| 1. |
- Berntsson, Tommy, et al.
(författare)
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Ambulanssjukvården måste bli jämlik
- 2013
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Ingår i: Helsingborgs Dagblad. - Helsingborg : Helsingborgs Dagblad. - 1103-9388. ; 2013-06-17
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Skiftande vårdkvalité hotar patientsäkerheten inom ambulanssjukvården. Nu måste regeringen och Socialstyrelsen skapa nationella riktlinjer, skriver Nätverket för utbildning av ambulanssjuksköterskor .
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| 2. |
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| 3. |
- Axelsson, Lena
(författare)
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Living with haemodialysis close to death - patients' and close relatives' experiences
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to generate understanding and knowledge a bout the experiences of patients living with haemodialysis, and their close relati ves, near the end of life. In studies I and II we conducted a series of 31 qualitative interviews over a period of 12 months with 8 severely ill patients (aged 66–87) treated with haemodialysis. For study I the text of the interviews was analysed using phenomenological hermeneutics to describe and to el ucidate the meanings of being severely ill living with haemodialysis when nearing end of life. For study II the text was analysed using qualitative content analysis to describe inner thoughts and feelings relating to death and dying of these patients. For studies III and IV, we conducted 14 retrospective qualitative interviews with close relatives of deceased patients treated with haemodialysis about th eir experiences during end of the patient’s life. For paper III the interview text was analysed usi ng phenomenological hermeneu tics to describe and elucidate the meanings of being a close relative at the end of life of a severely ill family member treated with maintenance haemodialysis. For paper IV the text was analysed using qualitative content analysis to describe end of life for the patients from the perspective of their close relatives. The findings of study I suggest that being severely i ll and living with haemodialysis near the end of life means living with suffering from a deteriorating body, a high symptom burden, and dependence on advanced medical technology, simultaneously with r econciliation and well-being. The meanings of living with illness and dialysis are intertwined with the meanings of being old. Study II shows that thoughts and feelings about deat h and dying are significant and complex for those living with haemodialysis as they approach the end of life. Patients experience a multifaceted presence of death. Their awareness of approaching death may include their repressing of thoughts of death, not as denial, but to allow them to focus on living as fully as possible the time they have left. Study III shows that close relatives strive to maintain balance and well-being for themselves and for the patient, which we interpreted as their striving to regain balance, and inner equilibrium in their changed and challenged rhythm of life. Study IV shows that after gradual deterioration and increasing care needs, older patients in haemodialysis care with co-morbidities follow three different main paths at the end of life: uncertain anticipation of death; awaiting death after dialysis withdrawal; and sudden but not unexpected death. The ends of their lives are marked by complex symptoms and existential issues related to haemodialysis treatment and withdrawal, and their uncertainty of what to expect at the end of life suggests the need for increased continuity and coordination of whole person care. Both patients and their close relatives are often alone with their existential thoughts. In their complex lifeworlds, intertwined meanings of living with illness and maintenance of life with haemodialysis treatment near the end of life show that patients live in a borderland of living-dying that is shared by the close relative. Patients and close relatives focus on living when death is close but uncertain, with severe illness and the maintenance of life through advanced technology. Integrating the philosophy of palliative care (with a focus on symptom relief, team work, communication, relationships, and support of family members) into dialysis care, may support health care professionals in haemodialysis units and other re nal contexts, to improve the care of severely ill patients, both earlier in their illness and as they approach the end of their lives.
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| 4. |
- Axelsson, Lena, et al.
(författare)
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Living with haemodialysis when nearing end of life
- 2012
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 26:1, s. 45-52
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The aim of this study was to describe and to elucidate the meanings of being severely ill living with haemodialysis when nearing end of life.INTRODUCTION: To have end stage renal disease and to be treated with maintenance haemodialysis implies being dependent on lifelong treatment. Several studies have reported that these patients suffer a high symptom burden and an impaired quality of life due to both disease and treatment. In the dialysis unit, where the focus is on handling technology and maintaining life, end of life care may be neglected or overlooked. Nevertheless, mortality rates show that about one-fourth of patients in haemodialysis care are in their last year of life.DESIGN: A qualitative interpretative design was used.METHODS: Serial qualitative interviews over a period of 12 months were conducted with eight patients (aged 66-87). Altogether text of 31 interviews was interpreted using a phenomenological hermeneutical method in three phases. The study is ethically approved.FINDINGS: The structural analysis resulted in 11 subthemes and thereafter the following three themes were formulated; being subordinate to the deteriorating body, changing outlook on life and striving for upheld dignity. The comprehensive interpretation revealed that being severely ill living with haemodialysis near the end of life means living with suffering simultaneously with reconciliation and well-being. Further, the meanings are understood as intertwined with being old.CONCLUSIONS: Findings contribute to an increased awareness of the complexities of these patients' life worlds and their meanings, and thus of the importance to listen to their experiences and their understandings. Findings suggest that to integrate the philosophy of palliative care in haemodialysis units may improve care for patients who are living with haemodialysis and approaching the end of their lives.
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| 5. |
- Axelsson, Lena, et al.
(författare)
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Thoughts on death and dying when living with haemodialysis approaching end of life
- 2012
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 21:15-16, s. 2149-59
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To describe inner thoughts and feelings relating to death and dying when living with haemodialysis approaching end of life.BACKGROUND: Patients who undergo maintenance haemodialysis suffer a significant symptom burden and an impaired quality of life. The high mortality rate in these patients indicates that about one-fourth of them are in their last year of life, suggesting the presence of death and dying in the haemodialysis unit.DESIGN: A qualitative descriptive design was used. Methods. A total of 31 qualitative interviews were conducted with eight patients (aged 66-87) over a period of 12 months. Qualitative content analysis was used to analyse data.RESULTS: The analysis revealed 10 subthemes that were sorted into three main themes. Being aware that death may be near comprises being reminded of death and dying by the deteriorating body, by the worsening conditions and deaths of fellow patients, and by knowing haemodialysis treatment as a border to death. Adapting to approaching death comprises looking upon death as natural, preparing to face death, hoping for a quick death and repressing thoughts of death and dying. Being alone with existential thoughts comprises a wish to avoid burdening family, lack of communication with healthcare professionals and reflections on haemodialysis withdrawal as an hypothetic option.CONCLUSIONS: Living with haemodialysis approaching, the end of life involves significant and complex existential issues and suffering, and patients are often alone with their existential thoughts.RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals in haemodialysis settings need to combine technical and medical abilities with committed listening and communication skills and be open to talking about death and dying, with sensitivity to individual and changeable needs.
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| 6. |
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| 7. |
- Axelsson, Östen, et al.
(författare)
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A principal components model of soundscape perception
- 2010
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Ingår i: Journal of the Acoustical Society of America. - : Acoustical Society of America (ASA). - 0001-4966 .- 1520-8524. ; 128:5, s. 2836-2846
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for a model that identifies underlying dimensions of soundscape perception, and which may guide measurement and improvement of soundscape quality. With the purpose to develop such a model, a listening experiment was conducted. One hundred listeners measured 50 excerpts of binaural recordings of urban outdoor soundscapes on 116 attribute scales. The average attribute scale values were subjected to principal components analysis, resulting in three components: Pleasantness, eventfulness, and familiarity, explaining 50, 18 and 6% of the total variance, respectively. The principal-component scores were correlated with physical soundscape properties, including categories of dominant sounds and acoustic variables. Soundscape excerpts dominated by technological sounds were found to be unpleasant, whereas soundscape excerpts dominated by natural sounds were pleasant, and soundscape excerpts dominated by human sounds were eventful. These relationships remained after controlling for the overall soundscape loudness (Zwicker’s N10), which shows that ‘informational’ properties are substantial contributors to the perception of soundscape. The proposed principal components model provides a framework for future soundscape research and practice. In particular, it suggests which basic dimensions are necessary to measure, how to measure them by a defined set of attribute scales, and how to promote high-quality soundscapes.
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| 8. |
- Axelsson, Östen, 1971-
(författare)
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Aesthetic Appreciation Explicated
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present doctoral thesis outlines a new model in psychological aesthetics, named the Information-Load Model. This model asserts that aesthetic appreciation is grounded in the relationship between the amount of information of stimuli and people’s capacity to process this information. This relationship results in information load, which in turn creates emotional responses to stimuli. Aesthetic appreciation corresponds to an optimal degree of information load. Initially, the optimal degree is relatively low. As an individual learns to master information in a domain (e.g., photography), the degree of information load, which corresponds to aesthetic appreciation, increases. The present doctoral thesis is based on three empirical papers that explored what factors determine aesthetic appreciation of photographs and soundscapes. Experiment 1 of Paper I involved 34 psychology undergraduates and 564 photographs of various motifs. It resulted in a set of 189 adjectives related to the degree of aesthetic appreciation of photographs. The subsequent experiments employed attribute scales that were derived from this set of adjectives. In Experiment 2 of Paper I, 100 university students scaled 50 photographs on 141 attribute scales. Similarly, in Paper II, 100 university students scaled 50 soundscapes on 116 attribute scales. In Paper III, 10 psychology undergraduates and 5 photo professionals scaled 32 photographs on 27 attribute scales. To explore the underlying structure of the data sets, they were subjected to Multidimensional Scaling and Principal Components Analyses. Four general components, related to aesthetic appreciation, were found: Familiarity, Hedonic Tone, Expressiveness, and Uncertainty. These components result from the higher-order latent factor Information Load that underlies aesthetic appreciation.
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| 9. |
- Axelsson, Östen, et al.
(författare)
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Soundscape management urgently needed in developing countries
- 2010
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Ingår i: Inter Noise 2010. - Lisbon, Portugal : Portuguese Acoustical Society.
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Konferensbidrag (refereegranskat)abstract
- Soundscape management is urgently needed in developing countries. Take for example Lima, the capital of Peru. Because people have moved to cities to seek a better life and to work in the growing industrial sector, Lima’s population has grown rapidly since the 1960’s, to reach 8.5 million in 2007 (30 % of Peru’s population). Public transport in Lima is by road vehicles rather than by trams and trains. Apart from chemical air pollution and particulate matter, noise pollution increases intensely with the ever-increasing number of vehicles (on average 3.7 % per year). Current developments are all but sustainable, and Lima city urgently needs to implement efficient noise-abatement strategies to control noise emissions and immissions. Soundscape management would be able to provide high acoustic quality. Thus, urban planning and environmental management have to be creatively developed.
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| 10. |
- Axelsson, Östen, et al.
(författare)
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Validation of the Swedish soundscape-quality protocol
- 2012
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Ingår i: Journal of the Acoustical Society of America. - New York : Acoustical Society of America (ASA). - 0001-4966. ; 131:4, s. 3474-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish Soundscape-Quality Protocol was developed to help non-experts (e.g., officials working for municipalities rather than soundscaperesearchers) to make informed, accurate measurements of soundscape quality. The Protocol has hitherto been used in England, France, Italy, Spain, Sweden, and The Netherlands; a Korean version is being developed. Based on field studies – soundwalks in urban residential areas, recreational areas, and parks – the present paper reports on the psychometric properties of the scales of the Protocol. Participants were residents, or visitors to the areas and their results support the reliability and validity of the scales in the Protocol. Because high acoustic quality has a greater effect in visually attractive than in visually poor areas, the Swedish Soundscape-Quality Protocol includes scales for cross-sensory tabulation. These are sound source identification – sounds from humans, nature and technology – attribute scales (e.g., eventful, exciting, pleasant, and calm), overall soundscape quality, and concomitant visual impressions. In brief, the Swedish Soundscape-Quality Protocol is an easy to use and practical tool for measuringsoundscape quality. It has the potential to help operationalize how soundscapes can be measured in “quiet areas” to meet a future guideline value of the World Health Organization.
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