O objetivo da pesquisa foi compreender como os auxiliares e técnicos produzem sentidos sobre seu trabalho e sua vida. Entendendo que experiências de sofrimento emocional e transtornos psicossociais podem intervir na produção de sentido, este trabalho investigou também a qualidade de vida no trabalho e a existência de burnout. Foi utilizado o método quantitativo e qualitativo. Os instrumentos utilizados foram o Inventário de Burnout de Maslach para profissionais de saúde (MBI-HSS), a escala BPSO-96 e um protocolo de entrevista semidirigida. A pesquisa foi realizada no Hospital Universitário da Universidade de São Paulo, as escalas foram aplicadas a 166 profissionais de saúde, dentre técnicos, auxiliares e outros profissionais do hospital e foram entrevistados 20 destes participantes. As escalas foram analisadas estatisticamente tanto na amostra inteira quanto segmentada em dois grupos, um de auxiliares e técnicos de enfermagem e um grupo de outros profissionais para verificar se os fenômenos observados no primeiro grupo são específicos dessa categoria profissional. As entrevistas foram categorizadas e analisadas. Os resultados apontaram alto nível de despersonalização, médio de exaustão, baixa realização pessoal.e nível médio de satisfação com a Qualidade de Vida no Trabalho, não havendo diferença estatística significativa entre os dois grupos. O momento de crise política vivenciado pelo hospital durante a coleta de dados pode ter interferido nos resultados, uma vez que as entrevistas semidirigidas revelaram insegurança, luto pela perda do hospital idealizado e insegurança quanto ao seu futuro profissional. Quanto aos sentidos produzidos, os profissionais entendem que sua prática é imprescindível para o tratamento médico, percebem-se como elo essencial entre paciente e equipe multidisciplinar e referem reconhecimento social pela atuação na área da saúde. Os auxiliares e técnicos de enfermagem revelaram ainda satisfação pelo ato de cuidar, tendo na recuperação dos pacientes e seu reconhecimento e gratidão, importante fonte de produção de sentido da prática profissional / The objective of the research was comprehending how they give meaning to their work and life. Seeing that experiences of emotional suffering and psychosocial disorders may interfere in the meaning of work, this research has also looked into the quality of work life and the existence of burnout syndrome. Quantitative and qualitative methods were used. The research instruments applied were Maslach Burnout Inventory- Human Services Survey (MBI-HSS), the BPSO-96 scale and a guide of semi structured interviews. The research was carried out at the University Hospital in São Paulo, the scales were applied to 166 health professionals, among assistants and other health professionals. 20 participants were interviewed. The scales were statically analyzed on the whole and segmented samples in two groups, one with nursing assistants and other one with other professionals, so both results were compared. The interviews were categorized and analyzed. The results have shown a high level of depersonalization, a medium level of exhaustion, a low level of personal fulfillment and a medium level of satisfaction with the quality of work life, there has not been a representative statistical difference between the two groups. The hospital was going through a political crisis during the data collection which may have interfered in the results, once the semi structured interviews have revealed insecurity, mourning over the loss of the idealized hospital and feeling of uncertainty towards their professional future. With regard to the meaning of work, the professionals understand that their practice is indispensable for medical treatments. They see themselves as a necessary link between patients and multidisciplinary teams. They also mention social recognition for the work in the health area and satisfaction when taking care of patients, seeing their recovery and gratitude as an important source of meaning in the professional practice

O objetivo da pesquisa foi compreender como os auxiliares e técnicos produzem sentidos sobre seu trabalho e sua vida. Entendendo que experiências de sofrimento emocional e transtornos psicossociais podem intervir na produção de sentido, este trabalho investigou também a qualidade de vida no trabalho e a existência de burnout. Foi utilizado o método quantitativo e qualitativo. Os instrumentos utilizados foram o Inventário de Burnout de Maslach para profissionais de saúde (MBI-HSS), a escala BPSO-96 e um protocolo de entrevista semidirigida. A pesquisa foi realizada no Hospital Universitário da Universidade de São Paulo, as escalas foram aplicadas a 166 profissionais de saúde, dentre técnicos, auxiliares e outros profissionais do hospital e foram entrevistados 20 destes participantes. As escalas foram analisadas estatisticamente tanto na amostra inteira quanto segmentada em dois grupos, um de auxiliares e técnicos de enfermagem e um grupo de outros profissionais para verificar se os fenômenos observados no primeiro grupo são específicos dessa categoria profissional. As entrevistas foram categorizadas e analisadas. Os resultados apontaram alto nível de despersonalização, médio de exaustão, baixa realização pessoal.e nível médio de satisfação com a Qualidade de Vida no Trabalho, não havendo diferença estatística significativa entre os dois grupos. O momento de crise política vivenciado pelo hospital durante a coleta de dados pode ter interferido nos resultados, uma vez que as entrevistas semidirigidas revelaram insegurança, luto pela perda do hospital idealizado e insegurança quanto ao seu futuro profissional. Quanto aos sentidos produzidos, os profissionais entendem que sua prática é imprescindível para o tratamento médico, percebem-se como elo essencial entre paciente e equipe multidisciplinar e referem reconhecimento social pela atuação na área da saúde. Os auxiliares e técnicos de enfermagem revelaram ainda satisfação pelo ato de cuidar, tendo na recuperação dos pacientes e seu reconhecimento e gratidão, importante fonte de produção de sentido da prática profissional / The objective of the research was comprehending how they give meaning to their work and life. Seeing that experiences of emotional suffering and psychosocial disorders may interfere in the meaning of work, this research has also looked into the quality of work life and the existence of burnout syndrome. Quantitative and qualitative methods were used. The research instruments applied were Maslach Burnout Inventory- Human Services Survey (MBI-HSS), the BPSO-96 scale and a guide of semi structured interviews. The research was carried out at the University Hospital in São Paulo, the scales were applied to 166 health professionals, among assistants and other health professionals. 20 participants were interviewed. The scales were statically analyzed on the whole and segmented samples in two groups, one with nursing assistants and other one with other professionals, so both results were compared. The interviews were categorized and analyzed. The results have shown a high level of depersonalization, a medium level of exhaustion, a low level of personal fulfillment and a medium level of satisfaction with the quality of work life, there has not been a representative statistical difference between the two groups. The hospital was going through a political crisis during the data collection which may have interfered in the results, once the semi structured interviews have revealed insecurity, mourning over the loss of the idealized hospital and feeling of uncertainty towards their professional future. With regard to the meaning of work, the professionals understand that their practice is indispensable for medical treatments. They see themselves as a necessary link between patients and multidisciplinary teams. They also mention social recognition for the work in the health area and satisfaction when taking care of patients, seeing their recovery and gratitude as an important source of meaning in the professional practice

The purpose of this study was to examine Residential Care Aides’ (RCAs) experiences of good quality dementia care provision. Informed by a political economy perspective, I sought to understand how RCAs conceptualize quality dementia care, whether such conceptualizations are reflected in their daily care practice and how the organizational care context impedes or facilitates such care provision. Drawing on a focused ethnographic approach, I utilized in-depth interviews, participant observation and the review of selected documents to contextualize RCAs’ experiences within the organizational care environment. Over a 12-month period, in-depth interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers) and 239 hours of participant observation were conducted in four small-scale dementia units in two nursing homes in British Columbia, Canada. In-depth interviews yielded information-rich data about RCAs’ care experiences and their relationships with residents, while participant observation afforded the opportunity to strategically link RCAs’ actions and interactions with what was said, a feature missing from much of the previous research examining staff perceptions of quality dementia care. A select review of facility documents and provincial licensing regulations provided additional insight regarding the relevance of the larger structural context for RCAs’ care experiences. In general, RCAs conceptualized, and exhibited in their daily physical care provision, quality dementia care as that which focused on tangible care outcomes (i.e., keeping residents clean, comfortable, calm and happy), on their care approach (i.e., delivering care in a compassionate, patient and affectionate manner) and was guided by family ideology (i.e., invoking of family metaphors). Inherent in their care provision was a sense of role tension, as they sought to incorporate social interaction with task completion and their co-workers’ conflicting expectations. Study findings also illustrated how, in the face of continued disempowerment and organizational constraints, RCAs sought to provide quality dementia care by negotiating their peer and supervisory relationships and selectively breaking formal and informal policies/procedures. Salient to RCAs’ experiences of personhood was the limited recognition and appreciation they received from management and the manner in which work-life balance, staffing coverage, human resource management practices and limited information sharing further devalued them and their work. Study findings draw attention to the importance of: acknowledging the role of structural constraints in the pervasiveness of a task-oriented work culture; attending to (and facilitating) staff personhood; facilitating supportive peer and supervisory relationships and; fostering effective management practices as a means of potentially improving care quality. As such, the study sheds important light on what RCAs require within their work environments to help facilitate resident well-being, reinforcing the assertion that residents’ care conditions are inextricably linked to RCAs’ care work conditions. / Graduate / 0351

Bakgrund: Cirka 40 % av de som lider av en demenssjukdom i Sverige bor på särskilt boende. Omvårdnaden som ges bör enligt Socialstyrelsen vara personcentrerad vilket innebär att personens upplevelse sätts i centrum.   Syfte: Att beskriva undersköterskors erfarenheter av personcentrerad omvårdnad för personer med demenssjukdom på särskilt boende.   Metod: En kvalitativ design med semistrukturerade intervjuer. Intervjuerna analyserades med en kvalitativ innehållsanalys som grund.   Resultat: Studien visar två kategorier och fem subkategorier. Den första kategorin är levnadsberättelsens betydelse för personcentrerad omvårdnad där flera erfarenheter av att arbeta utifrån levnadsberättelsen beskrivs. Den andra kategorin är en känsla av otillräcklighet där undersköterskornas vilja att göra mer men inte kunna beskrivs.   Slutsats: Undersköterskornas erfarenheter visar att en väl ifylld levnadsberättelse ger förutsättningar för att ge en god personcentrerad omvårdnad. Informationen som framkommer i levnadsberättelsen gör det möjligt att skräddarsy omvårdnaden kring personen med demenssjukdom. Det finns även en känsla av otillräcklighet hos undersköterskorna och tidsbrist är en bidragande faktor. / Background: About 40 % of the persons suffering from dementia in Sweden lives in nursing homes. According to the National Board of Health and Welfare, the care ought to be person-centred, which means that the person is the centre of the care.  Aim: To describe the experiences of assistant nurses working with person-centred care for people with dementia living in nursing homes.  Method: A qualitative design with semi-structured interviews. The interviews were analyzed with qualitative content analysis.  Result: The outcome of the study shows two categories and five subcategories. The first category is the significance of life story for person-centred care where several experiences to work based on the life story are described. The second category is a feeling of inadequacy where the nursing assistants describes a desire to do more but not be able to.  Conclusion: The nursing assistants experience that a prerequisite to be able to provide a good person-centred care is a life story with a lot of information. The information about the person enables the nursing assistant to customize the care of the person with dementia. There are also feelings of inadequacy expressed by the nursing assistants.

No description available.

Undersköterskors arbetsliv inom äldrevården har genomgått omvälvande förändringar övertid. Efter den omfattande reformen under 90-talet har undersköterskornas arbetsliv genomgått betydande förändringar. Det var dessa förändringar som inspirerade och låg till grund för studiens inriktning att skapa en djupare förståelse för undersköterskors upplevelse av motivation och trivsel kopplat till den organisatoriska strukturen och arbetsvillkor. Tidigare forskning inom området har granskats och undersköterskor från Norrbotten med lång erfarenhet inom äldrevården har intervjuats. Genom att ta del av deras erfarenheter och insikter har en sammanställning och analys genomförts med hjälp av motivations-teorier av bland annat Herzberg (1966). Studiens resultat visar att flera respondenter uttrycker en längtan efter mer tid för vårdnära arbetsuppgifter. Undersköterskorna ansvarar idag för fler ”lätta” uppgifter som städ och tvätt, samtidigt som de flesta sjukvårdsuppgifter har tagits ifrån dem och lagts över på sjuksköterskor. Tidigare fanns en hierarkisk arbetsfördelning baserad på kompetens och utbildning under "långvårdstiden". Det gav en rättvisare ansvarsfördelning som belönade utbildade undersköterskor. Idag anställs i högre grad outbildad personal, vilket ökar arbetsbelastningen för de utbildade. Undersköterskor kompenserar genom extra arbete utan direkt belöning. En efterfrågan på erkännande och belöning kopplat till kompetens samt en mer rättvis ansvarsfördelning finns. Resultatet kan förklaras genom tidigare forskning, där undersköterskor påverkas negativt av organisatoriska förändringar och kompetensbrist. Äldreomsorgsreformen 1992 och införandet av New Public Management försämrade arbetsmiljön. Effektiviseringsåtgärder minskade tid för vårdnära arbete, och arbetskraftbristen i Norrbotten ökade anställningen av outbildad personal. Den ökade kompetensbristen trots minskad arbetslöshet utmanar rekrytering och kompetensförsörjning. Studien betonar att identifiera faktorer för arbetsmotivation och utforma effektiva förbättringsåtgärder är viktigt. / The work life of nursing assistants in elderly care has undergone significant changes over time. Following the extensive reform in the 1990s the work life of nursing assistants has experienced notable transformations. It was these changes that inspired and formed the basis for the study's focus on gaining a deeper understanding of nursing assistants experiences of motivation and satisfaction related to organizational structure and working conditions. Previous research in the field has been reviewed, and nursing assistants from Norrbotten with extensive experience in elderly care have been interviewed. By exploring their experiences and insights, a compilation and analysis have been conducted using motivation theories, including those of Herzberg (1966). The study's findings indicate that several respondents express a desire for more time for caregiving tasks. Nursing assistants today are responsible for more "light" tasks such as cleaning and laundry, while most healthcare tasks have been taken away from them and delegated to nurses. Previously, there was a hierarchical work distribution based on competence and education during the "long-term care period." This provided a fairer distribution of responsibilities that rewarded educated nursing assistants. Today, there is a higher prevalence of hiring untrained personnel, increasing the workload for the trained ones. Nursing assistants compensate by working extra without direct compensation. There is a demand for recognition and rewards linked to competence, along with a more equitable distribution of responsibilities. The results can be explained by previous research, where nursing assistants are negatively affected by organizational changes and a lack of competence. The eldercare reform in 1992 and the introduction of New Public Management worsened the working environment. Efficiency measures reduced time for caregiving tasks, and the labor shortage in Norrbotten led to increased employment of untrained personnel. The increased competence shortage, despite decreased unemployment, poses a challenge for recruitment and competence supply. The study emphasizes the importance of identifying factors affecting work motivation and designing effective improvement measures.

No description available.

Cette thèse de doctorat, qui s’inscrit dans un programme de doctorat en sciences humaines appliquées, s’est d’abord construite en réponse à un problème concret, celui du roulement des infirmières et des infirmières auxiliaires dans le réseau de la santé et des services sociaux. En cours de route, il est toutefois apparu nécessaire d’élargir le questionnement à la question du rapport au travail des jeunes infirmières pour être en mesure de saisir les dynamiques sociales plus larges qui conditionnent certains choix professionnels, dont la décision de quitter son emploi. Cette thèse poursuit donc deux grands objectifs. D’une part, elle s’attarde à cerner l’ensemble des processus qui conduisent les jeunes infirmières à faire le choix de quitter leur emploi. D’autre part, elle vise à mieux comprendre comment a évolué leur rapport au travail dans le temps. La perspective théorique retenue s’appuie sur deux approches complémentaires, soit celles de la perspective des parcours de vie et de divers courants en sociologie de l’individu qui ont comme point commun d’accorder une place importante au contexte social, aux contraintes structurelles, de même qu’à l’autonomie des acteurs et à leur capacité d’agir sur leur parcours de vie. Ces approches s’avèrent particulièrement pertinentes dans le cadre de notre étude puisqu’elles permettent de rendre compte des liens complexes entre le contexte social plus global, les différents contextes de vie d’un individu et ses comportements en emploi. Elles invitent à conceptualiser le rapport au travail comme un processus qui évolue dans le temps à travers lequel plusieurs éléments de la vie d’un individu et de ses proches se combinent pour donner une orientation particulière aux trajectoires professionnelles. Vu sous cet angle, la décision de quitter se présente également comme un processus qui se construit dans un laps de temps plus ou moins long où entrent en jeu plusieurs dimensions de la vie d’un individu. La perspective adoptée dans le cadre de cette thèse permet de combler des lacunes dans ce champ de recherche où peu d’études se sont attardées à comprendre les différents processus qui façonnent le rapport au travail dans le temps et qui conduisent les infirmières à la décision de quitter leur emploi. Pour répondre aux objectifs de recherche, une étude qualitative a été menée. Des entrevues individuelles de type récit de vie ont été effectuées pour comprendre, du point de vue des participantes, comment a évolué leur rapport au travail et les processus qui les ont amenées à quitter leur emploi. Une étude de cas a été effectuée dans un centre de santé et de services sociaux de la province de Québec qui affichait un taux de roulement particulièrement élevé. L’étude visait les infirmières et les infirmières auxiliaires, groupe professionnel fortement touché par le roulement de la main-d’œuvre. Des entretiens en profondeur, d’une durée de 2h30 à 3 heures, ont été réalisées auprès de 42 infirmières et infirmières auxiliaires. Les résultats de la recherche sont présentés à travers la production de trois articles scientifiques. Le premier article, Pour une compréhension dynamique du rapport au travail: la valeur heuristique de la perspective des parcours de vie, a pour objectif de faire ressortir l’intérêt que présentent les principes analytiques associés à cette perspective dans l’étude du rapport au travail. Dans cet article, nous démontrons que le rapport au travail est le résultat d’un processus complexe où les aspirations des individus, leurs conditions concrètes d’emploi et les événements qui surviennent dans leur vie personnelle et familiale entretiennent des liens dynamiques et interdépendants qui façonnent le rapport au travail tout au long de la vie. Cet article apporte des éléments de réflexion à la question posée par plusieurs chercheurs : par quel moyen saisir ce qu’il en est du rapport au travail des jeunes? Le deuxième article, Rencontre entre l’idéaltype de travailleur et l’idéal de travail : le cas de jeunes infirmières en début de vie professionnelle, vise à rendre compte de la manière dont s’est faite la rencontre entre les attentes que les infirmières nourrissent à l’égard du travail et leur réalité concrète de travail à une période précise de leur trajectoire professionnelle, soit celle de leur insertion en emploi et des premières années de pratique. L’article démontre que trois dimensions du rapport au travail sont affectées par les nouvelles normes managériales qui prévalent dans le réseau de la santé et des services sociaux : 1) la place souhaitée du travail dans la vie, 2) la réalisation de soi par le travail et 3) le sens au travail. Cet article apporte une contribution dans la compréhension du rapport au travail de jeunes professionnelles qui exercent un métier de relation d’aide dans le contexte spécifique du réseau québécois de la santé et des services sociaux. Le troisième article, Comprendre le roulement comme un processus lié au cycle de la vie : le cas des infirmières, traite plus spécifiquement de la question du roulement de la main d’œuvre infirmière. Quatre parcours de départs sont présentés qui possèdent des caractéristiques distinctes relatives à la rencontre entre les attentes et la réalité concrète de travail, l’interaction entre le travail et la vie hors travail et la manière dont s’est construite dans le temps la décision de quitter son emploi. Les résultats démontrent que la décision de quitter se présente comme un processus qui se construit dans un laps de temps plus ou moins long, qui implique différentes dimensions de la vie d’un individu et qui est intimement lié à la quête de réalisation de soi au travail et dans les autres domaines de la vie. Cet article propose une façon d’appréhender le phénomène du roulement qui se distingue des modèles dominants qui abordent cette question à partir d’une lecture essentiellement individualisante et psychologisante des départs. La contribution de cette thèse à l’avancement des connaissances réside principalement dans le fait qu’elle appréhende autrement la question du rapport au travail et celle du roulement de la main-d’œuvre en recourant à la perspective des parcours de vie et à la sociologie de l’individu. L’approche que nous avons préconisée permet de saisir les processus sociaux et la multiplicité des éléments à prendre en considération dans l’étude du rapport au travail des jeunes infirmières et de la décision de quitter son emploi. Elle met en exergue l’importance de considérer le contexte social plus global dans lequel s’inscrit tout individu qui, dans les sociétés contemporaines, doit s’engager dans un travail de construction identitaire tout au long de la vie. / This doctoral thesis in applied social sciences first set out to address a very concrete problem, namely turnover among nurses and nursing assistants in the health and social services system. Along the way, however, it became apparent that there was a need to broaden our investigation to include the issue of young nurses’ relationship with work so as to grasp the broader social dynamics behind some work-related decisions, including the nurses’ decision to leave their jobs. This thesis therefore pursued two main goals. First, it sought to identify all the processes that lead young nurses to decide to leave their jobs. Second, it aimed to better understand how young nurses’ relationship with work evolves over the course of their lives. The theoretical perspective chosen was based on two complementary approaches, that is, the life course perspective and various streams of sociology of the individual which all place great importance on the social context and structural constraints as well as the autonomy of actors and their capacity to take action to influence their life course. These approaches proved to be particularly fruitful for our study because they made it possible to consider the complex relationships between the more general social context, the particular contexts involved in individuals’ lives, and their employment behaviours. Thus, the relationship with work was conceptualized as a process that evolves over time and through which different aspects of individuals’ lives and of the lives of their loved ones combine to guide their professional trajectories. Viewed from this perspective, the decision to leave one’s job involves a process that is constructed over a relatively long period of time and involves several dimensions of one’s life. The perspective adopted in this thesis addresses some gaps in this field since few studies have examined – from the point of view of the actors themselves – the various processes that shape individuals’ relationship with work over time and lead to the decision to leave their jobs. To meet the goals of this research, a qualitative study was conducted. Individual life-narrative interviews were carried out to investigate – from their own point of view – how the participants’ relationship with work evolved and the processes that led them to leave their jobs. A case study was undertaken in a health and social services centre in the province of Quebec which had a particularly high turnover rate. It involved nurses and nursing assistants, a professional group affected by a high rate of turnover. In-depth interviews lasting from 2½ to 3 hours were conducted with 42 nurses and nursing assistants. The study results were presented in three scientific articles. The first, Pour une compréhension dynamique du rapport au travail: la valeur heuristique de la perspective des parcours de vie (For a dynamic understanding of the relationship with work: the heuristic value of the life course perspective) aims to bring out the usefulness of the analytical principles associated with the life course perspective for the study of the relationship with work. This article shows that individuals’ relationship with work involves a complex process wherein their aspirations, concrete working conditions and the events that occur in their personal and family lives are dynamically and interdependently linked and shape their relationship with work throughout their lives. This article reflects on a question posed by researchers, that is, how best to grasp the factors involved in young people’s relationship with work? The second article, Rencontre entre l’idéaltype de travailleur et l’idéal de travail: le cas de jeunes infirmières en début de vie professionnelle (Encounter between the ideal type of worker and the ideal of work: the case of young nurses at the start of their working lives) explores how nurses’ expectations regarding work came up against the concrete realities of their work at a specific time in their professional trajectory, that is, their initial integration into the job and their first years on the job. The article shows that three dimensions of the nurses’ relationship with work were affected by the new managerial practices prevailing in the health and social services system: 1) the desired role of work in their lives 2) the ability to self-actualize through work, and 3) the meaning given to work. This article makes an important contribution to the understanding of the relationship with work of young professionals practising a helping profession in Quebec’s health and social services system. The third article, Comprendre le roulement comme un processus lié au cycle de la vie: le cas des infirmières (Understanding turnover as a lifecycle process : the case of nurses), more specifically examines turnover among nurses. It presents four turnover trajectories with distinct characteristics related to the mismatch between the nurses’ expectations regarding work and the realities of their work, the interaction between work and life outside of work and the way the nurses’ decision to leave their jobs developed over time. The results show that the nurses’ decision to leave their jobs involved a process that developed over a shorter or longer period of time, involved various dimensions of their lives, and was intimately tied to the quest for self-actualization through work and in other spheres of their lives. This article proposes a way to grasp turnover that differs from the dominant models, which approach this issue from an essentially individualizing and psychologizing perspective. The contribution of this thesis to the advancement of knowledge mainly resides in its innovative way of examining the relationship with work and employee turnover, that is, by applying the life course perspective and sociology of the individual to these issues. Our approach aimed to grasp the social processes and many other aspects that need to be taken into consideration when examining young nurses’ relationship with work and their decision to leave their jobs. It highlights the importance of considering the broader social context affecting all people in modern societies who must construct their identity over the course of their lives.

Cette thèse de doctorat, qui s’inscrit dans un programme de doctorat en sciences humaines appliquées, s’est d’abord construite en réponse à un problème concret, celui du roulement des infirmières et des infirmières auxiliaires dans le réseau de la santé et des services sociaux. En cours de route, il est toutefois apparu nécessaire d’élargir le questionnement à la question du rapport au travail des jeunes infirmières pour être en mesure de saisir les dynamiques sociales plus larges qui conditionnent certains choix professionnels, dont la décision de quitter son emploi. Cette thèse poursuit donc deux grands objectifs. D’une part, elle s’attarde à cerner l’ensemble des processus qui conduisent les jeunes infirmières à faire le choix de quitter leur emploi. D’autre part, elle vise à mieux comprendre comment a évolué leur rapport au travail dans le temps. La perspective théorique retenue s’appuie sur deux approches complémentaires, soit celles de la perspective des parcours de vie et de divers courants en sociologie de l’individu qui ont comme point commun d’accorder une place importante au contexte social, aux contraintes structurelles, de même qu’à l’autonomie des acteurs et à leur capacité d’agir sur leur parcours de vie. Ces approches s’avèrent particulièrement pertinentes dans le cadre de notre étude puisqu’elles permettent de rendre compte des liens complexes entre le contexte social plus global, les différents contextes de vie d’un individu et ses comportements en emploi. Elles invitent à conceptualiser le rapport au travail comme un processus qui évolue dans le temps à travers lequel plusieurs éléments de la vie d’un individu et de ses proches se combinent pour donner une orientation particulière aux trajectoires professionnelles. Vu sous cet angle, la décision de quitter se présente également comme un processus qui se construit dans un laps de temps plus ou moins long où entrent en jeu plusieurs dimensions de la vie d’un individu. La perspective adoptée dans le cadre de cette thèse permet de combler des lacunes dans ce champ de recherche où peu d’études se sont attardées à comprendre les différents processus qui façonnent le rapport au travail dans le temps et qui conduisent les infirmières à la décision de quitter leur emploi. Pour répondre aux objectifs de recherche, une étude qualitative a été menée. Des entrevues individuelles de type récit de vie ont été effectuées pour comprendre, du point de vue des participantes, comment a évolué leur rapport au travail et les processus qui les ont amenées à quitter leur emploi. Une étude de cas a été effectuée dans un centre de santé et de services sociaux de la province de Québec qui affichait un taux de roulement particulièrement élevé. L’étude visait les infirmières et les infirmières auxiliaires, groupe professionnel fortement touché par le roulement de la main-d’œuvre. Des entretiens en profondeur, d’une durée de 2h30 à 3 heures, ont été réalisées auprès de 42 infirmières et infirmières auxiliaires. Les résultats de la recherche sont présentés à travers la production de trois articles scientifiques. Le premier article, Pour une compréhension dynamique du rapport au travail: la valeur heuristique de la perspective des parcours de vie, a pour objectif de faire ressortir l’intérêt que présentent les principes analytiques associés à cette perspective dans l’étude du rapport au travail. Dans cet article, nous démontrons que le rapport au travail est le résultat d’un processus complexe où les aspirations des individus, leurs conditions concrètes d’emploi et les événements qui surviennent dans leur vie personnelle et familiale entretiennent des liens dynamiques et interdépendants qui façonnent le rapport au travail tout au long de la vie. Cet article apporte des éléments de réflexion à la question posée par plusieurs chercheurs : par quel moyen saisir ce qu’il en est du rapport au travail des jeunes? Le deuxième article, Rencontre entre l’idéaltype de travailleur et l’idéal de travail : le cas de jeunes infirmières en début de vie professionnelle, vise à rendre compte de la manière dont s’est faite la rencontre entre les attentes que les infirmières nourrissent à l’égard du travail et leur réalité concrète de travail à une période précise de leur trajectoire professionnelle, soit celle de leur insertion en emploi et des premières années de pratique. L’article démontre que trois dimensions du rapport au travail sont affectées par les nouvelles normes managériales qui prévalent dans le réseau de la santé et des services sociaux : 1) la place souhaitée du travail dans la vie, 2) la réalisation de soi par le travail et 3) le sens au travail. Cet article apporte une contribution dans la compréhension du rapport au travail de jeunes professionnelles qui exercent un métier de relation d’aide dans le contexte spécifique du réseau québécois de la santé et des services sociaux. Le troisième article, Comprendre le roulement comme un processus lié au cycle de la vie : le cas des infirmières, traite plus spécifiquement de la question du roulement de la main d’œuvre infirmière. Quatre parcours de départs sont présentés qui possèdent des caractéristiques distinctes relatives à la rencontre entre les attentes et la réalité concrète de travail, l’interaction entre le travail et la vie hors travail et la manière dont s’est construite dans le temps la décision de quitter son emploi. Les résultats démontrent que la décision de quitter se présente comme un processus qui se construit dans un laps de temps plus ou moins long, qui implique différentes dimensions de la vie d’un individu et qui est intimement lié à la quête de réalisation de soi au travail et dans les autres domaines de la vie. Cet article propose une façon d’appréhender le phénomène du roulement qui se distingue des modèles dominants qui abordent cette question à partir d’une lecture essentiellement individualisante et psychologisante des départs. La contribution de cette thèse à l’avancement des connaissances réside principalement dans le fait qu’elle appréhende autrement la question du rapport au travail et celle du roulement de la main-d’œuvre en recourant à la perspective des parcours de vie et à la sociologie de l’individu. L’approche que nous avons préconisée permet de saisir les processus sociaux et la multiplicité des éléments à prendre en considération dans l’étude du rapport au travail des jeunes infirmières et de la décision de quitter son emploi. Elle met en exergue l’importance de considérer le contexte social plus global dans lequel s’inscrit tout individu qui, dans les sociétés contemporaines, doit s’engager dans un travail de construction identitaire tout au long de la vie. / This doctoral thesis in applied social sciences first set out to address a very concrete problem, namely turnover among nurses and nursing assistants in the health and social services system. Along the way, however, it became apparent that there was a need to broaden our investigation to include the issue of young nurses’ relationship with work so as to grasp the broader social dynamics behind some work-related decisions, including the nurses’ decision to leave their jobs. This thesis therefore pursued two main goals. First, it sought to identify all the processes that lead young nurses to decide to leave their jobs. Second, it aimed to better understand how young nurses’ relationship with work evolves over the course of their lives. The theoretical perspective chosen was based on two complementary approaches, that is, the life course perspective and various streams of sociology of the individual which all place great importance on the social context and structural constraints as well as the autonomy of actors and their capacity to take action to influence their life course. These approaches proved to be particularly fruitful for our study because they made it possible to consider the complex relationships between the more general social context, the particular contexts involved in individuals’ lives, and their employment behaviours. Thus, the relationship with work was conceptualized as a process that evolves over time and through which different aspects of individuals’ lives and of the lives of their loved ones combine to guide their professional trajectories. Viewed from this perspective, the decision to leave one’s job involves a process that is constructed over a relatively long period of time and involves several dimensions of one’s life. The perspective adopted in this thesis addresses some gaps in this field since few studies have examined – from the point of view of the actors themselves – the various processes that shape individuals’ relationship with work over time and lead to the decision to leave their jobs. To meet the goals of this research, a qualitative study was conducted. Individual life-narrative interviews were carried out to investigate – from their own point of view – how the participants’ relationship with work evolved and the processes that led them to leave their jobs. A case study was undertaken in a health and social services centre in the province of Quebec which had a particularly high turnover rate. It involved nurses and nursing assistants, a professional group affected by a high rate of turnover. In-depth interviews lasting from 2½ to 3 hours were conducted with 42 nurses and nursing assistants. The study results were presented in three scientific articles. The first, Pour une compréhension dynamique du rapport au travail: la valeur heuristique de la perspective des parcours de vie (For a dynamic understanding of the relationship with work: the heuristic value of the life course perspective) aims to bring out the usefulness of the analytical principles associated with the life course perspective for the study of the relationship with work. This article shows that individuals’ relationship with work involves a complex process wherein their aspirations, concrete working conditions and the events that occur in their personal and family lives are dynamically and interdependently linked and shape their relationship with work throughout their lives. This article reflects on a question posed by researchers, that is, how best to grasp the factors involved in young people’s relationship with work? The second article, Rencontre entre l’idéaltype de travailleur et l’idéal de travail: le cas de jeunes infirmières en début de vie professionnelle (Encounter between the ideal type of worker and the ideal of work: the case of young nurses at the start of their working lives) explores how nurses’ expectations regarding work came up against the concrete realities of their work at a specific time in their professional trajectory, that is, their initial integration into the job and their first years on the job. The article shows that three dimensions of the nurses’ relationship with work were affected by the new managerial practices prevailing in the health and social services system: 1) the desired role of work in their lives 2) the ability to self-actualize through work, and 3) the meaning given to work. This article makes an important contribution to the understanding of the relationship with work of young professionals practising a helping profession in Quebec’s health and social services system. The third article, Comprendre le roulement comme un processus lié au cycle de la vie: le cas des infirmières (Understanding turnover as a lifecycle process : the case of nurses), more specifically examines turnover among nurses. It presents four turnover trajectories with distinct characteristics related to the mismatch between the nurses’ expectations regarding work and the realities of their work, the interaction between work and life outside of work and the way the nurses’ decision to leave their jobs developed over time. The results show that the nurses’ decision to leave their jobs involved a process that developed over a shorter or longer period of time, involved various dimensions of their lives, and was intimately tied to the quest for self-actualization through work and in other spheres of their lives. This article proposes a way to grasp turnover that differs from the dominant models, which approach this issue from an essentially individualizing and psychologizing perspective. The contribution of this thesis to the advancement of knowledge mainly resides in its innovative way of examining the relationship with work and employee turnover, that is, by applying the life course perspective and sociology of the individual to these issues. Our approach aimed to grasp the social processes and many other aspects that need to be taken into consideration when examining young nurses’ relationship with work and their decision to leave their jobs. It highlights the importance of considering the broader social context affecting all people in modern societies who must construct their identity over the course of their lives.

O presente estudo tem como objeto de análise a readaptação funcional de servidores públicos enquanto uma expressão das condições objetivas de trabalho em um hospital universitário no Brasil e seus possíveis impactos na saúde dos trabalhadores; sendo ainda, momento potencial para análise das possibilidades de reconstrução do trabalho público. Os objetivos da investigação consistem em: identificar através do processo de readaptação funcional se o crescente adoecimento do servidor público seria uma expressão dos impactos do ajuste neoliberal no desmantelamento do Estado, via instituições públicas, precariedade das condições de trabalho e de suas formas de gestão; refletir sobre a intervenção interprofissional voltada para a reinserção do trabalhador ao processo produtivo em função da readaptação funcional e avaliar em que dimensões e processos as tendências de gestão pública, no campo analisado, interferem na saúde dos trabalhadores da área estudada e como poderiam contribuir para a mudança dos seus condicionantes. A metodologia de investigação baseou-se em pesquisa bibliográfica e documental e entrevistas individuais com técnicos da equipe interdisciplinar, gestores e representante sindical e entrevistas em grupo com auxiliares de enfermagem readaptados. O estudo confirmou a relevância da reconstrução do trabalho no serviço público por meio de uma gestão democrática com controle social, garantindo a participação da comunidade em todo o processo, para a definição de uma política institucional, norteada pelos pressupostos da saúde do trabalhador. / The present study has as its object of analysis "job retraining" of public servants as an expression of the objective conditions of work in a university hospital in Brazil and their potential impacts on the health of workers, and yet, when the potential for analysis of the possibilities of reconstruction the public work. The objectives of the research are to: identify through the process of "job retraining" the increasing illness of the public servant would be an expression of the impacts of neoliberal adjustment in dismantling the state by public institutions, precarious working conditions and their ways of management; reflect on interprofessional intervention aimed at the reintegration of the worker in the production process due to the "job retraining" and evaluate which dimensions and processes of public management trends in the field examined, interfere with the health of workers in the study area and how they could contribute to change their conditions. The research methodology was based on literature and documents and interviews with technicians of the interdisciplinary team, managers and union representative and group interviews with nursing assistants "repurposed". The study confirmed the importance of the reconstruction work in the public service through a social democratic management control, ensuring community participation in the whole process, the definition of an institutional policy, guided by the assumptions of worker health.