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Le système de santé québécois à l’épreuve de la pandémie

Nancy Côté and Charles Fleury

Le mandat temporaire de la Clinique santé des réfugiés de Québec en contexte de crise sanitaire : une réponse aux iniquités d’accès aux soins pour les personnes à statut migratoire précaire

Lucienne Martins-Borges, Marie-Elisa Fortin, Mariá Boeira-Lodetti, Stéphanie Arsenault and Lucille Langlois
Based on a qualitative research design, this article presents the implementation and outcomes of a temporary mandate undertaken by Quebec’s Capitale- Nationale Refugee Health Clinic (RHC) during a health crisis. This mandate aimed to provide services to immigrants facing difficulties accessing care due to their migration status or existing linguistic and cultural barriers. Data were collected from fifteen participants, including professionals and managers from the RHC intervention team assigned to the temporary mandate. All participants worked at the RHC between March 16, 2020 and March 31, 2021. The research results indicate that the mandate introduced a new organizational logistics to address inequities in access to care affecting this population. The RHC prevented situations from worsening and became a provincial reference in terms of innovation.

Expériences de soins en télésanté lors de la pandémie de Covid-19 : une étude qualitative auprès d’usagers de services ayant des troubles de santé mentale et des maladies physiques chroniques

Savannah Dubé, Myreille Bédard, Arnaud Duhoux, Jean-Sébastien Paquette, Amélie M. Achim, Patrick Archambault, Virtue Bajurny, Marie Baron, Mylaine Breton, Marjorie Brochu, Jean-Daniel Carrier, Yves Couturier, Stefany Dufour, Martin Fortin, Morgane Gabet, Marie-Pierre Gagnon, Ariane Girard, Anita Kothari, Audrey L’Espérance, Annie LeBlanc, Marie-Thérèse Lussier, Frances S. Mair, Emily Gard Marshall, Marie-Eve Poitras, Sophie Rivet, Maxime Sasseville, Brigitte Vachon, Sabrina Wong and Matthew Menear
The COVID-19 pandemic has led to significant transformations in health care delivery, notably in the shift towards telehealth. While previous studies have shed light on the benefits and challenges of the rapid shift to telehealth, few studies have explored the telehealth care experiences of individuals with co-existing mental and physical health conditions. This article sets to explore the telehealth care experiences of 29 service users during the COVID-19 pandemic. Through semi-structured interviews conducted as part of a broader mixed-methods study, participants were asked about the accessibility, continuity, person-centredness and comprehensiveness of their care. Interview transcripts were analyzed using a mixed inductive-deductive approach. Findings suggest that telehealth helped maintain accessibility and continuity of care for many participants. There was also a perception that it raised challenges with respect to the person-centredness and comprehensiveness of care, highlighting areas that can be targeted for quality improvement.

Favoriser le recrutement éthique des infirmières diplômées hors Canada : appel à l’action politique

Houssem Eddine Ben-Ahmed and Ivy Lynn Bourgeault
In Canada, the recruitment of internationally educated nurses is an increasingly topical issue that raises ethical questions in the media and scientific literature. Although the nursing shortage is a global problem, Canada—particularly at the provincial and territorial levels—and other developed countries have actively implemented international recruitment campaigns to fill vacant positions. The surge in vacancies in recent years is explained by a number of complex and interconnected factors, such as inadequate staffing, excessive workloads, mandatory overtime, toxic workplaces, endemic violence against nursing staff and a lack of adequate workforce planning. Thousands of nurses have left or are leaving their workplaces or even the profession. At the same time, many internationally educated nurses already living in Canada are unemployed or underemployed. Many face barriers related to immigration, professional licensing and labour market integration. They report that the process of entering the nursing profession in Canada remains long, complex, costly and stressful, preventing them from appropriately applying their knowledge, experience and expertise to integrate into the Canadian nursing workforce. Observing the power dynamics between provinces, this article describes recruitment and integration measures adopted in three Canadian provinces – Quebec, New Brunswick and Nova Scotia. We analyze whether these measures adequately align with the 2010 Global Code of Practice on the International Recruitment of Health Personnel. Subsequently, we propose priority strategic actions for policymakers to invest in local recruitment, initiate more robust workforce planning and encourage Canada to become more self-sufficient, in order to foster the transformation of health and social services systems.

L’impact de la crise de la COVID-19 sur les emplois du care : une partition déjà connue?

Carol-Anne Gauthier, Annick Parent-Lamarche and Yves Hallée
The COVID-19 crisis highlighted the importance of recognizing women’s work, especially that of those providing essential, close-proximity services in the care sector. Additionally, the crisis exacerbated the already challenging working conditions and work organization conditions of these occupations. Using a mixed methods approach, we examined the impact of the COVID-19 crisis on individuals employed in care occupations. Interviews and a questionnaire administered to a number of these individuals during the crisis revealed that certain services and tasks had been temporarily reorganized. This change degraded their working conditions and work organization, notably increasing the use of feminized skills and stress levels. However, some temporary changes proved beneficial and represent promising solutions. In conclusion, we propose solutions and reflections to promote better recognition of care jobs, particularly in the health and social services sector.

Confiance organisationnelle du personnel soignant durant la pandémie de COVID-19

Charles Fleury, Nancy Côté, Simon Coulombe, Émilie Dionne, Isabelle Feillou and Sylvain Luc
This article examines organizational trust among healthcare staff in Quebec during the pandemic. We consider trust to be a condition for the resilience of Quebec’s health and social services system. Based on data collected through questionnaires, as well as individual and group interviews with healthcare staff between 2021 and 2022, our aim is to document the state of trust and its evolution one year after the beginning of the pandemic, as well as to understand the factors affecting this trust. We examine three dimensions of organizational trust: trust in the employer, trust in immediate supervisors and trust in colleagues. The results show a significant decrease in trust toward employers and immediate supervisors compared to the pre-pandemic situation. This decrease is mainly due to poor human resource management, ineffective communication, and a lack of recognition. Trust in colleagues remained relatively strong, although slightly diminished. The article discusses these results in light of other studies on the subject and in consideration of the recent reform adopted by the Quebec government (Bill 15) which led to the creation of Santé Québec.

La mise à distance des Centres intégrés de santé et de services sociaux comme condition de bien-être au travail. Le cas des travailleuses sociales transférées en groupes de médecine de famille

Yves Couturier, Maude-Émilie Pépin and Julie Martin
Since 2016, nearly 400 social workers have been redeployed from CLSCs to family medicine groups (FMGs). Initially against their will, this move effectively distanced them from the large organizations comprising the integrated health and social services centres (CISSS). This article explores the relationship between this distancing and the observed improvement in workplace well-being among these social workers at FMGs. Using qualitative methods such as interviews and observations, we demonstrate that, despite the operational challenges involved, this distancing appears to be a prerequisite for enhancing the professional autonomy and workplace well-being of these social workers.

Entre conformité et résistance : mieux comprendre la capacité d’action des cadres intermédiaires en période de crise pandémique

Nancy Côté and Charles Fleury
This article examines the strategic role of middle managers in Quebec’s health and social services system during the COVID-19 pandemic. Specifially, it analyzes these managers’ agency in the face of organizational logics that became increasingly contradictory given the unpredictability and instability of this time. It shows how these middle managers mobilize different action logics, oscillating between compliance and resistance, in response to organizational directives. The observed resistance practices lie on a continuum, ranging from individual micro-resistances to collective forms of “productive resistance.” Resistance here is not mere opposition; it is part of a search for meaning, political positioning and alternatives that are better adapted to field realities and aligned with organizational interests. In the cases studied, these practices supported organizational capacities, fostered team mobilization and helped maintain care quality. Overall, the forms of resistance deployed were shown to be able to play a decisive role in organizational resilience during times of crisis. The article emphasizes the strategic importance of middle managers and the need for recognizing their agency in crisis contexts.

Penser et réaliser « ensemble » une transformation architecturale favorable à la santé durable des résidents et des travailleurs en centre d’hébergement de longue durée

Isabelle Feillou, Nathalie Jauvin, Melina Papalampropoulou-Tsiridou, Sonia Paquet-Martel and Raphaëlle Bruyère
The deterioration of Quebec’s long-term care centres (CHSLDs) and other organizational issues require certain transformations, including architectural ones, whose processes are poorly documented. In this article, we present an aspect of an action research project that began in 2020 amidst the ongoing COVID-19 pandemic: the renovation of two secured units intended for elderly people with severe loss of autonomy and cognitive disorders in a CHSLD in the Quebec region. This intervention created new living spaces and aimed to provide a built environment favourable to the health of workers and residents. We describe the origin of the action research project, the stages of intervention and the issues that emerged at each stage of the co-construction. Then, we discuss facilitating and hindering factors from both contextual and process perspectives. In our conclusion, we situate the lessons learned in terms of sustainable health and the resilience of the health and social services system.

Rassembler des résidents dans des « micro-milieux » en CHSLD : un impact sur la pratique des préposées aux bénéficiaires?

François Aubry and Francis Etheridge
This article presents the results of a study examining nurse aides’ perspectives on the development of an organizational initiative in long-term care centres (CHSLDs) termed “adapted micro-environments.” We conducted 28 semi-structured interviews with nurse aides around two themes: the organizational consequences of such a development for their practice, and their perception of developing (or not) a specialization within these micro-environments. Despite an initiative that promised to be participatory and rewarding, our results highlight the predominance of classic organizational issues in CHSLDs (e.g., staff shortages, poor recognition).

La modernisation agricole a-t-elle dégradé la situation des femmes en agriculture? / Julie Francoeur, Sortir du rang. La place des femmes en agriculture, Montréal, Remue-ménage, 2023, 103 p.

Antoine Rignault
Au Québec comme en France, les approches écoféministes gagnent en popularité dans les sciences sociales. Ces approches s’articulent sur un principe fondamental : la domination des femmes aurait partie liée avec la domination de la nature. À l’aune de ce principe, certaines autrices s’inscrivant dans ce courant de recherche ont proposé des relectures du processus de modernisation agricole, qui s’est surtout accéléré au Québec et en France à partir de la Seconde Guerre mondiale. C’est une telle relecture que propose, avec ce livre, la sociologue Julie Francoeur en s’appuyant sur une série d’affirmations qui font l’objet d’une discussion scientifique dans cette note critique.

En guise de réponse à Antoine Rignault

Julie Francoeur

Hervé Guay, Louis Patrick Leroux et Sandria P. Bouliane (dir.), La culture au Québec au temps de la pandémie. Réaction, adaptation, normalisation, résistance et hybridation, Montréal, Presses de l’Université de Montréal, 2024, 433 p.

Laura Trottier

Isabelle Wallach, Isabelle Van Pevenage et Julie Beauchamp, Sexualités et conjugalités en contexte de vieillissement. Perspectives sociales et critiques, Québec, Presses de l’Université du Québec, 2024, Coll. Problèmes sociaux et interventions sociales, 212 p.

Émilie Gervais

Sophie Mathieu, Égalité, fécondité et maternité. Le soutien aux familles au Québec, Montréal, Presses de l’Université de Montréal, 2023, 224 p.

Charlotte Sannier-Bérusseau

Jacques Rouillard, Le mythe tenace de la Folk Society en histoire du Québec, Septentrion, 2023, 219 p.

Nicole Gagnon

Jean-Philippe Carlos et Stéphane Savard, avec la collaboration d’Andréanne Lebrun et Philippe Pinay, La Révolution tranquille entre l’ici et l’ailleurs, Québec, Les Éditions du Septentrion, 2024, 324 p.

Jacques Palard

Félix Mathieu, Les nations fragiles. Ces peuples qui affrontent la modernité, Boréal, 2024, 384 p.

Michel Seymour

Martin Geoffroy et Marc Imbeault, La montée de l’extrême droite au Québec (2010-2020), 2025, Presses de l’Université Laval, 262 p.

Vincent Boucher

Linda Cardinal, Bernard Gagnon, Virginie Hébert et François Rocher, Une langue, des voix : débats autour de la loi 96 au Québec, Presses de l’Université Laval, 2023, 216 p.

Michael Akinpelu