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Master Thesis

Validation finale d'un questionnaire explorant la dimension éthique du soin en psychiatrie, le QDES, du point de vue des patients, lors de l'hospitalisation en psychiatrie

Abstract : Objectives: Hospitalization in psychiatry is a place of care but more generally a home for suffering. From our point of view, ethics and therapeutics are intimately linked in the same dynamic in order to achieve subject constitution and personal realization. Care involves a properly ethical approach as it takes into consideration the patient in a global dimension. Therefore, being able to assess patients’ feelings during such an experiment seemed important as literature provides little data. The objective of our study is to validate a questionnaire - the Questionnaire Exploring the Ethical Dimension of Care in Psychiatry “QDES” - to study the perception and experience of patients hospitalized in the psychiatric department. Methods: The first version of the “QDES” is comprised of 16 items divided into four dimensions: “atmosphere in the department”, “relationship with caregivers”, “hospitalization effects” and “feelings related to hospitalization”. Recruiting was done at l'Hôpital de la Conception in Marseille (France) between August 2018 and March 2019. The patients recruited (91 in total) had to have been hospitalized for more than seven days in one of the psychiatric wards taking part in the study, had given their consent, and had a sufficient level of proficiency in French. Patients had to fill the 4-PAS scale of therapeutic alliance and three Visual Analogic Scale (VAS) exploring therapeutic alliance, hospitalization satisfaction and state of health at the end of hospitalization. Caregivers had to fill the Clinical Global Impression Severity Scale (CGI-Severity) and the Global Functioning Scale (GFS). Item sorting and questionnaire validation were based on the analyses of answers distribution and principal components. External validity was also explored and was based on Pearson’s correlation study between our questionnaire and various validated scales as well as certain sociodemographic data, and we compared averages with a Student’s t-test. Results: The final version of the “QDES” is comprised of 16 items divided into three major dimensions: “atmosphere in the department and relationship with the caregivers”, “hospitalization effects” and “feelings related to hospitalization” returning 54.2% of the total variance. The alpha coefficients of Cronbach range between 0.78 and 0.83 and demonstrate good internal consistency. The external validation stage shows a significant positive correlation between the “QDES” and the 4-PAS scale (r = 0.25; 0.65), the VAS “therapeutic alliance” (r = 0.3; 0”48), the VAS “satisfaction” (r = 0.43; 0.64), the VAS “state of health” (r = 0.25; 0.43). The Student's t-test revealed a statistically significant difference in the hospitalization experience for two categories of patients: those who were first hospitalized (t-test = - 2.286, p = 0.025) and those who live in couples with children (t-test = - 3.654, p = 0.003). In contrast, no other significant correlation existed between the “QDES” and the length of hospital stay, the age and the gender of patients, the CGI-Severity or the GFS. Only one significant positive correlation exists between the GFS and one of the dimensions of the “QDES”: “feelings related to the hospitalization” (r = 0.23). Conclusion: The literature review confirmed that there is no questionnaire concerning psychiatric hospitalization that collects the feelings of patients from the specific angle of medical ethics. Most of the literature dealt with the issue from the caregiving point of view and in the specific situations of isolation and care without consent. As expected, the experience of hospitalization is positively correlated with the satisfaction of hospitalization, the therapeutic alliance and the assessment of his state of health by the patient himself. Moreover, we were able to highlight that more the hospitalization experience is painful, the more the EGF will be pejorative. We can conclude that the caregivers can perceive the arduousness of hospitalization for patients and that the experience of hospitalization influences the improvement of clinical state. The “QDES” can thus be considered as a measurement tool of the hospitalization experience - by the patients - in terms of ethical perspective, presenting satisfactory psychometric properties. It could be used in current practice, institutional reflexion and clinical research by studying the experience of first hospitalization, subject understudied in current literature data.
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https://dumas.ccsd.cnrs.fr/dumas-02518558
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Submitted on : Wednesday, March 25, 2020 - 12:13:33 PM
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Karine Berkouk. Validation finale d'un questionnaire explorant la dimension éthique du soin en psychiatrie, le QDES, du point de vue des patients, lors de l'hospitalisation en psychiatrie. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02518558⟩

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