Le contrat de soins : une démarche originale de soins par objectifs pour les patients hémiplégiques

The center “Les Baumes” is a rehabilitation center which manages patients with a wide range of conditions. The development of neurological rehabilitation has been particularly important over the last few years. In order to improve the rehabilitation process, the center has chosen to develop a new information sharing aid called the “care contract”. Although a variety of tools, such as “PIII”, a plan quite helpful in facilitating information sharing within a rehabilitation team, already exist, current regulations and the recommendations of the French National Authority for Health have created a challenging new context. Our center decided to create a new tool integrating the habits and the history of the establishment and introducing the concept of a common commitment linking health care professionals, the patient and his/her family. A working group, including an outside consultant and members of all of the health care professions, was thus started to examine specific goals for rehabilitation of adult stroke victims and designate appropriate actions for meeting these goals. The process of rehabilitation for adult stroke patients has now been improved, leading to the “care contract”, conceived as a real-life tool for sharing, exchange and collaboration between the team, the patient and his/her family. This tool based on rigorous reasoning is helpful in achieving goals within set deadlines, defining, in simple everyday words easily understandable for the patient and family, the various stages of the rehabilitation program and the final goal of social integration. Although it took a long time to set up, with a lot of intense work at the beginning, this contract has greatly streamlined the rehabilitation process for adult stroke patients in our center. Work is ongoing on extensions of the contract to other neurological conditions.