AUTHOR=Stepanow Clara , Stepanow Jefim , Walter Marc , Borgwardt Stefan , Lang Undine E. , Huber Christian G. 

TITLE=Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis

JOURNAL=Frontiers in Psychiatry

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2019.00096

DOI=10.3389/fpsyt.2019.00096

ISSN=1664-0640

ABSTRACT=<p><bold>Objectives:</bold> Current risk assessment tools can predict problematic behavior and the need for coercive measures, but only with a moderate level of accuracy. The aim of this study was to assess antecedents and triggers of seclusion.</p><p><bold>Methods:</bold> Narrative notes of health care professionals on psychiatric inpatients were analyzed daily starting 3 days prior to seclusion in the case group (<italic>n</italic> = 26) and compared to a matched control group without seclusion (<italic>n</italic> = 26) by use of quantitative and qualitative research methods, based on qualitative content analysis.</p><p><bold>Results:</bold> Quantitative measures showed more aggression in the case group with highly significant differences between the groups (<italic>p</italic> &lt; 0.001) at all measurement times. Seclusion was significantly associated with the total word count of the narrative notes. Subjective emotional expressions by staff were more apparent before seclusion (<italic>p</italic> = 0.003). Most frequently, subjective expressions regarding “arduous/provocative” (<italic>p</italic> &lt; 0.001) and “anxious” (<italic>p</italic> = 0.010) sentiments could be identified in the case group. Description of patients' behavior in the case group included more negatively assessed terms (<italic>p</italic> = 0.001). Moreover, sleep loss, refusing medication, high contact frequency, demanding behavior and denied requests were present in a significantly higher frequency before seclusion. Expressions like “threatening” (<italic>p</italic> = 0.001) were found only before seclusion and appeared to have the function of personal risk assessment. The expression “manageable” (<italic>p</italic> = 0.035) appeared often in difficult situations that could still be handled.</p><p><bold>Conclusion:</bold> Several factors preceding seclusion could be identified. Narrative notes of staff already showed differences 3 days before the escalation. Particularly the word count, the analysis of terms describing patients' behavior, subjective expressions of staff, and terms used as a function of personal risk assessment could help to provide better predictions of aggressive incidents and to prevent coercive measures.</p>