The aim of the doctoral thesis study of Kirsi Kauppila, MHSc, was to investigate what kind of changes have occurred in coercive measures, specifically seclusions and manual restraints, used as restraint measures on children during a 30-year period as well as to describe the experiences of children who have faced these restraint measures and opinions of their parents about these measures. Furthermore, documentation by the staff on the execution of the manual restraint was assessed. Data concerning the use of coercive measures and restraint covered years 1987−1988, 2008−2009 and 2017−2018. The factors preceding the restraint situations and related causes (n=331) were collected from staff documentation from 2008−2009. The remaining data were collected by interviewing 6−13-year-old children (n=34) who had been treated at a child psychiatric unit between 2009 and 2012 concerning their first experiences of manual restraint as well as using surveys to the children’s parents (n=17) on the implementation of restraint. Documentation by staff of the situations were also analysed. The data were analysed using statistical method and qualitative content analysis.
Based on the register data, in 1987−1988, nearly half of the children (n=43, 48 %) had experienced seclusion, while in 2008−2009, a quarter (n=70, 25 %) and in 2017−2018, 14,5 % (n=65) had undergone manual restraint during inpatient treatment. The interview results showed that children had primarily negative experiences of manual restraint, including feelings of anger, sadness, fear and shame, and their gestures and verbal and non-verbal communication also indicated these emotions. The children described their bodily experiences as different physical symptoms, such as pain caused by nurses and as general psychological anguish. Six of the children described the manual restraint as a fairly neutral experience. All the parents reported that they had been immediately informed about the restraint after the situation. Most parents assessed that the manual restraint had not caused a lot of pain. More than half of the parents felt that the inpatient period had been useful and the child’s aggressive behavior had been reduced. Based on the documentation by staff, the manual restraint had been preceded by the child’s behavioural problems in half the cases. Staff perceived violence against staff and non-compliance with rules as the major cause for using restraint in nearly half the cases. This doctoral dissertation produces news evidence of the prevalence of restrictive measures and experiences of children and parents of manual restraint. There is need for training and work supervision for harmonizing physical restraint situations and preventing the need for manual restraint.
The knowledge obtained in this study can be utilised in education on the safe management of physical restraint measures and in clinical work.
The doctoral dissertation of Kirsi Kauppila, Master of Health Sciences, entitled Coercive measures in child psychiatric inpatient care – seclusions and manual restraints will be examined at the Faculty of Health Sciences on 13 December 2019. The Opponent in the public examination will be Professor Eija Paavilainen of Tampere University, and the Custos will be Professor Katri Vehviläinen-Julkunen of the University of Eastern Finland.
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