What is Challenging Behaviour in Health and Social Care?

The life of a care worker is not an easy one. You always have to be on your toes to ensure that the right level of care is provided for your patients. When working in a care home, it is quite common to come across someone that exhibits signs of a challenging nature. Left untreated this can be very difficult to manage.

Before we move into the detail of how you can deal with this sort of condition, it is important to understand exactly what challenging behaviour is.

What is challenging behaviour in health and social care?

Firstly, care workers must discern the difference between conflict and behaviour that challenges. Conflict is a dispute between individuals about a specific situation, whereas challenging behaviour is seen as a long term set of actions that puts themselves and those around them (including a carer) at risk, or reduces their quality of life.

In short, a person’s behaviour can be described as 'challenging' if it puts them or the people near them in danger.

Challenging behaviour includes:

• Aggression towards carers
• Aggression towards other patients or family members
  
• Attempts to self-harm
  
• Intense feelings of fear and paranoia
  

These are some attitudes that can be observed in people that exhibit signs of challenging behaviour. It is also worth mentioning that challenging behaviour can impact the patient’s ability to perform and join routine activities. In this situation, it is important to work with them on how they interact with those around them, making them feel safe in their current environment.

Communication allows us to express our emotions and it empowers us to interact with each other. In most cases, a lack of communication is a recurring problem with this type of patient. They don’t find anyone with whom they can express their feelings and discuss their issues. If the problem is down to communication, it can frustrate the patient and lead to challenging behaviour. If the patient sees that their behaviour results in the desired outcome, this behaviour will ultimately be repeated again and again.

How to deal with challenging behaviour

As any qualified experienced care worker will tell you, you have to understand things from the patient's point of view and identify what the reason for such exaggerated behaviour is. There could be different causes behind it, for example, they might be feeling frustrated or threatened and unable to explain why.

It is very important to identify the early warning signs of challenging behaviour so that you can come up with a suitable solution. If the initial signs are not taken care of, it can result in exaggerated behavioural outbursts. Once these early signs have been identified, if the ensuing reaction from the patient cannot be prevented, carers should establish strategies for dealing with challenging behaviour in adults.

It is believed by a large number of care workers, as well as psychologists, that a distraction can make the patient utilise their energies in some activities that they like doing and prevent any challenging behaviour.

A focus on hobbies or recreational activities can help. Try diverting their attention elsewhere in the preliminary stages of an attack and see if they respond positively. If this works, remember it and use it again the next time the patient exhibits signs and you may find that you quickly create a rapport with them that allows you to rapidly defuse tense situations. Humour can quite often help, if done properly.

Of course, sometimes an outburst may be caused by something as simple as the patient wanting to gain the carer's attention. Patients with a tendency to be aggressive often require, or strive for, constant care. Any slight decline in the support offered to them may result in an outburst. It is important to be mindful of this, especially when altering care plans.

One thing to be careful of, especially if you have multiple patients in your care, is not to focus all attention on the challenging patient when they lose their temper if it is done for little or no reason.  Don't ignore them but be mindful that sometimes their requirements for attention may be down to the fact that you are working with another patient. Giving in to every outburst can make things worse. The patient needs to learn that challenging behaviour is not rewarded. If it escalates, intervene in the calmest possible way making sure they know that you will help them when they are being responsible.

Challenging behaviour – a guide for care workers

As a care worker, you will inevitably have to deal with challenging behaviour. The job involves balancing the needs of multiple patients and their medical care in a wide range of situations. Care workers need to ensure that they are not preventing the patients from doing what they like by imposing limitations based on time or other factors, but also need to ensure that limited time is split fairly amongst patients.

In any difficult situation, remember that if you react aggressively to any challenging behaviour, you are going to make things worse for the patient and those around them, including other staff members. As a carer, it is you who is most likely to be harmed by challenging behaviour. It is important to always keep your posture friendly and ensure gestures aren't taken as being aggressive. Try to keep your facial expressions neutral and that the pitch and volume of your voice low. Do not shout.

9 times out of 10, if you treat aggression with a passive response the aggressor will gradually back down. Patients are more likely to respond to you if you treat them with compassion than by screaming back at them in response.

What are the causes of challenging behaviour?

There can be several root causes behind challenging behaviour. If a patient is known to be of a challenging disposition prior to moving into care, it is useful to identify the reasons behind this in advance. By understanding potential problem areas or flair points, as a carer, you can implement the right level of treatment or take necessary precautions to minimise disruptions on site.

Some causes of challenging behaviour are:

• Abuse, maltreatment, neglect, frustration, pain, or some medical issues
• Depression & anxiety
• Lack of communication
• Not sharing their feelings with others
• It can be a response to the environment, such as the poor physical environment

Developmental disabilities such as autism can also result in challenging behaviour from the person with the condition. De-escalation techniques for challenging behaviour in autism remain similar: be aware of triggers and warning signs, then stay calm, gentle and patient if challenging behaviour follows by give them clear instructions and space.

It is also worth mentioning that challenging behaviour is not the same as a psychiatric illness. A mental problem is something else that a psychiatric nurse can identify and treat. Challenging behaviour is generally due to past environmental issues that cause patients to react abnormally in anticipation of a negative outcome. As a result of these causes, whenever the same or similar situation is repeated in any way, the outburst occurs in the form of challenging behaviour. As a care worker, you should look to support the patient by understanding the trigger points and be prepared for anything to happen particularly at a time when the patient begins showing signs of challenging behaviour.

Identify and understand the trigger points by listening to the patient's concerns.

Challenging behaviour can only realistically be tackled with positive responses and a full understanding of the real cause behind the behaviour. If you are not able to identify the reason for such an outburst, listen to the patient when they are calm and work with them on how to avoid future overreactions.

As a care worker, it is your responsibility to not only protect the patient from any potential risks but also yourself and others around them. By treating them with respect, using a measured response and working with them to understand that such behaviour is not acceptable, you can ultimately help reduce flair-ups by helping them understand why they feel the need to act this way in the first place.

At Flexebee, we offer a range of e-learning training courses specific to the care sector, including Challenging Behaviour training. For more care worker training courses, take a look at our Health & Social Care page.