The relevance of professional-patient interactions in progress notes. A focus group study with mental health staff in inpatient psychiatry

Introduction: The aim of this study was to gain insight into mental health staff’s perception of writing progress notes in an acute and subacute psychiatric ward context in Norway. Progress notes are the staff’s daily reports in the electronic patient journal. The staff represents professionals with different educational backgrounds, for instance registered nurses and social workers. The therapeutic professional-patient relationship is recognized as a key component of psychiatric care, implying models of person-centered care and recovery.  At the same time, the problem and deficit-oriented medical model remains strong. Progress notes are written within this context of competing models and within a hierarchical system of professions. Research literature exploring staff’s experiences with writing progress notes in psychiatric contexts, and especially the space given to staff-patient relations, is sparse. To keep and further develop efficient cooperation in inter-professional work in mental health settings oral and written reports are of paramount importance.  The main aims of this presentation are to report 1 staff experiences of the role of progress notes in focusing on staff-user interactions, and 2 staff perceptions of the impact of different treatment models on the progress notes.

Methods: Staff who were familiar in writing progress notes and worked in one acute and one subacute psychiatric ward were invited to participate in two focus groups. A moderator and a co-moderator facilitated the interviews. Data analysis followed Systematic text condensation, which is a systematic method for transverse thematic analysis within a qualitative design.

Results: The analysis revealed two themes: The position of the professional as an expert and distant observer in the progress notes, and The weak position of professional-patient interactions in progress notes.    Reporting neutral observations of the patient for diagnostic purposes was considered most important. Though the participants told stories about challenging staff-patient situations where they drew on advanced communication skills to attune to the patient, they did not prioritize to document these interactions. In addition, the participants found it difficult to report patient resources in the reporting system.

Discussions: The discussion of the results addresses the issue of progress notes in relation to different perspectives of recovery and person-centered care, and traditional medical models, respectively. The role of progress notes in inter-professional care and coordination is also discussed.

Conclusions: The participants did not perceive that the current recording model supported a focus on patients’ resources or reporting professional-patient interactions. This model appeared to put staff in an expert position in relation to patients, which made it challenging to involve patients in the recording process.

Lessons learned: Essential aspects of care related to recovery and person-centered perspectives were not prioritized for documentation.

Limitations: The focus groups covered two different contexts of psychiatric inpatient wards. The small sample may limit the findings’ generalizability.

Suggestions for future research: Our findings reflect staff’s point of view. Studies designed to explore patients’ perceptions of the use and content of progress notes are called for.