PAB/PSW Documentation for Difficult Behavioural Situations
The short answer
When behaviour becomes difficult, the most useful note describes what you saw and heard, what happened just before, what you did, and what happened next. Labels such as "aggressive", "difficult" or "manipulative" describe your impression and tell the next person very little. Safety comes first: respond according to your workplace procedure, and write the note once everyone is safe. Scope, forms and reporting lines differ by employer and province, so your workplace policy and job description come first.
Use a before, during, after structure
- Before: what was happening just before (a task, a noise, a request, a time of day, pain, a change in routine).
- Behaviour: exactly what the person did or said, in plain words, with quotes where possible.
- Response: what you did and said, including steps you tried that did not help.
- After: how the person responded, how long it lasted, and who you informed.
In dementia care these are often called responsive behaviours, a way of saying the behaviour may be the person's response to something unmet or unfamiliar. Describing what triggered and calmed the behaviour helps the care team find a plan.
A filled-in example (fictional resident)
"14:05 During a bath, Mr. F. pulled his arm away and shouted, 'Get out! Leave me alone!' He pushed the washcloth out of my hand. Just before, I had turned on the water spray and said I was washing his back. I stepped back, said I would wait and turned off the water. At 14:10 he said, 'It is cold.' I brought a warm towel and he allowed me to finish washing his arms. I stopped the bath at 14:20 at his request. No injury to either of us. Told Nurse P. at 14:25."
Compare that with "Mr. F. was aggressive during bath." The first version shows a likely trigger (cold water), what worked, and what the nurse needs to know.
Words to replace
| Instead of | Write what you saw or heard |
|---|---|
| Aggressive | "Raised his voice and hit the bed rail twice with his fist." |
| Refused care | "Said 'no' three times and turned his face away when I offered the toothbrush." |
| Agitated | "Walked up and down the hall for 40 minutes, repeating that he had to go home." |
| Uncooperative | "Kept her arms crossed and did not stand when asked twice." |
Common mistakes
- Writing labels and conclusions without the behaviour behind them.
- Leaving out your own actions and what helped.
- Writing the note hours later and guessing the time.
- Including your feelings or opinions about the person.
- Forgetting to write who you informed.
A fill-in template
Time and place: ___
What happened just before: ___
What the person did or said (quote if possible): ___
What I did: ___
What happened next, and how long it lasted: ___
Any injury or damage: ___
Told (name and role) at (time): ___
Where Fiabita fits
Fiabita's rewrite and SBAR tools can turn rough notes into clearer wording, and you review every line before it goes anywhere. Fiabita does not know your employer's policy, cannot certify that a note is compliant and does not replace your judgment, your instructor or your supervisor.
FAQ
Q: Should I write down what I felt during the incident?
Write what you saw, heard and did. If you were frightened or hurt, report that through your employer's incident or injury process as well.
Q: What if I was not there for the start?
Write only what you saw yourself, and note what you were told and by whom.
Q: Who should I tell?
Follow your workplace policy. In most settings, you tell the nurse or supervisor immediately and record who you informed.