Health professionals' decision making process about the use pf physical restrains in patient pediatric psycatric units in Madrid
Author
Pértega Andia, Elvira MaríaEntity
UAM. Departamento de Cirugía; USA. NYU. College of DentistryDate
2015-12-16Subjects
Profesionales sanitarios - Toma de decisiones - Tesis doctorales; Psiquiatría infantil - Tesis doctorales; MedicinaNote
Tesis doctoral inédita cotutelada por College of Dentistry New York University y la Universidad Autónoma de Madrid, Departamento de Cirugía. Fecha de lectura: 16-12-2015Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
Abstract
Background. The use of physical restraints (PR) in inpatient pediatric psychiatric units (IPPU) is
a highly prevalent clinical practice extended throughout the world. The high rates and negative
consequences of PR are particularly serious with youth, and this practice has also important
ethical, legal and human rights implications. Importantly, decisions about PR use are not only
frequent but are also inconsistent, which suggests that existing PR protocols and standards may
not be sufficient to regulate this practice in accordance to human rights standards. To date, health
professionals’ (HP) decision-making process about PR have not been explained in its
complexity, and to what extent existing PR protocols are useful to guide PR decisions is
unknown. The purpose of this study was to explore HPs’ decision making process about the use
of PR in IPPU.
Methods. Qualitative approach, with phenomenological and ethnographic strategies. Setting:
IPPU in Madrid (Spain). Sampling: Maximum variation sampling according to professional
category and range of experiences. Data collection: In-depth semi-structured interviews,
participant observation, other data sources (hospital documents and focus group transcripts).
Data analysis: computer assisted qualitative data analysis package (ATLAS.ti.7) and the
“Listening Guide Method”.
Findings. Factors related with restraints depend on the contain capacity of the contextual matrix
(inpatient psychiatric unit). Regulatory elements (containers) are also variable elements, which
leads to uncertainty-insecurity among health professionals. Hence, health professionals use
restraints as a “secure” or “safe” element despite it may cause also harm. Variability related with
attributes (body and mind) cannot be contained. Hence, in order to control behavior,
professionals need to handle or restrain the patient. Persons are not only affected by factors, but they are also porters of factors. Hence there is no way not to influence the scene. Decision
process about restraints use mainly depend on the reference framework and the information
acquisition. Without reference framework it is not possible to make decisions. Hence novice
professionals depend on experts or “instinct” to make decisions. Development of a reference
framework is an individual and collective process. There is diversity among each professional
but also unanimity as a team. Information transmission between times, spaces and people may
leads to voids and gaps of information. Hence, some decisions may be adjusted to the current
situation, but other might be unadjusted decisions as they were taken in a different place and
time to the situation. Restraints guidelines may not reflect the reality of restraints decisions to be
able to help professionals improve their decision-making process.
Conclusion. PR decisions are context dependent, culturally shaped, interpersonal, emotionally
intense and morally charged. Hence, policy and guidelines may need to address the complex
reality that embrace PR events and the particularities of PR use with minors
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