UNDERSTANDING
the causes of behaviours that challenge
Sean Page
Consultant Nurse - Dementia
A reductionist model of explanation
M
E
N
I
E
D
T
Behaviour
A
• Changes in behaviour are as a direct
consequence of dementia
• Most changes in behaviour are a problem
• That problem rests with the patient
• The solution to that problem rests with us
A broader explanatory approach
History
Environment
Premorbid
personality
Lived
experience
Filtered through
Cognitive Abilities
Physical health
Mental health
Cognitive status
Lived
experience
Unmet
need
Cohen-Mansfield’s
Unmet Needs Model
Behaviour as an
attempt to fulfil a
need
Unmet
need
Behaviour as
means of
communicating a
need
Behaviour as outcome of
frustration
Cohen-Mansfield’s
Unmet Needs Model
Behaviour as an
attempt to fulfil a
need
Unmet
need
Behaviour as
means of
communicating a
need
Behaviour as outcome of
frustration
A holistic model of explanation - Stokes & Goudie (2002)
Context
Environment
Social
Built
Behaviour
Health
Person
A holistic model of explanation - Stokes & Goudie (2002)
Context
Environment
Built
Behaviour
Built Environment
• ‘It is naïve to propose a deterministic view of the relationship
between buildings and people who live in them. ….. Buildings
can hinder or help the provision of quality care: in extreme
cases they can prevent it but buildings by themselves can
never provide it’
• ‘Quality of care depends upon staff morale, motivation and
training. Hence it can be confidently argued that the quality
of the social environment is of greater importance than
the physical, for negative staff attitudes will negate the
effects of even the best architectural design’.
A holistic model of explanation - Stokes & Goudie (2002)
Context
Environment
Social
Behaviour
Social Environment
• ‘Quality of care depends upon staff morale, motivation and
training. Hence it can be confidently argued that the quality
of the social environment is of greater importance than
the built for negative staff attitudes will negate the effects of
even the best architectural design’.
Aspects of MSP
•
•
•
•
•
•
•
•
Accusation.
Banishment.
Disempowerment.
Disparagement.
Disruption.
Ignoring.
Imposition.
Infantalisation.
•
•
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•
•
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•
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Intimidation.
Invalidation.
Labelling.
Mockery.
Objectification.
Outpacing.
Stigmatisation.
Treachery.
Witholding.
From Kitwood (1991)
A holistic model of explanation - Stokes & Goudie (2002)
Context
Behaviour
Health
Physical health
A holistic model of explanation - Stokes & Goudie (2002)
Context
Behaviour
Person
The person
CBT cycle – understanding a person’s
experience
Thoughts
What people
say/shout
NEED
Actions
What people do/don’t do
From Ian James public seminar 2005
Feelings
Observations & CT
themes (anxiety,
depression, anger)
Neurological
impairment
Medication
Life
story
Mental
health
Personality
Social
environment
TRIGGERS
Physical
health
Behaviour
Need &
possible
thoughts
Appearance
Conversations or
vocalisations
A holistic model of explanation - Stokes & Goudie (2002)
Context
Environment
Social
Built
Behaviour
Health
Person
Sean Page
Consultant Nurse – Dementia
[email protected]