Une étude clinique de l'activité de médecin de premier secours : vers une modélisation d'une profession complexe

Ce travail a pour objectif d'étudier l'évolution du métier de médecin de premier recours à la lumière du réel de son activité. Afin de pallier les lacunes de la littérature, nous proposons d'investiguer les perceptions et les pratiques rapportées de médecins de premier recours, considérant leur activité comme située dans un contexte spécifique. Un cadre théorique multiréférencé, intégrant les apports de Bischoff (2012), de la théorie de l'activité (Engeström et al., 1999), de l'ergonomie (Daniellou, 1996 ; Falzon, 2004a; Leplat, 1997) et de certains courants de la psychologie du travail (Curie et al., 1990 ; Curie, 2000b ; Malrieu, 1989) permet de tenir compte de la complexité du travail des médecins de premier recours. Une méthodologie mixte, alliant une approche qualitative par entretiens semi-structurés (n=20) à une approche quantitative par questionnaire (n=553), a été développée. Les résultats de l'analyse thématique des entretiens mettent en évidence trois thèmes majeurs : l'Evolution du métier (Thème 1), caractérisé par les changements perçus, les demandes des populations qui consultent et les paradoxes et vécus des médecins ; les Ajustements et supports (Thème 2) mis en place par les médecins pour faire face aux changements et aux difficultés de leur métier ; les Perceptions et les attentes par rapport au métier (Thème 3), mettant en avant des écarts perçus entre la formation et la réalité du métier. La partie quantitative permet de répondre aux questionnements générés à partir des résultats qualitatifs et de généraliser certains d'entre eux. Suite à l'intégration des deux volets de l'étude, nous présentons une nouvelle modélisation du métier de médecin de premier recours, soulignant son aspect dynamique et évolutif. Cette modélisation rend possible l'analyse de l'activité réelle des médecins, en tenant compte des contraintes organisationnelles, des paradoxes inhérents au métier et du vécu des médecins de premier recours. L'analyse des limites de cette étude ouvre à de nouvelles perspectives de recherche. A l'issue de ce travail, nous proposons quelques usages pragmatiques, qui pourront être utiles aux médecins de premier recours et aux médecins en formation, non seulement dans la réalisation de leur activité, mais également pour le maintien de leur équilibre et leur épanouissement au sein du métier. - This study aims to investigate the evolution of primary care physicians' work, in the light of the reality of their activity. In order to overcome the limitations of the literature, we propose to focus on primary care physicians' reported perceptions and practices, considering their activity as situated in a specific context. The theoretical framework refers to Bischoff (2012), Activity theory (Engeström et al., 1999), ergonomy (Daniellou, 1996; Falzon, 2004a; Leplat, 1997) and work psychology (Curie et al., 1990 ; Curie, 2000b ; Malrieu, 1989) and enables to take into account the complexity of primary care physicians' work. This mixed methods study proposes semi-structured interviews (n=20) and a questionnaire (n=553). Thematic analysis of interviews points out three major themes : Evolution of work (Theme 1) is characterised by perceived changes, patients' expectations and paradoxes ; Adjustments and supports (Theme 2), that help to face changes and difficulties of work ; Perceptions related to work, including differences between work reality as represented during medical education/training and actual work reality. Quantitative part of the study enables to answer questions generated from qualitative results and to generalise some of them. Integration of qualitative and quantitative results leads to a new modelling of primary care physicians ' work, that is dynamic and evolutionary. This modelling is useful to analyse the primary care physicians' activity, including organisational constraints, paradoxes of work and how primary care physicians are experiencing them. Despite its limitations, this study offers new research perspectives. To conclude, we state pragmatic recommendations that could be helpful to primary care physicians in private practice and junior doctors, in order to realise their activity, to maintain their balance and to sustain their professional fulfilment.

Toimintarajoitteisten henkilöiden ajokyvyn arvioinnin mallintaminen psykologisen toimintateorian avulla

Veli Matti Heikkilän väitöskirja Evaluation of driving ability of the disabled persons in the context of the psychological activity theory (Helsingin yliopisto 2008).

Informaatio-ohjauksen vaikuttavuus : toiminnan teoriaan perustuva metsäsuunnittelutyön analyysi

Seloste artikkelista: Hokajärvi, R., Hujala, T., Leskinen, L.A. & Tikkanen, J. 2009. Effectiveness of sermon policy instruments: Forest management planning practices applying the Activity Theory approach. Silva Fennica 43 (5) : 889–906.

Ligniinin hienojauhatus planeettamyllyllä

Kirjallisuusosassa tarkastellaan ligniiniä luonnon polymeerinä sekä sen kemiallisia perustietoja. Aiheena on myös sen tuotanto ja käyttö uusiutuvana raaka-ainelähteenä energian-, materiaali- ja kemikaalituotantoon sekä niiden mahdolliset tulevaisuudennäkymät. Mekaanisten prosessien osalta keskitytään kiintoaineen hienontamiseen. Lisäksi perehdytään planeettamyllyn toiminnan teoriaan sekä tuoreimpiin tutkimuksiin planeettamyllyjauhatukseen liittyen. Työn kokeellisen osan tarkoituksena oli tutkia ligniinin jauhautuvuutta, sillä partikkelien pienentämisellä voidaan kasvattaa ligniininijauheen ominaisalaa ja tasoittaa sen kokojakaumaa. Jauhautuvuuden avulla voidaan esimerkiksi arvioida ligniinille tehtävän hienojauhatuksen kannattavuutta jatkoprosesseja varten. Tutkimuskysymyksinä oli ”kuinka hyvin ligniini jauhautuu planeettamyllyllä?”, ”onko kylmäkäsittelyllä vaikutusta jauhatustulokseen?”, ”miten eri parametrit (jauhatusaika, kuulakoko ja kierrosnopeus) vaikuttavat jauhatustulokseen?” sekä ”muuttaako hienojauhatus ligniinin kemiallista koostumusta?”. Tutkittavana materiaalina oli kaupallinen kraft-ligniini ja koelaitteena käytettiin planeettamyllyä. Syötölle ja kaikille jauhatustuotteille suoritettiin partikkelikokoanalyysi, ja lisäksi syötölle ja erittäin hienoksi jauhetulle tuotteelle suoritettiin FTIR-analyysi. Kokeiden mukaan ligniini oli hyvin jauhautuvaa, eikä kylmäkäsittelyllä ollut merkittävää vaikutusta jauhatukseen. Kuulakoon pienentäminen sekä jauhatusajan ja kierrosnopeuden kasvattaminen alensivat ligniininjauheen partikkelikokoa. Lisäksi hienojauhatuksen ei todettu muuttaneen ligniinin kemiallista koostumusta.

Agent Based Simulation of Street Robbery

Routine activity theory introduced by Cohen& Felson in 1979 states that criminal acts are caused due to the presenceof criminals, vic-timsand the absence of guardians in time and place. As the number of collision of these elements in place and time increases, criminal acts will also increase even if the number of criminals or civilians remains the same within the vicinity of a city. Street robbery is a typical example of routine ac-tivity theory and the occurrence of which can be predicted using routine activity theory. Agent-based models allow simulation of diversity among individuals. Therefore agent based simulation of street robbery can be used to visualize how chronological aspects of human activity influence the incidence of street robbery.The conceptual model identifies three classes of people-criminals, civilians and police with certain activity areas for each. Police exist only as agents of formal guardianship. Criminals with a tendency for crime will be in the search for their victims. Civilians without criminal tendencycan be either victims or guardians. In addition to criminal tendency, each civilian in the model has a unique set of characteristicslike wealth, employment status, ability for guardianship etc. These agents are subjected to random walk through a street environment guided by a Q –learning module and the possible outcomes are analyzed

Artefact-oriented business process modelling: an ontological dependency approach

Business process modelling can help an organisation better understand and improve its business processes. Most business process modelling methods adopt a task- or activity-based approach to identifying business processes. Within our work, we use activity theory to categorise elements within organisations as being either human beings, activities or artefacts. Due to the direct relationship between these three elements, an artefact-oriented approach to organisation analysis emerges. Organisational semiotics highlights the ontological dependency between affordances within an organisation. We analyse the ontological dependency between organisational elements, and therefore produce the ontology chart for artefact-oriented business process modelling in order to clarify the relationship between the elements of an organisation. Furthermore, we adopt the techniques from semantic analysis and norm analysis, of organisational semiotics, to develop the artefact-oriented method for business process modelling. The proposed method provides a novel perspective for identifying and analysing business processes, as well as agents and artefacts, as the artefact-oriented perspective demonstrates the fundamental flow of an organisation. The modelling results enable an organisation to understand and model its processes from an artefact perspective, viewing an organisation as a network of artefacts. The information and practice captured and stored in artefact can also be shared and reused between organisations that produce similar artefacts.

The influence of system designer intention over collaborative tagging. an analysis of tagging behaviour in CiteULike and Delicious

Tagging provides support for retrieval and categorization of online content depending on users' tag choice. A number of models of tagging behaviour have been proposed to identify factors that are considered to affect taggers, such as users' tagging history. In this paper, we use Semiotics Analysis and Activity theory, to study the effect the system designer has over tagging behaviour. The framework we use shows the components that comprise the tagging system and how they interact together to direct tagging behaviour. We analysed two collaborative tagging systems: CiteULike and Delicious by studying their components by applying our framework. Using datasets from both systems, we found that 35% of CiteULike users did not provide tags compared to only 0.1% of Delicious users. This was directly linked to the type of tools used by the system designer to support tagging.

Theoretical perspectives of enterprise architecture

The number of published Enterprise Architecture (EA) research has increased during the last few years. As a discipline, EA is still young and lacking theoretical foundation. Lately some research trying to ground EA to theory has been published, including linkage to systems theory. Enterprise Architecture can be defined as; (i) a formal description of the current and future state(s) of an organisation, and (ii) a managed change between these states to meet organisation’s stakeholders’ goals and to create value to the organisation. Based on this definition, this conceptual paper tries to shed light to theoretical underpinnings of EA from three theoretical perspectives; EA as a communication media, EA as an activity, and EA as an information technology system. Our conclusions are that; (i) EA can be categorised as a communication media and theoretically underpinned by ontology and semiotics, (ii) EA can be explained and theoretically underpinned by Activity Theory, and (iii) EA can be categorised as an information technology system and theoretically underpinned by General Systems Theory and Technology Acceptance Theory.

Introducing matrix management within a children's services setting - personal reflections

This article reflects on the introduction of ‘matrix management’ arrangements for an Educational Psychology Service (EPS) within a Children’s Service Directorate of a Local Authority (LA). It seeks to demonstrate critical self-awareness, consider relevant literature with a view to bringing insights to processes and outcomes, and offers recommendations regarding the use of matrix management. The report arises from an East Midland’s LA initiative: ALICSE − Advanced Leadership in an Integrated Children’s Service Environment. Through a literature review and personal reflection, the authors consider the following: possible tensions within the development of matrix management arrangements; whether matrix management is a prerequisite within complex organizational systems; and whether competing professional cultures may contribute barriers to creating complementary and collegiate working. The authors briefly consider some research paradigms, notably ethnographic approaches, soft systems methodology, activity theory and appreciative inquiry. These provide an analytic framework for the project and inform this iterative process of collaborative inquiry. Whilst these models help illuminate otherwise hidden processes, none have been implemented following full research methodologies, reflecting the messy reality of local authority working within dynamic organizational structures and shrinking budgets. Nevertheless, this article offers an honest reflection of organizational change within a children’s services environment.

Resources, staff beliefs and organizational culture: factors in the use of information and communication technology for adults with intellectual disabilities

Background  Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First-order (e.g. time and money) and second-order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method  Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT-related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results  Staff members reported time, training and budget as significant first-order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second-order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion  The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first- and second-order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.

Från ord till handling : En kvalitativ studie om värdegrund och socialt innehåll för äldre på särskilt boende

Socialstyrelsens brukarundersökning visar att äldre som bor på särskilt boende är mest missnöjda med de aktiviteter och den sociala samvaron som verksamheten erbjuder. Äldreomsorgen bygger på den nationella värdegrunden som innefattar att den äldre ska få leva ett värdigt liv och känna välbefinnande, men det är inte klart hur denna värdegrund påverkar personalens arbetssätt eller de sociala aktiviteter som erbjuds. Vår studie angriper denna fråga. Fem särskilda boenden var representerade både från kommunala och privata vårdgivare i två olika kommuner. Semistrukturerade intervjuer genomfördes med de särskilda boendes enhetschefer, som sedan transkriberades och tematiskt analyserades. Vårt resultat tyder på att den nationella värdegrunden inom äldreomsorgen tolkas olika på alla de särskilda boendena. Alla enhetschefer la stor vikt på personcentrerad vård, men trots det så erbjöd man liknade sociala aktiviteter ofta då som gruppaktivitet. Resultaten diskuterar vi med hänvisning till Aktivitetsteorin och Gerotranscendenceteorin.

Machine translation and the disruption of foreign language learning activities

This study examines the question of how language teachers in a highly technology-friendly university environment view machine translation and the implications that this has for the personal learning environments of students. It brings an activity-theory perspective to the question, examining the ways that the introduction of new tools can disrupt the relationship between different elements in an activity system. This perspective opens up for an investigation of the ways that new tools have the potential to fundamentally alter traditional learning activities. In questionnaires and group discussions, respondents showed general agreement that although use of machine translation by students could be considered cheating, students are bound to use it anyway, and suggested that teachers focus on the kinds of skills students would need when using machine translation and design assignments and exams to practice and assess these skills. The results of the empirical study are used to reflect upon questions of what the roles of teachers and students are in a context where many of the skills that a person needs to be able to interact in a foreign language increasingly can be outsourced to laptops and smartphones.

Professores de ciências naturais: necessidades formativas para ensinar a medir em trabalhos práticos e experimentais

This paper presents a research realized with Physics, Chemistry and Biology teachers, and it aimed to evaluate: 1) the development level of those teachers regarding the abilities that make possible to teach high school students about how to measure in practical and experimental work; 2) the formatives necessities regarding those abilities; and 3) the order of priority for teacher´s formation regarding those abilities. The study is based on the activity theory, from A. N. Leontiev (1983), since we considerer the teacher´s formation a kind of activity for which the category necessity is source of motivation and in which is a necessary condition for professionality and for the professional development. A questionnaire with open and closed questions was applied to 116 teachers during three pedagogic workshops realized to dynamize the science laboratory. The instrument allowed us to obtain the personal and professional profile of the participants, as well as their development level, their formative necessities and their order of priority about the teaching of the abilities related to the work of testing measuring hypothesis, regarding: a) to operationalize variables of a hypothesis in experimental work; b) to measure in practical and experimental work; c) to estimate possible measuring mistakes and use proper procedures to minimize them; d) to estimate the validity of a measuring; and e) to estimate the confiability of a measuring. The research results indicated some limitations of the teachers about their development level in all the analyzed abilities. More than 90% of the teachers considered those deficiencies as necessities of the continuing formation. Most of them (about 54%) expressed immediate priority for formation in each one of the abilities. From a correlation, using the statistic chi-square test, between the development level and the formative necessities for the five abilities, the obtained results allow us to assure that, for all those teaching abilities, there is a strong correlation between the development level and the formative necessity. This situation is symptomatic of the importance of approaching more the science teaching and the teacher´s formation on practical and experimental work in high school as key-component of scientific education in basic education. The obtained results can contribute, as subsidy, for continuing formation courses, having as base the necessities that constitute motivation elements of the teachers for professional development