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

Area of Science:

• Psychiatry
• Mental Health Research
• Clinical Psychology

Background:

• Current risk assessment tools for predicting problematic behavior and coercive measures have moderate accuracy.
• Identifying antecedents and triggers of seclusion is crucial for improving patient care and safety.

Purpose of the Study:

• To assess the antecedents and triggers of seclusion in psychiatric inpatients.
• To determine if narrative notes by healthcare professionals can predict seclusion events.

Main Methods:

• A comparative study analyzing daily narrative notes of psychiatric inpatients (case group, n=26) for three days prior to seclusion versus a matched control group (n=26) without seclusion.
• Utilized quantitative and qualitative research methods, including qualitative content analysis.

Main Results:

• The case group exhibited significantly higher aggression (p < 0.001) at all measurement times.
• Seclusion was associated with increased narrative note word count and more subjective staff emotional expressions (p = 0.003), particularly "arduous/provocative" (p < 0.001) and "anxious" (p = 0.010) sentiments.
• Pre-seclusion notes contained more negatively assessed terms for patient behavior (p = 0.001), sleep loss, medication refusal, demanding behavior, denied requests, and "threatening" expressions (p = 0.001).

Conclusions:

• Several factors preceding seclusion were identified in staff narrative notes up to three days before escalation.
• Analysis of note word count, patient behavior descriptions, staff subjective expressions, and risk assessment terms can enhance prediction of aggressive incidents.
• Improved prediction may lead to the prevention of coercive measures, such as seclusion.