Abstract : The redefinition of the nursing profession, in effect in Europe since 1990 in order to meet the new health needs of the population, requires professionals to focus on the prevention, the maintenance and the promotion of health in all care situations (OMS, 1986). This reorientation, developed in initial training, concerns the development of a role depicted in the professional legal texts as "autonomous" and "independent", while raising the issue of its integration into nurses' care-giving practices. Indeed, these practices, which are mainly delegated by the medical corps and the institution, highlight the paradoxical injunction in which nurses find themselves: developing their autonomous practice in accordance with heteronomously-set objectives.
Based on a sample (n=841) taken from a study which surveyed the nursing population of a Swiss university hospital (n=1951), via a social cognitive approach (BANDURA, 2003), the search for main factors that foster the development of "health practices", identified as a focus on the patient and the patient's health according to one's own definition of health, brings to the fore a double dimension of agency : autonomous and heteronomous.
Thus, the results show that the value attributed by the nurse to her "health practices" determines their orientation within a context that remains first and foremost directed toward "treatment practices" centered on the management of patient care in all its forms as defined by the institution. Consequently, autonomy in nursing practices appears to be the exercise of agency or of the nurse's personal power to act, according to her own orientation, health or treatment. It develops significantly in highly-qualified professionals, according to an approach centered on lifelong learning.
This thesis allows for a marking out of perspectives pertaining to the clarification of nurses' roles and missions as well as the development of these roles within the university hospital structure. It raises the question of the construction of a self-efficacy which would not correspond to the explicit, nor priority expectation of the context. Lastly, by distinguishing agency and autonomy, this thesis contributes to the conceptual construction of questions linked to self-directed learning (CARRE, 2005).