Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Cette thèse est consacrée à un examen critique des tentatives actuelles pour donner à l’appel à « plus d’humanisme » en médecine un fondement philosophique. En effet, comme je le montre, les deux approches « humanistes » aujourd’hui prédominantes – la médecine narrative et la phénoménologie de la médecine – échouent à donner un sens convaincant au concept même d’humanisme. Les deux approches ont d’abord en commun de se construire en opposition à ce qu’elles appellent le modèle biomédical, mais sont incapables d’en donner une caractérisation cohérente et d’en produire une critique convaincante, qu’elles le considèrent comme un produit de la science (cas de la médecine narrative) ou comme avatar du naturalisme (cas de la phénoménologie de la médecine). En deuxième lieu, les deux approches s’enlisent dans des problèmes qui leur sont propres. La médecine narrative s’appuie sur des thèses problématiques : thèse de l’unicité de l’expérience subjective, thèse de la narrativité. La phénoménologie de la médecine rencontre de son côté des problèmes métaphilosophiques quant à la définition de la phénoménologie elle-même, qu’elle tend à réduire à l’étude de l’expérience vécue ou psychologique. Enfin, je critique la stratégie qui leur est commune, consistant à mettre l’empathie au centre de leur conception de l’humanisme. J’esquisse pour conclure une voie possible pour reformuler le problème initial et déplacer la discussion vers des questions de justice et d’accès aux systèmes de santé. / This dissertation is a critical appraisal of contemporary attempts at giving a philosophical basis to the claim that medicine is in need of “more humanism”. I argue that two prominent medical “humanistic” approaches today – narrative medicine and phenomenology of medicine – fail to give a convincing account of the concept of humanism. Both approaches are reactions against what they call the biomedical model, yet they fail to provide either a coherent account or a convincing criticism of that model, whether they define it as an instance of science (as does narrative medicine) or as a product of naturalism (as does phenomenology of medicine). Moreover, both approaches founder on issues in their own terms. Narrative medicine is built on problematical theses, notably the narrativity thesis and the singularity of subjective experiences thesis. Meanwhile, phenomenology of medicine runs into meta-philosophical obstacles regarding the definition of phenomenology itself, notably by reducing it to the study of lived or psychological experience. Finally, I criticise what brings together their humanistic strategy and which consists in putting empathy at the centre of their definition of humanism. By way of conclusion, I then sketch an alternative path for medical humanism, focused on issues of justice and access in health systems.

Terapeuter ingår i riskgruppen för utvecklandet av psykisk ohälsa. Det finns både risk- och skyddsfaktorer som påverkar compassion fatigue (CF) - empatitrötthet - och sekundär traumatisk stress (STS) hos terapeuter. Forskningen visar att traumaarbete upplevs såväl positivt som negativt. Syftet i föreliggande studie var att beskriva terapeuters upplevelser om CF och STS. Därtill att ta reda på om detta kunde relateras till terapeuten själv och arbetsvillkoren samt vad som tycktes ha betydelse för att undvika CF och STS. En litteraturstudie gjordes där artiklarna analyserades genom kvalitativ innehållsanalys. Resultatet innehåller ett huvudtema; Att arbeta med människors trauma är ett privilegium, samtidigt har det sitt pris och sju subteman. I studien diskuteras CF och STS utifrån att det som terapeut i traumaarbete är oundvikligt att drabbas samt att dessa fenomen behöver vara pratbara. Dessutom framkom källor till resiliens. / Therapists are at risk of developing mental illness. Research shows that working with traumatreatment gives both positive and negative experiences. There are both risk and protective factors that affect Compassion Fatigue (CF) and Secondary Traumatic Stress (STS). The aim of this study was to describe therapists' experiences of CS and STS. Furthermore finding out if they could be related to the therapist in person and working conditions as well as if certain elements were important to avoid CF and STS. A literature study was carried out where articles were analyzed using a qualitative content approach. The result includes a main theme; “Working with people ́s trauma is a privilege, at the same time it has its price” and seven subthemes. CF and STS are thereafter discussed based on the idea of the importance that these phenomena are known and that as a traumatherapist it is inevitable to be affected. In addition sources of resilience emerged.

Den här studien har undersökt huruvida det föreligger något samband mellan prokrastinering, self-compassion och livstillfredsställelse. Det har även undersökts om studenter prokrastinerar i högre grad än de som arbetar. Studien har genomförts med en enkät som delats på internet och som till största delen spridits i Facebook-grupper. Det var 96 respondenter som svarade på enkäten och av dessa arbetade 61 personer och 35 studerade. Genom histogram framkom att underlaget för prokrastinering och livstillfredsställelse inte var normalfördelat. För att testa huruvida det föreligger någon signifikant skillnad mellan de som arbetar och de som studerar avseende prokrastinering, har det icke-parametriska testet Mann Whitney U använts. Resultatet visade att en signifikant skillnad föreligger och det är studenterna som i genomsnitt prokrastinerar i högst grad. Även skillnaden i grupperna avseende livstillfredsställelse testades med Mann Whitney U och en signifikant skillnad återfanns även här. Self-compassion jämfördes mellan studenter och arbetande med ett oberoende t-test, men någon signifikant skillnad förelåg inte. Vidare genomfördes korrelationsundersökningar, vilka testades med Spearman´s rho. Resultatet visade att det förelåg signifikanta korrelationer mellan prokrastinering och self-compassion samt self-compassion och livstillfredsställelse, men korrelationerna var relativt svaga. Slutsatsen blev således att studenterna prokrastinerade i högre grad än de som arbetade och att det fanns en signifikant negativ korrelation mellan prokrastinering och self-compassion samt en signifikant positiv korrelation mellan self-compassion och livstillfredsställelse. / The present study has examined whether there is any correlation between procrastination, self-compassion and life satisfaction and also whether students procrastinate to a greater extent than those who work. The study was conducted with a survey that was shared on the internet and was mainly distributed in Facebook groups. There were 96 respondents who answered the questionnaire and of these 61 worked and 35 studied. Histograms showed that the substrate for procrastination and life satisfaction was not normally distributed. To test whether there is any significant difference between those working and those studying when it comes to procrastination, the non-parametric Mann Whitney U test has been used. The results showed that there is a significant difference and it is the students who, on average, procrastinate most. The difference in life satisfaction groups was also tested with Mann Whitney U and a significant difference was also found here. The results from the self-compassion scale were tested with an independent t-test, and no statistically significant result was found. Correlation studies were also conducted, which were tested with Spearman´s rho. The results showed that there were significant correlations between procrastination and self-compassion as well as self-compassion and life satisfaction, but the correlations were relatively weak. The conclusion was that the students procrastinated to a greater extent than those who worked, and there was a significant negative correlation between procrastination and self-compassion and a significant positive correlation between self-compassion and life satisfaction.

No description available.

Sekundär traumatisk stress är ett problem inom socialt arbete. Begränsad forskning finnsangående hur det skulle kunna förebyggas samt behandlas. Syftet med litteraturöversikten vardärför att sammanställa kunskapsläget av befintlig litteratur angående faktorer som förebyggersamt behandlar sekundär traumatisk stress hos socialarbetare. Studien avsåg även att undersökavilken effekt faktorerna hade. Litteraturöversikten utgick från metodiken av en scoping review.Datamaterialet bestod av 15 vetenskapliga artiklar. Samtliga artiklar analyserades medinnehållsanalys, ytterligare gjordes en narrativ sammanställning av de kvantitativa artiklarna.Resultatet visar att individuella faktorer som att kunna hantera sina känslor i olika situationeroch sammanhang samt att utföra egenvård, är exempel på betydelsefulla förebyggande ochbehandlande faktorer. Regelbunden handledning samt stöd från chefer och medarbetare, ärexempel på organisatoriska faktorer som hade en betydande roll i det förebyggande ochbehandlande arbetet mot sekundär traumatisk stress. / The purpose of this study was to compile the state of knowledge in the existing literature aboutfactors that prevent and treat secondary traumatic stress in social workers. The study also aimedto investigate the effect of the factors. This literature review was based on the methodology ofa scoping review. The data was contained by 15 different scientific articles. All these articleswere analyzed by content analysis, and further there were a narrative compilation of thequantitative articles. The results of the study show individual factors like to be able to deal withtheir emotions in different kind of situations and contexts, and to perform selfcare, are someexamples of meaningful factors. Regular guidance and support from managers and other coworkersare some examples of important organizational factors in the prevention and treatingwork against secondary traumatic stress.

The current study examined the impact of resilience and self-compassion on the relationship between combat exposure and psychological outcomes, specifically post-traumatic stress and post-traumatic growth. Service members and veterans with combat exposure (N = 143) completed an online survey, through which they were administered a Background Questionnaire, the Combat Exposure Scale, the PTSD Checklist for DSM-5, the Posttraumatic Growth Inventory, the Connor-Davidson Resilience Scale, and the Self-Compassion Scale. Results of a path analysis revealed a positive direct effect of combat exposure on post-traumatic stress symptoms and post-traumatic growth and a negative direct effect of self-compassion on post-traumatic stress symptoms. Furthermore, self-compassion moderated the relationship between combat exposure and post-traumatic growth. Implications of these findings and future directions for research are discussed.

No description available.

Abstrakt   Bakgrund: Akutsjuksköterskan förväntas bedriva en personcentrerad vård där vårdtagarens emotionella, medicinska och existentiella krav tillgodoses. Vid hög arbetsbelastning tvingas personal prioritera medicinska aspekter vilket leder till att etiska och psykosociala aspekter får vänta. Compassion fatigue är ett fenomen som uppstår i vårdanden yrken genom en långvarig exponering av empatiska påfrestningar. Compassion fatigue leder till beteende-, känslomässiga och fysiska förändringar hos sjuksköterskan vilket kan medföra svårigheter att identifiera vårdtagares upplevelser, eller reaktioner, både fysiskt, mentalt, socialt och existentiellt. Detta kan leda till en osäker och otrygg vårdmiljö och riskera att hota patientsäkerheten.  Syfte: Syftet var att identifiera och beskriva faktorer som bidrar till compassion fatigue hos sjuksköterskor på akutmottagningen.  Metod: En strukturerad litteraturöversikt med inspiration från en systematisk litteraturöversikt och en kvantitativ ansats. Sökningarna genomfördes i databaserna CINAHL, PubMed och PsychInfo vilket resulterade i 17 inkluderade artiklar. Dataanalys har genomförts utefter Bettany-Saltikov och McSherry. Resultat: Resultatet sammanställdes till fyra kategorier och presenteras i Demografiska faktorer, Arbetsrelaterade faktorer, Arbetsrelaterade känslor som faktor samt Yttre faktorer. Resultatet visar flertalet faktorer som bidrar till compassion fatigue bland annat att upplevd fysisk och psykisk hälsa inom demografiska faktorer minskade utfallet av compassion fatigue.  Inom yttre faktorer påvisas det att psykosocialt stöd från chefer och kollegor minskar förekomsten av compassion fatigue.   Slutsats: Litteraturöversikten identifierar och beskriver flertalet faktorer som statistiskt signifikant påverkar CF både negativt och positivt. Vidare forskning krävs då resultatet ger en spridd bild med betydande faktorer samt bristen av studier utförda på akutmottagningar i Sverige. / Abstract   Background: Emergency nurses are expected to provide person-centered care that meets the emotional, medical, and existential needs of patients. During times of high workload, staff members are forced to prioritize medical aspects, which results in ethical and psychosocial aspects being put on hold. Compassion fatigue is a phenomenon that occurs in caregiving professions due to prolonged exposure to empathic stressors. Compassion fatigue leads to behavioral, emotional, and physical changes in nurses, which can make it difficult to identify patients' experiences or reactions, both physically, mentally, socially, and existentially. This can lead to an insecure and unsafe care environment and pose a risk to patient safety. Purpose: The purpose was to identify and describe factors contributing to compassion fatigue in nurses in the emergency department.Method: A structured literature review inspired by a systematic literature review and a quantitative approach was conducted. Searches were conducted in the CINAHL, PubMed, and PsychInfo databases, resulting in 17 included articles. Data analysis was carried out according to Bettany-Saltikov and McSherry. Results: The results were compiled into four categories and presented as Demographic factors, Work-related factors, Work-related emotions as factors, and External factors. The results show several factors contributing to compassion fatigue, including perceived physical and mental health within demographic factors, which reduced the outcome of compassion fatigue.In the external factors category, it was found that psychosocial support from managers and colleagues reduces the incidence of compassion fatigue. Conclusion: The literature review identifies and describes several factors that statistically significantly affect CF both negatively and positively. Further research is needed as the results provide a scattered picture with significant factors, as well as the lack of studies conducted in emergency departments in Sweden.

Le mantra de la compassion fascine depuis très longtemps de nombreux chercheurs de tous bords et de différentes époques. Ces derniers semblent cependant s’être toujours plus intéressés à sa signification plutôt qu’à sa fonction, son usage ou son utilité. Ce mémoire, qui se base sur l’expérience d’un travail de terrain ethnologique au sein d’un centre bouddhiste affilié à l’école guélougkpa, vise autant à se rapprocher de l’authenticité de sa signification que d’un usage de la formule pouvant être utile afin de protéger l’esprit. L’une des traductions du mot mantra est « protection de l’esprit ». Nous nous intéresserons particulièrement à notre objet sous le prisme de sa performance. La question du sens de la formule sera progressivement déplacée d’une dimension statique et sémantique à une autre plus dynamique et métapragmatique. Nous profiterons notamment des outils fournis par l’ethnomusicologie afin d’observer la part prise au sein de cette protection par les composantes musicales de la récitation. Ce travail sera aussi l’occasion de rassembler différentes théories et plusieurs concepts occidentaux au sein d’un même cadre théorique. La cadre de la sémiologie de la musique proposé par Molino et Nattiez, constituera une fondation étique solide à laquelle nous tenterons d’intégrer et d’articuler deux autres pensées majeures : la pensée austinienne de la « performativité » et la conception bachelardienne des images. Une fois nos outils d’observation affinés, nous regarderons mieux comment doit être comprise la « compassion » au sein de l’épistémè bouddhiste tibétaine, comment celle-ci est évoquée au sein de notre terrain de recherche et le lien tout à fait particulier qu’elle entretient avec le mantra qui porte son nom. La performance du mantra sera considérée comme étant, et au moins partiellement, une manifestation sonore de cette compassion. / The mantra of compassion has long fascinated many scholars from all walks of life and from different eras. However, they seem to have always been more interested in its meaning than in its function, use or utility. This M.A. thesis, which is based on the experience of ethnological fieldwork in a Buddhist center affiliated with the gelugkpa school, aims to get closer to both the authenticity of its meaning and to a use of the formula that may be helpful in protecting the mind. One of the translations of the word mantra is "protection of the mind". We will be particularly interested in our object under the prism of its performance. The question of the meaning of the formula will then be progressively moved from a static and semantic dimension to a more dynamic and metapragmatic one. We will use the tools provided by ethnomusicology, to observe the part taken by the musical components of the recitation in this protection. This work will also be an opportunity to bring together different theories and several Western concepts within the same theoretical framework. The framework of the semiology of music proposed by Molino and Nattiez, will constitute a solid etic foundation to which we will try to integrate and articulate two other major thoughts: the austinian thought of the "performativity" and the bachelardian conception of images. Once we have refined our tools of observation, we will look more closely at how "compassion" is to be understood within the Tibetan Buddhist episteme, how it is evoked within our research field and the very particular link it has with the mantra that bears its name. The performance of the mantra will be considered as being, at least partially, a sound manifestation of this compassion.