Constructing Quality of Care in Neurology: Anticipation Strategies of a Team of Nurses

Neurological patients are characterized by multiple handicaps and by physical, behavioral, and psychological symptoms that are diverse and fluctuating. They need specialized, multidisciplinary and constant health care, a large amount of hygiene care and technical care, but also relational care. The objective of this communication is to present the anticipatory operative strategies used by a team of nurses working in a neurology hospitalization sector and their representations of healthcare quality. Healthcare quality is studied from the constructive perspective of activity ergonomics: it considers quality as a permanent process on-going in the work situation, articulating the effective conditions provided by the organization for the realization of work-as-imagined and the individual and collective resources available by the agents who deal with the actual context. The methodology used is based on an exploratory field study using the clinical method of work analysis in ergonomics. The results show that quality is the result of arbitrations and individual and collective adjustments built in context, which incorporate formal and informal standards of care quality according to the content of care, the type of patient and the current state of the latter. The strategies identified allow the agents to reconcile in more or less satisfactory ways the different existing standards.