L’interdisciplinarité pour des soins holistiques en hôpital psychiatrique : pourquoi et comment relever ce défi ?

IF 0.5 4区 医学 Q4 PSYCHIATRY Annales medico-psychologiques Pub Date : 2024-04-01 DOI:10.1016/j.amp.2023.09.013
Patricia Kirkove , Pierre Oswald
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引用次数: 0

Abstract

There is considerable confusion between the terms multidisciplinarity, interdisciplinarity and transdisciplinarity. Multidisciplinarity suggests a juxtaposition of knowledge. The various specialists in their disciplines complement each other and intervene alongside each other around a common subject. This produces points of view, which are superimposed, without bringing out any real added value. Interdisciplinarity requires interaction and interrelation. The pooling of knowledge requires a greater intertwining of disciplines, minimizing the differences between them while preserving their specificities and their foundations. A specialist's robust monodisciplinary expertise enriches the other members of the team, allowing for a more global, more systemic approach. Refusing to approach complex problems through the categorial prism of individual disciplines, transdisciplinarity seeks to integrate disciplines to go between, through and beyond disciplines by completely dissolving traditional boundaries. One of the particularities of complex holistic care, such as that in psychiatry, is that it cannot be managed effectively by a single person or a single discipline. Hyperspecialization results in a segmentation of the human being by no longer taking into account the entirety of the person treated. By analyzing and harmonizing the links between the different disciplines, interdisciplinarity sheds light on complex situations and enriches the responses offered. It improves quality, offers a global approach to the patient by mobilizing knowledge from different disciplines and by defragmenting and decompartmentalizing their knowledge. Interdisciplinarity is not self-evident and it cannot be likened to a simple mode of coordination where complementarity is valued. To meet this challenge, communication, coordination and clarification of roles by the team leader, whose leadership is recognized and valued, are essential. The medical literature recognizes a real added value of interdisciplinary approaches in complex medical situations. Eventually, it may be necessary to go a step further. Nevertheless, transdisciplinarity is of such complexity and requires such maturity of the teams, that we do not support it as the first step toward implementing a patient holistic approach. By way of conclusion, we propose the metaphors that Choi and Pak developed. Multidisciplinarity is in a way a mathematical equation of the “2 + 2 = 4” type or, more daringly, a “salad bowl”, juxtaposition and addition of ingredients or skills. Interdisciplinarity is likened to an equation of the “2 + 2 = 5” type or a “melting pot”, which postulates that the result, due to an effective and harmonious interaction, is greater than the sum of the parts. Finally, they compare transdisciplinarity using a “2 + 2 = yellow” equation with the culinary metaphor of the “cake” highlighting integration.

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精神病院的跨学科整体护理:我们为何要迎接这一挑战?
多学科性、跨学科性和跨学科性这三个术语之间存在着相当大的混淆。多学科性意味着知识的并置。不同学科的专家围绕一个共同的主题,相互补充,相互介入。这样产生的观点是叠加的,没有带来任何真正的附加值。跨学科需要互动和相互关联。知识的汇集需要学科间更大程度的交织,尽量减少学科间的差异,同时保留学科的特性和基础。专家强大的单学科专业知识可以充实团队的其他成员,使他们能够采取更全面、更系统的方法。跨学科性拒绝通过单个学科的分类棱镜来处理复杂的问题,而是寻求通过彻底消除传统的学科界限来整合各学科,在各学科之间、通过各学科并超越各学科。复杂的整体护理(如精神病学)的一个特点是,单个人或单个学科无法对其进行有效管理。过度专业化的结果是不再考虑接受治疗者的整体情况,从而导致人的分割。通过分析和协调不同学科之间的联系,跨学科性揭示了复杂的情况并丰富了所提供的应对措施。它通过调动不同学科的知识,对其知识进行细分和分解,从而提高质量,为病人提供全面的治疗方法。跨学科性并不是不言而喻的,也不能将其比作一种简单的协调模式,在这种模式下,互补性受到重视。为了应对这一挑战,团队领导者的沟通、协调和角色明确至关重要,他们的领导作用得到了认可和重视。医学文献承认,在复杂的医疗情况下,跨学科方法确实具有附加值。最终,可能有必要更进一步。然而,跨学科的复杂性和对团队成熟度的要求都很高,因此我们不支持将其作为实施患者综合治疗方法的第一步。最后,我们提出 Choi 和 Pak 提出的比喻。多学科性在某种程度上是一个 "2 + 2 = 4 "的数学公式,或者更大胆地说,是一个 "沙拉碗",是各种成分或技能的并列和相加。跨学科则被比作 "2 + 2 = 5 "式的等式或 "大熔炉",它假定由于有效和谐的互动,结果大于各部分的总和。最后,他们用 "2 + 2 = 黄色 "等式与突出整合的 "蛋糕 "烹饪比喻来比较跨学科性。
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来源期刊
Annales medico-psychologiques
Annales medico-psychologiques 医学-精神病学
CiteScore
1.30
自引率
33.30%
发文量
196
审稿时长
4-8 weeks
期刊介绍: The Annales Médico-Psychologiques is a peer-reviewed medical journal covering the field of psychiatry. Articles are published in French or in English. The journal was established in 1843 and is published by Elsevier on behalf of the Société Médico-Psychologique. The journal publishes 10 times a year original articles covering biological, genetic, psychological, forensic and cultural issues relevant to the diagnosis and treatment of mental illness, as well as peer reviewed articles that have been presented and discussed during meetings of the Société Médico-Psychologique.To report on the major currents of thought of contemporary psychiatry, and to publish clinical and biological research of international standard, these are the aims of the Annales Médico-Psychologiques.
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