La méthode qualitative est en plein essor en médecine et particulièrement en psychiatrie, où la place du sujet, et ses représentations de la maladie et du soin sont centrales dans la prise en charge. Dans le champ de la santé de l'adolescent, de grands travaux permettent des avancées importantes dans la compréhension de la souffrance et les propositions de soins. Les méthodes qualitatives sont pourtant souvent critiquées de par leur contextualité et leur manque de pouvoir de généralisation. Une façon d'améliorer ces deux aspects consiste à appareiller les études traitant la même problématique de manière à en synthétiser les principaux résultats. Cet exercice de synthèse, notablement différent de celui de méta-analyse propre à la recherche quantitative, est réalisé depuis longtemps dans le champ des sciences humaines. Il s'agit de la métasynthèse, ou meta-ethnography. L'exercice de synthèse de la littérature est aujourd'hui de plus en plus codifié en recherche scientifique. Pourtant, certains points sont toujours en discussion - critères d'inclusion des études, critères de qualité des études-. De plus, aucune équipe psychiatrique ne s'est approprié l'outil de la métasynthèse pour l'adapter à la discipline. Ce travail décrit les étapes de la construction et de l'adaptation, à partir du corpus existant, d'une méthode rigoureuse, effective, simple à transposer et enseigner, permettant la métasynthèse de données de la littérature dans le domaine du soin psychique de l'adolescent. Il s'agit d'une part d'une réflexion théorique, épistémologique et méthodologique sur les métasynthèses et leur adaptation au champ de la clinique psychiatrique. Il s'agit d'autre part d'une construction pratique, réalisée à partir de métasynthèses effectuées sur des thématiques du soin psychique de l'adolescent. Les deux premiers articles sont deux travaux de métasynthèse. Le premier concerne l'obésité de l'adolescent. Les résultats obtenus mettent en lumière les limites de la méthode utilisée. Le deuxième article s'intéresse à la question des comportements suicidaires à l'adolescence. Les enseignements méthodologiques du premier article ont permis de perfectionner la méthode de métasynthèse. Enfin, le troisième article propose une description détaillée des étapes de la méthode construite. En discussion, nous proposons de resituer la méthode de la métasynthèse dans le contexte historique du niveau de preuve scientifique. Nous illustrons avec les articles les plus récents les liens toujours plus forts qui se construisent entre la méthode de la métasynthèse, aujourd'hui appelée Qualitative Evidence Synthesis, et la médecine fondée sur les preuves. La métasynthèse est une méthode moderne, qui montre tout son intérêt dans la recherche médicale. Notre méthode appliquée à la psychiatrie de l'adolescent est rigoureuse et fiable, et permet d'accroître la connaissance scientifique et d'améliorer la prise en charge des patients. / Qualitative research is expanding fast in medicine and especially in psychiatry, where the patient and his representations of illness and care are central to treatment. In the field of adolescent health, great work provides important advances in the understanding of suffering and care. Qualitative methods are however often criticized because of their contextuality and their lack of generalization power. One way to improve these aspects is to match studies addressing the same issue so as to synthesize the main results. From a long time, human sciences have taken hold of this exercise of synthesis, which is significantly different from meta-analysis of quantitative research. They have called this work metasynthesis or meta-ethnography. The literature synthesis exercise is now increasingly codified in scientific research. However, some points are still under discussion - For example, inclusion criteria for studies, study quality criteria -. Moreover, no metasynthesis exist in the field of psychiatric research. This work describes the stages of construction and adaptation of a simple, rigorous, efficient, easy to share and teach method, which enables to do qualitative data synthesis in the field of psychological care to adolescents. On the one hand, we propose a theoretical, epistemological and methodological reflection on metasyntheses and their adaptation to the field of psychiatric care. On the other hand, we describe a practical progression: our method is built from metasyntheses conducted on two themes of adolescent psychological care. The first two papers are both metasyntheses. The first one is about adolescent obesity. The results highlight the limitations of the method we used. The second article focuses on the issue of suicidal behavior in adolescence. The methodological lessons of the first article helped us to improve the meta-synthesis method. The third article provides a detailed description of each steps of the method. In discussion, we propose to situate the method of metasynthesis in the historical context of the scientific evidence. We illustrate with recent papers the increasingly strong links that exist between metasynthesis, now called Qualitative Evidence Synthesis, and Evidence-Based Medicine. The metasynthesis is a modern method. It shows its interest in medical research. Our method applied to adolescent psychiatry is rigorous and reliable, and can increase scientific knowledge and improve the care of patients.

Trots lagstiftning kring patienters delaktighet i vården ses en tydlig brist på delaktighet vid vårdplanering hos patienter inom psykiatrisk vård. Syftet med det här arbetet var att sammanställa kunskap genom en metasyntes för att nå en djupare förståelse av patienters upplevelser av delaktighet vid vårdplanering i den psykiatriska vården. Detta genom frågeställningarna vad beskriver patienter främjar respektive hindrar delaktighet vid vårdplanering i den psykiatriska vården. Tio artiklar svarade mot vårt syfte och inkluderades. Analysen av dessa resulterade i att tre teman identifierades: 1.“Det yttre lagret: Vårdplanen som ett värdefullt stödverktyg eller en meningslös upprepning” 2. Det mellersta lagret: “Att navigera oenigheter för en känsla av att äga innehållet”, och 3. Det inre lagret: “En vilja att ses som expert men en samtidigt upplevd maktlöshet”. De tre identifierade lagren syntetiserades i syfte att få en djupare förståelse och ny kunskap av patienters upplevelser av delaktighet i vårdplaneringsprocessen. Syntesen visar på tre lager som har en bestämd ordning där kärnan i syntesen och de tre identifierade lagren utgår från individen, som är expert.

Thesis advisor: Brinton Lykes / This study used a systematic meta-synthesis methodology to explore and expand upon the field of youth participatory action research (YPAR) through synthesizing findings for a change-oriented audience interested in how YPAR has been and can be leveraged to support youth outcomes reported in current and future YPAR academic literature. With that in mind, I screened, coded, and synthesized studies using both inductive and deductive processes to support my meta-synthesis. This included defining, and systematically searching databases for keywords, screening the academic literature, assessing the quality of the literature, and extracting and presenting the formal data before undergoing detailed thematic analysis and validation. Of the 153 non-duplicated English-language US-based YPAR sources read and analyzed for fit, 20 distinct studies were included in the final sample. These studies were coded for documented reports of youth-led research activities and youth-directed change. A description and analysis of YPAR principles, project and contextual characteristics, study methods, and reported youth outcomes are included. Analyses confirmed that this YPAR literature emphasized youth leadership in problem-posing and data collection contexts, with fewer studies involving youth in leading the data analysis and reporting the academic findings. Moreover, while thereare many studies that report a change as part of the desired action, there are fewer that explicitly explore how the youth understand the change as being aligned with their interests ‒ or that show the youth seeing the change through to the end of their involvement with the project. While most common outcomes associated with participation in YPAR were related to the discussion of youth leadership, followed by academic or social changes, interpersonal outcomes were also explored through discussions about the importance of youth involvement in YPAR. Additionally, more recent research has tended to emphasize the role of change (also called “action” or “impact”) and youth’s protagonism in exploring if the actions that the YPAR studies initiated are beneficial to the youth’s own goals, versus more general goals or outcomes. This meta-synthesis provided increasing support for the role of YPAR in fostering some of the skills and competencies youth wish to acquire and that their teachers, mentors, etc. seek for them. This dissertation offers a methodological discussion on YPAR that can provide greater evidence of YPAR’s contributions to youth outcomes, where youth’s protagonism is explored as a contributing factor for the shifts in intrapersonal, relational, and contextual outcomes. Throughout the dissertation, this meta-synthesis offers suggestions as to implications for research, practice, and policy. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Bakgrund: Att genomgå en förlossning kan vara skrämmande och outforskat för den födande kvinnan. För att erhålla en positiv förlossningsupplevelse krävs det att kvinnan känner säkerhet och besitter kontroll under förlossningsprocessen. Ett alternativ som visat sig ha medicinska fördelar för kvinna och barn under förlossning är när kvinnan ligger nedsjunken i vatten under förlossningsarbetet. Syfte: Syftet var att undersöka kvinnors upplevelser av att befinna sig nedsjunken i vatten i samband med förlossningsarbete. Metod: Kvalitativ metasyntes med metaetnografisk analysmetod. Datainsamling har genom sökning i relevanta databaser genererat i 15 artiklar som ligger till grund för resultatet. Resultat: I resultatet identifierades fyra huvudteman: En tro på det naturliga som innefattade en önskan om naturlig förlossning och en medicinsk misstro. En tilltalande förlossning som berörde vattnets välgörande effekter, stärkande flytkraft, hemlik miljö och ett effektivt förlopp. I En stärkande upplevelse framgick att metoden innebar en känsla av kontroll och tillfredsställelse och att stödet från andra ansågs viktigt. Försvårande omständigheter beskrev olika hinder för en god förlossningsupplevelse, det handlade om poolen, negativa inställningar hos vårdpersonal och anhöriga men också en oro eller rädsla hos kvinnan. Slutsats: Förlossningsarbete i vatten innebär möjligheter för kvinnan till positiv förlossningsupplevelse där hon erhåller kontroll och tillfredsställelse. Ökad kunskap behövs hos barnmorskan och annan relevant vårdpersonal för att kunna stödja och erbjuda kvinnan vård efter hennes önskemål och behov. Klinisk tillämpbarhet: Metasyntesens resultat kan användas av barnmorskor och annan vårdpersonal som möter gravida kvinnor. Dels för att informera och stödja kvinnan, dels för vidare implementering av vattenförlossning på kliniker. / Background: Giving birth can be an intimidating and unexplored experience for women. In order to obtain a positive birth experience, it is required that women feel safe and in control during the birthing process. Water immersion has been shown to have medical benefits during labor and childbirth.Aim: The aim was to investigate women’s experiences of immersion in water in connection with labor and birth.Method: A qualitative metasynthesis with metaethnographic analysis was used. Searching the relevant databases generated in 15 articles and results are based on this data.Results: In the results, four main themes were identified: A belief in the natural that included desire for a natural childbirth and a medical mistrust. An appealing birth that included the beneficial effects of the water as strengthening buoyancy, homely environment and an efficient process. A strengthening experience showed that the method entailed a feeling of control and satisfaction and that the support from others was considered as important. Aggravating circumstances described obstacles for a good experience. It was about the pool, negative attitudes among care staff and relatives but also a worry or fear for the woman.Conclusion: Water immersion during childbirth means a possibility for the women to have a positive childbirth experience where she can feel in control and satisfaction. Increased knowledge is needed for the midwife and other relevant health care professionals to be able to support and offer the woman care according to her wishes and needs.Clinical applicability: The results of metasynthesis can be used by midwives and other healthcare professionals who meet pregnant women. Partly to inform the woman, to be able to support the woman but also for further implementation of waterbirths in clinics.

Bakgrund: Den psykiska ohälsan bland befolkningen har ökat under de senaste decennierna och medellivslängden i Sverige ökar kontinuerligt. Risken att drabbas av depression var vanligare hos personer över 65 år. Depression påverkar personens känslor, tankar och beteende negativt. Det är av vikt att upptäcka, diagnostisera och behandla depression för att minska personens lidande samt minska samhällskostnader som depression medför. Personcentrerad vård är ett etiskt förhållningssätt och syftar till att involvera den enskilda personen, samt anpassa vården efter dennes behov. Sjuksköterskor arbetar ofta självständigt i vården av den äldre personen med depression. Syfte: Syftet med studien var att belysa sjuksköterskors upplevelser av att möta och vårda den äldre personen med depression. Metod: En metasyntes (Noblit och Hare, 1988) med kvalitativ design. Resultat: Metasyntesen resulterade i fyra huvudteman; organisationens betydelse, vikten av hög kompetens, vikten av att ge tid, betydelsen av ett holistiskt förhållningssätt. Teamarbete och resurser var grundläggande för att kunna stötta den äldre personen med depression. Kunskap, erfarenhet samt normmedvetenhet underlättade identifiering av depression och bidrog till god omvårdnad. Skapandet av en relation med den äldre personen tog tid och byggdes på tillit samt kontinuitet. Att se till hela personen och relationens betydelse påverkade omvårdnaden positivt. Slutsats: Stöttning från organisationen behöver finnas, mer utbildning behöver erbjudas samt möjlighet att få tid i mötet och vården av den äldre personen med depression för att kunna förbättra omvårdnaden. Det kan inte nog betonas hur viktigt det är att sjuksköterskan får resurser som ger möjligheter att skapa en personcentrerad vård. / Background: Mental illness among the population has increased in recent decades and life expectancy in Sweden is continuously increasing. The risk of suffering from depression was generally more common for people over 65 years of age. Depression negatively affects the person's feelings, thoughts and behaviour. It is important to detect, diagnose and treat depression in order to reduce the person's suffering and reduce the societal costs that depression entails. Person-centered care is an ethical approach and aims to involve the individual, as well as adapt care to his or her needs. Nurses often work independently in the care of the elderly person with depression.Aim: The aim of the study was to describe nurses' experiences of meeting and caring for the elderly person with depression. Method: The study is a metasynthesis (Noblit and Hare, 1988) with a qualitative design. Results: The metasynthesis resulted in four main themes; the importance of the organization, the importance of high competence, the importance of giving time, the significanceof a holistic approach. Teamwork and resources were essential in order to be able to support the elderly person. Knowledge, experience and norm awareness facilitated the identification of depression and contributed to good nursing. The creating of a relationship with the older person took time and was built on trust and continuity. Looking at the whole person and the importance of the relationship had a positive impact on nursing. Conclusion: Support from the organization needs to be available, more education needs to be offered as well as the opportunity to have time in the meeting and care of the elderly person with depression in order to improve care. It cannot be emphasized enough how important it is for the nurse to receive resources that provide opportunities to create a person-centered care.

Bakgrund: ​Förlossningsdepression är ett tillstånd som drabbar upp till 15 procent av kvinnor i              Sverige efter förlossning. Obehandlat kan tillståndet medföra negativa konsekvenser för både           kvinnans och barnets hälsa. Barnmorskan har en viktig roll i att tidigt fånga upp kvinnor som                utvecklat eller är i risk för att utveckla en förlossningsdepression. ​Syfte: ​Att beskriva kvinnors              upplevelser av att genomgå en förlossningsdepression. ​Metod: ​Kvalitativ metasyntes med en           metaetnografiskanalysmetod.Datainsamlinghargenomförtsitredatabaser;PubMed,CINAHLoch           PsycInfo. Totalt ingår 17 artiklar i metasyntesens resultat, där samtliga genomgått en            kvalitetsgranskning. ​Resultat:​Fyra teman identifierades;​En identitet i förändring, En ny roll som             moder, En förhindrad anknytning och En känslomässig storm. ​Slutsats: ​Under en           förlossningsdepression upplever kvinnor känslor av identitetsförlust, svårigheter att anpassa sig till           modersrollen, problem i anknytning med barnet samt en känslomässig berg- och dalbana.            Barnmorskan har en betydande roll i förebyggandet och tidig upptäckt av förlossningsdepression.            Klinisk tillämpbarhet:​Metasyntesen kan användas av barnmorskor inommödrahälsovården,som          utgångspunkt och stöd i förbättringsarbete av vård för kvinnor som utvecklat eller är i risk för att                 utveckla en förlossningsdepression. / Background: Postpartum depression is a condition that affects up to 15 percent of women in               Sweden after childbirth. Untreated, this condition can have a negative effect on the health of both                the woman and the child. Midwives have an important role in identifying women who have               developed or are at risk of developing postpartum depression. ​Aim: ​To describe women's             experiences of postpartum depression. ​Method: ​Qualitative metasynthesis with metaethnographic         analysis method. Data was collected through three databases; PubMed, CINAHL and PsycInfo. A             total of 17 articles are included in the result of this metasynthesis, of which all of them passed a                   thorough quality critique.​Results: Four themes were identified;Achangingidentity,Anewroleas               a mother, A hindered bondingandAnemotionalstorm.​Conclusion:​Duringpostpartumdepression             women experience feelingsoflosingtheiridentity,difficultiesadaptingtomotherhood,problemsin             bonding with the child as well as a rollercoaster of emotions.Themidwifehasanimportantrolein                  prevention and early identification of postpartum depression. ​Clinical implications: This          metasynthesis can be used by midwives working in maternity care, as atooltoimprovethequality                 of care for women who have developed or are at risk of developing postpartum depression.

This thesis 'The Symphony of Care' consists of four studies focusing on care relationships between patients and professional caregivers. Care relationships are central to the health process and a fundamental element in caregiving. The term care relationship is widely used in caring science but lacks a clear definition, which can create misunderstanding and can constitute an obstacle when attempting to optimize care relationships. The aim of this thesis is to describe the phenomenon of care relationships in order to add to the body of knowledge in caring science.The main research questions are: • What is a care relationship within the caring science field? • How can a care relationship be optimized to improve its caring function, in order to promote health? The ontological foundation of this thesis is caring science. Phenomenology and Lifeworld theory are used as its epistemological bases. Reflective Lifeworld Research is used as a methodological approach. The four studies were conducted in different contexts and cultures- the first two empirical studies were performed in China and the remaining two, a metasynthesis and a secondary analysis, were carried out in a Swedish context. The results show that care relationships are temporary intentional relationships between a person who needs help and a helper. The purpose of this relationship is to support the patient in his/her dynamic health process, which is unique for each person in different times and contexts. Care relationships are fragile because the patient is vulnerable and the demand on the helper is great. It is an inter-human relationship between equals, which can at the same time be an asymmetric relationship due to the professionalism with the caregiver and the vulnerability with the patient. A care relationship is not independent, but is affected by internal factors such as the two individuals' lifeworlds and external factors such as health policies, organization, economics, health culture and environment. To optimize the effectiveness of caring, the relationship and its surrounding need to be in harmony. The view of care relationships should be broadened to include the external resources in order to optimize their caring potential.

Metasynthesis about the concept of youth in brazilian scientific production in the Humanities Sciences and Applied Social Sciences scope. The theoretical and methodological assumption is socio-historical perspective, dialectical materialism, especially as presented by Vygotsky. To such end, are studied 189 scientific documents produced in the years 2007 to 2011: 37 papers identified in the virtual database Scientific Electronic Library Online - SciELO / Google Scholar, and 120 dissertations and 32 theses, by CAPES database. Use as descriptors to find documents: 'youth' and 'youth concept'. Criteria for selection of the sample: the presence of the word 'youth' in the title or the expression 'concept of youth' in the abstract, and explain in the summary or abstract the intention of discussing the concept of youth. The results appoint that: There is significant importance acquired by the subject in academic and scientific Brazil production, growing in the analyzed period in 23 of the 26 knowledge areas of Humanities Sciences, and Applied Social Sciences, specially in Education, Sociology and Psychology areas. Diversity in theoretical and methodological approach. Psychology has the largest proportion of studies about the concept of youth. The concept of youth in 189 documents analyzed develops sociological aspects considering roles, generational relations and juvenile political participation; biological aspects, from body changes with age; and psychological aspects, reflecting about the constitution of the individual person and their relationships with other. The concept of youth widens with increasing number of areas of interest that do studies about youth or that use those concepts already established. Moreover, there is a strong presence of operational issues that help define and locate the youth as a social category and specific research object: relationship between youth and adolescence, characteristics of the condition and youth situation, relationship with time and the 'becoming'. Some challenges present themselves to current studies of youth: the dialogue between the various sciences from a historical and cultural assumption; the identity process through which young people spend amid strong calls for a 'subordinate autonomy' to the market; a overlapping generations as space to generational transmition in favor of strengthening and accumulation of experience, and the young people relationship with other social categories, in an effort to understand contemporary society. The subsidies of this study are potentially useful to the theoretical and methodological reflection about the concept production, especially youth concept in the field of academic research, as well as to the intervention in youth policies. / Metassíntese do conceito de juventude, na produção científica brasileira, no âmbito das Ciências Humanas, incluindo a Linguística, Letras e Artes; e as Ciências Sociais Aplicadas. Pressuposto teórico e metodológico sócio-histórico, materialista e dialético, especialmente como apresentado por Vigotski. Para tanto, realiza estudo de 189 documentos científicos produzidos nos anos 2007 a 2011, sendo 37 artigos científicos identificados no banco de dados virtual Scientific Eletronic Library Online – SCIELO / Google Acadêmico, 120 dissertações e 32 teses, via banco de dados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES. Utiliza os descritores juventude, juventudes e conceito de juventude. Critério de escolha da amostra: presença da palavra juventude ou juventudes no título, ou da expressão ‘conceito de juventude’ no resumo e, por explicitarem no resumo, ou no sumário, a intenção de discutir o conceito de juventude. Os resultados indicam: a significativa importância adquirida pelo tema na produção acadêmica e científica brasileira, crescente no período analisado em 23 das 26 áreas do conhecimento das Ciências Humanas, incluindo a Linguística, Letras e Artes e das Ciências Sociais Aplicadas especialmente nas áreas de Educação, Sociologia e Psicologia; a diversidade na abordagem teórico e metodológica; a Psicologia possuindo a maior proporção de estudos sobre o conceito de juventude. O conceito de juventude nos 189 documentos analisados desenvolve aspectos: sociológicos, considerando papéis, relações geracionais e participação política juvenil; biológicos, a partir das mudanças corporais em função da idade; e psicológicos, refletindo sobre a constituição da pessoa individual e suas relações com o outro. O conceito de juventude se amplia com o aumento das diversas áreas de interesse que empreendem estudos a respeito ou utilizam aqueles já estabelecidos. Por outro lado, há uma forte presença de questões operacionais que ajudam a definir juventude e a localizá-la como categoria social específica e objeto de pesquisa: relação juventude e adolescência, características da condição e da situação juvenil, juventude e a relação com o tempo e o devir. Apresentam-se como desafios para os estudos atuais de juventude: o diálogo entre as distintas ciências a partir de um pressuposto histórico e cultural; o processo identitário pelo qual passa o jovem, em meio a fortes apelos por uma ‘autonomia tutelada’, pelo mercado; a sobreposição geracional como espaço de transmissão geracional a favor do fortalecimento da acumulação de experiência; e a relação da juventude com outras categorias sociais, no esforço de se compreender a sociedade contemporânea. Consideram-se potencialmente úteis, os subsídios deste estudo para a reflexão teórica e metodológica acerca da produção de conceito, especialmente, da juventude no campo da pesquisa acadêmica, bem como a intervenção junto às políticas juvenis.

This thesis addresses the paradigm shift required for an MBA qualification in a world order of inclusive globalisation (WOIG) – where humankind‟s security is assured, and where global poverty has been eradicated. A new research methodology, termed critical metasynthesis, which is the enrichment of critical management research with metasynthesis and Socrates‟ dialectic method of systematic inquiry has been used. The critical metasynthesis derives its outcome from the insights of global leaders from the developed and developing world, refuted by Nobel Laureates from the past decade. From the Socratic dialogue an end-purpose Statement of Visions for a new world order, society, business, business leadership, and the postmodern MBA emerged, namely: to deliver a WOIG; requiring a society that finds its greatness in protecting both its humanity and its economy as a whole; requiring world-class businesses – financially robust across business cycles, with global stewardship as the dominant business logic; requiring global business leaders with an ability to envision the WOIG, and then to lead thereto in an entrepreneurial and path-breaking manner exerting leadership qualities associated with the golden Rule of Humanity; requiring an MBA that educates and inspires the business leader to lead (and, to co-lead with societal and political leaders) the planetary turn-around to a WOIG. For this, a fundamental change of paradigm for the MBA emerged as a prerequisite. The first prerequisite is a Social Contract with Business as a trichotomy of global business responsibility towards society, politics and the Earth. This, becomes the raison d‟être of the postmodern MBA. The second prerequisite is an educational context aligned with the values and aspirations of a WOIG society. The outcome of the postmodern MBA is a fundamental personal re-orientation as thé kairos moment - through holistic critical reasoning excellence and achieving a WOIG mindset. Flowing from this to craft, build and to manage enterprises for the turn-around from today‟s world order of destructive globalisation to a WOIG. The thesis contributes a new educational context, vocabulary, and guidelines for a new canon of MBA knowledge. The thesis concludes by describing new vistas of follow-up research in four interlocking priorities for the professoriate, namely: discovering, integrating, applying and teaching a postmodern MBA in a WOIG – to deliver MBA graduates who can lead any business in any industry sector in any country towards positive sustained results for all stakeholders. / Business Leadership / D.B.L.

En chirurgie, les critères d’évaluation des soins sont surtout relatifs à la technique et à la biologie, et les facteurs psychologiques et sociaux sont peu présents. En particulier, la subjectivité du chirurgien et son rôle dans les soins prodigués sont des aspects peu étudiés, malgré (i) un taux de burnout des chirurgiens proche de 40%, (ii) la singularité du chirurgien (son expérience, sa personnalité, ses choix de prise en charge, etc.), variable clé dans les soins prodigués (comme le psychothérapeute en psychothérapie), (iii) l’environnement social et culturel particulier dans lequel travaillent les chirurgiens. L’objectif de cette thèse est d’explorer les facteurs psychosociaux qui peuvent influencer la pratique de la chirurgie et le bien-être des chirurgiens. Trois études ont été menées. La première est une revue systématique de la littérature qualitative (méta-synthèse) portant sur comment les chirurgiens vivent leur pratique. A l’issue de la première étude, nous avons approfondi les résultats au travers d’une étude qualitative sur l’expérience émotionnelle des chirurgiens hépatobiliaires (chirurgie à haut risque ; surtout oncologique). Une troisième étude prospective de cohorte s’est intéressée à la détermination de l’influence des facteurs psychologiques du patient (dépression et anxiété) sur l’outcome de la chirurgie hépatique, et a permis d'explorer comment les chirurgiens prennent en compte ces facteurs dans leur pratique. Nous avons discuté les implications de nos résultats par rapport à la santé mentale et aux burnouts des chirurgiens, ainsi que par rapport à la mise en œuvre du modèle bio-psycho- social dans les soins des patients chirurgicaux. / In surgery, psychological and social factors are not widely studied, and the only variables considered important in surgical care are those related to operating technique and biology. Additionally, surgeons’ experience of their practice is neglected, despite the fact that (i) epidemiological studies showed a 40% burnout rate among surgeons, (ii) the difference between individual surgeons is a key variable in the performed care (like psychotherapists in psychotherapy), and (iii) surgeons work in a high salient social and cultural environment. The aim of this PhD thesis is to explore the psychosocial factors influencing surgical practice and surgeons’ wellbeing. Our findings are based on three studies. First, we performed a systematic review of international qualitative studies (metasynthesis) in order to describe how surgeons experience their practice from their perspective. Then, a second qualitative study extended the findings of the previous one exploring in-depth the everyday emotional experience of liver surgeons (high risk surgery, mainly cancer-related). Finally, a prospective cohort study investigated the influence of preoperative patient-related psychological factors (depression and anxiety) on the outcome of liver surgery, and how surgeons take these data into account in their practice. Several implications of our findings have been discussed, concerning surgeons’ mental wellbeing and burnout, as well as the implementation of the bio-psycho-social model in the care of surgical patients.