DVA-EES Course No. 10.V6GRECC.A
Promising Practices in Managing Challenging Behaviors -- Summary
Promising Practice: Behavioral Interventions Note
Location: Asheville
Contact: Kathryn (Kitty) Hancock, RN, MSN, Nurse Educator
Email: Kathryn.hancock@va .gov
Description:
• CPRS template developed by VISN-6 Challenging Behaviors Committee
• Systematically evaluated in pilot during 2009 in Asheville
Goals:
- Increase use of non-pharmacologic interventions
- Reduce use of psychotropic medications
Who implements: Nursing staff
When used: prior to use of PRN medications or restraints
Notable Features
• Facilitates implementation of ABC model
• Intended to be used prior to requesting/using PRN medication
• Developed with VISN-wide input
Why a good idea:
Allows systematic documentation of behaviors, their antecedents, & outcomes of interventions
Promising Practice: Snoezelen Room (Multisensory Stimulation)
Location: Salisbury
Contact: BJ Nelson, RN, Nurse Manager & Julie Merrick, OTR
Email:
Description: Multi-sensory stimulation program, originally developed for those with developmental disabilities
Goals: Provide systematic, controlled stimulation to those with severe dementia
When initiated: September, 2009
Notable Features
• Positive intervention whose cognitive function is at a low level (pearls)
• Interprofessional approach
• Builds on evidence-base borrowed from another population
Why a good idea:
• Addresses under-stimulation experienced by veterans with limited cognitive function
• Proactive rather than reactive
Promising Practice: Challenging Behaviors Education In Nurse Orientation Training
Location: Fayetteville
Contact: Jan Cavanaugh, PhD, HBPC Mental Health Provider
email:
Description:
• Development of curriculum on challenging behaviors for direct care nursing staff that is implemented during orientation
Goals:
• Highlight importance of behavior management skills
• Alert new staff to resources available to nursing staff and VA approach
When initiated: 2008
Notable Features
• Sets expectation that challenging behaviors are an important part of care
• Gives specific examples of nursing role in managing challenging behaviors
Why a good idea:
– Staff exposed to team care expectation when motivation to learn is high
– Psychologist can build upon skills learned in orientation when consulting with staff regarding Veterans with Challenging Behaviors
Promising Practice: Creation of a Dementia Special Care Unit within a CLC
Location: Hampton
Contact: Martin Cruz, PharmD, , Beverly Edmonds, RN
email: or
Targeted behaviors:
• Wandering
• Disturbing Inappropriate vocalizations
• Physical resistance to ADL care
• Sexually inappropriate behavior
• Hyperactivity due to delirium
Key Features:
• Increased square footage per patient
• Secured, keypad exit
• Increased hours per resident day
• Staff competencies in management of and ADL care for CLC residents with behavioral complications of dementia
• Weekly rounds by Interdisciplinary team (Medicine, Nursing, Mental Health, SW, Pharmacy)
Goals:
• Increase access to behavioral care for veterans in need of those services
• Reduce use of psychotropics
When initiated: 2007-2008
Why a good idea?
• Environment is a powerful influence on behavior
• Physical and social environmental changes made at the same time
• Systematic evaluation suggests that it was effective in reducing psychotropic use.
Promising Practice: Dementia Engagement Nooks (DENs)
Location: Richmond
Contact: Violet Oliver, RN, Nurse manager
email:
Description:
• Area painted with murals to be less hospital-like
• Vets encouraged to spend time there with each other.
• When possible, nurses assigned just to the DEN to direct activities, engage vets in conversation, exercise, painting, reading, etc.
• Structured activities planned in advance
Outcomes: Since DENS were created
• Bedfast days have dropped significantly
• Falls have also decreased dramatically.
• More peer-to-peer interaction
• Lately we’ve had student volunteers in there with the vets hanging out with them and interacting
Why a good idea?
• Structured environment that is adult, yet provides controlled stimulation
• Encourages innovative staff and volunteer assignments
Promising practice: Outpatient Dementia Care Team Clinical Demonstration
Location: Durham
Contact: Jack Twersky, MD, Barbara Kamholz, MD
Linda Chilton, RN, MSN, GNP; Judith Davagnino, MSW
email:
Description: Interprofessional, evidence-based chronic disease management program
Goals:
• Delay institutionalization
• Improve dementia care management
• Reduce caregiver burden
• Improve quality of life
When initiated: 2010
Notable Features
• Behavior management protocols from successful RCT
• Interprofessional approach
• Intervention targeted to veterans who are at home
Why a good idea:
• Teaches informal caregivers evidence-based behavior management techniques to caregivers in the home
• Proactive rather than reactive
1