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De la cécité empathique transitoire à la prudence dans les soins. Au sujet de la contention lors des soins en pédiatrie

Abstract : From transitional empathic blindness to caution during care. About physical restraint during nursing care in pediatric wardsThis thesis questions the use of strong physical restraint during pediatric care. The issue raises philosophical and ethical questions falling within daily practices of nursing acts. However, this custom to which nurses are frequently exposed is rather seldom questioned or is routinized.A child who is scared or in pain can struggle or jitter during the care and it happens that serval adults retrain the child in order to finish the treatment. It is a real power struggle between the nurses and the child. Sometimes, the child’s physical restraint is similar to violence. The step from using reasonable strength to using unfounded violence is not automatically identified.Moreover, the nurse restraining a child strongly faces a paradox: hurting a child for his wellbeing. This complicates the perception of the illegitimacy of some restraints.It is difficult if not impossible to forgo the treatment, but it is nevertheless unfortunate to use physical restraint on a sick child. A qualitative research backed by a philosophical reflection has been conducted among pediatric nurses. The aim was to probe the issue from the nurses’ point of view in order to understand how the use of physical restraint during a treatment in pediatric wards could lead to the use of unfounded strength. The result of the research highlighted that restraint was an unpleasant, cumbersome practice, but that it was often experienced as unavoidable and governed by the team’s habits. (The results of the research can be found in appendix) The “child’s wellbeing” justified the use of strength, like a kind of ethical prioritization, where achieving the technical act subordinated the respect of the child’s rhythm. Analyzing the nurses’ comments highlighted their empathy and attention to the child, but when talking about restraint, the child was no longer mentioned. It seemed the child disappeared from the nurse’s “emotional radar” during a physical restraint. The idea of “transitional empathy blindness” was suggested to characterize the phenomenon occurring during a strong physical restraint.The thesis also explores the reasons leading the adults in charge of the care to disqualify the child’s refusal by offering a means to resume the dialog with the child. The work is structured around the evolution of the attitudes and opinions that sometimes conceal the child’s and the nurse’s reality and sometimes make it visible. Nurses are like prisoners in a cave, hostages of their own illusions. The hope of mastering the fickleness of life thanks to biotechnology seems to force them to sacrifice their own subjectivity. Trying to subjugate the child but also the nurse to the technical act is food for thought. Throughout the work, the idea of an in-between differences stands out. It could lead to a new concept where the differences between the child and the nurses could meet in case of contingency. This in-between opens new possibilities and encourages caution. As practical measure, Aristotle’s principle of caution develops a new insight regarding this issue. The possibility of discussing nursing practices leads to a concrete proposal to spread the notion of care more specifically in the field of pediatrics.
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Bénédicte Lombart. De la cécité empathique transitoire à la prudence dans les soins. Au sujet de la contention lors des soins en pédiatrie. Philosophie. Université Paris-Est, 2016. Français. ⟨NNT : 2016PESC0054⟩. ⟨tel-01755821⟩

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