Abstract
Main Aim: To discover more about how care staff experience and understand the challenging behaviours (CB) of the people with learning disabilities who are in their care. Design & Analysis: A retrospective design was employed, eliciting carers’ accounts by means of a semi-structured interview. Interview transcripts were then subjected to Interpretative Phenomenological Analysis. Participants: Ten participants were interviewed in all (six men and four women). All were paid carers working in residential homes in the community for people with learning disabilities. Outcome: Three superordinates themes emerged from the analysis, labelled Understanding of CB, Attempting to Intervene and Sources of Knowledge and Support. Participants’ conceptualisations of CB varied in terms of how much they resembled definitions available in the published literature. Participants’ causal explanations also varied in terms of the range of contributory factors considered. Participants whose causal explanations were more restricted also tended to hold the client responsible for their actions and to feel anger toward the client. Participants spoke of attempts to conceal or deny their feelings. Exhaustion was linked to failing to identify triggers (so that early intervention was not possible), and a desperate attempt to try to make sense of the incident of CB. In attempting to intervene, participants spoke of the immediate need to assess risk and to act accordingly. Informal support from colleagues was identified as important in helping care staff to cope with the CB, as was direct experience with the clients themselves. Clinical Implications: The findings highlight a number of factors that could potentially contribute to stress in care staff. Of particular interest was the finding of how failure to identify triggers can lead to desperate attempts to make sense of the incident and consequent exhaustion. In the light of this finding, external consultants responsible for designing interventions and teaching Positive Behavioural Support (PBS) principles are encouraged to review the suitability of messages suggesting that triggers to challenging behaviour are always present and identifiable.