Research grounded in practice

Transcription

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2 Contents 1. The HES-SO A multicultural city and a wellspring of research competencies 2. Diverse backgrounds, common mission Portraits of researchers 3. Where does inspiration come from? A constant dialogue with professional practice 4. Health AR&D by the numbers 5. To find out more 6. Summary of research projects ( )

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4 Chapter 1 The HES-SO A multicultural city and a wellspring of research competencies With more than students and some employees in the schools, the HES-SO is today a mid-sized city that extends throughout Western Switzerland and the French speaking part of the Canton of Bern. It is a multicultural crossroads where activities take place across six fields of teaching and research. The HES-SO aims for world-class standards in its Applied Research and Development (AR&D) in all its fields of study, while ensuring that research results greatly impact the quality of HES-SO education and the relevant professional circles in the region. To achieve these objectives, the HES-SO orients its institutional policies along three axes of development : Reinforcing the regional impact of research; Promoting research results and knowledge transfer; Diversifying sources of research financing. Aware of the variety of research practices within it, the HES-SO entrusts the development of appropriate AR&D strategies to the various departments, enabling the achievement of its institutional objectives. The particulars of these strategies are aligned complementarily with those of other universities of applied sciences in Switzerland. AR&D activities are led from within the schools of the HES-SO themselves. Because of this, the HES-SO encourages the building of networks of competencies and internal collaborations, especially between different disciplines. Research project management is intentionally designed to give the various players involved the opportunity to act autonomously, according to their research traditions, in their specific contexts, and with their partners in the field. Many of the HES-SO s schools have been awarded key roles in European research projects, reinforcing its strong reputation in the international arena. 5 The HES-SO

5 The Department of Health By number of students, the Department of Health is the third largest in the HES-SO. It encompasses the following eight educational programmes : Bachelor s programmes Midwifery Nursing Nutrition and Dietetics Occupational Therapy Physiotherapy Psychomotor Therapy Radiologic Medical Imaging Technology Master s programme (in collaboration with the University of Lausanne) Master in Nursing Sciences Over the last six years, the various programmes have experienced a significant increase in the number of students, showing the popularity of this education. This point is encouraging since it shows we are moving towards the increase in graduate numbers that is needed to address the shortage of staff employed in the health professions. Applied Research and Development in the Department of Health There has been considerable progress in research since the integration of the Department of Health in the HES-SO. This has come about thanks to specific impetus at the level of the HES-SO, the national level with the Swiss National Science Foundation s DORE programme, and at the cantonal level with partial financing of research activities. Research is organised and built around four networks of competencies. These address issues of: cultural diversity and citizenship within the health and social fields (CEDIC); innovative thinking about the actors, relationships, challenges, and new relationships within the confines of the different health and social fields, professions, or disciplines (RECSS); themes touching on health practices, rehabilitation and reintegration (Ré-Sa-R); and finally issues of health, social, and family policies (REA). The HES-SO 6

6 The Department of Health aims for two ends with its research activities : Developing research within the various departments while optimising the transfer of results to the degree and continuing education programmes; Developing projects for innovation in professional practice. To achieve these ends, the field aims to reinforce the different means of implementation, mainly on the organisational, communications, promotion, and financial resource fronts. On the other hand, defining research priorities represents an important task for each programme. Taking into account national and international priorities with regard to health, the Department itself has outlined five priority themes : 1. Demographic evolution (aging, end of life, chronic need, migration, change of family structures). 2. Socio-health systems (economic, organisational, insurance-related, access to care). 3. Development and evaluation of tools and of clinical and technical competencies. 4. Prevention, health promotion. 5. Rehabilitation, reintegration. The Department of Health is committed to reinforcing the research skills of its professorial corps and promoting collaborations among different programmes and departments as well as with national and European research networks. Furthermore, it is particularly attuned to the needs and expectations from the practice environment, whether that be in initiating research or provi-ding services. 7 The HES-SO

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8 Chapter 2 Diverse backgrounds, common mission Portraits of researchers When speaking of research, it is important to first introduce the researchers. Mission impossible in so few pages! However, to offer a glimpse, here are four portraits that illustrate the variety and richness of skills and the fields explored. 9 Portraits of researchers

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10 I am first and foremost a curious clinician. Jérôme Favrod HES-SO Professor (HEdS La Source Nursing) A constant drive to understand and improve the quality of care given to people with mental health issues, handicaps or differences led Jérôme Favrod to become an HES Professor. He studies patient problems in order to find answers and improve nursing practices. His work is done in partnership with professionals in the field and patients themselves, as he continues a clinical activity. To be a researcher is to combine methodological rigour with creativity in order to resolve the challenges encountered. With clinical and scientific skills, he directs a variety of research projects and helps educate the next generation as advisor to Master s in Nursing Sciences students. Nursing researchers are distinguished by their desire to better understand those human responses that are dysfunctional in the face of health problems, and then to improve care in order to help patients adapt to the challenges arising from their health conditions. The researcher must develop alliances with patients and their care teams. Jérôme Favrod looks to other disciplines to identify means to address problems that do not currently have solutions in practice. For example, he explains that a basic research study showed that people who experience auditory hallucinations and read words aloud or in their heads have a tendency to mix up what they think with what they have said. Based on this finding, he is conducting a study on metacognitive training aimed at helping these patients become aware of their cognitive biases and reduce persistent psychotic symptoms. Offering a little word of advice, he points out that one must take editorial policy very seriously and aim for international publications. One has to enjoy having fun, taking things on, taking risks, and challenging the facts. 11 Portraits of researchers

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12 It s in facing research that you learn, you learn by doing... Séverine Rey, HES-SO Professor (HESAV Radiologic Medical Imaging Technology) A desire to conduct research led Séverine Rey to first follow a classical academic route before turning to applied research. With degrees in sociology and anthropology, as well as a doctorate in social sciences, Séverine Rey is a researcher in the Radiologic Medical Imaging Technology degree course (TRM). She brings the resources to teach research methodology and guide student work in the TRM degree course. In her research, she develops perspectives of gender social relations and of anthropology of technology, opening diverse fields of study like the impact of male-female ratios in care teams, or the technological culture in TRM work. She is also interested in other facets of the health field such as attitudes, behaviours and practices. Being a good researcher is a matter of experience and time, notes Séverine Rey. She explains that, despite all the seminars, workshops, lectures, it s really the moment you find yourself facing research that you learn, you learn by doing. This implies having good conditions, availability between teaching time, followthrough of projects in progress or new projects to submit. Having time means being able to discuss ideas, inform oneself, work in teams, share between academic environments, internationally... For Séverine Rey, research is a continuous process, a cycle that repeats itself, because, she notes, often the conclusion of a research project brings new questions, work undertaken brings new prospects. Finally, she highlights the importance of preserving a certain amount of academic freedom for HES researchers in order to keep enough room to manoeuvre, even with themes that may seem to not be applied research at first glance, but that in the end feed the field with new health questions to investigate. 13 Portraits of researchers

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14 Research, it s also about bringing the expertise of clinicians to the fore... Patricia Perrenoud, HES-SO Professor (HESAV Midwifery) Research within the Midwifery programme develops along several lines. The sciences of midwifery, psychology, socio-anthropology and education science are the disciplines investigated to develop knowledge around birth. To meet Patricia Perrenoud, one of the researchers, is to discover this universe. Patricia Perrenoud came to research thanks to the rich interaction within interdisciplinary teams she worked with. Interested by the idea of putting professional practice to the test, she launched into the game, first with a passion for Evidence-Based Practice. She accordingly questioned the status, the construction and the transmission of professional knowledge. It was the beginning of a doctorate examining creativity, and spontaneous forms of thought and selfreflection. What motivates Patricia Perrenoud today is the study of professional competencies in action. If Evidence-Based Practice contributes in part to determining professional actions, the study of practitioners helps contribute to a more complete and nuanced understanding of the professional field. Patricia Perrenoud is intrigued by the connections between group and individual expressions of speech and professional practice. She studies how circumstances, constraints and resources, as well as personal histories all come into play in the development and variations of expression. These elements therefore contribute to the richness and diversity of a profession. As starting points to begin a research activity, she suggests taking the time to sense what you are passionate about, identifying the subjects that motivate you, and choosing a field that is relevant and suits you. Her own wish? It s to better understand what happens around a birth experience today to contribute to its evolution tomorrow. 15 Portraits of researchers

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16 Conducting research to see things changing... Lara Allet, HES-SO Professor (HEdS-GE Physiotherapy) It was while doing a Master s programme that this physiotherapist trained in Valais discovered her passion for research. She wanted to pursue studies to find answers to questions that emerged in her clinical practice. She isn t satisfied with simply knowing that things should be done in this or that way she wants to know why, to truly understand. It s what she calls her perfectionist side. It was a clinical situation that revealed her desire to pursue studies to her : It was recommended to use quadripod as a walking aide in certain situations, but her experience told her the opposite. How to get beyond this contradiction? This was the starting point of her career as a researcher. Having earned a PhD in Physiotherapy at the University of Maastricht, she is currently in charge of research and quality in physiotherapy at the HUG (Hôpitaux universitaire de Genève) and an HES Professor. It was essential for her to find a job in which the everyday situations of rehabilitation would be able to feed her scientific activity. Balancing a double activity as both clinical and academic researcher requires passion, professional ambition and also endurance. These abilities are essential, she explains, because, while extremely satisfying, we take plenty of hits, getting turned down for funding, articles rejected... Of German mother-tongue, she teaches in French and previously did a postdoctoral fellowship in the US. This trilingualism is a valuable asset for a Swiss researcher. It enables her to expand her network and maintain international activity. Focused on the problematic of the analysis of movement, walking and balance for people with chronic conditions (diabetes, obesity, etc.), she seeks above all to conduct research that will bring about practical results doing research to see things change is fundamental for her! 17 Portraits of researchers

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18 Chapter 3 Where does inspiration come from? A constant dialogue with professional practice The distinct character of research in the HES shows above all in the close ties that the researchers maintain with the world of professional practice, from which many also come. Concretely, this continuous dialogue happens in partnership with a variety of health professionals. These professionals take part by validating the questions posed, in some cases participating in the analysis, and especially by handling the implementation of results in the professional context. At the same time, collaboration with universities or other research institutes ensures the flow of scientific knowledge. The following presentations illustrate the questions investigated, the methods used to drive the research, as well as the results that come out of it. They offer an idea of the vitality of the research and the researchers sharp understanding of the reality of the issues that emerge in the health care field. 19 Research

19 Integration of new BSc Nursing graduates into the hospital-based workplace [ Title of research Integration of new BSc Nursing graduates into the hospital-based workplace in French-speaking Switzerland Research team Jean-Luc Berberat, Haute Ecole de Santé Arc, Nursing / Danielle Bulliard Verville, Haute école de santé Fribourg, Nursing /Béatrice Perrenoud, CHUV Partners CHUV (Centre hospitalier universitaire vaudois) / Hôpital fribourgeois Financing SNSF 1 DORE 2 1 Swiss National Science Foundation (SNSF) 2 Do Research (DORE) There is great concern over a shortage of qualified nurses in Switzerland as the aging population means more and more people in care. Attracting and retaining well-trained nurses is becoming difficult as the profession seems unattractive (poor working conditions, perception of low salaries, lack of recognition and autonomy in the profession, absence of career prospects). Yet, it is recognised that the first year of work is a determining time for the ensuing career path. The failure of professional integration can lead to serious economic, practical and personal consequences. These elements highlight the issue of attracting and retaining newly qualified nurses to the workplace. A research project was begun in 2010 to explore the multiple factors that influence new graduate nurses integration into a first job. The questions investigated are as follows : How will they adapt to their first position? What resources do institutions draw upon to help new staff members integrate? What role does their education play when it comes to the workplace integration process? Information is gathered from two groups : newly graduated nurses and their colleagues who accompany them through their integration period. Participants in this study are employees of two cantonal hospitals in French-speaking Switzerland, the Centre hospitalier universitaire vaudois (CHUV) and the Hôpital cantonal de Fribourg. integration of nurses since a universitylevel programme was implemented (Bachelor s in Nursing). It should enable us to identify the strengths and weaknesses of the resources that the socio-health institutions offer to new graduates to help them make the transition from school to the professional environment. The results of this research will be disseminated along the usual routes : science days, publications and oral communication. In order to promote change, particular attention will be placed on informing institutional managers and key players in Frenchspeaking Switzerland. In collaboration with professional associations, a project to make information on professional insertion available through digital and print material is planned, and a monitoring body on this theme may also be established. Jean-Luc Berberat This is the first research project in Research Western Switzerland on the workplace 20

20 Interaction between patient and physiotherapist 21 The care environment readily promotes a patient-centred approach, which is why the development of therapeutic objectives in partnership with the patient is recommended. Although this recommendation is promoted by professional associations and by scientific theory, nothing is really known about this practice. The goal of our study was therefore to film patient-physiotherapist interaction to analyse the ways in which therapeutic objectives were developed. A university hospital as well as two private clinics opened their doors to us to film 37 patients with musculoskeletal problems with nine physiotherapists in action. These interactions were studied through an analysis of their conversations. The results of this qualitative study were surprising to us. The development of objectives is far more complex than the recommendations would have us believe. We observed three different methods of approaching the objectives with the patient. The first is to explicitly ask the question ( and so by the way, what are your expectations with regard to the physio ). This approach frequently leads to interactional difficulties. In reality, this question requires an understanding of physiotherapy and, because of this, can be difficult for the patient to respond to. In analysing these interactions, we realised that the order of the questions offered by the service documentation, if followed to the letter, does not respect the natural course of conversation, thus breaking the dynamic of the interaction. This unexpected result illustrates the importance of the questionnaires used in physiotherapeutic services. The second way to approach the therapeutic objectives relies on the initiative of patients who explicitly ask for a care plan adapted to their needs. This approach is therefore clearly patientcentric, but it rests upon previous experience of physiotherapeutic services. The third approach is to implicitly address the therapeutic objectives and is inherent in expert practice. The physiotherapists ask their patients about their activities and integrate this information to arrive at the therapeutic objectives. In fact, our results put into question the explicit approach of developing objectives which is promoted by clinical recommendations. Furthermore, the influence of the documentation on practice must be taken into consideration. These results have been discussed during presentations and workshops with professionals and have led to questioning about the professional relationship. Veronika Schoeb Research title Analysis of patientphysiotherapist interaction in ambulatory care for musculoskeletal problems Research team Veronika Schoeb, Liliana Staffoni, Haute Ecole de Santé Vaud HESAV, Physiotherapy / Ruth Parry, Alison Pilnick (University of Nottingham) Partners Services de physiothérapie, Centre hospitalier universitaire vaudois (Département Appareil Locomoteur) / Private physiotherapy clinics in Lausanne and Rolle Financing SNSF DORE Research ]

21 Evolution of mammography quality [ Research title Evolution of mammography quality from 1999 to 2007 : impact of the ordinance on guarantee of quality in the detection of breast cancer by mammography Research team Nicole Richli Meystre, Haute Ecole de Santé Vaud HESAV, Radiologic Medical Imaging Technology / Jean-Luc Bulliard, Institut universitaire de médecine sociale et préventive Partners Fondation vaudoise pour le dépistage du cancer du sein and Service de radiodiagnostic et radiologie interventionnelle du Centre hospitalier universitaire vaudois (CHUV) Breast cancer is the most common cancer among women. Currently, screening by mammography is the most effective screening method for early detection of breast cancer. Following the example of numerous countries, quality assurance procedures are mandatory in order to optimise the effectiveness of screening programmes in Switzerland. Given that only a minority of cantons offer organised screening programmes, the vast majority of mammograms are not subject to quality controls. The goals of our study were to (1) quantify the quality of mammograms in Switzerland to understand the temporal evolution thereof, (2) study the impact of quality assurance procedures on mammograms, and (3) identify aspects of quality that could be improved. As a first step, we developed an evaluation grid to be able to class mammograms within four levels of quality (excellent good moderate inadequate). Next, we evaluated the quality of 1832 mammograms, conducted in various hospitals in the cantons of Vaud and Bern. The analysis concerned the proportion of perfect or good images versus inadequate images. of images are more likely to be of good quality. The majority of inadequate images demonstrated a problem in the positioning of the woman and her breasts during the procedure. In order to maintain the course of constant improvement in image quality, it is essential that medical radiology technicians who conduct these exams can develop and maintain the necessary competencies. It also seems to us opportune to align the quality expectations between different regions. The conclusions of our study have led to the initiation of a revision of quality assurance procedures for screening mammograms as well as the creation of a national training plan for mammography for medical radiology technicians. Nicole Richli Meystre Our study revealed a continuous Financing improvement in the quality of mammograms done between 1999 and SNSF DORE But which criteria most particularly influenced the quality? Two elements caught our attention: mammograms conducted with the context of a screening programme and those done within radiology services where Research professionals produce a high number 22

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23 Robotic-assisted walking system for patients with multiple sclerosis [ Research title Effectiveness of roboticassisted walking (lokomat) on quality of life, gait, activity level, and balance in patients with multiple sclerosis Research team Claude Vaney, Brigitte Gattlen, Denise Foinant-Rytz, Anne-Marie Bellwald and Cécilia Palaci, Rita Hausammann Clinique Bernoise Montana / André Meichtry, Roger Hilfiker, HES-SO Valais Wallis, Physiotherapy Partner Clinique Bernoise Montana Financing Clinique Bernoise Montana, HES-SO Valais Wallis Research To no longer be able to walk... this idea scares all of us, but for people with multiple sclerosis, it is ever-present. The illness can progressively reduce their ability to move as it impacts the nervous system, causing loss of strength and balance, as well as affecting muscle elasticity. Reduced motility often negatively impacts physical activity in general, which engenders heart problems. Thus, it is primordial to maintain or improve mobility. The solution? It could be found in rehabilitation. For several years, robotic systems with suspensions that help lighten patients have been used in rehabilitation. The Clinique Bernoise Montana/ Berner Klinik Montana rehabilitation clinic in Bern, specialised in the treatment of multiple sclerosis, contacted us to evaluate whether or not patient rehabilitation with this robotic system is better than classic walking rehabilitation. Multiple sclerosis patients who were still able to walk 10 metres and agreed to participate in the study all followed a classic rehabilitation programme for three weeks. Prior to the rehabilitation, they were randomly selected to receive walking therapy either with the robotic system or else by the classic method. At the beginning and at the end of the therapy during which their balance and walking were tested patients filled out questionnaires about quality of life, pain, mobility, etc. Before and during the programme, accelerometers measured their physical activity; these measurements were redone two and nine months after the end of the programme. The main results showed that the patients in both groups improved and that there were no significant differences observed between them. We arrived at the conclusion that for a multiple sclerosis patient still able to move at more than 2.2 km/h, therapy for walking can be done without the robotic system. However, patients with greater problems walking could benefit from therapy using the robotic system with suspensions. Roger Hilfiker 24

24 Women with early-stage cancer vulvar cancer Despite the fact that cancer is no longer a taboo subject, there are certain tumours we talk about much less than others even though they cause great suffering. We in fact forget that cancer can develop on the vulva (pubis, outer and inner vaginal lips, vaginal entrance or clitoris). Yet, even in the early stage vulvar carcinoma which is affecting ever more young women requires surgical treatment. In 20% to 70% of cases, patients suffer postoperative complications that create physical and psychosocial problems. At the beginning of this study, there was little scientific literature on the experience of symptoms, such as haemorrhaging, nor on the emotional burden that they engender. Without this knowledge, it is difficult for physicians and caregivers to systematically evaluate patients experience of postoperative symptoms. This explains why the offering of treatment to diminish symptoms is currently quite unstructured in clinical practice. but also by the stigmatisation of the vulva, a term hardly spoken. This illness seems unspeakable and many women expressed a feeling of shame that held them back from consulting a physician or even telling those close to them. On the basis of the interviews and expert consultations, 31 symptoms and information needs were identified and placed in a symptoms journal. This journal was distributed to eight university clinics in Switzerland and Germany, to be given to patients in the post-operative phase. The results of this investigation, which included 54 patients, show that they experience on average 20 symptoms over the seven days following their discharge from hospital. It should be noted that among the most painful experiences were : sitting, taking on daily activities, and the symptom of an open scar. This journal outlines potential symptoms for patients and also encourages them to share their experience and to express their difficulties in communicating. The results of this study will enable the development of resources so that the women affected will now benefit from more appropriate advice, care and treatment. ] Research title A new symptoms journal for women with early-stage vulvar cancer Research team Beate Senn, University of Basel / Manuela Eicher, Haute école de santé-fribourg / Michael D. Mueller, Bern University Hospital / Sandra Engberg, Universities of Basel and Pittsburgh A team of specialists in nursing sciences from universities, universities of University clinics of Berlin, Partners applied sciences and university hospitals, Dusseldorf, Freiburg, Munich as well as the chief of a gynaecology (Germany); and of Basel, Bern, unit decided to conduct a research Zurich, as well as the cantonal hospital of St. Gallen project that included : Manuela Eicher (Switzerland) Open interviews with women affected; Financing The creation of a symptoms journal for clinical practice and research; Fondation recherche Suisse contre le cancer An investigation of descriptions of postoperative symptoms and information needs. The interviews conducted with women confirmed that they were not only distressed by symptoms, Research

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26 Accompaniment of new mothers throughout the birth process 27 In our western society, the birth of a child is generally seen as a natural and happy event. In the collective imagination, one naturally becomes a mother at the moment of giving birth. But is it always so simple and obvious? A few decades ago, a young woman entering motherhood received support and day-to-day teaching from her family circle. Nowadays, families are often spread out geographically and due to this, mothers no longer have the benefit of familial support. On the other hand, new fathers are more and more involved with their children. In parallel to these socio-familial changes, health professionals are developing teaching programmes and information to assist mothers both in the pre- and post-natal periods. But do new mothers need this advice and education offered by caregivers? It s to answer this question that we conducted semi-directed interviews six weeks postpartum with 60 firsttime mothers who delivered with the collaboration/partnership of midwives in the maternity ward of the Hôpitaux Universitaires de Genève (HUG). The principal results of this research show that birth is perceived as a succession of stressful events that require new mothers to adapt by drawing upon personal and professional social support. The main events perceived as stressful concern breastfeeding (83%), organisation of the household (81%), and the child s schedule and crying (75%). We note that midwives are significant for the mothers. The level of satisfac- tion with this professional support is linked to the nature of events: concerning breastfeeding, for example, the mothers expect a sympathetic understanding and recognition of their competence. With regard to the infant s crying, mothers want to understand what the cries signify and expect clear information to help them decipher what the child is expressing. Concerning birth preparation education, the women brought up the difficulty to apply these theoretical ideas that were offered too early relative to the experience. The conclusions of this study have enabled a review of the accompaniment of mothers in relation to their needs, particularly in the postpartum period. Scales to measure perceived stress, social support and coping strategies specific to the perinatal period were also developed as a result of this research. They are used to evaluate the impact of these factors on mothers mental health. Chantal Razurel ] Research title Stressful events, social support and adaptation strategies of first-time mothers during the post-partum period Research team Chantal Razurel, Haute école de santé Genève, Midwifery / Marilou Bruchon-Schweitzer, Université de Bordeaux 2 / Anne Dupanloup, Haute école de santé Genève / Olivier Irion, Manuela Epiney, HUG Partners Département de gynécologieobstétrique of the Hôpitaux Universitaires de Genève (HUG) Financing SNSF - DORE Research

27 From dependence to the fridge, between eating compulsion and addiction [ Research title Eating behaviours and nutritional state of patients hospitalised for drug and alcohol detoxification : a transversal multicentred study Research team Maaike Kruseman, Carmen Chuard, Haute école de santé de Genève, Nutrition and Dietetics / Barbara Broers, Jean-Michel Gaspoz, Michel Picard-Kossovsky, Yasser Khazaal, Rita Manghi, HUG Partners HUG (Hôpitaux universitaires de Genève) The telephone rings in the Nutrition and Dietetics Department : professionals working with patients being weaned off of psychoactive substances report that their patients are displaying bizarre eating behaviours nocturnal raiding of the food dispensers, untimely ordering of pizzas. They ask us to treat this eating compulsion and to train caregivers! The literature reports similarities between substance dependence and eating behaviour disorders : loss of control, overwhelming need, obsessive thinking, emotional regulation... Some authors class binge eating disorder as an addiction! Disturbingly, the same substrata, at the neurobiological level, are responsible for the responses linked to the consumption of drugs and of palatable food. We decided to investigate further : perhaps, after having fed themselves on drugs or alcohol so long, the patients are simply hungry and are making up for undernourishment? Perhaps their rhythm of life does not correspond to usual meal schedules? Perhaps they are transferring their need to intoxicate to more accessible substances? Or are these food disorders the precursors of a relapse? The first conclusions are coming forth : the people involved frequently suffer eating behaviour disorders, but it is not to catch up any undernourishment. Their body composition is mostly fine. We are following the trail of weight preoccupation that can lead to food disorders. We are highlighting the benefits of reducing tobacco use : those who cut their cigarette consumption by half have less risk of relapse than others. But this is not unrelated to food disorders, yet another path to follow. This is a fascinating exploration that is shedding some light on eating and substance use behaviours, and offers some interesting prospects for multidisciplinary care practice. Maaike Kruseman Financing SFNS DORE Research We studied 150 patients who agreed to be followed for three months after their detoxification treatment. They reported the substances and foods consumed, and were measured and evaluated. They all answered very personal questions about their social and legal situation, their health conditions, etc. The time with them was captivating and moving. 28

28 Occupational therapy for children with a developmental coordination disorder 29 Developmental coordination disorder (DCD), also called developmental dyspraxia, is little known although it affects 5% to 7% of school age children and can have serious consequences. In fact, children affected by DCD experience difficulties with activities like writing, crafts, getting dressed and gym. They risk scholastic failure and are often excluded from games at school. A child with DCD risks developing poor self-esteem. With no study having been done in Switzerland on the treatment of this disorder, we conducted a study at the national level wherein the objectives were to highlight the benefits of occupational therapy for children suffering DCD. This study concerned 45 children affected by DCD, comprised of 33 boys and 12 girls. Three research assistants conducted interviews with the parents to understand the impact of the disorder on daily life. They did tests three times : at the beginning of the treatment, after three months and after nine months. Parents filled out a questionnaire evaluating the progress of their children in their everyday lives. The assistants also conducted phone interviews with the teachers to solicit their observations. The principal results showed that therapy helped children with DCD and their families feel more comfortable thanks to the recognition of their difficulties and the support offered. As well, nearly all the parents mentioned that their child gained greater self-confidence. They appreciated the collaboration with the occupational therapist and the advice offered. The great majority of teachers noticed progress that they attributed to a group of factors but not specifically to occupational therapy. This study showed that the benefits of occupational therapy are seen not only at the level of motricity and activities of daily life but also at the level of self-confidence. Occupational therapy therefore plays a role in prevention of the secondary effects of DCD. In fact, lack of self-confidence and social isolation constitute risk factors for ] depression. Furthermore, this study helped describe the impact of this disorder for children and their families; it also legitimised care by physicians Research title Effects of occupational who prescribe occupational therapy. therapy on the daily lives of Marie-Laure Kaiser children with a developmental coordination disorder Research team Marie-Laure Kaiser, Haute école de travail social et de la santé Vaud EESP Lausanne, Occupational Therapy, CHUV; Anne Guidoux, Valérie Cosandey Gobet, Fabienne Mueggler Tobler, Haute école de travail social et de la santé Vaud EESP Lausanne, Occupational Therapy Partners Association Suisse des Ergothérapeutes (ASE), Centre hospitalier universitaire vaudois (CHUV) Financing SNSF DORE Research

29 Maltreatment of the elderly and prevention [ Research title Perception of maltreatment of the elderly and of the needs in terms of prevention among assistance/care institution management in Western Switzerland Author of the research Delphine Roulet-Schwab, Haute Ecole de la Santé La Source, Nursing / Anne Rivoir, association Alter Ego Partners Alter Ego, Leenaards Foundation Financing Leenaards Foundation Why question ourselves about the maltreatment of the elderly in Western Switzerland? This issue became a discussion subject at the end of the 1990s, following, notably, several scandals in medico-social institutions. In 2002, an association for the prevention of maltreatment of the elderly (Alter Ego) was created. It developed a variety of prevention services. These services are, however, infrequently requested. We remark moreover that cases of elder abuse brought to the police, to the justice system, to LAVI centres (federal victim help centres), to physicians working in the field, and to Alter Ego are very rare. The Alter Ego association commissioned the Haute Ecole de la Santé La Source to conduct this study in order to understand this invisibility. How do we go about exploring this subject? In order to have a global view of the situation in our study, we chose to cover all institutions with an elderly clientele in the six cantons of French-speaking Switzerland (medicosocial centres, home-care services, day programmes/temporary accommodation services, and certain hospital services). We targeted professionals in a position of hierarchical responsibility, as they play a key role in the supervision of teams and in the management of inci-dences of maltreatment. In all, 390 people in 230 institutions participa-ted via an on-line questionnaire. a situation of maltreatment of elderly people and therefore that abuse is a reality in the French-speaking part of Switzerland. It also reveals a movement towards awareness and the development of resources in institutions. As pointed out by a participant : maltreatment is often the tip of the iceberg. If we don t give ourselves the tools to uncover this tip, abuse will continue, because no-one will learn anything. With regard to this, many institution heads mention the awareness that this study brings about. The resources that institutions have at their disposal are nonetheless shown to sometimes be insufficient. Notably, professionals are in need of tools to identify, evaluate and treat situations of abuse. More generally, lack of knowledge in the legal realm, the taboo that continues to surround abuse and discrepancies in representations are all obstacles to the mobilisation of internal and external resources. These issues also prevent reporting of situations that should be reported to police or the justice system. This study underlines the importance for Alter Ego to update its mission and its priority axes of action, in order to best respond to the challenges posed by elder abuse in the care environment. Delphine Roulet Schwab What are the outcomes of this research? This study shows first of all that the vast majority of those in charge of institutions have already encountered Research

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32 Evaluation of effects of psychomotor therapy 33 This study was conducted by the Thérapie psychomotrice (Psychomotor Therapy) group of the Haute école de travail social de Genève at the request of the Association Suisse des thérapeutes en psychmotricité in order to support the steps being taken for recognition of psychomotor therapy by social insurances. What are the effects of psychomotor treatment for children from four to eight years of age suffering from psychomotor disorders as defined by the WHO in its Multiaxial Classification of Child and Adolescent Psychiatric Disorders? This is the question our study is concerned with. The objective was to study the changes, and the nature thereof, that came about over the course of a therapeutic psychomotor treatment. Within this framework, the children were evaluated using standardised scales in the fields of motor, affective and cognitive development, at the beginning of treatment and after 15 months. The parents also answered questionnaires to give the necessary information about their child and their socioeconomic situation. The psychomotor therapists transmitted information about the child s problems as well. Two groups of 15 children were studied : a clinical group and a control group. The clinical group was made up of children beginning a psychomotor treatment within the context of a public institution or a private practice. The control group consisted of random children undergoing no therapeutic treatment, who were recruited from day cares and primary schools in the Canton of Geneva. At the end of the study, we noted two major results : The motive for psychomotor consultation was either related to motor skills or related to psychoactive and interpersonal skills, but the condition expressed itself predominantly on one plane or the other, all the while being mainly associated with the other. This characteristic confirms the nature of true psychomotor disorders. Psychomotor therapy that approaches the individual from a global psycho-corporal (mind-body) perspective has a positive effect both on the motor skills front and on the affective front. The quality of motricity and the emotional register are both particularly improved. Our work confirms that the changes concern not only the motor aspects but also extend to other dimensions of the individual in the fullness of their psycho-corporal being. They also help to consolidate a spirit of research within the professional corps, a dynamism that will contribute to pursuit of this study and the recognition of the processes at play in psychomotor interventions. Sylvie Avet L Oiseau Research title Evaluation of effects of psychomotor therapy Research team Sylvie Avet L Oiseau-Tissot, Bernard Senn, Karinne Baligand Lecomte, Haute école de travail social Genève, Psychomotor Therapy Partners Association suisse des thérapeutes en psychomotricité, Office médicopédagogique Genève, Office de psychologie scolaire Vaud Financing SNSF, astp, Office médicopédagogique Genève, Office de psychologie scolaire Vaud Research ]