on the level of care and long-term commitment by staff working with challenging behaviours.
If we want to ensure a better level of care towards aggressive dementia residents or clients there has to be a responsibility or duty of care from the board of directors down to the operational staff working on the ward. Communication and education in the health facility is essential so that there is a common ground or platform to operate from so that person centred care is delivered. At the end of the day we are all human regardless of qualification and we need to look after ourselves especially when working in stressed work environments all the time. If we can appreciate each other’s qualities and expertise I am sure it will have a flow on effect to the challenging behaviours that care staff have to endure in their line of work.