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Le defi contemporain dans le domaine de la sante est indeniablement de penser la creation d’une integration humain-environnement favorable a la sante. Cet article presente la perspective philosophique de l’ICU et la notion d’imperatif cosmique qui amene les etres humains a etre creatifs dans leur rapport a la nature. Il propose, dans un premier temps, la consolidation de l’exegese des evolutions internes de la theorie de Roy, ainsi que le reperage des influences l’ayant inflechie. Les postulats epistemologiques et philosophiques sur lesquels s’est construite la theorie de Roy sont precises, puis l’evolution de la pensee de Roy est decrite en trois moments principaux. Dans un deuxieme temps, l’article decrit et explique les ouvertures epistemologiques que la theorie de Roy permet du point de vue de problematiques sanitaires actuelles, notamment celle de la medecine environnementale – dans une perspective macro-meso-micro de sante mondiale. La pensee de Roy s’inscrit dans la question du tournant actuel de la discipline infirmiere (cure-care-healing) et dans celle de la definition de son focus. La theorie de Roy resiste a des evolutions theoriques actuelles qu’elle permet de decrire et d’interroger sous un modele fructueux pour les chercheurs.

Background The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/design A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A, noise; B, task interruptions; C, noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within 2 h. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion Study results will inform the design of large-scale investigations and will help identify teaching, training, and research areas that require further development.

Background: Patient safety is a top priority of the health professions. In emergency departments, the clinical decision making of triage nurses must be of the highest reliability. However, studies have repeatedly found that nurses over- or undertriage a considerable portion of cases, which can have major consequences for patient management. Among the factors that might explain this inaccuracy, workplace distractors have been pointed to without ever being the focus of specific investigation, owing in particular to the challenge of assessing them in care settings. Consequently, the use of a serious game reproducing a work environment comprising distractors would afford a unique opportunity to explore their impact on the quality of nurse emergency triage. Methods/Design : A factorial design will be used to test the acceptability and feasibility of a serious game created to explore the primary effects of distractors on emergency nurse triage accuracy. A sample of 80 emergency nurses will be randomised across three experimental groups exposed to different distractor conditions and one control group not exposed to distractors. Specifically, experimental group A will be exposed to noise distractors only; experimental group B to task interruptions only; and experimental group C to both types combined. Each group will engage in the serious game to complete 20 clinical vignettes in two hours. For each clinical vignette, a gold standard will be determined by experts. Pre-tests will be planned with clinicians and specialised emergency nurses to examine their interaction with the first version of the serious game. Discussion : This study will shed light on the acceptability and feasibility of a serious game in the field of emergency triage. It will also advance knowledge of the possible effects of exposure to common environmental distractors on nurse triage accuracy. Finally, this pilot study will inform planned large-scale studies of emergency nurse practice using serious games.

At patient intake in emergency departments, triage is a key step in ensuring optimal patient care and good use of hospital resources. Triage nurses must be able to make correct clinical judgements and triage decisions despite extremely stressful working conditions including noise and task interruptions. This article presents a new serious game designed to closely reproduce the conditions of a typical emergency department. Its purpose is to provide a generic testbed both for teaching and for research, notably in order to enable studying the impact of stressors on the quality of decisions made. A study involving 49 professional triage nurses shows that, despite its relatively modest technological requirements, this serious game is considered by the participants as highly attractive and very close to their professional experience.

A traumatic brain injury constitutes a complex treatment situation. Nurses are on the frontline having to assume a difficult position between idealism and fatalism with regard to the care pathway and quality of life. Taking a long-term approach to the care and systemised feedback from the patients form simple and economical levers for improvement.

Vaudois university hospital in Lausanne, Switzerland, has an acute neurological rehabilitation unit. An interdisciplinary team cares for patients with brain injuries after their transfer from intensive care. In this context, nurses base their practice on different concepts and techniques for introducing early neurological rehabilitation into each care procedure.

Introduction Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction. Methods From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model. Results Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation between classes; longitudinal regression modelling of the CRS-R data identified distinct outcome evolution, but not earlier than 19 days. Second, the MBT yielded a significant outcome predictability in the acute phase (p 0.81). Third, a statistical comparison of the CRS-R subscales weighted by MBT became significantly predictive for DOC outcome (p