When Care Gets Challenging - using training and support interventions to improve the confidence of staff in managing challenging behaviours due to cognitive impairment in older adult inpatients.

Challenging behaviours including verbal and physical aggression are common in older patients with dementia and delirium admitted to hospital. Regularly managing patients with challenging behaviours is often stressful for staff, leading to burnout and poor job satisfaction. This quality improvement project aimed to increase staff confidence in managing challenging behaviours following an audit of incidents of aggressive behaviours which showed high prevalence across geriatric specialty wards at a tertiary NHS trust.

The project was conducted on a single geriatric specialty ward at [redacted for peer review]. An initial survey of ward staff showed that staff were reasonably confident in managing these behaviours, and slightly more confident in managing verbal aggression (average score 3.86/5) than physical aggression (average score 2.88/5). Common suggestions for improvement in the staff survey included training, a clear protocol and staff supervision/debrief. In response, we created a flowsheet for management of aggression based on existing trust policies. We also developed a training program to support staff in improving their communication skills and confidence in managing challenging behaviours. 

Post-intervention, a repeat staff survey showed an improvement in staff confidence in managing challenging behaviours for staff that complete face-to face training (staff rated their confidence an average 4.6/5 for verbal aggression and 4.1/5 for physical aggression). 70% of staff gave positive feedback on the training, with an average rating of 4.05/5 for usefulness of the training. 

This project has shown that a training intervention can improve staff confidence in managing challenging behaviours in older patients in an inpatient setting. Further to staff feedback, we plan to hold regular training sessions on the ward and introduce staff supervision sessions to offer a space for staff to debrief and access peer support.