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Forty-four introductory psychology students from Virginia Tech took part in a study concerning manning levels and the perception of crowding and related experiences. A new apparatus was designed and built (an HO-gauge train set) to manipulate manning level, physical constraint (using two different control designs), and cognitive load, variables suggested as important in the perception of crowding. Two methods of manipulating manning level were attempted: 1) changing the task and keeping the number of participants constant, and 2) Changing the number of participants and keeping the task constant. The former was found to be more successful in this study, the latter apparently confounded with the number of participants in the group. Both physical constraint and cognitive load affected the participants' expressed experiences. The results indicate that physical constraint had a more consistent negative impact on subjective experiences than did cognitive load. / Master of Science

This study examines the concept of authenticity as applied at Appomattox Court House National Historical Park (ACHNHP). Based on past theoretical research, a functional definition of authenticity is used in an effort to test whether or not visitors to the park come for reasons relating to authenticity. Further analyses are used to determine the relative importance of authenticity to other motivational reasons for visiting the park, and how the level of authenticity experienced at ACHNHP affects how respondents rate the importance and performance of many park setting attributes. Using motivation for authenticity and importance/performance variables as predictors, visitor knowledge, perceptions of crowding and conflict, and overall satisfaction are assessed. The results suggest that while authenticity is important for park visitors, experience outputs are difficult to forecast because of correlation among independent variables and homogeneity of park visitors. Recommendations are made for future researchers when examining the concept of authenticity. / Master of Science

This thesis makes a contribution to that part of the economics literature that explores how behavioural economics can inform environmental economics. Theoretically, the thesis develops the concept of environmental morale. Empirically, the study investigates the role of environmental morale on individuals’ behaviour within two different contexts: recycling participation and intertemporal choices over different goods (i.e., money, environment, and health) and outcomes (i.e., gains and losses). Major objectives of this analysis are: to shed light on how environmental morale interplays with individuals’ behaviour under different recycling policy schemes, and to examine whether temporal discounting is domain specific and depends on environmental morale heterogeneity. Original survey investigations are employed to analyse these issues. Results highlight the relevance of environmental morale both in motivating individuals’ contribution to recycling and intertemporal choices towards environmental outcomes. Regarding the interaction between environmental morale, recycling participation and government interventions, results from this analysis suggest that a facilitating nudge policy seems to be relatively more powerful in increasing individuals’ contribution and motivation towards recycling. Considering intertemporal choices, a paradox of hyperopia seems to be located in data provided in this analysis. Some of the original contributions of the thesis are, first the broader reconceptualization of the definition of environmental morale and its operationalization in analyses of questionnaire preferences. Secondly, in line with other areas of research (i.e., tax compliance literature); this study pursues an investigation of individual and cultural differences with respect to recycling policies, an area which has been neglected in the environmental economics literature. In this regard, the analysis considers a comparison between psychology and economics students in Italy and the UK. Thirdly, conditioning discounting on environmental morale offers a unique opportunity to analyse how ethical considerations influence the way individuals form expectations on (near and far distant) future environmental outcomes.

Tiden patienter får vänta och vistas på landets akutmottagningar ökar årligen. Detta i kombination med ett ökat antal vårdsökande och bristen på vårdplatser orsakar fenomenet crowding på akutmottagningen. Ibland uppstår en obalans mellan vårdbehovet och de tillgängliga resurser som finns att tillgå och arbetsbelastningen blir ohållbar. Att det leder till en ökad risk för vårdskada har tidigare forskning visat och det utgår ett hot mot patientsäkerheten. Akutsjuksköterskan har till uppgift att säkerställa en säker vård och ansvarar för patientens omvårdnads- och medicinska behov under vistelsen på akutmottagningen. Kan akutsjuksköterskan uppfylla detta krav och inte låta patientsäkerheten påverkas av hög belastning, så kallad crowding?  Syftet med denna studie var att beskriva om och i så fall hur crowding på en akutmottagning kan påverka patientsäkerheten. Metoden som användes var en litteraturöversikt med en integrerad innehållsanalys. Databassökningar genomfördes i PubMed, CINAHL och SwePub med sökorden “emergency department”, “emergency nursing”, “nursing”, “crowding”, “patient safety”, “caring” och “consequences”. Det resulterade i 19 artiklar, ytterligare två artiklar hittades efter manuell sökning. Både kvalitativa och kvantitativa artiklar inkluderades. Artiklarna kvalitetsgranskades och klassificerades sedan enligt Sophiahemmet högskolas bedömningsunderlag. Resultatet sammanställdes genom en integrerad innehållsanalys, vilket ledde till två huvudkategorier där organisatoriska brister och risk för vårdskador blev huvudfynden. Crowding orsakade en stressig arbetsmiljö, förlorad kontroll och ökade väntetider. Sjuksköterskorna upplevde en brist på resurser och en negativ inverkan på omvårdnadsarbetet som följd. Slutsatsen är att crowding påverkar patientsäkerheten ur flera olika perspektiv och utgör ett hinder för akutsjuksköterskan att kunna säkerställa en säker vård. Akutsjuksköterskan får svårigheter att uppfylla de krav som ställs vid crowding, då hon ständigt måste prioritera bort arbetsuppgifter. Detta belyser behovet av en förbättring av patientflödet på akutmottagningarna runt om i världen. / The time patients have to wait and stay in the country's emergency rooms is increasing annually. This in combination with an increased number of care seekers and the lack of care places causes the phenomenon of crowding in the emergency department. Sometimes there is an imbalance between the need for care and the available resources that are available and the workload becomes unsustainable. Previous research has shown that this leads to an increased risk of healthcare injuries, and there is a threat to patient safety. The emergency nurse has the task of ensuring safe care and is responsible for the patient's nursing and medical needs during the stay in the emergency department. Can the emergency nurse meet this requirement and not allow patient safety to be affected by high loads, so-called crowding? The aim of this study was to describe whether and, if so, how crowding in an emergency department can affect patient safety. The method used was a literature review with an integrated content analysis. Database searches were performed in PubMed, CINAHL and SwePub with the keywords "emergency department", "emergency nursing", "nursing", "crowding", "patient safety", "caring" and "consequences". This resulted in 19 items, two more items were found after manual search. Both qualitative and quantitative articles were included. The articles were quality reviewed and then classified according to Sophiahemmet University's assessment basis. The results were compiled through an integrated content analysis, which led to two main categories where organizational shortcomings and the risk of healthcare injuries became the main findings. Crowding caused a stressful work environment, loss of control and increased waiting times. The nurses experienced a lack of resources and a negative impact on the nursing work as a result. The conclusion is that crowding affects patient safety from several different perspectives and constitutes an obstacle for the emergency nurse to be able to ensure safe care. The emergency nurse has difficulty meeting the requirements for crowding, as she constantly has to prioritize tasks. This highlights the need for an improvement in patient flow in the emergency departments around the world.

Ett ökat patientinflöde på akutmottagning är en global trend där hög arbetsbelastning ärkopplad till ökad dödlighet. Tillgången på vårdplatser är en viktig faktor för att påverkaarbetsbelastningen. I Sverige har antalet vårdplatser på sjukhusen under de senastedecennierna minskat. En effekt av det ökade antalet patienter som årligen söker vård påakutmottagning blir en överbelastning vilket leder till crowding och boarding. Konsekvensenblir att sjuksköterskor frångår etiska principer när de utsätts för en hög arbetsbördasamtidigt som inflödet av nya patienter ligger utom sjuksköterskors kontroll. Etisk stress hossjuksköterskor uppstår. Syftet var att belysa sjuksköterskors erfarenheter av etisk stress på akutmottagning. Enkvalitativ intervjustudie genomfördes med semistrukturerade intervjuer av 14 sjuksköterskoroch analyserades med kvalitativ innehållsanalys. Resultatet visade att etisk stress på akutmottagning var ett komplext problem sompåverkades av olika faktorer och resulterade i flera negativa effekter för sjuksköterskor. Etiskstress kunde leda till försämrad återhämtning, en känsla av att negligera patienter, ett fysisktoch psykiskt lidande samt bidra till en försämrad arbetsmiljö. Slutsatsen blev att sjuksköterskors erfarenheter av etisk stress på akutmottagning var vanligtförekommande. Faktorer som påverkade erfarenheten av etisk stressen var högarbetsbelastning, höga krav från lagar, författningar och etiska koder samt sjuksköterskorsmålbild av yrkesrollen. / An increased influx of patients to the emergency department is a global trend where a highworkload is linked to increased mortality. The availability of care places is an importantfactor in influencing the workload. In Sweden, the number of hospital beds has decreased inrecent decades. An effect of the increased number of patients, who annually seek care in theemergency department, becomes an overload, which leads to crowding and boarding. Theconsequence is that nurses deviate from ethical principles when they are exposed to a highworkload while the influx of new patients is beyond the control of nurses. Ethical stress innurses arises The purpose was to shed light on nurses' experiences of ethical stress in the emergencydepartment. A qualitative interview study was conducted with semi-structured interviews of14 nurses and was analyzed with a qualitative content analysis. The results showed that ethical stress in the emergency department was a complex problemthat was affected by various factors and resulted in several negative effects for nurses. Ethicalstress could lead to impaired recovery, a feeling of neglecting patients, physical and mentalsuffering and contribute to a deteriorating work environment. The conclusion was that nurses' experiences of ethical stress in the emergency departmentwere common. Factors that affected the experience of ethical stress were high workload, highdemands from laws, ethical codes and nurses' goal picture of the professional role.

Crowding på akutmottagningar är ett problem som pågått under flera år och som kan leda till ökade omvårdnadsåtgärder till patienter som stannar kvar på akutmottagningen i väntan på en vårdplats. Många av dessa patienter är gamla och sköra och med ett stort omvårdnadsbehov. Efter en granskning av Inspektionen för Vård och Omsorg (IVO) på akutmottagningen på Huddinge sjukhus utarbetades omvårdnadsmål för att fungera som stöd i omvårdnadsarbetet. Syftet med denna studie var att sammanställa vilka omvårdnadsåtgärder som påverkas vid crowding på akutmottagningen och hur detta i sin tur påverkar patienten. Metod som använts är en litteraturöversikt med systematisk ansats och datasökningarna har utförts i Cinahl och PubMed där sökningarna genererade 25 originalartiklar med utgångspunkt i litteraturöversiktens syfte. Artiklarna är till största del med kvantitativ ansats och kvaliteten på artiklarna har genomgående bedömts som god. Analyseringen av artiklarna har gjorts med en integrerad analys. Omvårdnadsåtgärder har kategoriserats enligt Fundamentals of Care´s akuta vårdprocess. Den akuta vårdprocessen är uppdelad som initial bedömning, utförande av omvårdnadsåtgärder, övervakning och vidare bedömning och dokumentation. Resultatet i studien visar att crowding påverkar omvårdnaden av patienterna på akutmottagningen. Störst påverkan ses i omvårdnaden av patienten vid triagering, läkemedelshantering och följsamhet till riktlinjer för behandling av patienten på akutmottagningen. Slutsatsen är att en rad olika omvårdnadsåtgärder påverkas av crowding. Flertal risker har identifierats beträffande patientens omvårdnad på akutmottagningen då det råder crowding. Omvårdnadsåtgärder med störst påverkan vid crowding var den initiala bedömningen av patienten och läkemedelsadministreringen. Som patient att befinna sig på akutmottagningen då det råder crowding är en patientsäkerhetsrisk. Resultatet överensstämmer inte med de framtagna omvårdnadsmålen på akutmottagningen. / Crowding in emergency department is a problem that has been going on for several years, which in turn can lead to increased nursing measures for patients who remain in the emergency department while waiting for a care place. Many of these patients are old and fragile and in great need of care. After a review by Health and Social Care Inspectorate (IVO) the emergency department at Huddinge university hospital, nursing goals were developed to serve as a support tool in the nursing work. The aim of this study was to compile which nursing measures are affected by crowding in the emergency department and how this in turn affects the patient. The method used is a literature review with a systematic approach and the data searches have been performed in Cinahl and PubMed, where the searches generated 25 original articles based on the purpose of the literature review. The articles are mostly with a quantitative approach and the quality of the articles was consistently of good quality. The analysis of the articles has been done with an integrated analysis. Nursing measures were categorized according to the Fundamentals of Care´s acute care process. The acute care process is divided into initial assessment, execution of nursing measures, monitoring and further assessment and documentation. The results of the study show that crowding affects the care of patients in the emergency department, The greatest impact is seen in the care of the patient during triage, medication handling and compliance with guidelines for treatment of the patient in the emergency department. The conclusion is that a number of different nursing measures are affected by crowding. Several risks have been identified regarding the nursing of the patient in the emergency department as there is crowding. Nursing measures with the greatest impact from crowding were the initial assessment of the patient and drug administration. As a patient, being in the emergency department when there is crowding is a patient safety risk. The result does not correspond with the developed nursing goals at the emergency department.

Quand un stimulus visuel de haut contraste précède et puis succède à la présentation d'une cible de faible contraste à la même position, la cible peut devenir non-reconnaissable ou même non-détectable. Cet effet de masquage a été étudié en profondeur et beaucoup de ses paramètres sont bien définis. Mais en utilisant une nouvelle méthode avec une séquence de masques et de cibles en mouvement, il est maintenant possible de séparer de manière perceptuelle et attentionnelle la cible des masques tout en conservant l'ordre d'apparition des masques et de la cible à chaque endroit. Cette thèse utilise cette technique de stimuli en mouvement pour répondre à trois questions qui ne pourraient pas être résolu en utilisant une méthode de masquage conventionnelle. Dans la première série d'expériences on a testé si l'attention portée au masque influence l'impact de celle-ci sur la cible. Nous avons utilisé un écran où une séquence masque-cible-masque apparaît à une position puis à chaque 'frame' suivant elle apparaît à la position adjacente. Cette méthode permet à l'observateur de suivre attentionellement la cible sur son trajet, tout en évitant les masques distracteurs qui paraissent être à côté de la cible spatialement et non temporellement. Quand les masques sont efficaces, la position de la cible paraît être vide. Nous comparons l'efficacité du masquage quand l'attention n'est pas dirigée vers les masques, à l'efficacité du masquage quand l'attention ne peut pas éviter les masques, comme dans le masquage conventionnel. Nous n'avons trouvé aucune différence significative entre les deux conditions attentionnelles, ce qui indique que l'attention portée sur les masques ne module pas leur efficacité. Ensuite nous avons testé l'importance de l'espacement dans la séquence masque-cible-masque. Il n'y avait pas plus de masquage quand les espacements étaient réduits, ce qui suggère que le masquage n'est pas le résultat de masquage latéral ou de 'crowding' (encombrement spatial) aux distances testées. Enfin nous avons comparé la contribution de chaque masque: celui qui précède la cible (le pré-masque) et celui qui suit la cible (post-masque). Nous avons trouvé que le pré-masque génère la majorité de l'effet de masquage tandis que le post-masque a peu d'influence. Dans la seconde série d'expériences nous avons étudié ce qu'il advient du stimulus masqué. En baissant le contraste de la cible juste en dessous de son seuil de détection et en lui donnant une couleur saillante, nous avons découvert un stade intermédiaire où les caractéristiques ('features') de la cible sont reportées à la position d'un des masques. Avec une série d'expérience nous avons montré que la cible est intégrée avec le masque qui la suit directement et temporellement à la même position. Finalement nous avons étudié si un stimulus qui est masqué à un niveau invisible peut quand même exercer une influence sur une cible proche dans un arrangement de crowding. Nous avons comparé la détection d'une cible avec deux flankers (distracteurs adjacent) dans la zone de crowding, à la détection d'une cible quand les deux flankers sont masqué et que leur position paraît être vide. Pour conclure, la méthode de séquence en mouvement a révélé de nouvelles caractéristiques du masquage qui ne pouvaient pas être examinées en utilisant des techniques de masquage conventionnelles. Premièrement nous avons découvert que l'efficacité du masque est comparable que l'attention soit dirigée sur le masque ou non. Deuxièmement nous avons montré que les caractéristiques d'une cible qui est supprimée à sa position physique peuvent apparaître à la position du masque qui la suit temporellement. Et finalement, nous avons examiné l'effet de flankers masqués sur une cible dans un arrangement de crowding. / When high contrast visual stimuli precede and follow a low contrast target at the same location, the target may become unrecognizable and even undetectable. This masking effect has been extensively studied and many of its parameters are well characterized. However, using a new technique with a moving sequence of masks and targets it is now possible to perceptually and attentionally separate the target from the masks while retaining the same temporal order of masks and target at each location. This thesis exploits this moving stimulus technique to ask three questions that could not be addressed in standard masking paradigms. In the first series of experiments we looked at whether attention to the mask affected its impact on the target. We used a display where the mask-target-mask sequence appears at one location and on each subsequent frame it appears in the adjacent location. This allows observers to attentively track the target across locations without attending to the masks which appear perceptually adjacent in space rather than in time. When the masks are effective, the observer sees a blank space at the target location. We compare the effectiveness of this masking when the masks are unattended to the effectiveness when the masks are attended as in standard masking. We found no significant difference between the two attentional conditions suggesting that attention to the masks does not modulate their effectiveness. We next examined the importance of the spacing within the mask-target-mask sequences. There was no increase in the masking effect as spacing was reduced, suggesting that the masking was not a consequence of lateral masking or crowding at the spacings we tested. Finally, we compared the contributions of each mask individually: the one that preceded the target (pre-mask) and the one that followed (post-mask). We found that the pre-mask generated the majority of the masking effect while the post-mask was of little influence. In the second series of studies we investigated the fate of a masked stimulus. By lowering the target contrast just below its detection threshold and giving it a salient color, we found an intermediate, "lurking" stage where the target's features migrate to one of the mask locations. Through a succession of experiments we found that the target is integrated with the mask directly following it in time at the same location. Finally we looked at whether a stimulus that is masked to invisibility can still exert influence over nearby targets in a crowding array. We compared the detection of a crowded target with two flankers, compared to the detection of a target when the two adjacent flankers are masked so that their locations appear empty. In conclusion, the moving sequence technique revealed new characteristics of masking that could not be examined in standard masking paradigms. First, we found that the effectiveness of a mask was the same whether it is attended or not. Second, we showed that once a masked target has been suppressed from its physical location, its features can be found "lurking" at the location of the mask that follows the target in time. Finally, we examined the effect of masked flankers on a target in a crowding paradigm.

This thesis presents a reanalysis of data collected between 1999 and 2006 by the Institute for Outdoor Recreation and Tourism (IORT) at Utah State University. These data concern a variety of outdoor recreation sites in Utah, Idaho, and South Dakota, and were collected via intercept, mail, and, to a very limited extent, telephone surveys. Survey instruments contained questions related to visitor perceptions of crowding, overall satisfaction, support for use limits/rationing, and estimates of use density, in addition to other conceptually related factors. Analyses consisted of multiple regression models for both perceived crowding and visitor support for use limits dependent variables for each suitable data set. These were intended to ascertain the dependent variables' relationships with various factors hypothesized to contribute to both crowding perceptions and a perceived need for use limits--notably variations in use level. This thesis also incorporated bivariate and univariate analyses intended to investigate the relationship between perceived crowding and satisfaction, reasons for respondent support for use limits, and the potential of displacing visitors to similar recreation sites via use rationing. Side-by-side comparison of results yielded several interesting findings. First, use level was the variable most consistently showing a statistically significant association with perceived crowding. However, the amount of variation explained by use level variables was small, particularly from a managerial perspective. Results suggested support for use limits may have more to do with fears about potential changes in future conditions than actual on-site crowding. Results were not suggestive of a strong or consistent relationship between perceived crowding and satisfaction. Apprehensions about crowding were the most prevalent stated reason for respondents' support of use rationing, but concerns about safety at motorized (land- and water-based) sites were also a major factor, as was recreational conflict, though to a lesser extent. Results of all analyses highlighted the uniqueness of each study area. Overall, results suggested crowding-based recreational carrying capacities may lack utility as a generalized management framework and are perhaps best reserved for sites specifically managed for low use levels or solitude experiences. Results also support calls for regional scale, rather than site-specific, recreation planning.