[Obstacles, difficulties, and facilitators in setting up a research project funded by the Hospital Program for Nursing and Paramedical Research : Lessons learned from a mental health research project]

Nursing research continues to grow and become self-sustaining. It was in this context that we received funding from the Hospital Program for Nursing and Paramedical Research for our research project on schizophrenia. Schizophrenia is a mental disorder that affects 1% of the general population, and is a crippling disease both cognitively and socially. Cognitive remediation and therapeutic education are nursing practices deemed suitable for the psychosocial rehabilitation of schizophrenia patients. We hypothesized that a therapeutic education program placed upstream of cognitive remediation would have beneficial effects. We planned to include eighty patients aged eighteen to sixty, randomized into two groups, one combining cognitive remediation and therapeutic education, the second using just cognitive remediation. Each patient was assessed using a range of neuropsychological scales. Due to difficulties encountered in including and following up with participants, our statistical results could not be used. We therefore turned our focus to the factors that facilitate and hinder the setting up of a nursing research project. We organized these factors into three areas : those related to the nurse ; those related to the care facility and the organization ; and those related to the research. The results were consistent with the literature and show how important it is to encourage nurses to be more involved in a scientific approach.

["The care programme should be a clearly explained proposal to which the patient freely consents"]

Claude Finkelstein, president of the Fédération nationale des associations d'usagers en psychiatrie, has drawn up an inventory of care programmes, nine years after their establishment. In particular, she highlights the experience of patients and their familes regarding this system. The pitfalls concern the systematic search for the healthcare proxy and some application methods in the follow-up. Prospects for improvement should be discussed to give value to the interest of such programmes for the subjects.

["It will be important to avoid a rift opening up between nurses and advanced practice nurses"]

After a long process of negotiation, laws passed in 2018 mean that advanced practice has finally become a reality for nurses in French legislation. Benefits are expected for patients, doctors, caregivers, management, organisations and for the health system. However, it will be necessary to take into account certain limits, and practices are expected to evolve. This change highlights the evolution of nursing practices thanks to Evidence-Based Nursing. An interview with Christophe Debout, member of the advanced practice network training committee of the International Council of Nurses.

[A short history of clinical nursing in psychiatry]

The history and evolution of nursing practice in psychiatry provide us with some insights regarding the training needs of today's nurses. The care relationship, the central focus of practice, has been constructed as treatments have advanced and care has become more humanised. Nurses have been able to forge their professional identity on the basis of the "clinical nursing science, psychiatry and human sciences" triptych. The implementation of advanced practice, which essentially involves the delegation of medical acts, must not overshadow the need to develop nurses' specialisation in the clinical field in order to respond to patients' suffering.

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Advanced nursing practice in psychiatry is a major challenge for the discipline. It must meet the needs of the population as well as conform to national policies and tackle the problems within the mental health and psychiatric sector. For a long time, psychiatric nurses have developed their practices on the basis of precise indications and health policies. Advanced practice will not be able to replace these existing situations.

[Training caregivers to improve violence prevention and response]

Confronted with the phenomena of violence, hospital managers are putting in place continuing training sessions addressing the theme of prevention. These so-called 'violent' situations are generally triggered by patients or by their family. The analyses carried out subsequently enable the different mechanisms, notably institutional, which might have contributed to the emergence of these situations, to be identified.

["For us, as 'patients/users', the essential point remains the respect of the person"]

The first organisation to bring together the users of care in the history of the speciality, the French National Federation of Patient Associations in Psychiatry has always campaigned for the respect of users' freedom of movement. Despite the progress made in terms of legislation, the federation presents a mixed picture. For Claude Filkenstein, its president, there remains a long way to go, notably in the field of the culture of psychiatric care. In her opinion, training should be a major advantage.

[Therapeutic restraint and freedom of movement, changing practices]

From confinement to the philosophy of care in the community, the history of psychiatry testifies to the evolution of practices in the matter of the restriction of freedom. The French National Health Authority still too often recommends practices based on restraint. Caregivers, in relation to the clinical aspect of the patients, need clearly identified therapeutic projects. While training can be vital for them, risk management policies can prove to be a hindrance to patients' freedom.

[A step-by-step recovery]

A patient retraces her care pathway with authenticity and emotion. While her memories of her time in hospital are still raw, her path towards recovery was built on constructive stages and encounters, from one structure to another, towards refound freedom. An interview with Marie-Paule Chanel.

["The family should be prepared to play a role"]

With the onset of mental illness, families become disorientated. Lack of information, misunderstanding and poor clinical orientation are all challenges faced. The families must be, wherever possible, linked to health care, decisions and projects. Interview with Hervé Mignotte, volunteer at the National Union of families and friends of ill and / or mentally handicapped patients (UNAFAM).

[Supporting family carers in psychiatry]

The families of patients with psychiatric disorders are often ill-informed of the consequences of the condition of their loved one. The therapeutic alliance between the family and caregiving team enables the patient to derive the maximum possible benefit from remaining longer at home.

[Management, a containment tool]

Healthcare managers, in partnership with a doctor, are responsible for the care project, the coherence of the care activities and the cohesion of the team. Their managerial role means they need to be receptive to and contain the feelings of the team, as well as take an active part in the psychological containment approach used with the patient.

[The onset of illness: "it will blow over"]

The onset of the illness of a friend or family member does not always present strong clinical signs such as acute and transient psychotic disorder. It is sometimes insidious. For families, this period is punctuated with fears and hopes. Delusional disorders turn familiar reference points on their head and although the first contact with the universe of the psychiatric hospital remains painful, the institution can be reassuring for families. This article presents a moving testimony of a parent and member of the French National Union of the Friends and Families of Mental Health Patients (UNAFAM).

[Suffering, pain and care]

While psychic pain is linked to melancholy, to the loss of an object, psychological suffering indicates difficult affective phenomena, which are not necessarily connected to a personality structure or to a particular pathology, but which can be explained by the very nature of our humanity.

[Psychiatric nursing training and experience: a mutual structure]

Since the beginning of the 20th century, four generations of study curriculums for psychiatric nurses have been implemented successively. Since 1992, the proportion of training dedicated to psychiatry has been steadily decreasing and is likely to lead to a risk of insufficiency as regards the psychiatric practice of future nurses. A master specialization would appear to be necessary.