Patient et soignant : qui éduque l’autre ?

Abstract

Aborder l’asymétrie de la relation entre soignants et soignés par un de ces possibles excès, sous la forme de relation d’emprise.Analyse des formes du discours de 45 entretiens de recherche, par observation de la place de la locution de prise en charge (plutôt que d’accompagnement) et le recours au possessif pour désigner un intervenant ou un élément du dispositif de soin.La prise en charge domine, désignant aussi bien une situation, une maladie, qu’une personne (malade), tandis que le recours à un possessif apparaît dans plus d’un tiers des entretiens.Par le choix des mots, peut être perçue la place de l’appropriation et du pouvoir dans le soin, d’abord considéré dans ses dimensions excessives d’emprise, de réification du soigné, qui ainsi peut participer à son aliénation. Cependant, la place d’une forme modérée d’emprise positive ne peut être exclue comme possible modalité d’attachement, de soutien, d’investissement de la relation.The relations between caregivers and cared-for people are in essence asymmetric. Such essential asymmetry can lead to excess between providers and seekers of help or care and can appear with the aspect of an emprise relationship. In order to approach this, a study has observed caregivers choices of words to talk about their interactions with cared-for people.Based on the formal analysis of the discourses of 45 carers (29 hospital nurses and 16 hospital physicians) met during research interviews about their clinical practice with older people, two possible aspects of emprise were observed. They concerned on one hand the use of the naming support (rather than accompaniment) and on the other hand the use of a possessive determinant (my, your, our…) to designate human contributor or a material element of the relation of care or the care device. These two supposed aspects of emprise were chosen among different possible translations of such alteration of care relationship, in order to try to illustrate the hypothesis of a degradation of the care efficiency through a too high positioning of the caregivers.In the 45 studied interviews, as over of clinical experience at hospital and nursing home for elders, and then through a review of literature, it appears that the expression of support becomes predominant, rather than accompanying, designating as well a situation, as a sickness, as a sick person. To be supported, or in literal French language, to be taken in charge associates the two possible meanings of being caught and of being a weight for others. Thus, it might be thought that such approach can lead to takeover, appropriation and emprise. Furthermore, the use of a possessive determiner to refer to a colleague, a cared-person or an element of the care device, significantly appears in more than one third of the interviews. Such choice of words cannot only appear as fortuitous, but can reveal an appropriation of other human beings, like things, and so reifying them as well as alienating them. Even if these two kinds of language choices might seem to be banal, idiomatic, and so frequent that they would have lost their original meaning, the purpose of our analysis is to promote the taking into account of the first meaning of words by themselves, and so help carers to consider some aspects of care relationship through the possible inadequate way of emprise.Such choice of words could reflect an expression of power, of takeover of someone, of appropriation of others in the care relationship. This power, initially considered in an excessive way of emprise, subjugation, desubjectivation, even as reification of cared-people, can participate in alienation, dehumanization and loss of identity of aged people. At the same time, the place of a moderate form of emprise, considered as positive in the care relationship cannot be excluded as a possible method of attachment, support or adjustment of the link to elders, and so weighting the essentially negative approach initially developed.