{"id":95062,"date":"2025-12-02T11:34:27","date_gmt":"2025-12-02T10:34:27","guid":{"rendered":"https:\/\/hospitals.be\/?p=95062"},"modified":"2025-12-17T16:26:23","modified_gmt":"2025-12-17T15:26:23","slug":"quelles-solutions-pour-assurer-la-continuite-des-soins-hospitaliers","status":"publish","type":"post","link":"https:\/\/hospitals.be\/fr\/quelles-solutions-pour-assurer-la-continuite-des-soins-hospitaliers\/","title":{"rendered":"Quelles solutions pour assurer la continuit\u00e9 des soins hospitaliers\u00a0?"},"content":{"rendered":"\n

S\u00e9bastien Ninite
<\/strong>Directeur D\u00e9partement Infirmier<\/p>\n\n\n\n

Pand\u00e9mie de sars-cov-2 et p\u00e9nurie infirmi\u00e8re<\/h2>\n\n\n\n
\n

D\u00e9but mars 2020, le Plan d\u2019Urgence Hospitalier (PUH) \u00e9tait activ\u00e9 dans toutes les structures hospitali\u00e8res du pays \u00e0 la suite de la pand\u00e9mie de SARS-CoV-2. Nous \u00e9tions loin d\u2019imaginer que, deux ans apr\u00e8s, nous serions toujours en PUH. Le fonctionnement de l\u2019h\u00f4pital a d\u00fb \u00eatre revu en profondeur afin de pouvoir faire face aux vagues successives, mais aussi \u00e0 l\u2019absent\u00e9isme du personnel.<\/p>\n<\/blockquote>\n\n\n\n

D\u00e8s le d\u00e9but de la pand\u00e9mie, un nouvel organe a \u00e9t\u00e9 cr\u00e9\u00e9 afin de donner les directives aux h\u00f4pitaux: le Comit\u00e9 Hospital & Transport Surge Capacity (CHTSC). L\u2019organisation hospitali\u00e8re applique ces directives, ce qui am\u00e8ne beaucoup de changements et n\u00e9cessite une grande capacit\u00e9 d\u2019adaptation de la part des \u00e9quipes et des responsables hi\u00e9rarchiques.<\/p>\n\n\n\n

Un rapport du KCE (Centre F\u00e9d\u00e9ral d’Expertise des Soins de Sant\u00e9) met en \u00e9vidence dans ses messages cl\u00e9s \u00abque les h\u00f4pitaux ont fourni des efforts tr\u00e8s importants pour lib\u00e9rer et cr\u00e9er des capacit\u00e9s hospitali\u00e8res, en particulier en soins intensifs, pour les patients COVID-19. La disponibilit\u00e9 et la motivation du personnel de soins (m\u00e9dical, infirmier, soignant, soutien, etc.) se sont av\u00e9r\u00e9es d\u00e9cisives \u00e0 cet \u00e9gard\u00bb .<\/p>\n\n\n\n

Nous aborderons dans cet article une des difficult\u00e9s majeures des h\u00f4pitaux: comment assurer la continuit\u00e9 des soins dans un contexte de \u00abp\u00e9nurie\u00bb infirmi\u00e8re et dans la mesure o\u00f9 les directives du CHTSC nous demandent d\u2019augmenter notre capacit\u00e9 en lits de soins intensifs\u2009?<\/p>\n\n\n\n

D\u2019autres probl\u00e8mes ont \u00e9t\u00e9 rencontr\u00e9s comme les difficult\u00e9s d\u2019approvisionnement en mat\u00e9riel et m\u00e9dicaments, la gestion de l\u2019agressivit\u00e9, l\u2019isolement des patients, la gestion des fins de vie, l\u2019\u00e9puisement professionnel, la reconnaissance puis la non-reconnaissance des professionnels de la sant\u00e9, les cons\u00e9quences li\u00e9es aux reports des soins\u2026 Ces points ne seront toutefois pas trait\u00e9s dans cet article.<\/p>\n\n\n\n

\n

Un rapport du KCE met en \u00e9vidence dans ses messages cl\u00e9s \u00abque les h\u00f4pitaux ont fourni des efforts tr\u00e8s importants pour lib\u00e9rer et cr\u00e9er des capacit\u00e9s hospitali\u00e8res\u00bb<\/p>\n<\/blockquote>\n\n\n\n

Une \u00e9quation impossible \u00e0 r\u00e9soudre\u00a0?<\/h2>\n\n\n\n

Nous n\u2019avons pas la pr\u00e9tention de donner des solutions, mais tout simplement de partager notre exp\u00e9rience et d\u00e9gager des pistes d\u2019am\u00e9lioration pour l\u2019avenir [Figure 1].<\/p>\n\n\n\n

Premi\u00e8rement, nous sommes dans un contexte de \u00abp\u00e9nurie\u00bb infirmi\u00e8re major\u00e9e par l\u2019ann\u00e9e blanche \u00e0 la suite de la r\u00e9forme de l\u2019enseignement, mais aussi par un manque de reconnaissance et de vision positive de la profession v\u00e9hicul\u00e9 par nos politiques. La probl\u00e9matique est surtout la r\u00e9tention infirmi\u00e8re qui s\u2019est accentu\u00e9e \u00e0 la suite de la pand\u00e9mie: diminutions de temps de travail, pauses carri\u00e8re et r\u00e9orientations professionnelles.<\/p>\n\n\n\n

Ensuite, l\u2019absent\u00e9isme du personnel a aggrav\u00e9 les besoins des unit\u00e9s de soins. Au CHU de Charleroi, l\u2019absent\u00e9isme a \u00e9t\u00e9 ma\u00eetris\u00e9 jusqu\u2019\u00e0 l\u2019arriv\u00e9e de la vague Omicron. Cette derni\u00e8re a diss\u00e9min\u00e9 les \u00e9quipes avec un taux d\u2019absent\u00e9isme avoisinant les 40% dans certains services. Nous tenons \u00e0 souligner que, lors de la premi\u00e8re vague, le taux d\u2019absent\u00e9isme n\u2019avait jamais \u00e9t\u00e9 aussi bas (proche des 0%).<\/p>\n\n\n\n

De plus, le CHTSC a demand\u00e9 aux h\u00f4pitaux d\u2019augmenter la capacit\u00e9 de prise en charge intensive des patients COVID-19. Pour le CHU de Charleroi, en plus des 54 lits de soins intensifs difficilement ouvrables par manque de personnel infirmier, nous avons d\u00fb ouvrir des lits de soins intensifs suppl\u00e9mentaires en salle de r\u00e9veil et en hospitalisation provisoire aux urgences.<\/p>\n\n\n\n

La pierre d\u2019achoppement n\u2019\u00e9tait pas la structure (nombre de lits, locaux, mat\u00e9riel), mais bien l\u2019encadrement en personnel infirmier qualifi\u00e9.<\/p>\n\n\n\n

Un(e) infirmier\/\u00e8re n\u2019est pas polyvalent(e) et ne peut pas \u00eatre comp\u00e9tent(e) dans toutes les disciplines: soins intensifs et d\u2019urgence, oncologie, p\u00e9diatrie et n\u00e9onatalogie, g\u00e9riatrie\u2026 C\u2019est un \u00e9l\u00e9ment essentiel qu\u2019il faudra garder \u00e0 l\u2019esprit dans la recherche des solutions si nous voulons pr\u00e9server une certaine qualit\u00e9 des soins et la s\u00e9curit\u00e9 des patients.<\/p>\n\n\n\n

En plus de cette augmentation de capacit\u00e9 de prise en charge des patients COVID, la charge de travail g\u00e9n\u00e9r\u00e9e par les soins dispens\u00e9s aux patients COVID peut \u00eatre multipli\u00e9e par 3, voire 4. \u00c0 titre d\u2019exemple, pour les soins intensifs du CHU de Charleroi, en 2019 (hors pand\u00e9mie), nous avons 93 journ\u00e9es ECMO (Extracorporeal membrane oxygenation) contre environ 700 journ\u00e9es en 2021.<\/p>\n\n\n\n

Quatri\u00e8mement, la succession des vagues a engendr\u00e9 stress et \u00e9puisement professionnel. Les heures suppl\u00e9mentaires ont explos\u00e9. Le personnel est fatigu\u00e9 de devoir s\u2019adapter en permanence \u00e0 l\u2019\u00e9volution de la pand\u00e9mie et aux directives hospitali\u00e8res. Ces multiples changements et le manque de perspectives \u00e0 moyen\/long terme sont source d\u2019angoisse et de d\u00e9motivation.<\/p>\n\n\n\n

Enfin, dans certains secteurs et notamment aux soins intensifs, le personnel infirmier souffre d\u2019une perte de sens du m\u00e9tier li\u00e9e \u00e0 la r\u00e9p\u00e9tition des longues prises en charge st\u00e9r\u00e9otyp\u00e9es des patients COVID. L\u2019isolement architectural avec les \u00e9quipements de protection individuelle et la rupture de lien social avec les familles accroissent cette perte de sens.<\/p>\n\n\n\n

\n

Le personnel est fatigu\u00e9 de devoir s\u2019adapter en permanence \u00e0 l\u2019\u00e9volution de la pand\u00e9mie et aux directives hospitali\u00e8res<\/h3>\n\n\n\n

7 infirmiers\/\u00e8res sur 10 en Belgique francophone sont \u00e0 risque de burn out

<\/h3>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

Ecrit par S\u00e9bastien Ninite, Directeur D\u00e9partement Infirmier<\/p>\n","protected":false},"author":6,"featured_media":94534,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[118],"tags":[246,168,167],"class_list":["post-95062","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles","tag-magazine-13","tag-organisation-des-soins","tag-sebastien-ninite"],"acf":[],"yoast_head":"\nQuelles solutions pour assurer la continuit\u00e9 des soins hospitaliers\u00a0? - Hospitals.be<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/hospitals.be\/fr\/quelles-solutions-pour-assurer-la-continuite-des-soins-hospitaliers\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Quelles solutions pour assurer la continuit\u00e9 des soins hospitaliers\u00a0? - 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