Soins pénalement ordonnés et positionnements professionnels : des pratiques au carrefour de la Santé et de la Justice

At the crossroad of Health and Justice, penally ordered care underlies professional practices, the articulation of which can turn out to be delicate. Here we tackle the relevance and practical application of these measures. For that purpose, semi-directive interviews and field observations have been conducted with probation agents, judges (who follow up the way sentences are executed) and psychologists. The professionals’ comments and experiences show the complexity of these measures, which intend to make “care” into a recidivism prevention tool. Misconceptions appear about theory, practices and interprofessional relationships. The idea of “care” as a sole medical term appears to be ineffective and calls for the creation of new practices.     

Gender and Sexuality in the Pastoral Encounter

Abstract

At the ‘Embodied Ministry: Gender, Sexuality and Formation’ conference at which the articles in this special issue were delivered, three people in active ministry in different denominations — United Reformed Church, Metropolitan Community Church and Roman Catholic — were invited to take part in a panel discussion on gender and sexuality in the pastoral encounter. Their remarks were originally delivered in this conversational context. Martin Pendergast chaired this panel discussion.     

The impact of a rural or urban context in eating awareness and self‐regulation strategies in children and adolescents from eight European countries

Complex relationships exist between eating behaviour and personal and environmental factors. Rural and urban geographic contexts seem to play a role in eating behaviour, and therefore deserve a deeper study. A healthy eating behaviour and the conditions that promote it are a major issue in the promotion of adolescent health. The study aims to investigate the associations between the area of residence (urban vs. rural), self‐regulation strategies (TESQ‐E) and eating behaviours among children and adolescents. A total of 11,820 adolescents (50.6% girls) participated in the study, with a mean age of 13.30 years (SD= 2.13). Nine countries (The Netherlands, United Kingdom, Poland, Portugal, Denmark, Romania, Germany, Finland and Belgium) completed a questionnaire in the school context, asking about the use of self‐regulation strategies, eating behaviour awareness/care and sociodemographic questions such as age, gender and residential area. Both areas of residence (urban vs. rural) are associated with eating awareness/care in Romania and Portugal, controlling for age, gender and self‐regulation strategies. In some European countries at least, and most probably around the world, health promotion should focus on an ecological approach that includes the understanding of the effect of both environmental factors and personal skills on eating behaviour/awareness.     

Maternal and paternal infant representations: A comparison between parents of term and preterm infants

Objective

Research on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations.

Method

Mothers and fathers of term infants (≥37 weeks of gestational age, n = 71), moderately preterm infants (≥32–37 weeks of gestational age, n = 62) and very preterm infants (<32 weeks of gestational age, n = 56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D).

Results

The three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal.

Conclusion

Given the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations.     

Nonmaternal care hours and temperament predict infants’ proximity-seeking behavior and attachment subgroups

Using the NICHD Early Childcare dataset (N = 1281), this study examined whether infant temperament and the amount of time infants spend in nonmaternal care independently predict (1) the likelihood that they seek comfort from their mother when needed and (2) placement in a particular subgroup of infant-mother attachment patterns. Mothers reported the number of hours their infant spent in nonmaternal care each month and their infant's difficulty adapting to novel stimuli at 6 months. The degree to which 15-month-old infants seek comfort from their mother during reunion episodes in the Strange Situation was observed using two behavioral scales (“proximity seeking” and “contact maintaining”). Their average score forms the outcome variable of “proximity-seeking behavior.” The other outcome variables were the subgroups of infant-mother attachment patterns: two subgroups for insecure babies (resistant and avoidant) and four subgroups for secure babies (B1, B2, B3, and B4). Easy adaptability to novel stimuli and long hours of nonmaternal care independently predicted a low level of proximity-seeking behavior. These predictors also increased the likelihood of an insecure infant being classified as avoidant (vs. resistant). A secure infant with these same predictors was most likely to be classified as B1, followed by B2, and then B3, with B4 being the least likely classification. Although previous studies using the NICHD dataset found that hours of nonmaternal care had no main effect on infants’ attachment security (vs. insecurity), this study demonstrates that hours of nonmaternal care predict the subcategories of infant-mother attachment.     

Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother–infant relationship

Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory–tactile–visual–vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother–infant relationship compared to an attention control group.240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control).Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother–infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability.Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress variable. Kangaroo care mothers showed a more rapid decline in worry than the other mothers. The only interactive dimensions that differed between the groups were child social behaviors and developmental maturity, which were both higher for kangaroo care infants. Change over time in several individual infant behaviors was affected by the interventions. When mothers reported on the interventions they performed, regardless of group assignment, massage (any form including ATVV) was associated with a more rapid decline in depressive symptoms and higher HOME scores. Performing either intervention was associated with lower parenting stress. These findings suggest that as short-term interventions, KC and ATVV have important effects on mothers and their preterm infants, especially in the first half of the first year.     

Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

临床共情与护理技术结合：人性化的护理

临床共情是一种能体验患者内心世界的能力,通过患者的言语和非言语表达,觉察和认识患者情感和情绪需求,并对其做出恰当的回应.临床共情具有科学的理论和实践基础,具有缓解患者心理上的痛苦,改善护患关系,促进患者康复等作用.在当今复杂的医疗环境下,务必要重视共情培养,适时运用临床共情.然而,我们强调临床共情的重要作用,并不能忽视护理技术的根本作用,根除躯体上的病变仍有赖于护理技术的有效性.在临床护理实践中,坚持共情与护理技术的有机结合,推进人性化的护理构建.     

Adult Attachment Dimensions,World View Schemas,and the Psychological Health of Parents of Infants in a Neonatal Intensive Care Unit

This study reports the results of an exploration of the relationship of adult attachment dimensions (closeness, dependence, and anxiety) and world view assumptions (benevolence, meaningfulness, and worthiness) to psychological distress and psychological well-being in 142 parents (71 couples) of newborns recently hospitalized in a neonatal intensive care unit. The results of the Actor-Partner Interdependence Model, hierarchical multiple regression, and mediation analyses showed that parents who were more comfortable with attachment-dependence and parents who held more positive beliefs about benevolence and worthiness had less psychological distress and more well-being. In addition, parents with partners who were more comfortable with attachment-dependence had less psychological distress and more well-being. Attachment-dependence partially mediated the relationships of benevolence and worthiness with psychological distress and the relationship of benevolence with psychological well-being, whereas worthiness had a direct relationship with psychological well-being.