Supporting Residents with Responsive Behaviours during Feeding and Medication/Treatment Administration

COVID-19 Long Term Care Orientation for Redeployed Healthcare Workers

THANK YOU FOR SUPPORTING TEAMS IN LONG TERM CARE IN CARING FOR THE RESIDENTS DURING THE

PANDEMIC!

Housekeeping

Slide deck will be shared with you shortly following the training.

This webinar will be recorded and posted on the RGP Toronto YouTube channel.

Please type your questions related to the content into the chat. There will be opportunity for Q&A at the end of the webinar.

Goals for today

To understand the resident’s experience during feeding and medication/treatment administration

Strategies to consider

Managing escalation

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Getting to know you

Moments of opportunity

Consider using “tasks” as an opportunity for a moment to connect.

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All behaviour has meaning

In dementia care behaviours are viewed as responses to unmet needs.

A large percentage of those with dementia living in LTC will have some form of responsive behaviour.

This work can be time consuming and resource intensive however can be quite rewarding.

Understanding physical causes for behaviour

The 5 D’s

Disease

Delirium

DiscomfortDrugs

Disability

(PIECES Consult Group, 2008)

AAffective

(How a person feels)

CCognitive

(What a person is thinking)

BBehaviour

(How a person responds)

ABC’s of Brain Function

Advanced Gerontological Education Inc., 2019

Behaviour/Situation Common response

Feeding:

• Provide cueing to what is on the plate. “These potatoes look tasty, would you like to finish them?”

• Place their plate in their field of vision and cue them to its location.

Feeding:

• Not finishing their meal, but stating they are still hungry.

• Taking food from a roommates plate.

Feeding:

• “Why didn’t you finish your meal?”

• “That isn’t your food! Don’t do that!”

Strategies to consider

Environmental Misperceptions

Behaviour/Situation Common response

Feeding:

• Provide visual and verbal cueing, using simple direction and gestures.

• If cueing is not successful, try hand over hand to get them started .

Feeding:

• Resident is sitting in their room, but not starting to eat their meal.

Feeding:

• Assuming resident is not hungry and removing their plate.

• Assume resident requires feeding assistance and begins to feed them.

Strategies to consider

Loss of Initiation

Behaviour/Situation Common response

Medication Administration:

• Crush medications into small amount of a sweet food.

• Provide explanation that resident will “buy into.”

• Engage them in distracting topic.

Medication Administration:

• Refuses to take their medications, saying “I don’t need that, there is nothing wrong with me!” or spits medication out.

Medication Administration:

• “Your doctor says you need this medication.”

• “If you don’t take it, you will get sick!”

• “If you don’t take it, I will tell your daughter.”

Strategies to consider

Loss of Insight

Behaviour/Situation Common response

Medication Administration:

• Show resident and explain each pill. “This pill will help with your pain.”

• “Swallow with water, don’t chew this.”

Feeding:

• Provide minimal items at one time.

Medication Administration:

• Resident spits out medication saying “what is that?”

Feeding:

• Resident is pouring their drinks into their food.

Medication Administration:

• “That’s your medication!”

Feeding:

• “Why are you mixing your food and drink?”

Strategies to consider

Loss of Recognition

Behaviour/Situation Common response

Medication Administration:

• Provide explanation for the pills being administered

• Provide time for the resident to process the information

Feeding

• Provide visual information with our verbal cues. Explain what the food is.

Medication Administration:

• Tossing the pill on floor

Feeding:

• Not verbally responding and pushing away the spoon

Medication Administration:

• “That’s your medication! Why would you do that?!”

Feeding:

• “Open up! You have to eat!”

Strategies to consider

Loss of Language

Other strategies to consider

Other Strategies for Feeding:

•Check care plan for food/drink preferences

•Consider finger foods

•Match your assistance to their abilities

•Ensure resident has clean, working aids

•Ensure that resident is in an upright position

Other Strategies for Medication Administration:

Consider the consistency & preparation

Prioritize most important medications

Administer medication appropriately

Other Strategies to Support Treatments:

Consider only necessary monitoring

Provide pain medication before treatments

Utilize PRN’s appropriately

Managing escalation

• If you see clues the person is getting upset, consider stopping what you are doing and stepping away.

• Leave the person alone, if it is safe to do so, and re-approach later.

• Avoid correcting mistakes or telling them what they need to do.

The behaviour is a personal expression to an uncomfortable and perceived potential

threatening situation.

“Mealtime –throughout history, in all

parts of the world, has been a social interaction, a time to nourish ourselves,

an occasion for celebration, a time to replenish our energy.”

– Moyra Jones, Gentlecare

Resources

http://www.rgptoronto.ca/resources/covid-19/

http://www.covidcarelearning.ca

https://clri-ltc.ca/orientation/

https://nursing.ceconnection.com/ovidfiles/00000446-201104000-00018.pdf

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