Abstract
This thesis work aims to produce knowledge on the real, individual-social activity of neonatal nurses in interaction with the very premature neonate. This knowledge constitutes avenues for improvement for professionals’ training, in a context where prematurity is a global public health problem and when nursing care for these newborns represent a crucial issue for their neurosensory development. However, the training system concerning this high-risk nursing care has little anchoring in the scientific data allowing to take into account the human activity deployed in these complex situations.This research therefore aims to describe, analyze and characterize this activity, in order to understand how in a real situation, two experienced neonatal nurses use different resources such as body, language and artefactual resources to interact with the child, this other person who does not speak and has specific reactions. This epistemic and transformative study is based on the "Course of Action" research program (Theureau, 2004, 2006, 2015) which favors an enactive cultural anthropological approach. The activity is considered to be situated and is constantly accompanied by the construction of meaning which is actualized in practical actions, communications, interpretations, focuses and emotions. This approach makes it possible to gain an understanding of actors’ activity, partly silent, from their own point of view. The methodological device articulates : data concerning the constraints of activity in bodies, situations and cultures constructed according to the usual methods of ethnography ; psycho-phenomenological data constructed during self-confrontation interviews of filmed situations ; extrinsic proxemic.The results show that neonatal nurses’activity is constrained by the spatial, human and technological environment necessary for the survival of the child. It shows an exploratory commitment updated through continuous monitoring focused on the newborn environment and an enforceable commitment, updated through practical intermodal actions aimed at efficiency.Three preponderant concerns emerge and structure the activity: 1) Maintain a continuity of presence with the newborn during nursing care, by relying on the organization of the work environment and multimodal communication which aims to maintain a physical proximity; 2) Exercise vigilance, for which prevention, continuous monitoring and investigation activities constitute the priority orientations. By contributing to the newborn surveillance, they constrain the neonatal nurses’activity from loops of perception-action; 3) Support the neonate with stress management by relying on pluri-sensory mode of perceptions that promote the articulation of multimodal actions and help maintain interaction. These results show the importance of sensory and sensorimotor dimensions of the neonatal nurses’experience that underpin nursing care and show their commitment to the search for essential coordination with the neonate. They lead for improvement of neonatal nurses’ training, taking seriously into account the sensitive dimensions of activity in nursing care situation. The studied situations open up a greater questioning of all these care situations with fragile populations whose communication methods are altered and where technical and relational aspects will mingle.