Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care.

Introduction : L'hémophilie s'exprime par des accidents hémorragiques dont les signes cliniques sont traduits dans une sémiologie médicale. Le vécu de la maladie conduit les personnes hémophiles à percevoir des signes plus fins que ceux décrits par les professionnels. Certains patients sentinelles ont développé, par apprentissage personnel, la faculté de percevoir des signes précoces d'hémorragie. Ils ont élaboré une sémiologie personnelle qui leur permettrait de réagir plus tôt et de limiter ainsi les conséquences des hémorragies. Objectif : Une recherche collaborative a cherché à identifier et à analyser la sémiologie personnelle des patients hémophiles sentinelles, puis à envisager ses applications. Méthode : Neuf entretiens approfondis ont permis de recueillir des expressions utilisées pour traduire les signes précoces d'hémarthroses, puis de les rassembler en familles de sensations issues des sciences de la sensorialité. Résultats : La perception des signes étant difficilement communicable, le recours à l'abstrait aide à la verbalisation. Sa conscientisation répond à un apprentissage par auto et alloformation. Discussion : Une catégorisation des signes précoces, issue de l'oenologie, permet d'élaborer une « sémiologie personnelle du patient ». L'identification de seuils sensoriels facilite la prise de décision d'autosoins. Conclusion : Cette recherche ouvre à des applications en éducation thérapeutique ainsi que des perspectives dans la relation patient-soignant. Mots clés : sémiologie / signes précoces / patients sentinelles / hémophilie / éducation thérapeutique Abstract-Perception of early signs of hemarthrosis: towards a personal semiology from patients with sentinel hemophilia. Introduction: Hemophilia is expressed by hemorrhagic stroke whose clinical signs are translated into a medical semiology. The experience of the disease leads hemophilia patients to perceive more subtle signs than those described by the professionals. Some sentinel patients have, through personal learning, developed the ability to perceive early signs of bleeding. They have developed a personal semiology that allows them to react sooner and therefore limit the consequences of bleeding. Objective: A collaborative study sought to identify and analyze the personal semiology of sentinel hemophilia patients, then envisage its applications. Method: Nine in-depth interviews made it possible to collect expressions used to translate the early signs of hemarthrosis, then gather them into a family of sensations from sensory science. Results: Because the perception of signs is difficult to communicate, using the abstract helps verbalization. Making it conscious meets the need of self-and hetero-learning. Discussion: A categorization of early signs, from oenology, makes it possible to develop a "personal patient semiology". The identification of sensorial thresholds facilitates self-care decision-making. Conclusion: This research opens up applications in therapeutic education and prospects in the patient-healthcare provider relationship.

Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care.

No abstract