Studies have shown that patients receiving mechanical ventilation in an intensive care unit (ICU), who are entirely dependent on the nursing staff, often experience frustration due to a temporary loss of the voice source. Limited communication is an important factor contributing to patient discomfort. Nursing staff also report communication as frustrating and difficult. The aim of the present study is to introduce a neck-type electrolarynx as a communication aid in an ICU, to study the nursing staff experiences of communication with tracheotomized patients receiving mechanical ventilation, and to examine the patient´s experiences regarding communicative abilities. Communication between a ventilator treated, tracheotomized patient and members of the nursing staff was recorded and analyzed according to principles of Conversation Analysis (CA). The results show that several members of the nursing staff experience difficulties communicating with tracheotomized patients receiving mechanical ventilation. A majority believe that the conditions for communication could be improved. The results of CA also indicate that an electrolarynx may be an effective and appropriate communication aid for ventilator treated, tracheostomized patients. Further research is needed to broaden the knowledge of the electrolarynx as a communication aid for these patients. Keywords: communication, mechanical ventilation, electrolarynx, patient experience, nursing staff experience, Conversation Analysis (CA).

I institutionella samtal såsom närståendesamtal mellan en logoped, en närstående till en person med afasi och personen med afasi råder en asymmetri gällande maktförhållandet. Asymmetrin som uppstår i det institutionella samtalet kan innebära att samtalsdeltagaren med minst makt upplever ansiktshot. I samtal ses förståelse som en dynamisk process och när förståelsen innebär ett problem i konversationen störs den pågående aktiviteten. Mottagaren kan lösa problemet som uppstått genom att ge talaren en candidate understanding. Hur kommunikativa strategier används i närståendesamtal är ett relativt obeforskat område och ett viktigt område då närståendesamtal är en vanligt förekommande för logopeder. Syftet med föreliggande studie var därför att undersöka ett antal kommunikativa strategier för att få en gemensam förståelse och minska ansiktshot  vid delgivning av testresultat och rådgivning i närståendesamtal. Tre närståendesamtal mellan logopeder, närstående och i två fall personer med afasi spelades in, transkriberades och analyserades enligt samtalsanalytiska principer (CA). Två logopeder, tre närstående och två personer med afasi medverkade i studien. Totalt omfattade det inspelade materialet en timma och 37 minuter. Deltagande logopeder fick även fylla i ett frågeformulär. Strategier för avdramatisering och förståelse identifierades. Strategierna delades in i två kategorier; avdramatisering av råd och förmedling av testresultat och candidate understandings för att uppnå förståelse. I studien framkom det att candidate understandings ofta initierades av den närstående. Det framkom även att de positiva testresultaten som förmedlades inte avdramatiserades samt att dessa istället ofta framhävdes och att face threatenings acts vid delgivning av negativa testresultat ofta avdramatiserades med hedging. / In institutional interactions such as conversations between a speech and language therapist, a person closely related to a person with aphasia and the individual with aphasia there is an asymmetry considering the power. The asymmetry arising in institutional interactions may mean that the participant with the least power will experience a face threatening act. Understanding is seen as a dynamic process and when understanding is a problem in the conversation the ongoing activity is disturbed. The receiver can solve the problem by giving the speaker a candidate understanding. How these strategies are used in conversations between a speech and language therapist with a person closely related to a person with aphasia is a relatively unexplored field and an important area which is a common for speech therapists. The aim of the present study was to investigate a number of communication strategies in the conversation with a person closely related to a person with aphasia; how understanding was reached and how face threatening acts were reduced when the speech therapists delivered test results and gave counseling. Three conversations between speech and language therapists, persons closely related to a person with aphasia and in two of the recordings the person with aphasia were recorded, transcribed and analyzed according to principles of Conversation Analysis (CA). Two speech and language therapists, three persons closely related to a person with aphasia and two persons with aphasia participated in the study. In total, the recorded material is one hour and 37 minutes. Participating speech and language therapists also filled in a questionnaire. Strategies for mitigation and understanding were identified. The strategies were divided into two categories; strategies to mitigate FTA:s when delivering the test results and counseling, the other categorie was the use of candidate understandings for gaining an mutual understanding. The study revealed that candidate understandings were often initiated by the person closely related to a person with aphasia. The study also revealed that the test results with positive outcome where not mitigated and often emphasized and test results that could be perceived as negative were mitigated with hedging.

Aspergers syndrom (AS) innebär bland annat en begränsning i social interaktion, vilket resulterar i svårigheter inom flera kommunikativa förmågor. Trots dessa svårigheter finns ett begränsat utbud av kommunikativ intervention för personer med AS idag. Syftet med föreliggande studie var att analysera den vardagliga interaktionen hos vuxna personer med AS för att få fram ett underlag för hur en kommunikativ intervention skulle kunna utformas. Föreliggande studie bestod av en intervjudel och en videodel. I intervjudelen ingick sju deltagare och i videodelen ingick två deltagare. Intervjudelen bestod av semistrukturerade intervjuer, där deltagarnas uppfattning om sin egen och omgivningens kommunikation, medvetna strategier för att underlätta kommunikationen samt erfarenheter och preferenser för intervention undersöktes. Intervjudelen analyserades med metoden innehållsanalys. I videodelen spelades två videofilmer av vardaglig interaktion in. Videofilmerna analyserades med Conversation Analysis (CA) och deltagarnas interaktionella styrkor och svårigheter belystes genom detta.Innehållsanalysen resulterade i tio kategorier som åskådliggör olika aspekter av kommunikation hos personer med AS ur deras eget perspektiv. Majoriteten av deltagarna var intresserade av att medverka i kommunikativ intervention. Vid analys av videofilmerna framkom att reparationer och organisation av samtalsämnen kan utgöra kommunikativa svårigheter. Uppbackningar visade sig utgöra en kommunikativ styrka. Utifrån studiens samtliga fynd föreslår uppsatsförfattarna en varierad intervention där gruppintervention och individuell intervention varvas. Exempel på kommunikativa förmågor som kan tränas är reparation, organisation av samtalsämnen samt uppbackningar. Individens närmaste omgivning bör integreras i interventionen. I interventionen bör även filmning av verkliga situationer ingå, vilka med fördel kan analyseras med CA. Träning av enskilda kommunikativa beteenden kan bland annat genomföras med hjälp av rollspel. Då resultatet av både intervju- och videodelen tyder på stora individuella skillnader är det av stor vikt att individanpassa interventionen. / Asperger syndrome (AS) results, among other things, in a deficit in social interaction. This deficit causes difficulties with several communicative abilities. Still, there is a limited range of communicative intervention programs for people with AS. The aims of this study were to analyze the interaction in the daily life of adults with AS, to further be able to construct a foundation for the design of future intervention programs. The study consisted of an interview part and a video part. Seven individuals participated in the interview part and two in the video part. The interview part consisted of semi-structured interviews, where the following aspects were investigated: how the participant experienced her/his own and the surrounding’s communicative abilities, conscious strategies to facilitate the communication, and lastly, experiences of and preferences for intervention. The interview part was analyzed with content analysis. Regarding the video part, two film clips were recorded. The film clips were analyzed with Conversation Analysis (CA), in order to describe the interactional strengths and difficulties of the participants.The content analysis resulted in the identification of ten categories, which highlight different aspects of communication in individuals with AS from their own perspective. The majority of the participants showed an interest in participating in communicative. The analysis of the film clips indicated that repair and organization of topics may be problematic areas in the communication of individuals with AS. Continuers proved to be a communicative strength. Considering all of the results in this study, the authors suggest a varied intervention, where group and individual intervention are combined. Examples of communicative abilities that can be practiced are repair, organization of topics and continuers. People close to the individual with AS should be integrated in the intervention. Video recordings of real life situations should be part of the intervention and may advantageously be analyzed with CA. The practice of specific communicative behaviors can be carried out using role-playing. Since the result of both the interview and the video part suggest great individual differences, it is of great importance that the intervention is based on individual abilities.

Afasi är ett samlingsbegrepp för förvärvade språkstörningar. Symptomen förekommer i högst utsträckning hos personer som drabbats av en stroke. Personer som drabbats av någon typ av afasi upplever ofta att deras kommunikativa förmåga i hög grad begränsats efter insjuknandet, vilket kan leda till stor eller mycket stor social inskränkning. De psykologiska faktorer som påverkas rör kognition och emotion, sociala strukturer och relationer, exempelvis personliga relationer, yrkesliv eller utbildning. Därmed relateras de psykosociala konsekvenserna av afasi till hur tillståndet påverkar vardagslivet och förmågan till att interagera med den sociala omgivningen. Idag sker intervention för personer med afasi individuellt och gruppintervention eller anhöriginkludering ses som sekundära komplement till den individuella behandlingen. I föreliggande studie undersöks en form av intervention där personer med afasi och deras anhöriga gemensamt får ta del av kommunikativa strategier och tilldelas individanpassade råd. Inspiration har hämtats från den befintliga anhöriginkluderande metoden SPPARC. Målet med interventionen var att den vardagliga kommunikationen skulle stärkas och effektiviseras. Interventionen skedde under en fem veckor lång period och utförts i två olika konstellationer; ett par och en mindre grupp. Gruppkonstellationerna har sedan jämförts med varandra. Båda koncepten utvärderades positivt av deltagarna. De förefaller därmed vara tillämpbara båda två, men beroende på deltagarnas förväntningar och psykosociala behov kan något av koncepten föredras på ett individuellt plan. Resultatet av föreliggande studie indikerar att det finns ett psykosocialt behov av att inkludera anhöriga till personer med afasi i intervention. En ökad medvetenhet hos deltagarna noterades gällande flera av de kommunikativa strategier som behandlades under interventionens gång, bland annat gestikulering och prompting. Deltagarnas utvärdering av perioden tyder på att interventionsperioden framför allt fungerat som ett forum för samtal kring afasi och kommunikation och att den har tjänat sitt syfte i psykosocial bemärkelse. Deltagarna uppgav dock under utvärderingen att interventionen är bäst lämpad som en tidig insats efter personen med afasis insjuknande.

Allt fler personer lever med eller har en nära anhörig som lever med en demenssjukdom. En demenssjukdom leder till kognitiva nedsättningar som påverkar individens kommunikation. Deltagande i social interaktion är vitalt för en god livskvalitet samt känsla av själv, värde och identitet hos personer med demenssjukdom. Interaktion där personer med demenssjukdom deltar påverkas av de kommunikationssvårigheter som följer demenssjukdomen, men också av samtalspartners syn på personen med demenssjukdom. Föreliggande studie undersöker interaktion som involverar personer med demenssjukdom med fokus på hur kunskapande manifesteras i interaktionen, hur personer med demenssjukdom positionerar sig själva och positioneras av andra som personer som kan någonting samt vilken betydelse som positionering har för personer med demenssjukdoms deltagande i social interaktion. Kunskapande har definierats som ett aktivt görande av kunskap genom mellanmänsklig interaktion. Data har utgjorts av totalt 30 timmar audio- och/eller videoinspelning av naturligt förekommande interaktion där personer med demenssjukdom deltar, från vilken 14 representativa samtalsexempel lyfts fram. Vid analys har multimodal interaktionsanalys samt positioneringsteori använts. Analysen visar att kunskap kan manifesteras hos personer med demenssjukdom genom kunskapande, en dynamisk process där kunskap förhandlas fram genom samtal. Att positioneras som samt positionera sig själv som kunnande verkar ha en positiv effekt på personer med demenssjukdoms möjlighet att ge uttryck för sin kunskap. Personer med demenssjukdom kan således vara delaktiga i kunskapandeprocesser och de sociala situationer som ligger till grund för kunskapandet. Kliniska och praktiska implikationer kring främjandet av deltagandet i social interaktion hos personer med demenssjukdom presenteras. En demenssjukdom medför förändrade förutsättningar för social interaktion men viktigt är att se till individens styrkor och bevarade förmågor samt ge individen förutsättningar för att kunna delta i samtal och ge uttryck för sin kunskap. / An increasing number of people live with dementia or have a close relative who does so. Participation in social interactions is vital for sustaining quality of life and a feeling of self, value and identity in people with dementia. Dementia causes cognitive impairments that affect the person’s ability to communicate. Interactions in which people with dementia participate are influenced by the communicative difficulties that arise as a result of the disease, but also by the conversational partner’s view of the person with dementia. The present study investigates interactions involving people with dementia, focusing on how knowledging is manifested in the interaction, how people with dementia position themselves and are positioned by others as people with knowledge, and what effects this positioning has on the participation of people with dementia in social interactions. Knowledging is defined as the active making of knowledge through interpersonal interactions. The data consists of 30 hours of audio and video recordings of naturally occurring conversations in which people with dementia participate, from which 14 representative conversational examples were highlighted. Multimodal interaction analysis and positioning theory were used in the analysis. The analysis revealed that knowledge can be manifested in people with dementia through knowledging, a dynamic process in which knowledge is negotiated through conversation. Being positioned as knowing by others, as well as positioning oneself as knowing, seems to have a positive effect on the ability to express knowledge in people with dementia. People with dementia can therefore be involved in knowledging processes and the social situations that form the basis of knowledging. Some potential clinical and practical implications of promoting the participation of people with dementia in social interactions are suggested. Dementia changes the conditions for social interaction, but it is important to highlight each individual’s strengths and retained abilities and provide them with the conditions for participating in interactions and expressing their knowledge.

It would be favorable, during the clinical assessment of language in multilingual children, if the speech-language-pathologist (SLP)spoke all the languages of the child. This is, however, not always possible, hence the need for interpreter-mediation. Furthermore, it would be desirable if the interpreters used in clinical assessments of language are specifically trained. There are only a few studies concerning interpreter-mediated clinical assessment of language and cognition using Conversation Analysis as a method, and no studies of interpreter-mediated clinical assessment of language in multilingual children. The purpose of this study was therefore to investigate the interaction between the SLP, interpreter and child, in interpreter-mediated clinical assessments of language in multilingual children, with a specific focus on the SLP and the interpreter. Participants of the study were two licensed S LPs, three interpreters and two multilingual children and their caregivers. The study was based on three video recordings of clinical encounters and four semi-structured interviews. The video recordings were translated, transcribed and analyzed using the theory and method of Conversation Analysis, and the interviews were transcribed and analyzed. Analysis of the video recordings resulted in the discovery of three phenomena; the importance of preunderstanding of the working process of SLP, the importance of responsibility during interpreter-mediated clinical assessment of language, and finally communication and language approach. Analysis of the semi-structured interviews resulted in the discovery of four phenomena, which, in addition to the ones already discovered during the video recordings, also included the importance of dialects. Strategies and challenges that the SLP and interpreter faced could be revealed from the phenomena discovered in the video recordings and the semi-structured interviews. It was suggested in the conclusion that challenges were caused by expectations on the interpreter, a lack of preunderstanding of the working process of the SLP, uncertainty regarding the responsibilities of the interpreter versus the SLP, and finally, the demands of a high level of language competence. Strategies that were used within the discovered phenomena were partially consciously applied by the SLP and interpreter. However, there is a great need for further knowledge and awareness of the processes involved in this clinical context, in order to obtain reliable and satisfactory interpreter-mediated clinical assessments of language. Lastly, it was discussed that the patient safety might be compromised if no consideration is taken regarding the investigated challenges and strategies.

No description available.

This thesis is about the resources that speakers can draw on when producing actions, both verbal and non-vocal. It considers how identity categories, gaze and touch can contribute to action in everyday interactions. The study stemmed from an interest in how lesbian identity is made relevant by lesbian speakers in everyday co-present interaction. A corpus of approximately 23.5 hours of video-recordings was gathered: households self-designated as lesbian (including couples, families, and housemates) video recorded some of their everyday interactions (including mealtimes, watching television, and playing board games). Using the tools of Conversation Analysis and working with the video recordings and transcripts of the interactions, several ways of making a lesbian identity relevant through talk were identified. As the analysis progressed, it was found that many references to sexual identity were produced fleetingly; they were not part of or integral to the ongoing talk, and were not taken up as a topic by participants. Rather, this invoking of a participant s sexual identity appears to contribute to a particular action that is being produced. It was found that invokings of other identities, for example relating to occupation, nationality, and race, worked in a similar way, and this is explored in relation to explanations and accounts. Where the first half of the thesis focuses on verbal invokings of identity in relation to action, the second half of the thesis considers some of the non-vocal resources that participants incorporate into their actions. It was found that when launching a topic related to something in the immediate environment, speakers can use gaze to ensure recipiency. Also, when producing potentially face-threatening actions such as teases, reprimands or insults, speakers can use interpersonal touch to mitigate the threat. In addition to showing how identities can be made relevant in everyday interaction, the findings of this thesis highlight the complexity of action design, and that in co-present interaction the physical resources available to participants also need to be taken into account.

Kommunikativa svårigheter är en funktionsnedsättning som kan innebära språk-, röst- eller talsvårigheter och kan leda till begränsad interaktion med omgivningen. Taltjänst är en tolkservice som erbjuder ett sätt för personer med kommunikativa svårigheter att lättare kommunicera med omgivningen. Syftet med föreliggande studie är att undersöka hur taltjänsttolkar kan underlätta kommunikationen för personer med kommunikativa svårigheter i samtal mellan tolk, tolkanvändare och tredje part. Materialet består av fem olika videoinspelningar av tolksamtal samt svar från en enkätundersökning till taltjänsttolkar. Videomaterialet transkriberades utifrån samtalsanalytiska principer. Återkommande teman identifierades i svaren från enkätundersökningen. I resultatet och analysen observerades strategier för att skapa gemensam förståelse i form av begäran om förtydligande och begäran om bekräftelse av förståelse. Även upprepning/återgivning samt delad kunskap är fenomen som framkom i analysen av data. Förberedande möten visade sig spela en avgörande roll för att uppnå gemensam förståelse i samtal mellan tolk, tolkanvändare och tredje part. / Communicative disorders may involve language, voice or speech impairment and can lead to limited interaction with social surroundings. Speech Interpreter Service is an interpretation service which provides a way for people with communication disorders to communicate more easily with their surroundings. The aim of the present study is to investigate how speech interpreters can facilitate communication for people with communication disorders in conversation between the interpreter, users and third parties. The material consists of five different video recordings of interpreter conversation, and answers from a questionnaire to speech interpreters. The video material was transcribed based on conversation analytical principles. Recurring themes were identified in the answers from the survey. In the results and analysis, strategies to create common understanding were observed in the form of clarification requests and requests for confirmation of understanding. Other phenomena that appeared in the analysis were repetition/reproduction and shared knowledge. Preparatory meetings were shown to play a crucial role in achieving common understanding in conversation between the interpreter, users and third parties.

Using the theoretical approach of discursive psychology, this thesis examines the interactive uses of mental state talk, in particular the term want , in everyday family interaction. In mainstream cognitive psychology mental state terms are examined as words which signify internal referents. How individuals come to competently participate in social interaction is formulated as a problem of how individual, isolated minds come to understand the contents of other minds. This thesis challenges these individualistic notions and examines notions of wanting as interactionally managed participants concerns. The data are taken from two sources; a set of video recordings taken from a series of fly-on-the-wall documentary programmes which each focus on a particular family and videotapes of mealtimes recorded by three families. Recordings were initially transcribed verbatim and sections related to the emerging themes within the thesis were subsequently transcribed using the Jefferson notation system. These transcripts were then analysed, alongside repeated viewings of the video recordings. The thesis considers a range of analytic themes, which are interlinked via one of the primary research questions, which has been to examine how, and to what end, speakers routinely deploy notions of wanting in everyday talk-in-interaction. A major theme has been to highlight inherent problems with work in social cognition which uses experimental tasks to examine children s Theory of Mind and understanding of desires . I argue that the assumptions of this work are a gross simplification of the meaning wanting for both children and adults. A further theme has been to examine the sequential organisation of directives and requests in both adults and children s talk. Finally, I examine speakers practices for rejecting a proposal regarding their actions and for denying a formulation of their motivations by a co-interactant. The conclusions of the thesis show that expressions of wanting are practical expressions which work within a flow of interactional and deontic considerations and that making claims regarding one s own or others wants is entirely a social matter. I argue that rather than being examined for what they may reveal about the mind , mental state terms may be fruitfully examined as interactional matters.