Seclusion and Restraint in Psychiatry: Patients' Experiences and Practical Suggestions on How to Improve Practices and Use Alternatives

Authors

  • Raija Kontio RN, MSN,

    Corresponding author
    1. Raija Kontio, RN, MSN, is a Doctoral Student and Assistant Chief, Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Grigori Joffe, MD, PhD, is the Psychiatrist-in-Chief, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland; Hanna Putkonen, MD, PhD, is a Senior Researcher, Vanha Vaasa Hospital, Vaasa, Finland; Lauri Kuosmanen, RN, PhD, is a Project Manager, University of Turku, Department of Nursing Science, Turku, Finland, and Primary Health Care Organisation of City of Vantaa, Vantaa, Finland; Kimmo Hane, RN, is a Masters of Science Nursing Student and Head Nurse, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Matti Holi, MD, PhD, is the Medical Director, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital/Peijas, Vantaa, Finland; and Maritta Välimäki, RN, PhD, is Professor and Director of Nursing, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Southwest Finland, Turku, Finland.
      Author contact:raija.kontio@utu.fi, with a copy to the Editor: gpearson@uchc.edu
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  • Grigori Joffe MD, PhD,

    1. Raija Kontio, RN, MSN, is a Doctoral Student and Assistant Chief, Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Grigori Joffe, MD, PhD, is the Psychiatrist-in-Chief, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland; Hanna Putkonen, MD, PhD, is a Senior Researcher, Vanha Vaasa Hospital, Vaasa, Finland; Lauri Kuosmanen, RN, PhD, is a Project Manager, University of Turku, Department of Nursing Science, Turku, Finland, and Primary Health Care Organisation of City of Vantaa, Vantaa, Finland; Kimmo Hane, RN, is a Masters of Science Nursing Student and Head Nurse, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Matti Holi, MD, PhD, is the Medical Director, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital/Peijas, Vantaa, Finland; and Maritta Välimäki, RN, PhD, is Professor and Director of Nursing, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Southwest Finland, Turku, Finland.
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  • Hanna Putkonen MD, PhD,

    1. Raija Kontio, RN, MSN, is a Doctoral Student and Assistant Chief, Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Grigori Joffe, MD, PhD, is the Psychiatrist-in-Chief, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland; Hanna Putkonen, MD, PhD, is a Senior Researcher, Vanha Vaasa Hospital, Vaasa, Finland; Lauri Kuosmanen, RN, PhD, is a Project Manager, University of Turku, Department of Nursing Science, Turku, Finland, and Primary Health Care Organisation of City of Vantaa, Vantaa, Finland; Kimmo Hane, RN, is a Masters of Science Nursing Student and Head Nurse, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Matti Holi, MD, PhD, is the Medical Director, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital/Peijas, Vantaa, Finland; and Maritta Välimäki, RN, PhD, is Professor and Director of Nursing, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Southwest Finland, Turku, Finland.
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  • Lauri Kuosmanen RN, PhD,

    1. Raija Kontio, RN, MSN, is a Doctoral Student and Assistant Chief, Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Grigori Joffe, MD, PhD, is the Psychiatrist-in-Chief, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland; Hanna Putkonen, MD, PhD, is a Senior Researcher, Vanha Vaasa Hospital, Vaasa, Finland; Lauri Kuosmanen, RN, PhD, is a Project Manager, University of Turku, Department of Nursing Science, Turku, Finland, and Primary Health Care Organisation of City of Vantaa, Vantaa, Finland; Kimmo Hane, RN, is a Masters of Science Nursing Student and Head Nurse, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Matti Holi, MD, PhD, is the Medical Director, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital/Peijas, Vantaa, Finland; and Maritta Välimäki, RN, PhD, is Professor and Director of Nursing, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Southwest Finland, Turku, Finland.
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  • Kimmo Hane RN,

    1. Raija Kontio, RN, MSN, is a Doctoral Student and Assistant Chief, Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Grigori Joffe, MD, PhD, is the Psychiatrist-in-Chief, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland; Hanna Putkonen, MD, PhD, is a Senior Researcher, Vanha Vaasa Hospital, Vaasa, Finland; Lauri Kuosmanen, RN, PhD, is a Project Manager, University of Turku, Department of Nursing Science, Turku, Finland, and Primary Health Care Organisation of City of Vantaa, Vantaa, Finland; Kimmo Hane, RN, is a Masters of Science Nursing Student and Head Nurse, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Matti Holi, MD, PhD, is the Medical Director, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital/Peijas, Vantaa, Finland; and Maritta Välimäki, RN, PhD, is Professor and Director of Nursing, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Southwest Finland, Turku, Finland.
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  • Matti Holi MD, PhD,

    1. Raija Kontio, RN, MSN, is a Doctoral Student and Assistant Chief, Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Grigori Joffe, MD, PhD, is the Psychiatrist-in-Chief, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland; Hanna Putkonen, MD, PhD, is a Senior Researcher, Vanha Vaasa Hospital, Vaasa, Finland; Lauri Kuosmanen, RN, PhD, is a Project Manager, University of Turku, Department of Nursing Science, Turku, Finland, and Primary Health Care Organisation of City of Vantaa, Vantaa, Finland; Kimmo Hane, RN, is a Masters of Science Nursing Student and Head Nurse, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Matti Holi, MD, PhD, is the Medical Director, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital/Peijas, Vantaa, Finland; and Maritta Välimäki, RN, PhD, is Professor and Director of Nursing, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Southwest Finland, Turku, Finland.
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  • Maritta Välimäki RN, PhD

    1. Raija Kontio, RN, MSN, is a Doctoral Student and Assistant Chief, Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Grigori Joffe, MD, PhD, is the Psychiatrist-in-Chief, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland; Hanna Putkonen, MD, PhD, is a Senior Researcher, Vanha Vaasa Hospital, Vaasa, Finland; Lauri Kuosmanen, RN, PhD, is a Project Manager, University of Turku, Department of Nursing Science, Turku, Finland, and Primary Health Care Organisation of City of Vantaa, Vantaa, Finland; Kimmo Hane, RN, is a Masters of Science Nursing Student and Head Nurse, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital, Tuusula, Finland; Matti Holi, MD, PhD, is the Medical Director, Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital/Peijas, Vantaa, Finland; and Maritta Välimäki, RN, PhD, is Professor and Director of Nursing, University of Turku, Department of Nursing Science, Turku, Finland, and Hospital District of Southwest Finland, Turku, Finland.
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Author contact:raija.kontio@utu.fi, with a copy to the Editor: gpearson@uchc.edu

Abstract

PURPOSE:  This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland.

METHODS:  The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis.

RESULTS:  Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient–staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted.

PRACTICE IMPLICATIONS:  Patients' basic needs have to be met, and patient–staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient–staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development.

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