Proximal level

Factors

Personal

Emotions: Fear, surprise, anxiety, boredom, frustration

Physiological need states: Pain, cold, fatigue, elimination needs or problems

Functional performance not supported or limited

Special nine needs related to assaultive incidents

Territoriality, communication, self-esteem, safety/security, autonomy, own time, personal identity, comfort, and cognitive understanding

Social environment

Inappropriate communication - Elderspeak communication – Orders and commands – Being asked to do something the person doesn’t want to do

Invasion of privacy and bodily care­­- Body buffer zone

Inappropriate assistance: Inappropriate expectations compared to functional abilities

Physical restraints - Neuroleptic and benzodiazepine drug use

Resident-resident: Many different situational-reactive (circumstance-driven) factors, for e.g., wearing pyjamas during breakfast, coughing during mealtime, asking about the television program, protecting a resident from another, “bad manners” such as picking at the nose during lunch or burping repeatedly, and invasion of personal territory (when a resident enters the room of another, eats the lunch of another, or touches another person’s leg during mealtime)

Physical environment

Stimuli quantity, quality and duration: Light, noise, temperature, odour

Organisational environment

Special care unit - Ward ambiance and design/furnishing/decoration

Formal carer's perception of staffing and human/material resources adequacy - Age (lower) - Emotional exhaustion

Human resources, staff stability or turnover. Shift (evening)

Staff education, coaching, and support

Culture, leadership, and policies.