Managing Challenging Behaviour. A Dementia Case Study

Essay, 2018

11 Pages, Grade: 78.00




The Concepts of Challenging Behaviour

Challenging Behaviours and the Risk of Misdiagnosis

Potential Impact of Challenging Behaviour to Health and Social Care Organisations

Strategies for Working with Challenging Behaviours Associated with Specific Needs



The human behaviour, whether good, bad, or unusual, exhibits the expression of emotional needs and feelings. It is a form of communication, which is presented in innumerable ways. Nevertheless, these behaviours may at times be considered abnormal when the fall short of social expectations. This is exemplified by the loss of memory, concentration and the inability to reason or make rational decisions are some of the socially and clinically significant behaviours in people with dementia (SCIE, 2011). Restless, disturbing behaviours that hinder the creativity, skills along with the coping resources of the caregiver is commonly known as challenging behaviours. A person diagnosed with dementia may display agitation and aggressive behaviours in reaction to various external and internal stimuli. These features are mirrored on Mr. Holt’s case scenario (Miller et al., 2017). The details obtained indicates that the patient was initially fine and considered a model patient, until his behaviours drastically deteriorated and made it difficult for the caregivers to administer standard procedures and treatments (Griffith and Hastings, 2014). This illustrates the significance of understanding the concepts of challenging behaviours is paramount in behaviour therapies, especially in dementia management.

The Concepts of Challenging Behaviour

The term challenging behaviour is adopted from the discipline of learning disability and it is synonymously used as aberrant behaviour, abnormal behaviour, disorder behaviour, and disturbed behaviour. The phrase was first coined in the 1980s to explain the behaviour of individuals with major intellectual disabilities (Stokes, 2017). The concept of challenging behaviour is used to highlight that the behaviours of the affected individuals are abnormal, and presents significant challenges for those supporting the affected persons. In other words, people with challenging behaviours are require personalised services and professional capabilities in responding and managing the abnormal behaviours (Zwijsen et al., 2015). Challenging behaviour can at times strain the caregivers and may reduce the quality of life services users along with the staffs. The resulting conflict triggers transfer between care settings, referral to psychiatric services, hospitalisation, and also institutionalisation of the patient, which is time consuming, emotional and resource-draining (Jutkowitz et al., 2016). Even though there are multiple conditions that increase the risk of challenging behaviours, dementia has since been identified as the leading cause for these incidents in various care settings.

Consequently, challenging behaviour is conduct of a certain intensity, duration, or frequency, that jeopardises the physical safety and wellness of the patient or other people within the environs. It is also described as behaviour that hinder or limit the access to and the utilisation of the facility or standard treatments (Sheehan et al., 2015). In other words, challenging behaviour is used to describe the conduct that interferes with the carer’s or the patient’s daily life and functioning. Nonetheless, challenging behaviour is used in the context of labelling the behaviours as challenging as opposed to profiling a patient as the problem or a source of major concern (James and Jackman, 2017). Profiling the patient as the problem may lead to misdiagnosis, which is detrimental to the quality of life and the efficiency of the intervention approaches.

Challenging Behaviours and the Risk of Misdiagnosis

Patients exhibiting aberrant behaviours increase the risk of getting a wrong, misinformed or misplaced diagnosis. Studies indicated that clinical practitioners are at times absorbed by the behaviours of the patient that their decision making is impaired. Such patients are less likely to spend quality time with the patients, which increase the risk of misdiagnosis (National Collaborating Centre for Mental Health (UK), 2015). This is attributed to aggressive behaviours and anti-social skills make it hard to establish the underlying factors affecting the patient exhibiting these behaviours. On the contrary, patients considered as neutral and compliant, as they are easy to manage and evaluate their wellbeing (Brooker and Latham, 2015). This indicates that patients with challenging behaviours are more likely to go undiagnosed or untreated due to ascribed challenges.

Consequently, patients with dementia are characterised by problems with their memory, communication, concentration and also the ability to pass reasonable judgements, Internal and external environments can stimulate anti-social behaviours, which may lead to challenging behaviours (White et al., 2017). This hinders the ability to administer effective care and diagnosis, which may continue to upset the patient suffering from dementia. People with dementia may become paranoid, aggressive, irritable and agitated, hindering the ability of the care givers to administer effective care. They may display mood swings, wander off, engage in verbal aggression and evasive, or at times experience hallucinations. It is essential to strive to understand or make sense of aberrant behaviour, by establishing the cause of anti-social behaviour or why the conduct of the patient is below the expectations of the society (Dichter et al., 2015). This calls for the implementation of effective and thorough observations in attempts to establish the underlying causative factors. Usually, challenging behaviours are triggered by physical, psychological, communicative, and environmental problems.

Mr. Holt’s case illustrates an individual with a sudden change of behaviours and attitudes towards the staff at the Ivy Nursing Home. Having been diagnosed with mild dementia, the staff are naturally predisposed to associated the sudden change of conduct in Mr. Holt is attributed to the negative implications associated with this disease (Ballard et al., 2018). One of the primary factor driving misconception and misperception of Mr. Holt’s conduct is, perhaps, attributed to inexperience and limited knowledge among the Ivy Nursing Home staff in dealing with challenging behaviour. Despite observing that Mr. Holt has withdrawn from his usual custom conduct and appears very lethargic, little has been done to establish the primary cause of his exhaustion. It appears that the facility’s staffs are predisposed to believe that the patient is not manageable and are considering to transfer him to a specialised institution dealing with challenging behaviour management. The biasness in the management of challenging behaviour increase the risk of mismanagement due to poor diagnosis (Hazelhof et al., 2016). Nurse practitioners at the facility have go to an extent of labelling Mr. Holt as a “rude, insolent” and “violent man.” This shows impact of predisposed perceptions regarding the concepts of challenging behaviours in the patient. Instead of seeking creative, effective, and personalised strategies of dealing with Mr. Holt’s anti-social behaviour, the practitioners view the patient as the primary problem.

Judging a patient’s behaviour as challenging is influenced by manifold assumptions along with expectations that arise from human interactions. Nonetheless, it is paramount to maintain an objective judgement as opposed to subjective verdicts, which are obscured by preconceived opinions (Daly et al., 2015). This is the case with the Ivy Nursing Home, which considers Mr. Holt’s behaviour as unmanageable and can only be dealt with by a professional institution. Nevertheless, Mr. Holt’s behaviour changes almost immediately after he is diagnosed with acute chest and urine infection by a GP. His behaviour improved after being placed under anti-biotic treatment. This indicates that Mr. Holt’s anti-social behaviour was attributed to the inability to express his physical wellbeing, which led to the manifestation of challenging behaviours (Yordanova et al., 2016).

In particular, acute physical problems such as fatigue, pain and breathlessness are known to have direct or indirect impact on people with dementia. This increases the risk of developing delirium, which is characterised by acute confusion and eventually a change in behaviour. Infections are some of the leading causes of delirium but other medical conditions may also trigger acute confusion (Miller et al., 2017). Therefore, extreme exhaustion coupled with urine and chest infections may be the primary factor causing the development of challenging behaviour in Mr Holt’s case. This highlights the significance of understanding the concepts of challenging behaviours, especially within the practitioners dealing with patients with high risks of aberrant conducts (Griffith and Hastings, 2014). The anti-biotic therapy addresses the underlying health conditions causing challenging behaviour of Mr. Holt. The staffs at Ivy Nursing Home should be subjected to relevant training courses impacting knowledge and concepts of managing challenging behaviours. If the nurses had this knowledge prior to Mr. Holt’s behaviour deterioration, they would have developed effective observation plans and diagnostic approaches aimed at establishing the causative factors influencing challenging behaviour.

Potential Impact of Challenging Behaviour to Health and Social Care Organisations

Traditionally, challenging behaviours were handled as provided by the institutional policies regarding containment. These incidents comprise chemical, environmental, and mechanical restrictions. These approaches have since elicited ethical and legal repercussions, compelling most organisations to pursue alternative management approaches, which are less lethal and more ethical (National Collaborating Centre for Mental Health (UK), 2015). Managing challenging behaviours has now shifted towards the training of nursing home staff in attempts to promote personalised care coupled with alternative management interventions. Nonetheless, dealing with challenging behaviours presents potential consequences to health and social care organisations such as the Ivy Nursing Home.

Aggressive behaviours are characterised with violent actions of a patient poses direct risk to the nursing staff along with other patient. The nursing home staff and other patients may sustain physical and emotional injuries, which reduces the productivity of the workforce. This is the case when the patient interferes with the normal and routine functions of the health and social care organisation (Jutkowitz et al., 2016). The staff dealing with daily and regular verbal abuses and aggression are likely to suffer from emotional burden and fatigue. This is fatal as it reduces the productivity of the nursing staff, which makes it hard for the organisation to retain the workforce. As a result, the organisation is subjected to an expensive venture of hiring new staff, which is often costly and time demanding. Regular commotion between the workers and the patient is also likely to tarnish the reputation of the health and social care organisation, which affects the profitability of managing nursing homes (SCIE, 2011). In particular, this may lead to the profiling of the patients with dementia as the management and workers avoid such individuals due to the risk of challenging behaviour.


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Managing Challenging Behaviour. A Dementia Case Study
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Leonard Kahungu (Author), 2018, Managing Challenging Behaviour. A Dementia Case Study, Munich, GRIN Verlag,


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