Prenant appui sur une méthodologie d'enquête, de conceptualisation et de développement itérative - la Théorie Ancrée - notre recherche sur l'instrumentation informatique des annotations et des pratiques d'écriture professionnelles nous a permis de développer des concepts, un modèle et un prototype informatique originaux pour le support de l'organisation des soins en cancérologie. Pour mener à bien ce travail itératif de modélisation, nous nous sommes inspirés des pratiques d'écriture des soignants que nous avons observées durant plusieurs années dans un hôpital en cancérologie. Cette étude qualitative a été complétée par un état de l'art pluridisciplinaire. Ce travail d'articulation entre différents domaines scientifiques, enquête et confrontation aux acteurs du terrain nous a permis de développer les concepts de pratique annotative et d'écriture heuristique considérés comme constitutifs du travail d'organisation des soins. Ces pratiques permettent aux soignants d'appréhender leurs environnements de travail complexes, et de gérer efficacement les dynamiques et les variétés de situations et de prise en charge des patients. La caractérisation de ces pratiques nous a permis de développer un modèle informatique simple, robuste et ouvert, mais surtout ancré dans le terrain de recherche et dans les pratiques soignantes. Ce prototype grâce notamment aux contextes d'affichage diversifiés des réseaux d'annotation qu'il autorise, grâce à sa flexibilité et son évolutivité, permet effectivement d'adresser la question du support du travail collectif d'organisation des soins en cancérologie, autant qu'il est prometteur pour d'autres contextes d'exploitation. / Our research about computerized equipment of annotations and professional writing practices has articulated Computer Sciences and Communication and Information Sciences in order for us to develop a software prototype for the support of organisation of care in oncology thanks to an empirical and longitudinal study. This articulation has relied on 4 years long of multimodal ethnography, a conceptualization based upon Grounded Theory rules, a model and a software development that we iteratively conduct simultaneously with this qualitative inquiry. This original combination of methodologies from different domains has been remarkably rich to help us build a specific point of view about oncology hospital organizations, and about the accomplishment of care work and about patients' management in these complex professional organizations. The modern medical and hospital rationalizations, including ICT and e-health tools, are in the confluence of various movements that impact upon several elements of hospital organizations, and upon medical and care practices. We focused our study on the situated writing practices of caregivers and specifically on the richness of the materiality of writings that led us to question notions such as information systems, collective and distributed production of knowledge, and the documentary production cycles for the organization of activity. We are making the hypothesis that annotations can be opportunely considered as constitutive elements in the production of "organizational texts" that are in the core of the support of the organization and the realization of collective and individual work. Caregivers rely on these "organizational texts" that they build, actualize and stabilize thanks to what we call the "annotative practice" that enables them to apprehend their complex environments of work, and to handle the dynamics and the variety of situations and to manage patients. We will show how the characterization of this "annotative practice" helped us to develop a simple, robust and open software model. We will detail the iterative process between inquiry, analysis, conceptualizations and developments that led us to stabilize our model and our web prototype that implement this annotative practice. We will conclude our work by showing that this prototype, thanks to the numerous context displays of annotations networks, thanks to its flexibility and evolutivity achieves the support of the collective organization of patients' care in oncology, as much as it seems to be relevant in other exploitation context of collective organization of work.
| Identifer | oai:union.ndltd.org:theses.fr/2015TOU30173 |
| Date | 09 October 2015 |
| Creators | Marrast, Philippe |
| Contributors | Toulouse 3, Zaraté, Pascale, Mayère, Anne |
| Source Sets | Dépôt national des thèses électroniques françaises |
| Language | French |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation, Text |
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