Mougel, Sarra, At the bedside of the sick child. Parents/professionals, partnership model ?, Armand Colin, coll ” Societal “, 2009
With to the bedside of the sick child. Parents/professionals, partnership model ? Sarra Mougel wants to reflect on the place now given to parents in the hospital departments of pediatrics. The theoretical framework that supports the work is the one designed by Anselm Strauss in the Frame of the negotiation1.
Sarra Mougel wants to examine how parents take place in the “order negotiated” of the hospital and participate in the construction of the “trajectory of illness” of the child, from an ethnographic survey conducted in two paediatric wards : a service of general paediatrics, children’s for hospital admissions short, for infectious diseases of low severity, the other service is a service of hepatology pediatric hyperspécialisé.
The first chapter “Of the parents for a long time kept at a distance” returns to the history of the opening of the paediatric services to the parents, a historical context from the creation of the first children’s hospitals in the early Nineteenth century. The depth of the story captures the ambiguities of the policy of openness, delays in French compared to its neighbouring English and especially a reminder that the parental presence at the bedside of a sick child is not self-evident, the opening of the paediatric services to parents have not been formalized in France, in 1983. This opening of the hospital to the parents coincides with a new representation of the sick child, who began to emerge from the fifties, with the rise of knowledge psychological. Open the doors of the hospitals to the parents, tolerate within the medical center should address the concern to improve the conditions of hospitalization.
Has all the periods, parents are seen as disruptive elements of care, that the medical teams are seeking to keep away. The revolution pastorienne feeds the fear of germs, and parents, external agents are considered pathogens. Later, they will be considered as disturbing the medical service. Under the guise of the comfort brought to the children, the parents would complicate the work of caregivers and they are suspected of wanting to control the care of their little darlings. If today the parental presence is accepted, it must be done within certain specific limits.
The second chapter “Of the parents to be unevenly present “highlights the” division of the role of carer ” within the family settings. The role of carer is assigned predominantly to mothers, the absence of which to the bedside of the child is less tolerated than that of the father, and must be justified, which is not reciprocal to the fathers ! Even if they are the first to be approached, the mothers are not the only ones to take on the role of carer : “in the sharing of the duty of attendance, professional resources to each member of the couple can be balanced” (p 72). If it is not present, the spouse provides a relay in the domestic organization or hospital. It is not uncommon that both members of a couple wish to be present together, which allows you to analyze the sharing of tasks in the co-presence in the hospital. The survey would have deserved to be developed further. What is the social distribution of the terms of the parental presence ? In what social environments, the mother invests more at the bedside of the child ? If the need to be present at the bedside of the sick child disrupts the domestic organization, it is necessary to know in advance this organization is differentiated, the only variable gender cannot make sense of the upheaval.
The third chapter on “parents partners care ?” aims to take account of the status of “members” provisional organization of the hospital of the parents. It is a matter of “spot the space taken by the parents in the division of labour hospitable” (p 99). The participation of parents in daily care is strongly recommended by the circular of August 1, 1983, and this exhortation is widely accepted by the parents/mothers of the children. They are assigned tasks (feed, wash, dress, change…) in the continuity of those carried out at home. The parents also perform tasks of supervision of children, machines, and infusions, always keeping the concern to serve the interests of their children, and to provide cues to emotional. The border between professional practices and those of secular delegated to the parents are moving, depending on whether it is to save the resources of the hospital or to prepare the parents to return the child to the family home (” delegation “).
But the relationship between parents and professionals is not enchanted, as is intended to demonstrate the chapter four ” parents controllers care ? “. To alleviate controversy between parents and carers on the quality of care, the parents choose to operate in a discrete control interventions. The other point around which the emergence of tensions is one of access of parents to information and to intervention in the medical decisions.
Finally, in the light of the tensions between parents and professionals, the author asks if we can’t talk about “supervision and support of parenting” at the hospital, from the analysis of the discourse of the professional, behind-the-scenes of the service. During the meetings between professionals, parents are appreciated, in terms of their ability to support the child upon his release from the hospital, to meet medical requirements. Time of the presence of the parents, quality of parental presence are valued, so that we can speak of a real control on parenting practices. When they are non-compliant with the expectations, the medical team tries to reform them. “A certain style of mothering is transmitted to the parents directly or indirectly” (p 234), a “treatment education” is also of the professionals to the parents. If the medical team is to enhance the parental involvement, the professionals, fearing that she will become a interference, so that the parents are the subject of a control tightened.
A methodological annex complete the connection, but in this respect, we may express some reservations. The methodological annex would have deserved more details, in particular as regards the profile of the paediatric services studied. We would have liked to also find the profile of children in hospital (length of hospital stay at the time of the survey – type of disease), and the social profiles of the families. The book grants its general purpose, it reads well, the writing is extremely fluid, but the presentation of the methodological grounding of the investigation, which the public is interested in student or academic, a little lacking in the book. But this is perhaps not the intended audience for the collection ” Social “… In each of the analyses carried out, it would have been appropriate, in order to continue the analysis, to refer to the social origins of parents and the consequences of recent conflict in the parent-professional, in the involvement in the care…However, the work is a large part in the extracts from interviews and extracts from field diary, and shows a survey solidly built.