Contenu du sommaire : Accompagnement : le lien social sous tension

The accompaniment practices go through multiple spheres of social life. Everywhere socially and psychically unacceptable situations occur, accompaniment devices get organised. We formulate the hypothesis that, in a universe of fluidity and transactional precariousness, thanks to which we apprehend today's world, accompaniment turns up as one of the ways of the answers to the showing of social suffering, linked to the growing precariousness of transactions. It aims at supporting the individual, leading him to work on himself and to build social links. It fits in with a social necessity of “affiliation”, of construction of the connections between subjectivities and in the meanwhile it can not point out the social group in which to insert as “society” is less and less the supreme entity in which social beings would get a meaning. More precisely, accompaniment lies within those benevolence devices in which modes of sociability based on oral character and solicitude are invented. The help relation is taken for the horizon of the help situation, which the word “accompaniment” really means. The relation accompanying person – accompanied person becomes the principal stake of the relation, which leads to a particular type of transaction.

This article is a contribution to the reflection on the practices of accompaniment and the potential of regulation of the device associated to Validation of non formal and informal learning which enter in resonance with the necessary treatment the tensions relating to confrontation between the inherent constraints to the methods of certification and the degree of freedom that the actor manages to use to conclude his project. The adequacy between the offer of training and certification and waiting of the candidate can be reached only if this one admits, in particular grace the accompaniment, ensured by the administrative advisers, the trainers, the teacher-researchers, that the course of validation will not be able to develop all its learning resulting from its social experiment, professional or personal. Indeed, the device seems to bring an answer to the probable variation of conflicts between what the individuals are and what they would like to become, in the sense that they believe it what they are and are unaware of what it will occur of their situation, whereas there exists in fact a double transaction, at the same time internal, i.e. with respect to themselves, and external, opposite as well of the institutions habilited to deliver diplomas as their employers. Lastly, insofar as it invites to a reflexive step, the device of device does not reveal it new conflicts as much personal than interpersonal, than it falls to the guides to deal with, at least partly, at the moment when the candidate thought of solving other tensions.

During twenty years, Paul and Danielle Beck have been the general managers of a palliative care hospice in the Canton de Vaud in Switzerland. As such they have created and promoted, a place (Rive-Neuve, R.-N.) where every care giver, no matter their position, are supposed to be supportive with the patients. The goal of this interview is that of presenting a point of view coming from the practise without promoting any sociological or anthropological analysis.

This paper aims to reflect on the relationship between the concept of accompaniment and nursing. It assumes that both are tied in a common origin. As a nurse, a sociologist and a theologist, the author emphasizes the tensions and the ambiguity of this relationship. He follows the anthropological conception of care suggesting the idea that caring takes place in the centre of any life process and is far from being exhausted in the function of curing, since it equally implies existential, cultural and universal dimensions that do not only depend on illness. The question of the specificity of the nursing accompaniment is raised and developed from a specific vision of care. By focusing on the nursing care, the author proposes some open answers and attempts to promote an interdisciplinary and epistemological work around the accompaniment practices.

This article explores the activities of volunteers who work with people who are terminally ill and dying in Switzerland (French part). Following an ethnographic approach, it aims to explore the peculiar position of volunteers, which is divided between on the one hand an existential or spiritual « quest »; on the other hand some medical, institutional or social dimensions able to obstacle their intervention. The crucial point here is getting to know how this sort of ‘existential quest' is carried out (when it does) within the context of medical institutions. In parallel it is to emphasize that the accompanying process depends on several paradoxical tensions. As such, this analysis allows the author to propose some assumptions towards the concept of accompaniment and its heuristic value for social sciences.

The specific care of the dying offered by palliative care is based on the notion of autonomy, which implies an open discourse about the approaching death. To deploy their offer in the hospital, palliative care professionals wish to formalise the entry into the palliative phase so that it is better anticipated and coordinated, but also more explicit to the patient. This “passage” raises important interprofessional issues between a palliative mobile team and “front line” caregivers of a hospital, as well as it requires “enhanced” care of the patient around the announcement of end of life. In this article, we look closely at some treatments (opioids, sedatives used in palliative sedation) as regards to the tensions and negotiations they generate in the accompaniment of the dying. More specifically, the “misuses” of these substances – to accelerate, postpone or alter the end of life – tell us about what the accompaniment of end of life involves in the hospital setting respectively for patients, their families and for the health professionals. The relation to opiates and sedatives, acting on the remaining time, reveals the dilemmas and difficulties occasioned by the accompaniment of responsible and conscious end of life requested by palliative care.

To bereave a close relative or friend at the workplace is quite common; nonetheless firms are not very eager to grasp this subject, nor to anticipate the professional difficulties that may result from bereavement situations. Based on an anthropological research carried out in the French-speaking part of Canton of Valais with twenty-two medium and big-sized companies, this article tries to explain this gap; it shows that the way to deal with and to follow up the coming back of bereaved employees is similar to accompaniment. Unable to achieve fully its process, this sort of accompaniment denotes a specific relationship to grief that fears and refuses to trivialize such situations.

Based on an ethnographic fieldwork conduced in a psychiatric emergency unit, this article analyzes the psychiatric treatment of suicidal patients. Care providers use the suicidal potential estimation to credit medical practices with formal and scientific basis, in order to deal with the unpredictability of suicide. However, two major implicit aspects influence the choice of the more suitable treatment (inpatient or outpatient): patient's autonomy and compliance. Analysis of care providers discourses shows contradictory logics laying behind this decision: keeping a therapeutic link with the patient through an ambulatory treatment on one hand, securing his life through an hospitalisation on the other.

The rise of chronic illness challenges medicine and carers to accompany and follow up a new kind of patients. At the same time this challenge appears as a professional necessity. According to that, medical accompaniment can be seen as a palliative answer to the limits of a strict bio-medical approach of the patients. By accompanying them, the medicine makes some institutional choices which involve their biographical trajectory: it refers to their autonomy, to their self-determination, and thus attempts to create a new sort of social cohesion grounded on a conception of a common responsibility. However, the reality of this necessity appears to be rather contradictory, for it has at the same time to deal with the political and economical issues of the health systems.

The rise of chronic illness challenges medicine and carers to accompany and follow up a new kind of patients. At the same time this challenge appears as a professional necessity. According to that, medical accompaniment can be seen as a palliative answer to the limits of a strict bio-medical approach of the patients. By accompanying them, the medicine makes some institutional choices which involve their biographical trajectory: it refers to their autonomy, to their self-determination, and thus attempts to create a new sort of social cohesion grounded on a conception of a common responsibility. However, the reality of this necessity appears to be rather contradictory, for it has at the same time to deal with the political and economical issues of the health systems.

In its most spectacular aspects, the “humanist square” appears as a network of answers to situations of escape, aggressiveness or even violence from “sensitive” users, those who accumulate clues of vulnerability. But it is not only that. It opposes traditional authoritarian, descending, paternalist answers and those held behind the doors of the psycho-relational. The “researcher practitioner” keeps thinking to find solutions with others. So that the user could be as much as possible an actor (and not the passive subject of measures), we have imagined the metaphor of the land of the four hills. Law, listening, meaning, collective: four poles which start resonating in a dynamic interaction. The ultimate purpose: giving meaning to life.