INTRODUCTION : Les soins de première ligne au Québec vivent depuis quelques années une réorganisation importante. Les GMF, les cliniques réseaux, les CSSS, les réseaux locaux de service, ne sont que quelques exemples des nouveaux modes d’organisation qui voient le jour actuellement. La collaboration interprofessionnelle se trouve au cœur de ces changements. MÉTHODOLOGIE : Il s’agit d’une étude de cas unique, effectuée dans un GMF de deuxième vague. Les données ont été recueillies par des entrevues semi-dirigées auprès du médecin responsable du GMF, des médecins et des infirmières du GMF, et du cadre responsable des infirmières au CSSS. Les entrevues se sont déroulées jusqu’à saturation empirique. Des documents concernant les outils cliniques et les outils de communication ont aussi été consultés. RÉSULTATS : À travers un processus itératif touchant les éléments interactionnels et organisationnels, par l’évolution vers une culture différente, des ajustements mutuels ont pu être réalisés et les pratiques cliniques se sont réellement modifiées au sein du GMF étudié. Les participants ont souligné une amélioration de leurs résultats cliniques. Ils constatent que les patients ont une meilleure accessibilité, mais l’effet sur la charge de travail et sur la capacité de suivre plus de patients est évaluée de façon variable. CONCLUSION : Le modèle conceptuel proposé permet d’observer empiriquement les dimensions qui font ressortir la valeur ajoutée du développement de la collaboration interprofessionnelle au sein des GMF, ainsi que son impact sur les pratiques professionnelles. / INTRODUCTION: Primary care in the Province of Quebec has undergone a substantial reorganisation over the last several years, on several fronts. Family Medicine Groups (FMG's), designated medical clinics, regional health boards, and local health networks, are only a few examples of new health care delivery components which have been created during this reorganisation. METHODS: This is a case study based on a single Family Medicine Group created during a second wave of innovation. Data was collected via semi-directed interviews with the head physician of the FMG, the group of physicians and nurses within the FMG, the nursing director of the FMG, and the director of nursing at the regional health board. Interviews were conducted until all available contacts were exhausted. The author also accessed the clinical guidelines and the documents used for communication within the FMG. RESULTS: Practice activities in the FMG did evolve over time as a result of mutual clinical and administrative interactions between nurses and physicians. Participants noted a visible improvement in health outcomes as well as increased accessibility to health care by patients. The impact on physician workload, and overall capacity in terms of number of patients followed, after creation of the FMG, were inconsistent. CONCLUSION: This proposed analytic model allows empiric measurement of the added value of FMG's for the development of inter-professional cooperation, and its impact on professional practices.

Cette étude s'inscrit dans le champ de la didactique du français et porte sur l'analyse d'interactions langagières au cours de séances de révision de textes narratifs au CM2. Cette recherche se propose de réfléchir aux modalités d'une interaction qui favoriserait l'engagement des élèves dans la tâche. Elle se centre principalement sur l'activité du maître lors de séquences de "révisions interactives". La méthodologie s'appuie sur l'analyse de corpus oraux. Une étude empirique impliquant trois enseignantes ayant une ancienneté différente dans le métier nous permet de comparer les modes de communication pédagogique et d'examiner leur pertinence pour le développement de compétences évaluatives chez les élèves. Les résultats nous permettent de dégager quelques paramètres décisifs et d'esquisser un profil interactionnel des enseignantes lors de la révision de textes. L'étayage de l'enseignant est abordé sous différents angles : la posture assumée tout au long des échanges, les thèmes discutés, le degré d'adhésion par rapport aux propositions des élèves, la prise en compte des interventions par les reformulations mais aussi le rythme des échanges imposé. Nous prolongeons notre étude par l'analyse des stratégies inductrices de "bonnes réponses", c'est-à-dire tous les comportements verbaux du maître qui permettent d'influencer la réponse de l'élève et qui s'apparentent à une posture de contre-étayage. Cette étude permet de mettre en évidence la typicalité de l'expérience interactionnelle de l'enseignant dans le domaine de la révision de texte et d'ouvrir la voie à une didactique de l'écrit à l'école primaire fondée sur les interactions à l'oral. / This study belongs to the didactics of French and focuses on oral interactions analysis during revision sessions of narrative texts at the last year of primary school. The purpose of this study is to investigate how the oral interactions can improve pupils' commitment to the task. This research focuses more precisely on the activity of the teacher during interactive revision sessions. The methodological framework is based on oral resources. Our study implies three teachers at different levels of career and allows us to compare different modes of pedagogical communication in order to examine their pertinence for the development of the pupils' evaluative abilities. Results allow to bring out some decisive parameters and to suggest an interactional profile of teachers during texts revision. The teacher's scaffolding is approached from different points of view : the position held by the teacher throughout the exchanges, the discussed topics, the degree of joining to pupils' proposals, the consideration of pupils' interventions by reformulations and the interactional rhythm required by the teacher. The research will be extended by the analysis of the strategies which lead to the "right response" of the "expected response", in other words, all verbal communications which influence the response of the pupil and which correspond to wrong or inappropriate scaffolding. This study allows us to highlight the specificities of the interactional experience of the teacher in the field of the text revision and to pave the way to didactics of writing in primary school based on oral interactions.

A presente dissertação analisa como se configura a Competência Interacional (He; Young, 1998) de aprendizes adultos brasileiros durante um curso de italiano durante conversa espontânea. Os dados foram coletados durante um semestre, com foco em conversas livres, isto é, em interações imprevisíveis, sem duração definida e cujos temas nasciam a partir de algum acontecimento em sala de aula, sem planejamento prévio. A análise dos dados teve dois focos principais: a análise do sistema de turnos e dos reparos, procurando verificar de que forma a construção desses recursos determina aspectos da interação e do desempenho de papeis de professor e de aluno em sala de aula. Os dados foram analisados com base na disciplina, fortemente empírica, da Análise da Conversa; de modo mais específico, foram utilizadas as categorias encontradas por Sacks, Schegloff e Jefferson (1974) e por Schegloff, Jefferson e Sacks (1977), para análise do sistema de turnos e dos reparos, respectivamente. A análise dos dados indicou que os aprendizes utilizaram o sistema de turnos de forma parecida com o da conversa fora da sala de aula, já que na maioria dos casos se auto-selecionam como próximos falantes, o que nos levou a identificar uma postura autônoma e a percepção, por parte dos aprendizes, de um ambiente mais próximo ao genuíno de comunicação. Por outro lado, nota-se que os turnos dos aprendizes têm, quase sempre, menor duração do que os do professor, possivelmente, por causa de uma menor competência linguístico-comunicativa. Os dados evidenciam ainda, que os alunos utilizam pouco, muito menos que o professor, a seleção de um outro falante. Quanto à análise do sistema de reparos, verificaram-se duas tendências principais. Em primeiro lugar, os alunos, frequentemente, pedem para ser corrigidos, mas, ao mesmo tempo, há muitas ocorrências em que eles não esperam que alguém responda a esses pedidos e continuam a conversa. Em segundo lugar, o professor, na maioria dos casos, não corrige os desvios linguísticos dos alunos e, quando o faz, não parece existir uma lógica que guie essas ações. Se olharmos com mais atenção para os dados analisados, configura-se uma situação complexa, em que os alunos, por exemplo, corrigem outros alunos, ou em que eles interrompem o professor. Em conclusão, a detalhada análise das interações evidencia que, em vários momentos, os papeis de professor e alunos estão bem marcados, mas estão longe de ser os papeis tradicionais em que o professor é quem avaliava e distribui os turnos, e os alunos estão em posição mais passiva. Isso nos permite afirmar que a conversa é uma atividade de sala de aula em que os participantes têm liberdade de ação e na qual os recursos interacionais são aspectos essenciais não apenas na configuração da interação, como também na construção da competência interacional dos aprendizes e na compreensão do processo de ensino-aprendizagem de línguas em sala de aula. / This study analyzes the nature of Interactional Competence (He; Young, 1998) of adult Brazilian learners, attending a Italian language course, during spontaneous conversation. The data, collected during a semester, focused on unplanned conversations, which had no defined duration and whose topics emerged from anything occurring in the classroom. The analysis of the data consists of two main foci: speaker selection and repairs. They were analyzed in order to verify how their construction could determine aspects of interaction and how it influences the roles that the professor and the learners play in the classroom. The data were analyzed based on the, strictly empirical, discipline of Conversation Analysis; in particular, were used the categories found by Sacks, Schegloff e Jefferson (1974), and Schegloff, Jefferson e Sacks (1977), for speaker selection and repair, respectively. The analysis of the data revealed that the learners use speaker selection in a way that similar to that outside classroom, that is to say, they mainly selected themselves in order to take the floor. This learners skill is viewed as evidence of autonomous stance; furthermore, it indicates that they perceive the classroom as characterized by genuine communication. On the other hand, it can be noticed that learners turns are mainly shorter than professors, probably due to their lesser linguistic-communicative competence. In addition, the data show that the learners select the other participants fewer times than the teacher. Examination of the system of repairs revealed two main trends. Firstly, in spite of the fact that the learners frequently ask for a linguistic repair, they frequently do not wait for somebody to realize that repair and keep on speaking. Secondly, the teacher, in most of the cases, does not repair the learners linguistic problems and when it occurs, the fact does not seem to be supported by any underlying logic. At a closer look, the data show a complex situation in which the learners use the other-repair resource or interrupt the teacher. Finally, the detailed conversation analysis shows that even though many times the roles teacher and learners play are well defined, they are not even close to the traditional ones in which the teacher used to evaluate and distribute the turns, and the learners had a passive attitude. The analysis serve as evidence to affirm that conversation is a classroom activity in which students can perform freely and in which the interactional resources are aspects essential, not only to better understand and categorize the interaction, but also to the construction of the learners interactional competence and for the understanding of the foreign language classroom teaching process.

本研究的目的為探究中文母子對話中，母親的互動風格與話題延續的關係。 研究問題為: (a)本研究中兩位母親的互動風格為何? (b)兩位孩童的話題延續表現有何不同? (c)母親的互動風格與話題延續有怎樣的互動關係? 研究語料為兩組親子互動的自然語料，各取三個小時，孩童的年紀約為三歲。研究結果顯示兩位母親的互動風格有所不同，分別屬於命令型和引誘型。 而小孩的在話題延續上表現則是相近，大多用回應母親問題的方式來延續話題並且能在不同的情境中提供新資訊。對兩組親子互動的探究顯示命令型的母親比較不會延續對話而經常改變話題，造成較短的話題片斷。引誘型的母親則較注重對話的延續且較少改變話題，造成較長的話題片斷。 / The purpose of the study is to investigate the interaction of the maternal interactional styles and topic maintenance in Mandarin mother-child conversational interaction. There are three research questions: (a) What are the mothers’ interactional styles in the current case? (b) What are the differences among children’s competences of topic maintenance? (c) How do the maternal interaction styles interact with topic maintenance in the conversational interactions? Naturally occurring conversations of two dyads' conversational interactions were adopted as the data and analyzed. Results suggested that while the two mothers differed in terms of their interactional styles, the two children showed nearly equal sophistication in terms of their topic-maintaining competences. Examinations of the two dyads' interactions also revealed that the directive mother was less interested in maintaining the conversations, changed topics more frequently, and maintained discourse topics for less turns. The conversation-eliciting mother paid more attention on maintaining of the conversations, change topics less frequently, and maintained discourse topics for much more turns.

This dissertation based on a case study explores the acquisition and the guidance of Swedish Sign Language and spoken Swedish over a span of seven years. Interactions between a pair of fraternal twins, one deaf and one hearing, and their Deaf[1] family were video-observed within the home setting. The thesis consists of a frame which provides an overview of the relationship between four studies. These describe and analyze mainly storytime sessions over time. The first article addresses attentional expressions between the participants; the second article studies the mediation of the deaf twin’s first language acquisition; the third article analyses the hearing twins acquisition of parallel bimodal bilingualism; the fourth article concerns second language acquisition, sequential bimodal bilingualism following a cochlear implant (CI). In the frame, theoretical underpinnings such as mediation and language acquisition were compiled, within a sociocultural frame. This synthesis of results provides important information; in the 12- and 13-month sessions simultaneous-tactile-looking was noted in interchanges between the twins and their mother; mediation of bilingualism was scaffolded by the caregivers with the hearing twin by inserting single vocal words or signs into the language base used at that time, a finding that differs from other reported studies; a third finding is the simultaneousness in which the deaf child’s Swedish Sign Language skill worked as a cultural tool, to build a second and spoken language. The findings over time revealed actions that included all the family members. Irrespective of the number of modes and varied types of communication with more than one child, mediation included following-in the child’s initiation, intersubjective meaningfulness and encouragement. In accordance with previous research, these factors seem to promote the acquisition of languages. In conclusion, these findings should also prove useful in the more general educational field. [1] Deaf with a capital ‘D’ is commonly used for cultural affiliation whereas lower case ‘d’, as in deaf, refers to audiological status (Monaghan, Schmaling, Nakamura &amp; Turner, 2003). / <p>Disputationen tolkas till svensk teckenspråk, hörselslinga finns.</p><p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: Submitted. Paper 3: Accepted. Paper 4: Submitted.</p>

Antecedents:Malgrat la importància oferta en la literatura, el concepte de congruència de valors és encara poc conegut. La literatura és ambigua i el tema és encara poc conegut. La congruència de valors es tracta a les àrees de gestió i psicologia relacionant-la amb diverses actituds cap al treball o cap als resultats empresarials. No obstant això, el procés que afecta a aquests resultats segueix sent molt polèmic. És a dir, no sabem exactament per què la congruència de valors produeix efectes en els resultats empresarials. Pregunta de recerca:Aquesta tesi intenta explicar l'efecte de la congruència de valors. És a dir, quin és la correlació o relació semicausal entre la congruència o incongruència de valors i determinades actituds laborals tals com la satisfacció laboral, compromís organitzacional, d'una banda, i de salut, tals com l'estrès laboral o la salut física, per l'altre. Enfocament teòric:Reconeixent el fet que les explicacions actuals sobre els efectes de la congruència dels valors són especulatives, fragmentades i de caràcter social, en aquesta tesi s'utilitza la teoria basada en l’autoconcepte com a teoria subjacent per comprovar empíricament el mecanisme de mediació de les variables de autoconcepte en la relació entre la congruència de valors i els resultats empresarials. S'afirma que aquest mecanisme individual és similar a l'efecte de mediació dels mecanismes socials tals com la confiança. Disseny:En aquesta tesi s'utilitza l'enfocament de tres papers relacionats. En el primer d'ells es fa una revisió de la literatura existent sobre congruència de valors i contextualitza la investigació des d'un marc global. El segon paper utilitza la teoria de l’autoconcepte per explicar els efectes de la congruència de valors en els resultats laborals relacionats amb l'actitud, tals com a salut mental (burnout) i una sèrie de resultats relacionats organitzativament com la propensió d'accidents i de les intencions de rotar. Les dades van ser recollides entre les infermeres que treballen en un gran hospital universitari a Catalunya. El tercer paper utilitza algunes de les variables derivades de la teoria de l'autoconcepte per provar empíricament la importància relativa i la configuració de mecanismes individuals i mecanismes socials com a mediadors entre la congruència de valors i una sèrie de resultats específics individuals, com la satisfacció en el treball, el compromís amb l'organització i l'esgotament. Aquest tercer estudi es va dur a terme en un hospital del nord-est de Xina. Resultats: El primer paper estableix les bases per a futurs estudis especificant les necessitats i les limitacions de treballs previs. En els dos estudis empírics, s'ha trobat que la teoria de l’autoconcepte es pot aplicar en el context de la comprensió del procés d'efectes de la congruència dels valors. En el segon paper, s'ha observat que, per a diferents tipus de valors, l'esgotament intervé de forma diferent entre els efectes de la incongruència de valors en els resultats. Quant al tercer paper, s'ha trobat que, per a diferents resultats, les variables de l’autoconcepte intervenen entre els efectes de la congruència dels valors de forma diferent, però s'ha constatat que la confiança en l'organització és un mediador social consistent. Això últim reforça el recent interès a utilitzar en major mesurada la construcció de la confiança en les investigacions sobre organitzacions. Això va resultar ser vàlid en el context xinès. Conclusions: Aquesta tesi sosté que l'estudi sobre la congruència de valors és molt important tant per als individus com per a les organitzacions. A pesar que els seus efectes directes o de mediació, això també afecta a resultats relacionats amb la salut de l'individu (és a dir, esgotament o la salut física), així com a resultats relacionats amb la salut de l'organització (el compromís, la propensió d'accidents,, la previsió de volum de negoci, i similars). / Antecedentes: A pesar de la importancia ofrecida en la literatura, el concepto de congruencia de valores es aún poco conocido. La literatura es ambigua y el tema es aún poco conocido. La congruencia de valores se trata en las áreas de gestión y psicología relacionándola con diversas actitudes hacia el trabajo o hacia los resultados empresariales. No obstante, el proceso que afecta a estos resultados sigue siendo muy polémico. Es decir, no sabemos exactamente por qué la congruencia de valores produce efectos en los resultados empresariales. Pregunta de investigación: Esta tesis intenta explicar el efecto de la congruencia de valores. Es decir, cuál es la correlación o relación semicausal entre la congruencia o incongruencia de valores y determinadas actitudes laborales tales como la satisfacción laboral, compromiso organizacional, por un lado, y de salud, tales como el estrés laboral o la salud física, por el otro. Enfoque teórico: Reconociendo el hecho de que las explicaciones actuales sobre los efectos de la congruencia de los valores son especulativas, fragmentadas y de carácter social, en esta tesis se utiliza la teoría basada en el autoconcepto como teoría subyacente para comprobar empíricamente el mecanismo de mediación de las variables de autoconcepto en la relación entre la congruencia de valores y los resultados empresariales. Se afirma que este mecanismo individual es similar a los efectos de mediación de los mecanismos sociales tales como la confianza. Diseño: En esta tesis se utiliza el enfoque de tres papers relacionados. En el primero de ellos se hace una revisión de la literatura existente sobre congruencia de valores y contextualiza la investigación desde un marco global. El segundo paper utiliza la teoría del autoconcepto para explicar los efectos de la congruencia de valores en los resultados laborales relacionados con la actitud, tales como salud mental (burnout) y una serie de resultados relacionados organizativamente como la propensión de accidentes y de las intenciones de rotar. Los datos fueron recogidos entre las enfermeras que trabajan en un gran hospital universitario en Cataluña. El tercer paper utiliza algunas de las variables derivadas de la teoría del auto-concepto para probar empíricamente la importancia relativa y la configuración de mecanismos individuales y mecanismos sociales como mediadores entre la congruencia de valores y una serie de resultados específicos individuales, como la satisfacción en el trabajo, el compromiso con la organización y el agotamiento. Este tercer estudio se llevó a cabo en un hospital del noreste de China. Resultados: El primer paper establece las bases para futuros estudios especificando las necesidades y las limitaciones de trabajos previos. En los dos estudios empíricos, se ha encontrado que la teoría del autoconcepto se puede aplicar en el contexto de la comprensión del proceso de efectos de la congruencia de los valores. En el segundo paper, se ha observado que, para diferentes tipos de valores, el agotamiento media de forma distinta entre los efectos de la incongruencia de valores en los resultados. En cuanto al tercer paper, se ha hallado que, para diferentes resultados, las variables del autoconcepto median entre los efectos de la congruencia de los valores de forma distinta, pero se ha constatado que la confianza en la organización es un mediador social consistente. Esto último refuerza el reciente interés en utilizar en mayor medida la construcción de la confianza en las investigaciones sobre organizaciones. Ello resultó ser válido en el contexto chino. Conclusión: Esta tesis sostiene que el estudio sobre la congruencia de valores es muy importante tanto para los individuos como para las organizaciones. A pesar de que sus efectos directos o de mediación, ello también afecta a resultados relacionados con la salud del individuo (es decir, agotamiento o la salud física), así como a resultados relacionados con la salud de la organización (el compromiso, la propensión de accidentes,, la previsión de volumen de negocio, y similares). / Background: Albeit the critical importance accorded in the literature to the concept of value congruence it is still poorly understood. The literature dealing with it is ambiguous and inconsistent. Value incongruence in the management and psychological disciplines, has been related to various job attitudes and other work related outcomes, but the process of which it affects the latter remains controversial. That is, we do not know exactly why value congruence (or value incongruence) is supposed to have these effects on the outcomes studied. Research question:This thesis is an attempt to understand the process of value congruence’s effect. That is to say: what are the correlational or semi causal relationships between value congruence and value incongruence on selected attitudinal outcomes such as job satisfaction, organizational commitment on one hand, and health outcomes, such as job burnout or physical health , on the other hand?. Theoretical approach:The underlying theory of “self-concept” has been used in its application to the construct of value congruence. More specifically, the mediating mechanism of self-concept variables on the relationship between value congruence and outcomes was empirically tested. Furthermore, the relative importance and the particular configuration of individualmechanism vssocial mechanism functioning simultaneously as mediatorshave been tested. . Design:This thesis uses three connected papers. The first paper is a comprehensive review of the literature on value congruence. Itintegrates value congruence research into a coherent framework.A clear agenda for research results from the conclusions reached in this first paper. The second paper inspired by the “self-concept theory”,tests the relationships between value congruence on specific outcomes such as mental health (burnout), physical health, and a host of organizationally related outcomes such as accident propensity and turnover intentions. Data was collected amongst nurses working in a large university hospital in Catalonia. The third paper also uses some variables derived from the self-concept theory to empirically test the relative importance and the particular configuration of individualmechanism and social mechanism functioning simultaneously as mediatorsbetween value congruence and a host of specific individual outcomes such as job satisfaction, organizational commitment and Burnout. This third study was carried out in a county hospital in northeast China. Method: The first paper is qualitative in nature. It synthesizes and classifies related definitions, models and measurement based on the literature. The second and the third papers are empirical studies based on cross-sectional pre validated surveys conducted in Spain and China in the health care settings. Univariate, bivariate and multivariate analyses were employed throughout different phases of the studies. Multiple regressiontechnique was employed to test the mediation effect. Results:The first study sets up the agenda for future research in specifying needs and limitations of previous research. In the two empirical papers, it has been found that self-concept theory can serve for understanding the effects of value congruence. More specifically the second paper shows that for different types of value incongruence, burnout mediatesin a differential manner the effects on the outcomes studied. Third paper, found that, for different outcomes, self-concept variables mediates the effects of value congruence differentially, but trust in the organization, a specific variable that was added in this study, was a consistent social mediator. The latter reinforces recent call to further use the construct of trust in organizational research. This was found to be valid in the Chinese context. Conclusion: The thesis argues that studying value congruence can be very important to both individuals and organizations. Regardless of its direct or mediating effects, it impacts outcomes connected with individual health (i.e. Burnout or physical health) and also outcomes connected with organizational health (commitment, accident propensity, turnover intention, and alike). The thesis also shows how important it is to identify various linkages and configurations between value congruence and outcomes while borrowing from the self-concept theory.

Gruppentherapie ist in der stationären Allgemeinpsychiatrie weit verbreitet, ihre Wirksamkeit im Rahmen der allgemeinpsychiatrischen Pflicht- und Regelversorgung ist hingegen wenig untersucht. Die vorliegende Arbeit geht in einer naturalistischen Studie der Frage nach, ob psychoanalytisch-interaktionelle Gruppentherapie, eine psychoanalytische Behandlungsmethode, die speziell für die Arbeit mit schwerer beeinträchtigten Patienten entwickelt wurde, in einem solchen Setting wirksam ist. Hierzu wurden zwischen 2007 und 2009 42 Patienten bezüglich ihrer Symptomverbesserung untersucht, die in der Klinik für Psychiatrie und Psychotherapie der Katholischen Krankenhaus GmbH Hagen stationär mit psychoanalytisch-interaktioneller Gruppentherapie, ergänzt durch Elemente der Dialektisch-Behavioralen Therapie, behandelt wurden. Als Kontrollgruppe dienten 40 Patienten, die auf einer psychotherapeutischen Station des Asklepios Fachklinikums Tiefenbrunn mit Dialektisch-Behavioraler Therapie allein behandelt wurden. Die Ergebnisse zeigten signifikante Verbesserungen in beiden Patientengruppen bezüglich Symptombelastung, Lebenszufriedenheit und Beeinträchtigungsschwere von mittlerer bis hoher Effektstärke. Nur in der Hagener Gruppe zeigte sich auch eine signifikante Verbesserung interpersoneller Probleme. Die Hagener Patienten wiesen im Zwischengruppenvergleich signifikant bessere Ergebnisse in Bezug auf Beeinträchtigungsschwere und interpersonelle Probleme auf. Die Ergebnisse können ein Hinweis darauf sein, dass psychoanalytisch-interaktionelle Gruppentherapie in einer allgemeinpsychiatrischen Klinik wirksam ist und eine spezifische Beeinflussung interpersoneller Schwierigkeiten bewirkt. Methodische Einschränkungen werden diskutiert.

INTRODUCTION : Les soins de première ligne au Québec vivent depuis quelques années une réorganisation importante. Les GMF, les cliniques réseaux, les CSSS, les réseaux locaux de service, ne sont que quelques exemples des nouveaux modes d’organisation qui voient le jour actuellement. La collaboration interprofessionnelle se trouve au cœur de ces changements. MÉTHODOLOGIE : Il s’agit d’une étude de cas unique, effectuée dans un GMF de deuxième vague. Les données ont été recueillies par des entrevues semi-dirigées auprès du médecin responsable du GMF, des médecins et des infirmières du GMF, et du cadre responsable des infirmières au CSSS. Les entrevues se sont déroulées jusqu’à saturation empirique. Des documents concernant les outils cliniques et les outils de communication ont aussi été consultés. RÉSULTATS : À travers un processus itératif touchant les éléments interactionnels et organisationnels, par l’évolution vers une culture différente, des ajustements mutuels ont pu être réalisés et les pratiques cliniques se sont réellement modifiées au sein du GMF étudié. Les participants ont souligné une amélioration de leurs résultats cliniques. Ils constatent que les patients ont une meilleure accessibilité, mais l’effet sur la charge de travail et sur la capacité de suivre plus de patients est évaluée de façon variable. CONCLUSION : Le modèle conceptuel proposé permet d’observer empiriquement les dimensions qui font ressortir la valeur ajoutée du développement de la collaboration interprofessionnelle au sein des GMF, ainsi que son impact sur les pratiques professionnelles. / INTRODUCTION: Primary care in the Province of Quebec has undergone a substantial reorganisation over the last several years, on several fronts. Family Medicine Groups (FMG's), designated medical clinics, regional health boards, and local health networks, are only a few examples of new health care delivery components which have been created during this reorganisation. METHODS: This is a case study based on a single Family Medicine Group created during a second wave of innovation. Data was collected via semi-directed interviews with the head physician of the FMG, the group of physicians and nurses within the FMG, the nursing director of the FMG, and the director of nursing at the regional health board. Interviews were conducted until all available contacts were exhausted. The author also accessed the clinical guidelines and the documents used for communication within the FMG. RESULTS: Practice activities in the FMG did evolve over time as a result of mutual clinical and administrative interactions between nurses and physicians. Participants noted a visible improvement in health outcomes as well as increased accessibility to health care by patients. The impact on physician workload, and overall capacity in terms of number of patients followed, after creation of the FMG, were inconsistent. CONCLUSION: This proposed analytic model allows empiric measurement of the added value of FMG's for the development of inter-professional cooperation, and its impact on professional practices.

Une multitude de recherches évaluatives ont démontré que les victimes de crime, qu’elles soient victimes d’un crime contre les biens ou contre la personne, apprécient l’approche réparatrice. Cependant, nous sommes toujours à la recherche des facteurs théoriques qui expliqueraient la satisfaction des victimes en ce qui concerne leur expérience avec les interventions réparatrices. La recherche décrite dans cette thèse concerne l’exploration des facteurs contribuant à la satisfaction des victimes de crime avec l’approche réparatrice ainsi que ses liens avec la théorie de justice procédurale. Selon la théorie de justice procédurale, la perception de justice n’est pas uniquement associée à l’appréciation du résultat d’une intervention, mais également à l’appréciation de la procédure, et que la procédure et le résultat peuvent être évalués de façon indépendante. Les procédures qui privilégient la confiance, la neutralité et le respect, ainsi que la participation et la voix des parties sont plus appréciées. Notre objectif de recherche était d’explorer l’analogie entre l’appréciation de la justice réparatrice et le concept de justice procédurale. En outre, nous avons voulu déterminer si la justice réparatrice surpasse, en termes de satisfaction, ceux prévus par la théorie de justice procédurale. Nous avons également examiné la différence dans l’appréciation de l’approche réparatrice selon le moment de l’application, soit avant ou après adjudication pénale. Ainsi, nous avons exploré le rôle d’une décision judiciaire dans l’évaluation de l’approche réparatrice. Pour répondre à nos objectifs de recherche, nous avons consulté des victimes de crime violent au sujet de leur expérience avec l’approche réparatrice. Nous avons mené des entrevues semi-directives avec des victimes de crime violent qui ont participé à une médiation auteur-victime, à une concertation réparatrice en groupe ou aux rencontres détenus-victimes au Canada (N=13) et en Belgique (N=21). Dans cet échantillon, 14 répondants ont participé à une intervention réparatrice avant adjudication judiciaire et 14 après adjudication. Nous avons observé que l’approche réparatrice semble être en analogie avec la théorie de justice procédurale. D’ailleurs, l’approche réparatrice dépasse les prémisses de la justice procédurale en étant flexible, en offrant de l’aide, en se concentrant sur le dialogue et en permettant d’aborder des raisons altruistes. Finalement, le moment de l’application, soit avant ou après adjudication, ne semble pas affecter l’appréciation des interventions réparatrices. Néanmoins, le rôle attribué à l’intervention réparatrice ainsi que l’effet sur l’évaluation du système judiciaire diffèrent selon le moment d’application. Les victimes suggèrent de continuer à développer l’approche réparatrice en tant que complément aux procédures judiciaires, plutôt qu’en tant que mesure alternative. Les témoignages des victimes servent la cause de l’offre réparatrice aux victimes de crime violent. L’offre réparatrice pourrait aussi être élargie aux différentes phases du système judiciaire. Cependant, la préférence pour l’approche réparatrice comme complément aux procédures judiciaires implique la nécessité d’investir également dans la capacité du système judiciaire de répondre aux besoins des victimes, tant sur le plan de la procédure que sur le plan du traitement par les autorités judiciaires. / Multiple evaluative studies have demonstrated that victims of crime, irrespective of the type of crime, are satisfied with their participation in a restorative intervention. However, the theoretical explanation for victim satisfaction with restorative practices has, until recently, remained largely neglected. The research presented in this dissertation concerns the exploration of factors contributing to victim satisfaction with the restorative approach and their relation to the procedural justice theory. The theory of procedural justice predicts that the perception of fairness is not only related to the favourability of the outcome but also to the appreciation of certain procedural factors and that a procedure can be assessed irrespective of its outcome. Procedures in which authorities are perceived as trustworthy, neutral and respectful and in which disputants feel involved are more appreciated and perceived as fair. Our research objective is to verify whether victims’ appreciation of restorative justice complies with the procedural justice model. In other words, does the procedural justice theory explain victim satisfaction with the restorative approach or is there more to restorative justice than procedural justice? We also examined the appreciation of the restorative approach relative to its timing in the criminal justice proceedings, i.e. before and after penal adjudication. As such we could observe whether the absence or availability of a judicial decision colours victims’ evaluation of restorative justice. In search of parallels between the theory of restorative justice and procedural justice, we consulted victims of violent crime about their experiences with the restorative approach. Semi-directive interviews were conducted with victims of violent crime who had participated in victim-offender mediation, family group conference or victim-offender encounters in Canada (N=13) and in Belgium (N=21). Of these, 14 respondents participated in the restorative intervention before adjudication and 14 after judicial adjudication. We found that the restorative approach complies very well with the procedural justice model. However, it also exceeds the procedural justice model in being flexible, providing care, centring on dialogue and permitting prosocial justice motives to be addressed. Finally, the appreciation for restorative interventions is positive both when it is used before and after adjudication. Whether restorative justice precedes or follows adjudication is, however, related to victims’ satisfaction with the criminal justice system. Victims who participated in a restorative intervention after adjudication were generally dissatisfied with the criminal justice proceedings, while victims who participated prior to adjudication were generally satisfied with the criminal justice system. Moreover, victims appreciate the complementary nature of the restorative approach in relation to the judicial proceedings. The findings suggest that restorative justice is appropriate in cases of violent crime and as such that restorative justice should be made more available to victims of violence both prior and after adjudication. Nevertheless, because of its complementary nature, investment in the capacity of the criminal justice system to better respond to victims’ procedural and interactional needs is also required.

The social environment has been recognised as one of the key aspects in determining the quality of life throughout the human lifespan. Human behaviour, thoughts, feelings and attitudes are socially constructed and can only be understood when viewed from the perspective of social interaction. Older individuals, who live in residential facilities experience a diminished quality of life due to factors such as loss of independence, reduced social networks, functional dependence, and contextual changes. Depression, loneliness and social isolation are an integral part of these individuals’ lives. People develop specific styles of relating, also referred to as interpersonal styles. The systems theory is used to explain the circular processes of the interaction between people. In particular the Self-Interactional Group Theory (SIGT) is proposed as theoretical framework to explore the relational qualities of older people in a residential care facility. SIGT views the interaction between people on three levels, namely the intra-personal level, the interpersonal level and the group level, which operate interdependently in the interaction between people. The interpersonal level of analysis consists of the definition of the relationship, relational qualities, motivation to engage with people to address needs and needs satisfaction as well as the circular processes of which the interaction consists of. The interactions between people always take place in an interpersonal context, embedded in broader environments. A qualitative and exploratory research design was selected to explore the relational qualities in interactions between older individuals living in a residential care facility. This study is based on data collected during a primary research study at a residential care facility for older individuals in 2013. The purpose of study was to explore the quality of life of older individuals residing in a residential care facility in Gauteng, South Africa. The data-gathering process in the primary research study involved the Mmogo-Method, a visual projective data-gathering method, the World Café method and person-centred interviews to gain insight into the participants’ life experiences at the residential care facility. For the purpose of this research, only the person-centred interviews were used for the secondary analysis of the data. Twelve purposely-selected individuals (aged 80 to 95; 3 men and 9 women) from the residential care facility participated voluntarily in the person-centered interviews, which were audio recorded. The collected data were transcribed verbatim and subjected to two different methods of analyses. First, data were analysed thematically by adopting an inductive approach. The themes identified in this first phase were next subjected to a deductive content analysis. The themes were categorised according to the relational variables in accordance with the Interactional Pattern Analysis (IPA), thereby contributing to the trustworthiness of the findings. The findings revealed that the interactions between older individuals take place in a broader environment that advocate the active participation of people. Active participation takes place both in and outside the facility and older people reported that this contributed to their quality of life. The relational qualities that could be described as enhancing interpersonal connectivity and satisfying older people’s needs for confirmation were identified as empathy, unconditional acceptance of others, confirmation and interpersonal flexibility. This research, however, highlighted relational qualities that restrained quality of life of older people, namely confusing self-presentation, ineffective expression on needs and withdrawal due to physical immobility. Needs were expressed in a very unspecific, blaming or manipulative manner, and consequently needs were not satisfied, but provoked, instead, feelings of frustration, pain and guilt. This research highlighted the predicament that older people find themselves in. Their decreased physical abilities and limited emotional repertoire to move towards others and the environment also limit their needs satisfaction. The presenting problem of social isolation can be explained by the combination of limited physical mobility and relational qualities that restrain quality of life for older people. This research study thus holds important implications for relationship-focused approaches in residential facilities for older individuals in order to empower and enable them to enhance their quality of life. Specific recommendations include interventions to assist older people to express their needs more effectively and to use opportunities in interaction to confirm them as autonomous functioning older people. / MA (Psychology), North-West University, Potchefstroom Campus, 2014