Improving autonomy support: a collaborative learning experience / Améliorer les pratiques d'accompagnement à l'autonomie en santé : effets d'un dispositif d'apprentissage coopératif

Introduction: The ACESO project, which was part of the Autonomy support in health national experimentation, brought together 21 partners from Ile-de-France. Among these partners, 14 had practices similar to autonomy support. Partners' presupposition was that experimenting a cooperative approach would encourage the empowerment of participants, improve their autonomy support and put into place the conditions necessary for the empowerment of people who would be supported. To help participants to meet this goal, the project leader took on a role as third party whose function was to facilitate the cooperative approach by proposing a framework and a method. Purpose of research: The study aimed to report the effects of this approach on the participants' practices as well as to identify the process for achieving this. Results: The participants' learning enabled them to align themselves with the good practice guidelines collectively constructed within the project. With the project leader's support, they initiated a transformative learning process that allowed them to develop their reflexivity and empowerment. These transformations had repercussions on their teams and structures, through a halo effect. The halo effect varied, in each partner structure, according to the participation and involvement of the project referent and the other members of the structure, in particular managers. Conclusions: This study has highlighted the value of a cooperative approach to facilitate the learning necessary for sustainable practices transformations and the improvement partners autonomy supports. This resulted in gains in autonomy for the autonomy support practitioners and the people they supported.

Introduction: Le projet ACESO, participant à l'expérimentation nationale des dispositifs d'accompagnement à l'autonomie en santé (AAS), a rassemblé 21 partenaires franciliens parmi lesquels 14 portaient des pratiques qui empruntent à l'accompagnement. Son présupposé était qu'en expérimentant une démarche coopérative favorisant l'empowerment des partenaires, ceux-ci amélioreraient leurs pratiques d'accompagnement et mettraient notamment en place les conditions nécessaires à l'empowerment des personnes accompagnées. Pour les y aider, le porteur de projet a tenu un rôle de tiers dont la fonction était de faciliter la démarche coopérative en proposant un cadre et une méthode. But de l'étude: L'étude visait à rendre compte des effets de cette démarche sur les pratiques des partenaires, ainsi qu'à identifier le processus pour y parvenir. Résultats: Les apprentissages réalisés ont permis aux partenaires de se donner des balises de bonnes pratiques construites collectivement au sein du projet (valeurs, principes et postures). Avec le soutien du tiers, ils ont initié un processus d'apprentissage transformationnel développant leur réflexivité et leur empowerment. Ces transformations ont eu des répercussions sur leurs équipes et structures, par effet de halo. Ce dernier a varié, dans chaque structure partenaire, en fonction de la participation et de l'implication du référent-projet et des membres de la structure, en particulier la direction. Conclusion: Cette étude met en évidence l'intérêt d'une démarche coopérative pour faciliter l'apprentissage nécessaire aux transformations durables des pratiques et l'amélioration des pratiques de partenaires d'un collectif apprenant. Dans le cas de l'AAS, ceci s'est traduit par des gains d'autonomie pour les accompagnants et les personnes accompagnées.

Patient engagement in nursing training: An exploratory study / L'engagement des patients dans la formation des étudiants en soins infirmiers : une étude exploratoire

Context: The initial training of healthcare professionals can be used to develop health democracy if patients are sufficiently involved. Objectives: To describe the level of patient engagement in some nurse training institutes and to understand what motivates and hinders this engagement. Method: Exploratory study based on interviews with five patient trainers and eight nurse training institute trainers. The analysis of patient engagement levels was based in part on the Carman scale and the Montreal model. Results: Two trends emerged from this first study: consultation-style patient involvement, and partnershipstyle involvement, where the patient is involved in the pedagogical co-construction of a few teaching units and not of the entire training course. Elements facilitating patient involvement were linked to the participants' motivation, patient support, and patient recruitment methods. Conversely, a lack of institutional motivation, overly demanding recruitment, the absence of remuneration, and inaccessibility could be barriers to patient engagement. Conclusion: Patient engagement in preliminary healthcare training should be considered across the entire curriculum and formalized.

Contexte: La formation initiale des professionnels de santé peut être un levier au développement de la démocratie en santé si l'engagement des patients dans ces formations est suffisant. Objectifs: Décrire le niveau d'engagement des patients dans quelques instituts de formation en soins infirmiers et comprendre ce qui motive et ce qui freine cet engagement. Méthode: Étude exploratoire basée sur des entretiens auprès de cinq patients formateurs et de huit formateurs en IFSI. L'analyse des niveaux d'engagement des patients s'est basée en partie sur l'échelle de Carman et sur le modèle de Montréal. Résultats: Deux tendances ont été dégagées de cette première étude : un engagement patient de type consultation, et un engagement de type partenarial où le patient est impliqué dans la coconstruction pédagogique sur quelques unités d'enseignement et non sur l'ensemble de la formation. Les éléments favorisant l'engagement des patients étaient liés à la motivation des deux protagonistes, l'accompagnement et les modalités de recrutement des patients. À l'inverse, un manque de motivation institutionnelle, un recrutement trop exigeant, l'absence de rémunération et l'inaccessibilité des locaux pouvaient constituer des freins à l'engagement des patients. Conclusion: L'engagement des patients dans la formation initiale en santé doit être réfléchi sur l'ensemble du curriculum et formalisé.

Consensus Recommendations for the Use of Simulation in Therapeutic Patient Education.

INTRODUCTION: Simulation is rarely used to help individuals with chronic diseases develop skills. The aim of the study was to provide recommendations for the use of simulation in therapeutic patient education (S-TPE). METHODS: Expert consensus was achieved with the participation of the following 3 groups of experts: (a) expert patients and caregivers; (b) health professionals specialized in therapeutic patient education (TPE); and (c) simulation experts. Each expert received a list of questions by e-mail in 3 iterations. The synthesis of the 2 first questionnaires resulted in 34 first recommendations voted during the consensus conference meeting. Each recommendation was subject to an extensive literature review. The quality of the evidence and the strength of the recommendations were assessed through the evaluation, development, and evaluation criteria categories (GRADE criteria). The third questionnaire selected and illustrated recommendations more specific to the use of S-TPE. RESULTS: At the end of the process, the experts identified 26 recommendations specific to the use of S-TPE. They proposed examples of skills in different diseases and stressed the importance of adapting the conditions of use (location, equipment, time of the care) to the circumstances of the patient learner and skills to be developed. Experts should exercise great caution as this technique presents ethical considerations related to patient care. CONCLUSIONS: These recommendations underline the fact that simulation could bring added value to TPE. They provide a framework and examples for the experimental use of simulation in TPE. Research into feasibility and acceptability is needed.

L'évaluation des projets d'accompagnement à l'autonomie en santé : pourquoi privilégier une approche pragmatiste ?

INTRODUCTION: In connection with article 92 of the last Health Act, twenty-eight projects are being tested nationwide with a view to demonstrate the value of support to gain autonomy in health. These projects will be assessed on a case-by-case basis according to their specific situations. However, with the possible generalization of this type of programs, it was also necessary to assess them against the same frame of reference. METHOD: To this end, a participatory approach was conducted with their coordinators to identify a single evaluation framework, even though these projects were very heterogeneous. RESULTS: This development process led to the identification of a common intervention logic that made it possible, in the aftermath, to define support for autonomy in health, i.e. to set out the conditions under which a health intervention may be used. A pragmatic vision guided the production of the evaluation framework which articulates four dimensions (individual empowerment, enabling environment, collective empowerment, organizational empowerment) composed of 21 criteria and presented as inseparable. DISCUSSION: According to this logic, the process of empowering individuals, as an objective of interventions, cannot be pursued if it is not embedded in practices that are consistent with the values inherent to the original intention. This also calls for the effects of the empowerment of supported persons to be granted as much importance as the processes of the interventions and the learning processes of individuals and organizations.

Formation et conditions facilitant l'intégration de patients dans la coanimation de séances collectives d'éducation thérapeutique.

PURPOSE OF RESEARCH: The purpose of this research was to promote the involvement and intervention of patient-partners (PPs) in collective sessions of therapeutic patient education (TPE), including training and support for the implementation of these sessions, in co-facilitation with a health professional (HP). Therefore, the matter was to co-construct a training model, to experiment with its implementation and to define favorable conditions for this collaboration. METHODS: Collaborative research oriented by the design, led by a steering committee representative of different categories of stakeholders, which has been spread over 2 years, in Paris area and Montpellier, in 4 phases: 1/ exploration (bibliographic review and investigation); 2/ recruitment of PPs affected by different pathologies; 3/ implementation and evaluation of PPs training in inter-pathology; 4/ implementation and evaluation of co-facilitated group sessions. RESULTS: 35 patients solicited, 24 (69%) included. Of these, 22 (92%) completed the training entirely; 17 sessions were conducted in co-facilitation (15 planned) for 151 patients (150 expected). Satisfaction rates for PPs, HPs and patient beneficiaries were very high. CONCLUSIONS: This research validated a training model for patient-partners in therapeutic education and identified some conditions that could facilitate their integration into TPE programs.

The Patient Teacher in General Practice Training: Perspectives of Residents.

BACKGROUND: Patient teachers were involved in training general practice residents (GPRs) to strengthen the patient-centered approach. They teach a course on health democracy by themselves and teach in tandem with a physician teacher during reflective practice-based classes (named GEPRIs). We present the GPRs' representations of patient teacher characteristics and capacities and their perception of how useful patient teachers are to their professional development. METHODS: We administered a questionnaire based on a preliminary qualitative study to 124 GPRs. It explored (a) changes in the GPRs' representations about patient teacher characteristics and capacities with regard to teaching over the first year of the experiment; (b) GPRs' perception of patient teacher utility to their training and their contribution to developing patient perspective-related competencies. RESULTS: The response rate was 89.5% (111/124). The majority of GPRs agreed with 17 (before) and 21 (after) of the 23 patient teacher characteristics and with 17 (before) and 19 (after) of the 20 capacities. The agreement rate increased, overall, after patient teacher participation. The GPRs found patient teacher useful to their training in 9 of 11 topics (agreement rate 65%-92%). They felt they had developed the 14 patient knowledge-related competencies (agreement rate 62%-93%), and 52% to 75% of the GPRs rated the patient teachers' contribution to those competencies "high or very high," depending on the competency. CONCLUSION: This study demonstrates the specific contribution of patient teachers to university-level medical training in France. The GPRs recognized that patient teachers helped them develop competencies by providing patient-specific content.

[Training and conditions improving the integration of patients in the co-facilitation of collective sessions of therapeutic education]. / Formation et conditions facilitant l'intégration de patients dans la coanimation de séances collectives d'éducation thérapeutique.

Purpose of research: The purpose of this research was to promote the involvement and intervention of patient-partners (PPs) in collective sessions of therapeutic patient education (TPE), including training and support for the implementation of these sessions, in co-facilitation with a health professional (HP). Therefore, the matter was to co-construct a training model, to experiment with its implementation and to define favorable conditions for this collaboration. METHODS: Collaborative research oriented by the design, led by a steering committee representative of different categories of stakeholders, which has been spread over 2 years, in Paris area and Montpellier, in 4 phases: 1/ exploration (bibliographic review and investigation); 2/ recruitment of PPs affected by different pathologies; 3/ implementation and evaluation of PPs training in inter-pathology; 4/ implementation and evaluation of co-facilitated group sessions. RESULTS: 35 patients solicited, 24 (69%) included. Of these, 22 (92%) completed the training entirely; 17 sessions were conducted in co-facilitation (15 planned) for 151 patients (150 expected). Satisfaction rates for PPs, HPs and patient beneficiaries were very high. CONCLUSIONS: This research validated a training model for patient-partners in therapeutic education and identified some conditions that could facilitate their integration into TPE programs.

[Community-based research in therapeutic patient education: practices and contributions. A literature review]. / Pratiques et apport des recherches communautaires en éducation thérapeutique : une revue de littérature.

INTRODUCTION: Community-based research (CBR) in health involves both researchers and people concerned by the results of the research. It aims to empower populations, using their exposure to the phenomenon being studied as a starting point. The use of CBR in the field of therapeutic patient education (TPE) is of interest, as the two share such characteristics as the desire to foster self-reliance and participation and a culture of interdisciplinarity. AIM: To characterize CBR in the therapeutic patient education field. METHODS: A literature search on PUBMED using the keywords ?community-based (participatory) research?, ?patient education?, ?self-care? and ?self-management? retrieved 121 articles. The analysis looked at the type of research, the characteristics of both the populations involved and the co-researchers, the collaborative actions (analysed using a grid from the literature), and the difficulties in implementing these actions. RESULTS: Thirty-one studies were included. Ten consisted of methodological studies, which tended to show the added value of collaborating with users in implementing TPE programmes compared to standard methods. The remaining 21 studies described the co-design and/or co-execution of new educational programmes. We identified 5 collaborative actions that involved a preparatory phase of the research, and 17 collaborative actions that involved the prioritization, conduct, and analysis of the research and dissemination of the results. Preventive measures are needed for potential methodological, organizational, ethical, and emotional difficulties. DISCUSSION: The 22 identified actions need to be confirmed by other studies. The analysis grid could ultimately become a tool for guiding researchers for their researches within the CBR framework.

[Patients, players in healthcare research]. / Les patients, acteurs de la recherche en soins.

Healthcare research is developing in France, notably through hospital nursing and paramedical research programmes. Few research projects involve the patients as investigators as part of collaborative studies. These approaches favour the involvement of all the players concerned. Thereby, healthcare research, due to its holistic dimension, encourages the development of collaborative practices between researchers, patients and caregivers.