What makes a behavior note good?
A good note helps someone who wasn't there understand what happened. It records the relevant observation, the support provided, and the result you actually saw. It separates your own observations from what someone else reported, uses respectful language, and follows the resident's plan and your facility's documentation process.
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Good documentation helps someone who was not there understand what happened.
It identifies the relevant observation, the support provided, and the result you actually saw.
It separates your own observations from something another person reported.
It uses respectful language and follows the resident’s plan and your facility’s documentation process.
A judgment: “She was manipulative.”
An observation, if that is what actually happened: “She requested the same item four times after being told it was unavailable.”
More words do not automatically make a better note. Accurate, relevant details do.
Divinity’s approach is to guide staff toward those details using questions they can understand.
The staff member still needs to check that the final note is true.
Written for someone who wasn't there
The test of a good note is simple: could someone who wasn't on your shift read it and understand what happened? The next caregiver, a supervisor and a reviewer all depend on that.
What a good note includes
- The relevant observation. What you saw or heard that matters for this resident.
- The support provided. What you or another staff member did.
- The result you actually saw. Not what you hoped would happen, or what probably happened.
Your observation, or someone else's?
A good note is clear about where each detail came from. "I saw" and "the day staff told me" are different, and the note should say which is which.
Observations, not judgments
Compare these two:
- "She was manipulative."
- "She requested the same item four times after being told it was unavailable."
The first is a judgment. It tells the reader what the writer concluded, not what happened. The second is an observation, if that is what actually happened. It gives the reader the facts and lets them understand the situation for themselves.
Respectful language matters for the same reason: it keeps the note about what happened rather than about the writer's opinion of the resident.
Longer isn't better
More words do not automatically make a better note. Accurate, relevant details do. A few sentences that cover what happened, what you did and what followed can be more useful than a full paragraph of general statements.
Follow the plan and the process
A good note also fits the resident's plan and your facility's documentation process. If the plan describes a specific support, the note shows whether it was offered and what happened.
How Divinity approaches this
Divinity's approach is to guide staff toward those details using questions they can understand. The staff member still needs to check that the final note is true.
Frequently asked questions
Is it okay to describe a resident as manipulative in a note?
That word is a judgment. Describe what you observed instead, such as how many times a request was made and what the resident was told, if that is what actually happened.
Should I write down what another staff member told me?
If it's relevant, follow your facility's documentation process, and make clear it was reported to you rather than something you observed yourself.
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