Autogestion de la santé et humanisme en sciences infirmières

La maladie chronique fait partie de la vie de nombreux Canadiens. Ceux-ci doivent composer avec les exigences que comporte la gestion de leurs problèmes de santé tout en pratiquant leurs activités de la vie quotidienne. Plus particulièrement, la personne qui souffre d’insuffisance rénale terminale doit s’astreindre à un régime thérapeutique exigeant à cause de la capacité limitée de l’hémodialyse à remplacer le rein. Elle doit prendre des décisions et poser des actions en lien avec son alimentation, sa médication, ses activités sociales ou familiales ainsi que sur la surveillance de son état de santé. Pour intervenir auprès de cette clientèle, nous proposons de délaisser les perspectives d’observance ou d’adhésion aux traitements ainsi que d’autogestion de la maladie chronique pour adopter une perspective d’autogestion de la santé qui est plus cohérente avec une vision humaniste des soins. Cette proposition s’appuie sur des bases philosophique, empirique et clinique, en prenant des exemples tirés des soins des personnes souffrant d’insuffisance rénale chronique terminale. Elle aura pour conséquence le mieux-être des personnes soignées et des personnes soignantes.Living with chronic illness is part of everyday life for many Canadians. They must manage their health problems while continuing their normal activities of daily living. This is especially true for individuals living with end-stage kidney disease because the therapeutic regimen is demanding due to the limited capacity of haemodialysis to replace kidney function. Those individuals must make decisions about diet, medication, family and social activities while also monitoring their health status. In order to work with this clientele, we suggest a different focus away from observance or compliance with treatment and self management of chronic illness. We propose a model of self management of health which will be more in tune with a humanistic perspective on care. This model is based on philosophical, empirical and clinical evidence drawn from care experiences with people living with chronic end-stage kidney disease. It should improve the well-being of the clientele as well as that of the caregivers, including the nurses

Conception, implantation et évaluation d’une intervention de soutien à la décision pour aider le choix d’un type de dialyse pour des personnes atteintes d’une maladie rénale chronique avancée et leur famille

Les patients qui atteignent le stade avancé de la maladie rénale chronique et leur famille éprouvent de la difficulté à faire le choix d’un type de dialyse qui conviendra le mieux à leur style de vie. Or, les infirmières ont l’opportunité d’aider le patient et sa famille en offrant du soutien à la décision. But : Concevoir, implanter et évaluer une intervention de soutien à la décision auprès des patients-familles devant faire le choix d’un type de dialyse dans le cadre du suivi en clinique de prédialyse. Méthode : Devis qualitative inspirée de la méthode d’évaluation constructiviste de Guba et Lincoln (1989) avec un déroulement en trois phases. Guidée par le modèle de soutien à la décision d’Ottawa (MSDO), la première a servi à concevoir l’intervention comprenant un outil d’aide à la décision (OAD) et du coaching décisionnel. L’OAD a été conçu à partir des résultats de 2 synthèses des écrits et d’une évaluation des besoins décisionnels qui comportait 26 entrevues semi-structurées individuelles auprès d’informateurs-clés (patients, professionnels) et un groupe de discussion (n = 5 infirmières). L’analyse des données a révélé un parcours des besoins en cinq phases commençant avec celui de cheminer vers l’acceptation d’être dialysé tout en considérant les options de dialyse. Ainsi d’autres modèles théoriques en plus du MSDO ont servi d’assises à l’élaboration de l’intervention. Cinq infirmières ont reçu la formation de base en coaching décisionnel. La seconde phase a consisté à implanter l’intervention dans le continuum des soins en prédialyse. Deux des cinq infirmières ont pu parfaire leurs compétences en coaching décisionnel, en interventions familiales systémiques et en évaluation de la perception de la maladie en bénéficiant d’un accompagnement fondé sur le modèle de coaching de Rush et al., (2003). La troisième phase a permis l’évaluation qualitative et prospective de l’expérience de l’intervention qui repose sur une construction des connaissances s’appuyant sur les perspectives de 2 infirmières et de 6 patients-familles auprès desquelles l’intervention a été appliquée. Les résultats soutiennent l’acceptabilité, l’utilité et la faisabilité de l’intervention évaluée. De plus, ils suggèrent que l’intervention a permis aux patients de prendre une décision de qualité et d’être satisfait avec le processus décisionnel et aux infirmières, de vivre une expérience valorisante. Conclusion : Cette étude vient de jeter les bases pour améliorer la qualité de la prise de décision ainsi que la provision d'interventions de soutien à la décision et pour mener un programme de recherche pour tester l’efficacité de l’intervention

Symptoms and quality of life from patients undergoing hemodialysis in Switzerland

Background: Dialysis patients experience multiple symptoms impairing their quality of life. A relationship seems to exist between the cultural context and the burden of symptoms. In this study, the prevalence and severity of 30 symptoms and their relationship with quality of life among hemodialysis patients in Switzerland is explored. Methods: A cross-sectional correlation design was used with a convenience sample of 119 patients from five dialysis units. Presence and severity of symptoms were assessed with the Dialysis Symptom Index and quality of life with the WHOQOL-Bref questionnaire. Multivariate linear regressions were used to examine the relationship between the prevalence and severity of symptoms, respectively, and quality of life. T-tests and Fisher’s tests were used for the international comparison

Guidance and/or Decision Coaching with Patient Decision Aids: Scoping Reviews to Inform the International Patient Decision Aid Standards (IPDAS)

Introduction In 2005, the International Patient Decision Aid Standards (IPDAS) collaboration identified guidance and decision coaching as important dimensions of patient decision aids (PtDAs) and developed a set of quality criteria. We sought to update definitions, theoretical rationale, and evidence for guidance and/or decision coaching used within or alongside PtDAs for the IPDAS update 2.0. Methods We conducted 2 scoping reviews on guidance and decision coaching, including systematic searches and a hand search of the Cochrane Review on PtDAs. Eligible studies were randomized controlled trials (RCTs) on guidance or decision coaching used with/alongside PtDAs. Data, including conceptual models, were summarized narratively and with meta-analyses when appropriate. Results Of 1022 citations, we found no RCTs that evaluated guidance in PtDAs. The 2013 definition for guidance was endorsed, and we made minimal changes to the description of guidance. Of 3039 citations, we identified 21 RCTs on decision coaching informed by 5 conceptual models stating that people exposed to decision coaching are more likely to progress in making informed decisions consistent with their values. Compared to usual care, decision coaching with PtDAs led to improved knowledge mean difference [MD], 19.5/100; 95% confidence interval [CI], 10.0-29.0; 5 RCTs). Compared to decision coaching alone, PtDAs led to a small improvement in knowledge (MD, 3.6/100; 95% CI, 1.0-6.3; 3 RCTs). There were variable effects on other outcomes. We simplified the decision coaching definition slightly and defined minimal decision coaching elements. Conclusion We found no evidence on which to propose changes in guidance in IPDAS. Decision coaching is continuing to be used alongside PtDAs, but there is inadequate evidence on the added effectiveness compared to PtDAs alone. The decision coaching definition was updated with minimal elements

Protective Factors of Nurses’ Mental Health and Professional Wellbeing During the COVID-19 Pandemic: A Multicenter Longitudinal Study

ObjectiveUsing a salutogenic approach, this study aimed to identify similarities in the protective factors of nurses’ psychological Quality of Life (QoL) and professional wellbeing (PWB) in four countries and to assess their variability over time during the COVID-19 pandemic.MethodsThis multicentric study used a longitudinal design with three measurements points: Autumn 2021, spring 2022, and autumn 2022. The study consisted in a self-administered online questionnaire addressed to nurses working in hospitals. Across all measurement times, 3,310 observations were collected in France, 603 in Switzerland, 458 in Portugal, and 278 in Canada. The outcomes were psychological QoL and PWB, and several potential protective factors were used as determinants.ResultsAnalyses revealed few changes over time in the outcomes. Across all countries, psychological QoL was associated positively with resilience and perceived social support, whereas PWB was associated positively with the ability to provide quality work and support from colleagues and superiors.ConclusionThe findings of this study highlighted the potential of several factors protective of nurses’ psychological QoL and PWB. These should be fostered through policies and measures to support nurses

Coaching and guidance with patient decision aids : A review of theoretical and empirical evidence

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedCoaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA designPeer reviewedFinal Published versio

Comparison of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale and Hospital Anxiety and Depression - Depression subscale scores by administration mode: An individual participant data differential item functioning meta-analysis

Administration mode of patient-reported outcome measures (PROMs) may influence responses. We assessed if Patient Health Questionnaire-9 (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale – Depression subscale (HADS-D) item responses and scores were associated with administration mode. We compared (1) self-administration versus interview-administration; within self-administration (2) research or medical setting versus private; and (3) pen-and-paper versus electronic; and within interview-administration (4) in-person versus phone. We analysed individual participant data meta-analysis datasets with item-level data for the PHQ-9 (N = 34,529), EPDS (N = 16,813), and HADS-D (N = 16,768). We used multiple indicator multiple cause models to assess differential item functioning (DIF) by administration mode. We found statistically significant DIF for most items on all measures due to large samples, but influence on total scores was negligible. In 10 comparisons conducted across the PHQ-9, EPDS, and HADS-D, Pearson's correlations and intraclass correlation coefficients between latent depression symptom scores from models that did or did not account for DIF were between 0.995 and 1.000. Total PHQ-9, EPDS, and HADS-D scores did not differ materially across administration modes. Researcher and clinicians who evaluate depression symptoms with these questionnaires can select administration methods based on patient preferences, feasibility, or cost.</p