Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Väntrum och ångest har en stark koppling med varandra. Majoriteten av Sveriges befolkning besöker ett väntrum som patient minst en gång per år. I dagsläget planeras belysningen i första hand för vårdpersonalens behov och förutsättningar. På grund av detta blir ljusmiljön och väntrumsupplevelsen för patienter kan bli lidande. För att kunna skapa tillfredställande väntrumsmiljöer undersöktes det om det finns någon koppling mellan ångest och ljusnivå. I studien undersöktes även ljusupplevelsen och inverkan av fönster med utsikt på patienters ångest.  Studien undersökte påverkan av låg och hög belysningsstyrka samt påverkan av fönster på ångest. Dessutom undersöktes hur olika rumsutformning och belysningslösning påverkar upplevelsen av ljusmiljön och miljöns inverkan på måendet. Med hjälp av en förstudie kunde ett experiment utformas där fyra olika ljusscener testades. För att undersöka om fönster och utsikt har en påverkan, har två typrum skapats: ett med fönster och ett utan fönster.  Deltagarna i studien bestod av 16 kvinnor och 8 män med en blandning av studenter och yrkesverksamma som fick svara på 5 enkäter. Enkäter utvecklades från väl validerade metoder för att få svar från deltagarna angående hur de har mått de senaste två veckorna. Även hur deltagarna kände och upplevde ljusscenerna under experimentet, detta för att kunna besvara studiens frågeställningar.  Resultatet visade inga signifikanta skillnader gällande belysningsstyrkans eller fönsters påverkan på ångest. Men resultatet visade också att det fanns signifikanta skillnader i ljusupplevelsen när det kommer till ljushet, trygghet, ljusfärg samt bländning. Slutsatsen av studien är att belysningen kan påverka ljusupplevelsen och måendet. Men mer forskning behövs när det kommer till belysningsstyrkans samt fönster och utsikts påverkan på ångest. / Waiting rooms and anxiety have a strong connection with each other. Most of the Sweden's population visit a waiting room as patient at least once a year. At present, the lighting is primarily planned for the health professionals´ needs and conditions. Because of this, the lighting environment and the waiting room experience for patients suffers. To be able to create satisfying waiting room environments, this study wants to examine whether there is a connection between anxiety and light level. Also, it studies how the light will be experienced and if windows with views affects patient’s anxiety.  The study examined the influence of low and high illuminance and the influence of windows on anxiety. In addition, it was investigated how different room shapes and lighting solution affect the experience of the light environment and the environmental impact on the mood. With the help of a prestudy, an experiment could be designed where four different light scenes were tested. To investigate whether windows and views have an impact, two types of test rooms have been created: one with windows and one without windows. The participants in the study consisted of 16 women and 8 men with a mixture of students and professionals who had to answer 5 questionnaires. The questionnaires were developed from well-validated methods to get answers from the participants regarding how they have felt the last two weeks. Also, how the participants felt and experienced the light scenes during the experiment, in order to be able to answer the questions of the study.  The result showed no significant differences regarding the effect of illuminance or window on anxiety. The result showed however that there were significant differences in the light experience when it comes to brightness, safety, colour of the light and glare. The conclusion of the study is that the lighting can affect the light experience and the mood. But more research is needed when it comes to illuminance and windows and views impact on anxiety.

É recente a preocupação com as experiências dos portadores de tumor cerebral e as de seus familiares. O intenso impacto físico e psicossocial da doença sobre os pacientes e as repercussões em seu meio familiar, as adversidades do tratamento e o prognóstico desfavorável traçam um quadro muito severo, até mesmo em comparação com outros tipos de câncer. Neste contexto, o objetivo do presente trabalho é realizar uma aproximação compreensiva às experiências vividas por pessoas com tumor cerebral e pelos seus familiares. Os colaboradores da pesquisa, pacientes com diferentes diagnósticos de tumor cerebral e seus acompanhantes, freqüentaram sessões de grupo de sala de espera no Ambulatório de Neurocirurgia Oncológica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP. Para constituir o material discursivo, base da tarefa compreensiva, sete sessões de grupo foram gravadas em áudio e, posteriormente, transcritas integralmente. A orientação, em questões de método, segue uma perspectiva qualitativa em psicologia fundamentada na fenomenologia e as reflexões sobre o vivido fundamentam-se no pensamento de Maurice Merleau-Ponty. Na compreensão dos relatos analisados, duas questões ganharam evidência. Primeiramente, a de que a experiência do adoecimento para os pacientes, e decerto para os familiares, é marcada pelo sentido de que a vida presente é muito diferente da de outrora. Há como que um choque entre o eu-corpo atual e o eu-corpo passado. Em segundo lugar, é notável a restrição pessoal que marca esta experiência do enfermo. Tal restrição revela-se nas perturbações da motricidade, da linguagem e da sexualidade; nos temores e angústias que o assaltam; nas relações estabelecidas em família, marcadas por uma superproteção que cerceia e pela dependência em relação aos cuidados do outro; e nas experiências com o meio social extra-familiar que despertam vergonha e o ímpeto de se isolar. Quanto aos familiares, a sua experiência é pautada, sobretudo, no esforço para oferecer um cuidado que favoreça o bem-estar da pessoa enferma. Contudo, os cuidadores vivenciam uma intensa carga de preocupações e temores que os levam a uma atitude, por vezes, superprotetora. Ademais, os familiares da pessoa portadora de tumor cerebral também experienciam perdas pessoais e um grande desgaste físico e emocional. Alguns elementos da filosofia de Merleau-Ponty possibilitaram a elaboração e o enriquecimento das compreensões anteriormente destacadas. Somos um corpo dirigido incessantemente para o mundo e este corpo que somos não é o corpo do qual se fala no âmbito do conhecimento biomédico, mas um corpo fenomenal, o corpo vivido. Por conseguinte, nos casos mais graves de tumor cerebral, o movimento da pessoa em direção ao mundo pode ser severamente prejudicado. Destaca-se, ainda, a noção de que são construídas atitudes frente ao adoecimento, ou seja, movimentos do ser no mundo regidos por uma estrutura de conjunto existencial que contém, de maneira essencial, o acontecimento orgânico limitante. Por fim, explorou-se a idéia de que qualquer atitude frente à doença mobiliza todas as dimensões do ser, tendo sido abordadas, mais especificamente, a temporalidade e o ser com o outro na experiência dos colaboradores deste estudo. / Preoccupations with the experiences of brain tumor patients and their family members are recent. The disease’ intense physical and psychosocial impact on patients and the repercussions for their family environment, the adversities of treatment and the unfavorable prognosis result in a very serious picture, even in comparison with other types of cancer. In this context, this study aims to understand the experiences of brain tumor patients and their family members. The research collaborators, who were patients with different brain tumor diagnoses and their companions, attended waiting room group sessions at the Oncological Neurosurgery Outpatient Clinic of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. For the discourse material, which formed the base for the comprehension task, seven group sessions were audio-taped and fully transcribed. A qualitative method was adopted, using a phenomenology-based psychology, while reflections on the experience were based on the ideas of Maurice Merleau-Ponty. In understanding the analyzed reports, two issues stood out. Firstly, for the patients, and definitely for the family members, the sickening experience is marked by the sense that the current life is very different from the past. There is as if it were a shock between the I-current body and the I-past body. Secondly, the patient’s experience is marked by a noticeable personal restriction. This restriction appears in movement, language and sexuality disturbances; in the fears and anguish the patient is attacked by; in the family relations that are established, marked by a limiting overprotection and by the dependence in relation to other persons’ care; and in the experiences with the extra-family social environment, which arouse shame and the urge to get isolated. As to family members, their experience is mainly guided by the effort to offer a care that favors the ill person’s well-being. However, caregivers bear an intense burden of preoccupations and fears that lead to a sometimes overprotective attitude. Furthermore, the brain tumor patient’s family members also experience personal losses and great physical and emotional wear. Some elements in Merleau-Ponty’s philosophy made it possible to elaborate and enrich the comprehensions highlighted above. We are a body that is continuously directed at the world and this body we are is not the body discussed in the field of biomedical knowledge, but a phenomenal body, the lived body. Consequently, in the gravest cases of brain tumor, the person’s movement towards the world can be seriously impaired. Another notion that stands out is the fact that attitudes are constructed towards the sickening, that is, movements of the being in the world that are ruled by an existential structure that essentially contains the limiting organic event. Finally, the idea was explored that any attitude towards the disease mobilizes all dimensions of the being, more specifically temporality and being with the other in the experience of this study’s collaborators.

This study explores the experiences of relatives waiting. Often relatives wait for considerably long periods, especially in critical care areas, whilst their loved one, whose health status is unknown, receives care. To explore these experiences and to understand the symbolic meaning behind the participants’ stories, a grounded theory approach was utilised which is firmly rooted in the sociological theory of symbolic interactionism. A qualitative approach was employed in order to yield a rich description of the human experience often not found in quantitative studies (Jamerson, Scheibmeir, Bott, Crighton, Hinton and Kuckelman, 1996, p. 468). Similarly, the use of feminist principles to guide this study has facilitated a greater understanding of such issues as gender roles, language, power and hierarchy. Using grounded theory methodology, audio-taped interviews were conducted with six female relatives who were recruited using theoretical sampling. Simultaneous recruitment, data collection, analysis and literature review took place, as advocated and outlined by Barney Glaser and Anselm Strauss (1967). The overarching core category discovered using this approach which epitomises the waiting experience, is the balancing of both positive and negative aspects of the four codes identified. These four codes are -mothering, trust, flustered anxiety and institutional and medical power. Each code had negative aspects, such as being denied the felt need to mother the critically ill loved one, being asked to entrust the health of a loved one to people that relatives had never met, feelings of fluster and anxiety, and a perception that they would interfere with medial care if they were to be involved in their loved one’s care. Conversely, each code could potentially have a positive aspect, such as being involved in the care of the loved one, feelings of relief once the care of the loved one was entrusted to ‘professional’ health care providers, affiliating with other relatives who were waiting in similar circumstances, and receiving frequent information from staff. A final model was produced that illustrates the balance that many relatives aspire to when waiting in the Emergency Department waiting room. If the balance tips in favour of the negative aspects of the codes, a negative impact on the relative’s feelings of well being can result.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

É recente a preocupação com as experiências dos portadores de tumor cerebral e as de seus familiares. O intenso impacto físico e psicossocial da doença sobre os pacientes e as repercussões em seu meio familiar, as adversidades do tratamento e o prognóstico desfavorável traçam um quadro muito severo, até mesmo em comparação com outros tipos de câncer. Neste contexto, o objetivo do presente trabalho é realizar uma aproximação compreensiva às experiências vividas por pessoas com tumor cerebral e pelos seus familiares. Os colaboradores da pesquisa, pacientes com diferentes diagnósticos de tumor cerebral e seus acompanhantes, freqüentaram sessões de grupo de sala de espera no Ambulatório de Neurocirurgia Oncológica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP. Para constituir o material discursivo, base da tarefa compreensiva, sete sessões de grupo foram gravadas em áudio e, posteriormente, transcritas integralmente. A orientação, em questões de método, segue uma perspectiva qualitativa em psicologia fundamentada na fenomenologia e as reflexões sobre o vivido fundamentam-se no pensamento de Maurice Merleau-Ponty. Na compreensão dos relatos analisados, duas questões ganharam evidência. Primeiramente, a de que a experiência do adoecimento para os pacientes, e decerto para os familiares, é marcada pelo sentido de que a vida presente é muito diferente da de outrora. Há como que um choque entre o eu-corpo atual e o eu-corpo passado. Em segundo lugar, é notável a restrição pessoal que marca esta experiência do enfermo. Tal restrição revela-se nas perturbações da motricidade, da linguagem e da sexualidade; nos temores e angústias que o assaltam; nas relações estabelecidas em família, marcadas por uma superproteção que cerceia e pela dependência em relação aos cuidados do outro; e nas experiências com o meio social extra-familiar que despertam vergonha e o ímpeto de se isolar. Quanto aos familiares, a sua experiência é pautada, sobretudo, no esforço para oferecer um cuidado que favoreça o bem-estar da pessoa enferma. Contudo, os cuidadores vivenciam uma intensa carga de preocupações e temores que os levam a uma atitude, por vezes, superprotetora. Ademais, os familiares da pessoa portadora de tumor cerebral também experienciam perdas pessoais e um grande desgaste físico e emocional. Alguns elementos da filosofia de Merleau-Ponty possibilitaram a elaboração e o enriquecimento das compreensões anteriormente destacadas. Somos um corpo dirigido incessantemente para o mundo e este corpo que somos não é o corpo do qual se fala no âmbito do conhecimento biomédico, mas um corpo fenomenal, o corpo vivido. Por conseguinte, nos casos mais graves de tumor cerebral, o movimento da pessoa em direção ao mundo pode ser severamente prejudicado. Destaca-se, ainda, a noção de que são construídas atitudes frente ao adoecimento, ou seja, movimentos do ser no mundo regidos por uma estrutura de conjunto existencial que contém, de maneira essencial, o acontecimento orgânico limitante. Por fim, explorou-se a idéia de que qualquer atitude frente à doença mobiliza todas as dimensões do ser, tendo sido abordadas, mais especificamente, a temporalidade e o ser com o outro na experiência dos colaboradores deste estudo. / Preoccupations with the experiences of brain tumor patients and their family members are recent. The disease’ intense physical and psychosocial impact on patients and the repercussions for their family environment, the adversities of treatment and the unfavorable prognosis result in a very serious picture, even in comparison with other types of cancer. In this context, this study aims to understand the experiences of brain tumor patients and their family members. The research collaborators, who were patients with different brain tumor diagnoses and their companions, attended waiting room group sessions at the Oncological Neurosurgery Outpatient Clinic of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. For the discourse material, which formed the base for the comprehension task, seven group sessions were audio-taped and fully transcribed. A qualitative method was adopted, using a phenomenology-based psychology, while reflections on the experience were based on the ideas of Maurice Merleau-Ponty. In understanding the analyzed reports, two issues stood out. Firstly, for the patients, and definitely for the family members, the sickening experience is marked by the sense that the current life is very different from the past. There is as if it were a shock between the I-current body and the I-past body. Secondly, the patient’s experience is marked by a noticeable personal restriction. This restriction appears in movement, language and sexuality disturbances; in the fears and anguish the patient is attacked by; in the family relations that are established, marked by a limiting overprotection and by the dependence in relation to other persons’ care; and in the experiences with the extra-family social environment, which arouse shame and the urge to get isolated. As to family members, their experience is mainly guided by the effort to offer a care that favors the ill person’s well-being. However, caregivers bear an intense burden of preoccupations and fears that lead to a sometimes overprotective attitude. Furthermore, the brain tumor patient’s family members also experience personal losses and great physical and emotional wear. Some elements in Merleau-Ponty’s philosophy made it possible to elaborate and enrich the comprehensions highlighted above. We are a body that is continuously directed at the world and this body we are is not the body discussed in the field of biomedical knowledge, but a phenomenal body, the lived body. Consequently, in the gravest cases of brain tumor, the person’s movement towards the world can be seriously impaired. Another notion that stands out is the fact that attitudes are constructed towards the sickening, that is, movements of the being in the world that are ruled by an existential structure that essentially contains the limiting organic event. Finally, the idea was explored that any attitude towards the disease mobilizes all dimensions of the being, more specifically temporality and being with the other in the experience of this study’s collaborators.

In this bachelor thesis, a prototype of a digital tool is designed, aimed at self-registering patient data in an emergency ward. Normally, patients not arriving by ambulance are treated in the order they enter the waiting room. Nurses performing the first examination—a triage—must ask the patient about their identity, previous medical history and similar questions, and enter this data into a new treatment case in the healthcare information system. It has been suggested that having the patient enter this data themselves would be beneficial, allowing nurses to concentrate on the medical issues. After gathering and analyzing data from observations and from interviews with the staff at a Swedish hospital, a prototype of a digital tool was designed, where patients step-by-step could enter the required data in the waiting room, thus saving valuable time in the triage. Benefits for the patient include receiving feedback about the number of persons ahead in line. The prototype was received favorably by test persons and by the staff, indicating that it could work as a model for a product to be put into work use.

Notaufnahmen und Rettungsdienste bilden ein in sich geschlossenes System. Die Schnittstelle beeinflusst maßgeblich den Arbeitsverlauf des Rettungsdienstes. Außerdem führen die steigenden Patientenzahlen zur Überlastung von Notaufnahmen, wodurch auch Rettungsdienste in ihrer Funktionalität eingeschränkt werden. Bei überlasteten Notaufnahmen kommt es zu einer verzögerten Behandlung aller Patient:innen, auch derer, die durch den Rettungsdienst angeliefert wurden. In der vorliegenden Arbeit wird analysiert, inwiefern die Architektur das Problem einer überlasteten Notaufnahme beeinflusst. Dazu wurde ein Fragebogen erstellt, welcher online vom medizinischen Personal ausgefüllt wurde. Die Ergebnisse aus dem Fragebogen zeigen, dass Patient:innen und Rettungsdienstpersonal mehrmals täglich zwischen 5 bis 30 Minuten warten müssen, bis die Übergabe zum Notaufnahmepersonal stattfindet. Dies geschieht meistens in einem nicht zum Warten vorgesehenen Flur, welcher von Patient:innen und Personal als schlecht gestalteter Raum betrachtet wird. Spezielle Räumlichkeiten für das überwachte Warten und die Übergabe von Rettungsdienstpatient:innen verbessern die Wartezeit für Patient:innen und Personal.

MRI is one of the biggest and most growing imaging techniques. Even though itis one of the most harmless technologies a big portion of the patients experienceanxiety during the exam. By improving the patient experience unnecessary psychologicalstress for the patient can be prevented, the patient movement wouldthen decrease and therefore the imaging can be improved without changing thetechnique. Participant observations at four dierent MRI departments werecompleted with six interviews with radiographers and technical MRI personnelin order to get insight in the work around an MRI exam and the problemsthat patients experience. The data collection resulted in three improvementareas: the atmosphere of the waiting room, the atmosphere of the MRI roomand the headset used by the patient during the MRI exam. These improvementareas were paired up with solution suggestions which were then controlled andcommented by one MRI specialist, one MRI developer and one radiographer tovalidate the suggestions. The conclusion was that there is already much doneto improve the environment in the MRI room, even though more can be done.The waiting room, on the other hand ,has not been an object for studies orfor improvements before. Therefore more calculation about how big of a protit could be, to improving the atmosphere in the waiting room, should be doneso one knows how much resources one can be put into that improvement area.Lastly there are potential solutions for how to create a much better headset butbecause the generated solutions in this area are so technically challenging moreresearch has to be done before it can be realised. / MR är en av de största och mest växande medicinsk bildgivande teknikerna som finns. Även om tekniken är helt ofarlig är det många patienter som lider av ångest kopplad till undersökningen. Genom att förbättra patientens upplevelse kan man förbygga den ångesten, då kommer också patienten kunna ligga mera still under undersökningen och därför kommer bilderna kunna förbättras utan att ändra tekniken.Datainsamlingen bestod av deltagande observationer på fyra olika röntgenavdelningar tillsammans med sex stycken intervjuer med både röntgensköterskor och personal som jobbar med MR-tekniken. Detta för att få en inblick i jobbet runt en MR undersökning och problemtiken som patienterna upplever. Datainsamlingen resulterade i tre olika förbättringsområden: väntrummet, undersökningsrummet och headsetet som patienten använder under MR-undersökningen. Dessa förbättringsområden parades ihop med förbättringsförs-lag och validerades sedan med en MR speciallist, en utvecklare och en röntgensköterska.Slutsatsen var att det idag görs mycket för att förbättre miljön i undersökningsrummet, även om mycket mer kan göras. Väntrummet, och andra sidan, har inte varit föremål för varken studier eller förbättringar och därför behöver uträkningar göras på hur stor vinst det skulle vara med en förbättrad miljö där för att veta hur mycket resurser som kan läggas på det. Till sist kan det konstateras att det finns potentiella lösningar för hur ett bättre headset skulle kunna skapas, men eftersom de förslagen som genererats i den här studien är så tekniskt avancerade behövs mer forskning för att kunna realisera lösningarna.

The aim of the master’s thesis is a project documentation of an farm building. It is a new building of stable for breeding of cows of Holstein cattle and accessories necessary for securing it is operation. The building is located in the cadastral territory of municipality Chromeč, district Šumperk. Base consist of a single building object and a stable construction builds up a second object. These two objects are operationally linked and they are connected by the gangway. The stable is designed for a maximum of 278 heads of Holstein cattle. The stable is a single-storey indoor building. In the background there are rooms and equipment necessary to procuring stable operation. A Base is a brick object with two floors. On the ground floor is a waiting room, parlour, technical facilities, rooms for a production of cheese and a cheese shop. Attic there is a background of employees, which is only over a part of the object. Roofs are slanting saddle-shaped. Building estate is situated in the flat terrain.