L’apport de l’observation in situ pour décrire les interventions infirmières d’habilitation à l’autoprise en charge de sa santé dans le secteur des soins à domicile

L’utilisation de l’observation in situ a servi à décrire les interventions infirmières d’habilitation à l’autoprise en charge de sa santé, dans le cadre d’une recherche doctorale ayant un devis ethnométhodologique. Cet article traite de l’utilisation de cette stratégie de recherche qui a permis de décrire pas moins de soixante interventions d’habilitation grâce à l’observation de 30 visites à domicile d’infirmières du Programme Extra-Mural du Nouveau-Brunswick. Les aspects méthodologiques liés à cette recherche sont d’abord présentés. Ensuite, les résultats saillants sont abordés et discutés à la lumière de la contribution de l’observation pour décrire la nature multidimensionnelle de l’intervention, en plus de raffiner les connaissances sur les indicateurs et les fonctions de ces interventions. Enfin, il est suggéré que l’observation est une stratégie de recherche pertinente et non-intrusive ayant le potentiel de contribuer aux développements des connaissances sur l’intervention d’habilitation infirmière.An in situ observation technique was used to describe nursing interventions that enabled people to take greater responsibility for their own health as part of a doctoral research project with an ethnomethodological design. This article outlines the use of this research strategy that elicited the description of at least 60 enabling interventions through the observation of 30 home visits by nurses from the New Brunswick Extra-Mural Program. A review of the methodological aspects of this research is presented. Some of the salient results are also presented and discussed in light of the contributions of this observational technique to describe the multidimensional nature of enabling interventions and as a means to discover some of their indicators and functions. It is argued that an observational technique is a pertinent and a non-intrusive research strategy that can contribute to a growing body of knowledge of nurses’ enabling interventions

Conceptions et attitudes des parents d’adolescents par rapport au suicide

Devant la réaction des parents surpris du geste suicidaire posé par leur adolescent, nous avons été amenées à questionner 380 parents d'adolescents et à constater le réalisme de leurs conceptions à ce sujet. Nous avons noté des divergences d'opinions entre les pères et les mères chez les sujets ayant vécu différentes situations reliées au suicide et chez ceux ayant reçu de l'information en matière de suicide. Ces différents points de vue concernent le caractère impulsif du geste, l'âge des suicidaires, la possibilité d'intervenir et le niveau d'acceptabilité du suicide. Cette étude souligne aussi l'importance d'implanter des programmes de prévention dépassant le simple niveau de l'information.In the context of parents reacting with surprise to the suicidal tendencies of their teenage child, the authors prepared a questionnaire for 380 parents of adolescents to gauge the realism of their perceptions on the topic. The authors noted differences of opinion between fathers and mothers among parents who have experienced a variety of situations related to suicide and others who have received information on the matter. These differing points of view concern the impulsive nature of the gesture, the age of the suicidal person, the opportunity to intervene and the level of acceptance of suicide. In addition, this study underscores the importance of implementing prevention programs that go beyond the simple distribution of information

Do quality of life, participation and environment of older adults differ according to level of activity?

<p>Abstract</p> <p>Background</p> <p>Activity limitation is one of the most frequent geriatric clinical syndromes that have significant individual and societal impacts. People living with activity limitations might have fewer opportunities to be satisfied with life or experience happiness, which can have a negative effect on their quality of life. Participation and environment are also important modifiable variables that influence community living and are targeted by health interventions. However, little is known about how quality of life, participation and environment differ according to activity level. This study examines if quality of life, participation (level and satisfaction) and perceived quality of the environment (facilitators or obstacles in the physical or social environment) of community-dwelling older adults differ according to level of activity.</p> <p>Methods</p> <p>A cross-sectional design was used with a convenience sample of 156 older adults (mean age = 73.7; 76.9% women), living at home and having good cognitive functions, recruited according to three levels of activity limitations (none, slight to moderate and moderate to severe). Quality of life was estimated with the Quality of Life Index, participation with the Assessment of Life Habits and environment with the Measure of the Quality of the Environment. Analysis of variance (ANOVA) or Welch F-ratio indicated if the main variables differed according to activity level.</p> <p>Results</p> <p>Quality of life and satisfaction with participation were greater with a higher activity level (p < 0.001). However, these differences were clinically significant only between participants without activity limitations and those with moderate to severe activity limitations. When activity level was more limited, participation level was further restricted (p < 0.001) and the physical environment was perceived as having more obstacles (p < 0.001). No differences were observed for facilitators in the physical and social environment or for obstacles in the social environment.</p> <p>Conclusion</p> <p>This study suggests that older adults' participation level and obstacles in the physical environment differ according to level of activity. Quality of life and satisfaction with participation also differ but only when activity level is sufficiently disrupted. The study suggests the importance of looking beyond activity when helping older adults live in the community.</p

Integrated obesity care management system -implementation and research protocol

<p>Abstract</p> <p>Background</p> <p>Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals.</p> <p>Methods</p> <p>We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified.</p> <p>Conclusion</p> <p>This project is relevant to health system's decision-makers who are confronted with an important increase in the prevalence of obesity. It is therefore critical to develop strategies allowing the management of obesity in the 1^stline setting. Results of this research project could therefore influence health care organization in the field of obesity but also eventually for other chronic diseases.</p

The process of recovery of people with mental illness: The perspectives of patients, family members and care providers: Part 1

<p>Abstract</p> <p>Background</p> <p>It is a qualitative design study that examines points of divergence and convergence in the perspectives on recovery of 36 participants or 12 triads. Each triad comprising a patient, a family member/friend, a care provider and documents the procedural, analytic of triangulating perspectives as a means of understanding the recovery process which is illustrated by four case studies. Variations are considered as they relate to individual characteristics, type of participant (patient, family, member/friend and care provider), and mental illness. This paper which is part of a larger study and is based on a qualitative research design documents the process of recovery of people with mental illness: Developing a Model of Recovery in Mental Health: A middle range theory.</p> <p><b>Methods</b></p> <p>Data were collected in field notes through semi-structured interviews based on three interview guides (one for patients, one for family members/friends, and one for caregivers). Cross analysis and triangulation methods were used to analyse the areas of convergence and divergence on the recovery process of all triads.</p> <p>Results</p> <p>In general, with the 36 participants united in 12 triads, two themes emerge from the cross-analysis process or triangulation of data sources (12 triads analysis in 12 cases studies). Two themes emerge from the analysis process of the content of 36 interviews with participants: (1) <it>Revealing dynamic context</it>, situating patients in their dynamic context; and (2) <it>Relationship issues in a recovery process</it>, furthering our understanding of such issues. We provide four case studies examples (among 12 cases studies) to illustrate the variations in the way recovery is perceived, interpreted and expressed in relation to the different contexts of interaction.</p> <p>Conclusion</p> <p>The perspectives of the three participants (patients, family members/friends and care providers) suggest that recovery depends on constructing meaning around mental illness experiences and that the process is based on each person's dynamic context (e.g., social network, relationship), life experiences and other social determinants (e.g., symptoms, environment). The findings of this study add to existing knowledge about the determinants of the recovery of persons suffering with a mental illness and significant other utilizing public mental health services in Montreal, Canada.</p

Correlation entre le niveau du développement de l'égo et le niveau de compréhension empathique chez des étudiantes infirmières de niveau collégial III

Cette recherche avait pour objet d'étudier la relation entre le niveau du développement de l'ego et le niveau de compréhension empathique chez des étudiantes infirmières en troisième année de formation collégiale. Le niveau du développement de l'ego fut évalué selon la théorie de Loevinger (1966, 1970, 1980) à partir du Washington University Sentence Completion Test (W.U.S.C.T.). Le niveau de compréhension empathique fut obtenu à l'aide du Scale for Assessment of Interpersonal Functioning (S.A.I.F.) plus particulièrement la partie Empathic Understanding in Interpersonal Process (E.U.I.P.) construit par Truax et Carkhuff (1967) et corrigé par Carkhuff (1969)

Correlation entre le niveau du développement de l'égo et le niveau de compréhension empathique chez des étudiantes infirmières de niveau collégial III

Cette recherche avait pour objet d'étudier la relation entre le niveau du développement de l'ego et le niveau de compréhension empathique chez des étudiantes infirmières en troisième année de formation collégiale. Le niveau du développement de l'ego fut évalué selon la théorie de Loevinger (1966, 1970, 1980) à partir du Washington University Sentence Completion Test (W.U.S.C.T.). Le niveau de compréhension empathique fut obtenu à l'aide du Scale for Assessment of Interpersonal Functioning (S.A.I.F.) plus particulièrement la partie Empathic Understanding in Interpersonal Process (E.U.I.P.) construit par Truax et Carkhuff (1967) et corrigé par Carkhuff (1969)

La théorisation enracinée dans l’étude de la transition des perceptions de l’état de santé de femmes atteintes d’un cancer du sein

Être diagnostiquée d’un cancer du sein entraîne un changement important dans l’état de santé d’une personne provoquant un processus interne, soit une transition entre les perceptions de santé et de maladie. Ce processus interne reflète un processus social. La méthodologie de la théorisation enracinée permet de mettre en lumière ce processus. Le but de la présente étude est de proposer une modélisation de la transition des perceptions de l’état de santé de femmes diagnostiquées de ce cancer. Ainsi, 32 femmes, à divers moments dans la trajectoire de la maladie, ont été rencontrées lors d’une entrevue individuelle semi-dirigée. Les résultats illustrent que les perceptions de l’état de santé se modulent tout au long de la trajectoire de la maladie. La santé devient plus précieuse et le cancer surmontable. Les femmes redéfinissent leur état de santé en ne se déclarant pas malades du cancer du sein et en apprenant à vivre avec une épée de Damoclès au-dessus de leur tête