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Nilsen, Per
Alternative names
Publications (10 of 169) Show all publications
Levin, S. K., Nilsen, P., Bendtsen, P. & Bülow, P. (2019). Adherence to planned risk management interventions in Swedish forensic care: What is said and done according to patient records. International Journal of Law and Psychiatry, 64, 71-82
Open this publication in new window or tab >>Adherence to planned risk management interventions in Swedish forensic care: What is said and done according to patient records
2019 (English)In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 64, p. 71-82Article in journal (Refereed) Published
Abstract [en]

Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Risk assessment, Risk management, Forensic care, Violence risk
National Category
Forensic Science
Identifiers
urn:nbn:se:liu:diva-156724 (URN)10.1016/j.ijlp.2019.02.003 (DOI)000470949900009 ()31122642 (PubMedID)2-s2.0-85062027323 (Scopus ID)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-07-15Bibliographically approved
Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I. & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14, Article ID 51.
Open this publication in new window or tab >>Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses
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2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, article id 51Article in journal (Refereed) Published
Abstract [en]

Background

Implementation of evidence-based practices in health care implies change. Understanding health care professionals’ change responses may be critical for facilitating implementation to achieve an evidence-based practice in the rapidly changing health care environment. The aim of this study was to investigate health care professionals’ responses to organizational and workplace changes that have affected their work.

Methods

We conducted interviews with 30 health care professionals (physicians, registered nurses and assistant nurses) employed in the Swedish health care system. An inductive approach was applied, using a semi-structured interview guide developed by the authors. We used an analytical framework first published in 1999 to analyze the informants’ change responses in which change responses are perceived as a continuum ranging from a strong acceptance of change to strong resistance to change, describing seven forms of change responses along this continuum. Change response is conceptualized as a tridimensional attitude composed of three components: cognitive, affective and intentional/behavioral.

Results

Analysis of the data yielded 10 types of change responses, which could be mapped onto 5 of the 7 change response categories in the framework. Participants did not report change responses that corresponded with the two most extreme forms of responses in the framework, i.e., commitment and aggressive resistance. Most of the change responses were classified as either indifference or passive resistance to changes. Involvement in or support for changes occurred when the health care professionals initiated the changes themselves or when the changes featured their active input and when changes were seen as well founded and well communicated. We did not identify any change responses that could not be fitted into the framework.

Conclusions

We found the framework to be useful for a nuanced understanding of how people respond to changes. This knowledge of change responses is useful for the management of changes and for efforts to achieve more successful implementation of evidence-based practices in health care.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Change response, Attitude, Health care, Implementation, Evidence-based practice
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-157006 (URN)10.1186/s13012-019-0902-6 (DOI)000468112400001 ()31088483 (PubMedID)2-s2.0-85065737495 (Scopus ID)
Note

Funding agencies: Linkoping University

Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-07-01Bibliographically approved
Broström, A., Pakpour, A. H., Nilsen, P., Fridlund, B. & Ulander, M. (2019). Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated.. Sleep and Breathing, 23(3), 761-768
Open this publication in new window or tab >>Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated.
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2019 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 23, no 3, p. 761-768Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

METHODS: A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

RESULTS: The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

CONCLUSIONS: The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Continuous positive airway treatment, Ethos, Obstructive sleep apnea, Reliability, Validity
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-154639 (URN)10.1007/s11325-018-1762-z (DOI)000482433800006 ()30523558 (PubMedID)
Funder
Swedish Heart Lung Foundation
Note

Funding agencies:  Swedish heart and lung foundation [20140644]

Available from: 2019-02-24 Created: 2019-02-24 Last updated: 2019-09-09
Schildmeijer, K., Nilsen, P., Ericsson, C., Broström, A. & Skagerström, J. (2018). Determinants of patient participation for safer care: A qualitative study of physicians experiences and perceptions. Health science reports, 1(10), Article ID e87.
Open this publication in new window or tab >>Determinants of patient participation for safer care: A qualitative study of physicians experiences and perceptions
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2018 (English)In: Health science reports, ISSN 2398-8835, Vol. 1, no 10, article id e87Article in journal (Refereed) Published
Abstract [en]

Objective

There is a paucity of research on physicians' perspectives on involving patients to achieve safer care. This study aims to explore determinants of patient participation for safer care, according to physicians in Swedish health care.

Methods

We used a deductive descriptive design, applying qualitative content analysis based on the Capability‐Opportunity‐Motivation‐Behaviour framework. Semi‐structured interviews were conducted with 13 physicians in different types of health care units, to achieve a heterogeneous sample. The main outcome measure was barriers and facilitators to patient participation of potential relevance for patient safety.

Results

Analysis of the data yielded 14 determinants (ie, subcategories) functioning as barriers and/or facilitators to patient participation of potential relevance for patient safety. These determinants were mapped to five categories: physicians' capability to involve patients in their care; patients' capability to become involved in their care, as perceived by the physicians; physicians' opportunity to achieve patient participation in their care; physicians' motivation to involve patients in their care; and patients' motivation to become involved in their care, as perceived by the physicians.

Conclusion

There are many barriers to patient participation to achieve safer care. There are also facilitators, but these tend to depend on initiatives of individual physicians and patients, because organizational‐level support may be lacking. Many of the determinants are interdependent, with physicians' perceived time constraints influencing other barriers.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
barriers; determinants; facilitators; patient participation; patient safety; physicians
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-156016 (URN)10.1002/hsr2.87 (DOI)30623042 (PubMedID)
Available from: 2019-04-02 Created: 2019-04-02 Last updated: 2019-05-03Bibliographically approved
Abbott, A., Schröder, K., Enthoven, P., Nilsen, P. & Öberg, B. (2018). Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial. BMJ Open, 8(4), Article ID e019906.
Open this publication in new window or tab >>Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019906Article in journal (Refereed) Published
Abstract [en]

Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP.

Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context.

Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated.

Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and implementation in Sweden and associated national quality register data collection are potential future developments of the project.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-147879 (URN)10.1136/bmjopen-2017-019906 (DOI)000435176700106 ()29691246 (PubMedID)
Note

Funding agencies: Research Council in Southeast Sweden [FORSS<SUP>star</SUP>660371]; Swedish Research Council [2017<SUP>star</SUP>01444]

Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2019-04-10Bibliographically approved
Reichenpfader, U., Wickström, A., Nilsen, P., Abrandt Dahlgren, M. & Carlfjord, S. (2018). Medi(c)ation work in the emergency department: Making standardized practice work. Professions & Professionalism, 8(2), Article ID e2298.
Open this publication in new window or tab >>Medi(c)ation work in the emergency department: Making standardized practice work
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2018 (English)In: Professions & Professionalism, ISSN 1893-1049, E-ISSN 1893-1049, Vol. 8, no 2, article id e2298Article in journal (Refereed) Published
Abstract [en]

Medication review, the systematic examination of an individual patient’s medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners’ collective reflexive work when co-constructing meaning and argue here that practitioners’ local adaptations can serve as important prerequisites to make “standardized” practice function in everyday work. Organizations need to build a practical capacity to support practitioners’ work-based learning in messy and time-pressured  health care  settings.

Keywords
practice-based study, ethnography, practical knowledge, professional practice, medication review, implementation, patient safety
National Category
Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-151815 (URN)10.7577/pp.2298 (DOI)
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2019-05-01
Andersen, P., Holmberg, S., Lendahls, L., Nilsen, P. & Kristenson, M. (2018). Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden. Healthcare, 6(2), Article ID E34.
Open this publication in new window or tab >>Physical Activity on Prescription with Counsellor Support: A 4-Year Registry-Based Study in Routine Health Care in Sweden
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2018 (English)In: Healthcare, E-ISSN 2227-9032, Vol. 6, no 2, article id E34Article in journal (Refereed) Published
Abstract [en]

Background: Public health gains from physical activity on prescription (PAP) depend on uptake in routine care. We performed an evaluation of the implementation, in a Swedish county council, of counsellors who give personalized support to PAP recipients aimed at facilitating PAP delivery. The aim was to compare characteristics between PAP recipients and the health care population as well as between PAP recipients who used and did not use counsellor support. We also investigated professional belonging and health care setting of health care professionals who prescribed PAP. 

Methods: All patients’ ≥18 years who received PAP during 2009–2012 in primary and secondary care in the County Council of Kronoberg were included (n = 4879). Data were retrieved from electronic medical records. Main outcome measures were patient and professional characteristics. 

Results: A third of the PAP recipients had diseases in ≥5 diagnostic groups and more than half had ≥11 office visits the year before receiving PAP. Counsellor support was used by one-third and PAP recipients who used counsellor support had more multiple diagnoses and office visits compared with non-users. Physicians issued 44% of prescriptions and primary care was the predominant setting. The amount of PAP did not change over time, but the proportion of physicians’ prescriptions decreased while the proportion of nurses’ prescriptions increased. 

Conclusions: PAP recipients had high morbidity and were frequent health care attenders, indicating that PAP was predominantly used for secondary or tertiary prevention. PAP rates did not increase as intended after the implementation of counsellor support. View Full-Text

Place, publisher, year, edition, pages
MDPI, 2018
Keywords
counselling, implementation, physical activity prescription, primary care, secondary care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154036 (URN)10.3390/healthcare6020034 (DOI)000436494800007 ()29659546 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-07Bibliographically approved
Levin, S., Nilsen, P., Bendtsen, P. & Bülow, P. (2018). Staff Perceptions of Facilitators and Barriers to the Use of a Short- Term Risk Assessment Instrument in Forensic Psychiatry. Journal of Forensic Psychology Research and Practice, 18(3), 199-228
Open this publication in new window or tab >>Staff Perceptions of Facilitators and Barriers to the Use of a Short- Term Risk Assessment Instrument in Forensic Psychiatry
2018 (English)In: Journal of Forensic Psychology Research and Practice, ISSN 2473-2850, Vol. 18, no 3, p. 199-228Article in journal (Refereed) Published
Abstract [en]

Prospective adverse events within forensic settings should be assessed using structured risk assessment instruments. Our aim was to identify the barriers and facilitators of a structured instrument for assessment of short-term risk within inpatient forensic psychiatric care. The instrument was piloted at a forensic psychiatric clinic. Three focus group interviews were conducted with staff. Content analysis revealed three main categories of barriers and facilitators for clinical use: implementation object, context, and users. Complexity of the instrument, insufficient continuous training and support, difficulties retrieving assessments on wards, and insecurity about translating assessments into actions were perceived barriers to clinical use. Routines for documentation improved communication and the inclusion of protective and short-term dynamic clinical factors were perceived as clinically relevant. Problem-solving ability, attitude, and motivation of staff were facilitating factors. Comprehensive risk assessment instruments require substantial support for staff to find them manageable. Systematic documentation is required to measure actual daily clinical use.

Place, publisher, year, edition, pages
Routledge, 2018
Keywords
tructured risk assessment;START; implementation;clinical use of researchevidence
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-154051 (URN)10.1080/24732850.2018.1466260 (DOI)000452643000001 ()
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-05-13
Wallerstedt, B., Behm, L., Alftberg, Å., Sandgren, A., Benzein, E., Nilsen, P. & Ahlström, G. (2018). Striking a Balance: A Qualitative Study of Next of Kin Participation in the Care of Older Persons in Nursing Homes in Sweden.. Healthcare, 6(2), Article ID E46.
Open this publication in new window or tab >>Striking a Balance: A Qualitative Study of Next of Kin Participation in the Care of Older Persons in Nursing Homes in Sweden.
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2018 (English)In: Healthcare, ISSN 2227-9032, Vol. 6, no 2, article id E46Article in journal (Refereed) Published
Abstract [en]

Most of the care in nursing homes is palliative in nature, as it is the oldest and the frailest people who live in nursing homes. The aim of this study was to explore next of kin's experiences of participating in the care of older persons at nursing homes. A qualitative design was used, based on semi-structured interviews with 40 next of kin, and analyzed using qualitative content analysis. An overarching theme emerged, a balancing act consisting of three categories: (1) visiting the nursing home; (2) building and maintaining relationships; and (3) gathering and conveying information. The next of kin have to balance their own responsibility for the older person's wellbeing by taking part in their care and their need to leave the responsibility to the staff due to critical health conditions. The next of kin wanted to participate in care meetings and conversations, not only in practical issues. The findings indicate the need to improve the next of kin's participation in the care as an equal partner. Increased knowledge about palliative care and decision-making of limiting life-prolonging treatment may lead to a higher quality of care.

Place, publisher, year, edition, pages
MDPI, 2018
Keywords
end-of-life care, family member, involvement, life-limiting disease, next of kin, palliative care, participation, relatives, sheltered housing, significant others
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154039 (URN)10.3390/healthcare6020046 (DOI)29751660 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-07
Kristianssen, A.-C., Andersson, R., Belin, M.-Å. & Nilsen, P. (2018). Swedish Vision Zero Policies for Safety: A Comparative Policy Content Analysis. Safety Science, 103, 260-269
Open this publication in new window or tab >>Swedish Vision Zero Policies for Safety: A Comparative Policy Content Analysis
2018 (English)In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 103, p. 260-269Article in journal (Refereed) Published
Abstract [en]

The Vision Zero policy was adopted by the Swedish parliament in 1997 as a new direction for road traffic safety. The aim of the policy is that no one should be killed or seriously injured due to traffic accidents and that the design of the road transport system should be adapted to those requirements. Vision Zero has been described as a policy innovation with a focus on the tolerance of the human body to kinetic energy and that the responsibility for road safety falls on the system designers. In Sweden, the Vision Zero terminology has spread to other safety-related areas, such as fire safety, patient safety, workplace safety and suicide. The purpose of this article is to analyze, through a comparative content analysis, each Vision Zero policy by identifying the policy decision, policy problem, policy goal, and policy measures. How a policy is designed and formulated has a direct effect on implementation and outcome. The similarities and differences between the policies give an indication of the transfer method in each case. The results show that the Vision Zero policies following the Vision Zero for road traffic contain more than merely a similar terminology, but also that the ideas incorporated in Vision Zero are not grounded within each policy area as one would expect. The study shows that it is easier to imitate formulations in a seemingly successful policy and harder to transform Vision Zero into a workable tool in each policy area.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Vision Zero;policyRoad traffic safety;Fire safety;Suicide;Patient safety;Workplace safety
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154044 (URN)10.1016/j.ssci.2017.11.005 (DOI)000424722000024 ()
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-04-11
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