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Relation thérapeutique, soins centrés sur la personne et troubles cognitifs sévères

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Abstract

L’évolution inévitable des troubles cognitifs dans les maladies neurodégénératives, telle que la maladie d’Alzheimer, interroge les modalités et finalités des soins apportés aux personnes atteintes de ces pathologies. Elle justifie l’acquisition d’un regard holistique et humaniste pour préserver au centre des préoccupations la personne dans sa globalité. Les soins centrés sur la personne répondent à ce critère d’exigence, en s’enracinant dans une relation favorisante. The inevitable evolution of cognitive disorders in neurodegenerative diseases, such as Alzheimer's disease, questions the modalities and aims of the care provided to people with these conditions. It justifies the acquisition of a holistic and humanistic view to preserve the person as a whole in the center of concerns. Person-centered care meets this requirement by being rooted in a supportive relationship.

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... Évidemment, ayant ouvert la porte, il est souhaitable de travailler sur la peur de mourir, le deuil de la mère… Après la fibroscopie par exemple. La présentation ici réalisée est une invitation à explorer plus en détail le concept d'empathie dans les soins (1)(2)(3) en tant qu'attitude relationnelle et humaine positive (4) ...
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When caring for people with severe Alzheimer's disease (AD), the concept of the person being central is increasingly advocated in clinical practice and academia as an approach to deliver high-quality care. The aim of person-centred care, which emanates from phenomological perspectives on AD, is to acknowledge the personhood of people with AD in all aspects of their care. It generally includes the recognition that the personality of the person with AD is increasingly concealed rather than lost; personalisation of the person's care and their environment; offering shared decision-making; interpretation of behaviour from the viewpoint of the person; and prioritising the relationship as much as the care tasks. However, questions remain about how to provide, measure, and explore clinical outcomes of person-centred care. In this Review, we summarise the current knowledge about person-centred care for people with severe AD and highlight the areas in need of further research.
Sept éléments clés des soins centrés sur la personne pour les résidents atteints de l'Alzheimer ou d'une maladie apparentée
  • Société Alzheimer
  • Canada
Société Alzheimer du Canada. Sept éléments clés des soins centrés sur la personne pour les résidents atteints de l'Alzheimer ou d'une maladie apparentée. 2014. https://alzheimer.ca/ sites/default/fi les/fi les/national/ culture-change/pcpearls_full_f. pdf.
Client-centered therapy: Its current practice, implications and theory . Boston : Hoghton Miffl in
  • C R Rogers
Rogers CR. Client-centered therapy: Its current practice, implications and theory. Boston : Hoghton Miffl in ; 1951.
Le développement de la personne . 2 e éd Malakoff : Dunod
  • C R Rogers
Rogers CR. Le développement de la personne. 2 e éd Malakoff : Dunod ; 2005.
Psychotherapist's Casebook
  • I Kutash
  • A Wolf
Kutash I, Wolf A. Psychotherapist's Casebook. San Francisco (États-Unis) : Jossey-Bass Inc Pub ; 1986. p. 197 -208.
Dementia reconsidered. The person comes fi rst
  • T Kitwood
Kitwood T. Dementia reconsidered. The person comes fi rst. Buckingham (Royaume-Uni) : Open University Press ; 1997.
Patient-or personcentred practice in medicine? -A review of concepts
  • J M Louw
  • T S Marcus
  • Jfm Hugo
Louw JM, Marcus TS, Hugo JFM. Patient-or personcentred practice in medicine? -A review of concepts. Afr J Prim Health Care Fam Med 2017 ; 9 ( 1 ) : e1 -7.
Person-centered care for older people with dementia in the acute hospital
  • Fhe Tay
  • C L Thompson
  • C M Nieh
Tay FHE, Thompson CL, Nieh CM, et al. Person-centered care for older people with dementia in the acute hospital. Alzheimers Dement (N Y) 2018 ; 4 : 19 -27.
Essai sur l'absurde . Paris : Gallimard ; 1942
  • A Camus
  • Le Mythe De Sisyphe
Camus A. Le mythe de Sisyphe. Essai sur l'absurde. Paris : Gallimard ; 1942. p. 63.