Univers lexicaux et représentations sociales de l'utilisation du Midazolam au sein de trois unités de soins palliatifs

National audienceDans les Unités de Soins Palliatifs (USP), l’objectif premier est d’améliorer le confort du patient dont le corps est épuisé par la maladie et les thérapeutiques qui ont été administrées pour tenter de la juguler. La réalisation de cet objectif dépend concrètement de la possibilité de soulager les symptômes physiques et psychiques au croisement de leur réalité multiple, entre objectivation physiopathologique des causes et des effets et subjectivité des interprétations, des vécus, des représentations

Les effets de l'accréditation et des mesures d'amélioration de la qualité des soins sur l'activité des personnels soignants: Document de travail

Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), Série Études, n° 48, juin 2005, 181 p. Post-enquête "Conditions et organisation du travail dans les établissements de santé" (2/5). En ligne à l'adresse suivante : http://www.sante.gouv.fr/IMG/pdf/serieetud48.pdfL'étude s'intéresse aux transformations de l'organisation du travail dans les établissements de santé, et plus précisément à celles qui résultent de la mise en œuvre récente de l'accréditation. L'objectif annoncé d'une telle procédure est de garantir une amélioration continue de la qualité et de la sécurité des pratiques effectuées. L'accréditation impulse la mise en place de protocoles, d'outils de traçabilité et de contrôle qui témoignent d'une tentative de rationalisation de l'activité de soin. Chez beaucoup de soignants interrogés, l'image de cette démarche est essentiellement négative et suscite une certaine réticence. Cependant, au-delà de ces représentations spontanées, l'accréditation ne semble pas avoir eu le même retentissement sur leur activité quotidienne, celui-ci variant en fonction du degré de technicité des services concernés. Ainsi, certains professionnels jugent l'impact de la démarche minime voire nul, tandis que d'autres l'associent systématiquement à une surcharge de travail et à une dégradation des modes de coopération au sein de leurs équipes. Seule une partie des professionnels considère que la démarche participe à l'amélioration de la qualité des soins, notamment sur le plan de la relation au patient. Cependant, le décalage qui existe entre cette conception de la qualité (centrée sur la prise en charge globale du patient) et celle véhiculée par l'accréditation (centrée sur les résultats) peut être repéré comme une source d'insatisfaction au travail. Au final, l'introduction des démarches qualité semble avoir eu des impacts très différents en fonction de plusieurs facteurs : le contexte organisationnel, la conduite de la démarche et l'appropriation de celle-ci. Ces effets apparaissent assez largement ambivalents et incertains chez les professionnels interrogés

Mourir aux urgences: Étude des pratiques de soins et d'accompagnement du malade en fin de vie et de sa famille dans un service d'urgences, représentations des soins palliatifs chez les soignants et rapport subjectif au travail

Étude réalisée pour la Fondation de France "Recherche en soins palliatifs", UBO-Ethique, professionnalisme et santé (ERCS A02), UBO-ARS (EA 3149), Université Paris 13- CRESP, 191 p

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study, BMC Palliative Care

International audienc

Dying in the emergency unit: a study on the caregivers' practices

Résumés des communications en ligne à l'adresse suivante : http://www.eapcnet.eu/LinkClick.aspx?fileticket=b7egmUIKSMo%3D&tabid=631International audienceIntroduction: The goals of emergency ward hospitalization units (EWHU) are to take care of severely-ill patients before their admission into a hospital department and to provide immediate intensive care. The number of deaths (1 /2 per week) is one of the highest in comparison to other hospital units. However, death remains a relatively ''surprising'' event in such units. Our hypothesis is that the gap between the objectives of acute care and the frequent confrontation with death may induce breaks along the care practices leading to psychological suffering of the caregivers. Methods: Both the approaches and the methodological aspects of our research, performed in two different EWHU, are clearly multidisciplinary. Approaches, Objectives, Methods: 1-Epidemiology. To characterize the clinical care and the trajectories of the deceased patients. Restropective analysis of 300 patient files. 2-Sociology. To formalize the various aspects of care. Direct observation. 3-Psychology of work. To unveil the subjective relations to the work and analyse the representations of palliative care. Group discussions. Results: The results obtained are both corrobatory and complementary. They show that, although there is no explicit palliative approach, informed palliative care giving does however exist, the goal of which being to improve the quality of the patient's life and the accompanying of the family. They also highlight some specific representations of palliative care : one is related to the care of very terminally-ill patients whereas another is linked to its non-professional content. Finally, our results lead to an increased knowledge of the causes of work-induced suffering. Conclusion: The investigation of death in EWHU, still poorly developed, may however reveal changes in the dominant medical paradigm and raise the issue of the incorporation of palliative care in EWHU

Palliative care in emergency departments: an impossible challenge?

International audienceThe aim of this study was to investigate the care practices surrounding end-of-life patients and the scope for providing palliative care in two emergency department short-stay units. Two qualitative methods of investigation were used: direct ethnographic-type observation and semi-directed group interviews. The results highlight the fact that end-of-life situations inflect the practices of care and give rise to adjustments in the organization of work. These practices operate in two registers: that of supporting the family and that of attention to the patient's comfort. We propose a typology of end-of-life patients. In conclusion, the practices, termed 'palliative care' by the caregivers, are addressed to terminally ill patients expected to die shortly. This issue should be debated within emergency departments

Mourir aux urgences: Étude des pratiques de soins et d'accompagnement du malade en fin de vie et de sa famille dans un service d'urgences, représentations des soins palliatifs chez les soignants et rapport subjectif au travail

Étude réalisée pour la Fondation de France "Recherche en soins palliatifs", UBO-Ethique, professionnalisme et santé (ERCS A02), UBO-ARS (EA 3149), Université Paris 13- CRESP, 191 p

Dying in the emergency unit: a study on the caregivers' practices

Résumés des communications en ligne à l'adresse suivante : http://www.eapcnet.eu/LinkClick.aspx?fileticket=b7egmUIKSMo%3D&tabid=631International audienceIntroduction: The goals of emergency ward hospitalization units (EWHU) are to take care of severely-ill patients before their admission into a hospital department and to provide immediate intensive care. The number of deaths (1 /2 per week) is one of the highest in comparison to other hospital units. However, death remains a relatively ''surprising'' event in such units. Our hypothesis is that the gap between the objectives of acute care and the frequent confrontation with death may induce breaks along the care practices leading to psychological suffering of the caregivers. Methods: Both the approaches and the methodological aspects of our research, performed in two different EWHU, are clearly multidisciplinary. Approaches, Objectives, Methods: 1-Epidemiology. To characterize the clinical care and the trajectories of the deceased patients. Restropective analysis of 300 patient files. 2-Sociology. To formalize the various aspects of care. Direct observation. 3-Psychology of work. To unveil the subjective relations to the work and analyse the representations of palliative care. Group discussions. Results: The results obtained are both corrobatory and complementary. They show that, although there is no explicit palliative approach, informed palliative care giving does however exist, the goal of which being to improve the quality of the patient's life and the accompanying of the family. They also highlight some specific representations of palliative care : one is related to the care of very terminally-ill patients whereas another is linked to its non-professional content. Finally, our results lead to an increased knowledge of the causes of work-induced suffering. Conclusion: The investigation of death in EWHU, still poorly developed, may however reveal changes in the dominant medical paradigm and raise the issue of the incorporation of palliative care in EWHU

Palliative care in emergency departments: an impossible challenge?

International audienceThe aim of this study was to investigate the care practices surrounding end-of-life patients and the scope for providing palliative care in two emergency department short-stay units. Two qualitative methods of investigation were used: direct ethnographic-type observation and semi-directed group interviews. The results highlight the fact that end-of-life situations inflect the practices of care and give rise to adjustments in the organization of work. These practices operate in two registers: that of supporting the family and that of attention to the patient's comfort. We propose a typology of end-of-life patients. In conclusion, the practices, termed 'palliative care' by the caregivers, are addressed to terminally ill patients expected to die shortly. This issue should be debated within emergency departments