Abstract
The aim of this thesis is to improve the initial training of nursing students in the learning field of clinical reasoning. The conceptual framework of professional didactics, that investigates the conceptualizations involved by the actors, allowed to analyze the verbatims collected from nurses conducting the welcome interview called "triage" of patients in the emergency department. Based on the identification of the resources mobilized by the professionals, situational invariants relating to the initial identification of patients' health problems were identified, enabling the correct orientation to the emergency department. But the speech that professionals make explicit about the permanent adjustments they achieve according not only to the answers given by the patient, but also according to the indicators that they perceive, that they select, that self-impose on their own on the patient when he or she expresses himself or herself, communicates or does not communicate, have gradually led researches to the track of adjustment in the historical-cultural sense of Vygotski. Subject invariants, mixed with locutionary, illocutionary and perlocutionary acts have been identified. These combinations demonstrate nurses' strategic concerns for generating and maintaining authentic patient speeches and relaxed social relationships marked by dialogue and respect. Certainly, the identification of situational invariants allowed to understand the key points on which the nurses focus during the patient triage interview in the emergency department, but they also allowed to understand why and at what times the nurses constantly adjusted their speech. Concepts in cognitive psychology were needed to understand and investigate the cognitive process of nurses required for their clinical reasoning. The results of the study provide guidance to the training improvement on three main axis. The first one concerns the visibility of the nurses' cognitive process that would generate students' motivation to write. The second axis concerns the development of the lexical field specific to nursing which would allow the development of students' scriptural skills. Finally, the last axis concerns the elaboration of a class of emblematic situations that would provide students with a sufficiently stable environment in order to create their own operating invariants linked to these classes of situations and thus transfer their knowledge and experiences into new situations. The development of self-confidence is the sine qua non condition for the development of cognitive fluency that would give students access to intuitive reasoning in the sense of cognitive psychologies.