Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patient safety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate data entry. Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).

Bien qu’il soit largement reconnu dans différents milieux d’intervention au Québec que l’intervenant est un des agents actifs les plus importants de l’efficacité d’une intervention – et c’est un des postulats centraux de l’intervention psychoéducative –, il existe encore très peu d’instruments de mesure validés empiriquement permettant l’évaluation du fonctionnement d’un groupe d’intervenants. Néanmoins, il existe un instrument pouvant mesurer le climat social d’une équipe, soit le Questionnaire du climat social d’une équipe d’intervenants (QCSÉI; Le Blanc, Trudeau-Le Blanc, & Lanctôt, 1999; Moos 1987). Le QCSÉI compte 10 échelles de premier niveau. Dans ses écrits théoriques, Moos (2003) a suggéré que le climat social est un construit hiérarchique et que l’ensemble des instruments mesurant différentes dimensions du climat social d’un groupe ou d’une équipe devrait se regrouper en trois facteurs d’ordre supérieur, soit les relations interpersonnelles, la découverte de soi et le maintien de l’ordre et du changement. Un examen conceptuel des échelles du QCSÉI suggère que ce modèle théorique est problématique. Cette étude visait à déterminer si la structure hiérarchique proposée par Moos était adéquate pour le QCSÉI dans un échantillon d’intervenants québécois. L’échantillon utilisé était composé d’intervenants faisant partie de Boscoville2000, un projet d’intervention cognitivecomportementale en milieu résidentiel pour les adolescents en difficulté. Des analyses factorielles exploratoires ont d’abord démontré que la structure de premier niveau est bien reproduite. Deux échelles jugées importantes pour mesurer le climat social ont ensuite été ajoutées. Par la suite, des analyses factorielles exploratoires et confirmatoires ont démontré que la structure théorique hiérarchique en trois dimensions d’ordre supérieur de Moos ne représente pas bien les données. Les analyses ont révélé une structure alternative plus intéressante sur le plan conceptuel et qui représentait mieux les données. Des corrélations entre les échelles de climat social de l’équipe et les traits de personnalité des intervenants ainsi que différentes variables sociodémographiques et liées à la pratique professionnelle ont procuré un appui qui suggère que le QCSÉI possède une validité de critère acceptable. / Even though it is largely recognized in various psychosocial intervention settings that the counselor is one of the main active component of an intervention efficacy – and it is one of the central postulate of psychoeducation –, there are still very few empirically-validated instruments for the assessment of a youth counselors’ team functioning. Still, there is one interesting instrument for assessing the social climate of a team, the Counselors’ Team Social Climate Questionnaire (“Questionnaire du climat social de l’équipe d’intervenants”, QCSÉI; Le Blanc, Trudeau-Le Blanc, & Lanctôt, 1999; Moos 1987). The QCSÉI is composed of 10 first order scales. In his theoretical writings, Moos (2003) suggested that the social climate is a hierarchical construct and that all instruments measuring different foci of the social climate should group into three higher-order dimensions, namely Relationships, Personal Growth, and System Maintenance and Change. A conceptual examination of the QCSÉI scales suggested that this theoretical model is problematic. This study aimed at evaluating if the hierarchical structure postulated by Moos was adequate in a sample of youth counselors from Quebec. The sample that was used was composed of youth counselors from Boscoville2000, a residential cognitive-behavioral intervention program for adolescents with serious adjustment problems. Exploratory factor analyses first demonstrated that the first order structure was well reproduced. Two additional scales judged as important aspects of the social climate were then added. Next, exploratory and confirmatory factor analyses confirmed that the theoretical hierarchical structure with three higher-order dimensions was not well reproduced in the data. The analyses rather revealed an alternative structure that was conceptually more interesting and provided a better fit to the data. Correlations between the teams’ social climate and youth counselors’ personality traits, as well as socio-demographic and professional practice variables provided evidence suggesting that the instrument have acceptable criterion-related validity.

Si l’alternative est de nos jours et dans nos sociétés occidentales un concept de plus en plus en vogue, son caractère lui, en demeure pas moins ambigu. En effet, et alors même que nombre de pratiques dites alternatives émergent de part et d’autre de la société, en faire allusion dans certains domaines équivaut à s’affliger soi-même d’une étiquette sur laquelle serait inscrite « New-Age » en caractère gras. Pourtant, son caractère loin d’évoquer cette seule dimension, semble par ailleurs être conséquente d un déséquilibre de plus en plus prégnant au sein même des prérogatives de l’État. Ce mémoire tente donc de rendre compte de ce phénomène tout en investiguant les répercussions de cette asymétrie sur l’intégration de pratiques médicales alternatives au Québec. Ceci dans l’intention non seulement d’explorer davantage la nature de la relation entre médecine alternative et biomédecine, mais aussi afin de poser un nouveau regard sur son expansion. Un regard, lequel permettrait potentiellement de poser les jalons nécessaires à un espace de conciliation entre les médecines, lequel découlerait alors d’un nouvel équilibre au cœur des prérogatives mêmes de l’État. / If the alternative is to our days and in our western societies a concept more and more in vogue, its character remains ambiguous. In effect, and even that number of practices called “alternatives” emerge on both sides of the society, in referring to in some areas is equivalent to plague itself-even a label on which would be marked “New-Age” in bold. Yet, its character far from referring to this single dimension, seems also be consistent to a more and more significant unbalance within the prerogatives of the State. This dissertation therefore attempts to account for this phenomenon while inquiry into the repercussions of this asymmetry on the integration of alternative medical practices in Quebec. This with the intention not only to further explore the nature of the relationship between alternative medicine and biomedicine, but also in order to install a new look on its expansion. A look, which would potentially lay the groundwork necessary to a space of conciliation between the medicines and which would lead to a new balance in the heart of the prerogatives of the State.

Le rôle que jouent les services orthophoniques dans l’ajustement des proches de personnes aphasiques ainsi que le contexte dans lequel les orthophonistes mettent en place des interventions auprès de ces proches ne sont actuellement pas connus. La présente thèse a donc pour but de comprendre de quelle manière les relations entre les orthophonistes et les proches de personnes aphasiques, développées en contexte de réadaptation, s’inscrivent dans la trajectoire dynamique des proches et dans la pratique des orthophonistes. Une approche qualitative par théorisation ancrée a été utilisée dans quatre études pour analyser les entrevues effectuées auprès de proches de personnes aphasiques et d’orthophonistes. Dans l’étude 1, les entrevues menées à trois reprises dans la première année suivant l’accident vasculaire-cérébral (AVC), et ce, auprès de quatre filles dont la mère est aphasique, ont été analysées. Un modèle théorique représentant la relation mère-fille a été développé. Ce modèle illustre que les perceptions de fragilité, de difficultés et de compétence, qu’ont les filles à l’égard de leur mère, les amènent à adopter des comportements de protection ou de confiance, ce qui génère des réactions de satisfaction ou d’insatisfaction chez la mère, renforçant alors les perceptions initiales des filles. Quatre patterns relationnels peuvent donc coexister au sein d’une même dyade. L’aphasie complexifierait cet ajustement relationnel. Dans l’étude 2, les entrevues effectuées à trois reprises durant la première année suivant l’AVC, auprès d’une fille dont la mère est sévèrement aphasique, ont été analysées. Un modèle théorique représentant l’expérience d’aider a été élaboré. Selon ce modèle, percevoir des difficultés chez sa mère et ressentir que leur relation antérieure est menacée a déclenché le processus d’aide chez la fille. Parallèlement, la reconnaissance de la compétence de sa mère a motivé la fille à offrir de l’aide visant à rendre sa mère heureuse et à favoriser son indépendance. Ce type d’aide a contribué à augmenter l’indépendance de sa mère, à retrouver une relation satisfaisante avec celle-ci et à s’adapter à l’aphasie. Dans l’étude 3, les entrevues de 12 proches de personnes aphasiques ont été analysées. Un modèle théorique représentant l’expérience de l’aphasie et de la réadaptation post-AVC a été développé et illustre que les proches sont centrés sur la personne aphasique et participent à la réadaptation dans le rôle d’aidant. Cette disposition influence alors leurs attentes envers la réadaptation, leurs interactions avec les professionnels, dont les orthophonistes, et leur appréciation de la réadaptation. Dans l’étude 4, les entrevues effectuées auprès de huit orthophonistes travaillant en réadaptation ont été analysées. Un modèle théorique illustrant le processus d’intervention des orthophonistes auprès des proches de personnes aphasiques a été construit. Pour les orthophonistes, le travail avec les proches est majoritairement perçu comme un ajout positif, mais exigeant, à leur pratique de base centrée sur la personne aphasique. Une satisfaction professionnelle peut en découler, mais des idéaux non-atteints peuvent persister. La relation proche-orthophoniste serait donc principalement axée sur le rôle d’aidant que joue le proche, et ce, en raison de leur expérience respective. Un agrandissement du territoire de rencontre entre les orthophonistes et les proches pourrait soutenir les proches dans les ajustements relationnels induits par l’AVC avec aphasie ainsi que permettre aux orthophonistes d’atteindre leurs idéaux. / The role speech-language therapy (SLT) services play in significant others’ adjustment to stroke and aphasia as well as the context in which SLTs offer interventions to significant others are currently unknown. The present dissertation aims to understand how in rehabilitation settings, relationships between SLTs and significant others of persons with aphasia develop, and fit within significant others’ process of change, on one hand, and into SLTs’ practice, on the other hand. A grounded theory approach was used in four studies to analyze interviews conducted with significant others of persons with aphasia and with SLTs. In study 1, four daughters of aphasic women were each interviewed three times over the first year post-stroke and their discourse was analyzed. A theoretical model of the daughter-mother relationship was constructed. This model shows how the daughters’ perception of maternal fragility, problems, and abilities motivated daughters to take on protective and trusting behaviors that resulted in maternal reactions of satisfaction and dissatisfaction that, in turn, reinforced the daughters’ initial perceptions. Four relational patterns may therefore coexist in a given dyad. Aphasia could make relational adjustments more complex. In study 2, three interviews conducted over the period of one year with the daughter of a woman with severe aphasia were analyzed. A theoretical model representing the experience of caregiving was elaborated. This model illustrates that for the daughter, perceiving her mother’s problems and feeling their previous relationship was threatened triggered the caregiving process. In parallel, the daughter’s recognition of her mother’s competence encouraged her to offer care aiming to make her mother happy and to foster her mother’s independence. Increases in her mother’s independence, a renewal of their relationship and adaptation to aphasia were consequences of this type of caregiving. In study 3, the interviews conducted with 12 significant others of aphasic persons were analyzed. A theoretical model representing significant others’ experience of aphasia and rehabilitation following stroke was developed and showed that significant others participated in rehabilitation as caregivers centered on the person who had aphasia. This disposition influenced their expectations of rehabilitation, their interactions with professionals, such as SLTs, and how they appraised rehabilitation. In study 4, the interviews conducted with eight SLTs working in rehabilitation settings were analyzed. A theoretical model representing SLTs’ process of working with significant others of persons with aphasia was elaborated. SLTs mostly perceived work with significant others as a challenging bonus to their fundamental approach centered on the person with aphasia. As a consequence, SLTs felt professional satisfaction while dreaming for something more to offer significant others. The relationship between significant others and SLTs thus mainly seem to focus on the caregiver role endorsed by significant others as a result of the experience of each of them. Expanding the shared territory of SLTs and significant others could support significant others’ adjustment to the relational changes induced by stroke and aphasia and could help SLTs attain their professional dreams.

La réflexion est considérée comme un élément significatif de la pédagogie et de la pratique médicales sans qu’il n’existe de consensus sur sa définition ou sur sa modélisation. Comme la réflexion prend concurremment plusieurs sens, elle est difficile à opérationnaliser. Une définition et un modèle standard sont requis afin d’améliorer le développement d’applications pratiques de la réflexion. Dans ce mémoire, nous identifions, explorons et analysons thématiquement les conceptualisations les plus influentes de la réflexion, et développons de nouveaux modèle et définition. La réflexion est définie comme le processus de s’engager (le « soi » (S)) dans des interactions attentives, critiques, exploratoires et itératives (ACEI) avec ses pensées et ses actions (PA), leurs cadres conceptuels sous-jacents (CC), en visant à les changer et en examinant le changement lui-même (VC). Notre modèle conceptuel comprend les cinq composantes internes de la réflexion et les éléments extrinsèques qui l’influencent. / Although reflection is considered a significant component of medical education and practice, the literature does not provide a consensual definition or model for it. Because reflection has taken on multiple meanings, it remains difficult to operationalize. A standard definition and model are needed to improve the development of practical applications of reflection. In this master’s thesis, we identify, explore and thematically analyze the most influential conceptualizations of reflection, and develop a new theory-informed and unified definition and model of reflection. Reflection is defined as the process of engaging the self (S) in attentive, critical, exploratory and iterative (ACEI) interactions with one’s thoughts and actions (TA), and their underlying conceptual frame (CF), with a view to changing them and a view on the change itself (VC). Our conceptual model consists of the five defining core components, supplemented with the extrinsic elements that influence reflection.

La thèse interroge les modalités d’organisation des dispositifs de formation alternée à l’insertion. Créés il y a une quarantaine d’années, dans un contexte de crise économique, ces dispositifs représentent aujourd’hui un passage nécessaire particulièrement pour les jeunes non-diplômés. En étudiant les logiques sous-jacentes des politiques publiques d’insertion, l’impact du mode de production « serviciel » sur l’activité des salariés et les pédagogies constitutives de ces formations, la thèse révèle les tensions existant entre les enjeux portés par différents acteurs, et leurs effets sur le processus d’apprentissage et d’insertion des jeunes. À partir de ces éléments, étayés au cours de la première partie, il s’agit de voir quelle place occupe l’activité du stagiaire déployée en entreprise. L’enquête de terrain permet, dans un premier temps, d’appréhender la diversité et la complexité des situations de service auxquelles se confrontent quotidiennement les stagiaires. Elle montre comment ils parviennent ou non à mobiliser, dans ces situations, les savoirs théoriques appropriés et les connaissances en acte forgées auparavant, à réguler leurs émotions, à investir les enseignements puisés dans leur histoire, à « retraiter » les valeurs portées par le milieu du travail, pour répondre aux exigences de la tâche et aux attendus du service à accomplir. Ensuite, l’enquête empirique se concentre plus spécifiquement sur les pratiques des formateurs d’encadrement des espaces réflexifs dédiés aux retours d’expériences. Pris en tenaille entre l’urgence, les critères de rentabilité économique, les formateurs n’entraînent pas véritablement les stagiaires à une analyse de l’expérience vécue. De nombreux apprentissages restent alors dans l’ombre faute d’être valorisés dans le processus d’insertion. / The thesis questions the methods of organizing the devices for alternating training for insertion. Created forty years ago, in a context of economic crisis, this devices represent today a necessary step, especially for the young un-graduated. By studying the underlying logic of public insertion policies, the impact of the type of production "serviciel" on the activity of the employees and the constitutive pedagogy of these formations, the thesis reveals the tensions between the issues brought by different stakeholders and their effects on the learning process and insertion of youth. Starting from these aspects, substantiated in the first part, we have to see what is the position of the trainee activity carried in the company within these formations. The field survey allows, firstly, comprehending the diversity and the complexity of these work situations to which the trainees are daily confronted. It shows how the manage to mobilize or not, in this situations, the appropriate theoretical knowledge and the knowledge previously forged, to control their emotions, to invest the teachings drawn from their own history to reprocess the values held by the work place, to meet the requirements of the task and the expectations of the service to be performed. Afterwards, the empirical survey focuses specifically on the practices of the trainers upon the reflective moments dedicated to feedback. Caught in a pincer between urgency, economic efficiency criteria, the trainers do not really involve the trainees in an analysis of the lived experience. Therefore, many lessons rest in the shadow, resting undervalued in the insertion process.

__Les réflexions sur le FLE en Angola sont envisagées dans le cadre historique, sociolinguistique et pédagogique. Elle a pour objectif la mise en place d’un dispositif du FLE niveau A1 vers A2 et B1 vers B2 en vue d’aider les enseignants du FLE qui se trouvent en difficultés d’améliorer leurs pratiques et aux étudiants de mieux s’approprier le FLE.La recherche porte sur une problématique spécifique qui est les difficultés langagières des étudiants en FLE qui nous interpelle et nous nous sommes posés les questions suivantes : dans quelle mesure les difficultés langagières des étudiants seraient en lien avec les difficultés des enseignants peu formés pour enseigner le français langue étrangère.Qui enseigne ? Quelle est sa formation ? Comment enseigne-t-il ? À qui enseignent-ils ?Les réponses à ces questions ont nécessité l’élucidation des plusieurs concepts. Ce travail a privilégié une approche comparative avec des vidéographies de classe et des entretiens. Nous avons décrit les activités de classe en nous intéressant à la fois à la circulation des savoirs et surtout à l’analyse des gestes professionnels des professeurs de nos institutions universitaires. Ainsi, deux types d’analyse ont été privilégiés à savoir linguistique et didactique.La thèse a vérifié l’hypothèse selon laquelle la didactique du français langue étrangère permet d’élaborer des savoirs linguistiques et culturels adaptés au contexte angolais, de pallier les difficultés dans l’activité enseignante et de faire des apprenants les acteurs de leur propre apprentissage. ________________________________________ ______________________________________ / French as a Foreign Language (with the French acronym FLE) in Angola is first considered in its historical, socio-linguistic and pedagogic contexts. This thesis focuses on teaching methods with the objective of proposing a teaching strategy for FLE from level A1 to A2 and from B1 to B2. The aim is to assist those FLE teachers who find themselves in difficulty to improve their practice as well as to increase students’ mastery of FLE. The research centres on the specific problem which is the language difficulties of the poor results that students achieve in FLE, which is a cause for concern and has led to the following questions: to what extent the language difficulties of students would be linked to the difficulties of teachers who are poorly trained to teach French as a foreign language? Who are the teachers? What training have they received? How do they teach? Whom do they teach to? The answers to these questions have required the clarification of linguistic concepts and different aspects within linguistics. This study has adopted a comparative approach using video recordings of classes and interviews. We have described classroom activities with a focus on the exchange of knowledge and in particular on an analysis of the professional practice of teaching staff in our university institutions. Two types of analysis have thus been undertaken: linguistic and pedagogic. The results confirm the hypothesis that the approach adopted in teaching French as a Foreign Language allows the acquisition of linguistic and cultural knowledge appropriate to the Angolan context, overcomes difficulties faced by teachers and enables learners to take an active role in the own learning.

A função educativa do bibliotecário é mencionada com frequência na literatura e ganha diferentes contornos nas discussões sobre as relações entre a Ciência da Informação e a Educação, principalmente ao tratar do apoio do profissional da informação nos processos de ensino-aprendizagem. Embora o tema esteja presente nos discursos da área, não há clareza sobre o delineamento dessa função e as atividades e competências necessárias para desenvolvê-la, o que dificulta a inserção desta temática na proposta político-pedagógica dos cursos de formação do bibliotecário. Trata-se de estudo exploratório, que tem como base a discussão conceitual sobre o papel de mediação do bibliotecário em diferentes ambientes, principalmente em bibliotecas de pesquisa; estudos sobre formação e potencial de inserção no mundo do trabalho; e estudos sobre competências, aptidões e habilidades esperadas na formação deste profissional. A metodologia inclui estudo bibliométrico dos trabalhos apresentados no GT-6 - Informação, Educação e Trabalho do Encontro Nacional de Pesquisa e Pós-Graduação em Ciência da Informação (ENANCIB), no período de 2003 a 2012, para identificar principais autores e aspectos temáticos pesquisados, complementado por estudo de citações para identificar potenciais influências teóricas sobre a produção brasileira na área. O estudo utilizou procedimentos de análise de conteúdo para extrair eventuais definições, discussões ou exemplificações sobre desempenho de atividades que pudessem configurar-se como inerentes à função educativa do bibliotecário, de modo a orientar propostas para adequação das diretrizes curriculares de um curso de formação bibliotecário. O estudo confirmou a exigência para que o bibliotecário promova ações educativas nos ambientes informacionais, porém não aponta diretrizes teórico-metodológicas que possam sustentar um programa de formação baseado no desenvolvimento de competências ou habilidades para formação de um bibliotecário apto a desenvolver esta função. Indica que a formação desse profissional com competências de educador preparado para enfrentar os desafios cognitivos, sobretudo nos ambientes educacionais, é ainda um desafio para as escolas de Biblioteconomia e exige equipe multidisciplinar de pesquisadores que possam promover maior aproximação entre a pesquisa acadêmica e os ambientes sociais de atuação dos bibliotecários. / The educational role of the librarians is often mentioned in the literature and receives different approaches in discussions about the relationship between Information Science and Education, especially when dealing with the support of the information professional to the teaching - learning processes. Although the subject is presented in the discourses of the area, the boundaries of this function and of the activities and skills it requires are not clear, and the inclusion of this discussion in political-pedagogical proposal to the formation of librarians. This is an exploratory study, based on the conceptual discussion on the mediating role of the librarian in different professional contexts, mainly in research libraries; on studies about professional formation and potential for inclusion in the working world; and on studies on competencies, abilities and skills that this professional should have. The methodology uses bibliometric study of papers presented on the GT - 6 - Informação, Educação e Trabalho do Encontro Nacional de Pesquisa e Pós-Graduação (ENANCIB) in the period 2003-2012, in order to identify main authors and thematic aspects researched, and also a citation study in order to identify potential theoretical influences on Brazilian production in these area. The study used content analysis procedures to extract definitions, exemplifications or discussions about performing activities that could be configured as inherent to the educational role of the librarian, in order to guide proposals for adaptation of curriculum guidelines for a Librarianship bachelor\'s course. The study confirmed that the librarians shall promote educational activities in information contexts, but it do not indicate theoretical and methodological guidelines that could sustain a course based on the development of skills and abilities to form a librarian who is able to perform this role. It indicates that the formation the librarians should recognize educational competencies in order to prepare them to face cognitive challenges, especially in educational contexts is still a challenge for schools of Librarianship and requires a multidisciplinary team of researchers that may promote further integration between the academic research and social contexts of work of the librarians .

Pensar a formação de enfermeiros pressupõe articular essa questão às expressões de referenciais teóricos, na perspectiva de uma vertente pedagógica que passe pelo construtivismo e por competências. Assim, os objetivos foram: caracterizar, numa visão longitudinal, a proposição competências assistenciais na graduação; identificar o potencial de competência clínica de graduandos de Enfermagem; analisar representações discentes relativas à aprendizagem das experiências clínicas e propor referenciais para a construção da competência clínica no âmbito da Graduação em Enfermagem. O estudo foi de natureza qualitativa; os sujeitos foram alunos do último semestre da graduação, num total de 29 participantes; foi realizada análise documental dos planos de ensino das disciplinas assistenciais da graduação e utilizou-se também a Técnica do Incidente Crítico (TIC) como estratégia metodológica apta a identificar experiências significantes para a aprendizagem clínica. A instituição de ensino e os sujeitos aceitaram participar do estudo, conforme as recomendações ético-legais. Os dados evidenciaram uma organização curricular centrada em disciplinas, com modalidades organizativas que partem do genérico para o específico, mantendo lógicas internas aparentemente refratárias à organizações somativas. Uma direção da aprendizagem voltada à execução metódica de práticas em evolução, escolhidas pelos docentes, estimulando a inserção discente em programações pré-estabelecidas e reiterativas. A ligação das atividades de ensino à vida real se faz por meio de práticas em campo que respondem timidamente à problematização da realidade. As intervenções parecem ser privilegiadas segundo uma ordem externa, às vezes distante da realidade dos alunos. Emergem também, sinalizações de uma aprendizagem com vínculos pouco substantivos entre os conhecimentos prévios e a potencialização do julgamento crítico e do raciocínio clínico. Como proposição, o estudo trouxe reconsiderações para o processo ensino-aprendizagem e a influência da concepção construtivista na proposição das competências clínicas. / Conceiving nurse graduation is an assumption to utter this question to theoretical reference expressions, in prospect of a pedagogical under discussion, which entails constructivism and competences. Therefore, the aims were: to characterize under a longitudinal view, assistance competence propositions on graduation; to identify clinical competence potential of Nursing graduate students; to analyze student body representations related to learning of clinical experiences and suggest information to construct clinical competence on Nursing Graduation field of action. The study was a qualitative one; individuals were students at the last graduation semester with a total of 29 participants; a documentary analyses was performed on teaching plans of graduation assistance subjects and Critical Incident Technique (CIT) was also used as a methodological strategy prone to identify significant experiences for clinical learning. The Institution and the individuals agreed to participate according to ethical and legal recommendations. Data has shown a subject -centered syllabus system with organized features which comes from the general to the specific, keeping apparently inflexible inner logic to adding organizations. A learning direction toward methodical performance of ongoing practices chosen by teachers, stimulating students participation in pre-established and reiterative programs. The link of learning activities to real life is done by field practices, which timidly responds to reality problems. Interventions seem to be privileged according to an external order sometimes distant from students reality. It also emerges a signaling of a learning with poor substantial bonds among previous knowledge and critical thinking potentialization and clinical reasoning. As a postulate, the study brought re-considerations for teaching-learning process and the influence of constructivism conception on clinical competence postulating.

Dentre os diversos campos profissionais contemporâneos, que mais têm sido afetados pelos avanços tecnológicos, globalização e transformações sociais, destacam-se os que têm ênfase na criação, processamento e disseminação da informação. A biblioteca, que vê a informação transformar-se em fenômeno social, além do valor mercadológico assumido ultimamente, é compelida a adequar o seu papel e serviços; sendo exigidas dos bibliotecários, atitudes, competências e capacitação no exercício da profissão. Considerando a escolha da profissão bibliotecária na área médica, cenário que representa o contexto deste trabalho, o objetivo é identificar através dos discursos, motivações e opiniões sobre o exercício da profissão nesta área. Das entrevistas gravadas e transcritas, com doze bibliotecárias de uma faculdade de medicina e pela metodologia do Discurso do Sujeito Coletivo, são analisadas as respostas que revelam as opiniões dos sujeitos de pesquisa. Os discursos apontam vários caminhos na adoção e exercício da profissão, sendo referidas a satisfação e dedicação da parte destas bibliotecárias. São identificadas as necessidades de especialização e atualização, e a preocupação com a imagem da profissão e a manutenção dos cargos, pelos profissionais bibliotecários. São abordados os desafios, dificuldades e facilidades específicas da área, a literatura médica, os usuários e o ambiente de trabalho. A especialização e o desenvolvimento profissional possibilitam a ampliação das atribuições e papéis dos bibliotecários em equipes multiprofissionais na área médica. / Among the several contemporary professional fields, which have been mostly affected by the technological improvements, globalization and social transformation one may highlight those wich emphasise creation, processing and dissemination of information. The library that witnesses the information being transformed into social phenomenon, besides its recently invested market value, is compelled to adjust its role and services; being required from librarians, attitudes, skills, qualifications in the professional practice. Considering the choice of being a librarian in the medical field, scenario which represents the context of this work, the goal is to identify through the speeches, motivations and opinions about the professional practice in this field. Trought taped and transcribed interviews, with twelve librarians in a medicine school, and considering the methodology of Collective Subject Speech, the answers which show the opinions about the subjects which are part of the research, are analysed. The speeches point out a lot of ways to adopt the profession as well as dealing with it, while being concerned to the satisfaction and commitment on the part of those librarians. The updating and specialization needs are identified, and the concern with the image required by the profession as well as the keeping of jobs by the librarians. The challenges, the difficulties and specifc facilities of this field, the medical literature, the users and the work environment, are taken on consideration. The specialization and professional development make it possible to broaden the roles and atributions of the librarians in multiprofessional groups in the medical field.