Équipements de protection individuelle et outils de sécurisation alternatifs à la contention dans la prise en charge des troubles graves du comportement des personnes avec autisme et déficience intellectuelle (partie 2 : perspective des soignants)

Abstract

ContextThe management of severe behavioral disorders (SBD) in people with autism and intellectual disability (ID) can lead to an escalation of seclusion and restraints, even to abuse. In this context, we offer a literature review regarding the use of personal protective equipment (PPE), as well as the practical experiences associated with their use. MethodAn exhaustive review of the literature was conducted as well as an ethnographic study of three specialized units, supplemented by 37 interviews of healthcare professionals. ResultsWe have distinguished between patients’ PPEs and caregivers’. Their description is correlated with a detailed topography of patients’ and caregivers’ injuries. The functional model underpinning their use makes it possible to better capture, according to clinical targets (self-harm, Pica, hetero-aggression), how PPEs can contribute to the restoration of clinical reasoning useful for the management of SBDs among people with autism and ID. DiscussionPPE appears to be a step forward from a risk-benefit point of view since it leads to fewer injuries and less physical constraints. They reassure caregivers who can better assess and reduce SBDs and foster less restrictive protective measures within the institution. Finally, from an ethical point of view, they contribute to promote the child's best interest and to recognize of the concept of shared vulnerability.