Un modèle cognitif de l’apprentissage de la compétence « agir avec humanisme » d’un programme de formation en sciences infirmières basé sur une approche par compétences

Several papers illustrate the outcomes of humanization and dehumanization of care for patients. Educators and researchers are testing many promising educational strategies aimed at promoting humanization of care. However, little is known about the development of the “humanistic caring” competency.  This thesis presents a phenomenological study aimed at elaborating a cognitive learning model (CLM) of the “humanistic caring” competency, from the lived experiences of nursing students and graduates of a competency-based program, and to identify related developmental indicators. A conceptual perspective combining nursing, the Humanistic Model of Nursing Care – UdeM (HMNC-UdeM) developed by Cara et al. (2016), and education, a conception about competency development (Tardif, 2006), oriented the study. The humanistic philosophy at the roots of the HMNC-UdeM was scrutinized and analyzed in the context of five conceptual models. An analysis of the HMNC-UdeM, based on Chinn and Kramer’s method (2018), was also carried out.  Benner’s (1994) interpretive phenomenology, grounded in the philosophical foundations of Heidegger (1927/2008), was used as the study methodology. The participants (n = 26), students and nurses, were recruited into six groups based on their progression in the education program and their clinical experience. Individual interviews were conducted, and the stories collected were transcribed and analyzed according to an operationalization of Benner’s (1994) phenomenological perspective.  The CLM of the “humanistic caring” competency comprised five developmental stages: 1) conscientization to humanization of care, 2) assimilation of communication skills integrated in a humanistic approach, 3) reconciliation of an ideal of humanistic practice with the responsibilities of a nurse, 4) integration of a humanistic approach in nursing care, and 5) mastery of a humanistic approach in the work environment. Other results showed that a development of "humanistic caring" began before studying nursing and that it was different from one student to another.  The results also highlighted facilitators and constraints to the development of "humanistic caring" residing in both educational institutions and healthcare facilities. These included the presence of humanistic role models and environments that promote humanization of care, and the work overload, that impedes it. The participants also suggested recommendations aimed at optimizing the development of "humanistic caring", and these were highly consistent with the aforementioned facilitators and constraints.  Implications for the five domains of practice emerge from this study and offer some avenues that could promote the development of "humanistic caring". One of them is to facilitate the entry into the nursing profession after graduation, a turning point where the development of "humanistic caring" has proven to be the most vulnerable.

Keyphrases: Caring, Humanization of care, Discipline of nursing, Competency, Cognitive learning model, Competency-based approach, Phenomenology, Nursing education, Humanistic Model of Nursing Care – UdeM