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Holding children and young people for clinical procedures

Analysing holding techniques (which involve keeping patients still during invasive treatment or examination) within the NHS, BCU Researcher Andrea Page found a lack of defined holding training or techniques, which has highlighted potential negative implications. The research has led to Clinical Holding being taught in modules at BCU and other universities, as well as The Royal Wolverhampton NHS Trust planning to introduce the Clinical Holding website and techniques into practice during Spring 2020

Clinical Holding project large

Researchers

Andrea Page 

Research background

Holding practices are employed to help children, young people and adults stay still during the administration of treatments, prevent treatment interference or to undertake an examination which can sometimes be invasive.

Research aims 

The aim of this thesis was to explore holding practices from the perspective of nurses and healthcare professionals. This included identifying and examining holding techniques currently in use to help a child or young person stay still.

Research methods 

An exploratory sequential mixed methods design was followed. Studies 1, 2 and 3 examined assumptions and practices of holding to develop theories about ‘what is happening on the ground’ following Grounded Theory methodology for practising nurses and other allied health professionals (1), undergraduate nursing students, university lecturers and clinical mentors (2) and university lecturers from other institutions (3). A core category of ‘indifference’ emerged. Studies 4 and 5 explored technique preference to establish theories about what is known about the techniques in use. Descriptive statistics were used to analyse the data.

Results

This study was completed in 2015. The practice of therapeutic holding is often covert and not considered to be part of the treatment per se, which has led to concealment and a reticence to discuss practices openly. Studies 1, 2 and 3 identified that there is variance in the experiences and practices of the participants. The prominent themes that emerged were a lack of clarity, lack of policy, lack of training, and that parents are often expected to hold their child. There appears to be a strong element of denial that there is a problem and little evidence that this is a national issue. Studies 4 and 5 showed that healthcare staff ‘prefer’ techniques they are familiar with, in particular, ‘cuddling’ and ‘wrapping’ of young children and found it more difficult to judge techniques for young people. It appears that therapeutic holding practices have moved from being viewed as ‘uncontested’ to ‘indifferent’. These findings have serious implications for current practice and the future training of healthcare professionals.

As a result of this research, the subject of clinical holding is now taught to all fields of students within the first year of the BSc (Hons) nursing programme. The subject is also taught to students at Chester University, Worcester University from 2020 and hopefully Wolverhampton University from 2020.

Trainers for Studio 3 (who promote the ideals, philosophies and benefits of non-aversive behaviour management when working with individuals who present with challenging behaviours) are also using this work.

The Royal Wolverhampton NHS Trust is looking at introducing the Clinical Holding website and techniques into practice during Spring 2020