Health professionals' decision making process about the use pf physical restrains in patient pediatric psycatric units in Madrid

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dc.contributor.advisor Serrano Gallardo, Pilar (dir.) Pértega Andia, Elvira María
dc.contributor.other UAM. Departamento de Cirugía es_ES
dc.contributor.other College of Dentistry New York University en_US 2016-05-19T14:04:09Z 2016-05-19T14:04:09Z 2015-12-16
dc.description Tesis doctoral inédita cotutelada por College of Dentistry New York University y la Universidad Autónoma de Madrid, Departamento de Cirugía. Fecha de lectura: 16-12-2015 es_ES
dc.description.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 en_US
dc.format.extent 238 pag. es_ES
dc.format.mimetype application/pdf en
dc.language.iso eng en
dc.subject.other Profesionales sanitarios - Toma de decisiones - Tesis doctorales es_ES
dc.subject.other Psiquiatría infantil - Tesis doctorales es_ES
dc.title Health professionals' decision making process about the use pf physical restrains in patient pediatric psycatric units in Madrid en_US
dc.type doctoralThesis en_US
dc.subject.eciencia Medicina es_ES Reconocimiento – NoComercial – SinObraDerivada es_ES
dc.rights.accessRights openAccess en

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