Acoustic Design in Urban Development : analysis of urban soundscapes and acoustic ecology research in New York City

The world is urbanizing rapidly with more than half of the global population now living in cities. Improving urban environments for the well-being of the increasing number of urban citizens is becoming one of the most important challenges of the 21st century. Even though it is common that city planners have visions of a ’good urban milieu’, those visions are concerning visual aesthetics or practical matters. The qualitative perspective of sound, such as sonic diversity and acoustic ecology are neglected aspects in architectural design. Urban planners and politicians are therefore largely unaware of the importance of sounds for the intrinsic quality of a place. Whenever environmental acoustics is on the agenda, the topic is noise abatement or noise legislation – a quantitative attenuation of sounds. Some architects may involve acoustical aspects in their work but sound design or acoustic design has yet to develop to a distinct discipline and be incorporated in urban planning.My aim was to investigate to what extent the urban soundscape is likely to improve if modern architectural techniques merge with principles of acoustics. This is an important, yet unexplored, research area. My study explores and analyses the acoustical aspects in urban development and includes interviews with practitioners in the field of urban acoustics, situated in New York City. My conclusion is that to achieve a better understanding of the human living conditions in mega-cities, there is a need to include sonic components into the holistic sense of urban development.

Patient participation : what it is and what it is not

In general, patient participation is regarded as being informed and partaking in decision making regarding one’s care and treatment. This interpretation is common in legislation throughout the Western world and corresponding documents guiding health care professionals, as well as in scientific studies. Even though this understanding of the word participation can be traced to a growing emphasis on individuals’ autonomy in society and to certain dictionary defi nitions, there are other ways of understanding participation from a semantic point of view, and no trace of patients’ descriptions of what it is to participate can be found in these definitions. Hence, the aim of this dissertation was to understand patients’ experience of the phenomenon of patient participation. An additional aim was to understand patients’ experience of non-participation and to describe the conditions for patient participation and non-participation, in order to understand the prerequisites for patient participation. The dissertation comprises four papers. The philosophical ideas of Ricoeur provided a basis for the studies: how communication can present ways to understand and explain experiences of phenomena through phenomenological hermeneutics. The first and second studies involved a group of patients living with chronic heart failure. For the fi rst study, 10 patients were interviewed, with a narrative approach, about their experience of participation and non-participation, as defi ned by the participants. For the second study, 11 visits by three patients at a nurse-led outpatient clinic were observed, and consecutive interviews were performed with the patients and the nurses, investigating what they experience as patient participation and non-participation. A triangulation of data was performed to analyse the occurrence of the phenomena in the observed visits. For paper 3 and 4, a questionnaire was developed and distributed among a diverse group of people who had recent experience of being patients. The questionnaire comprised respondent’s description of what patient participation is, using items based on findings in Study 1, along with open-ended questions for additional aspects and general issues regarding situations in which the respondent had experienced patient participation and/or non-participation. The findings show additional aspects to patient participation: patient participation is being provided with information and knowledge in order for one to comprehend one’s body, disease, and treatment and to be able to take self-care actions based on the context and one’s values. Participation was also found to include providing the information and knowledge one has about the experience of illness and symptoms and of one’s situation. Participation occurs when being listened to and being recognised as an individual and a partner in the health care team. Non-participation, on the other hand, occurs when one is regarded as a symptom, a problem to be solved. To avoid non-participation, the information provided needs to be based on the individual’s need and with recognition of the patient’s knowledge and context. In conclusion, patient participation needs to be reconsidered in health care regulations and in clinical settings: patients’ defi nitions of participation, found to be close to the dictionaries’ description of sharing, should be recognised and opportunities provided for sharing knowledge and experience in two-way-communication.

Movies and meaning : studying audience, fiction film and existential matters

In what ways and under what circumstances can a movie be a resource for individuals and their thoughts about existential matters? This central research question has been investigated using a both quantitative and qualitative approach. First, a questionnaire was distributed amongst 179 Swedish students to provide a preliminary overview of film habits. The questionnaire was also used as a tool for selecting respondents to individual interviews. Second, focus group and individual interviews were conducted, with viewers choosing their favourite movie of all time. In the study socio-cognitive theory and a schema-based theoretical tool is adopted to analyze how different viewers make use of movies as cultural products in an interplay between culture and cognition in three contexts; a socio-historic process, a socio-cultural interaction with the world and inner psychological processes. The viewers in the study seem to be inspired by movies as a mediated cultural resource, promoting the development of a personal moral framework with references to values deeply fostered by a humanistic tradition. It is argued that these findings support theories discussing individualised meaning making, developing ‘self-expression values’ and ‘altruistic individualism’ in contemporary western society.

Existential issues in surgical care : Nurses’ experiences and attitudes in caring for patients with cancer

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

An Evaluation of”Middle Ages Dead or Live?”The first interactive exhibition at the National Museum of History

This is a study conducted at, and for, the National Museum of History in Stockholm. The aim of the study was to confirm or disconfirm the hypothesis that visitors in a traditional museum environment might not take part in interactivity in an interactive exhibition. And if they do the visitors might skip the texts and objects on display. To answer this and other questions a multiple method was used. Both non participant observations and exit interviews were conducted. After a description of the interactive exhibits, theory of knowledge and learning is presented before the gathered data is presented. All together 443 visitors were observed. In the observations the visitors were timed on how much time they spent in the room, the time spent on the interactivity, texts and objects. In the 40 interviews information about visitors’ participation in the interactivity was gathered. What interactivity the visitor found easiest, hardest, funniest and most boring.The result did not confirm the hypothesis. All kinds of visitors, children and adults, participated in the interactivities. The visitors took part in the texts and objects and the interactive exhibits.

Elevers möjlighet till reflektion i matematikundervisningen : En studie i grunskolans årskurs 9

Studiens huvudsakliga syfte är att få kunskap kring om och hur elever i skolår 9 stimuleras till reflektion i matematikundervisningen. Den tidigare forskning som presenteras i litteraturgenomgången visar på reflektionens betydelse i lärprocessen och ger riktlinjer för vilka aktiviteter som uppmanar till respektive hämmar elevers reflektion. Genom en kvalitativ fallstudie, med i huvudsak lektionsobservationer som utgångspunkt och med efterföljande lärarintervjuer som stöd, har syftet uppnåtts genom att kartlägga den aktivitet som förekommer i praktiken. Undervisningsaktiviteter som kan uppvisa en positiv respektive negativ effekt på elevers möjlighet till reflektion har vid bearbetning och analys av materialet kunnat urskiljas. Resultatet visar att trots att lärare är positivt inställda till metakognition och ett reflekterande arbetssätt förekommer endast i vissa fall tillfällen då eleven stimuleras till reflektion och denna får ske. Vanligt förekommande i lärares undervisning är situationer som skulle kunna fungera som reflektionsstimulerande om de ges utrymme och reflektionen följs upp. Studiens resultat kan bidra till att påminna och göra lärare medvetna om vilka aktiviteter som stödjer reflektion samt förmedla vikten av att eleverna redan i grundskolans tidigare år undervisas om och utsättas för en undervisningspraktik som kontinuerligt kräver förekomsten av reflektion.

Att göra sig anställningsbar : Om instrumentella identitetspositioner och könad säljbarhet

To make oneself employable – instrumental identity positions and gendered marketability. The article takes up the question of the negotiation of expert discourses in career advice and constructing the self in the practice of CV writing. Drawing on data from semi-structured interviews with 19 students (11 women and 8 men) the stories about job search are analyzed. The concept of discursive positioning is used in order to analyze how the students position themselves in relation to career advice and position the self in CV writing. The results show that the female students had difficulties embodying the position as a marketing self as they described it as conflicting with feelings of ‘who they were’. ‘Being you’ in CVs and job interviews is, further, an ideal that is negotiated in relation to what to display as a job-seeking subject. CV writing involves a process of identifying suitable characteristics in an instrumental manner, but it is also combined with an introspective reasoning and identification to find ‘authentic’ strengths and characteristics in ‘who you are’.

Att tillämpa återkommande mätning av kundnöjdhet i IT-projekt : En vidareutvecklad modell baserad på modellerna American Customer Satisfaction Index (ACSI) och SERVQUAL

I dagens samhälle är det allt viktigare för företag att behålla sina existerande kunder då konkurrensen blir allt hårdare. Detta medför att företag försöker vidta åtgärder för att vårda relationer med sina kunder. Detta problem är även högst relevant inom IT-branschen. Inom IT-branschen är det vanligt att arbeta agilt i IT-projekt. Vår samarbetspartner har sett ett ökat behov av att mäta servicekvalitet på ett återkommande sätt inom IT-projekt, detta för att mäta relevanta variabler som sträcker sig utanför kravspecifikationen. För att mäta framgång gällande detta arbetssätt vill man kunna mäta Nöjd Kund Index (NKI) för att kunna jämföra IT-projekt internt i företaget. Då tidigare forskning visat avsaknad av modeller innehållande både mätning av servicekvalitet samt NKI har lämplig litteratur studerats där det framkommit att modellen SERVQUAL är vedertagen för mätning av servicekvalitet och modellen American Customer Satisfaction Index (ACSI) är vedertagen för mätning av NKI. Detta har legat till grund för arbetets problemformulering och syfte. Syftet med arbetet är att skapa en vidareutvecklad modell för mätning av NKI för att jämföra IT-projekt internt samt återkommande mätning av servicekvalitet inom IT-projekt. Framtagande av denna modell har sedan skett genom forskningsstrategin Design and Creation. Intervjuer har genomförts för kravfångst till den vidareutvecklade modellen. Resultatet av denna forskningsstrategi blev sedan en vidareutvecklad modell baserad på ovan nämnda modeller med återkommande förhållningssätt för mätning av servicekvalitet inom IT-projekt och mätning av NKI för att jämföra IT-projekt internt i företaget. Den framtagna modellen har sedan verifierats genom ytterligare intervjuer med respondenter som innehar god erfarenhet från kundsidan av IT-projekt. Från dessa intervjuer kunde sedan slutsats dras att denna modell är att anse som applicerbar i empirin gällande IT-projekt.

Barnmorskors strategier för att främja fysisk aktivitet under graviditeten : En Kvalitativ Intervjustudie

Fysisk aktivitet är viktigt för att främja hälsa och förebygga ohälsa och bör även rekommenderas till kvinnor under graviditeten. Barnmorskan har en central roll i det hälsofrämjande arbetet då hon ibland är den enda hälso- och sjukvårdspersonal som träffar kvinnan under graviditeten. Det finns rekommendationer för hur mycket den gravida kvinnan bör träna men studier visar att det är få som följer dessa. Barnmorskan upplever det svårt att ge råd och det finns ett behov av att hitta strategier som kan användas i arbetet med att främja fysisk aktivitet. Syftet med denna studie var att beskriva barnmorskors strategier för att främja fysisk aktivitet under graviditeten. Studien utfördes enligt kvalitativ metod där semistrukturerade intervjuer användes för insamling av data som sedan analyserades utifrån tematisk analys. I studien framkom ett flertal olika strategier som barnmorskorna använde för att främja fysisk aktivitet under graviditeten; Att ge råd, Att motivera, Att söka stöd i omgivningen, Att individualisera, Att vårda relationen och Att utveckla. Studien visade också att barnmorskorna upplevde arbetet med att främja fysisk aktivitet som viktigt men svårt. Författarna anser att strategierna är användbara, inte bara av barnmorskan utan även av annan personal inom hälso- och sjukvården som arbetar med att främja fysisk aktivitet under graviditeten.

Anmälningspliktens komplexitet : En kvalitativ studie om förskolepersonals upplevelser av anmälningsprocesser

I föreliggande kvalitativa studie var syftet att undersöka hur förskolepersonal upplever och resonerar i anmälningsprocesser samt vilka aspekter de anser vara främjande respektive hindrande för arbetet i dessa. Studiens empiriska material har samlats in genom fokusgruppsintervjuer och individuella intervjuer. Det övergripande resultatet visar att förskolepersonal upplever anmälningsprocesser som komplexa då de måste förhålla sig till omständigheter på såväl en mikro- som en mezzo- och makronivå. Omständigheterna utgörs bland annat av individuella roller och rollkonflikter, gruppdiskussioner och hänsynstagande till kollegor samt rådande samhällsnormer. Det är också den upplevda komplexiteten i anmälningsprocesserna som gör att förskolepersonal resonerar huruvida en anmälan ska göras eller inte. Detta resultat stämmer väl överens med tidigare forskning gjord på området men är något som inte överensstämmer med lagstiftarens intentioner. Resultatet visar vidare på att förskolepersonal anser det som främjande med stöd och rådgivning från kollegor och andra professioner för att få hjälp med arbetet i anmälningsprocesserna.

Tro, hopp och kärlek : Berättelser om återhämtning från psykisk ohälsa

Syftet med föreliggande studie var att undersöka vilken betydelse hopp, egenmakt samt stigmatisering kan ha i en återhämtningsprocess från psykisk ohälsa. En kvalitativ metod tillämpades och individuella intervjuer med deltagare ur Högskolan Dalarnas erfarenhetspanel genomfördes. För att analysera empirin tillämpades en kvalitativ innehållsanalys som resulterade i följande teman: att bli accepterad, hoppets förutsättningar samt normaliserande. Resultatet visade att hopp snarare var en produkt av återhämtningen än det var en bidragande faktor. Att bli accepterad främjade egenmakt och skyddade mot stigmatisering. Normaliserande faktorer som medmänsklighet och att se till de friska sidorna främjade egenmakt och bröt vanmakt. Uppsatsens resultat kan betraktas som erfarenhetsbaserad kunskap, vilket är en grundförutsättning för en evidensbaserad socialtjänst där brukarperspektivet betonas.

Facilitation of learning in specialist nursing training in the PICU : the supervisors´ concerns in the learning situation

With the aim to unfold nurses’ concerns of the supervision of the student in the clinical caring situation of the vulnerable child, clinical nurses situated supervision of postgraduate nursing students in the Pediatric Intensive Care Unit (PICU) are explored. A qualitative approach, interpretive phenomenology, with participant observations and narrative interviews, was used. Two qualitative variations of patterns of meaning for the nurses’ clinical facilitation were disclosed in this study. Learning by doing theme supports the students learning by doing through performing skills and embracing routines. The reflecting theme supports thinking and awareness of the situation. As the supervisor often serves as a role model for the student this might have an immediate impact on how the student applies nursing care in the beginning of his or her career. If the clinical supervisor narrows the perspective and hinders room for learning the student will bring less knowledge from the clinical education than expected, which might result in reduced nursing quality.

Health problems in elderly patients during the first post-stroke year

BACKGROUND: A wide range of health problems has been reported in elderly post-stroke patients. AIM: The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year. METHODS: A total of 390 consecutive patients, ≥65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission. RESULTS: More than 90% had some health problem at some time during the year, while based on patient record data only 4-8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness. CONCLUSIONS: Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.