Understanding Resident Needs When Coping With Physically Aggressive Behavior (PAB) & Other Disruptive Behavior

Learning Objectives

The participants will be able to:
  1. Give a definition of physically aggressive behavior
  2. List two common background factors that can lead to PAB
  3. List two variable factors that can lead to PAB.
  4. Use a worksheet to document a resident's PAB and the circumstances under which they occur
  5. Work with the group to brainstorm ways to help a resident cope without using disruptive behavior

Time 60 Min.

  • 15 min. Lecture and discussion on PAB and disruptive behavior
  • 15 min. Discussion of Worksheet A sample on resident with PAB or disruptive behavior
  • 15 min. Break up into groups to fill out Worksheet B discuss using flip chart
  • 15 min. Discussion using Solving Problems by Being a Detective flip chart


  1. Read the guidelines. Meet with charge nurses and staff on each unit that has residents with dementia that display PAB
  2. Discuss types of PAB displayed by residents and effectiveness of care plan approaches used
  3. Fill out Worksheet A (PDF, 39KB, 2pg.), using Handout A (PDF, 11KB, 1pg.) as a guide, with a member of the nursing staff using an MDS and medical record of a resident who displays PAB or other disruptive behavior to use for discussion. Copy the MDS without the resident's name (or make up a sample MDS) to use as a reference during the inservice to point out where you obtained the information for the worksheet.
  4. Copy the filled in Worksheet A as a handout. Make a flip chart (PDF, 16KB, 1pg.) and another from the Solving Problems by being a Detective worksheet.
  5. Prepare lecture.
  6. Copy handouts: Worksheet B (PDF, 82KB, 2pg.) and Sample Worksheet B and the Worksheet C: Solving Problems by Being a Detective (PDF, 21KB, 1pg.)


  1. All staff who interact with residents should be together at the in-service to brainstorm solutions as they actually walk through the steps used to try to determine the cause of PAB in a resident and what can be done about it. Each discipline and caregiver has a different perspective and information to offer on the possible cause of PAB or disruptive behavior in an individual resident
  2. Give definition of PAB and discuss the difference between other agitated behaviors and PAB and its consequences.
  3. Discuss the background and variable causes of PAB, and strategies for identifying them using the guidelines.
  4. Ask participants to follow along on the sample Worksheet A as you use the sample MDS or resident's record to point out where you found the information to answer each question. Ask how the background and variable factors could effect the resident's behavior.
  5. Have participants break up into pairs to work on Worksheet B using a resident they have cared for. Set timer for 10 min. and then use the flip chart to record answers on one or two residents. (Could do this as a group asking the question "What resident are you having a problem caring for because of disruptive behavior?" Ask the questions on the worksheet and put answers on flip chart). Ask participants if they can tell you the background, variable factors and medical conditions on the resident they chose after they describe the type of behavior and surrounding factors from their worksheet.
  6. Tell participants that now that they have the information on Worksheet B, they can then try to figure out what the behavior means to the resident. When there is an ongoing problem with disruptive behavior, Worksheet B is filled out on every shift to record what actually took place when the resident reacted with disruptive behavior. After one week, or two if it happens less frequently, the worksheets are reviewed to try to determine what is triggering the behavior. Primary Care staff tries to brainstorm possible solutions by working together with interdisciplinary staff using the Solving Problems by Being a Detective Worksheet as we are going to do next.
  7. Use the flip chart made from the Solving Problems by Being a Detective Worksheet to record one of the resident problems reported on from Worksheet B. Ask everyone in the group who knows the resident to offer information to try to brainstorm what it could feel like/mean to the resident.

    ASK participants from all disciplines and primary care staff:

    • What was the problem in this situation? Write it in the first column.
    • Why do you think the resident reacted with disruptive behavior?
    • What could the resident have been feeling? Write it in the second column.
    • What do we know about the resident? What kind of a person is (s)he? What makes him/her happy/ upset?
    • What has the resident said about why (s)he became upset.
    • What strengths does (s)he have? What brings that "spark of life to the resident's eyes? Write it in 3rd column.
    • Has anyone found something that works when this resident is upset or in a similar situation to this one?
    • What were the triggers that could have caused or added to this behavior?
    • What can we do the next time this situation comes up to help the resident cope better? Write under possible solutions.

    Tell participants that they need to obtain input from all staff on every shift who interacts with the resident as well as the family. Someone usually has found a way to help this resident cope in a better way. This information can be used to help you think of better ways to help the resident.

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