Evaluer les difficultés, les besoins et les ressources chez les patients souffrant de psychiques. Une approche centrée sur le rétablissement

Dans un contexte de psychiatrie sociale et communautaire, le suivi des patients est complexe. Il nécessite des traitements psychosociaux, multimodaux et pluridisciplinaires. Face à cette complexité, le besoin d’une évaluation facilitant un meilleur pilotage de la clinique est prépondérant. Dans cette perspective, les difficultés, les besoins et les ressources apparaissent comme des éléments clés à identifier. Ce type d’évaluation favorise la mise en place d’un traitement clinique adapté, efficace et centré sur le patient. D’une part, l’objectif de cette thèse est de répondre à des questionnements cliniques sur le type de besoins et de difficultés présents au sein d’une population de patients souffrant de troubles psychiques en utilisant ELADEB, un outil d’auto-évaluation des difficultés et des besoins. D’autre part, l’objectif de ce travail est de développer et valider un nouvel outil d’auto- évaluation des ressources, AERES. Deux études ont permis d’augmenter les connaissances sur le type de besoins présents chez les patients, de même que les différences en termes d’importance des difficultés et d’urgence des besoins en fonction de la psychopathologie présente. Les outils standardisés mesurant les ressources et adaptés aux spécificités des patients souffrant de troubles psychiques sont extrêmement rares et peu utilisés dans la pratique clinique. C’est pourquoi, un nouvel outil, AERES, a été développé, puis validé afin de permettre l’identification des ressources internes et externes des patients. Trois études ont permis, premièrement, de tester la faisabilité de cet outil au sein d’une population de patients souffrant de troubles psychiques sévères ; deuxièmement, d’évaluer qualitativement la perception des patients face à ce nouvel outil ; troisièmement, de valider ses propriétés psychométriques, d’identifier les profils de ressources existants chez les patients et d’explorer l’impact d’une telle évaluation. Une introduction générale inscrit les dimensions des difficultés, besoins et ressources dans le modèle théorique vulnérabilité-stress-ressources. Une discussion finale met en évidence les apports, limites et perspectives futures pour ces deux outils d’auto-évaluation. -- In the context of social and community psychiatry, patient care is complex. It requires psychosocial and multidisciplinary treatments. Therefore, the necessity of an investigation allowing a better steering of clinical treatments is essential. In this perspective, the patient’s difficulties, needs and strengths appear to be key components to identify in order to facilitate adapted, efficient and patient-centered clinical treatments. The objective of this thesis is to answer clinical questions regarding the type of needs and difficulties present within a population of patients suffering from psychiatric disorders using a difficulties and needs self-assessment tool, ELADEB. It is also to develop and validate a new strengths Q-sort self-assessment scale, the SQSS. Two studies increased our knowledge regarding the type of patient needs, as well as the differences in terms of the importance of difficulties and urgency of needs depending on their psychopathology. Standardized strengths tools adapted to the specificities of patients suffering from severe psychiatric disorders are rare and not routinely used in mental health services. Therefore, a new strengths assessment, the SQSS, has been developed and validated in order to measure patients’ internal and external strengths. Three studies allowed, firstly, to test the feasibility of this new tool within a population of patients suffering from severe psychiatric disorders; secondly, to evaluate the patients’ perception regarding this new tool; thirdly, to validate the psychometric properties, to identify psychiatric patients’ strengths profiles and to explore the impact of such an evaluation. A general introduction integrates the dimensions of difficulties, needs and strengths in the theoretical vulnerability-stress-ressources model. A final discussion highlights the contributions, limitations and future perspectives for these two self-assessment scales

A comparative descriptive analysis of perceived quality of caring attitudes and behaviours between haemodialysis patients and their nurses

Despite its importance in nursing, perceived quality of the nurse-patient relationship has seldom been researched. This study sought to examine and compare the quality of caring attitudes and behaviours as perceived by haemodialysis patients and their nurses. Design This comparative descriptive study involved 140 haemodialysis patients and 101 nurses caring for them in ten haemodialysis units in the French-speaking part of Switzerland. Methods Participants completed a sociodemographic questionnaire and the Caring Nurse-Patient Interaction Scale (CNPI-70). Results Both nurses and patients reported a high frequency of caring attitudes and behaviours. Patients gave higher ratings than nurses did on all the caring dimensions, except spirituality. Implications are discussed

Evolving from Clinical to Positive Psychology: Understanding and Measuring Patients' Strengths: A Pilot Study

Empirical evidence suggests that concentrating on patients' internal and external strengths serves a preventative function against psychopathology. However, standardized tools assessing strengths of patients suffering from mental disorders are rare and often limited to research purposes. As current practice in mental health rarely stresses the importance of patients' personal resources, the feasibility of strengths-based assessments has rarely been validated within such a population. We designed a new instrument, the Strengths Q-sort Self-Assessment Scale, aimed at identifying patients' strengths profile. This new scale measures 30 strengths classified in three sections: (i) personal characteristics, (ii) hobbies/passions, (iii) environmental/social strengths. In order to be adjusted for patients with cognitive or language impairments, this instrument is based on a Q-Sort method with figurative items. The aim of this study was to test the feasibility and acceptability of this scale in a sample of 21 psychiatric patients. Preliminary results showed that this tool can easily be administered and is well appreciated by patients. Feedback from clinicians highlight the benefits of identifying the strengths profiles in order to help defining realistic shared clinical objectives based on patients' strengths

Assessing resources in a population of hemodialysis patients ::a new approach to improve quality of care

Hemodialysis patients constitute a vulnerable population. Their health needs are considerable and they often present psychological symptoms such as depression and anxiety. Empirical studies have demonstrated the efficacy of positive psychology interventions to enhance the well-being of patients and alleviate their depressive symptoms. One such intervention consists in identifying and mobilizing patient resources to activate their recovery. An intervention of the sort was implemented in Switzerland with hemodialysis nurses using AERES, a novel self-assessment instrument. AERES covers 31 domains under three dimensions: personal characteristics/qualities, hobbies/passions, and social/environmental resources. The aim of this qualitative study was to explore hemodialysis nurse perceptions of the use of this instrument. Sixteen hemodialysis nurses were recruited in six hospitals in French-speaking Switzerland and interviewed after delivering the intervention. A consensual qualitative research method was used to analyze the data. Results showed that the resources instrument was easy to administer and beneficial to patients and health professionals. Patient wellbeing became the top priority for the nurses and new interventions centered on patient resources were undertaken. Quality of patient care was improved. Nurses perceived this positive psychology instrument as a means of creating a positive relationship with patients and supporting them emotionally. Assessing the resources of this vulnerable population can provide health professionals with a powerful tool to understand patient intact resources, which can be used to alleviate symptoms and foster wellbeing

Evaluer les ressources des patients

Dans le contexte du rétablissement, l’évaluation clinique doit, en parallèle du diagnostic et du repérage des troubles, rechercher les ressources et les forces du patient. L’outil AERES (Auto-évaluation des ressources) a été conçu pour les mettre en évidence via un jeu de cartes. Cette intervention s’inscrit dans un changement de perspective, qui considère le patient comme un partenaire libre et responsabl

Transformation of clinical nursing practice following a caring-based educational intervention ::A qualitative perspective

INTRODUCTION: Hemodialysis (HD) patients experience numerous physical and psychological symptoms on a daily basis. These symptoms have a heavy impact on their quality of life, which is a key indicator of their survival in the short term. Numerous empirical studies have shown that the quality of the nurse-patient relationship (NPR) is essential in promoting positive outcomes for patients. When patients receive caring, their autonomy and independence grows, their sense of hope increases, their quality of life improves, and their sense of satisfaction with nursing care received rises. Inversely, the presence of dehumanizing practices in hemodialysis settings can contribute to delay healing for patients. In light of the importance of the quality of the relationship between nurses and HD patients and of the benefits to be had from a quality relationship, an educational intervention based on Watson's Theory of Human Caring was delivered to HD nurses. OBJECTIVE: The purpose of this study was to explore qualitatively the perceptions of nurses working with HD patients in French-speaking Switzerland regarding changes to their clinical practice after receiving an educational intervention intended to reinforce caring attitudes and behaviors towards patients. METHODS: The method used was that of consensual qualitative research (CQR). Sixteen semi-structured interviews were conducted with hemodialysis nurses post-intervention. RESULTS: The results evidence a transformation of clinical nursing practice illustrated by three core ideas: (1) caring practice was reinforced; (2) new practices emerged; and (3) some limitations appeared. CONCLUSION: In these times of global pandemic where the issue of the humanization of nursing care is front and center, this professional development activity helped reinforce caring-based practice. This practice needs to be developed within the various care units in order to guarantee and promote quality of care and patient safety