Behaviour settings as a way to order types of situations for the study of speech aids.

This article revisits the notion of behaviour settings, coined by Roger G. Barker (Barker 1968, Ecol. Psychol. 28, 39-55 (10.1080/10407413.2016.1121744)), as a useful concept for the analysis of situations and communicative needs of persons after larynx removal surgery (laryngectomy). We claim that behaviour settings offer a way to characterize types of situations and types of participation, which, in turn, helps to identify aspects of communication where compensation is needed; these steps are crucial in the design process of reliable and context-sensitive speech aids. Moreover, we advocate complementing the behaviour setting concept as a unit of analysis with modern developments in the cognitive sciences, such as conversational analysis of co-operative actions (Goodwin 2017, Co-operative action (learning in doing: social, cognitive and computational perspectives). Cambridge: Cambridge University Press (10.1017/9781139016735)) and the analysis of multi-perspectival experience (De Jaegher 2021, Phenomenol. Cogn. Sci. 20, 847-870 (10.1007/s11097-019-09634-5)). Such an integration of macro- and micro-level patterns should help discover the relevant relations and values in particular situations. We illustrate our claims with examples from Barker's own work and from our ongoing analyses of the everyday life of persons after laryngectomy. This article is part of the theme issue 'People, places, things, and communities: expanding behaviour settings theory in the twenty-first century'.

Making the visible seen: The interactional competence of a person in a disordered state of consciousness.

We examine a 12-min video-recorded interaction among a patient (KN) in a disordered state of consciousness (DOC) and a speech language pathologist clinician (CL) that takes place in a medical rehabilitation setting. The video is a demonstration of how caregivers could use a clinical assessment to observe their loved one's behavior to communicate potential behavioral changes to healthcare professionals. The purpose of this paper is to make visible the communication practices used by participants that may not be obvious to researchers, medical rehabilitation practitioners, and clinical assessment developers. We use phenomenological, linguistic and conversation analytic approaches to analyze the interaction. We found that KN demonstrates multiple conversational competencies, some (but not all) of which are acknowledged by CL, and most of which are not directly addressed by the assessment scoring criteria. For example, KN demonstrates conversational competency by responding non-verbally to CL's prompts from the assessment protocol and following along with the unspoken rules of discourse. He does this primarily through gaze, which broadcasts the focus of his attention and actively signals his participation in the conversation. Though KN does not always respond correctly to CL's questions, he nevertheless demonstrates implicit conversational competencies during turns of talk such as returning to 'neutral' position which signals the completion of a turn of talk. KN's conversational competencies may be missed by CL and the assessment protocol but we argue that they are important in understanding KN's capacity. Our analyses show that competency is not simply a performance by one person who appropriately and correctly responds to a series of questions in a prescribed time frame. Competence is a collaborative achievement among participants, co-produced in situ, and influenced by linguistic and cultural habits of talk and epistemic norms that privilege clinical knowledge and expertise.

On the division of labor in the maintenance of intersubjectivity: insights from the study of other-initiated repair in Vietnamese.

Few ideas have figured more centrally in the history of social theory than that of the division of labor. Here we ask whether conversational interaction, like other forms of social activity, exhibits a division of labor and, if so, what functions this serves and how it might be understood in relation to the theories of Marx and Durkheim. We begin by noting that, though conversational participants actively work to achieve and sustain understanding, much of the time this work is invisible and only its products are displayed in the form of sequentially fitted next turns at talk. However, in sequences of other-initiated repair, the work involved in the maintenance of intersubjectivity rises to the surface. On these occasions, we can see and thus describe what participants do to achieve and sustain what they take to be adequate understanding. In our data, which consist of video recordings of casual conversations among Vietnamese same-generation peers, participants continuously display an orientation to relations of relative seniority through the selection of terms used to accomplish interlocutor reference. This pervasive orientation is also reflected in practices of repair initiation. Specifically, seniors regularly initiate repair with so-called "open class" forms such as "huh?" and "ha?" which display a minimal grasp of the talk targeted, require little effort to produce and, at the same time, push responsibility for resolving the problem onto the trouble source speaker (i.e., the junior member of the dyad). In contrast, juniors often initiate repair of a senior participant's talk by displaying a detailed understanding of what has been said, either in the form of a repeat or a reformulation, and inviting the senior to confirm. We suggest then that this asymmetry in the distribution of initiation practices reflects a "division of intersubjective labor". We conclude with some thoughts on the theoretical implications of our findings and relate them not only to the theories of Marx and Durkheim but also to the writings of feminist sociolinguists who sought to describe the way in which women seem to be burdened more than men with what Fishman called "interactional shitwork."

Differential diagnosis between epileptic and psychogenic nonepileptic seizures through conversational analysis: A blinded prospective study in the Russian language.

The current study examined the validity of conversational analysis (CA) in Russian patients with seizures, using a scoring table for the Simplified Linguistic Evaluation (SLE). The study sample was composed of 12 adult participants suffering either from epilepsy (ES) or psychogenic nonepileptic seizures (PNES) recruited in the Moscow Research and Clinical Center for Neuropsychiatry. Definitive diagnosis was established only after a habitual event was captured onvEEG. All participants with PNES or ES and at least one mental disorder underwent a 20-minute-long interview recorded on video. The interview then was evaluated by the external blinded physician already experienced in CA. Finally, that physician filled the SLE, consisting of 5 items analyzing the main characteristics of patient narrations. A score of ≥12 suggested a diagnosis of ES, while a score of <12 suggested a diagnosis of PNES. The blinded evaluator correctly identified 11 out of 12 cases. The concordance between the vEEG diagnosis and the CA diagnostic hypothesis was 91.67%. The sensitivity of the scoring table was 100%, while the specificity was 80%. The positive and the negative predictive values were, respectively, 87.5% and 100%. Our results suggested that the differences in seizure descriptions between patients with PNES and patients with ES are similar across Indo-European language family and are independent of psychiatric comorbidity.

Communicating With Parents and Preschool Children: A Qualitative Exploration of Dental Professional-Parent-Child Interactions During Paediatric Dental Consultations to Prevent Early Childhood Caries.

The aim of this study was to explore communication interactions and identify phases adopted by dental professionals with parents and their young children and to examine the hypothesis that successful social talking between the actors together with the containment of worries allows the formation of a triadic treatment alliance, which leads to achieving preventive dental treatment goals. Conversation analysis of the transcribed data from video recordings of dental professionals, parents and preschool children when attending for preventive dental care was conducted. The transcriptions were read, examined and analysed independently to ensure the trustworthiness of the analysis. The transcriptions were explored for interactive patterns and sequences of interaction. Forty-four individual consultations between dental professionals, parents, and preschool children were recorded. The number of communication behaviours was 7,299, with appointment length ranging from 2 min 10 s to 29 min 18 s. Two patterns of communication were identified as dyadic (between two people) and triadic (between three people) interactions within a continuous shifting cycle. The three phases of communication were social talking, containing worries and task-focusing. Social talking was characterised by shifts between dyadic and triadic communication interactions and a symmetry of communication turns and containing worries. This typified the cyclical nature of the triadic and dyadic communication interactions, the adoption of talk-turn pairs, and triadic treatment alliance formation. Task-focusing pattern and structure were different for dentists and extended-duty dental nurses. For dentists, task-focusing was characterised by a dyadic interaction and as an asymmetrical communication pattern: for extended-duty dental nurses, task-focusing was typified by symmetrical and asymmetrical communication patterns within dyadic and triadic interactions. Empathy and understanding of the young child's emotional needs during containing worries allowed the formation of the triadic treatment alliance and with this treatment alliance, the acceptance of interventions to prevent early childhood caries during "task-focusing." This qualitative exploration suggests that dyadic and triadic communication interactions are of a dynamic and cyclical quality and were exhibited during paediatric dental consultations. The communication phases of social talking, containing worries and task-focusing were evident. Successful social talking signalled the entry to containing worries and triadic treatment alliance formation which permitted the preventive goals of the consultation to be achieved (task-focusing). Future work should generate additional data to support the hypotheses created here namely that, social talking and containing worries triggers an integral pathway to task-focusing and the achievement of preventive dental goals.

Building Community in the HIV Online Intervention Space: Lessons From the HealthMPowerment Intervention.

BACKGROUND: Mobile health platforms can facilitate social support and address HIV (human immunodeficiency virus) stigma but pose challenges for intervention design and participant engagement. Giddens's structuration theory, that individuals are shaped by-and shape-their communities through rules and resources that give them power to operate within these environments, provides a useful analytic framework for exploring these dynamic intervention spaces. METHOD: Data were drawn from an online randomized controlled trial intervention (HealthMpowerment) for young Black men who have sex with men to reduce condomless anal intercourse. We applied a conversational analysis informed by structuration theory to 65 user-generated conversations that included stigma content. We aimed to understand how the interdependent relationship between the intervention space and participants' contributions might contribute to behavior change. RESULTS: Thirty five intervention participants contributed to the analyzed conversations. Our analysis identified three types of conversational processes that may underlie behavior change: (1) Through intervention engagement, participants established norms and expectations that shaped their discussions; (2) participants used anecdotes and anonymity to reinforce norms; and (3) intervention staff members sought to improve engagement and build knowledge by initiating discussions and correcting misinformation, thus playing an integral role in the online community. CONCLUSIONS: The lens of structuration theory usefully reveals potential behavior change mechanisms within the social interactions of an online intervention. Future design of these interventions to address HIV stigma should explicitly characterize the context in which individuals (study staff and participants) engage with one another in order to assess whether these processes are associated with improved intervention outcomes.

Managing exactness and vagueness in computer science work: Programming and self-repair in meetings.

The formulation of computer algorithms requires the elimination of vagueness. This elimination of vagueness requires exactness in programming, and this exactness can be traced to meeting talk, where it intersects with the indexicality of expressions. This article is concerned with sequences in which a team of computer scientists discuss the functionality of prototypes that are already implemented or possibly to be implemented. The analysis focuses on self-repair because this is a practice where participants can be seen to orient to meanings of different expressions as alternatives. By using self-repair, the computer scientists show a concern with exact descriptions when they talk about existing functionality of their prototypes but not when they talk about potential future functionality. Instead, when participants talk about potential future functionality and attend to meanings during self-repair, they use vague expressions to indicate possibilities. Furthermore, when the computer scientists talk to external stakeholders, they indicate through hedges whenever their descriptions approximate already implemented technical functionality but do not describe it exactly. The article considers whether the code of working prototypes can be said to fix meanings of expressions and how we may account for human agency and non-human resistances during development.

Conversational analysis of consciousness during seizures.

OBJECTIVE: The objectives of the study were to 1) investigate how patients with epilepsy describe the subjective, conscious experience of having a seizure and 2) determine whether certain themes and descriptions correspond to specific types of epilepsy. METHODS: We interviewed thirteen patients with electroencephalographically confirmed epilepsy about their subjective experience of having a seizure and used conversational analysis (CA) to analyze the language they used to describe this experience. RESULTS: Seven patients had focal to bilateral tonic-clonic seizures (FBTCS), 7 had focal impaired awareness seizures (FIAS), 1 had focal aware seizures (FAS), and one had generalized onset tonic-clonic (GTC) seizures. Three had multiple types of seizures. Focal seizure origin was frontal in 2 patients, right hemisphere in 1, parieto-occipital in 1, and temporal in 8. Focal to bilateral tonic-clonic and GTC seizures were most frequently associated with descriptions of a total loss of consciousness (n = 8), whereas FIAS were most frequently associated with a perceived loss of consciousness but able to describe some aspects of being unconscious (n = 5). Temporal seizures most frequently accompanied reports of memory loss/impairment (n = 4). Ten patients provided specific descriptions of the transition between the interictal and ictal state or auras. Descriptions consciousness and unconsciousness ranged significantly, resembling a continuum rather than corresponding to distinct levels. CONCLUSION: The subjective experience of consciousness for patients with epilepsy may differ by seizure type and origin. These may reflect different involvement of brain regions involved in producing consciousness and arousal. Conversational analysis and narrative approaches can significantly aid clinicians in the diagnosis and management of epilepsy.

Differentiating PNES from epileptic seizures using conversational analysis on French patients: A prospective blinded study.

Psychogenic nonepileptic seizures (PNES) resemble epileptic seizures (ES) but are not caused by the occurrence of excessive cortical neuronal discharge. Previous studies in German-, English-, and Italian-speaking patients showed that patients used a different communicative style to talk about their seizures. They demonstrated that the diagnosis between PNES and ES could be predicted using qualitative assessment and a diagnostic scoring aid (DSA). The objective of our study was to evaluate the contribution of linguistic analysis in the differential diagnosis between ES and PNES in a French patient population. During an extended video-electroencephalogram (video-EEG) monitoring, 13 patients presented PNES and 19 patients with ES. Two neurologists blindly and independently analyzed the interview of each patient. Rater 1 predicted the correct diagnosis in 27 of 32 patients (84%) and Rater 2 in 28 of 32 patients (88%). Interrater reliability of qualitative analysis was satisfactory (k = 0.68, interrater agreement = 84.4%). Using a simplified DSA, Rater 1 and Rater 2 would have correctly diagnosed 88% (28/32 patients) and 91 % (29/32) of the cases, respectively. Our blinded prospective study confirms the diagnostic value of conversational analysis, performed by neurologists, to differentiate PNES from ES in French-speaking patients.

Impact of EHR-based rounding tools on interactive communication: A prospective observational study.

OBJECTIVE: Structured rounding tools have shown to improve the overall efficiency and perceived satisfaction with the rounding process. However, little is known about how EHR-integrated rounding tools impact the content, structure and interactivity of communication during rounds. METHOD: We conducted a prospective pre-post evaluation with two rounding tools: a Microsoft Word-based fillable rounding tool (usual tool), and an EHR-integrated rounding report tool (RRT). 27 clinicians across two teams participated in rounds for 169 patients (nusual=84, nRRT=85). We audio-recorded and coded communication during rounds using conversational analysis methods. Using the coded communication interactions, we investigated differences between the two tools on: clinical content discussed, questions raised, and breakdowns in interactive communication. Additionally, we gathered clinician perspectives on the rounding tools through follow-up interviews. RESULTS: We found that the use of RRT was associated with significantly more discussion of patient identifiers (e.g., name), and action items (e.g., to-do list) and significantly less discussion of imaging (e.g., X-rays) than the usual tool. RRT was also associated with fewer questions (t = 3.1, p = 0.03), and correspondingly, fewer responses (t = 3.2, p = 0.02). Communication breakdowns related to incorrect responses was fewer during the use of RRT (t = 0.5, p = 0.01). There were no statistically significant differences in the time spent for rounding between the two tools. CONCLUSIONS: Our findings showed that RRT impacted rounding workflow: during pre-rounding, by saving time and effort in gathering information from multiple sources; during rounding, by streamlining content of the conversations using the structured RRT template; and during post-rounding, by supporting explicit discussion of patient tasks and action items for patient care planning and management.

Learning Clinical Hypnosis Wide Awake: Can We Teach Hypnosis Hypnotically?

Conversational hypnosis has been promoted as both more congruent with mechanisms of psychobiological change and more feasibly integrated into clinical care than the more dominant, ritualistic, hierarchical, induction-based Standards of Training in Clinical Hypnosis. Further, it has been argued that, in teaching the legacy standard, clinical hypnosis training lacks pedagogical integrity. This article builds on these premises by piloting a mixed-methods approach to studying the pedagogy and participant evaluations of two professional education events that focused on conversational hypnosis. Results indicate that this is an effective methodology for studying the impact of teaching hypnosis hypnotically and fostering wider integration of hypnosis into health and care.

Knowledge and agency in interprofessional care: How nurses contribute to the case-construction in an Intensive Care Unit.

This paper focuses on the epistemic and interactional resources displayed by nurses participating in medical case construction and the ways through which they make a difference in the unfolding of this activity. This paper draws on an ethnographic research in an Italian Intensive Care Unit (ICU) selected according to a purposeful sampling approach out of a national sample of 40 ICUs participating in a larger research project. Our dataset, collected over a period of six months of ethnographic observations, consisted of the observers' field notes and log-books, audio and video-recordings of morning briefings, in-depth interviews, informal conversations and shadowing of bedside practices. For the purpose of this article, we analyzed the video-recorded morning briefings, involving nine attending physicians and three specialized nurses. Adopting a conversational analysis approach, this paper identifies the epistemic activities through which the nurses orient the physicians' ongoing reasoning. It illustrates how the nurses' contributions display different degrees of agency depending on the type of activity, the turn taking and the turn design. We contend that the nurses' interactional competence in managing their epistemic resources and rights related to their professional territory of knowledge makes their knowledge relevant and contributes in constituting the case construction as an interprofessional activity. Implications, limitations and suggestions for future research are discussed.

Measuring content overlap during handoff communication using distributional semantics: An exploratory study.

OBJECTIVE: We develop and evaluate a methodological approach to measure the degree and nature of overlap in handoff communication content within and across clinical professions. This extensible, exploratory approach relies on combining techniques from conversational analysis and distributional semantics. MATERIALS AND METHODS: We audio-recorded handoff communication of residents and nurses on the General Medicine floor of a large academic hospital (n=120 resident and n=120 nurse handoffs). We measured semantic similarity, a proxy for content overlap, between resident-resident and nurse-nurse communication using multiple steps: a qualitative conversational content analysis; an automated semantic similarity analysis using Reflective Random Indexing (RRI); and comparing semantic similarity generated by RRI analysis with human ratings of semantic similarity. RESULTS: There was significant association between the semantic similarity as computed by the RRI method and human rating (ρ=0.88). Based on the semantic similarity scores, content overlap was relatively higher for content related to patient active problems, assessment of active problems, patient-identifying information, past medical history, and medications/treatments. In contrast, content overlap was limited on content related to allergies, family-related information, code status, and anticipatory guidance. CONCLUSIONS: Our approach using RRI analysis provides new opportunities for characterizing the nature and degree of overlap in handoff communication. Although exploratory, this method provides a basis for identifying content that can be used for determining shared understanding across clinical professions. Additionally, this approach can inform the development of flexibly standardized handoff tools that reflect clinical content that are most appropriate for fostering shared understanding during transitions of care.

[Pediatrician-parent interaction and early prevention : A review about the limits in addressing psychosocial risks during well-child visits]. / Das pädiatrische Elterngespräch und Frühe Hilfen : Eine Übersicht über Grenzen der Belastungsansprache in Früherkennungsuntersuchungen.

BACKGROUND: Pediatricians can be a door opener to early prevention for families at risk. The German well-child program is well-established, but there is a gap between the structural possibilities and the observed placements. OBJECTIVE: The aim of this review is to show how pediatricians and parents talk about psychosocial risks under the very structured conditions of well-child visits. The challenges and traps of the framed interactions will be described and options for early prevention will be shown. METHODS: The review is primarily based on the work of conversational and ethnomethodological studies reconstructing the pediatrician's discussion with parents about psychosocial issues in the family. RESULTS: Well-child visits are a highly routinized practice. Talking about family issues for both partners is a difficult task. Discussions about psychosocial issues are seldom and vague . Predominantly, they work cooperatively on reciprocal normalization of the child's development. Based on this shared orientation, pediatricians make an early, mostly general, prescription of parental tasks, supporting the child in the next developmental step. This kind of routine anticipatory counselling puts some pressure on the parents. Parents under unknown stress could be overburdened with this advice. CONCLUSION: In the script of well-child visits, there are no slots that indicate to pediatricians and parents when, which, how and for what purpose psychosocial issues can be discussed and negotiated. For implementing such slots in well-child visits, three steps are necessary: a structured and regular assessment of psychosocial issues, a trained pediatrician in motivational interviewing and a social worker guiding the family in the network of early prevention.

Characterizing the structure and content of nurse handoffs: A Sequential Conversational Analysis approach.

Effective communication during nurse handoffs is instrumental in ensuring safe and quality patient care. Much of the prior research on nurse handoffs has utilized retrospective methods such as interviews, surveys and questionnaires. While extremely useful, an in-depth understanding of the structure and content of conversations, and the inherent relationships within the content is paramount to designing effective nurse handoff interventions. In this paper, we present a methodological framework-Sequential Conversational Analysis (SCA)-a mixed-method approach that integrates qualitative conversational analysis with quantitative sequential pattern analysis. We describe the SCA approach and provide a detailed example as a proof of concept of its use for the analysis of nurse handoff communication in a medical intensive care unit. This novel approach allows us to characterize the conversational structure, clinical content, disruptions in the conversation, and the inherently phasic nature of nurse handoff communication. The characterization of communication patterns highlights the relationships underlying the verbal content of nurse handoffs with specific emphasis on: the interactive nature of conversation, relevance of role-based (incoming, outgoing) communication requirements, clinical content focus on critical patient-related events, and discussion of pending patient management tasks. We also discuss the applicability of the SCA approach as a method for providing in-depth understanding of the dynamics of communication in other settings and domains.