Stuart discusses challenging behaviour and gives some advice on what it really means to understand your patients and their behaviour.
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I'd like to talk to you today about something that really winds me up actually.
You see, probably like you, I've had to sit through many mandatory training courses on challenging behaviour or people who present in challenging ways, whatever the title might be.
And to my mind, every single course that I've been on has failed in exactly the same way right at the beginning, at the part where they define what they mean by challenging behaviour.
Because they give no workable definition.
What you end up with, usually, are lists of examples of behaviour like aggression, violence, shouting, noncompliance with medication, as though that's a challenge and not a right.
They list types of behaviour, but they don't define what makes them challenging.
Giving A Correct Definition
So I'd like to present to you a definition, a two-part definition, which is this.
First, challenging behaviour is behaviour that I disagree with.
And secondly, it's behaviour with which I feel I need to intervene.
And it's important that both of those criteria are met for it to be challenging.
There are lots of behaviours that I disagree with, but which people have a perfect right to do, for example.
That's not challenging behaviour.
That's simply people disagreeing with me.
And that's okay, let's face it, nobody put me in charge of everybody else's life.
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Feeling The Necessity To Respond
So, the second criteria that really matters.
Behaviour that I think I have to respond to, to be involved in.
For example, it's pretty much a statistical certainty that somewhere in this country, right now, someone is being assaulted.
And I don't like that behaviour.
I don't do violence of any kind, I gave that up when I was a young man because to me, violence is almost never necessary or appropriate.
Now, it's true that sometimes I'm involved in violent incidents at work, but that's always from the perspective of trying to reduce harm and violence, not trying to escalate it.
Because violence to me is something that is pretty abhorrent to be honest.
Now, I'm currently sat at home in Cumbria.
I am pretty sure that somebody somewhere in London is getting a kicking right now.
There is nothing I can do about that.
Therefore, although I dislike it, I'm not challenged by it.
It's not a challenging behaviour as far as I'm concerned because I have no role.
I have no need to intervene.
So one way that we don't need to intervene and, therefore, behaviour is not, to us, challenging, is geography.
But there's another, and one that is often much more relevant and important at work.
It's often geographically close to us, but not within our sphere of responsibility.
If people do things that we don't like but they have a right to do them, that's not a challenging behaviour.
It's just a choice.
And we may not like it, but we have absolutely no right to intervene in it.
Anyway, often intervening in someone else's behaviour simply escalates it and makes it worse.
Very often the right thing to do is simply to allow that behaviour to run its course.
Let me give you an illustration of the sort of thing I mean though.
Many years ago, I was delivering training on challenging behaviour in a learning disabilities unit.
I won't tell you where it was, except it was somewhere in the north of England, and it was a group home for people with various learning disabilities staffed by learning disabilities Nurses who as far as I'm concerned, to be perfectly honest, really ought to have known better.
Now, one of these residents, an autistic man, used to stand in the communal area, which to all intents and purposes was the lounge in his home, and he used to stand and he used to spin round and round and round and round.
And if left unattended he'd do this for hours.
He was bothering no one.
And he was doing something that presumably gave him some sense of wellbeing or made him feel better than not doing it because otherwise he wouldn't be doing it.
People only do what works for them after all.
Even if it's just in the short term.
So what would happen is a couple of these Nurses would get up, they'd take him by the arms, they'd move him to a seat, and sit him down.
They'd often sit next to him and hold him in place until eventually they were called away to do something else, and then he'd get up and start spinning again.
And a few minutes later, the same Nurses, or maybe others, would come and grab him and sit him down, and the moment he got the chance, the moment their backs were turned, he'd do it again.
I'd seen this fellow as I came in, but in the training course, these Nurses told me about this man and described it as challenging behaviour.
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Empathising With Coping Mechanisms
Well, my argument is that yes, there was challenging behaviour, but it didn't come from him.
It came from them.
He was simply exercising his right to do something that bothered no one else in his own home.
They took it upon themselves to define that behaviour as challenging because without him having any other options as far as I could tell to feel better, they didn't like that coping mechanism.
The point I want to make is not to slag off some anonymous Nurses that you probably will never meet.
The point I want to make is that very often we make the job hard for ourselves by intervening when it's not necessary.
Not only that, in doing so we are actually in breach of a person's human rights.
If we're doing it from a position of authority, that can be defined as a form of torture.
Now that might seem a bit extreme, but think about it.
The real impact of torture is psychological.
It's frustrating your attempts to feel okay.
That's exactly what these Nurses were doing.
And it's exactly what many other Nurses and other care workers do on a daily basis without even realizing the harm that they're causing.
So I would ask you to not exactly throw away the lists that you get from training, but see them in a context.
And the context is always, is this something that I need to intervene in?
Because they may simply be exercising a choice, which is their right, or it may be that the quickest way to extinguish this behaviour is not to respond to it.
Either way, we don't always have to jump in and create a conflict that would not otherwise exist.
My name's Stuart Sorensen, I'm a mental health Nurse and trainer.
Thank you for watching.