Documentation practices in Norwegian adolescent psychiatry: tracing the institutional circuit of physical restraint

This article examines how staff in Norwegian adolescent psychiatric inpatient units interpret their legal obligations to document physical restraint, and how these interpretations shape reporting practices. Drawing on qualitative interviews with 79 staff members across eight units and using institutional ethnography as a framework, it is shown that staff, in some situations, have divergent interpretations of whether physical restraint is used or should be reported. Staff consistently document restraint when substantial force is used. However, less forceful interactions—such as physically guiding compliant patients or minor contact during tube feeding—are interpreted differently, leading to inconsistent documentation of coercion. These divergent practices result in unreliable statistics. In addition, when comparable interactions are being documented as coercive for some patients but not for others, legal safeguards are being applied unevenly. This may have serious legal consequences for individual patients. The presented findings have important implications for patient care, legal safeguards and policy.