Choice and Challenge: Caring for Aggressive Older Adults Across Levels of Care*
Videotape (with manual); 23 minutes; Produced by the American Psychiatric Association; 1998
This is an excellent training videotape which provides invaluable information on the assessment and management of aggressive behaviors. Videotape project consultants include Kathleen C. Buckwalter, RN, PhD, FAAN, Ellen Maxson, RNCS, MS, and Mary Eccard, RN, MS. The videotape is supplemented by a 20-page printed manual (with 75 references), which was authored by Marianne Smith, RN, MS, and Kathleen C. Buckwalter, RN, PhD, FAAN. The written training material may be reproduced as handouts to facilitate learning. The training material comes highly recommended for nurses, nursing assistants, and other profession and paraprofessional health care providers who work with this population.
The videotape contains actual footage of patients exhibiting aggressive behavior during personal care activities (e.g., bathing, toileting) and at mealtime. The perception of these behaviors as identified by the residents, families, and staff are explored. This is followed by a comprehensive discussion of possible antecedents or "triggers" that precipitate the behavior. These include, but are not limited to: an underlying physical problem, an unmet need the individual is unable to articulate, or invasion of personal space. The basic premise is that every behavior conveys a "message" that caregivers must learn to "read."
The management of aggressive behaviors are viewed as a "shared responsibility" that warrants a team approach. This includes communicating behavior management techniques with another facility in the event of a transfer, to facilitate the resident's transition to a new environment.
Basic principles in the management of aggressive behavior are discussed. The videotape demonstrates an individualized approach through specific examples. It is emphasized that the implementation of daily care activities should focus on the "person and not just the task." In addition, care should be adjusted to meet individual resident needs rather than forcing residents into a routine that is convenient for staff. Staff are encouraged to "listen" and "follow the lead of the resident." This requires providing care in a flexible manner, which ultimately will be more effective in meeting the residents' needs and less stressful to staff. The videotape also points out that as the disease progresses the goals of treatment change.
An added bonus to this training course is the opportunity to obtain 1.3 continuing education units from The University of Texas at Arlington School of Nursing for a nominal fee of $10.