Pilot Study

A database contains a number of fields. A field is a place which holds a specific piece of information, for instance the day of the week the violent incident fell on. The field headings which are entered into a database define the type of information held there, so it is important that the fields are pertinent to the research aim before information is entered. Before the fields could be finalised, a comparison of what was actually contained in the records against the aims of the research needed to take place. In this early stage, an efficient way of accessing the information relevant to the violent incident was also required. As previously discussed, the records do hold a lot of information, some of which will be relevant to aggression and some which will not. In order to use time efficiently and get the most from the records, an effective way of accessing aggressive incidents in the records needed to be written.

3.3.1.1 Data Base: Pilot Study Aims.

The main aims of the pilot study were to:

Examine the details of the information contained in the records. Develop an effective strategy for accessing violent incidents.

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Determine what fields, based on the available information and project aims should be in the database

3.3.1.2 Health Record Content.

When the research was in the conceptual stage of development, there was an awareness of the general types of information contained in the health records to the extent that the records were judged a suitable data source for Sequence Analysis. However, due to confidentiality and ethical constraints, specific records could not be examined until participants or their representatives had agreed to have their records studied. When a record set was released, a selection of running records, care plans and MDT notes that covered the last three months of the participants residence were copied. The first wave of recruitment resulted in five participants agreeing to have their health records examined. These five sets of records formed the basis of the pilot study. By reading these records several times, the researcher became familiar with the kinds of information kept about these people, the format of the information and which kinds of records might be most useful for this research.

3.3.1.3 Effective Strategies for Accessing Aggressive Incidents.

The next stage of developing the database was to find what kinds of information about violence were written, and where in the records was this located. This knowledge would help to use research time effectively and inform which fields should be in the database.

Timelines were constructed for each of the five individuals for the three month period which their records covered. The timelines displayed the available information about activities and events in the people with intellectual disability from the different record types alongside each other. Where each piece of information had come from was also shown. An example of the timeline can be seen in Figure 3.1.

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Figure 3.1.

Example of a Time Line for Jane.

Date and Time Source Event

25/5/2007 06:00 Running Records P.R.N Record Distress and Agitation Care Plan Observation Levels

10 pm Jane was loud and vocal and threw a picture from the wall in the games room down the corridor. PRN given and Jane slept for four and half hours.

Night Sedative given at 11:15.

From 21:00 Jane started to talk and shout at the air. She was gesticulating and began to flail her arms. Staff tried to distract Jane through 1:1 but this did not work and Jane was encouraged to go to her bedroom. Jane refused to go and moved to the games room. She continued to shout and other service users were cleared from the room. She began to pace the games room and started to pick up objects. She began to take pictures off the walls. Staff intervened verbally but at this point Jane picked took a picture off the wall and threw it down the corridor while shouting loudly. Jane was encouraged again to go to her bedroom. At 10:15 she went to her bedroom still talking but lower in volume. She was pacing round her room for half an hour and was offered her night P.R.N. She accepted this and allowed staff to assist her get into her night things. She calmed and was asleep by 12:00.

Jane is on general observation.

13:05 Running Records Jane was awake at 4:30 but remained in bed

until 9am. She bathed with assistance and after breakfast she went out with staff for a drive to

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the shops. She bought a chocolate bar that she ate on return. Jane appears settled and in good spirits. She is currently eating her lunch.

19:30 Running Records

Visitor Record

Distress and Agitation

Jane has had a mostly settled afternoon. She was visited by her mum who she talked with in the visitor’s room. After her mum left she became tearful, staff talked to Jane about why she was upset. Jane said she wanted to go with her mum and did not like living at the unit.

Reasons for Jane’s stay in the unit were

discussed with her and she seemed to accept this. Later Jane became very vocal shouting and screaming at nothing in particular. She was spoken 1:1 to by staff and remains agitated but calmer. Jane refused her dinner saying she had eaten some snacks with her mum and did not feel hungry.

Mum visited Jane from 14:15 until 15:30.

Jane became agitated at 17:00 shouting and screaming loudly in the corridor. Staff gave verbal intervention that seemed to calm Jane a little but at time of writing is still agitated.

23:30 Distress and

Agitation

Jane was agitated (see previous entry) and was pacing her room occasionally shouting. She moved into the corridor and began to scream while pacing up and down the corridor while circling her hands in the air. When a staff member approached Jane, she hit him in the face with her hand due to her circling her arms. Staff tried to verbally intervene with Jane’s behaviour as her screaming was disturbing other residents but she refused to lower her voice or go to her room. At this point she was physically escorted to her bedroom where she calmed.

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When viewing these time lines, the types of information about participants that was available became apparent. Care Plans and Running Records provided information about the ‘concrete’ events that occurred in the people with intellectual disabilities lives such as activity, visits, outings, Doctors appointments and reviews. Although this information was often replicated in the MDT notes, these notes were seen as a secondary or supplementary form of information so it was decided it was not necessary to examine those records when creating database entries. When looking at information on aggressive incidents, the majority of information about aggressive behaviour was recorded, albeit in a brief form in the Distress and Agitation Care Plan. A discussion of the aggressive incident would often be in the Running Records, but as a supplement rather than primary information. There were also occasions when aggression would be mentioned only in the Distress and Agitation Care Plan. Due to this, it was decided that the Distress and Agitation Care Plan entry would provide the starting point when investigating an aggressive incident. However, as these entries are often brief, the date and time information from the Distress and Agitation Care Plan would then be used to build up an account of an aggressive incident. This information was used to write a strategy for entering aggressive incidents into the database which can be seen in Figure 3.2.

Figure 3.2.

Strategy for Assessing Violent Incidents.

Go to the Care Plan Entry for ‘Distress and Agitation’. Create a new database entry and add up what is described

there to the Incident Database. Include any information written in Baseline Behaviour Monitoring Records and Restraint Monitoring Records if applicable.

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For each of the other care plans, look for details on the date the incident occurred from the time of the incident up to the 24hour period prior to that incident.

Go to the running records and find the entry that corresponds to the date and time of the incident. Add any additional information that appears.

Note any inconsistencies in the narratives between records in red in the database.

If there has been a record of this incident sent to the Sentinel System, get a copy of that record and add to the database entry.