L’influence du stress perçu et de la fatigue des éducateurs sur leur recours aux contentions et isolements : une étude longitudinale en centre de réadaptation pour jeunes en difficulté

Background: Restraints and seclusions (R&S) in youth residential treatment centers (RTCs) are used regularly even though their use is controversial. Although R&S are meant to be used within a legal framework, their application in the day-to-day operations can be influenced by personal characteristics of the caregiver, such as his stress and fatigue level. Thus, the use of R&S could be due to the situation itself, but also possibly by the educator’s stress and fatigue. Considering the physical and psychological iatrogenic effects of R&S for both youth and educators, it is highly relevant to study the impact of the stress and fatigue of the educator in relation to his usage of R&S, as well as factors which could potentially lower those psychophysiological reactions. In light of the results, we could suggest the implementation of stress coping strategies which could promote better recovery. Suggestions towards the development of a reflexive practice and higher consideration of the wellbeing of the educators could also be of interest. Objective: To examine the associative links between the level of perceived stress, acute fatigue, chronic fatigue, intershift recovery and physical activity on the use of R&S in youth RTCs. Methodology: A mixed sequential explanatory design was used. The participants were 155 educators working in RTCs of the Centre intégré de santé et services sociaux de la Montérégie-Est (CISSSME). They completed weekly diaries from March to May 2017, which included standardized instruments such as the Perceived Stress Scale, the International Physical Activity Questionnaire and the Occupational Fatigue/Exhaustion Recovery Scale. The data obtained was crossed with objective R&S data acquired from the CISSSME. Cross-lagged analyses were conducted in order to test the associative links between the variables. Five focus groups were organized where participants had to give their interpretation of our results. Results: Results shown that (a) an educator’s stress is negatively associated with the use R&S in the upcoming weeks (Bz = - 0,28, p  0,01); (b) physical activity is negatively associated with the use of R&S in the same week (Bz = - 0,13, p  0,05); (c) use of R&S is positively associated to the use of R&S in the next weeks (Bz = 0,33 à 0,78, p  0,001) and (d) the use of R&S is positively associated with acute fatigue (Bz = 0,10, p  0,01) and negatively associated with recovery (Bz = - 0,14, p  0,01) in the following weeks. Finally, recovery is negatively associated with the use of R&S via high chronic fatigue and high stress level (Bz = 0,03, p = 0,076). Against our expectations, stress and fatigue were not positively related with the use of R&S. iv Conclusion: This study shows that a higher level of stress and physical activity is linked to a lesser use of R&S. We can hypothesize that some educators’ personal characteristics can influence their use of R&S, but also that they would be able to put their own stress aside when it comes to intervening. The project highlighted that educators might banalize the stress and fatigue they experience, contributing to underestimate the impact on their work on their wellbeing. Suggestions towards higher levels of clinical supervision and organizational support would be relevant.

Keyphrases: Fatigue, Stress, Restraint, Seclusion, Residential treatment centre, Physical activity, Educators