La tendresse des soignants, passager clandestin en néonatalogie ?

Abstract

ObjectivesThe study took place in a neonatology unit, the aim of which was to analyse the different meanings of the signs of tenderness that caregivers might show towards their baby patients. Three hypotheses were put forward to explain tender behavioural attitudes that at first seemed surprising in such a technical and medical environment. The first hypothesis was that tenderness is used as a defense mechanism, an anticathexis, whereby the caregivers underwent violent feelings when taking care of the baby. The second hypothesis is that tenderness resulted from their position of “caring parentalisation”. The concept of caring parentalisation is inspired by Winnicott's primary maternal preoccupation and based on the possibility of sharing feelings between patient and caregiver. This parentalisation would work through a bigenerational, bisensual and biparental psychic position. The third hypothesis is that tenderness is the result of the caregiver's Ego Ideal coming under regular attack when the patient is not getting better or the care given does not meet his/her own expectations, or when the patient does not provide satisfaction. After such an attack, we would notice a tendency to try and repair what had been damaged, through words or gestures of reparation or acting out. Materials and methodsSix professionals working in a neonatology unit accepted to be part of the study, two doctors and four nurses. The protocol consisted of a 30-minute observation of the caregivers. The method of observation was based on E. Bick's fine observation method. Notes were taken immediately afterwards and analysed. There was a 30-minute semi-guided interview with the caregiver, about tenderness in general, parental tenderness and tenderness as a caregiver. ResultsTenderness appeared in every observation, notwithstanding the very different contexts. In each interview, parental tenderness was spontaneously mentioned. Tenderness mostly consists of gestures of patting or wrapping the baby, in the use of certain words, in the tone of the voice and the use of motherese. Regarding the hypothesis of anticathexis: tenderness increases when there is a painful or aggressive moment during caregiving. Denegation was used in interviews, half of the participants referring to what tenderness does not mean to them. Regarding the hypothesis of parentalisation: References to family would rise up in the chosen vocabulary, in the identification to multiple generations (bigenerational) and through the combination of soft and hard elements during care (bisensuality). Gestures and words of reparation, particular prosodies and even acting out in a tender way illustrated now the attacks on the professional Ego Ideal were compensated. ConclusionsTenderness can be used as a professional tool, under certain conditions. The minimal condition to transform these emerging feelings into professional behaviour is to be aware of this emerging tenderness and to share it, avoiding the repression of these feelings that might lead to acting out.