Connaissance infirmière de la personne de confiance et des directives anticipées

Abstract

Le Groupe infirmier en soins palliatifs de Basse-Normandie (GISPBN) a souhaité travailler sur la connaissance qu’avaient les infirmiers des directives anticipées et de la personne de confiance. Un questionnaire a été remis aux infirmiers des établissements publics et privés de Basse-Normandie, exerçant dans les services de médecine, chirurgie, urgences et gériatrie. L’objectif de départ était d’interroger au moins 200 infirmiers dans les trois départements de Basse-Normandie. Cette étude a mis en évidence que les infirmiers connaissent l’obligation de la désignation de la personne de confiance. Ils confondent la personne de confiance et la personne à prévenir et ils ne connaissent pas les directives anticipées. Ce travail fait apparaître comme indispensable la formation des infirmiers à ces dispositifs afin de faciliter l’information aux patients sur leurs droits. “Leonetti's Law” gives French patients the right to draw up advance directives and to designate a health care proxy or “personne de confiance”. However, many questions remain unanswered concerning the role of health care professionals in informing patients of their rights in end of life issues. The Association of palliative care nurses in Basse-Normandie (GISPBN) believed that nurses had insufficient knowledge of these two devices and so were unable to adequately inform patients of their rights. A questionnaire on the subject was devised and distributed among nurses working in medical, surgical, geriatric and trauma departments with the aim of reaching at least 200 nurses in all the departments of the region. The results of this study indicated that nurses tended to consider the designation of a health care proxy as mandatory. There appeared to be a lack of differentiation between naming a health care proxy and naming a personal contact like “next of kin”. A discussion also emerged as to whether or not a health care professional could accept the role of health care proxy. The results concerning advance directives clearly showed a lack of knowledge at all levels. Furthermore, the nurses who responded did not link advance directives to the designation of a health care proxy. It would appear that these devices are not perceived as united by a common concern to safeguard self determination in end of life situations, as promoted by “Leonetti's Law‘”. These results raise the issue of teaching programmes and the importance of placing these subjects in their legal and ethical context, in order to enable nurses to understand the issues at stake and hence better inform patients of their rights.