Ansel, D., Laurent, A., Bonnet, M., Aubert, L., Quenot, J.-P., and Capellier, G.
Résumé L’objectif de cette étude est d’explorer les liens qu’établissent les professionnels de la santé entre le fonctionnement de leur équipe de travail et le risque d’erreur médicale. Les entretiens menés auprès de services de réanimation (30 sujets) ont mis en évidence plusieurs dimensions : une logique de confiance collective reposant en partie sur la vision partagée d’une rationalité scientifique des techniques et procédures propres à ces services, une importante pratique de transmission des compétences renforçant la cohésion groupale, l’aspect central de l’ambiance de travail, et l’ambivalence de l’influence de l’hétérogénéité des fonctions. Les données recueillies illustrent les différences et complémentarités des soutiens interindividuels et institutionnels et le risque de repli identitaire sur sa fonction professionnelle en cas d’erreur ou de risque d’erreur. La nature des liens qui définissent les équipes de soin participe fondamentalement à la prévention des risques d’erreur et à la gestion des angoisses individuelles et collectives associées. The health workers are daily faced with multiple decisions that depend both on individual skills and professional practices as well as on the collective action taken. When decisions are made under conditions of uncertainty and emergency, as it is often the case in intensive care unit, they become elicitors of stress. The aim of this study was to examine the links that the health workers usually make between their teamwork functioning and the chance for medical errors when vital prognosis is concerned. More especially, we addressed the main topic of medical error focalizing on the health workers’ professional relationships, the way the role played by the team was seen, and the work atmosphere. To this aim, we conducted interviews in two intensive care units with 10 nurses, 10 young and 10 senior doctors who reported having encounter medical error at least on time throughout their career. After transcription, the interview contents were analyzed according to the approach of the interpretative phenomenological method. This qualitative methodology was carried-out in order to identify the discourse's units as well as the core themes. Our findings provided evidence for a team's collective sense of confidence based on the shared view that their procedures stand on scientific and technical rationality, the critical role given to transferable skills for the group cohesion, the core aspect of good atmosphere among workers and the ambivalent influence of heterogeneous functions. Data showed different but complementary interindividual and institutional supports. They also emphasized the risk that health workers fall back on their professional role when they are faced with medical errors. However, results also indicated that the collective dimension of labor relations might promote the knowledge of the reality of the colleagues’ work. As a consequence, teamwork can be a relevant alternative to expert's attitude. Strengthening the links among health workers remains the main way to prevent medical errors and to manage individual and collective distress. [ABSTRACT FROM AUTHOR]