Table 3.

Statements regarding the characterization of the educative attitude

1. Concerning the relationship with time, educative attitude in the field of TPE is characterized by recognition of

– the need to take time for activities involving informing the patient of the diagnosis, patient identification, definition of a care plan;

– the possibility of postponing a TPE activity if the patient is not ready or to increase their motivation before undertaking the activity;

– the need to adapt the TPE to the patient’s psychological readiness and the caregiver’s need to be flexible and adaptable;

– the fact that chronic illness involves a long-term relationship (patient’s illness for life);

– the need to situate one’s intervention in relation to the patient’s life history and their medical treatment.

2. Concerning the benefits of TPE practice for the caregiver, the educative attitude in the field of TPE is characterized by the recognition that TPE

– helps reinforce the caregiver’s capacity for action in relation to the chronic patient;

– helps caregivers overcome the feeling of powerlessness and helps the caregiver get out of a dead-end/overcome an obstacle;

– allows the caregiver to have a more positive approach to their job (no longer being obliged to have a result-oriented approach);

– legitimizes (by giving real power) some of the caregiver’s activities (for instance, asking about the patient’s life history);

– helps improve the quality of the caregiver’s work life;

– improves the caregiver’s motivation.

3. Concerning the emotions, the educative attitude in the field of TPE is characterized by the recognition that TPE

– requires identifying and being aware of one’s emotions in order to avoid transference and projection;

– requires accepting and recognizing the patient’s emotions;

– requires an adjustment in the caregiver’s thoughts, emotions and actions (toward authenticity and coherence);

– requires acknowledging that patients’ resistance is an integral part of their development with regard to their illness;

– helps the caregiver recognize the impact of their verbal and nonverbal attitudes on the therapeutic relationship;

– helps the caregiver be more humble and more careful about their knowledge with regard to the patient;

– helps make caregivers more thoughtful about their professional practice.

4. Concerning the professionalizing nature of TPE, the educative attitude in the field of TPE is characterized by the recognition that TPE

– is more than just supplying information;

– requires trained, competent caregivers; in other words, TPE cannot be improvised;

– formalizes certain activities undertaken implicitly by caregivers;

– relies on an approach that acknowledges the essential stages such as assessment and educational diagnosis as therapeutic acts;

– requires in-depth biomedical knowledge of a specific chronic disease.

5. Concerning the holistic, interdisciplinary approach to the patient, the educative attitude in the field of TPE is characterized by the recognition that

– the aims of TPE are the individual’s QOL and health;

– TPE objectives, learning activities and indicators are situated in the biopsychosocial sphere;

– only a holistic approach to the patient is effective (vs compartmentalization or division): the illness is the result of a set of environmental and biopsychosocial determining factors;

– close friends and relations must be considered as a determining factor in the illness and a resource or obstacle to care;

– chronic illness requires recourse to health care professionals specializing in different areas and interdisciplinary approach;

– caregivers have their own limits with regard to patients and it is sometimes necessary to refer the patient to someone else or work with other caregivers.

6. Concerning the educational nature of the therapeutic relationship, the educative attitude in the field of TPE is characterized by the recognition that

– the caregiver’s role changes from a curative to an educational one;

– the educational role consists of learning to create, develop and recognize resources, facilitate learning and establish the right conditions for learning, to inform the patient so that they can make their own health choices;

– making mistakes is an integral part of learning, including in the learning associated with TPE;

– it is important to use the patient’s knowledge and perceptions of the illness as a starting point;

– the patient is solely responsible for changing their own behavior (active position of the patient);

– the patient is capable of making choices (patient’s competence);

– the patient’s internal motivation must be stimulated.

7. Concerning the ethical relationship, the educative attitude in the field of TPE is characterized by the recognition that

– above all, we are caring for a human being and not an organ/illness;

– TPE involves the following values: being nonjudgmental, positive, trustworthy, transparent and humble;

– TPE requires changing from an interventionist mode to a deliberative mode, ie, partnership;

– the patient must be recognized for who they are (personalized approach);

– the patient is an expert in the experience of his illness;

– the patient is free to make their own health choices, and the caregiver’s job is to make that choice is an informed one;

– the patient’s view can be different from the caregiver’s, especially with regard to therapeutic objectives.

Abbreviations: TPE, therapeutic patient education; QOL, quality of life.