Le Tallec P, Gesbert C, Mercier C, Crenn É
Association française du personnel paramédical d'électroradiologie, 92120 Montrouge, France.
Direction de la qualité, des services aux patients et des parcours, centre hospitalier de Versailles, 78150 Le Chesnay, France; Centre de recherche des Cordeliers, Sorbonne université, Inserm, université de Paris, laboratoire ETRES, 75006 Paris, France.
Cancer Radiother. 2022 Oct;26(6-7):841-845. doi: 10.1016/j.canrad.2022.06.015. Epub 2022 Sep 6.
Many situations can be considered as a crisis in radiotherapy (failure of equipment, absenteeism, excessive workload, errors, urgent care, pandemic, etc.). Such events are defined as difficult situations in the course of daily activity, they can at any time escape the vigilance of the concerned actors when they are not prepared for it. The crisis can induce a disruption of balance between the normal course of the radiation therapy and the obligation for the manipulators to reconcile the consequences of the ongoing crisis with the objective of taking charge of all patients scheduled for the program. The crisis and its management will inexorably cause stress, fatigue and, as a consequence, impact patient safety. Management has an essential role to play in maintaining team dynamics when a crisis occurs, the work environment may no longer be the same. The aim of this article is to describe these situations in order to highlight the needs of the teams and more specifically the needs of the radiation therapist. It highlights the organization of patient care in the event of crisis management (Covid-19), during palliative radiotherapy with an opportunity to develop advanced practice. The reflection on the ethical concern of the radiation therapist in the prioritization of patients leads us to analyze the knowledge of medical ethics provided during initial training. When they perform their duties, manipulators seem to be confronted with situations that give rise to ethical dilemmas. It is then a question of understanding how they reflect on their practice in order to make it evolve. Is the radiation therapist confronted with ethical issues in the course of his practice? What solutions can be implemented to deal with these issues?
许多情况都可被视为放射治疗中的危机（设备故障、人员缺勤、工作量过大、失误、紧急护理、大流行等）。此类事件被定义为日常活动过程中的困难情况，当相关人员对此未做好准备时，它们随时可能逃过其警惕。危机可能会导致放射治疗正常流程与操作人员职责之间的平衡被打破，操作人员既要应对当前危机的后果，又要负责计划安排的所有患者。危机及其管理必然会造成压力、疲劳，进而影响患者安全。危机发生时，管理层在维持团队活力方面起着至关重要的作用，工作环境可能会变得不同。本文旨在描述这些情况，以突出团队的需求，更具体地说是放射治疗师的需求。它强调了危机管理（新冠疫情）期间以及姑息性放射治疗过程中患者护理的组织情况，并有机会发展高级实践。对放射治疗师在患者优先级排序中的伦理关注进行反思，促使我们分析初始培训期间提供的医学伦理知识。当操作人员履行职责时，他们似乎会面临引发伦理困境的情况。那么问题在于了解他们如何反思自己的实践以使其发展。放射治疗师在其执业过程中是否面临伦理问题？可以实施哪些解决方案来处理这些问题？
