Renouer avec le sujet dans le champ de la santé : proposition théorique pour un soin fondé sur l'expérience vécue

Abstract

Dominé par un paradigme bio-mécaniste, les systèmes de santé occidentaux souffrent d’un grand nombre de problèmes. L’un d’entre eux consiste tout particulièrement en un manque de considération de l’expérience vécue et de toute la complexité et l’épaisseur de sens qui la caractérisent. Évoquant alors ces problèmes, nous soulignons dans ce texte l’importance de plonger dans le vécu du sujet soigné, et de changer de point de vue sur son mal. À l’aide de quelques réflexions empruntées à Georges Canguilhem nous défendons ce point et proposons ensuite de nous inscrire dans une approche socio-phénoménologique inspirée des travaux d’Alfred Schütz afin d’élaborer une lecture qui puisse nous permettre de saisir les expériences vécues. Nous réhabilitons ainsi le sujet dans un prendre-soin à travers ses rapports au corps, au temps, aux autres et à l’espace, et à partir de référents identitaires qui donnent sens à son existence. L’ensemble de cette réflexion consiste en un essai de théorisation sur le prendre-soin qui va dans le sens de la collaboration professionnelle et de l’interdisciplinarité, et qui n’ignore pas la pratique concrète d’acteurs et de professionnels soucieux de personnes préoccupées par leur existence.

Empowering Nurses to Provide Humanized Care in Canadian Hospital Care Units

“…Recognizing that each person has his or her own personal history and worldviews, humanized care maintains that these should be respected, as they give the patient his or her sense of dignity and the ability to self-actualize. 36,37,[42][43][44][45][46][47][48] This approach also rejects caregiving practices that pay excessive attention to objectivity, nursing techniques, standardized practices, and positivist principles of biomedicine. 5,36,49 It distances itself from managerial logics and the neoliberal standardization of practices and task accounting, which serve only efficiency and productivity.…”

“…Each person can reach his or her own decisions, make his or her own judgments, and is empowered to do so Traynor (2009) 36 Hesbeen (2010) 41 Morgan and Yoder (2012) 45 Todres et al (2007) 34 Vonarx and Desgroseilliers (2013) 44…”

“…Human life is fragile and valuable. Recognizing that each person has his or her own personal history and worldviews, humanized care maintains that these should be respected, as they give the patient his or her sense of dignity and the ability to self-actualize 36,37,42–48. This approach also rejects caregiving practices that pay excessive attention to objectivity, nursing techniques, standardized practices, and positivist principles of biomedicine 5,36,49.…”

Patient Engagement in Medical Education During the COVID-19 Pandemic: a Critical Reflection on an Epistemic Challenge

“…The hermeneutical injustice thus lies in the potential inability for medical teachers -and medical students -to make sense of the patient's experience because the collectively accepted dominant biomedical paradigm they refer to (and the interpretative resources it implies) does not fit the paradigm within which the patient's narrative is forged. The tendency will be to understand the disease in terms of vital norms and objective indicators, to reduce it to its physiological dimension, in a logic that is disconnected from the patient's lived and signified reality (Vonarx and Desgroseilliers, 2013). The patient's unique subjective experience thus risks being assimilated to an objectified, dehumanized and universalized 'patient perspective' (Rowland et al, 2017;Sharma, 2018), and to be instrumentalized in the reproduction of existing power dynamics and ideological systems rather than possibly being used to resist or transform them (Rowland et al, 2017).…”

Patient Engagement in Medical Education During the COVID-19 Pandemic: A Critical Reflection on an Epistemic Challenge [Version 2]

“…In such a paradigm, people’s experience of health will tend to be considered as existing outside the patients-subjects, independently of the knowledge or representations they may have of it. Indeed, the tendency will be to understand health and disease in terms of vital norms and objective indicators, to reduce them to their physiological dimension, in a logic that is disconnected from the patient’s lived and signified reality ( Vonarx and Desgroseilliers, 2013 ). The patient’s unique experience thus risks being assimilated to an objectified, dehumanized and universalized ‘patient perspective’ ( Rowland et al , 2017 ; Sharma, 2018 ), and to be instrumentalized in the reproduction of existing power dynamics and ideological systems rather than possibly being used to resist or transform them ( Rowland et al , 2017 ).…”