Délégation Paris 5

Research on relatives' experiences with controlled donation after circulatory determination of death (cDCDD) is limited. This study aims to explore the challenges and experiences of relatives whose loved ones die under cDCDD, focusing on how they navigate the process. A qualitative study using semi-structured, in-depth interviews conducted 6 months post-death. This research is part of a larger quantitative multicenter study on the psychologic burden in relatives of cDCDD patients. Relatives of patients in the cDCDD process were purposively sampled and invited to participate in qualitative interviews. Thematic analysis was used to explore the phenomenon from the participants' perspectives. This study was conducted in France between November 2022 and November 2023. Family members of ICU patients identified as potential cDCDD donors. None. Of 23 family members approached, 19 (mean age 53 yr; 11 women) agreed to participate. The mean interview duration was 43 minutes. In three cases, organ retrieval was not possible. Thematic analysis revealed three key themes: 1) "Two decisions, two worlds"-discussing the decision to withdraw life-sustaining therapies and the organ donation request; 2) "Waiting for death"-the period between the decision and its implementation; and 3) "A controlled death"-dying and death in a monitored and technical environment. Relatives can be deeply engaged in cDCDD when well-prepared. However, additional support is needed during the waiting period, as families witness their loved one's decline. Proper preparation for dying is crucial to prevent perceptions of suffering, thereby reducing distress. Healthcare professionals must balance emotional, ethical, and medical considerations to facilitate informed choices in a highly regulated system.

La pratique avancée infirmière s’inscrit dans une dynamique historique internationale de réponse à des besoins de santé insuffisamment ou non couverts. En France, sa reconnaissance dans le système de soins à partir de 2016 résulte d’une construction progressive, fondée sur l’évolution de pratiques professionnelles, des expérimentations organisationnelles encadrées et l’universitarisation de la formation infirmière. Cet article propose une synthèse de l’histoire internationale de la pratique avancée infirmière, du cadre juridique français, des modalités de formation et de financement, ainsi que des enjeux et perspectives actuels. Les évolutions juridiques récentes ont permis de lever plusieurs freins identifiés lors des premières années de mise en œuvre, notamment en matière d’accès des patients et de périmètre d’exercice. Toutefois, le déploiement de la pratique avancée demeure en deçà des objectifs initiaux et soulève des enjeux majeurs en matière d’organisation des mentions, de formation universitaire, de financement, de clarification des rôles et de pilotage institutionnel. La pratique avancée infirmière apparaît ainsi comme un dispositif en évolution, nécessitant une consolidation globale afin de répondre durablement aux besoins de santé de la population. Advanced practice nursing has developed internationally as a structured response to unmet or insufficiently met health needs. In France, its recognition within the healthcare system since 2016 results from a progressive process combining the evolution of professional practices, organizational experimentation and the academisation of nursing education. This article provides an overview of the international historical foundations of advanced practice nursing, the French regulatory framework, education and funding mechanisms, as well as current challenges and future perspectives. Recent legislative and regulatory changes have addressed several early barriers identified during the initial implementation phase, particularly regarding patient access and scope of practice. However, deployment remains below initial policy objectives and raises major challenges related to the organisation of advanced practice tracks, university education, funding, role clarity and institutional governance. Advanced practice nursing should therefore be considered an evolving model of care, requiring further consolidation to sustainably meet population health needs.