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Nilsen, Per
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Publications (10 of 149) Show all publications
Avby, G., Nilsen, P. & Ellström, P.-E. (2017). Knowledge use and learning in everyday social work practice: A study in child investigation work. Child & Family Social Work, 22, 51-61.
Open this publication in new window or tab >>Knowledge use and learning in everyday social work practice: A study in child investigation work
2017 (English)In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206, Vol. 22, 51-61 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore knowledge use and learning among social workers in everyday child investigation work. Research was undertaken in two Swedish children’s services departments. The study applied an ethnographic approach. Methods for data collection included interviews, participant observations, reflective dialogues and a documentary analysis of case files. The social workers’ knowledge sources were classified into research-based, practice-based and ordinary knowledge. The findings show that the social workers preferred practice-based knowledge, which was primarily conveyed from colleagues and previous experience, and rarely consulted knowledge from sources found outside the practice setting. Furthermore, the findings suggest that the integration of knowledge was made possible through the social workers' engagement in both a verbal and a more cognitive (tacit) reasoning activity, processes that fostered learning at work. The social workers’ learning was predominantly adaptive as they learned to handle tasks in a fairly routinized way on the basis of rules or procedures. The findings lend support to the notion that the use of different knowledge forms could potentially trigger learning in everyday social work.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2017
Keyword
Child and family social work, ethnography, reserach in practice, evidence-based practice, knowledge use, learning
National Category
Work Sciences
Identifiers
urn:nbn:se:liu:diva-115275 (URN)10.1111/cfs.12227 (DOI)2-s2.0-84925046374 (Scopus ID)
Available from: 2015-03-11 Created: 2015-03-11 Last updated: 2017-12-04Bibliographically approved
Kirk, J. W. & Nilsen, P. (2016). Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture. Journal of Clinical Nursing, 25(3-4), 555-565.
Open this publication in new window or tab >>Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 3-4, 555-565 p.Article in journal (Refereed) Published
Abstract [en]

Background. An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. Objectives. How does the flow culture in an emergency department influence nurses use of a research-based clinical guideline and a nutrition screening routine. Methods. Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. Results. The main contradiction identified was that guidelines and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being a professional. Conclusion. We found that research-supported guidelines and screening routines were not used if they were perceived to stop the patient flow, suggesting that the practice was not fully evidence based.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keyword
acute care; advanced practice; clinical guidelines; emergency care; emergency department; evidence-based practice
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-126264 (URN)10.1111/jocn.13092 (DOI)000370637600028 ()26818380 (PubMedID)
Note

Funding Agencies|Capital Region of Denmark

Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2018-01-10
Gabrielsson-Jarhult, F. & Nilsen, P. (2016). On the threshold: older peoples concerns about needs after discharge from hospital. Scandinavian Journal of Caring Sciences, 30(1), 135-144.
Open this publication in new window or tab >>On the threshold: older peoples concerns about needs after discharge from hospital
2016 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 1, 135-144 p.Article in journal (Refereed) Published
Abstract [en]

Discharge from hospital is often strenuous for older people and requires adjustments from living an independent life to being in need of care and support. This study aims to explore older peoples concerns about their needs after discharge. Twenty-seven observations recorded at hospital discharge planning meetings were analysed with content analysis. An overarching theme emerged: being in a life transition, which reflected the older persons vulnerable and ambiguous situation in the discharge process. The theme was developed from three categories: obtaining a secure life situation, need of continuous care and support, and influencing and regaining independence. The findings highlight that older patients want to influence their care after discharge. They strive to regain independence and express their concerns about how to obtain a secure life situation through care organised to fit their individual needs. Knowledge about older peoples concerns is important for healthcare providers and social workers involved in planning and individualised care and services.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keyword
care pathways; clinical decision-making; communication; discharge planning; elder care; patient participation
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-126826 (URN)10.1111/scs.12231 (DOI)000371477400015 ()25919854 (PubMedID)
Note

Funding Agencies|Institute of Gerontology, School of Health Sciences at Jonkoping University

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2018-01-10
Ridelberg, M., Roback, K., Nilsen, P. & Carlfjord, S. (2016). Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.. BMC Health Services Research, 16(98), 1-9.
Open this publication in new window or tab >>Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 98, 1-9 p.Article in journal (Refereed) Published
Abstract [en]

Background

There is widespread recognition of the problem of unsafe care and extensive efforts have been made over the last 15 years to improve patient safety. In Sweden, a new patient safety law obliges the 21 county councils to assemble a yearly patient safety report (PSR). The aim of this study was to describe the patient safety work carried out in Sweden by analysing the PSRs with regard to the structure, process and result elements reported, and to investigate the perceived usefulness of the PSRs as a tool to achieve improved patient safety.

Methods

The study was based on two sources of data: patient safety reports obtained from county councils in Sweden published in 2014 and a survey of health care practitioners with strategic positions in patient safety work, acting as key informants for their county councils. Answers to open-ended questions were analysed using conventional content analysis.

Results

A total of 14 structure elements, 31 process elements and 23 outcome elements were identified. The most frequently reported structure elements were groups devoted to working with antibiotics issues and electronic incident reporting systems. The PSRs were perceived to provide a structure for patient safety work, enhance the focus on patient safety and contribute to learning about patient safety.

Conclusion

Patient safety work carried out in Sweden, as described in annual PSRs, features a wide range of structure, process and result elements. According to health care practitioners with strategic positions in the county councils’ patient safety work, the PSRs are perceived as useful at various system levels.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keyword
Healthcare, Patient safety, Patient safety reports
National Category
Social and Clinical Pharmacy Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-127298 (URN)10.1186/s12913-016-1350-5 (DOI)000372864800001 ()27001079 (PubMedID)
Note

Funding agencies:  Swedish National Board of Health and Welfare

Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2018-01-10Bibliographically approved
Abidi, L., Oenema, A., Nilsen, P., Anderson, P. & van de Mheen, D. (2016). Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts. Prevention Science, 17(6), 689-699.
Open this publication in new window or tab >>Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts
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2016 (English)In: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695, Vol. 17, no 6, 689-699 p.Article in journal (Refereed) Published
Abstract [en]

Despite the evidence base, alcohol screening and brief intervention (ASBI) have rarely been integrated into routine clinical practice. The aim of this study is to identify strategies that could tackle barriers to ASBI implementation in general practice by involving primary healthcare professionals and addiction prevention experts. A three-round online Delphi study was carried out in the Netherlands. The first-round questionnaire consisted of open-ended questions to generate ideas about strategies to overcome barriers. In the second round, participants were asked to indicate how applicable they found each strategy. Items without consensus were systematically fed back with group median ratings and interquartile range (IQR) scores in the third-round questionnaire. In total, 39 out of 69 (57 %) invited participants enrolled in the first round, 214 participants completed the second round, and 144 of these (67 %) completed the third-round questionnaire. Results show that participants reached consensus on 59 of 81 strategies, such as the following: (1) use of E-learning technology, (2) symptom-specific screening by general practitioners (GPs) and/or universal screening by practice nurses, (3) reimbursement incentives, (4) supportive materials, (5) clear guidelines, (6) service provision of addiction care centers, and (7) more publicity in the media. This exploratory study identified a broad set of strategies that could potentially be used for overcoming barriers to ASBI implementation in general practice and paves the way for future research to experimentally test the identified implementation strategies using multifaceted approaches.

Place, publisher, year, edition, pages
SPRINGER/PLENUM PUBLISHERS, 2016
Keyword
Alcohol; Screening; Brief intervention; Implementation; General practice
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-130373 (URN)10.1007/s11121-016-0653-4 (DOI)000379611400003 ()27167074 (PubMedID)
Available from: 2016-08-15 Created: 2016-08-05 Last updated: 2018-01-10
Bernhardsson, S., Öberg, B., Johansson, K., Nilsen, P. & Larsson, M. E. H. (2015). Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden. Journal of Evaluation In Clinical Practice, 21(6), 1169-1177.
Open this publication in new window or tab >>Clinical practice in line with evidence?: A survey among primary care physiotherapists in western Sweden
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2015 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 6, 1169-1177 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aims and objectives

Evidence-based practice is becoming increasingly important in primary care physiotherapy. Clinical practice needs to reflect current best evidence and be concordant with evidence-based clinical guidelines. There is limited knowledge about therapeutic interventions used in primary care physiotherapy in Sweden. The objectives were to examine preferred treatment interventions reported by publicly employed physiotherapists in primary care for three common musculoskeletal disorders (low back pain, neck pain and subacromial pain), the extent to which these interventions were supported by evidence, and associations with demographic variables.

Methods

419 physiotherapists in primary care in western Sweden were surveyed using a validated web-based questionnaire.

Results

The survey was completed by 271 respondents (65%). Median number of interventions reported was 7 (range 1–16). The most common treatment interventions across the three conditions were advice on posture (reported by 82–94%), advice to stay active (86–92%), and different types of exercise (65–92%). Most of these interventions were supported by evidence. However, interventions with insufficient evidence, such as advice on posture, TENS and aquatic exercise, were also used by 29–96%. Modalities such as laser therapy and ultrasound were sparingly used (<5%), which is in line with evidence. For neck pain, use of evidence-based interventions was associated with gender and for subacromial pain, with work experience.

Conclusions

Advice and exercise therapy were the interventions most frequently reported across the three diagnoses, illustrating an active treatment strategy. While most reported interventions are supported by evidence, interventions with unclear or no evidence of effect were also used to a high extent.

Place, publisher, year, edition, pages
John Wiley & Sons, 2015
Keyword
clinical practice, evidence, evidence-based practice, interventions, physical therapy, treatment
National Category
Health Care Service and Management, Health Policy and Services and Health Economy General Practice
Identifiers
urn:nbn:se:liu:diva-122555 (URN)10.1111/jep.12380 (DOI)000371414500032 ()25988993 (PubMedID)
Note

Funding agencies: local Research and Development Board for Gothenburg and Sodra Bohuslan; Linkoping University

Available from: 2015-11-09 Created: 2015-11-09 Last updated: 2018-01-10Bibliographically approved
Avby, G., Nilsen, P. & Ellström, P.-E. (2015). Exploring evidence-based practice in practice: the case of social work. In: Mattias Elg, Per-Erik Ellström, Magnus Klofsten, Malin Tillmar (Ed.), Sustainable development in organizations: studies on innovative practices (pp. 153-168). Cheltenham: Edward Elgar Publishing.
Open this publication in new window or tab >>Exploring evidence-based practice in practice: the case of social work
2015 (English)In: Sustainable development in organizations: studies on innovative practices / [ed] Mattias Elg, Per-Erik Ellström, Magnus Klofsten, Malin Tillmar, Cheltenham: Edward Elgar Publishing, 2015, 153-168 p.Chapter in book (Refereed)
Place, publisher, year, edition, pages
Cheltenham: Edward Elgar Publishing, 2015
Keyword
evidence-based practice, learning, social work, Socialt arbete
National Category
Educational Sciences
Identifiers
urn:nbn:se:liu:diva-123638 (URN)000374407200010 ()9781784716882 (ISBN)9781784716899 (ISBN)
Funder
VINNOVA
Available from: 2016-01-04 Created: 2016-01-04 Last updated: 2016-11-15Bibliographically approved
Dannapfel, P. & Nilsen, P. (2015). Fostering a culture of evidence-based physiotherapy practice: a qualitative analysis of the influence of health care leaders in Sweden. .
Open this publication in new window or tab >>Fostering a culture of evidence-based physiotherapy practice: a qualitative analysis of the influence of health care leaders in Sweden
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Research in physiotherapy has increased rapidly over the last decade, yet studies have shown that many practice decisions continue to be based on knowledge obtained during initial physiotherapy education and/or personal experience, rather than findings from research. Both barriers and facilitators to achieving a more evidence-based practice (EBP) in physiotherapy have been identified. Leadership is one facilitator that has been recognized to have an important influence on the implementation of EBP in various settings. Our aim was to explore how physiotherapy leaders in Sweden influence the culture for implementation of evidence-based physiotherapy practice.

Methods: Nine interviews with managers of physiotherapy clinics were conducted in various settings in Sweden. Data were analysed using qualitative analysis and a framework developed by Schein (Schein EH. Organizational culture and leadership. 4th ed. San Francisco, CA: Jossey-Bass; 2010) was applied.

Results: The framework identifies a number mechanisms by which leaders can influence the culture of an organization and/or groups within an organization. The mechanisms of paying attention to, measuring and controlling on a regular basis as well as deliberate role modelling, teaching and coaching did have some relevance. However, EBP issues seemed to depend on committed individuals, often younger physiotherapists, who were interested in research.

Conclusions: Overall, there was limited relevance for most of the embedding mechanisms. The findings suggest that physiotherapy leaders in Sweden contribute to a modest degree to establishing a culture conducive to implementation of an evidence-based physiotherapy practice.

Keyword
Leadership; Culture; Evidence-based practice; Implementation; Physiotherapy
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-122171 (URN)
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2015-10-23Bibliographically approved
Neher, M., Ståhl, C., Ellström, P.-E. & Nilsen, P. (2015). Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.. Clinical Nursing Research, 24(6), 661-679.
Open this publication in new window or tab >>Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.
2015 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, 661-679 p.Article in journal (Refereed) Published
Abstract [en]

As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keyword
extended roles, health care, informal learning, workplace learning, qualitative
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-118283 (URN)10.1177/1054773814543355 (DOI)000364723000006 ()25059719 (PubMedID)
Available from: 2015-05-25 Created: 2015-05-25 Last updated: 2017-12-04
Reichenpfader, U., Carlfjord, S. & Nilsen, P. (2015). Leadership in evidence-based practice: a systematic review. Leadership in Health Services, 28(4), 298-316.
Open this publication in new window or tab >>Leadership in evidence-based practice: a systematic review
2015 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 28, no 4, 298-316 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: We aimed to systematically review published empirical research on leadership as a determinant for the implementation of evidence-based practice (EBP) and to investigate leadership conceptualization and operationalization in this field.

Design/methodology/approach: A systematic review with narrative synthesis was conducted. Relevant bibliographic databases and reference lists of pertinent review articles were searched. To be included, a study had to involve empirical research and refer to both leadership and EBP in health care. Study quality was assessed with a structured instrument based on study design.

Findings: A total of 17 studies were included. Leadership was mostly viewed as a modifier for implementation success, acting through leadership support. Yet, there was definitional imprecision as well as conceptual inconsistency and studies seemed to inadequately address situational and contextual factors. Although referring to an organizational factor, the concept was mostly analysed at the individual or group level.

Research limitations/implications: The concept of leadership in implementation science seems to be not fully developed. It is unclear whether attempts to tap the concept of leadership in available instruments truly capture and measure the full range of the diverse leadership elements at various levels. Research in implementation science would benefit from a better integration of research findings from other disciplinary fields. Once a more mature concept has been established, researchers in implementation science could proceed to further elaborate operationalization and measurement.

Originality/value. Although the relevance of leadership in implementation science has been acknowledged, the conceptual base of leadership in this field has received only limited attention.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2015
Keyword
Leadership, Conceptualization, Measurement, Evidence-based practice, Systematic review
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-120935 (URN)10.1108/LHS-08-2014-0061 (DOI)
Available from: 2015-08-31 Created: 2015-08-31 Last updated: 2017-12-04
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