Intimidating Behaviors

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IntimidatingBehaviors

• Laura Cote RN
• Behavior Management Consultant
• State of Maine

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Definition

• Intimidate
• To make afraid, as with threats
• What we perceive as threatening,
• based on our past experiences

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What Kind of Behaviors Intimidate?

• Intentional Intimidation
• vs.
• Reactional Intimidation
• Verbal Abuse manipulative, demanding, rude,
  crude, obnoxious, critical, demeaning,
  belligerent, hostile, swearing, name calling,
  verbal threats, raised voice, yelling, shouting,
  screaming, etc.

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• Physical Abuse spitting, biting, kicking,
  pinching, scratching, slapping, shoving, hitting,
  pulling hair, using a wheelchair as a weapon,
  backing you into a corner, chasing you.

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• Sexual Abuse inappropriate remarks,
  propositions, physical touching, grabbing and
  groping, the aggressive predator.

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Who Intimidates?

• Psychiatric Residents (unpredictable)
• Schizophrenia
• Bipolar Disorder (manic phase)
• Personality Disorders
• (borderline, anti-social, etc)

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• Traumatic Brain Injured (explosive)
• Head injured open or closed
• Strokes TIAs
• Anoxia
• Brain infections or tumors

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• Dementia (reactive)
• Internal stimuli
• External environmental stimulation
• Approach

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What Triggers Intimidating Behaviors?

• Intrusive thoughts hallucinations, delusions
• Medical triggers pain, UTIs, infections,
  constipation, not feeling well, altered lab
  values
• Frustration anger
• Control need to be the center of attention
• Overstimulation
• Invading personal or environmental space
• Being confronted
• Sensory deprivations hearing, vision, spatial
  sense
• Impaired communication

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Triggers (cont.)

• Fear perceived threats fight/flight
• response
• Startle response
• Anxiety
• Boredom
• Fatigue
• Confusion disorientation
• Loss of impulse control
• Negatives body language, tone of voice,
• facial expression
• Agitated depression
• Jealousy

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Managing Intimidating Behavior

• Determine whats triggering the behavior
• Know the resident well before you approach!
• Social history
• Medical and psychiatric history
• Behavior history
• Know yourself what intimidates you and why
• Do not personalize the abuse!

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Managing Intimidating Behavior (cont.)

• If the intimidation is intentional
• Provide structure, set limits, give clear
  expectations and educate to the consequences
• Confront the behavior as it occurs
• If the intimidation is reactive
• Alter your approach
• Instead of confrontation, use distraction
• Team problem solving
• Input from all staff regarding problem behavior,
  triggers, when the behavior occurs, warning
  signs, what makes the behaviors worse, and what
  helps

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Managing Intimidating Behavior (cont.)

• Behavior Profile Cards
• Thumbnail sketch of the resident
• Medication management and other treatment options
• Therapeutic lab values
• Avoid unintentionally raising sexual awareness
• Unnecessary touching
• Staff clothing issues
• Personal space what body part are you putting
  near their hands or face
• Language Sweetie, Lets __ ___