Multi element behaviour support in intellectual disability nursing
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Multi Element Behaviour Support in Intellectual Disability Nursing. Catherine Kelly, Staff Nurse Intellectual Disability Services, Donegal. WHAT IS CHALLENGING BEHAVIOUR. Impact of BTC

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Multi Element Behaviour Support in Intellectual Disability Nursing

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Multi element behaviour support in intellectual disability nursing

Multi Element Behaviour Support in Intellectual Disability Nursing

Catherine Kelly, Staff Nurse

Intellectual Disability Services,

Donegal


What is challenging behaviour

WHAT IS CHALLENGING BEHAVIOUR

Impact of BTC

The person: exclusion, deprivation, physical harm, misdiagnosis, exposure to ineffective interventions and reduced quality of life

The carers: physical and psychological harm, apathy, attitudes and beliefs.

Services: escalating costs, high staff sickness/turnover, and service breakdown

  • Definition

  • Behaviours of such intensity, frequency or duration that the physical safety of the person or others could be placed in serious jeopardy.

  • Behaviour, which is likely to seriously limit use of, or result in the person being denied access to community facilities (Emerson 1998)

  • Prevalence studies show that 5.5 – 16.8% of people with a intellectual disabilities present with behaviours that challenge (BTC).

  • (Lowe et al, 2007)


What is multi element behavioural support

What is Multi-element Behavioural Support

Model of Positive Behaviour Support

It redesigns an individual’s environment to enhance the individual’s quality of life

Minimises behaviours that challenge

The principles are linked to a Human Rights Based Approach participation, empowerment, non-discrimination, and accountability.

(Carr et al. 2002).

Provision of skilled practitioners available on the frontline.

Use of non-aversive interventions.

Promotes community activity and participation.

Supports the rights of the person, advocacy and person centered planning.

Evaluates the long term use of psychotropic medication.

Efficient use of resources and cost effective.

Good contextual fit.


Driver for role expansion

Driver for Role Expansion

There has been:

Significant focus on the provision of community based services for people with challenging behaviour. (Congregated Settings Report)

Increased emphasis on human rights and evidence based practice

Increasing numbers of people coming into service with complex challenges including behavioural challenges

Poor accessibility to specialist resources to meet this need

HIQA National Quality Standards


Nurse role expansion

Nurse Role Expansion

18 Nurses completed a 9 month course at level 9, developing the skills to:

  • Undertake a comprehensive assessment and perform a functional analysis of behaviour

  • Develop a hypothesis on the meaning and function of the behaviour

  • Plan and implement appropriate interventions for all aspects of the person’s life

  • Monitor and evaluate effectiveness and outcomes through the use of a periodic service review

  • Undertake the development of a multi-element person-centred behaviour support plan for 18 people who presented with behaviours that challenge

  • Collaborate with the multi-disciplinary team, families/carers, in the development of each element of each plan

  • Undertake a comprehensive assessment and perform a functional analysis of behaviour

  • Develop a hypothesis on the meaning and function of the behaviour


Outcomes

Outcomes

  • Outcomes for Nurses

  • Leadership in Cultural

  • change

  • Clinical Effectiveness

  • Evidence Based Practice

  • Increased confidence

  • Attitude change

Organisational Benefits

Values and skills of the person upheld

Enhanced quality of life

Trained practitioners

Responsive to changing needs

Sustainable & compatible

Unique to the individual

Long-term, effective behaviour support

Social and personal validity

Cost effective

Behavioural Outcomes

Moderate improvement in 42% cases

Significant improvement in 42% cases

No change in 16% cases


Challenges supports

Challenges & Supports


Multi element behaviour support in intellectual disability nursing

Thank you for Listening

Catherine Kelly, Staff Nurse

Intellectual Disability Services,

Donegal


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