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In a healthcare facility, the way in which health professionals envisage quality can explain the different levels of investment observed. Documentary research into the representations of quality among caregivers identified the human and regulatory dimensions which influence their engagement. It opens up prospects for the involvement of lead nurses for quality, trained in encouraging a change of perspectives and the appropriation of a quality culture.

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The deployment of quality approaches in hospitals and the evolution of the place of users in the health care system is resulting in patients becoming more involved in the quality of care. Taking into consideration the contribution of collaborative practices is necessary in order to enable patients and caregivers to work together effectively, and to improve the quality of care. Finally, the recognition of patients' expertise and the implementation of adapted methods allow different points of view to come together and decisions to be made jointly.

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Healthcare research is developing in France, notably through hospital nursing and paramedical research programmes. Few research projects involve the patients as investigators as part of collaborative studies. These approaches favour the involvement of all the players concerned. Thereby, healthcare research, due to its holistic dimension, encourages the development of collaborative practices between researchers, patients and caregivers.

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In the context of the evolution of care practices, continuing training enables caregivers to keep their practices up-to-date and to treat the patient more as a whole, by drawing on their experience in the field. Trainers support them in the development of academic and practical skills for which the expertise of patients plays a significant and recognised role. Patient-trainers enable caregivers to understand the constraints of chronicity and its treatment, not always visible when a purely clinical approach is adopted. They also help to raise awareness of the capacities for action and adaptation.

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Haemophilia: how sentinel patients have developed warning semiotics. The experience of the disease may help the patient to develop effective actions to manage every day, if it is accompanied by a personal reflection. Following a process that sometimes can be long, some people with hemophilia, called sentinel patients have developed a personal semiology of early and subclinical signs of hemarthrose, complementary to medical semiology. Learning such an approach can be made possible within therapeutic education workshops co-facilitated by patient/parent and caregiver resources. Facilitated by peer intervention, the expression of singular feelings of early signs, helps patients reflect on strategies adapted to their situation and conducive to faster adequate reaction towards their bleeding episodes, particularly through self-care actions. This collaborative work between patients and caregivers also brings benefits to professionals who, for some, consider differently the care they provide to people they meet in their healthcare activity.

Hémophilie : comment des patientssentinelles ont élaboré une sémiologie d'alerte. L'expérience de la maladie peut aider le patient à développer des actions efficaces pour la gérer au quotidien, si elle s'accompagne d'un travail de réflexion personnelle. À la suite d'un processus parfois long, certaines personnes hémophiles, appelées patients sentinelles, ont développé une sémiologie personnelle de signes précoces et infracliniques d'hémarthrose, complémentaire de la sémiologie médicale. L'apprentissage d'une telle démarche s'avère possible dans le cadre d'ateliers d'éducation thérapeutique co-animés par des patients/parents ressources et des soignants. Facilitée par l'intervention des pairs, l'expression du ressenti singulier des signes précoces aide les patients à réfléchir à des stratégies adaptées à leur situation et favorables à la prise en charge plus rapide de leurs accidents hémorragiques, notamment à travers l'auto-soin. Ce travail de collaboration entre patients et soignants apporte également des bénéfices aux professionnels qui, pour certains, envisagent différemment la prise en charge des personnes qu'ils rencontrent dans leur activité de soins.

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Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care.

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