P0323 - Confronting challenge: Enabling care home staff to understand and work effectively with challenging behaviours in dementia

Abstract

Background and Aims:

Challenging behaviours in dementia exceed the capability of many care home staff precipitating admission to hospital even though ninety percent of problematic behaviours occur as a response to care practices or environmental factors. Instead, the reasons should focus on when, where, why and with whom these behaviours occur. In 2006, a five-month pilot study within the Northern Health and Social Services Board (NHSSB) (Northern Ireland), using the Newcastle Model, a bio-psycho-social intervention received 20 referrals involving 11 care homes.

The Newcastle Model formulates challenging behaviour in terms of peoples' needs, which are assumed to drive their behaviours. The model is a hybrid of well-established ideas from various psychological models, but its distinguishing feature lies in the unique integration of teaching, supervision and intense support provided to staff in care homes.

Methods:

The NeuroPsychiatric Inventory Caregiver Distress (NPI-D) measures frequency and severity of behaviours and level of distress this causes staff. This was administered pre and post intervention. At discharge staff completed an anonymous satisfaction questionnaire.

Results:

Following interventions four hospital admissions were averted which, based on the average length of stay, would have cost an estimated £81,500. NPI-D scores decreased and staff questionnaires were positive.

Conclusions:

The potential of this pilot study was noted by the Institute of Healthcare Management Quality Awards scheme prompting the NHSSB to fund a Behaviour Sciences Nursing Service. This preliminary study will form the basis of a study that will evaluate the service using a quasi-experimental intervention – comparison non-equivalent design.