Analysis of communication and logistic processes in neonatal intensive care unit

BACKGROUND

In neonatology, parents play a central role as guarantors of the new-born's autonomy. Notifying parents about their infant's status in neonatal critical care is an integral part of the care. However, conveying this information can be very difficult for physicians and the neonatal medical team. The objective of this work is to assess the dimensions and dynamic processes of critical care communications in neonatal intensive care in order to enhance the development of theoretical and applied knowledge of these discussions.

METHODS

This qualitative, descriptive study was conducted on critical care new-borns less than 28 days-old who were hospitalized in a neonatal intensive care unit. Verbatim communications with the parents were recorded using a dictaphone.

RESULTS

The verbatim information had five themes: (a) critical care, (b) establishing the doctor-patient relationship, (c) assistance in decision making, (d) Socio-affective and (e) socio-symbolic dimensions. Our recordings underscored both the necessity of communication skills and the obligation to communicate effectively. Analysis of the dynamics of the communication process, according to the categories of delivering difficult information, showed few significant differences.

CONCLUSION

Physician training needs to include how to effectively communicate to parents to optimize their participation and cooperation in managing their care.

Assessment of illness representations in mental disorders: A mini review

Health beliefs, and especially illness representations, have been widely used to understand clinical outcomes and psychosocial adjustment in people with physical diseases. However, this area of research has been under-explored in the field of mental health, and the few studies that have been conducted have used very different methods. Therefore, the aim of our study was to identify the tools and methods that have been used to evaluate illness representations in psychiatry. To this end, a mini review has been conducted and 58 articles were retained. This mini review highlights that the quantitative method is the most used, and that the scales mobilised are often adapted for the study, but not validated. Indeed, multiple modifications and adaptations have been made by the authors (e.g. deletion of subscales, addition of items), which lead to questions about the reliability of what is measured. In the future, it is essential to have a validated generic tool for mental disorders, which could be based on the Illness perceptions questionnaire for schizophrenia.

Spirituality and Cancer: a Qualitative Study

Aims: Patients suffering from cancer are often confronted with an awareness of their own finiteness and with the fact that their life is now ruled by the cancer. This existential upheaval can be accompanied by spiritual “work” which contributes to the adjustment to the disease and to the conditions of the end of life. Spirituality can be defined as a process through which individuals seek for and give meaning to their life, feel connected to the self, to others, at the present moment and in what is sacred. Few studies in France have studied spirituality in the context of cancer. So, the aim of our research was to identify and to study the role of spiritual components in the experience of cancer.

Procedure: We carried out 15 semi-directed interviews with patients at the medical oncology and palliative care department at the CHU in Timone (Marseille). A double analysis was performed: 1) a lexicographical analysis and 2) a thematic content analysis of the most typical interviews from the lexicographical analysis.

Results: The lexicographical analysis highlighted three lexical classes. Class 1 represented the illness of cancer as a personal transformation (40.5%), Class 2 concerned the biographical disruption experience (13.4%) and Class 3 corresponded to daily life with the illness (46.1%). Moreover, the thematic content analysis revealed different themes testifying to spirituality in the lived experience of cancer, in particular the experience of and the relationship with the sacred, the relationship with transcendence and the role of spirituality in the lived experience of patients who are suffering from cancer.

Conclusion: The two analyses of the interviews allowed us to identify the expression of spirituality. Spirituality was expressed as a resource, an “invisible spring,” allowing people to adjust to the extreme experience of the disease of cancer. Both “secular” and “central” dimensions of spirituality: the transcendence and the relationship with the sacred open perspectives for the integration of spirituality into the care of patients suffering from cancer, without threatening the principle of secularism in French hospitals.

Identifying binge-eating disorders in obese young people living in vulnerable areas of Marseille

Background

While anxiety, depression and self-esteem have been identified as contributors to obesity, binge-eating disorder (BED) also requires attention to avoid worsening obesity. However, handling obese young people living in vulnerable neighbourhoods is rather difficult both in terms of psychosocial representations of obesity and the poor care offer. The objective of our exploratory research is to study the impact of a dedicated multidisciplinary management program on anxiety and depression of obese young adolescents presenting with, or not, a binge-eating disorder.

Methods

Twelve patients (7 girls, 5 boys; mean age: 12.8 +/-1.3 years, range: 11-17) participated so far in this ongoing study. The mean body mass index was 36.5 +/- 7.2 (range: 27-53.4) for the group. They were all residents of vulnerable neighbourhoods of Marseille (France). They were evaluated at inclusion and 3 months after the 6-weeks program with the following self-questionnaires: Adolescent Binge Eating Disorder scale (ADO-BEDS), Hospital Anxiety Depression (HAD), 6-item Kutcher Adolescent Depression Scale (KADS-6), Self-esteem Measurement Scale for Adolescent (EMESA).

Results

So far, only 3 patients were evaluated pre- and post-management. For two patients with ADO-BEDS scores at inclusion and post-management showing the presence of a BED, the KADS-6 and EMESA (general and physical appearance items) scores improved at 3 months. The remaining patient, without any depression signs at both inclusion and after 3 months, experienced a decreased self-esteem while a BED, not assessed at inclusion, was clearly revealed at 3 months. BMI did not change from pre- to post-management.

Conclusions

Our clinical impression is that participating to the management program failed, at least for our first patients, to make them engage in a psychiatric/psychological therapy. Nevertheless, the program contributed to provide a motivating support system allowing them and their parents to become involved in their care.

Key messages

A multidisciplinary management program could potentially have a beneficial impact on depression and self-esteem in obese young adolescents presenting with a binge-eating disorder. The management program seemed to provide a motivating support system allowing obese young adolescents living in vulnerable neighbourhoods, and their parents, to become involved in their care.

[Practice of trauma and emergency units in delivering care to youth who attempt suicide--experiences from Provence]

Suicide attempts (SA) represent a significant public health problem and raise questions wih respect to the best, most appropriate methods for triage and the delivery of care. A prospective investigation to evaluate the quality of SA health care was carried out over a three month period within 18 hospitals having an emergency care unit. A total of 393 youth having attempted suicide were triaged and treated by these establishments during the period of the survey, with a large majority of them being girls (77%). Medicinal intoxication was the most often used method (85.1%). The criteria and regulations relating to the initial health care provided upon the patient's arrival were most followed, contrary to those concerning hospitalisation modalities and preparation for release following treatment. Factors explaining the implementation of these criteria were related to the type of emergency unit, the presence of a mental disorder and the duration of the patient's hospitalisation. These results show that several aspects of health care provided to young suicide attempters should be improved in Provence.

[Study of the social representations of drugs and cannabis: motivation for prevention]

Drugs and cannabis are two complex, multifaceted social objects. Two exploratory research projects were conducted from semi-directive interviews (n = 50) and questionnaires (n = 300) in order to investigate the social representations contained in these two objects according to both the social characteristics of individuals (gender, age) and their proximity to cannabis (consumption versus non-consumption). The study of their representations allows for emphasis to be placed upon the socio-cognitive reconstruction that individuals maneuver, reconstruction largely influenced by the social insertion of individuals but also by their method of cannabis consumption. Knowledge of these representations seems to be a tool for understanding the often complex realities linked to the world of drugs and allows for reflection upon more adapted prevention methods.