Notes

A clear case of longitudinally substantial transversus myelitis following vaccine towards Covid-19.
The presentation of this dossier is an opportunity to highlight the extent to which digital technology was used during the health crisis. This very important use of digital technology during the crisis has allowed access and continuity of care for many people. Nevertheless, the particular context of the crisis and the fact that it benefits particularly vulnerable people must make us particularly attentive to the ethical and legal issues of the use of these technologies. The question of evaluation is therefore essential. In this perspective, it seems that clinical and organizational ethics offers an interesting evaluation modality, in particular, of the use of telehealth. The various articles in the dossier highlight a number of important issues to be taken into consideration for the future.In the context of end of life, palliative care offers support for the patient and his family, from a global perspective. This means paying attention to pain and difficult symptoms, but also to psychological, social and spiritual issues. Some situations confront healthcare teams with the difficulty of providing support to the end of life, not only in terms of relieving pain and suffering, but also when communication is impaired or even impossible. This is particularly the case with sedative practices. These situations involve providing comprehensive support by different evaluations of the patient’s pain and discomfort. This is therefore carried out by hetero-evaluation, by following observational pain assessment scales. Monitoring devices, such as ANI, usually used in anesthesia services, are experimented, for clinical purposes but also for research. In this article, we propose to analyze a clinical situation in which the use of ANI raised a whole series of questions about the use of the technical approach in palliative medicine and its integration into a care team. We will question some issues, in context, on the use of techniques and technologies in palliative medicine.Introduction At least one preoperative shower is recommended to avoid surgical site infection. Caregivers must explain the showering technique, help the patient if necessary, and assess skin cleanliness after showering.Context Showering may be more difficult for obese patients because of inadequate equipment and difficulties moving, as well as insufficient explanation regarding the showering technique and an insufficient skin cleanliness assessment from caregivers.Objective to assess whether patients and/or caregivers report difficulties in the preoperative shower process that could be linked to patient obesity. Methods pilot qualitative survey with semi-structured interviews conducted with 9 obese surgery patients and 11 surgery caregivers.Results Patients did not report feelings of discrimination. They described no problem with equipment, but declared having received little explanation on the showering technique and no visual skin cleanliness assessment. Caregivers reported equipment as inadequate, they stated having delivered detailed information, but found the skin cleanliness assessment difficult.Discussion The lack of skin cleanliness assessment by caregivers after preoperative showering is new information. Limits preliminary study with a small number of interviews and no non-obese patients.Conclusion the subject warrants additional work with both quantitative and qualitative surveys to better understand the difficulties with preoperative showering.Introduction Sickle cell disease, while it is the most common genetic disease in France, is little known to caregivers and the general public.Context Only a few studies have examined the daily lives of people suffering from this disease.Objectives The purpose of this project was to describe the specific strategies helping adult patients to manage the symptoms of their disease.Method To reach this objective, a qualitative study was conducted among eight homozygous (SS) people over 30 years old living in the Ile-de-France region of France. The semi-structured interviews took place at the patients' homes, selected from several regional competence centers and on social media. An inductive methodology and a thematic analysis were used to draw the conclusions of this research.Results They show that pain and suffering are patients' main complaints. Patients suffering from sickle cell disease seek numerous effective self-care strategies to manage their long-term pain preventive measures and drugs, as well as complementary and alternative medicine.Discussion A sociological approach shows us the considerable work that patients undertake to manage symptoms daily.Conclusion The findings support interventions that would increase the feeling of control over the disease through better self-awareness and appropriate physical activity.In the contemporary debate between advocates of nursing ethics and those who consider that nursing ethics is indistinguishable from medical ethics, virtue ethics allows us to identify elements that could be characterized as specific to nursing ethics. The aim of this study is to show that the specific ethical purpose of the nurse's relationship with the patient is the empowerment and strengthening of the patient's virtues. Nursing ethics draws its specificity not from the therapeutic or care relationship that the nurse - like other healthcare personnel - establishes with the patient, but from the helping relationship that the nurse maintains with the patient. This helping relationship involves professional virtues specific to nursing that are in correlation with the patient's virtues. Such a relationship is characterized by its discursiveness, with the aim of supporting and advising the patient, and includes an important pedagogical dimension.Context Quebec's "medical aid in dying" (MAID) is a medical intervention mostly practiced in palliative care units. MAID results from a deep revolution within Quebec's ethics regarding end-of-life care. However, there is a lack of empirical studies regarding nursing practice within the context of MAID.Aim To conduct a literature review of legal and scientific data, as well as data from the media, related to the patient experience of nursing practices in palliative care for patients in Quebec who have requested MAID.Methodology Burn, Grove, and Sutherland's methodology allowed us to extract and analyze six empirical studies from the CINAHL database. We also analyzed 17 media articles and one legal paper that documents the legalization of MAID in Quebec.Results There has been a strict law governing MAID since 2015, but some major social events and issues have recently allowed for the expansion of the practice. The literature review allowed us to identify two themes 1). the nature of nursing practice within MAID, and 2). the need for nursing education that addresses the complex aspects of MAID.Discussion and conclusion We discuss the effects of the domination of the biomedical narrative on MAID and the collapse of Quebec's health system, which both negatively impact nursing practice in the context of MAID.Introduction Life expectancy in psychiatric patients is reduced by 15 to 20 years due to the presence of comorbidities and the lifestyle of these patients. Metabolic syndrome, also a side effect of antipsychotic drugs, is an aggravating factor of this phenomenon, which is why health promotion is essential. The objective of this study is to describe the knowledge, attitudes, and practices of psychiatric nurses with regard to metabolic syndrome, using N. Pender's health promotion model as a framework.Methodology A multicenter descriptive study using a « knowledge, attitude, practice » survey was conducted in 16 psychiatric departments in the Ile-de-France region. 70 nurses were interviewed via online questionnaires.Results The results show partial knowledge. A gap exists between attitudes and nursing practices. The nurses' actions mainly involve counseling. The type of nursing knowledge is discussed, as well as the need for reflection on the nurse-patient relationship. BTK assay Nursing interventions need to be further developed to better manage metabolic syndrome.Conclusion Training is needed to carry out preventive measures and promote health more effectively.Patient autonomy is an equivocal notion that refers to several intertwined figures. What is expected of young cystic fibrosis patients when speaking to actors (professionals and associations) involved with them ? In this sociological contribution, we show the limits of a medical model of autonomy that does not allow us to think about a whole series of micro-adjustments to the practices of people with cystic fibrosis. The analysis is based on publications by national associations fighting against cystic fibrosis, and on semi-structured interviews with professionals working with people living with this disease. It shows that autonomy is not only thought of by the professionals who support them in terms of an individual management model centered on the patient's medical skills and personal resources, but also as the result of environmental factors. It reveals an innovative characteristic of autonomy in the field of health care, largely supported by the specialized and reinforced medical support of coordinating nurses. This support allows the development of a detailed clinical knowledge of the situations experienced by their patients.Introduction A child's hospitalization can be a difficult experience for many parents and can disrupt parenting. However, parenthood in relation to this care context is little studied.Objectives The purpose of this study is to describe the experience of parents in their relationship to the care setting and the social adjustment of children.Method A sequential mixed-methods survey was conducted, involving 94 parents with children aged between 17 and 48 months after a hospital stay in three regions of Quebec. After completing the questionnaire, 16 participated in semi-structured interviews.Results 1) The mothers' perceived stressors, related to care as well as the child's behavior, are associated with maternal cognitions and behaviors two months after a hospital stay.2) The parents' relationship to the care setting and the child's adaptation highlights four relational processes continuous, difficult, ambivalent, and complex.Discussion The care context influences the parent's ability to assume their role two months after a hospital stay.Conclusion It is important to offer nursing to parents that takes into account the psychological dimension of parenthood and the social adaptation of children to the care context.Context Nurses are regularly confronted with suicidal people. Their involvement is essential in the detection and prevention of suicide risk.Objectives Through a literature review, we wanted to highlight the role of the advanced practice nurse by conducting specific training to improve nursing skills in the management of people with suicidal thoughts.Method Our literature review was carried out according to the PRISMA recommendation criteria from several databases.Results The review showed an improvement in confidence, attitudes, and nursing skills in assessing suicide risk. However, no long-term change in practice was demonstrated.Discussion In France, a national training program on suicide risk prevention is implemented at the regional level by the Regional Health Agencies. At the same time, since 2019, Psychiatry and Mental Health has been part of the training program for advanced practice nurses.Conclusion The advanced practice nurse is a central player in supporting teams in increasing their skills, particularly when conducting specific training.
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