La présente recherche a pour objet la pratique orthophonique en suppléance à la communication (SC) auprès de personnes qui ont une déficience intellectuelle (DI). Des recherches ont montré que les aides à la communication à sortie vocale (ACSV) pouvaient améliorer la communication des personnes ayant une DI. Cependant, la plupart de ces recherches ont été menées dans des conditions idéales qui ne reflètent pas nécessairement celles que l’on retrouve dans les milieux cliniques typiques. On connaît peu de choses sur les pratiques professionnelles en SC auprès des personnes ayant une DI. Le but de cette recherche est de décrire la pratique orthophonique, de documenter les perspectives des utilisateurs sur les résultats des interventions et de décrire l’implication des parents et leurs habiletés à soutenir leur enfant dans l’utilisation d’une ACSV afin de proposer un modèle d’intervention en SC auprès de cette clientèle qui tienne compte de ces différentes perspectives. Une méthode qualitative a été choisie pour réaliser la recherche. Des entrevues individuelles semi-structurées ont été réalisées avec onze orthophonistes francophones et avec des parents ou familles d’accueil de dix utilisateurs d’ACSV et des entrevues structurées ont été menées avec huit utilisateurs d’ACSV. Un outil d’entrevue a été conçu à l’aide de pictogrammes pour permettre aux utilisateurs d’ACSV de répondre à des questions portant sur leur appréciation et utilisation de leur ACSV, leur satisfaction et priorités de communication. Un cadre conceptuel a été conçu à partir des guides de pratique clinique et un codage semi-ouvert a été utilisé pour réaliser les analyses thématiques des données provenant des orthophonistes. Un codage ouvert a servi à analyser les données provenant des parents. Des analyses descriptives ont servi à examiner les réponses des utilisateurs. Diverses procédures ont assuré la crédibilité des analyses. Entre autres, les analyses des entrevues des orthophonistes ont été validées lors d’un groupe de discussion avec sept participantes orthophonistes. Les résultats montrent que les ACSV sont utilisées surtout dans le milieu scolaire. Elles sont parfois utilisées lors des loisirs et dans la communauté, mais ces contextes sont ceux où les utilisateurs ont exprimé le plus d’insatisfaction et où se situe la majeure partie des priorités qu’ils ont identifiées. Les analyses ont permis d’identifier les facteurs qui rendent compte de ces résultats. Les orthophonistes manquent d’outils pour réaliser des évaluations exhaustives des capacités des clients et elles manquent de procédures pour impliquer les parents et obtenir d’eux une description complète des besoins de communication de leur enfant. Conséquemment, l’ACSV attribuée et le vocabulaire programmé ne répondent pas à l’ensemble des besoins de communication. Certaines orthophonistes manquent de connaissances sur les ACSV ou n’ont pas le matériel pour faire des essais avec les clients. Il en résulte un appariement entre la personne et l’ACSV qui n’est pas toujours parfait. À cause d’un manque de ressources en orthophonie, les parents sont parfois laissés sans soutien pour apporter les changements à la programmation lors des transitions dans la vie de leur enfant et certains ne reçoivent pas d’entraînement visant à soutenir l’utilisation de l’ACSV. Un modèle d’intervention en SC est proposé afin d’améliorer la pratique orthophonique auprès de cette population. / This research targets the practices in Augmentative and Alternative Communication (AAC) of speech-language pathologists (SLPs) who work with individuals who have an intellectual disability (ID). Prior research has shown that speech generating devices (SGDs) can help individuals with ID to improve their communication. However, these studies were conducted under ideal conditions, which do not necessarily reflect those that prevail in typical clinical settings. We have little information about AAC practices with individuals with ID or about the efficacy of SGD attribution and AAC intervention under typical conditions. The goals of this research are therefore to describe AAC practices of SLPs with individuals who have an ID, to document the users’ perspectives on the outcome of AAC interventions and to describe the parents’ implication and their abilities to support their child’s use of an SGD in order to propose an intervention model that takes into account these different perspectives. Qualitative methods were chosen to address these questions. Individual semi-structured interviews were conducted with eleven French-speaking SLPs and with the parents or foster families of ten SGD users, and structured interviews with eight SGD users. These interviews were analyzed in order to gather information about research questions. An evaluation tool, made of graphic symbols, was developed to gather information from SGD users about their use of their SGD, their satisfaction, and communication priorities, and about their appreciation of their SGDs. A conceptual framework was developed based on clinical practice guidelines to analyze SLP’s interviews, and a thematic analysis was conducted with semi-open coding. Open coding was used for the data from parents’ interviews, and descriptive analysis of the SGD users’ responses was performed. Steps were taken to ensure credibility of the findings; in particular a focus group was conducted with seven of the participating SLPs to validate the interview results. The results showed that the SGDs are used most frequently in school settings. They are used only occasionally in leisure activities and in the community, but these are the contexts in which the users were most dissatisfied with their communication and in which they most frequently indicated priorities for communication. Factors that explain these results were identified through thematic analysis. SLPs lack the tools they need to perform a comprehensive evaluation of the users’ capacities. They lack procedures for involving parents in the evaluation and for obtaining a thorough description of their child’s communication needs. This might result in attribution of SGSs and identification of vocabulary that do not meet the user’s needs. Some of the SLPs lack sufficient knowledge and do not have SGDs available for trials with their clients, resulting in a less-than-perfect matches between the users and the SGDs. Lack of professional resources leaves parents without support to make changes needed in times of transition in their child’s life. Parents may be unable to support their child’s use of SGD in a variety of contexts. An attribution and AAC intervention model is proposed in order to improve AAC intervention and SLP’s practices.

The thesis examines accompanied asylum-seeking children’s position in Swedish asylum reception management and in the determination of their claims. The three articles of the thesis focus on children’s own experiences of seeking asylum, on the experiences and practices of the civil servants at the Migration Board, as well as those of the legal representatives that assist asylum-seekers in the application process. The thesis builds on ethnographic fieldwork carried out between 2008 and 2010 in southwest Sweden. Theoretical inspiration has been sought in the new sociology of childhood as well as in practice theory. The first article in the thesis concerns children’s caseworkers who are responsible for safeguarding children’s interests in the Migration Board’s daily work with reception. The study highlights a range of dilemmas caseworkers have to deal with in their role as frontline bureaucrats. The study shows that the children’s caseworkers often perceive their discretion as limited, but also that they themselves contribute to limiting it, for example due to their hesitation in challenging existing norms and collegiality.    The second article examines the ways in which legal representatives, who act on behalf of families in asylum determinations, in their practice perceive and relate to the concept of children’s best interests and children’s right to participate. The study shows that children in families can become invisible in the legal representatives’ daily rounds. This invisibility is due to practical limitations in the representatives’ work as well as a general view that children rarely have their own grounds for asylum, as separate claimants to their parents. The third paper of the thesis explores the ways in which children experience and seek to influence circumstances that signify their time spent as asylum-seekers. The study shows how the children developed a range of tactics to deal with their particular situations, which varied with their housing and schooling, and the family’s financial resources. The conclusion is that the children themselves are the primary representatives of the child perspective in the asylum-seeking process, not least through their struggle to belong and create a life like that of ’ordinary’ children.  In line with previous research in the field, the thesis points to the contradiction between the principle of regulated migration and the child perspective in the asylum-seeking process. Together with practical circumstances, such as lack of resources, this contradiction results in a more limited implementation of the child perspective than rules and regulations actually stipulate. Finally, the thesis points to the active role asylum-seeking children take in their efforts to create an everyday life that is as similar as possible to that of  the ’ordinary’ children (e.g. non asylum-seeker and permanently settled children) around them. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 1: Submitted.</p>

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

I denna studie undersöker vi matematiklärares olika synsätt utifrån deras erfarenheter kring visuella representationer och aspekter av bråk. Lärare intervjuades om en uppsättning problem som deras elever fick lösa, vilka var de metoderna som användes. Vi undersöker därav även om det finns några samband mellan klassresultaten och matematiklärarnas olika synsätt. Tre olika teorier användes som ramverk vid både metodövervägandet och analysen; Fyra utvecklingsstadier vid inlärning med representationer, fem aspekter av bråk och pedagogical content knowledge. Resultaten visar att det finns likheter och skillnader i deltagande lärares synsätt. Några likheter var att alla deltagande lärare finner visuella representationer att vara ett användbart hjälpmedel vid utveckling av elevers förståelse samt att de alla uttrycker en större bekantskap med aspekten del-helhet jämfört med de övriga aspekterna. Några skillnader mellan lärarnas synsätt var att de har olika inställningar till huruvida bråk uppfattas som svårt för eleverna men också i vilken utsträckning visuella representationer ska användas i årskurs 9. Vid analys av klassresultaten finner vi några samband där eleverna har svårare för uppgifter med areamodeller som inte är indelade i lika stora delar, uppgifter med tallinjer och uppgifter där eleverna ska uttrycka sig med ord. Lärarnas kommentarer till detta är att eleverna saknar förståelse för den matematik som ska användas och att eleverna på så sätt använder en felaktig metod. Lärarna kommenterar även att vissa uppgifter i studien kräver en större begreppsförståelse vilket påverkar elevernas resultat på uppgifterna. / In this study we examine mathematics teacher’s verity in their reasoning and their different perspectives about visual representations and sub-constructs of fractions. Teachers were interviewed about task that their students solved, which were the methods used in this study. Therefor we also examine if there are any correlations between the teacher’s different perspectives of visual representations and the classes results on fraction tasks. The study was based on three theoretical frameworks; Four stages through the use of representations, five sub-constructs of fraction and pedagogical content knowledge. The methodological consideration and analysis were based on these theories. The result showed that there were some similarities and differences in the teacher’s reasoning. A similarity was that all participated teachers found visual representations as a helpful tool when teaching fractions for student’s conceptual understanding. Another similarity was that all teachers were more familiar with the part-whole sub-construct than the other subconstructs of fraction. Some differences in the teacher’s reasoning were if they found fraction difficult or not for the students and in which extent visual representation should be used in the ninth grade. When the class results were analyzed some connections were found. Student have difficulties with tasks where area models are not equaled partitioned, with tasks related to number lines and to tasks were the students must change from a visual to a textual representation. According to the teachers comments these difficulties accurse due to that the students lacks a curtain mathematical understanding that is required when solving these tasks. This leads to the use of an inaccurate method. The teacher’s also comments that some tasks in this study requires a higher conceptual understanding which affects the classes’ results.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2015-10-23T11:54:41Z No. of bitstreams: 1 Jacqueline Aguiar da Silva_.pdf: 756114 bytes, checksum: ac7574302d0052b68ea757e09aee174f (MD5) / Made available in DSpace on 2015-10-23T11:54:41Z (GMT). No. of bitstreams: 1 Jacqueline Aguiar da Silva_.pdf: 756114 bytes, checksum: ac7574302d0052b68ea757e09aee174f (MD5) Previous issue date: 2014-12-18 / Nenhuma / A caracterização da maternidade impositiva e simbólica, tendo no filho biologicamente estabelecido o objeto do desejo, faz analisar a inserção do direito de procriação no campo dos direitos humanos reprodutivos, que se torna mola propulsora do desenvolvimento do saber biomédico apto a desconstruir a reprodução como algo natural e transpô-la para a alcova do laboratório, imersa em um contexto bioético e biopolítico, e fincado em embates políticos e jurídicos. O corpo reprodutivo aparece no cerne da discussão domesticado, controlado e politizado, na medida em que a reprodução se torna a mola propulsora do desenvolvimento biomédico, impulsionado pelos critérios de liberdade, autonomia e igualdade e, pelas incursões da economia de mercado em contraponto com os princípios bioéticos a serem respeitados pelo saber médico, enaltecendo teias de biopoder nas relações que se estabelecem entre os sujeitos envolvidos. Nesta perspectiva, em função dos embates a serem verificados entre individual e coletivo, público e privado, ganha relevo o papel do Estado, do qual se exigem a definição de posturas ativas prestacionais, sob a forma de políticas públicas, aptas a tornar exequível o direito à concretização do projeto parental por intermédio do uso de técnicas de reprodução assistida. Não mais a mera figura de um Estado assistencialista, mas um Estado estrategista e inteligente, que insere a biopolítica na agenda de perspectivas de governamentalidade. / The characterization of imposing and symbolic motherhood, considering the biologically established child as the object of desire, conducts to analyze the insertion of the right of procreation in the field of human reproductive rights, which becomes a springboard for development of knowledge able to deconstruct biomedical playback as something natural and transpose it to the alcove of the lab, immersed in a bioethical and biopolitical context, and stuck in political and legal struggles. The reproductive body appears at the core of the discussion tamed, controlled and politicized to the extent that reproduction becomes the mainspring of the biomedical development, driven by the criteria of freedom, autonomy and equality and, by the incursions of the market economy in contrast with the bioethical principles to be respected by the medical knowledge, extolling webs biopower relations established between the individuals involved. In this perspective, in terms of the collisions to be checked between individual and collective, public and private, becomes important the role of the State, which requires the definition of prestacionais active stance in the form of public politics, such as to make enforceable the right to implementate the parental project through the use of assisted reproduction techniques. No longer a mere figure of a welfare state but a clever and strategist State, which placed biopolitics in the prospects of governmentality agenda.

The study undertook to explore the notion of stuckness within interpersonal and intrapersonal relationship dynamics. Stuckness has different presentations and can pertain to an individual’s’ inability to move beyond a particular challenge, or find resolution to one or more persistent problems. Alternatively, the stymied dynamic could manifest as a person becoming consistently highly activated or triggered. This has negative ramifications, within both interpersonal and intrapersonal relationships. Therapeutically, psychological stuckness is frequently encountered, and a lack of resolution of past trauma, is speculated as being a contributory factor. A qualitative, explorative research study was conducted over a period of one year, to collect data. The research design consisted of five case studies of participants who engaged in approximately one year of therapy. Participants were seen fortnightly, by a clinical psychologist, who is also the researcher of the study. The notes taken in the therapy sessions, as well as other qualitative methods, were utilised to collect the data. The data was analysed for themes formulated by the researcher, which themes correlated with the principles of the two schools of thought applied in the study. Logotherapy and somatic experiencing are the therapeutic interventions, which were included in the research method. These approaches were utilised in an endeavour to explore their efficacy, in resolving stuckness, speculated as being due to unprocessed trauma. Participation in the study was voluntary and boundaries of ethical codes, as well as values of psychotherapeutic therapy adhered to. There was no monetary exchange for the therapy received, and no costs incurred to the participants, in the research study. The presence of a long-standing persistent problem, or issue (stuckness) that had belied resolution, was the main criteria for inclusion in the study. The research explored the possible association between unresolved trauma, as well as various types of interpersonal, and intrapersonal stuckness. Impulsivity, explosive tempers, irrationality, emotionality and bizarre acting out behaviours, are some of the presentations, that the study speculated, as being due to unprocessed traumatic energy. A contribution of this research is that there is an absence of any prior studies conducted which explores stuckness and its correlation with unresolved trauma. In addition, no other research assessing the combined, top-down, and bottom-up efficacy of the therapeutic approaches of logotherapy and somatic experiencing were sourced. Payne, et al. (2015 b) state that they could not find evidence of more than five papers which provided case studies on somatic experiencing as a trauma intervention. The number of studies undertaken on somatic experiencing in general, is also significantly limited (Changaris, 2010; Samardzic, 2010). This adds to the value, meaning and purpose of this research, as it is a unique endeavour, motivated by the researcher’s intention to add more value to individuals’ lives, especially when the presenting problem, appears to be unfathomable stuckness. In an absence of any understanding for the reasons for such stuckness, these people may experience significant distress at being stymied, within the self, or in relation to others, as well as feel at a loss for any possible recourse. This study could prompt other researchers to conduct similar investigations, not only of the combined body-based, and cognitive psychotherapuetic interventions, but also of the link between stymied interpersonal, as well as intrapersonal relationship dynamics, and trauma. The application of a mind, body and soul approach in the study, through the inclusion of logotherapy, is also relevant. In reviewing the direction of psychological fields, one can detect that the trends are towards constructs such as meditation, enlightenment, consciousness, meaning, purpose, mindfulness, presence, and spiritual identity. Individuals are seeking more enlightenment, and want to explore more of the noetic dimension, which I believe psychotherapy has to include, in order to meet the needs of an evolving society. / Psychology / D.Phil. (Psychology)

The call to better prepare nurses in safety and quality performance resulted from the concern of the Institute of Medicine regarding egregious gaps and errors in U.S. hospitals that resulted in serious injuries and patient deaths. Quality and safety education for nursing (QSEN) competencies were set forth in 2005 to enhance nursing curricula and nursing students' preparation for practice; however, QSEN's integration and implementation have been gradual and inconsistent. This qualitative interpretive study was guided by Senge's principles of the learning organization and Benner's professional development model. Using face-to-face interviews, the perspectives of 9 full-time nursing faculty members at 2 private nursing colleges in the Northeast United States were obtained about QSEN integration into their curriculum. Data analysis employed the use of open in vivo coding, categorizing, and the formation of themes. The results indicated that QSEN integration was perceived as complex and daunting due to faculty's limited knowledge about QSEN, lack of adequate preparation to develop and employ instructional strategies, lack of adequate time to teach, and limited learning opportunities at clinical sites to develop competencies such as teamwork and collaboration and informatics. Meaningful reform in nursing education may occur as leaders engage faculty members in meaningful dialogue to better understand the complexity and challenges of QSEN integration, including faculty members' needs for successful implementation. Nursing students may then be better trained to understand the nature and consequences of human and system errors and appreciate higher standards of care that will result in a decrease in preventable injuries, medication errors, and patient deaths.

Our modern health care system requires technology that can deal with multidisciplinary and complex processes, operations, and situations. The EHR, by far, is one of the greatest health information technology innovations that satisfy these requirements because of its efficiency and the effectiveness of its features. This study sought to develop an in-depth understanding of how underserved patients' perspectives about their health and illness, can contribute to greater use of the EHR. It also sought to improve their health outcomes and maintain sustainable change in the lives of the underserved. A quantitative non-experimental design study was conducted over a 6-week period outside of three different internal medicine clinics, one in the Northwestern and the two others in the Southeastern regions of Washington, DC. Surveys were distributed directly to patients coming out of these health clinics, and participants sent their responses via mail. Data collection included 215 surveys out of 560, but, only 155 fit the overall study categories. A strong level of significance in the relationships between clinical outcome measures and the EHR was identified at a 95% confidence interval. There were considerable health determinants that demonstrated the essence of patients' perspectives and the need for its incorporation into health outcomes measures for the underserved populations. The study also identified sets of environmental health predictors which acted as facilitators and contributors to a holistic health management model designed to contribute to the needs of the underserved communities. The holistic health model and the individual care plan model derived from the study are applicable at the level of the underserved population. It can help achieve sustainable health outcomes that will save lives and promote better health.

I denna studie undersöker jag hur hörande vuxna andraspråksinlärare (L2) använder och utvecklar perspektiv i tre olika kategorier: karaktärens, observatörens ochblandat perspektivi svenskt teckenspråk under en tidsperiod på ett år. Målgruppens resultat har jämförts med en kontrollgrupp bestående av döva förstaspråkstalare (L1). Resultatet visar att målgruppen från andra inspelningstillfället till fjärde inspelningstillfället har utvecklat flera perspektiv i alla kategorier. När det gäller språkliga likheter och skillnader mellan målgruppen och kontrollgruppen är en tydlig likhet att alla uttrycker sina imiterande gester på samma sätt. Resultatet visar också att flera informanter i målgruppen använder dubbla referenter i teckenrummet. Det kan bero på att de föredrar observatörperspektivet eftersom de har svårigheter med blandat perspektiv. Kontrollgruppen har istället betydligt högre andel blandat perspektiv än målgruppen. / In this study, I investigate how hearing adult second language (L2) learners use and develop perspective in the three different categories – character, observerand mixed perspective– in Swedish Sign Language over the course of one year. The results of the target group are compared to those of a control group consisting of deaf first language (L1) users. The results show that the target group, between the second and fourth recording session, has developed multiple perspectives in all categories. Furthermore, linguistic similarities and differences between target and control groups are investigated, one similarity being that all informants express imitating gestures in the same way. The results show that several informants in the target group use double referents in signing space. This may be a consequence of their preference for observer perspective, since they have difficulties with mixed perspectives. Conversely, the control group has a considerably higher percentage of mixed perspectives than the target group.

Les travaux que nous présentons pour l'obtention du doctorat de didactique des mathématiques portent sur deux domaines d'inégale importance: les Expressions Symboliques de l'Algèbre élémentaire ("ESA") d'une part et les situations de Discussions Autour de Problèmes ("DAP") de l'autre. Le corps principal de la thèse expose "les principales caractéristiques de modèles structuraux, didactiquement plausibles des systèmes d'ESA". Ces travaux constituent essentiellement ce que nous appelons une recherche "prodidactique". Il ne s'agit pas d'une étude de didactique de l'algèbre au sens strict, qui serait plus ou moins directement applicable à ce qui se passe dans les classes, mais plutôt d'une recherche fondamentale sur la structure des expressions symboliques qu'emploient élèves et professeurs en algèbre élémentaire (ESA), destinée à servir d'outil aux études didactiques ultérieures. Cette étude est structurée en trois grandes parties. La première (chapitres I à III) expose le problème, le délimite et le resitue par rapport aux travaux existants. La seconde partie (chap. IV à VIII) présente nos propositions, à savoir une grammaire du système des ESA. La troisième et dernière partie (chap. IX à XIII) est la plus proche de la didactique, en ce qu'elle s'appuie sur des résultats d'enquêtes auprès d'élèves pour aborder le domaine de la signification des ESA. En annexe figurent deux articles: * "Recherche d'une démarche d'enseignement en mathématiques avec des adultes", réalisé en collaboration avec Y. Paquelier et paru en 1987 dans la revue Education Permanente, * "Quelques développements récents des recherches sur la Discussion Autour de Problèmes", réalisé en collaboration avec Y. Paquelier, H. Lymberopoulos et H. Nikolakarou et paru en 1988 dans les actes de la douzième conférence annuelle du Groupe International "Psychology of Mathematics Education" â Veszprém (Hongrie). Ces articles présentent une recherche d'ordre didactique (et non "pro "didactique). qui se situe dans un domaine tout â [ait différent, celui de la construction sociale des connaissances en mathématiques, dans le cadre de la classe. Cette recherche a été menée en collaboration avec Y. Paquelier. H. Lymberopoulos et H. Nikolakarou.