Psychologue en équipe mobile de soins palliatifs, nous intervenons en pluridisciplinarité en intrahospitalier mais aussiauprès de structures relevant du sanitaire et du social. Nous avons pu constater que les professionnels du handicap ont un lien d'attachement particulier à leurs résidents. L'accompagnement des résidents dans le quotidien et les projets de vie inhérents aux institutions sont le signe d'un transfert et d'un contre-transfert massifs. Dans ce contexte, penser l'éventualité de la mort des résidents est marqué du sceau du refoulement. Le fantasme d'immortalité - "ça n'arrive qu'aux autres" - est présent, ce qui peut empêcher la parole à ce sujet et susciter des angoisses primitives.
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Au-delà des difficultés et exigences inhérentes à la clinique hospitalière lourde, la réanimation implique "un autre monde" propre à l'humain réanimé. Elle convoque une disposition d'esprit, une information relative aux enjeux, conditions, effets et nécessités d'une réalité interne, d'un vécu, impensable pour autrui, paradoxal parce qu'aux antipodes des apparences et du fonctionnement psychique normal, opaque et méconnu même des professionnels, soignants et réanimateurs qui la côtoient au quotidien.
La Loi du 2 février 2016 reconnaît au patient le droit de bénéficier d'une Sédation Profonde et Continue Maintenue Jusqu'au Décès (SPCMJD) associée à une analgésie. Il s'agit de qualifier les signes de souffrance vécus comme insupportables chez une personne gravement malade, dont le pronostic vital est engagé à très court terme. Si la loi promulgue ce droit, nos expériences cliniques démontrent de l'ampleur des difficultés à appréhender ce soin, notamment lorsqu'il s'agit de qualifier le caractère insupportable de la souffrance et de faire face à des subjectivités multiples. Ce sujet amène à un nécessaire recul et à des pratiques réflexives élaborées pour éclairer l'ensemble des partenaires dans l'application de la loi.
Le conflit psychique se manifeste lorsque des exigences internes contraires s'opposent comme celles des pulsions de vie et des pulsions de mort. Les soins palliatifs, tissés de contradictions, de forces qui s'affrontent et d'ambivalences multiples, ne peuvent échapper au conflit. Si leur nécessité n'est plus à démontrer, la confrontation à la détresse que la déchéance, le sentiment d'indignité et l'approche de la mort génèrent reste profondément problématique.
This paper argues that existing English and Welsh mental health legislation (The Mental Health Act 1983 (MHA)) should be changed to make provision for advance decision-making (ADM) within statute and makes detailed recommendations as to what should constitute this statutory provision. The recommendations seek to enable a culture change in relation to written statements made with capacity such that they are developed within mental health services and involve joint working on mental health requests as well as potential refusals. In formulating our recommendations, we consider the historical background of ADM, similarities and differences between physical and mental health, a taxonomy of ADM, the evidence base for mental health ADM, the ethics of ADM, the necessity for statutory ADM and the possibility of capacity based ‘fusion’ law on ADM. It is argued that the introduction of mental health ADM into the MHA will provide clarity within what has become a confusing area and will enable and promote the development and realisation of ADM as a form of self-determination. The paper originated as a report commissioned by, and submitted to, the UK Government's 2018 Independent Review of the Mental Health Act 1983.
Background: Since Belgium legalised euthanasia, the number of performed euthanasia cases for psychological suffering in psychiatric patients has significantly increased, as well as the number of media reports on controversial cases. This has prompted several healthcare organisations and committees to develop policies on the management of these requests.
Method: Five recent initiatives that offer guidance on euthanasia requests by psychiatric patients in Flanders were analysed: the protocol of Ghent University Hospital and advisory texts of the Flemish Federation of Psychiatry, the Brothers of Charity, the Belgian Advisory Committee on Bioethics, and Zorgnet-Icuro. These were examined via critical point-by-point reflection, focusing on all legal due care criteria in order to identify: 1) proposed measures to operationalise the evaluation of the legal criteria; 2) suggestions of additional safeguards going beyond these criteria; and 3) remaining fields of tension.
Results: The initiatives are well in keeping with the legal requirements but are often more stringent. Additional safeguards that are formulated include the need for at least two positive advices from at least two psychiatrists; an a priori evaluation system; and a two-track approach, focusing simultaneously on the assessment of the patient's euthanasia request and on that person's continuing treatment. Although the initiatives are similar in intent, some differences in approach were found, reflecting different ethical stances towards euthanasia and an emphasis on practical clinical assessment versus broad ethical reflection.
Conclusions: All initiatives offer useful guidance for the management of euthanasia requests by psychiatric patients. By providing information on, and proper operationalisations of, the legal due care criteria, these initiatives are important instruments to prevent potential abuses. Apart from the additional safeguards suggested, the importance of a decision-making policy that includes many actors (e.g. the patient's relatives and other care providers) and of good aftercare for the bereaved are rightly stressed. Shortcomings of the initiatives relate to the aftercare of patients whose euthanasia request is rejected, and to uncertainty regarding the way in which attending physicians should manage negative or conflicting advices, or patients' suicide threats in case of refusal. Given the scarcity of data on how thoroughly and uniformly requests are handled in practice, it is unclear to what extent the recommendations made in these guidelines are currently being implemented.
BACKGROUND: Cancer patients who have reached the terminal stage despite attempts at treatment are likely to experience various problems, particularly as they encounter increasing difficulty in doing what they were able to do easily, and their physical symptoms increase as the disease advances. The purpose of this study is to explore how terminal cancer patients who have not clearly expressed a depressed mood or intense grief manage their feelings associated with anxiety and depression.
METHODS: Eleven terminally ill patients with cancer who were receiving symptom-relieving treatment at home or in palliative care units were interviewed. Interviews were generally conducted weekly, two to five times for each participant. In total, 33 interviews were conducted, and the overall interview time was 2027 min. Data were analyzed via qualitative methods.
RESULTS: The following five themes were extracted regarding the experience of managing feelings associated with anxiety and depression when facing death: "I have to accept that I have developed cancer," "I have to accept the undeniable approach of my own death," "I have to accept my need for assistance," "I have to accept this unsatisfactory circumstance" and "I have to accept this as my destiny and an outcome of my life."
CONCLUSION: The present study revealed key themes related to how patients come to terms with their impending death. Nurses are required to comprehend the patients' complicated mental patterns that are expressed in their daily languages. Furthermore, the findings clarify the necessity for nurses to help patients understand the acceptance of a terminal disease state during a patient's final days.
C'est à dessein que nous employons ce terme si imprécis de "douleurs chroniques diffuses", tandis que le lecteur ou soignant informé pensera immédiatement "fibromyalgie".
Little is known about the strengths of parents caring for their child who is receiving hospice/palliative care in Kenya. The purposes of this study were (1) to identify the sources of strength parent caregivers of Kenya turn to when their child is receiving palliative/hospice care in the home, (2) to assess if new strengths emerge with this population in comparison to previous studies, and (3) to assess if the Strengths Guide (SG) is an intervention that improves the parents’ awareness of their value and utilization of their strengths. This descriptive study explored how these parents define strength and specifically where they find strength to carry on. A constant comparative analysis was used to identify the sources of strength. Before and after administering the SG, a “pre and post” Personal Strengths Scale was utilized to rate any differences in the parent’s strength. Participants were located through a rural hospice in Western Kenya. No new themes were identified when compared with previous studies. The source of spirituality was unanimously identified as the most extremely important strength and overwhelmingly threaded throughout nearly the 10 other sources of strength identified. The SG was found to be a welcomed and effective intervention for nurses to use with this population.
BACKGROUND: Although caregiver burden may continue to influence the mental health of cancer patients' caregivers long after bereavement few studies have examined this issue.
METHODS: A systematic review was conducted to provide a summary of (1) operationalizations of caregiver burden used in this field and (2) the effect of caregiver burden on post-bereavement mental health of adult caregivers of cancer patients. A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted across empirical studies published in a peer-reviewed journal up until April 2017.
RESULTS: Caregiver burden was rarely defined and it was operationalized in multiple and diverging ways. The 20 included papers present varying results but generally indicate that caregiver burden (especially emotional) has an adverse effect on post-bereavement mental health.
CONCLUSIONS: In future studies, researchers seeking to ascertain which aspects of caregiver burden may prove an appropriate target for prevention and intervention should first employ a precise operational definition of the concept.
No research drawing from Self-Determination Theory has investigated the bereavement experience of individuals or how motivation can help facilitate posttraumatic growth (PTG) following the death of a loved one. In two cross-sectional studies, university students completed an online survey. Study 1 investigated the contribution of global autonomous and controlled motivation in statistically predicting PTG above and beyond previously researched correlates. Study 2 explored the mediating role of cognitive appraisals and coping in explaining the relationship between global motivation orientations and PTG. Results indicated that in comparison to controlled motivation, autonomous motivation was positively related PTG, even after controlling for previously researched correlates. Mediation results indicated an indirect effect of global autonomous motivation on PTG through task-oriented coping. Collectively, these findings suggest the importance of incorporating motivation into models of PTG. Clinical implications of these findings are also discussed.
Twenty-three nonclinical relatives of long-term missing persons were interviewed. Patterns of functioning over time were studied retrospectively by instructing participants to draw a graph that best described their pattern. Patterns most frequently drawn were a recovery and resilient/stable pattern. Participants were also asked to select 5 out of 15 cards referring to coping strategies, which they considered most helpful in dealing with the disappearance. Acceptance, emotional social support, mental disengagement, and venting emotions were most frequently chosen. This study provided some indication of coping strategies that could be strengthened in treatment for those in need of support.
Objectives: Patients with cancer experience a lot of emotional, mental, social, and spiritual crises. However, not much has been done to meet these needs. The aim of this study was to evaluate the influence of spiritual group therapy on hope and the mental and spiritual health of patients with colorectal cancer.
Design and methods: This quasi-experimental study was carried out in 2013 in Kerman, Iran, on 80 colorectal cancer patients, who fulfilled the eligibility criteria. After the pre-test of both groups, eight sessions of 1.5 h were held once a week for spiritual group therapy, and finally both groups underwent the post-test. To collect data, Snyder’s hope scale, the Paloutzian–Ellison 20-item spiritual health questionnaire, and the Goldberg Health Questionnaire were used. The data were analysed using the SPSS statistical software version 16.Results: Comparing the mean scores of hope, mental health, and spiritual health before and after the intervention showed a significant difference (P < 0.001) in the test group. In the control group, no significant difference was found before and after the study. This indicates the benefits of the spiritual group therapy in cancer patients.
Conclusion: The study results show that spiritual group therapy has a significant positive impact on the mental and spiritual health of patients with colorectal cancer, and that it also gives them hope. Thus, the use of spiritual therapy is suggested as a good way to improve the spiritual and mental health and hope in patients with colorectal cancer.
S'approprier son corps, faire sienne sa maladie, garder le lien avec sa vie : c'est tout l'enjeu lorsqu'en raison d'une maladie grave le corps perd de sa familiarité, lorsqu'il se manifeste dans son étrangeté, lorsque les médecins et les soignants finissent par mieux le connaître et le soigner que nous-mêmes ou nos proches. Comment, dans ces conditions, rester soi-même ? Comment regagner sa souveraineté subjective et narcissique ? La réponse à ces questions exige d'étudier les processus psychiques à l'oeuvre dans la maladie grave, et en particulier ceux qui relancent la subjectivité. Ce travail d'appropriation signifie, pour le patient, de subvertir les éprouvés provoqués par la maladie et les traitements, afin de reconstruire un corps sensoriel et libidinal auquel il pourra de nouveau s'identifier. C'est grâce à cette "subversion libidinale" qu'il parviendra à raconter ce corps, cette maladie, ces traitements, de sorte qu'ils prennent un sens dans sa vie et dans son histoire.
Origine : BDSP. Notice produite par EHESP CpErmR0x. Diffusion soumise à autorisation
Cet article reprend quelques extraits de l'un des chapitres du livre "La mort ne s'affronte pas" de Jérôme Alric et Jean-Pierre Benezech. Il traite de comment concilier information du patient et respect de son psychisme ainsi que du déni.
Le cancer a un impact sur l'économie psychique du sujet. Dans ce contexte, il arrive que les mots manquent. Comment la fonction contenante d'une position psychique intervient-elle pour redonner au patient une permanence du sentiment d'exister et des capacités de symbolisation ? Quelle est la place du travail d'équipe ? Réponses à travers l'analyse d'une situation clinique relevant de soins palliatifs. (Intro.).
Origine : BDSP. Notice produite par APHPDOC Ip79R0xp. Diffusion soumise à autorisation
L'auteure, psychothérapeute, aborde l'ensemble des questions que se pose la personne face à la maladie et à la mort, questions qui la fragilisent et l'amènent à se réorganiser psychiquement.
Les auteures abordent la question suivante : pourquoi le processus de deuil menace-t-il parfois si profondément notre équilibre psychique. A l'aide de l'analyse transactionnelle et de l'oeuvre de Wilma Bucci, les auteures examinent les manières de travailler avec une personne en deuil ainsi que l'utilité d'adopter un point de vue contemporain sur le travail du deuil. Elle traite aussi de la nature homéostatique du scénario dans la théorie de l'analyse transactionnelle.
Les personnes vivant avec une maladie grave, potentiellement mortelle, sont confrontées brutalement à l’angoisse de mort, et plus précisément à l’angoisse du temps du mourir ; le temps devient comme un objet contenant, accueillant dans son creux le vide de la mort. À partir d’une situation clinique et en s’appuyant sur un éclairage sociologique et philosophique, les auteurs tentent de comprendre comment il est possible chez une patiente de faire du temps un mécanisme de défense la protégeant de l’angoisse de mort.
[Adapté résumé auteur]
Cet article décrit l'expérience d'une infirmière et du professionnel de soins spirituels qui l'a aidé à identifier le parallèle entre la situation de sa patiente et sa propre situation ainsi que la croissance spirituelle et émotionnelle qui a émergé tant au niveau personnel que professionnel.