L'expérience de l'accouchement en milieu surveillé dans la province d'Essaouira au Maroc: Quelle réalité?

RésuméUne expérience positive de l'accouchement (EPA) est fondamentale pour des soins maternels de qualité. Toutefois, de nombreuses femmes subissent des comportements non respectueux lors de ce moment crucial. Au Maroc, peu d'études ont mesuré cette expérience, et les éléments l'influençant demeurent insuffisamment documentés. Nous avons conduit une recherche mixte dans la province d'Essaouira entre avril et décembre 2021. Notre enquête, basée sur un questionnaire, a sollicité l'avis de 240 femmes issues de huit centres de santé choisis au hasard. Par ailleurs, des entretiens semi-directifs ont été conduits avec 20 femmes, 47 professionnels de santé et quatre responsables administratifs. Les données quantitatives ont été soumises à des analyses descriptives, bi- et multivariées, tandis que les entretiens ont été analysés selon une approche de contenu thématique. Les données révèlent que 59.2% des participantes ont eu une expérience défavorable lors de leur dernier accouchement. Parmi elles, la majorité a déploré des soins non consentis (86.7%), un manque de respect de leur intimité (45.4%) et des abus verbaux (25%). L'EPA était principalement associée à la qualité de l'environnement de l'accouchement, au soutien pour l'allaitement, à la propreté des installations, au type d'établissement (privé) et à l'absence de complications médicales pendant le travail. Les entretiens ont révélé que le manque de motivation des professionnels de santé, l'absence de formation continue appropriée et des lacunes organisationnelles et managériales ont affecté l'EPA. Notre étude souligne le besoin crucial de formation continue axée sur le respect des patients, l'éthique et la déontologie, et met en lumière l'importance d'une politique motivante pour les professionnels de santé, notamment dans le secteur public.

From ethical approval to an ethics of care: Considerations for the inclusion of older adults in ethnographic research from the perspective of a 'humanisation of care framework'.

A deeper understanding of care demands the methodological finesse of qualitative research: we must observe, listen, and witness to expose what matters to care recipients. In this paper, we - a team of three: one early-career researcher and two supervisors - reflect on our experiences of designing and then seeking ethics approval for ethnographic research on care for older adults, many of whom demonstrate a lack of capacity to consent to research. Viewing experiences of well-being and dignity as embedded within interpersonal negotiations, this study privileges care home residents' daily life, looking to stories and observations of daily life to reveal the complexities of well-being in the care home setting. This paper emphasizes the importance of using qualitative research methods to gain a deeper understanding of care practices, particularly in the context of care for older adults with varying cognitive capacities. By privileging the daily life experiences of care home residents and employing the logic of process consent, we aim to include the voices of all participants, not just those who can provide written informed consent. However, obtaining ethics approval for this type of research presents several challenges, requiring careful negotiation and the inclusion of consultee advice. This paper highlights the tensions between procedural ethics and the need for better inclusion of vulnerable populations in ethnographic research on care. By addressing these challenges, we can move towards a more context-sensitive and humanised approach to research ethics that values the lived experiences of care recipients.

Leisure Programmes in Hospitalised People: A Systematic Review.

Nurses carry out holistic assessments of patients during hospital admission. This assessment includes the need for leisure and recreation. Different intervention programmes have been developed to meet this need. The aim of this study was to investigate hospital leisure intervention programmes described in the literature in order to determine their effects on patient health and highlight the strengths and weaknesses of the programmes as reported by health professionals. A systematic review of articles in English or Spanish published between 2016 and 2022 was carried out. A search was performed in the following databases: CINAHL COMPLETE, PubMed, Cochrane Library and Dialnet and the Virtual Health Library and Web of Science resources. A total of 327 articles were obtained, of which 18 were included in the review. The methodological quality of the articles was assessed using the PRISMA, CASPe and STROBE scales. A total of six hospital-based leisure programmes were identified, including a total of 14 leisure interventions. The activities developed in most of the interventions effectively reduced the levels of anxiety, stress, fear and pain in patients. They also improved factors such as mood, humour, communication, wellbeing, satisfaction and hospital adaptation. Among the main barriers to implementing hospital leisure activities is the need for more training, time and adequate spaces for them develop. Health professionals consider it beneficial for the patient to develop leisure interventions in the hospital.

Humanizar os cuidados: norma de orientação clínica para uma unidade de cuidados intensivos / Humanising care: clinical guidelines for an intensive care unit

O presente relatório enquadra-se no âmbito do curso de Mestrado em Enfermagem à Pessoa em Situação Crítica, na Unidade Curricular de Estágio e Relatório Final ou Dissertação de Natureza Aplicada II. Cimentado por uma componente teórica, um dos objetivos deste relatório é descrever e refletir as atividades e intervenções desenvolvidas durante a evolução do estágio, analisando de forma crítico-reflexiva os saberes desenvolvidos na prática clínica bem como as competências adquiridas enquanto futura enfermeira especialista em enfermagem médico-cirúrgica. A realização do estágio numa Unidade de Cuidados Intensivos Polivalente (UCIP), bem como o desenvolvimento de um trabalho de projeto fundamentado pela metodologia de projeto suportaram o desenvolvimento destas competências. Neste enquadramento, o desenvolvimento de competências em contexto de estágio numa UCIP centrou-se nos domínios da prestação de cuidados, da formação, da gestão e da investigação, em concordância com as competências do enfermeiro especialista em enfermagem médico-cirúrgica. No domínio da prestação de cuidados à pessoa em situação crítica e família pudemos integrar competências técnicas, científicas, humanas e relacionais, sustentadas numa base ética. Os estudos de casos clínicos, as pesquisas de literatura científica e o debate com os profissionais do serviço, proporcionaram o desenvolvimento de estratégias face aos problemas encontrados. Sustentámos a sua organização e documentação através do Processo de Enfermagem. No domínio da formação estivemos envolvidas em diversas atividades que considerámos terem contribuído para a melhoria do desempenho profissional e para a uniformização dos cuidados. Paralelamente, permitiram uma atualização sistemática e o aperfeiçoamento dos conhecimentos e capacidades, imposta pelos avanços constantes da ciência e da tecnologia. No domínio da gestão, a utilização eficiente dos recursos existentes, com o fim de alcançar a máxima qualidade com o menor consumo de recursos, foi primordial na prestação de cuidados. Das atividades que desenvolvemos neste domínio destacamos a colaboração na gestão dos recursos humanos e materiais, gestão do risco clínico e, perante situações complexas, a aplicação dos feixes de intervenção da prevenção da infeção. No domínio da investigação, o ambiente criado numa Unidade de Cuidados Intensivos (UCI) aliado ao elevado desenvolvimento tecnológico em que as ações são sustentadas nos seus princípios põe em tese a prática do cuidado humano e, portanto, da temática da humanização dos cuidados. Esta, é uma situação complexa, vivenciada pelos enfermeiros da UCIP onde estagiámos, que expressaram sentir uma necessidade de transformação no sentido da melhoria dos cuidados de enfermagem que prestam. Assim, tivemos como objetivo: desenvolver uma Norma de Orientação Clínica (NOC) centrada na humanização de cuidados numa Unidade de Cuidados Intensivos, assente na metodologia de projeto. Pretendemos com esta NOC sensibilizar os enfermeiros para uma prática de cuidados centrados nas necessidades da pessoa em situação crítica e sua família e, deste modo, permitir uma postura ativa de forma a prestar cuidados mais humanizados, holísticos e eticamente sensíveis a fim de promover a saúde e o bem-estar da pessoa em situação crítica e família, tendo em conta as suas reais e potenciais necessidades. A elaboração deste relatório permitiu-nos evidenciar, analisar e refletir as aprendizagens adquiridas através da exposição das atividades realizadas para a consecução dos objetivos previamente traçados. Concluído este percurso, considerámos que foram desenvolvidas as competências do enfermeiro especialista e acreditámos, no futuro, sermos capazes de prestar cuidados especializados na área de enfermagem médico-cirúrgica, assente numa prática humanizadora, refletida e baseada na evidência científica.

This report falls within the scope of the Master´s Degree in Nursing for People in Critical Situation, in the Internship Curricular Unit and Final Report or Dissertation of an Applied Nature II. Cemented by theorical component, one of the goals of this report is to describe and reflect about the activities and interventions developed during the evolution of the Internship Curricular Unit, analysing in a critical-reflexive way the knowledge developed in the clinical practice as well as the skills acquired as future specialist nurse in medical-surgical nursing. The accomplishment if the internship in a Multipurpose Intensive Care Unit (MICU), as well as the development of a project based on the Project Methodology, supported the development of these skills. In this context, the development of skills in the context of an internship at the MICU focused on the domains of care, training, management and research, in accordance with the skills of the specialist nurse in medical-surgical nursing. In the sphere of providing care to people in critical situations and family, we were able to integrate technical, scientific, human and relational skills, supported on an ethical basis. Clinical cases studies, the research of scientific literature and debate with the professionals from the department, provided the development of strategies for the problems found. We supported its organisation and documentation through the Nursing Process. In the area of training, we have been involved in several activities, which we considered that have contributed to the improvement of professional performance and the standardization of care. Parallelly, they allowed a systematic update and improvement of knowledge and skills, imposed by constant advances in science and technology. In the management field, the efficient use of the existing resources, in order to achieve maximum quality with the lowest consumption of resources, was primordial in the provision of care. From the all activities developed in this domain, we highlight the collaboration in the management of human and material resources, clinical risk management and, face to complex situations, the application of infection prevention intervention bundles. In the domain of research, the environment created in an Intensive Care Unit (ICU) combined with the high technology development in which the actions are based on its principles, underlines the practice of human care and therefore the theme of humanisation of care. This is a complex situation, experienced by ICU professionals, who expressed to feel a need for transformation in order to improve the care they provide. Thus, we had as goal: develop a Clinical Guidance Standard (CGS) focused on the humanisation of care in an Intensive Care Unit, according to the project work methodology, based on the assumptions of the AGREE II Instrument. With that, we intend to sensitise nurses to a care practice, focused on the needs of the critical person and their family and, therefore, allow an active posture in order to provide more humanised, holistic and ethically sensitive care, to promote, autonomously and independently, the health and well-being of the person in critical situation condition and their family, taking in account their real and potential needs. The elaboration of this document allowed us to emphasise, analyse and reflect the knowledge acquired through the exposure of the activities carried out to achieve the objectives previously set. We believe that the skills of the specialist nurse were developed, and we consider, in the future, to be able to provide specialised care in the medical-surgical nursing area, based on a humanising and reflected practice and based on scientific evidence.