pertega_andia_elvira contención mecánica

Tesis doctoral sobre contención mecánica.

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  ! #$%! '()* ++,)-#$+. / 0,+,)-+ )- '!1+,0#$ ( +%(#,-%+ Sponsoring Committee: Dr. Michele Shedlin Dr. Pilar Serrano Dr. Madeline Naegle HEALTH PROFESSIONALS’ DECISION MAKING PROCESS ABOUT THE USE OF PHYSICAL RESTRAINTS IN INPATIENT PEDIATRIC PSYCHIATRIC UNITS IN MADRID Elvira Pértega Andía, RN, MS Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in  NYU College of Nursing at the College of Dentistry  New York University and Sección Departamental de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid  ! #$%! '()* ++,)-#$+. / 0,+,)-+ )- '!1+,0#$ ( +%(#,-%+ DEDICATION To all children, families and health professionals who suffer the consequences of violence in  psychiatry. Thank you God for showing me that life is about giving away and enjoying the way towards Truth. Mom and dad, you are always within me and with me; thanks to you I am. Sister, this is also yours.  ! #$%! '()* ++,)-#$+. / 0,+,)-+ )- '!1+,0#$ ( +%(#,-%+ ACKNOWLEDGEMENTS My sincere gratitude to my Committee Chair, Dr. Michele Shedlin for knowing me, accepting me, guiding me, understanding me and supporting me throughout this process. To my tutor and Co-Chair, Dr. Pilar Serrano for accompanying me, becoming so important to me, for  being a source of inspiration and strength, instilling enthusiasm and perseverance in me. To my co-advisor Dr. Madeline Naegle, for challenge my thinking and providing essential inputs from the psychiatric nursing perspective. My heartfelt thanks to my sister, for always believing in me and stand by me. I extend a loving thank you to my good friends for showing me who I am and help me not to get lost on the way. A deep appreciation to the generous and brave health professionals who opened me their doors and made this research possible.  ! #$%! '()* ++,)-#$+. / 0,+,)-+ )- '!1+,0#$ ( +%(#,-%+ 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
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