Negotiating the Gray Areas of Ethical Decision Making: Deaf Therapists Working in the Deaf Community

Deaf and Hard-of-Hearing psychologists, who provide services to the Deaf and Hard-of-Hearing community, face unique dilemmas when dealing with overlapping relationships. Similar to psychologists from other small or rural communities, dual relationships are generally unavoidable. The ethical guidelines for psychologists do not provide for the exceptional struggles that many Deaf therapists face in this regard. This study was conducted to explore the decision-making patterns that Deaf therapists have used in negotiating nonsexual, multiple relationships with clients. Ten taped interviews were conducted to collect preliminary data on the overlapping relationship dilemmas of participants who are Deaf, licensed therapists and have been providing therapy in the Deaf community for at least a year. Grounded theory qualitative research approach was used when analyzing the data to identify themes and categories in an effort to identify primary topic areas for future research, further our understanding of ethical decision-making theory, and propose a model for ethical decision-making

Quantifying mutual-understanding in dialogue

PhDThere are two components of communication that provide a natural index of mutual-understanding in dialogue. The first is Repair; the ways in which people detect and deal with problems with understanding. The second is Ellipsis/Anaphora; the use of expressions that depend directly on the accessibility of the local context for their interpretation. This thesis explores the use of these two phenomena in systematic comparative analyses of human-human dialogue under different task and media conditions. In order to do this it is necessary to a) develop reliable, valid protocols for coding the different Repair and Ellipsis/Anaphora phenomena b) establish their baseline patterns of distribution in conversation and c) model their basic statistical inter-relationships and their predictive value. Two new protocols for coding Repair and Ellipsis/Anaphora phenomena are presented and applied to two dialogue corpora, one of ordinary 'everyday' conversations and one of task-oriented dialogues. These data illustrate that there are significant differences in how understanding is created and negotiated across conditions. Repair is shown to be a ubiquitous feature in all dialogue. The goals of the speaker directly affect the type of Repair used. Giving instructions leads to a higher rate of self-editing; following instructions increases corrections and requests for clarification. Medium and familiarity also influence Repair; when eye contact is not possible there are a greater number of repeats and clarifications. Anaphora are used less frequently in task-oriented dialogue whereas types of Ellipsis increase. The use of Elliptical phrases that check, confirm or acknowledge is higher when there is no eye contact. Familiar pairs use more elliptical expressions, especially endophora and elliptical questions. Following instructions leads to greater use of elliptical (non-sentential) phrases. Medium, task and social norms all have a measureable effect on the components of dialogue that underpin mutual-understanding

TVcalls and reacquainting visits : video conferencing with long-term care residents

A long-term care resident sits in front of a TV. With the push of a remote control button she instantly sees and visits with her children and grandchildren over 500 miles away. She last saw them on her 80th birthday, four years ago. She and her family are participants in a social action inquiry that explores video conferencing in order to understand the value of technology enhanced face-to-face interaction in a long-term care home. This research, designed as a compassionate response to the serious problems of isolation, loneliness, helplessness, and boredom in long-term care, set out to determine what video conferencing can mean to long-term care residents and to the people they connect with. The study queried possibilities for improving the quality of social interactions of residents in long-term care facilities with family members living at some considerable distance from them. It involved setup of technical equipment, then three residents in a long-term care facility in western Canada were introduced to the practice of video conferencing with their families. Each conferencing event was supported with volunteers for a three-four month exploration period. The research was intended to contribute to knowledge about learning in later life, to promote a way of increasing communication between the elderly and younger generations, and to address issues associated with elderly long-term care residents’ access to video conferencing technology. Data collected through memory logs, observations, and interviews indicates that all study participants, including residents, family, and volunteers, responded favourably to the video conferencing experience. This study supports the claims that video conferencing can increase the frequency of contact between long-term residents and family members, and that the quality of this contact is enhanced through the visual presence and engagement of participants, through use of video conferencing technology. The video conferencing enabled family members separated by distance and unable to visit frequently to take on a "regular visitor role" and for residents to go visiting. The visually enhanced communication / visits transformed the otherwise limited audio interaction of phone calls or no interaction into socially substantive experiences of connectedness, inclusion about which residents reported feeling excited and connected with something to look forward to. This suggests video conferencing could contribute to a good quality of life for residents. Future communications infrastructures should seriously consider inclusion strategies and availability of effective applications to long-term care residents

Practical issues arising from the use of telemedicine applications: An evaluation of equipment used for colour imaging in teledermatology, automated weight monitoring and patient-operated 12-lead ECG recording in arrhythmia.

Three telemedicine applications which depend on relatively simple telephone technology to transfer data in the care of patients managing chronic conditions at home are investigated in order to evaluate their application from the users’ perspectives. Part one provides an evaluation of four mobile cameraphones, of varying quality, such as those commonly used to photograph patients for remote diagnosis. The cameraphones are compared with a digital camera, two videophones and an ISDN6 conferencing facility, in their ability to replicate colour and shape. The effects of uploading the images to a laptop computer and of transferring an image by MSN messaging are also evaluated. Part two provides an evaluation of electronic weighing scales connected via a wireless gateway to a landline telephone for the purpose of remote weight monitoring in patients with chronic heart failure. Self-reported experiences of patients, carers and specialist nurses are explored and outcomes compared with previously published opinion. The idiosyncratic nature of health care is highlighted as a main factor in the success or failure of the system. The third application is a patient-operated 12-lead ECG unit which transmits data via a home landline to a call centre, where it is displayed as an ECG trace and a report is given by specialist clinicians. Self-reported experiences of patients with arrhythmia reveal systematic phenomena which hinder the effectiveness of the device and which are related to human, not technological, failings. ECG traces obtained by unskilled lay persons on paediatric patients are compared with the ECG traces obtained by skilled and experienced paediatric nurses on the same patients. The results show that in the case of the cameraphones the technology is less accurate than normally assumed. In the case of the weight monitoring and ECG equipment however it is more usually human factors which cause a disappointing outcome

Qualitätstaxonomie für skalierbare Algorithmen von Free Viewpoint Video Objekten

Diese Dissertation beabsichtigt einen Beitrag zur Qualitätsbeurteilung von Algorithmen für Bildanalyse und Bildsynthese im Anwendungskontext Videokommunikationssysteme zu leisten. In der vorliegenden Arbeit werden Möglichkeiten und Hindernisse der nutzerzentrierten Definition von subjektiver Qualitätswahrnehmung in diesem speziellen Anwendungsfall untersucht. Qualitätsbeurteilung von aufkommender Visualisierungs-Technologie und neuen Verfahren zur Erzeugung einer dreidimensionalen Repräsentation unter der Nutzung von Bildinformation zweier Kameras für Videokommunikationssysteme wurde bisher noch nicht umfangreich behandelt und passende Ansätze dazu fehlen. Die Herausforderungen sind es qualitätsbeeinflussende Faktoren zu definieren, passende Maße zu formulieren, sowie die Qualitätsevaluierung mit den Erstellungsalgorithmen, welche noch in Entwicklung sind, zu verbinden. Der Vorteil der Verlinkung von Qualitätswahrnehmung und Servicequalität ist die Unterstützung der technischen Realisierungsprozesse hinsichtlich ihrer Anpassungsfähigkeit (z.B. an das vom Nutzer verwendete System) und Skalierbarkeit (z.B. Beachtung eines Aufwands- oder Ressourcenlimits) unter Berücksichtigung des Endnutzers und dessen Qualitätsanforderungen. Die vorliegende Arbeit beschreibt den theoretischen Hintergrund und einen Vorschlag für eine Qualitätstaxonomie als verlinkendes Modell. Diese Arbeit beinhaltet eine Beschreibung des Projektes Skalalgo3d, welches den Rahmen der Anwendung darstellt. Präsentierte Ergebnisse bestehen aus einer systematischen Definition von qualitätsbeeinflussenden Faktoren inklusive eines Forschungsrahmens und Evaluierungsaktivitäten die mehr als 350 Testteilnehmer inkludieren, sowie daraus heraus definierte Qualitätsmerkmale der evaluierten Qualität der visuellen Repräsentation für Videokommunikationsanwendungen. Ein darauf basierendes Modell um diese Ergebnisse mit den technischen Erstellungsschritten zu verlinken wird zum Schluss anhand eines formalisierten Qualitätsmaßes präsentiert. Ein Flussdiagramm und ein Richtungsfeld zur grafischen Annäherung an eine differenzierbare Funktion möglicher Zusammenhänge werden daraufhin für weitere Untersuchungen vorgeschlagen.The thesis intends to make a contribution to the quality assessment of free viewpoint video objects within the context of video communication systems. The current work analyzes opportunities and obstacles, focusing on users' subjective quality of experience in this special case. Quality estimation of emerging free viewpoint video object technology in video communication has not yet been assessed and adequate approaches are missing. The challenges are to define factors that influence quality, to formulate an adequate measure of quality, and to link the quality of experience to the technical realization within an undefined and ever-changing technical realization process. There are two advantages of interlinking the quality of experience with the quality of service: First, it can benefit the technical realization process, in order to allow adaptability (e.g., based on systems used by the end users). Second, it provides an opportunity to support scalability in a user-centered way, e.g., based on a cost or resources limitation. The thesis outlines the theoretical background and introduces a user-centered quality taxonomy in the form of an interlinking model. A description of the related project Skalalgo3d is included, which offered a framework for application. The outlined results consist of a systematic definition of factors that influence quality, including a research framework, and evaluation activities involving more than 350 participants. The thesis includes the presentation of quality features, defined by evaluations of free viewpoint video object quality, for video communication application. Based on these quality features, a model that links these results with the technical creation process, including a formalized quality measure, is presented. Based on this, a flow chart and slope field are proposed. These intend the visualization of these potential relationships and may work as a starting point for further investigations thereon and to differentiate relations in form of functions

Mentoring in the Department of Access Services at the National Technical Institute for the Deaf

Not provided

An action research study to investigate the strategies that can be used by health care professionals, during video consultations with palliative care patients, to enhance the therapeutic alliance

Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts

The role of perceived proximity in video-mediated communication

As technology for remote communication continues to advance and become more widespread, there is a need for research to attempt to understand the manner in which such technology may most suitably support human communication. This thesis describes a series of experiments which investigated the role of proximity within video-mediated communication. Proximity is one of the most fundamental forms of non-verbal communication used in a face-to-face interaction. Even subtle changes in interpersonal positioning are rich in information which people use to attempt to regulate the behaviour of themselves and others. At present it is unknown whether this type of non-verbal communication is preserved in video-mediated interactions. The aim of the present research project was to investigate whether impressions of proximity could be conveyed across a video link. In addition the research attempts to illuminate the physical parameters which may underpin the perception of proximity and to explore the impact upon users that any changes in perceived proximity may cause. The research uses a wide range of approaches to study the potential impact of proximity including analyses of the structure and content of dialogue, objective and subjective task outcome measures. The research demonstrates that perceptions of proximity can exist in a video-mediated environment and when they do, they can lead to differences in the communication behaviour of individuals communicating across a video link. It is found that when participants interact with a remote interlocutor who appears to be close, they tend to be more interactive. The research goes on to investigate the perceptual basis behind this effect and also considers how this relates to other variables which are known to affect communication, most notably familiarity