Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M....

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Whose Problem Is It? Whose Problem Is It? Mental Health & Illness in Mental Health & Illness in Long-term Care Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It? Mental Health & Illness in Long-term Care,” The Geriatric Mental Health Training Series, for the John A. Hartford Center of Geriatric Nursing Excellence, College of Nursing, University of Iowa

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Transcript of Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M....

Page 1: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Whose Problem Is It?Whose Problem Is It?Mental Health & Illness in Mental Health & Illness in Long-term CareLong-term Care

Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It? Mental Health &

Illness in Long-term Care,” The Geriatric Mental Health Training Series, for the John A. Hartford Center of Geriatric Nursing Excellence, College of Nursing, University of Iowa

Page 2: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Training GoalsTraining Goals

Improve . . . Quality of life for residentsQuality of knowledge among staffStaff’s feelings of competency and

satisfaction with providing care to sometimes difficult-to-understand residents

Remember! Not all “problems” are the same!!

Page 3: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Mental Health & IllnessMental Health & Illness

There are LOTS of different causes of behavioral and psychological symptoms!

Mental ILLNESS THREATS to Mental HEALTH

Understanding DIFFERENCES is often key to providing needed care!

Page 4: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Stop and LOOK!Stop and LOOK!

Knowing the person “behind the illness’ is critically important!

Page 5: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Think again!Think again!

Who IS this person?? And as important, who has this person been throughout his life?

Page 6: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

EXAMINE!… the causes of behavioral

and psychological symptoms AND how we

manage our own feelings!I think he

is just really

lonely… and

needy today!

(Sigh!)I need to

be patient!

Page 7: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

The “Real Problem?”The “Real Problem?”

Many behaviors “look the same . . .” Anxiety, fear, restlessness Verbal “assaults” or name-calling Apathy, indifference Resistiveness, refusal to participate Failure to cooperate or complyBUT often have DIFFERENT CAUSES

that require different solutions!!!

Page 8: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Many Possible CausesMany Possible Causes

MENTAL HEALTH Personality traits Loss of self

esteem Loss of control Situational stress

MENTAL ILLNESS Dementia, such

as Alzheimer’s disease

Depression Anxiety disorder Paranoid ideation

Page 9: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Reminds Me Of . . . Reminds Me Of . . .

Think about residents that you know and provide care to…

Does anyone “come to mind” as we describe symptoms and causes of problem behaviors?

Make a note It’s the beginning of a plan of care!

Page 10: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Threats to Mental HealthThreats to Mental Health

Problem not “manageable” with usual coping methods failure to adapt behavioral symptoms

Supportive interventions are neededHelp RESIDENT cope, possibly using

new methodsChange what STAFF do to reduce

problems

Page 11: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Personality TraitsPersonality Traits

Long-standing personality traits

and coping methods are often

the root of the problem!

Page 12: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Personality TraitsPersonality Traits

Coping, managing, ways of interacting with others were not effective earlierin life & are not effective NOW!BLAMECRITICIZEGOSSIP

*#!*&#@*@!!!

What’s WRONG with you people!?!

Page 13: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Loss of Self EsteemLoss of Self Esteem

Self worth or esteem is a HUGE influence on behavior

Low self worth often has a negative effect on how a person relates to others!

I wonder why he is such a bully? Talk

about “my way or the

highway!”

Page 14: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Symptoms of Low Self Symptoms of Low Self EsteemEsteem Criticism of self Criticism of others Disturbed

relationships Exaggerated

sense of self importance

Minimizing own abilities

Page 15: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Loss & ChangeLoss & Change

Health Mobility Sensory input Activity Relocation Finances Loss of loved ones: death, divorce,

separation

. . . associated with advanced age can affect coping

Wow. Tough situation. I

wonder what that means to

HER?

Page 16: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Loss of ControlLoss of ControlMy tea is NOT hot enough, AGAIN!!!

My medicine is to be taken at

NOON, not at 1 pm!!!!

Can’t you people

ever get it

straight?!

Residents… Get a life. I’ve got 10 people to

think about besides YOU!!! STAFF

Page 17: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Situational StressSituational StressI’ve HAD IT with you people!! Why don’t

you listen?!? I’ve lived a long life! I’m not stupid!! What on

earth does it take to get you to do it MY

way?!. . . Like everyone else, residents will react to situations or events that are upsetting to them

Page 18: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Threats to Mental Health: Threats to Mental Health: Key PrinciplesKey Principles Identify SOURCE of stress,

unhappiness, “problem” behaviors Focus on PAST COPING methods

with similar type of stress Identify and employ current

RESOURCES and abilities

Page 19: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Dementia: Leading Cause of Dementia: Leading Cause of Behavioral SymptomsBehavioral Symptoms Progressive loss

of ability toThink, reasonControl impulsesUse judgmentRemember what

to do & how

Page 20: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

DepressionDepression

Loss of ability to experience pleasure

Nothing is fun, not interested

Lethargic, apathetic Nay saying, nothing

is “right” Can’t be pleased

ORProminent

Dysphoria (or other Mood disturbance)

Sad, blue, depressed

Anxious, irritable Suspicious,

paranoidPlus physical symptoms: sleep, appetite, activity, fatigue…

Page 21: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

AnxietyAnxiety

A symptom of MANY disorders: Depression, dementia, delirium

The primary symptom of anxiety disorders – usually generalized anxiety disorder in older people

Emotional worry, apprehensive expectation

Different from FEAR: Can’t identify WHAT is worrisome

Like depression, many physical symptoms!!!

Page 22: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

ParanoiaParanoia

Delusions (false, fixed beliefs) that someone or something is “out to get them”

Perhaps the most “troubling” of all symptoms!

Symptom of many mental illnessesDepressionDementiaAnxiety disordersPsychotic disorders

Primary symptom of paranoid disorder

Page 23: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Mental Illness: Key Mental Illness: Key principlesprinciples Identify CAUSE of symptoms to

determine treatments Dementia? Depression? Anxiety disorder?

Take ALL concerns SERIOUSLY Respond PROMPTLY to behaviors; don’t

“wait to see what happens” Try to understand

problems from theresident’s pointof view!!

I SAW what I SAW! Are you calling me a

LIAR, you little #$&!! ?

Page 24: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

What is really going on???What is really going on???

? Is the person suffering from a mental illness or disorder?

? Has the person been this waytheir “whole life long”?

? Have recent losses & stresses upset the balance of their

coping?

Page 25: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Believe!Believe!

Change is possible In residents In their families In yourself and

other staff caregivers

Together, we can solve problems!

Page 26: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

How we manage our OWN How we manage our OWN feelingsfeelings

I CAN”T let her yelling upset me! I have to stay

calm and THINK!!!!

Don’t let the behavior upset you! Then NOBODY wins!!

Page 27: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Physical DistancePhysical Distance

“Out sight, out of mind…” just never works with difficult

residents!!!

Residents

Page 28: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Psychological DistancePsychological Distance

Take a deep breath . . .

Keep my brain working . . .Thi

nk! NOW speak!

Don’t let THEIR problems become YOUR problems!!

Page 29: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Cognitive ControlCognitive Control

Okay. He called me a name. I can get mad, or be hurt. Or I can

remember that he is unhappy and it has NOTHING to do with

ME, really!!!

Our ability to understand, and “RELABEL” gives us “distance” from

the problem!

Page 30: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

!!!!WARNING!!!!

Focus on CAUSES, not “COOKBOOK” Cures!!!

Page 31: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Look for “Chain of Events”Look for “Chain of Events”

Avoid looking at a behavior all by itself!

Underlying Cause

Behavioral Symptom

Page 32: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Treat the REAL problem Minimize the risk of

“PARTICIPATING” in problems Do things to PREVENT problems Avoid PERSONALIZING problems

Simple ideas that are HARD to achieve!!

Page 33: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Respond EMPATHETICALLY and INTERVENE in a way that is

Helpful to the PERSONAND

Helpful to the CAREGIVERS!!!

Page 34: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Summary: Key principlesSummary: Key principles

STOP and reconsider . . .

Collect information to understand the “real” problems!!

Hateful, mean old . . . What is really

going on??

Page 35: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Summary: Key principlesSummary: Key principles

Adapt CARE PROCESSES (routines, approaches, & environment) to promote safety, security, sense of predictabilityCONSISTENCY in staff approach is criticalEncourage a sense of CONTROL

(e.g., encourage choice, involvement)Ensure basic HEALTH needs

(e.g., hydration, nutrition, pain management)

Compensate for SENSORY deficitsCompensate for COGNITIVE deficits

Page 36: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Summary: Key principlesSummary: Key principles

Team work to solve problemsDevelop, maintain behavioral LOGSImplement behavior management

TEAMS; include all shifts, disciplinesEVALUATE if any or all of plan workedMonitor successful changes,

restrategize, reprioritize, START AGAIN!

Page 37: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Requirement of time & Requirement of time & energyenergy MINIMZE or

PREVENT problemsSlow downThink & observeTalk to othersRead recordsTry new

approaches

“Manage” problem AFTER it occursFeeling angry,

upsetAvoiding resident

(or family)Keeping up with

constant demands(+) (-)

Page 38: Whose Problem Is It? Mental Health & Illness in Long-term Care Revised by M. Smith (2005) from M. Smith & K.C. Buckwalter (1993), “Whose Problem Is It?

Whose Problem Is It?Whose Problem Is It?Mental Health & Illness in Mental Health & Illness in Long-term CareLong-term Care

The End


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