Journal 04/10

This is why we would like to focus our work on the consideration of the psychological dimension in the therapeutic follow-up during the transfer of a patient from one unit to the other on the Belle Idée site.

Objectives: During this work we propose to:

• Carry on a survey of the current practises;
• Propose some lines of reflection hoping to optimise the quality of this activity.

Delimitation of the area of investigation: We plan to study the admission and crisis management unit (les Sillons1) and a Intellectual Disability Unit, Le Lison (UPDM), within the psychiatric department of Belle Idée.

Summary of documentation: In order to produce this work, we have questioned ourselves about our history and our experience in our respective units. We have recalled the difficulties encountered (lack of information and of specific tools) when patients were transferred within our care units.

To verify whether our remarks were objectives, we have met with Ms VAUCHER, the nurse in charge of care (Infirmière Responsable des Soins – IRS) of the Psychiatric Department to validate this problematic.

During this meeting, Ms. Madame VAUCHER underlines the importance of transferring the information between two care units that meet around the person in care.

The latter does not always possess the cognitive skills to express with words his needs, his difficulties, his habits, his rituals, his pleasures. Sometimes the ability to judge is scarcely or not at all present.

In the future we intend to contact various experts and specialists, focusing on the investigation sites and centred on our research theme.

These different encounters make us sensitive and question us about:

• Which elements of information are necessary to the receiving caregivers to refine the quality of their service? Does one has to know everything immediately? Are we trying to focus on the information that is necessary for the immediate care or on a longer timescale?
• What is the place of the patient in the elaboration of the written communication? This is the moment that allows recording all that has been set in motion and to make an assessment of the sojourn.
• Does partnership help to represent the end of the relationship that is necessary for all process of separation? Doing this together means to say already “see you again” and to leave the place for a new meeting. What is at stake for each one in this end of relationship?
• The hospitalisation requests do not always allow respecting the administrative boundaries between units. The patient can therefore, during his illness, be integrated in different care units. Each one acquires some information and provides specific therapies. What happens of this different knowledge and fragmented experiences?
• What can we do to collect all this information and to make it useful in the future? In the era of Information Technology should we not trust the evolution of the existing electronic systems for data transfer and sharing that are used by the different professionals?

Concerning bibliography: We were not able to find studies directly treating the issue of the transfer of a patient between different care units. We therefore make reference to the different existing works dealing with the concepts of reception, the oral and written transmission of the information, theoretical and practical juridical aspects, the experience of the different actors and the end of the relationship

The continuity of care is an important concern. The COMPAQH organisation, in collaboration with the HAS (previously ANAES), aims to develop quality of care indicators for the health institutions and also to establish effective ways to make use of these indicators. In its 2003 report “Ensure the continuity of the patient care” it states that “the continuity of care from the patient’s standpoint is an experience which he lives with the caregivers; from the caregiver point of view continuity resides in the extension of the therapy in time. These two elements must be present for continuity to be there.” According to him, “Three types of continuity can be identified: information continuity, relational continuity and the continuity of the treatment.”.

As far as the patient reception is concerned, Christophe BITTOLO proposes in his paper “Hospital reception and psychological process: therapeutic and institutional issues in psychiatry” (“Accueil hospitalier et processus psychiques : enjeux thérapeutiques et institutionnels en psychiatrie.”, Revue de psychothérapie psychanalytique de groupe. Editions : ERES p143¬-159.2001), to approach some individual and institutional issues. According to him, the patient hospitalisation is an instrumental moment in the healing process and in the continuation of the therapy.

As far as written transmission is concerned, we are interested in the history of the nurse written transmission. According to Bernard GRADIN et Michèle GROSJEAN in they research “Et en plus elles diagnostiquent... La recatégorisation de la profession infirmière.” (“They even make diagnosis… The re-classification of the nurse profession”), the nurse should use the “nurse file”, afterwards renamed “file of nurse care” and more recently “care file”, which is the written medium of information and transmission of the therapy of each patient since the seventies.

The transfer of information creates the heritage of what has been done, it allows to establish the history of a patient. Hervé BOKOBZA, in “Les enjeux de la transmission en psychiatrie” (“The challenges of the transmission in psychiatry”) in Journal français de la psychiatrie n°27, 2006, considers the transmission as an action, the one of passing on as we pass on life, a name, a heritage. According to him, psychiatry is specially confronted with this issue as the psychiatric patient in his discomfort, always raises the issue of the origins, of the filiation or identity, and therefore of the transmission.

We also took inspiration from the HES diploma work of Ms LUDWING, attending the Ecole de La Source, with the title “Ce que tu écris te ressemble : mais à quoi ressemble l’écriture infirmière.” (“What you write resembles to you. But to what nurse writing does resemble?”). Her work “consists in understanding how the nurses consider the usage of writing via the production of written transfer notes, and, more specifically, of the nurse observations.

When considering the issue of the computerisation of the transfer note, we have considered the work of Sylvie PALMIER, (2007) Réseaux ville/hôpital, transmettre pour mieux soigner. (The network city / hospital, transmission for a better care) in SOINS n°702 p44-46. This article conveys the idea that the nursing activity, as well as the rest of the medical domain, cannot remain unaffected by the profound changes of the Information Society. Therefore the new communication technologies open the road to modernity.

To confront the end of the relationship, we have used PEPLAU, H. (1995) Relations interpersonnelles en soins infirmiers. (Interpersonal relationships and nursing care) Paris : InterEditions. Indeed, she explains that the end of the relationship has to be elaborated since the beginning of the hospitalisation, and that it can reactivate a feeling of abandonment.

To conclude we would like to mention the phase of crisis intervention, DE COULON, N (1994). La crise : stratégies d’intervention thérapeutique en psychiatrie. (The crisis: strategies of therapeutic intervention in psychiatry) Paris : Gaétan Morin. Indeed, the end of the therapeutic bond may reactivate the symptomatology. Therefore the team that initiate the transfer may observe a resurgence of the anxiety and the receiving team may find a patient with crisis symptoms.