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If you’ve been in a hospital recently, or a railway station, or a bus, really anywhere providing a service to the public, you may have noticed posters reminding people that violence and abuse towards staff will not be tolerated. Quite right too, but some new guidance from the NHS on challenging behaviour goes further and deeper in analysing the causes and how to manage the consequences of this behaviour in clinical settings. Its basic premise is that behind every incident of challenging behaviour there is a reason.
Protecting staff and users
This new guidance is produced by NHS Protect whose role includes protecting NHS staff from violence. A good start point is to look at the website that NHS Protect have developed which can be found at http://www.reducingdistress.co.uk/reducingdistress/guidance. This website includes a downloadable version of the guide itself, as well as training videos and some case studies. It also provides forum for sharing ideas, experiences and best practice. The guide itself can be used by a range of staff in clinical or nursing care settings, and the guide is designed in such a way that specific staff groups can look at the sections most applicable to them.
Thinking about what’s happened
The guide offers a definition which describes challenging behaviour not just as physical behaviour, but includes verbal behaviour that stops care being carried out and poses a safety risk. The guide begins by giving an overview of relevant legislation and then goes onto to explore reasons for challenging behaviour. It puts management of challenging behaviour in the context of assessing need and planning care, so that ensuring service user needs are identified is the first step in addressing behaviours. The guide also stresses the importance of staff being given the opportunity to reflect on situations. The danger for staff exposed to challenging behaviour is that can it almost be seen as the norm, and so staff become immune to changes in behaviour, or the trigger factors that might cause it. Their responses might become the same for all behaviours. Regular supervision and debriefing can give staff those opportunities. The guide also stresses the importance of good record keeping as a means of communicating information amongst staff.
The QCS Challenging Behaviour Policy and Procedure CP05 incorporates underpinning values which include awareness of how challenging behaviour meets a particular need for the individual engaging in it. The key is how to address that need.