DESCRIPTION/DEFINITION:

Emotional outburst, usually in response to failure or feeling overwhelmed ---manifested by crying, sudden mood change, anger or fighting.

CAUSES/CONTRIBUTING FACTORS:

Most often occurs during morning hours, when daily care activity is the highest, more demand on the resident, ie; bathing dressing, grooming. Can also occur later in the day when over tired and ability to handle stress is compromised.

KEY POINTS FOR IMMEDIATE MANAGEMENT:

Stay clam and use a firm voice. When possible seek help from an associate the resident is comfortable with.
If necessary to protect yourself, use a pillow or padding in the chest or shoulder area to shield yourself from possible blows or injuries. Use folded towels under your uniform to protect shoulders and chest while cleaning up an incontinent resident who is striking out.
Do not use gestures that could startle or frighten the resident.
Stay a safe distance from the resident and respect his/her need for personal space
Do not confront or accuse the resident of wrongdoing
Do not argue or try to reason with the resident
Whenever possible, take the resident away from the triggering event or person to a quiet, controlled space. This can be the resident's room, a utility room, or any area that can serve as a "time out" space. Give the resident time to calm down
If a restraint is needed to keep the resident and others safe, use the least amount possible for the shortest time period.
Offer reassurance throught gentle touch and express support when the resident is able to hear you. EX "I know you're upset. You're ok. I'm hear to help you. Sit down in this chair. I'll sit with you.

KEY POINTS FOR LONG TERM MANAGEMENT:

After the reaction is over, assess the event to see if altering the environment or situation can prevent future reactions.
A family conference may help with evaluating the event and providing input in techniques that have been successful in the past.
In extreme cases you may need to call the physician to discuss the use of medicines.