Increasing numbers of older patients with cognitive impairment and disturbed behaviour are likely to present to acute care hospitals in the future. Nurses are not well disposed towards care due to safety and morale issues caused by knowledge deficits, job stress, oppressed group behaviours and ageist attitudes. Patient outcomes are often poor with multiple adverse events, long lengths of stay and levels of mortality. Disturbed behaviour may be caused by delirium, depression or other mental disorders and dementia or all. The research question addressed was “Can the instigation of a person-centred approach to care of patients with cognitive impairment and disturbed behaviour result in decreased nursing stress, improved patient care practices, outcomes and relatives’ satisfaction?” A conceptual framework incorporating the constructs of Person-Centred Care, the Integrated Structural Model of Human Behaviour and Practice Development informed the action research methods utilised. The processes of facilitation were used to undertake four action research cycles incorporating plans, actions, observations and reflections in one 25-bed acute aged care ward in a large tertiary referral hospital The first cycle involved setting up the study, recruitment of nurses and patients, gathering of baseline data and application of nonparticipant observational studies of the quality of nurse-patient interactions which served to inform the plan for interventions. The following three cycles demonstrated efforts to undertake those interventions through strategies to increase nursing empowerment and knowledge in the context of constant staff turnover and diversions that compromised support and participation. During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives’ satisfaction with care, nursing care practices involving the completion of a Communication and Care Cues form and nurses’ interactions with the patients. New care planning tools were developed that will enable ongoing activities for practice improvement. Conversely, there was a significant increase in the nurses’ stress levels when caring for hypoactive delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates. Nursing care practices were unchanged and the new care planning tools were not well utilised. Reflection on the implications and limitations of action research methods supported by practice development strategies in the dynamic, often chaotic environment experienced during the study, suggested that if there is an absence of hierarchical managerial sponsorship for such activities, then sustainable change is difficult. Therefore, it was shown that a person-centred approach to care of patients with cognitive impairment and disturbed behaviour using action research methods in this environment, can result in some enhanced nurse-patient interactions, patient care practices, outcomes and relatives’ satisfaction. However, progress is likely to be slow and time consuming. Further improvements require attention to the well-being status of the nurses through actions that generate feelings of empowerment through individual recognition, knowledge enhancement, adequate access to patient information and sufficient time to undertake their duties as equal members of the multidisciplinary team.

Ubiquitous computing aims to make human-computer interaction as naturalistic and functionally invisible as possible through embedding computing potential within a particular context to support human activity. However, much of ubiquitous computing research is focussed on technical innovation due to the challenges involved with deploying embedded computing, thereby reducing the commitment to the philosophical ideals of ubiquitous computing in research. This dissertation describes the investigation of a participatory approach to technically-complex research in order to understand how our view of the engineering and human challenges changes when the two are approached hand-in-hand. The domain chosen for this system was a dental surgery. Dentistry involves a complex workspace with computer interaction constrained by surgery hygiene. Ubiquitous computing offers a compelling interaction alternative to the keyboard and mouse paradigm in such an environment. A multi-method approach that employed ethnographic research and design prototyping was undertaken with dentists from several different private practices. A series of field studies used ethnographic methods such as observation and interview. Design events explored prototypes with activities such as design games, contextual interviews, role-playing and contextual prototyping. Activities were devised with the aim of providing a level playing field, whereby both designers and participants feel they can contribute equally, with their respective disciplinary knowledge. It was found that methods needed to be carefully chosen, devised and managed, in order to communicate complex concepts with participants and to constrain the design to technically feasible options. The thesis examines the design problem from the perspectives of a variety of different stakeholders within a participatory design framework, reflected upon by means of human-centred action research. Data was gathered through design speculations and observation, and explored using methods such as the Video Card Game and Video Interaction Analysis. Fieldwork was analysed using a multi-stage qualitative analysis process which informed further design collaboration with participants. The analysis of data gathered during design studies with dentists also contributed to the development of a prototype system to validate methodological contributions. The resulting prototype utilised off-the-shelf hardware and software which allowed for innovative customisation and development. In-situ prototyping (defined by the author as “participatory bootstrapping”) and a comprehensive knowledge of the domain afforded the creative application of technology. In addition to contributing to the prototype design, the interpretive understandings drawn from analysis identified how technical ideas were presented and utilised by participants of the studies, and how best to engage busy professionals. The final outcomes of the research were a multimodal ubiquitous computing system for interacting within a dental surgery; the development and implementation of a variety of methods aimed at communicating technical concepts and eliciting user motivations, practices and concerns; and a set of design principles for engineers engaging in design of systems for human use. The research presented within this thesis is primarily part of the field of human-computer interaction, but provides evidence of how engineering development can be influenced by a user-centred participatory approach. The benefits that derive from inclusive methods of design are demonstrated by the evaluation of a prototype that employed such methods. The contribution of this thesis is to demonstrate and delineate methods for developing ubiquitous computing technologies for the context of human use. This led to a set of design principles for the engineering of systems for human use: 1. Technology needs to be robust and simple to appropriate. This allows users to give insights on technology developments and also to allow users to discover for themselves how they would use the technology. 2. An evolving and carefully considered set of methods are needed to elicit communication between practitioners and across disciplines. The gaps in understandings and the different representations that arise across the disciplines provide essential clues to next steps in design. These gaps and differences form tensions that can be exploited productively. 3. Context is important for determining which design steps to take. Rather than abstracting a problem in order to solve it, as is usual in engineering design, the problem should remain grounded in the context of use. It reveals what the real problems are that need to be solved rather than the imagined ones. This requires an appreciation of the situated nature of action and of the variability of work. In turn it also requires an appreciation of what the human can and does do and what the machine should support. 4. Accountability in design is required. There is a fundamental tension between trying to make something work and seeing what really does work; specifically it is necessary to understand when automation is worth it in human machine systems. While engaged in the design process, engineers should ask how much technology should reconfigure human practices because of a useful outcome, rather than attempting to automate and converge devices for its own sake. A clear understanding of the constraints and workings of the work space needs to be balanced with the understandings of the limitations of the technology in order to design a system that improves work practice and empowers the practitioner.

Abstract The aim of this thesis is to suggest a model to assist in the ability to judge access by private persons to Information Technology, IT, and to Public Information Sys-tems, PIS. It has its starting point in the Swedish Government´s endeavour to turn Sweden into the first information society for all. When the available statistics con-cerning the access to a PC and the Internet in Swedish homes are studied it is easy to think that this vision may soon be realised. Of course, access to the technical equipment is a fundamental condition in order to be able to use the Public Informa-tion Systems, but unfortunately, is not the only one. A number of studies have shown that it is not possible to equate possession and use. A number of access models or frameworks designed to judge whether or not a person has access to the ICTs do exist. However, it is my opinion that there is a de-ficiency in these models; they do not start out from the individual user´s prerequi-sites, but rather judge the external conditions available for possible access. Assisted by four empirical studies, interviews and questionnaires, a number of ac-cess barriers experienced by the users have been identified. The studies show that in addition to the technological hindrances, a series of more elusive ones also exist originating from prevailing norms and values in the environment the user lives in. The barriers are categorised into five groups; to have, to be able, to will, to may and to dare. Together these notions form the User Centred Access Model, UCAM, which is suggested for use in charting and communicating the necessary considera-tions that must be taken into account in the development of Public Information Sys-tems. KeywordsLanguage / PI - Publika Informationssystem

This thesis addresses the research question of how social awareness support in computer systems for groups and communities can be designed in a successful way. While the field of human-computer interaction has been working with similar questions for more than 20 years, many aspects of people’s cooperation and the way those should be considered in system design still need further consideration and research. The thesis presents a number of projects where systems for cooperation have been designed for different settings and different kinds of use with a particular interest in social awareness. Drawing from the experiences of the different projects, design sensitivities around awareness, as a central prerequisite for collaboration, are suggested. Another contribution of the thesis is the presentation of a theoretical model for awareness, called Aether, introduced by us a number of years ago. We will discuss the theoretical implications of the model as well as a number of applications of it based on our own work as well as based on the work of other researchers who used Aether, by this providing confirmation of our model. Based on the findings around awareness, the thesis argues for a ‘translucent’ approach to the issue of socio-technical balance that one has to consider in the design process. Instead of trying to understand and model human behaviour or the social organization of cooperation, in order to ‘code’ them into the computer system, this approach advocates for systems that mediate information in a ‘translucent’ way so that people can retain the control of the organization of cooperation in their given context. By using a ‘reflective practitioner’ approach, the thesis discusses how people-centred methods have been used throughout these projects and looks into how awareness could be considered by using these methods. The focus of this investigation is twofold: on one hand to understand how the used methods have influenced our discussion about awareness and on the other hand it aims to address the practitioners of the field by questioning some of the common beliefs in the field. By investigating social awareness support in collaborative systems, the thesis contributes to theoretical arguments in the field of humancomputer interaction, and the area of CSCW in particular, while at the same time it provides the interaction design practitioner with a number of considerations for practical use. / QC 20100913

Program evaluation is becoming increasingly important in pediatric rehabilitation settings that adhere to FCS philosophy. This philosophy recognizes that each family is unique, that parents know their children best, and that optimal child functioning occurs within a family context. However, researchers know little about the specific evaluation activities occurring in these settings or the extent to which evaluators uphold FCS philosophy in their activities. The primary goal of this study is to examine the strengths, limitations, and consequences of current evaluation practice, including its compatibility with FCS philosophy. As a secondary goal, the study aims to understand the promise and prospects of alternative evaluation approaches that, in theory, are compatible with FCS philosophy. To address these goals, this study uses a mixed-methods approach and includes three phases. Phase 1 involves a survey of staff members involved with program evaluation at 15 Canadian pediatric rehabilitation centres. It determines the level of program evaluation occurring in these settings, verifies on the motivation for evaluation, and describes the degree to which evaluation activities are consistent with the FCS philosophy. Phase 2 involves interviews with staff members and explores the values, factors, and conditions that support and inhibit the evaluation of family-centred programs in pediatric rehabilitation settings as well as the benefits and limitations of using mainstream practices for evaluating these programs. Phase 3 then uses focus groups with staff members and interviews with parents to explore how the evaluation of family-centred programs can be improved as well as to identify the compatibility and practicality of using alternative evaluation approaches within these settings. Overall, the findings show that the amount of evaluation activities occurring within these centres is variable; that the majority of individuals working in program evaluation do not have formal training in it; and that the centres have limited resources for evaluation. The findings also demonstrate that participatory evaluation approaches are more compatible with FCS philosophy but that it might be difficult to implement such approaches given the limited resources and diverse characteristics of rehabilitation settings. In light of these circumstances, the study notes ways for improving program evaluation activities.

Uncertainty is inherent in complex socio-technical systems such as in aviation, military, and surface transportation domains. An improved understanding of how operators comprehend this uncertainty is critical to the development of operations and technology. Towards the development of a model of time of arrival (TOA) uncertainty, Experiment 1 was conducted to determine how air traffic controllers estimate TOA uncertainty and to identify sources of TOA uncertainty. The resulting model proposed that operators first develop a library of speed and TOA profiles through experience. As they encounter subsequent aircraft, they compare each vehicle’s speed profile to their personal library and apply the associated estimate of TOA uncertainty. To test this model, a normative model was adopted to compare inferences made by human observers to the corresponding inferences that would be made by an optimal observer who had knowledge of the underlying distribution. An experimental platform was developed and implemented in which subjects observed vehicles with variable speeds and then estimated the mean and interval that captured 95% of the speeds and TOAs. Experiments 2 and 3 were then conducted and revealed that subjects overestimated TOA intervals for fast stimuli and underestimated TOA intervals for slow stimuli, particularly when speed variability was high. Subjects underestimated the amount of positive skew of the TOA distribution, particularly in slow/high variability conditions. Experiment 3 also demonstrated that subjects overestimated TOA uncertainty for short distances and underestimated TOA uncertainty for long distances. It was shown that subjects applied a representative heuristic by selecting the trained speed profile that was most similar to the observed vehicle’s profile, and applying the TOA uncertainty estimate of that trained profile. Multiple regression analyses revealed that the task of TOA uncertainty estimation contributed the most to TOA uncertainty estimation error as compared to the tasks of building accurate speed models and identifying the appropriate speed model to apply to a stimulus. Two systematic biases that account for the observed TOA uncertainty estimation errors were revealed: Assumption of symmetry and aversion to extremes. Operational implications in terms of safety and efficiency for the aviation domain are discussed.

Background: Considerable attention has been paid to evaluating the roles and relationships of professionals participating in team-based or collaborative practice; however, less attention has been paid to exploring the patients’ views and impact of such practice despite claims of it being patient-centred. Objectives: To examine the relationship between patient and provider characteristics and patients’ ratings of measures of quality of care and integration, and to explore the patient views of care delivered in a patient-centred collaborative study involving chiropractors and physicians. Design: Cross-sectional survey. Method: A mixed methods sequential approach with a quantitative priority was used in data analysis. Quantitative data were collected from 2597 patients participating in a collaborative study involving chiropractors and physicians and 530 patients attending chiropractors not involved in collaborative care. All participants presented with musculoskeletal pain. The Primary Care Assessment Survey (PCAS) was modified and scores from six of its scales were used to assess attributes of quality patient-centred care between the two study groups. Qualitative transcript-based data from six purposefully selected focus groups was analyzed using an interpretivist approach. Results: The revised PCAS demonstrated acceptable psychometric properties. Patients in both study groups received quality, patient-centred care. Patients’ reporting being completely satisfied and feeling improved by their care was positively associated with rating chiropractors as high performers on all scales. Survey findings were confirmed in focus groups of study patients. Patients appreciated positive interpersonal interactions, sharing in the treatment decision-making process, having a choice in provider and treatment, and the provision of holistic care. Patients perceived that collaboration between chiropractors and physicians varied, favouring those who were co-located. Patients with chronic or co-morbid conditions desired greater involvement in their care. Patients felt sharing of clinical information was more important than co-location as facilitating coordination and integration of collaborative care. Conclusion: The study suggests that patients suffering from musculoskeletal pain benefit from interprofessional collaborative care that includes improved access to and choice of providers and treatment options, as well as enhanced interprofessional communication and coordination of care.

Increasingly, technology impacts how we communicate and behave following the death of a loved one. However, little is known about technology use by the bereaved. This thesis contributes to understanding this phenomenon through three linked studies. These studies establish an appreciation of how technology engages with human mortality, and proposes "thanatosensitive design" (TSD) as an approach for developing such systems. An exploratory study fi rst examines technology use by the bereaved through a survey with follow-up interviews. Findings show that systems for inheriting data and devices are lacking, despite widespread use of technology for remembrance and communication. Using digital assets in social support is selected as a domain for further inquiry. The second study consists of focus groups with bereaved parents at two community organizations complemented by the perspectives of professional bereavement workers. Based on this fieldwork, 6 considerations concerning interpersonal communication, new ways of being, and materiality are presented. These considerations suggest that systems should permit connections with peers, support storytelling activities, and avoid tendencies to "fix" grief, among others. In the final study, I present Besupp - a website that permits bereaved users to engage in online peer-support groups. Besupp applied these design considerations and was deployed in a 10-week study. Nineteen bereaved individuals met in 3 support groups for bereaved parents, partners/spouses, and young adults. Based on system logs/data, questionnaires, and interviews, the study identified barriers to using digital mementos, preferences for online support systems, and issues concerning timing of use. In the discussion, I reflect on the three studies through four thematic lenses: temporality, materiality, identity, and research ethics/methods. I remark on how systems should consider the varying emotional needs of the bereaved over time. In the conclusion, I summarize and reflect on the status of TSD and identify areas for future work concerning social support for the bereaved, and computing's role at the end of life more broadly.

Increasingly, technology impacts how we communicate and behave following the death of a loved one. However, little is known about technology use by the bereaved. This thesis contributes to understanding this phenomenon through three linked studies. These studies establish an appreciation of how technology engages with human mortality, and proposes "thanatosensitive design" (TSD) as an approach for developing such systems. An exploratory study fi rst examines technology use by the bereaved through a survey with follow-up interviews. Findings show that systems for inheriting data and devices are lacking, despite widespread use of technology for remembrance and communication. Using digital assets in social support is selected as a domain for further inquiry. The second study consists of focus groups with bereaved parents at two community organizations complemented by the perspectives of professional bereavement workers. Based on this fieldwork, 6 considerations concerning interpersonal communication, new ways of being, and materiality are presented. These considerations suggest that systems should permit connections with peers, support storytelling activities, and avoid tendencies to "fix" grief, among others. In the final study, I present Besupp - a website that permits bereaved users to engage in online peer-support groups. Besupp applied these design considerations and was deployed in a 10-week study. Nineteen bereaved individuals met in 3 support groups for bereaved parents, partners/spouses, and young adults. Based on system logs/data, questionnaires, and interviews, the study identified barriers to using digital mementos, preferences for online support systems, and issues concerning timing of use. In the discussion, I reflect on the three studies through four thematic lenses: temporality, materiality, identity, and research ethics/methods. I remark on how systems should consider the varying emotional needs of the bereaved over time. In the conclusion, I summarize and reflect on the status of TSD and identify areas for future work concerning social support for the bereaved, and computing's role at the end of life more broadly.

Uncertainty is inherent in complex socio-technical systems such as in aviation, military, and surface transportation domains. An improved understanding of how operators comprehend this uncertainty is critical to the development of operations and technology. Towards the development of a model of time of arrival (TOA) uncertainty, Experiment 1 was conducted to determine how air traffic controllers estimate TOA uncertainty and to identify sources of TOA uncertainty. The resulting model proposed that operators first develop a library of speed and TOA profiles through experience. As they encounter subsequent aircraft, they compare each vehicle’s speed profile to their personal library and apply the associated estimate of TOA uncertainty. To test this model, a normative model was adopted to compare inferences made by human observers to the corresponding inferences that would be made by an optimal observer who had knowledge of the underlying distribution. An experimental platform was developed and implemented in which subjects observed vehicles with variable speeds and then estimated the mean and interval that captured 95% of the speeds and TOAs. Experiments 2 and 3 were then conducted and revealed that subjects overestimated TOA intervals for fast stimuli and underestimated TOA intervals for slow stimuli, particularly when speed variability was high. Subjects underestimated the amount of positive skew of the TOA distribution, particularly in slow/high variability conditions. Experiment 3 also demonstrated that subjects overestimated TOA uncertainty for short distances and underestimated TOA uncertainty for long distances. It was shown that subjects applied a representative heuristic by selecting the trained speed profile that was most similar to the observed vehicle’s profile, and applying the TOA uncertainty estimate of that trained profile. Multiple regression analyses revealed that the task of TOA uncertainty estimation contributed the most to TOA uncertainty estimation error as compared to the tasks of building accurate speed models and identifying the appropriate speed model to apply to a stimulus. Two systematic biases that account for the observed TOA uncertainty estimation errors were revealed: Assumption of symmetry and aversion to extremes. Operational implications in terms of safety and efficiency for the aviation domain are discussed.