JCPSLP Vol 19 No 2 2017

Shaping innovative services: Reflecting on current and future practice

Top 10 resources Supporting patients with behaviours of concern in an acquired brain injury unit setting Delwyne Stephens

D r Delwyne Stephens is the grade 4 speech team of allied health, nursing, medical and psychiatric staff who provide sub-acute rehabilitation to patients with severe – catastrophic brain injury. Unfortunately many patients who experience severe brain injury also exhibit behaviours of concern (BOC). The team in the Brain Injury Unit are highly skilled in the management of patients who present with behaviours of concern. Below is a list of suggestions complied by Dr Stephens based on her experiences as to how a speech pathologist can either be a resource in an ABI team or utilise resources to support an ABI team to be effective when working with patients who have BOC. 1 Know what a BOC is Being aware of the kinds of behaviour you might encounter in a specialised, secure brain injury unit is important. Working in this kind of setting is not for everybody. If you are applying to work in this kind of setting, ask for a tour of the service. Ensure you understand the complexity of the patients and your role in the team. Challenging behaviours commonly occur in health care settings; for example when patients have a dementia, when families demonstrate aggressive behaviour, or when a person is drug or alcohol affected. In an acquired brain injury unit, behaviours of concern are commonly displayed by younger people with brain injury, who may also have a complex background including a drug or alcohol history, psychiatric illness, and/or trauma background. These patients are often mobile. Behaviours of concern in this setting can include verbal or physical aggression towards staff or families, threats of self-harm, unpredictable behaviours which may cause harm to the person or staff, psychotic symptoms (e.g., delusions), absconding, severe confusion and high levels of distress. Usual strategies for staff who encounter patients or families with aggressive or violent behaviour may not be appropriate or effective with a patient who has BOC resulting from ABI. 2 Tailored behaviour plans are a resource for the team An effective approach to managing BOC is for the treating team to meet and develop a behaviour management plan. In the ABI Unit at Caulfield hospital this is coordinated by the psychology and neuropsychology teams. The treating team meets and provides input into the types of behaviours that have been observed, and what has and has not worked. Pharmacological review is undertaken by the medical, nursing and psychiatry members of the team and adjusted if necessary. The behaviour plan is disseminated to all staff working in the unit, and is effectively utilised to support patient behaviour. The plan is regularly reviewed and adjusted accordingly. pathologist in the Acquired Brain Injury (ABI) Unit at Caulfield Hospital, Alfred Health. She is part of a

3 Resources for safety When working in this setting it is important that staff have access to duress systems, such as electronic duress tags which silently alarm and notify the rest of the team for whom, and where, immediate assistance is required. Immediate access to security, while not available in all services, is also a great resource for teams working with patients who have BOC. 4 Understanding your role so you can be an effective resource Every person in the team within an ABI unit has a role to play in supporting patients with BOC, and their fellow team members. The role of each team member may vary according to a range of factors. For example, if you have strong rapport with a patient you may be one of the people involved in approaching the patient first, using strategies from the behaviour plan. Knowing your limitations and your level of confidence is vital in these situations, as it is not appropriate to intervene directly if you feel you lack the skills to do so. Everyone has an important role to play; this may be manning the door and directing the rest of the team or redirecting other patients or families away from a potentially inflammatory situation. 5 Utilise colleagues or professional services as a resource to de-brief Working with patients with BOC can be very stressful for staff. It is important to utilise available resources, and be aware of your own and your colleagues’ well-being needs. Debriefing after an incident, whether you are directly involved or not, is important. Talking with colleagues, or utilising other more formalised supports, such as group employee assistance program debriefing, or individual employee assistance programs can assist staff to effectively manage being involved in a challenging situation. 6 The psychiatry team resource Access to a psychiatrist and a psychiatry nurse in an ABI unit is a tremendous resource for patients and staff alike. Patients with ABI often have complex mental health histories and they can require a range of medications as well as psychiatric insights to help support their recovery and reduce BOC. For the speech-language pathologist and the broader team these team members are a wealth of knowledge. 7 The environment as a resource to manage BOC A secure environment is generally required for patients with BOC and ABI. Having an enriched environment (e.g., highly personalised room, bringing in a pet dog to visit), and

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JCPSLP Volume 19, Number 2 2017

www.speechpathologyaustralia.org.au