Free Nursing Home Behaviour Log Template
Nursing Home Behaviour Log
The Behavior Log serves as a comprehensive record of residents' behaviors, triggers, interventions, and outcomes. Efficiently complete each section by accurately documenting observed behaviors, identifying triggers, implementing targeted interventions, and evaluating outcomes to ensure individualized and effective resident care.
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Name: |
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Room Number: |
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Date of Birth: |
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Admission Date: |
Behavior Observation
This section captures residents' behaviors observed during specific time frames. Provide a detailed description of each behavior, including frequency, severity, and duration, to facilitate accurate tracking and analysis.
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Behavior |
Description |
Frequency |
Severity (Mild/Moderate/Severe) |
Duration (in minutes) |
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Agitation |
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Aggression |
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Wandering |
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Sundowning |
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Social Withdrawal |
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Participation in Activities |
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Other (Specify) |
Triggers
Identify potential triggers that may contribute to residents' behaviors. Describe the trigger, related events or contexts, and any patterns observed. This information helps in understanding underlying causes and implementing targeted interventions.
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Trigger |
Description |
Related Events/Context |
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Loud noises |
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Mealtime |
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Changes in routine |
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Staff transitions |
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Family visits |
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Environmental factors |
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Other (Specify) |
Interventions Implemented
Document interventions used to address residents' behaviors. Describe each intervention, staff members responsible, and effectiveness. Utilize evidence-based approaches and regularly review interventions for optimal resident care.
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Intervention |
Description |
Staff Member(s) Responsible |
Effectiveness |
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Reassurance and redirection |
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Providing comfort measures |
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Engaging in therapeutic activities |
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Medication administration |
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Other (Specify) |
Follow-up/Outcome
Detail follow-up actions and outcomes resulting from interventions. Discuss any adjustments to care plans, consultations with the healthcare team or family, and referrals to specialists. Monitor progress and adapt interventions accordingly for improved resident outcomes.
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Follow-up Action |
Description |
Result |
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Review with healthcare team |
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Adjustment of care plan |
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Consultation with family |
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Referral to specialist |
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Other (Specify) |
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Additional Notes/Comments |
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