Building Trusting Relationships Research Articles

Обратная связь как инструмент эффективного управления проектами: значимость, методы использования и практические примеры

This article analyzes the importance of feedback in Agile projects, emphasizing its role in improving management processes and motivating personnel. Methods of collecting feedback, such as surveys, meetings, and project data analysis, are discussed. Special attention is paid to practical aspects of giving and receiving feedback, including strategies for effective communication among project participants. Principles of transparency, openness, and respect are discussed in the context of the Agile approach, along with recommendations for developing authentic leadership and building trusting relationships within teams. The influence of feedback on the process of continuous improvement and project refinement is explored. Overall, the article provides an overview of modern methods and practices of using feedback in Agile projects and recommendations for their application to achieve suc-cessful outcomes.

Branding countries through multicultural events: a quantitative analysis of the impact of the FIFA World Cup 2022 on Qatar’s brand

Private and public companies, as well as public authorities and governments, resort to corporate communication to build trust relationships with their stakeholders and, in this way, reinforce their corporate brands. However, they face different challenges including social transformations and cultural changes. This study evaluates how the FIFA World Cup 2022 impacted Qatar’s brand. To do that, we conducted a review of the literature about corporate communication and nation branding, and then, we carried out a quantitative content analysis of how the leading newspapers in the world’s most influential countries (United States, China, United Kingdom, France, and Germany) covered this event from a corporate communication perspective. These newspapers were selected based on highest circulation. The results from the analysis showed that media companies from France were the ones making more references to Qatar’s History (59); journalists from the United States were the most interested in the Qatar Brand (14); and British newspapers were the ones who published more content about the FIFA World Cup 2022 brand (53).

Cannabis use amongst students attending an alternative provision in the United Kingdom

ABSTRACT For reasons explored within the paper, adolescents excluded from mainstream education are more likely to use cannabis regularly. Research into the cannabis use (CU) of adolescents excluded from mainstream school in the United Kingdom (UK) is limited and seldom focuses on what students perceive as effective support. In this exploratory study, information from 55 students attending an alternative provision (AP) in the North of England was gathered via electronic survey. Questions were asked about patterns of student CU, motivations for use, perceived impact on mental health and educational outcomes, and effective support. Current users reported CU was motivated by enhancement and coping motives, while conformity motives were less significant than expected. Past users endorsed coping motives less than expected. Support of trusted adults was perceived as the most effective support strategy. Findings are explored in relation to discussions with key staff prior to and after the survey. These reflect previous research into adolescent CU motives, and the positive impact of school connectedness on student CU. Recommendations include early intervention for high-risk youth based on accurate identification of CU motives. Staff should focus on building trusting relationships with students as a platform to support the management of adolescent CU.

Establishing consensus on principles and competencies for the use of play in clinical practice in hospitals: An international Delphi study

Although play has existed in paediatric hospitals for decades, a shared understanding of why and how healthcare professionals use play in clinical practice is lacking. This study aims to reach consensus on a common set of principles and competencies for play interventions and practices in hospitals. We conducted a three-round Delphi study that included healthcare professionals selected by hospital management. The first round comprised open-ended questions on the use of play in clinical practice. Principles and competencies, including learning objectives, were established using content analysis through an iterative process. Participants rated the importance of each principle and learning objective in the second and third rounds. Among the 66 participants, 45 (68%) responded in round 1 and 41 (62%) in rounds 2 and 3. The participants represented ten countries and nine different health professions. After the three rounds, we identified 33 principles and six overall competencies: building trusting relationships; delivering information and increasing understanding; promoting cooperation and participation; reducing procedure-related anxiety and pain; supporting coping and development; and ensuring a professional approach to play, which comprised 20 learning objectives. Conclusion: According to healthcare professionals, play in clinical practice can be used to communicate and build relationships with paediatric patients and thus potentially help provide patient-centred care. Our findings may help guide and prioritize future research initiatives and operationalize play interventions and practices in hospitals.What is Known:• Evidence suggests that using play in clinical practice can help paediatric patients during hospitals stays.• Despite the evidence supporting the use of play, a shared understanding of why and how paediatric healthcare professionals use play is needed.What is New:• This international Delphi study contributes to a shared interprofessional understanding of the principles, competencies and learning objectives for the use of play in clinical practice.• The findings have the potential to aid initiatives in developing training programmes for healthcare professionals in using play to provide care with a patient-centred approach.

The significance of the senior pastor for change and growth

This is a literature-based article on the importance of the pastor for change and growth in the local church. The article discusses five themes derived from a review of the research literature, namely the general leadership literature and the church leadership literature. The contribution of this article is its discussion of the church leadership literature on the role of the pastor, taking into account the general research on the role of a top leader. Six propositions on how the pastor contributes to change and growth in the church are derived: 1) The pastor, as the senior leader, is vital for team development, change, and growth. 2) The personality traits and gifts of the pastors are important. 3) To increase change and growth, the senior pastor must emphasize a change-promoting leadership role and style, moderated by the roles and styles of the leadership team members. 4) A change- and task-oriented style must be moderated and reinforced - probably more so than in other organizations - by a transformational and relational leadership style. 5) The pastor should build an influential top-leader team to create direction, strategy, and change. Diversity facilitates the necessary discussion within the team. A common goal and appealing vision contribute positively to cooperation within the team. 6) Leadership should not only be understood as what the leader or pastor does but also as a complex interaction with other actors and the context. Building trust and good relationships with subordinate leaders and coworkers is thus vital for change and growth. Finally, a model for understanding the connection between the pastor, change, and growth is outlined.

Nurse-patient relationship and its implications for retention in the PMTCT of HIV programme in Ghana: an appreciative inquiry

BackgroundRelationships established between nurses and midwives, and their patients have far-reaching implications; the most significant being their impact on the health-related outcomes of patients. These relationships are especially relevant in the Prevention of Mother-to-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) programme as women, diagnosed with HIV navigate the emotional and psychological effects of their diagnosis while carrying pregnancies. This study aimed to explore the relationships between nurses, midwives and mothers diagnosed with HIV and its impact on retention in the PMTCT Programme.MethodsAn Appreciative Inquiry approach that employed qualitative research methods was conducted among twenty-four participants made up of 12 HIV positive mothers, and eight midwives and four community health nurses engaged in the PMTCT programme. Individual generative interviews were conducted among the mothers while paired interviews were conducted among the health professionals. Thematic analysis guided by Colaizzi’s approach was conducted.ResultsThree main themes emerged each with its subthemes. Under Establishing Rapport, two sub-themes emerged; making the connection and building trusting relationships. The second theme, Journeying Together, describes how the nurse-patient relationship evolved as the participant engaged in the programme; sub-themes include developing mutual goals, impactful communication, and showing commitment and building self-worth. The third theme; Ending the professional relationship details two sub-themes; continuity of care across the cascade, and termination of care which proved unsuccessful in some relationships due to blurring professional boundaries.ConclusionsThe nurse-patient relationship in the PMTCT programme evolved as the relationship progressed along the PMTCT cascade. Strengthening of the nurse-patient relationships was underscored by building trust through the maintenance of confidentiality, setting mutual goals, shared emotional experiences and personal stories, and building clients’ self-worth. Therefore, there is a need to ensure that professional boundaries are set and maintained to reduce the occurrence of over-dependence of the clients and burnout of the nurses.

NONVIOLENT COMMUNICATION
 IS AN EFFECTIVE WAY OF INTERACTING WITH OTHERS

The article presents a theoretical review devoted to the model of nonviolent communication proposed
 by M. Rosenberg. Four components of the concept of nonviolent communication are described in detail, which allow
 building trusting and conflict-free relationships with people around them. Observation, feelings, needs, and requests are
 the four components of the nonviolent communication model. The necessity of a more detailed study and application
 of the concept of nonviolent communication is substantiated. It should be noted that the model of nonviolent
 communication can be effectively applied in all spheres of communication: family relations, school, therapy and
 counseling, disputes and conflicts. Several ways of educating people in the field of nonviolent communication and some
 methods that contribute to the development of nonviolent communication skills are proposed. Clarity and accuracy is the
 main principle of the method of nonviolent communication developed by M. Rosenberg. Having mastered his four basic
 rules, people learn to speak so that the interlocutor can hear and understand him. As a result, communication will become
 effective.

Recruiting Black and White patients to a behavioral oncology clinical trial: Lessons from the DISCO trial.

102 Background: Data show that 55% of trials are terminated due to insufficient accrual, which is especially low for patients identifying as Black. In 2021, we initiated recruitment to a clinic-based behavioral oncology trial testing the effectiveness of a health equity communication intervention designed to address patient cost concerns. This study involves patients and clinicians completing surveys before and after a video-recorded clinical interaction. We are implementing this study at an NCI-designated comprehensive cancer center in Detroit, Michigan, a city comprised of a majority of Black residents (80%). Based on the aims and literature showing that most patients agree to participate in trials if they are eligible and invited, we set a sample goal of 50% Black and 50% White patients. We use strategies based on literature and our own experience, including having a diverse staff and building trusting relationships with participants. As we begin the third and final year of recruitment with about 2/3 of our required patient sample (N=180) recruited, we consider what suggestions we can offer teams seeking to efficiently recruit a diverse patient sample to clinical trials. Methods: We based our strategies on evidence that racially concordant (same racial group) clinical dyads have greater communication quality than racially discordant (different racial group) dyads, and that medical mistrust is greater among Black than among White patients. First, we hired and trained a team that includes both Black and White members, and encouraged them to take leadership roles in the team. Second, we built trust with clinic staff, clinicians and patients. Procedures involve discussing the study with clinicians and their staff, recruiting clinicians as participants, and screening their patients for eligibility. We then recruit patients in-person in the clinic or by phone. Patients who provide oral consent are later met in person to collect written consent. Results: We have achieved a consent rate of 52% across 4 clinics; our sample includes 74 (62%) Black patients and 45 (38%) White patients. We attribute this to critical aspects of our protocol. First, recruitment of clinicians as participants helps capture the attention of and build trust with patients. Second, we have a flexible recruitment approach. Once potential participants are screened, we decide whether to approach them in person or by phone. Third, our team is comprised of Black and White individuals to reflect the patient population we hope to recruit. Last, we have the support of a diverse group of medical student team members who assist in times of increased recruitment. Conclusions: Our strategies, based on social science literature, helped achieve our goal of recruiting a sample that reflects racial diversity in our patient population. These and similar strategies can be adapted for other trials with the goal of achieving clinical trial recruitment equity. Clinical trial information: NCT04766190 .

A reputation-based trust evaluation model in group decision-making framework

In group decision-making (GDM) problems, experts need to communicate and adjust their opinions in order to achieve consensus on the final decision-making output. Since experts may have conflicting opinions, trust can be critical and an important reference to use in the decision-making process when some experts are required to modify opinions. Recently, decision-making models based on trust and reputation have been investigated intensively. However, these research works usually rely on the constructed social trust network and honesty and fairness of the trust ratings from experts are taken for granted. The objective of this study is to develop a reputation-based trust model for GDM framework to obtain the trust relationship among experts from their direct interaction and word of mouth. First, the paper defines a trust credibility measure to filter out malicious experts before trust assessment, and designs direct trust feedback based on the interaction quality. Then, based on this direct trust feedback, the global reputation model is proposed according to the synthetical performance of received and provided trust feedback, which encourages long-term good behaviour and guarantees trustworthy communications and interactions. The reputation-based trust and direct trust feedback together build trust relationship among experts. Finally, a simulation experimental analysis of the proposed trust and reputation models is carried out to verify their effectiveness in trust and reputation establishment among the experts, even under the presence of malicious ones.

The Evaluation of Equity-Focused Community Coalitions: A Review of the Empirical Literature

Conducting evaluation and research with community coalitions involved in health equity initiatives is inherently complex. In this paper we provide a review and synthesis of the empirical literature on the evaluation of equity-focused community coalitions. We explore issues, challenges, and barriers experienced by evaluators, as well as techniques and approaches that were considered beneficial. Our review identified 11 peer reviewed articles, from which we identified seven overlapping themes: (1) framing equity in the evaluation process, (2) use of multiple theoretical frameworks, (3) use of systems-focused approaches, (4) strategic use of intersectoral partnerships and collaborations, (5) intentional communication and building trusting relationships, (6) challenges dedicating purposeful time to the work, and (7) issues of cultural and contextual clarity and responsiveness. Our findings point to a significant focus on context, history, learning, communication, relationships, and power. The cultural complexity and historical scope of each context, diversity of stakeholders, and enormity of the systemic issues involved, shape and challenge the evaluation and research process in fundamental ways, requiring a creative and kinetic thinking -- a shifting from methodological certainty to an acknowledged uncertainty, where mixing, blending and the innovative use of approaches and theories becomes a way of moving beyond the colonizing past.

Teaching English in Palestine: Building trusting relationships by centering humanity

As educators, we recognize the centrality of humanness above and beyond everything else in our professional practice. As such, the affective aspects of instructional engagement rest at the center of language learning and teaching. Through this paper, four educators from the US explore the ways the affective side of language learning and use shows up in their work in Palestine. Drawing from feminist epistemologies, critical race theory, and liberatory practices, the authors trace the trajectories of their professional practices, and explore the ways they learned to center the affective aspects of instruction, leveraging culturally sustaining practices, and highlighting various ways to engage in solidarity. Through four vignettes, set at four distinctly different Palestinian institutions of higher education, each contributor highlights a unique experience that exemplifies centering the affective aspects of language teaching and learning. / Keywords: Palestine, affective, relationships, solidarity, occupation

텍스트 네트워크 분석을 통한 ‘좋은 상담교사’에 대한 예비 교원의 인식

The purpose of this study is to explore pre-service teachers' perception of 'good counselors'. To this end, data were collected through open-ended questions about 'good counselors' from 111 students in the college of education who agreed to participate in the study. For data analysis, a text network analysis method was applied using the NetMiner program. As a result of the study, it was found that the most important things in the pre-service teachers' perception of a 'good counselor' were 'student', 'conversation', and 'empathy'. In addition, as a result of exploring the substructure of the perception of 'good counselor' through community analysis, it was classified into five communities. The five communities appeared as Building relationships of trust, empathic attitude, professional competence, communication skills, deep understanding of students. After discussing this, the research and limitations were identified, and further research was suggested.

Experiences of Underground Mine Backfilling Using Mine Tailings Developed in the Andean Region of Peru: A Green Mining Solution to Reduce Socio-Environmental Impacts

In Peru, socio-environmental conflicts related to the development of mining-metallurgical processes and the responsible disposal of mine tailings have become central issues for accepting mining projects, especially regarding building relationships of trust with the communities. This condition has prompted the Peruvian mining industry to advance in managing alternatives to the conventional surface disposal of mine tailings. A promising and increasingly popular management strategy for mine tailings in Peru is their disposal inside underground mines. This article presents: site-specific conditions, advantages/disadvantages, and lessons learned from practical experiences of mine tailings disposal in underground mines in Peru. In addition, some techniques are highlighted, such as (i) hydraulic fill, (ii) cemented hydraulic fill, and (iii) cemented paste backfill. Finally, this article concludes that the responsible disposal of mine tailings in underground mines is a green mining solution that reduces negative socio-environmental impacts, limiting the generation of acid rock drainage (ARD) and the leaching of metals due to the decrease in contact with oxygen and rainfall, thus mitigating the contamination of surface and underground waters, reducing the footprint of affectation in the territory, and eliminating the emission of particulate matter in the environment.

A cluster-based trusted routing method using fire hawk optimizer (FHO) in wireless sensor networks (WSNs)

Today, wireless sensor networks (WSNs) are growing rapidly and provide a lot of comfort to human life. Due to the use of WSNs in various areas, like health care and battlefield, security is an important concern in the data transfer procedure to prevent data manipulation. Trust management is an affective scheme to solve these problems by building trust relationships between sensor nodes. In this paper, a cluster-based trusted routing technique using fire hawk optimizer called CTRF is presented to improve network security by considering the limited energy of nodes in WSNs. It includes a weighted trust mechanism (WTM) designed based on interactive behavior between sensor nodes. The main feature of this trust mechanism is to consider the exponential coefficients for the trust parameters, namely weighted reception rate, weighted redundancy rate, and energy state so that the trust level of sensor nodes is exponentially reduced or increased based on their hostile or friendly behaviors. Moreover, the proposed approach creates a fire hawk optimizer-based clustering mechanism to select cluster heads from a candidate set, which includes sensor nodes whose remaining energy and trust levels are greater than the average remaining energy and the average trust level of all network nodes, respectively. In this clustering method, a new cost function is proposed based on four objectives, including cluster head location, cluster head energy, distance from the cluster head to the base station, and cluster size. Finally, CTRF decides on inter-cluster routing paths through a trusted routing algorithm and uses these routes to transmit data from cluster heads to the base station. In the route construction process, CTRF regards various parameters such as energy of the route, quality of the route, reliability of the route, and number of hops. CTRF runs on the network simulator version 2 (NS2), and its performance is compared with other secure routing approaches with regard to energy, throughput, packet loss rate, latency, detection ratio, and accuracy. This evaluation proves the superior and successful performance of CTRF compared to other methods.

Community health workers' perspectives on integrating into school settings to support student health.

While schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health. This qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes. Among 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work. This study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments.

Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners.

Building trust and therapeutic relationships between healthcare providers and patients are crucial for delivering high-quality, comprehensive sexual and reproductive health (SRH) services. Yet, while patients face substantial SRH disparities in Tanzania, little is known about health care professionals' [HCPs] SRH history-taking practices and experiences. This paper describes HCPs' interdisciplinary practices, experience in conducting SRH taking, and the critical lessons learned to optimize quality SRH care. We conducted 18 focus group discussions in June 2019 in Dar es Salaam, Tanzania, with 60 healthcare practitioners and 61 students in midwifery, nursing, and medicine. We implemented a purposive, stratified sampling design to explore the experiences and perspectives of HCPs regarding providing sexual health services. We employed a grounded theory approach to perform the analysis. We provided seven scenarios to participants to discuss how they would manage SRH health problems. The scenarios helped us evaluate the practice and experience of SRH in Tanzania. Four broad themes and sub-themes emerged during the discussion; 1) SRH history-taking practices and experiences in the health care facilities; 2) the perceived benefit of effective SRH history-taking; 3) Factors hindering the SRH history-taking process; 4) The power of confidence. These findings have implications for strengthening a sexual health curriculum for medical students and continuing education programs for practicing health professionals designed to address the observed health disparities in Tanzania. These findings affirm that proper SRH history-taking requires a conducive environment, knowledge of relevant SRH-related laws and regulations; application of evidence-based techniques; and giving patients autonomy to make decisions for their health while making recommendations regarding standard care. Comprehensive SRH history-taking identifies critical data for illness diagnosis, provides foundational information for risk-reduction behavioural change counselling, and reduces medical costs. Therefore, the primary goal is to optimize health professional training on SRH issues and history-taking skills within the medical interview.

Employee engagement and trust relationships during COVID-19 pandemic: the expanded role of internal communication

Internal communication turns into the most valuable aspect of strengthening the relationship between the organization and employees since it causes employees to become involved in maintaining the organization's sustainability during the crisis, particularly during the COVID-19 pandemic. By interviewing 10 Human Resource Officers, this study examines how to engage with the employees and enhance trust relationships through expanding the role of internal communication when COVID-19 was in the air. This study reveals that, as a department with a huge responsibility to build a relationship with employees during the pandemic, Human Resource Officers use various methods to communicate with the employees, including face-to-face and mediated communication. Internal communication built in this pandemic encourages trust and engagement with the employees. Human Resource Officers expand their internal communication role to strengthen employee engagement and build trust relationships, particularly in mediated communication. This study advances knowledge of the significance of human resource officers' roles in selecting internal communication strategies to foster employee engagement and trust during times of crisis.

"Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States.

Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap. This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods. Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic. Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.

Corpus-semantic analysis of the value of trust in phraseology (on the material English, German, Russian and Chechen)

The article is devoted to the study of the value of trust in the phraseology of English, German, Russian and Chechen. Semantic, corpus, comparative analysis of idioms by taxa is carried out: complete trust, formation of trust, destruction of trust. In English, Russian and Chechen, trust is associated with faith. In German contexts, a negative attitude towards blind and complete trust is reflected, the importance of having reliable data is emphasized. In Russian, idioms express the meaning of “seeking trust,” which requires effort. In Russian, trust is community, ownership, work, language. In the Chechen language, trust is highly appreciated and must be achieved, earned. In the contexts of the use of idioms, the theme of the language factor and speech communication in the process of building trust relationships also develops. In all languages, a common language model of trust is built, which includes communication participants, communication content, semantic and connotative aspects. In different languages, the value of trust is expressed through the prism of human relations and character properties, as openness, kindness, community. Data from the British National Corps, the Corps of Modern American Language, the National Corps of the Russian Language showed that in different languages quasi-equivalent idioms are characterized by different frequencies of use.

Medical interview in the system of dental care providing to patients with special needs

Among the leading trends in the field of medicine – improving the quality of various services; focus on individually targeted care, experience and needs of patients; creating equal opportunities and favorable treatment conditions. Relevant in this context is the “Cambridge guide to the medical interview” designed to identify effective communication skills between physician and patient and to provide a sound framework for their analysis. To solve the two leading tasks, an adapted interview model for dentists was developed and tested, taking into account the communicative needs of patients with severe hearing impairment (to the general tasks of “providing structure”, “building the relationship”), which are cross-cutting for each stage of medical interview, “ensuring a universal design of the environment” included, before the stage of “initiating the session” an additional “selection of priority means of communication/necessary adaptations”, etc.) was proposed. Based on the described modern approaches to building trusting relationships in medical practice, taking into account the adapted version of the interview, the key components of working with patients with special needs (hearing impairment) in dentistry are identified.