[The experience of being diagnosed with type 2 diabetes in primary care]. / Le vécu de l'annonce d'un diabète de type 2 en soins primaires.

The announcement of diabetes can be an ordeal for the person learning about it, and a difficult time for the doctor notifying them. By setting up a multi-professional team, we can offer personalized nursing support. This meets patients' expectations. These include reassurance, sufficient time to obtain answers to their questions, the ability to plan ahead, and the understanding that they have a say in their own health.

Preparing Adults with Cerebral Palsy to Move from Assisted to Independent Living.

Background. To evaluate effectiveness of The Greenhouse for autonomy and independence to prepare adults with severe cerebral palsy (CP) for the transition from assisted to independent living. The intervention combines weekly individual sessions using Pathways and Resources for Engagement and Participation together with weekly group sessions. Method. Seven adults with severe CP ages 23-45 years (M = 35; SD = 10) participated in the 20-week program. An Interrupted Time Series quasi-experimental design was used, assessing the intervention effect over time. The Canadian Occupational Performance Measure was administered bi-weekly from baseline to post-intervention to assess activity performance. Functional Independence Measure (FIM), Wheelchair use Confidence scale (WheelCon) and Impact on Participation and Autonomy (IPA) were administered baseline (4 weeks pre-intervention), mid and post-intervention, using Freidman test. Interviews were conducted four weeks after intervention. Findings. All participants' activity performance improved over time with significant clinical improvement in 95% of COPM goals. Significant improvement was seen in FIM (χ2 = 8.07, p = .018) and WheelCon (χ2 = 7.18, p = .028) though not in IPA. Participants described being better prepared, however more aware of challenges. Conclusion. The findings suggest the program may be effective to help adults with severe CP attain goals related to independent living and enhance function.

[Palliative care and care for the elderly: Worlds to be reconciled around an ethic of vulnerability]. / Soins palliatifs et soins au grand âge : des univers à réconcilier autour d'une éthique de la vulnérabilité.

The ageing of Western societies is leading to a marked increase in mortality. Death and old age are now intertwined. This situation should be of particular concern to palliative care. But in reality, palliative care remains too inaccessible to the oldest sections of the population. Why this paradox? After reviewing the clinical and organisational reasons that are often given, we invite you to take a more global look, one that is both sociological and ethical.

[Design of information tools on technical aids for front-line professionals working with people losing their autonomy]. / Conception de supports d'information sur les aides techniques pour les professionnels travaillant auprès de personnes en perte d'autonomie.

The use of technical aids has a positive impact on the autonomy and quality of life of elderly or disabled people, and is also beneficial for the caregivers and professionals who support them. Nevertheless, there are still major obstacles to their use, notably a general lack of information on technical aids. This observation led us to produce a set of information tools to help people better understand these aids and how to use them.

[The role of occupational therapy in Parkinson's disease]. / La place de l'ergothérapie dans la maladie de Parkinson.

Occupational therapy works with Parkinson's sufferers and their caregivers to help them maintain or resume their activities of daily living and their independence, by recommending environmental adaptations, technical aids, compensation strategies and functional training.

[Ethical stakes of psychosocial rehabilitation]. / Les enjeux éthiques de la réhabilitation psychosociale.

Psychosocial rehabilitation (PSR) is a therapeutic approach which aims to improve the overall functioning of people with severe mental disorders. We detail the principles of bioethics applied to care and seek to demonstrate how PSR meets the requirements of a humanistic psychiatry. The four fundamental principles of the ethics of care - autonomy, beneficence, non-maleficence and justice - are found in the practice of PSR. The practice and implementation of PSR is strongly encouraged in universal codes of ethics.

[In Makemo, a nurse in a remote island setting]. / À Makemo, une infirmière en milieu insulaire isolé.

A nurse graduating in 2018, Noémie's guiding principle has always been her desire to discover IDE practice outside our borders. To this end, once she had her diploma in hand, and in parallel with her nursing practice in her native Isère region, she enriched her knowledge by taking a university diploma (DU) in "international solidarity action in humanitarian health". When she obtained her diploma, she decided to settle in French Polynesia, a French territory at the end of the world. Here, she shares her experiences as a nurse in an isolated island environment, highlighting the added value of this experience.

[Restraint in child psychiatry]. / La contention en pédopsychiatrie.

In child psychiatry, there are significant ethical challenges when patients put themselves at risk or refuse to cooperate in their care. This article illustrates two situations of violence and restraints and looks at how the vulnerability of caregivers can be acknowledged in order to find the best balance between the imperatives of protection and the respect of young inpatients in child psychiatry.

[Restraint in intensive care: between patient safety and respect for autonomy]. / Contention en réanimation : entre sécurité du patient et respect de son autonomie.

The use of physical restraint in the context of medical resuscitation is relatively frequent. Although temporary or prolonged physical restraint is justified by patient safety (possibility of self-extubation, etc.), this practice is itself a source of risk, leads to suffering on the part of the patient, and raises dilemmas and ethical questions within teams. Inherent to the working conditions and training of professionals, restraint must nevertheless be balanced and lead to the search for alternatives.

[What place for ethics in psychiatry?] / Quelle place pour l'éthique en psychiatrie ?

At a time when healthcare establishments are facing sensitive financial and institutional challenges, how can ethics be given a place in psychiatry? In society, ethical debates focus on surrogate motherhood, active euthanasia or assisted suicide, and embryo research. In psychiatry, the question often crystallizes around violent incidents that are hardly representative of the daily lives of professionals and patients. Militant discourse prevails over listening to the people concerned. The law requires establishments to reflect on the ethical issues raised by the reception and medical care of patients, without specifying the boundaries. Ethics in healthcare facilities focuses on care situations - what is possible or desirable - with no single theoretical model to serve as an example to follow.

[Autonomy and medical aid in dying: the place of psychiatry]. / Autonomie revendiquée et aide médicale à mourir, la place de la psychiatrie.

Autonomy has become the highest value in our society, and while it is having an impact on the debate on a future law on medical assistance in dying, it is also opening the door to a reflection on vulnerability. Although seemingly unaffected, at least initially, psychiatry could join the field of this reflection and bring out the avenues of renewal.

[Growing up with an EBH, an example of pediatric-adult transition in the field of rare diseases]. / Grandir avec une EBH, un exemple de transition pédiatrie-service d'adultes dans le domaine des maladies rares.

The transition from pediatrics to adult wards concerns all chronic diseases with a pediatric onset, but there are a number of specific features in the case of severe forms of hereditary epidermolysis bullosa: worsening wound surface and chronicity with age, appearance or increase in certain complications (carcinological, renal, nutritional, dental), sometimes difficult therapeutic choices, sometimes life-threatening prognosis. But one of the major problems limiting the patient's autonomy is the difficulty of finding a paramedic to take over skin care, often provided from birth by a parent who has become a caregiver through necessity.

[Sophrology, an experience of corporality for student nurses]. / La sophrologie, une expérience de la corporalité des étudiants infirmiers.

The body approach is a real challenge in nursing training. It is part of the relationship between the caregiver and the cared-for. Through their bodies, students experience all their sensations and perceptions. Questioning nursing students through the phenomenological approach of sophrology means enabling them to achieve body-mind harmonization, a fundamental pillar of this mind-body technique. The regular practice of sophrology teaches them to act autonomously on themselves, developing their personal resources for a better body-mind and/or mind-body well-being.

[Ballistic injury, decaying wounds: the nurse at the heart of the long rehabilitation process]. / Lésion balistique, plaies délabrantes : l'infirmier au cœur du long parcours de réhabilitation.

Ballistic injuries are disabling. Its functional impact is determined by its trajectory. Whether the injury affects a limb that could jeopardize its preservation, visceral lesions or craniocerebral and vertebro-medullary wounds, the nurse is at the heart of multidisciplinary care to limit and compensate for the after-effects. Directed healing, appropriate analgesia, settling in, technical training for this new, modified body (stoma, self-catheterization, appliances, etc.) and support in accepting the injury are all part of the nurse's role in helping the injured person rebuild his or her life.

[The benefits of home visits for patients on home hemodialysis]. / Intérêt des visites à domicile pour les patients traités par hémodialyse à domicile.

The success of home hemodialysis depends on several criteria. On the one hand, the patient's willingness to be autonomous, his or her degree of understanding, the technical feasibility at home, and the presence of a third party. Secondly, the quality of initial training (which must respect the patient's rhythm) and follow-up at home. This is a true patient-caregiver partnership, based on trust. Home visits are part of this approach, and help maintain the link, as a team at Caen University Hospital can testify.

[Human rights and transgender surgery]. / Droits de la personne humaine et chirurgie de la transidentité.

René Sève recalls that Contemporary Law in the Western World is based on autonomy of equal subjects, mutually recognizing the right to each carry out their own life project. The LGBTQIA+ person therefore exercises their ability to be their own species, according to Kirkegaard's word. It remains that "life project" also implies a constraint of stability and rationality. The author then shows, using Canadian and French statistical data, the difficulties of achieving this ideal for minors and, for adults, the other medical, paramedical and social conditions required. The rights of LGBT people cannot be considered independently of the physical and financial limits of the health system and therefore of the public debate on its priorities.

Advance Care Planning in Spain.

In the last decade in Spain, an important push has been given to the development of health policies that define the framework of action in the care of people with advanced chronic diseases. Respect for the autonomy of the patient, shared decision-making processes and advance care planning (ACP) are recognized into health plans as a key aspect in chronic care, frailty, and palliative care. A few but significant number of institutions, local governments, and healthcare professionals from different regions of Spain have started a rationale and roadmap for a new twist in Spain's theoretical, ethical and policy development, promoting ACP implementation into public health care systems. In 2020, a working group founded in 2017, evolved into the "Spanish Association of Shared Care Planning" (AEPCA). The Shared Care Planning (SCP) concept grows up after the two international consensus Delphi studies in 2017 and pretends to shift from the framework of ACP programs to a person-centred care approach. In the last years, several experiences show how professionals are more sensible and interested on the ACP process, but it cannot be said, for now, that it has taken effect in the global Spanish health system. Even both ACP and SCP are being used simultaneously in Spain, each day more people and autonomous communities embrace renewed concept and foundations of SCP, supporting the work of AEPCA on spreading the value of this process into the care of people who are coping with chronic diseases, vulnerability, and frailty.

Real-world experience implementing Advance Care Planning in the Asia-Pacific: ACP in Japan.

Promoting Advance Care Planning (ACP) in the super-aged society of Japan has become increasingly important for supporting older adults to continue to live in the community until the end of life. To promote ACP further in Japan, Japanese family-centered decision-making and high-context culture need to be taken into account. Therefore, we describe the environmental and historical backgrounds surrounding ACP in Japan, and based on the results, introduce research and education programs regarding its implementation.

[Measuring the impact of a multimodal intervention on falls and the fear of falling]. / Mesure de l'impact d'une intervention multimodale sur les chutes et la peur de chuter.

Falls are common among the elderly, and can have serious consequences: fracture, hospitalization, loss of independence, institutionalization and death. However, falls are not inevitable, and they can be prevented. The "autonomy prevention" kit (Equilibr'Age workshops, occupational therapy advice) has helped to reduce the number of falls and improve people's quality of life. The program will now be rolled out to a wider public.

[The contribution of physical activity to motivation in patients with minor to major cognitive impairment]. / Apport de l'activité physique sur la motivation des patients atteints de troubles cognitifs mineurs à majeurs.

Alzheimer's disease (AD) brings with it the need to think about the loss of autonomy caused by cognitive impairment, and how to manage it. In this context, adapted physical activity has been shown to benefit the overall quality of life of people suffering from the disease. In our study of thirteen patients with AD or related neurodegenerative diseases, we assessed the impact of physical activity on self-esteem and motivation, with patients taking part in group exercise sessions lasting twelve weeks, one hour a week.