L’accompagnement infirmier des proches dans un processus décisionnel concernant la fin de vie d’une personne âgée vivant avec un trouble neurocognitif en centre d’hébergement

Les proches qui accompagnent une personne âgée vivant avec un trouble neurocognitif majeur à un stade avancé (TNC) en centre d’hébergement et de soins de longue durée (nommé CHSLD au Québec) rencontrent de multiples défis au quotidien. Parmi ceux-ci se retrouve la responsabilité qui leur est conférée de prendre les décisions relatives aux soins de santé pour la personne vivant avec un TNC lorsque celle-ci devient incapable de le faire. Certaines de ces décisions placent les proches dans un processus complexe qui doit être accompagné par l’équipe soignante, notamment lorsque les décisions en question auront potentiellement une incidence sur la fin de vie de la personne âgée. Les infirmières et infirmiers, par leurs compétences relatives aux soins à la famille et leur présence quotidienne directe auprès des résidentes et résidents et de leurs proches, se retrouvent dans une position privilégiée pour offrir cet accompagnement. Toutefois, peu d’études se sont intéressées aux différentes composantes de cet accompagnement. Par conséquent, cette étude visait à proposer une théorie de l’accompagnement infirmier des proches qui doivent prendre des décisions concernant la fin de vie d’une personne âgée vivant avec un TNC en CHSLD. Inspirée par la philosophie herméneutique de Gadamer (1960/2018) et la théorie du human caring élaborée par Watson (2012), une théorisation ancrée constructiviste a été réalisée auprès de neuf infirmières ou infirmiers et 10 proches rencontrés dans le cadre d’une entrevue semi-structurée individuelle. Les infirmiers et infirmières occupaient toutes un poste régulier en CHSLD depuis au moins un an, alors que les proches étaient ou avaient été impliqués dans le processus de prise de décisions concernant la fin de vie d’une personne âgée vivant avec un TNC en CHSLD. L’analyse des données s’est appuyée sur les principes suggérés par Charmaz (2014), qui incluent entre autres la codification initiale, la codification ciblée, la comparaison constante et l’écriture de mémos. Il découle de la théorie proposée l’aspect fondamental du lien de confiance établi entre l’infirmière ou l’infirmier et les proches, celui-ci ayant un impact important sur le processus de prise de décisions vécu par les proches et la qualité de l’accompagnement offert par l’infirmière ou l’infirmier. Ensuite, l’exploration du refus des soins palliatifs et le soutien du besoin des proches d’être témoin de l’état de santé actuel de la personne âgée vivant avec un TNC se sont aussi avérés des composantes essentielles de l’accompagnement infirmier. Finalement, l’enseignement au moment opportun ainsi qu’une transmission claire de l’information complètent les thèmes centraux de la théorie. Ces connaissances permettent de mieux comprendre les principaux éléments d’un accompagnement infirmier de qualité, contribuant ainsi à soutenir la pratique infirmière basée sur des résultats probants et à guider la recherche dans le développement d’interventions efficaces afin de faciliter l’expérience des proches. En outre, ces résultats démontrent l’apport indispensable des infirmières et infirmiers au processus de prise de décisions des proches.Relatives supporting an older person living with an advanced major neurocognitive disorder (NCD) in a long-term care home (called a CHSLD in Quebec) encounter multiple challenges every day. Among them is the responsibility of making healthcare decisions on behalf of a relative living with an NCD, who is no longer able to do so themself. Some of these decisions launch relatives into a complex process that requires guidance from the healthcare team, especially when the decisions may impact the end-of-life of the person living with an NCD. Through their skills in family care and their daily presence directly among residents and relatives, nurses have a privileged role to play in offering this support. However, few studies have examined its various components. The aim of this study is therefore to propose a theory on nurses’ support of relatives making end-of-life decisions for a resident living with an NCD in a CHSLD. Inspired by Gadamer’s hermeneutical philosophy (1960/2018) and Watson’s theory of human caring (2012), a constructivist grounded theory was conducted with nine nurses and 10 relatives, whom were met in individual semi-structured interviews. These nurses had all held regular positions in CHSLDs for at least one year, while relatives were or had been involved in the end-of-life decision-making process for a person living with an NCD in a CHSLD. The data analysis was based on principles suggested by Charmaz (2014), including initial coding, focus coding, constant comparison, and the writing of memos. The proposed theory highlights trust as the fundamental aspect in the nurse-relative relationship. Indeed, trust has a significant impact on families’ decision-making process and on the quality of the support nurses provide to relatives. Exploring the refusal of palliative care and supporting relatives’ need to witness and take stock of the state of health of the person living with an NCD for themselves are two other essential components of nursing care. Finally, nurses’ well-timed education of relatives and clear transmission of information are other themes that are central to this theory. Deepening the understanding of the main elements of quality nursing support, this study reinforces evidence-based nursing practice and guides research leading to effective interventions that will ultimately facilitate relatives’ experience. Our results also demonstrate nurses’ invaluable contribution to relatives’ decision-making process

Analyse des obstacles à l'intervention infirmière auprès des familles dans les unités de soins de santé mentale à la lumière du modèle de changement de Collerette

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l’obtention du grade de Maître ès sciences (M.Sc.) option expertise-conseil en soins infirmiersAccompagner au quotidien un proche souffrant d’un problème de santé mentale est une expérience qui transforme profondément l’identité des familles. Celles-ci doivent souvent composer avec des sentiments tels que la culpabilité et l’impuissance. L’hospitalisation en psychiatrie du membre atteint n’améliore guère la situation. Or, dans ce contexte, les écrits existants reconnaissent massivement les bienfaits de l’inclusion des membres de la famille dans les soins, autant pour la personne atteinte que pour les proches et les professionnels de la santé impliqués. Pourtant, ces familles se sentent toujours exclues des soins et non-reconnues dans leur rôle par les infirmières, ceci ayant des conséquences importantes sur le patient, sa famille et sur les soins offerts. Cette recension critique des écrits avait donc pour but d’analyser les obstacles à la pratique de l’approche familiale par l’infirmière sur les unités de soins psychiatriques, afin de proposer des recommandations visant la transformation des pratiques cliniques actuelles à cet égard. Une recherche systématique des écrits a été effectuée dans les bases de données CINHAL, PsychInfo et PubMed et l'analyse des écrits a été réalisée à partir de la théorie du changement proposée par Collerette. Les résultats montrent que la confidentialité, le manque d’habiletés et d’expertise ainsi que certains problèmes organisationnels sont les principaux obstacles à la pratique quotidienne d’interventions infirmières auprès des proches. Ces obstacles provoquent un sentiment important d’impuissance, ce qui entraîne un désengagement de la part des infirmières.Accompanying loved ones suffering from a mental health problem on a daily basis is an experience that profoundly transforms the identity of families. Such families must often cope with feelings such as guilt and helplessness. The psychiatric hospitalisation of a family member suffering from mental illness hardly improves the situation, instead provoking an exacerbation of the anxiety and stress felt by friends and relatives. In this context, existing literature recognises without contest the benefits of including family members involved in care, as much for the afflicted person as for loved ones and the health professionals involved. However, these families inevitably feel excluded from care and unrecognised in their role by nurses, leading to important consequences for the patient, his or her family and the care provided. This critical review of literature was meant to analyse the obstacles to practicing a family-oriented approach by nurses working in mental health units, in order to propose recommendations aiming at the transformation of present clinical practices in this regard. A systematic study of literature was carried out on the databases CINHAL, PsychInfo and PubMed and the analysis of literature was realised based on the Theory of Change proposed by Collerette. The results demonstrate that confidentiality, lack of abilities and expertise in addition to certain organisational problems constitute the principal barriers to the practice of nursing interventions for loved ones on a daily basis. These barriers provoke a significant feeling of helplessness, which in turn leads to the disengagement of nurses

End-of-life care in long-term care homes : a scoping review protocol

Background: Quality end-of-life (EOL) care is essential in long-term care homes (LTCHs), as the average survival time of newly admitted residents is estimated to be around 2 to 2.5 years. However, significant challenges exist when it comes to providing EOL clinical care in LTCHs, and the available empirical evidence does not offer a clear idea of the best practices to adopt. Aim: To systematically map the state of knowledge on EOL clinical care in LTCHs, as it relates to people receiving care, family care partners, health care professionals, the characteristics of the organization, the social context, and the implementation of guides. Methods: The scoping review method by Levac et al. (2010) will be used. Data will be collected from multiple sources, including eleven databases using a combination of keywords and descriptors, references list, prospective and manual searches, and by consulting clinicians and managers from LTCHs for additional publications. The literature from 2012 and onwards will be selected if it directly concerns EOL care in LTCHs, with no restriction on the age of residents or on the type of health care professionals or family care partners. The screening and data extraction will be performed by two people independently and any discrepancies will be resolved by consensus. We will also assess the quality of publication with the critical appraisal tools developed by the Joanna Briggs Institute. We will synthesize the extracted data using content analysis and consult stakeholders in LTCHs when a first version of the data synthesis is available to enhance the interpretation of the results based on their experience. We will present results in narrative form with tables and graphs. Discussion: The results will provide evidence-based recommendations for clinical practice when available findings are conclusive and will allow identifying knowledge gaps to orient future research programs focusing specifically on EOL clinical care in LTCHs

Apathy in older people living with a major neurocognitive disorder in long-term care homes : a scoping review protocol

Background: Apathy has major consequences for older people (e.g., deconditioning), their family care partners and formal caregivers. Although systematic reviews have been conducted, they have focused on the effectiveness of interventions to reduce this behaviour. Furthermore, they have not been specific to long-term care homes, despite studies conducted in that setting. However, older people in this setting have very different characteristics and more severe cognitive impairment than those in the community. For this reason, knowledge about existing interventions, causes, associated factors, and consequences of apathy is needed to choose or develop personalized interventions. Thus, this scoping review aims to map the state of knowledge about apathy in older people living in long-term care homes to develop personalized interventions. The Senses Framework, which provides a humanistic and relational perspective to examine apathy, will guide this review. Methods: Levac, Colquhoun, and O'Brien (2010) scoping review methods will be used. Eleven databases (e.g., CINAHL, MedLine, PsycINFO, Web of Science, Grey Literature Report) will be searched for literature using a combination of keywords and descriptors. Other data sources will be used to identify non-indexed literature or unpublished results (e.g., article references, journal tables of content, contact with key authors). The literature will be selected if it concerns older people, aged 65 or older, with a major neurocognitive disorder who exhibit apathy and live in long-term care homes. Data will be extracted using standardized extraction grids. A quality assessment of the literature will be done to consider this aspect in the data synthesis. A content analysis will be used to synthesize the results, as well as tables and graphs. Discussion: No scoping review has been found on apathy in older people living with a major neurocognitive disorder in long-term care homes. The results of this review will help identify the needs for further research and clinical and training development on this problem from a humanistic and relational perspective. It will also guide the development of personalized interventions

Characteristics and impact of physical activity interventions during substance use disorder treatment excluding tobacco: A systematic review.

Substance use disorder is a worldwide issue that entails negative health and physical activity is a promising complementary therapy for alleviating the consequences. The objective of this reviews is to characterize physical activity interventions offered in the literature and explore their effects during treatment for people with substance use disorders with excluding studies focusing only on tobacco use. A systematic search of seven databases on articles including a physical activity intervention during a treatment for substance use disorder was done and an examination of the presence of bias was performed. A total of 43 articles including 3135 participants were identified. Most studies were randomized controlled trial (81%), followed by pre-post design (14%) and cohort studies (5%). The most common physical activity intervention identified was of moderate intensity, 3 times per week (≈ 1 hour) for 13 weeks. Cessation/reduction of substance use was the most studied outcome (21 studies, 49%), and 75% showed a decrease in substance use following physical activity intervention. Aerobic capacity was the second most studied effect (14 studies, 33%), with more than 71% of studies showing improvement. Twelve studies (28%) reported a decrease of depressive symptoms. Physical activity interventions in a treatment for substance use disorder seem to be a promising, but more methodologically rigorous scientific studies are needed

Characteristics and impact of physical activity interventions during substance use disorder treatment excluding tobacco: A systematic review

Substance use disorder is a worldwide issue that entails negative health and physical activity is a promising complementary therapy for alleviating the consequences. The objective of this reviews is to characterize physical activity interventions offered in the literature and explore their effects during treatment for people with substance use disorders with excluding studies focusing only on tobacco use. A systematic search of seven databases on articles including a physical activity intervention during a treatment for substance use disorder was done and an examination of the presence of bias was performed. A total of 43 articles including 3135 participants were identified. Most studies were randomized controlled trial (81%), followed by pre-post design (14%) and cohort studies (5%). The most common physical activity intervention identified was of moderate intensity, 3 times per week (≈ 1 hour) for 13 weeks. Cessation/reduction of substance use was the most studied outcome (21 studies, 49%), and 75% showed a decrease in substance use following physical activity intervention. Aerobic capacity was the second most studied effect (14 studies, 33%), with more than 71% of studies showing improvement. Twelve studies (28%) reported a decrease of depressive symptoms. Physical activity interventions in a treatment for substance use disorder seem to be a promising, but more methodologically rigorous scientific studies are needed

Keywords search strategy for each database.

Substance use disorder is a worldwide issue that entails negative health and physical activity is a promising complementary therapy for alleviating the consequences. The objective of this reviews is to characterize physical activity interventions offered in the literature and explore their effects during treatment for people with substance use disorders with excluding studies focusing only on tobacco use. A systematic search of seven databases on articles including a physical activity intervention during a treatment for substance use disorder was done and an examination of the presence of bias was performed. A total of 43 articles including 3135 participants were identified. Most studies were randomized controlled trial (81%), followed by pre-post design (14%) and cohort studies (5%). The most common physical activity intervention identified was of moderate intensity, 3 times per week (≈ 1 hour) for 13 weeks. Cessation/reduction of substance use was the most studied outcome (21 studies, 49%), and 75% showed a decrease in substance use following physical activity intervention. Aerobic capacity was the second most studied effect (14 studies, 33%), with more than 71% of studies showing improvement. Twelve studies (28%) reported a decrease of depressive symptoms. Physical activity interventions in a treatment for substance use disorder seem to be a promising, but more methodologically rigorous scientific studies are needed.</div

Quality assessment tool for randomized trial (K = 35).

Quality assessment tool for randomized trial (K = 35).</p

PRISMA flowchart.

Substance use disorder is a worldwide issue that entails negative health and physical activity is a promising complementary therapy for alleviating the consequences. The objective of this reviews is to characterize physical activity interventions offered in the literature and explore their effects during treatment for people with substance use disorders with excluding studies focusing only on tobacco use. A systematic search of seven databases on articles including a physical activity intervention during a treatment for substance use disorder was done and an examination of the presence of bias was performed. A total of 43 articles including 3135 participants were identified. Most studies were randomized controlled trial (81%), followed by pre-post design (14%) and cohort studies (5%). The most common physical activity intervention identified was of moderate intensity, 3 times per week (≈ 1 hour) for 13 weeks. Cessation/reduction of substance use was the most studied outcome (21 studies, 49%), and 75% showed a decrease in substance use following physical activity intervention. Aerobic capacity was the second most studied effect (14 studies, 33%), with more than 71% of studies showing improvement. Twelve studies (28%) reported a decrease of depressive symptoms. Physical activity interventions in a treatment for substance use disorder seem to be a promising, but more methodologically rigorous scientific studies are needed.</div