LE «TOUR DE LIT» AUX SOINS INTENSIFS : REPRÉSENTATIONS ET PRISE D'INFORMATION

Following Rasmussen (1986), numerous research studies have been carried out in cognitive activity diagnosis and decision making in dynamic situations. In this field of study, the object of our research is the clinical assessment undertaken by critical care nurses at the beginning of their task. Our study took place at the Geneva University Hospital (Switzerland). A real clinical assessment was filmed. Six expert nurses were shown the film, in accordance with work analysis methods (Leplat, 2000; Clot, 1999). The clinical assessment made by the nurse structures the organization of her daily tasks and contributes to her safety as well as that of the patient. Although precisely defined, the assessment procedure is adapted to each situation, depending on the patient's pathology, the stability of his vital functions and his specific equipment. Inspired by the methods developed by Hoc to analyze the work of blast furnace operators (1989,1991), the objective of the confrontational interviews was to thoroughly study data collection processing by analyzing the information used by nurses in their reasoning and how this information is elaborated during bedside assessment. Our study offers an approach to nursing care which is complementary to current studies on decision making (Bucknall, 2000,2003; Banning, 2006) and evidence-based practice. These models of best practice applied in different fields of nursing care, such as in acute care, are proposed by several authors (Aitken, 2000; Currey & Botti, 2006). Indeed, the analysis carried out in this study reverses the current perspective by highlighting the singularity of reasoning by nurses in real situations in the management of critical situations. This singularity is underlined by recognizing the specificity of each clinical situation, characterized by environmental evolution, as well as by constraints imposed during the activity. The thought process developed by the nurse during clinical assessment shows an ability to target pertinent entities with action plans and to mobilize deep knowledge to face dilemmas whilst in action. En nous inscrivant dans le champ disciplinaire de la prise de décision en situation dynamique (ergonomie cognitive) et dans celui des soins infirmiers, nous avons étudié l'activité de tour de lit réalisée par les infirmières en soins intensifs. Notre recherche s'est déroulée aux Hôpitaux Universitaires de Genève (Suisse). Nous avons confronté six infirmières expertes à un film de tour de lit tou