[New nursing competencies since 2004 : scope and limits]. / Les nouvelles compétences infirmières depuis 2004: étendue et limites.

Since 2004, procedures which can be carried out by nurses have no longer been subjet to a single global decree and now feature in different legislative and/or regulatory articles. Since 2006, several laws and decrees have expanded the scope of nursing practice, but the lists of authorised procedures for a large part of the profession have not been updated, except for theatre nurses and nurse anaesthetists. The obsolescence of these regulatory lists is out of step with the technical evolution of care, the organisation of the health system and patients' needs.

Music for pain relief during bed bathing of mechanically ventilated patients: A pilot study.

BACKGROUND: Pain is a universal issue and is of particular concern in mechanically ventilated patients, as they require intensive nursing care and multiple invasive procedures, while being unable to communicate verbally. The aim of this study was to assess the effect of music on pain experienced by mechanically ventilated patients during morning bed bathing. METHODS: Of the 60 mechanically ventilated patients enrolled in this single-center pilot study between March 2013 and October 2015, the first 30 received no music and the next 30 the music intervention, during the morning bed bath. The Behavioral Pain Scale (BPS) score was determined during and at the end of the bath then 30, 60, and 120 minutes after the bath. BPS score changes over time were assessed and the proportions of bath times spent with a BPS score ≥5 and with the maximal BPS score were determined. RESULTS: At baseline, no patient had pain (defined as a BPS score <5) and the median BPS score was 3 [IQR, 3;3] in both groups (P = 0.43). After bed bath initiation, 88% of patients experienced pain. The maximum BPS value during the bath was lower in the music group (5 [5;6.7] vs. 7 [5;7]). Proportions of total bath time spent with BPS≥5 and with the maximum BPS were significantly lower in the music group than in the control group (2.0 [0.3;4.0] vs. 10 [4.3;18.0]; P < .0001 and 1.5 [0;3.0] vs. 3.5 [2.0;6.0]; P = .005; respectively). Two hours after the end of the bath, the BPS values had returned to baseline in both groups. CONCLUSION: In our population, music significantly decreased pain intensity and duration during the morning bed bath in mechanically ventilated patients. These results warrant further assessment in a large multicenter randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT02883959.

[Nurses and medication, an expanding role]. / L'infirmière et le médicament, un rôle en devenir.

The administration of medicines has always been a central responsibility for the nursing profession in both its prescribed and autonomous roles. Since 2001, the latter has grown and other activities relating to medicines have been added: the prescription of certain products, repeat treatments, extemporaneous preparations, therapeutic patient education. For nurses, these developments make way for new relations with doctors, pharmacists and the pharmaceutical industry.

[Home nursing care, daily assistance and specialized individual treatments]. / Soigner g domicile, assistance quotidienne et traitements individuels spécialisés.

Home nursing care, long overshadowed by a conception of health care which is essentially curative and hospital-centred, is returning to the forefront of nursing activities. It is a source of efficiency for the health care system and of quality of life for users but remains a challenge. When the patient requires frequent and essential technical procedures, home nursing care requires a number of adjustments between the health care workers to ensure quality care is provided.This article looks back at the development of these professions.

[Patient education, from implicit nursing practice to structured programs]. / Education thérapeutique, d'une pratique soignante implicite aux programmes structurés.

Therapeutic patient education, which with the "Hospital, patients, health and territories" law became a priority of the healthcare system, notably for chronic diseases, has been rooted in nursing training and practice since the 1960s. Following in the steps of the World Health Organisation and the International Council of Nurses, successive laws relating to the profession have continuously emphasised it. Now that it has an official and general framework in France, it should develop within nursing practice.

[Cooperation protocols, which concept for nursing care?]. / Les protocoles de coopération, quelle conception des soins infirmiers?

The implementation of cooperation protocols as provided for by the "Hospital, patients, health and regions" Law may greatly alter the organisation of healthcare practices. But an excessively limited vision, focused on the medical act to be delegated, might remove the clinical aspect of the nurse's role and reduce it to merely executing prescriptions. The French National Order of Nurses, through the opinions it will give to national health Authorities, wishes to prevent this danger.