Enjeux relationnels et limites d’application des directives anticipées : étude qualitative exploratoire auprès de médecins

International audienceIn view of the development of advance directives (AD) in France since 2016, the aim of our study was to take a look at the knowledge of this measure, what it represents and how the doctors integrate it. We carried out a qualitative monocentric study by means of exploratory interviews with doctors (n = 12). An analysis of thematic content was made from these interviews. Analysis of the content of these conversations revealed limited knowledge of ADs, reservations regarding the role of doctors in this respect and a number of perceived limitations with regard to their implementation (complexity of end-of-life situations ; impact on care relationships ; psychological repercussions ; uncertainty ; “changing” nature of ADs ; the culture of care services). Psychosocial limits explain in part the reservation concerning this document and play a part in the hesitation about its “legitimacy” or “utility”. The challenge of developing the understanding of ADs must take into account the psychosocial conditions of its acceptability and its integration into care practices and relations.Dans le contexte du développement des directives anticipées (DA) en France depuis 2016, notre étude avait pour objectif d’étudier les connaissances, représentations et modalités d’intégration de ce dispositif auprès de médecins. Nous avons conduit une recherche qualitative monocentrique par entretiens de recherche auprès de médecins (n = 12). Une analyse de contenu thématique a été réalisée sur l’ensemble des entretiens. L’analyse de contenu des entretiens a mis en évidence une connaissance relative des DA, des réserves quant au rôle des médecins par rapport à ce dispositif et un ensemble de limites perçues concernant leur mise en œuvre (complexité des situations de fin de vie ; impact sur la relation de soin ; répercussion psychologique ; incertitude ; caractère « changeant » des DA ; culture des services de soins). Des limites d’ordre psychosocial expliquent en partie les réticences concernant ce dispositif et contribuent à une mise en question de sa « légitimité » ou « utilité ». L’enjeu du développement des connaissances sur les DA doit s’accompagner d’une réflexion sur les conditions psychosociales de son acceptabilité et de son intégration dans les pratiques et la relation soignantes

Liver Trauma in the Kitchen: Preparing Whipped Cream with a Siphon Is Not without Risk

We report the case of a 36-year-old woman suffering from liver injury caused by the malfunction of a whipped cream siphon. When this patient handled the whipped cream siphon, the screwed metallic upper part of the siphon was suddenly dissociated from its base and came violently striking her right hypochondrium. At first, the severity of injury was underestimated. Subsequently, due to the persistence of pain experienced by the patient, an abdominal CT scan was performed. It highlighted a severe liver injury with rupture of a branch of the hepatic artery. The evolution was favorable after completion of an embolization and a secondary capsular rupture

Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries

International audienceOver the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown

Assessing physicians’ and nurses’ experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments

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Complicated grief after death of a relative in the intensive care unit

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