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Éditorial

Jean-François Desbiens

Exploration des pratiques infirmières de suivi de deuil auprès des familles en CHSLD : une revue narrative des écrits

Sarah Caouette and Émilie Allard
Residential and long-term care centers are living environments that provide support not only for residents, but also for their loved ones, throughout the resident’s stay. This support should continue in the post-death period, as the family grieves. Bereavement can have a significant impact on families’ quality of life, such as the development of complex persistent grief, which requires healthcare professionals, including nurses, to support families through this important transition. Current bereavement follow-up practices in long-term care centers are rather limited, consisting mainly of commemorative gestures. The aim of this study is to explore the state of knowledge related to nursing practices in grief support for families in long-term care centers. A literature review was conducted according to the principles of a structured narrative review. A total of 21 articles were selected according to the established selection criteria. A thematic analysis of the articles identified three main themes: bereavement care, the nurse’s role and bereavement care nursing interventions. Bereavement follow-up comprises five components: 1) acknowledgement of death, 2) transmission of bereavement information, 3) assessment of bereavement, 4) intervention in bereavement and 5) refer to specialized resources as needed. The nurse is described as a professional with a central role in bereavement follow-up, because of the privileged relationship she develops with families and the interpersonal and communication skills she possesses. The literature does, however, recognize a need for training nurses in bereavement. Nursing interventions for bereavement follow-up could be grouped into four types: 1) an interdisciplinary bereavement follow-up meeting, 2) a strength-oriented therapeutic family conversation, 3) a written bereavement adjustment tool and 4) an individual bereavement follow-up meeting. This study provides an in-depth understanding of bereavement follow-up, as well as interventions that can be adapted to the residential context. These could help guide nurses’ practice in this care setting.

Feuille de route pour un accès équitable et une utilisation responsable de la psychothérapie assistée par la psilocybine dans les soins palliatifs

Michel Dorval, Sue-Ling Chang, Houman Farzin, Olivia Nguyen, Jean-François Stephan, Diane Tapp, Pierre Deschamps, Yann Joly, Florence Moureaux, Robert Foxman, Marianne Masse-Grenier and Jean-Sébastien Fallu
Psilocybin-assisted psychotherapy represents a promising addition to palliative care interventions, potentially improving quality of life by addressing existential distress. Despite its safety and effectiveness, this therapy remains limited in Canada, underscoring the need for improved access to ease suffering from life-threatening illnesses. However, important questions remain regarding how to integrate psilocybin-assisted psychotherapy into existing healthcare frameworks, navigate regulatory challenges, and ensure equitable access for all patients. These unanswered questions highlight the complexity of expanding access and the need for thoughtful, informed approaches to its implementation. To address this, the P3A team (Psilocybin at End of Life: Audacity, Acceptability, Access) held a forum on March 22, 2024, in Quebec, Canada, to explore actionable steps for the responsible use and equitable access to psilocybin-assisted psychotherapy.A total of 57 participants with knowledge in palliative care, including professional and patient associations, patients, healthcare professionals, researchers, and policymakers, attended the event, which featured presentations, a panel discussion, and small-group workshops. This report provides sixteen recommendations across six previously identified key topics: 1) Patient Eligibility and Equity, 2) Regulatory Framework and Respect for Autonomy, 3) Logistical and Organizational Aspects, 4) Professional Education and Training, 5) Public Awareness and Information, and 6) Research. The elements and recommendations discussed in this paper could offer valuable insights for expanding access to psilocybin-assisted psychotherapy in other jurisdictions, particularly in global contexts where similar barriers to care exist.

La bouche en fin de vie

Marie Simon
In the West culture, the mouth of a patient at the end of life is laden with representations. It is simultaneously a place of tenderness, speech, physical interaction, and sensory pleasure. As life draws to a close, the loss of autonomy becomes more pronounced, and gradually, the deteriorating individual becomes dependent on others to compensate for their loss of independence. They can no longer manage their oral hygiene alone. The mouth, once powerful, deteriorates. We can observe that the representations we have of this robust mouth change as the person approaches death. Thus, our perceptions differ when observing the mouth of someone nearing the end of life.This reflection stems from a daily observation within healthcare services: this orifice is unfortunately too often neglected by health professionals, due to feelings of revulsion, disgust, or apprehension. This neglect generates numerous problems, affecting both patients and their families, as well as healthcare providers. Therefore, our research question is as follows: what issues surround the mouth at the end of life in Western contexts? Our presentation will aim to highlight these representations in order to better understand, engage with, and identify them, thereby seeking to influence caregiving practices.In this paper, we will reflect on how the mouth, in the process of dying, evokes the gaping sepulcher. Just like the individual, the oral cavity gradually dies. The cultural imprint surrounding this process does not appear to be coincidental.

Entre médecine et philosophie : exploration du rôle du médecin de soins palliatifs dans le soulagement de la souffrance spirituelle (deuxième partie)

Jean-Nicolas Moncion
Pursuing his reflexion on the role of the palliative care physician in the relief of spiritual pain based on a definition of spirituality rooted in the concepts of meaning, value and choice, the author begins by the identification of what spiritual pain is not. Then, grounded on the existentialist philosophy of french author Jean-Paul Sartre, the author explores the impact of the ever growing liberty in the medical domain on spiritual pain. The author identifies the action of choice making as a specific moment of the patient-physician relation where the later can plays a role on spiritual pain relief. Ways of playing that role are then explored.

Lion, caméléon, éléphant : le safari pour illustrer les dynamiques familiales en soins palliatifs / Dr Christian Ntizimira, Le concept de safari: Un cadre africain pour les soins de fin de vie, 2023, 161 pages

Marc Dumas