[The place of smell in clinical nursing reasoning]. / Place de l'odeur dans le raisonnement clinique infirmier.

Pleasant, annoying or unbearable, odours are part of the daily life of nurses. Difficult to describe, they are nevertheless at the origin of the nurse's clinical reasoning process by leading her to collect additional data in order to analyse the patient's situation and make decisions.

[Clinical rationale training and nursing internship]. / Apprentissage du raisonnement clinique et pratique infirmière en stage.

In the fieldwork setting, students often find it difficult to make connections between the care provided and the reasons for it. A committed and pedagogical tutoring program should make them aware of the knowledge they need to acquire to develop relevant clinical reasoning for an appropriate diagnostic approach and therapeutic project.

[A short history of clinical nursing in psychiatry]. / Petite histoire de la clinique infirmière en psychiatrie.

The history and evolution of nursing practice in psychiatry provide us with some insights regarding the training needs of today's nurses. The care relationship, the central focus of practice, has been constructed as treatments have advanced and care has become more humanised. Nurses have been able to forge their professional identity on the basis of the "clinical nursing science, psychiatry and human sciences" triptych. The implementation of advanced practice, which essentially involves the delegation of medical acts, must not overshadow the need to develop nurses' specialisation in the clinical field in order to respond to patients' suffering.

[Reference care plans and clinical pathways, from standardisation to personalisation]. / Plans de soins types et chemins cliniques, de la standardisation à la personnalisation.

The reference care plan and clinical pathway are complementary tools. Their implementation, once the method is acquired, is a real scientific approach. It formalises a clinical reasoning shared between the professionals involved in the patient's care. These tools are quality reference guides which give meaning to the caregiving activity. They help to consolidate competencies. This approach guides the clinical judgement and reasoning of caregivers. It is a health care decision support tool. This collective work is the result of reflective practice and is built on experiential knowledge.

[Professional practice and nursing records]. / Pratique professionnelle et dossier de soins.

Nursing record-keeping has evolved over the ages and has several functions. It is an act which provides proof of the professional's responsibility. These records reinforce notably the competencies of the caregivers and the collaboration of the patient.

[Nurses working in poison and toxicovigilance centres]. / Des infirmières dans un centre antipoison et de toxicovigilance.

Some nurses have chosen to work The skills acquired through their professional experience in the field, combined with specific training in clinical toxicology, equip them to fulfil their role in innovative missions. Their main activity consists in manning the emergency helpline with additional toxicovigilance missions.

[Informing the clinical reasoning of advanced practice students with nursing theories]. / Éclairer le raisonnement clinique des étudiants en pratique avancée par les théories infirmières.

This article examines the integration of a Clinical Nurse Reasoning (CNR) model into advanced nursing practice training to develop the clinical reasoning skills of advanced practice nurses. The article explores the contribution of Callista Roy's conceptual model of adaptation and presents a global analysis of a complex care situation that justifies the introduction of an CNR model paired with nursing knowledge to ensure comprehensive, quality nursing care.

[The expert panel for Script Concordance Tests: A truly adequate reference?] / Le panel d'experts pour les tests de concordance de script : une référence réellement adéquate ?

The Script Concordance Tests (SCTs) are an examination modality introduced by decree in the French National Ranking Exam for medical students in 2024. Their objective is to evaluate clinical reasoning in situations of uncertainty. In practice, SCTs assess the impact of new information on the probability of a hypothesis formulated a priori based on an authentic clinical scenario. This approach resembles probabilistic (or Bayesian) reasoning. Due to the uncertainty associated with the explored clinical situation, SCTs do not compare the student's response to an expected one in a theoretical knowledge reference. Instead, the distribution of responses from a panel of experienced physicians is used to establish the question's scoring scale. Literature data suggest that physicians, even experienced ones, like most humans, often exhibit biased intuitive probabilistic reasoning. These biases raise questions about the relevance of using expert panel responses as scoring scales for SCTs.

[The ISP, officer and caregiver: two visions for optimal care]. / L'ISP, officier et soignant : deux visions pour une prise en charge optimale.

When participating in activities related to emergency medical assistance, especially without medical presence, the firefighter nurse develops many skills. As a firefighter officer, he has a global and strategic vision of the response, which goes beyond the field of nursing skills to take on a civil security dimension. When he takes care of the victim, the clinical reasoning of the nurse, who intervenes alone, is crucial.

[Nursing at the heart of advanced practice]. / Les sciences infirmières au cœur d'une pratique avancée.

The posture of the advanced practice nurse (APN) is based on clinical leadership. Their missions contribute to improving the quality of care provided to patients and their families, as well as to deploying the skills of health professionals. It bases its clinical approach on nursing sciences. The RPN can be a lever for the development of the nursing discipline by conducting research or studies based on an epistemological approach.

[Tolerating uncertainty: Towards a competence-based approach]. / Faire de la tolérance à l'incertitude une compétence médicale.

Uncertainty in inherent to every aspects of medical practice. As the concept of uncertainty in healthcare is still to explore, deciphering the determinants and the roots of this uncertainty would benefit from the insights of various disciplines, such as epistemology, sociology, mathematics, or philosophy. The urgent need to improve physician's ability to cope with uncertainty, has been recently highlighted by the COVID-19 pandemic. Besides, the concept of uncertainty tolerance has been proposed, and could serve as a relevant basis for approaching uncertainty, in medical education. Thus, we propose at first to discuss the uncertainty tolerance framework from Hillen et al. Then, from an educational perspective, we outline some avenues regarding how uncertainty tolerance could be thought, in a competence-based approach, and discuss several educational activities, which have proven efficient in promoting uncertainty tolerance among medical practitioners abroad.

[The challenges of the professionalization of IPAs in France]. / Les enjeux de la professionnalisation des IPA en France.

Since the publication of the decree of July 18, 2018, the training of advanced practice nurses, at the master's level, has inevitably come to question the way in which this new profession of care is professionalized, which formalizes the right of nurses to prescribe in France. More precisely, the required alternation between theory and practice questions the construction of their clinical reasoning during their activity and raises discussions about the nursing knowledge to be taught.

[The advanced practice nurse as a health care influencer]. / L'infirmière en pratique avancée, une personne d'influence dans le domaine de la santé.

The skills that advanced practice nurses use with patients, health care professionals and within the health care system enable them to exercise real leadership. The use of conceptual models and theories in nursing, tools for tracking and valuing clinical judgment, and nursing diagnoses and other concepts are essential to guaranteeing their disciplinary identity and ensuring interprofessional collaboration.

The Clinical Challenges Experienced by New Graduate Occupational Therapists: A Matrix Review.

BACKGROUND.: The transition from student to new graduate occupational therapist is recognized as stressful. Current literature has not specifically drawn together the challenges new graduates face when learning to work with clients. PURPOSE.: This review aimed to synthesize common challenges that new graduate occupational therapists face when working with clients. METHODS.: Searches of online scholarly databases located research articles. Content related to working with clients in practice was charted using the Matrix Method. FINDINGS.: From 21 articles, four categories of challenges were identified: "reasoning and decision-making," "using knowledge and skills in practice with clients," "the context of service provision," and "managing caseload and priorities." "Having self-doubt" was a theme that pervaded the data. IMPLICATIONS.: New graduates often do not feel fully prepared for all aspects of occupational therapy practice. As they may not have access to substantial workplace support, exploring personal resources and professional support may assist this challenging transition.

Providing Verbal Assistance When Assessing Individuals Living with a Traumatic Brain Injury.

Background. Occupational therapists play a major role in identifying the assistance needs of individuals living with a traumatic brain injury. However, to obtain an accurate assessment, verbal assistance should be provided only when necessary, according to the person's needs. Purpose. This study aimed to understand (1) how verbal assistance is provided during an evaluation of Instrumental Activities of Daily Living and (2) why it is provided in this manner. Method. Interviews were conducted with three expert occupational therapists using their own videotaped evaluation and a "think-aloud" method to explore their clinical reasoning when providing verbal assistance. Data were analyzed using thematic analysis. Findings. The process of providing verbal assistance was recognized as flexible and nonlinear, and influenced by various factors including the participants' level of understanding of the client's abilities. Implications. This information will help therapists better understand how and when to provide verbal assistance when assessing their clients.

[Do artificial intelligence systems reason in the same way as clinicians when making diagnoses?] / Une intelligence artificielle raisonne-t-elle de la même façon que les cliniciens pour poser des diagnostics ?

Clinical reasoning is at the heart of physicians' competence, as it allows them to make diagnoses. However, diagnostic errors are common, due to the existence of reasoning biases. Artificial intelligence is undergoing unprecedented development in this context. It is increasingly seen as a solution to improve the diagnostic performance of physicians, or even to perform this task for them, in a totally autonomous and more efficient way. In order to understand the challenges associated with the development of artificial intelligence, it is important to understand how the machine works to make diagnoses, what are the similarities and differences with the physician's diagnostic reasoning, and what are the consequences for medical training and practice.

[Training through the prism of the difficulties of internship students]. / La formation au prisme des difficultés des étudiants en stage.

For 70 years, nurse training has been regularly reformed as knowledge and practices evolve. The 2009 reform is part of a professionalisation approach, with training supported by university. More than ten years after it came into force, the analysis of incidents encountered by students during clinical internships highlights two training points that need to be reinforced: acquisition of clinical reasoning and construction of a nursing identity.

[How to formalise the supervision of learning of clinical reasoning]. / Formalisation de la supervision de l'apprentissage du raisonnement clinique.

Since clinical reasoning is central to most decisions made in the clinic, it is essential to teach it with the greatest relevance. Knowing that around 10% of learners encounter major difficulties in clinical reasoning during their course, training supervisors in effective pedagogical interventions is crucial. Here we summarize the methods allowing supervisors to identify errors of clinical reasoning in medical students and interns and we explain remediation techniques adapted to the types of error identified. Access to short illustrative videos of a MOOC (Massive Open On line Course) devoted to the supervision of clinical reasoning constitutes practical help for supervisors who are not expert in the complexity of medical pedagogy at bedside.

Unacknowledged adverse transfusion reactions: Are they a mine to dig?

OBJECTIVES: Haemovigilance has long tried to characterize and understand transfusion reactions in order to prevent them. Unacknowledged ones are now a minority but they question us. Are they the result of incomplete clinical setting and/or insufficient medical reasoning, or can they contain real new entities we have not yet understood? MATERIAL AND METHODS: Ten volunteer experts reviewed 30 recent unacknowledged cases. Their diagnostic propositions were compared with data issued from a five-year repository we have analysed in terms of statistical links between clinical signs and diagnoses. RESULTS: Experts' opinions are only quite unanimous in 60% of the cases, and the proposed diagnosis remains unacknowledged in 53%. Repository comparison shows that signs like pain or digestive symptoms are far more frequent in unknown reactions. However, it is more the absence of some other signs which drives to that conclusion, in a default diagnosis mechanism. CONCLUSION: Errors in transfusion reactions medical analysis are rare. Unacknowledged cases are more often linked to poor or unspecific clinical setting. But a particular attention must be paid with infrequent diagnoses which are far less characterised, like metabolic complications. Pain high occurrence in unknown cases also commands us to go further in the characterisation of acute pain transfusion reaction diagnosis, which is suggested by some authors.

[Hypnoanalgesia and clinical nursing reasoning]. / Hypnoanalgésie et raisonnement clinique infirmier.

Hypnoanalgesia is practised in accordance with care ethics and as a complement to other medical and/or psychological therapies. It is aimed at people with acute, chronic or treatment-related pain. Its practice is founded on clinical nursing reasoning, which targets the health problem and the therapeutic objectives guiding the hypnosis session. A clinical assessment finalises the interactional process.