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BETA
Nilsen, Per
Alternative names
Publications (10 of 157) Show all publications
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: 2018-10-19Bibliographically 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: 2018-10-04
Danielsson, M., Nilsen, P., Rutberg, H. & Carlfjord, S. (2018). The professional culture among physicians in Sweden: potential implications for patient safety. BMC Health Services Research, 18(1), Article ID 543.
Open this publication in new window or tab >>The professional culture among physicians in Sweden: potential implications for patient safety
2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 543Article in journal (Refereed) Published
Abstract [en]

Background

Patient safety culture, i.e. a subset of an organization’s culture, has become an important focus of patient safety research. An organization’s culture consists of many cultures, underscoring the importance of studying subcultures. Professional subcultures in health care are potentially important from a patient safety point of view. Physicians have an important role to play in the effort to improve patient safety. The aim was to explore physicians’ shared values and norms of potential relevance for patient safety in Swedish health care.

Methods

Data were collected through group and individual interviews with 28 physicians in 16 semi-structured interviews, which were recorded and transcribed verbatim before being analysed with an inductive approach.

Results

Two overarching themes, “the competent physician” and “the integrated yet independent physician”, emerged from the interview data. The former theme consists of the categories Infallible and Responsible, while the latter theme consists of the categories Autonomous and Team player. The two themes and four categories express physicians’ values and norms that create expectations for the physicians’ behaviours that might have relevance for patient safety.

Conclusions

Physicians represent a distinct professional subculture in Swedish health care. Several aspects of physicians’ professional culture may have relevance for patient safety. Expectations of being infallible reduce their willingness to talk about errors they make, thus limiting opportunities for learning from errors. The autonomy of physicians is associated with expectations to act independently, and they use their decisional latitude to determine the extent to which they engage in patient safety. The physicians perceived that organizational barriers make it difficult to live up to expectations to assume responsibility for patient safety. Similarly, expectations to be part of multi-professional teams were deemed difficult to fulfil. It is important to recognize the implications of a multi-faceted perspective on the culture of health care organizations, including physicians’ professional culture, in efforts to improve patient safety.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Physicians, Patient safety, Safety culture, Qualitative research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-149792 (URN)10.1186/s12913-018-3328-y (DOI)000438433700009 ()29996832 (PubMedID)2-s2.0-85049780334 (Scopus ID)
Available from: 2018-07-23 Created: 2018-07-23 Last updated: 2018-08-10Bibliographically approved
Danielsson, M., Nilsen, P., Rutberg, H. & Årestedt, K. (2017). A National Study of Patient Safety Culture in Hospitals in Sweden. Journal of patient safety
Open this publication in new window or tab >>A National Study of Patient Safety Culture in Hospitals in Sweden
2017 (English)In: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Using the Hospital Survey on Patient Culture, our aim was to investigate the patient safety culture in all Swedish hospitals and to compare the culture among managers, physicians, registered nurses, and enrolled nurses and to identify factors associated with high overall patient safety.

METHODS: The study used a correlational design based on cross-sectional surveys from health care practitioners in Swedish health care (N = 23,781). We analyzed the associations between overall patient safety (outcome variable) and 12 culture dimensions and 5 background characteristics (explanatory variables). Simple logistic regression analyses were conducted to determine the bivariate association between each explanatory variable and the outcome variable. The explanatory variables were entered to determine the multivariate associations between the variables and the outcome variable.

RESULTS: The highest rated culture dimensions were "teamwork within units" and "nonpunitive response to error," and the lowest rated dimensions were "management support for patient safety" and "staffing." The multivariate analysis showed that long professional experience (>15 years) was associated with increased probability for high overall patient safety. Compared with general wards, the probability for high overall patient safety was higher for emergency care but lower for psychiatric care. The probability for high overall patient safety was higher for both enrolled nurses and physicians compared with managers.

CONCLUSIONS: The safety culture dimensions of the Hospital Survey on Patient Culture contributed far more to overall patient safety than the background characteristics, suggesting that these dimensions are very important in efforts to improve the overall patient safety culture.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2017
Keywords
hospital survey on patient safety culture, patient safety culture, patient safety climate
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:liu:diva-149791 (URN)10.1097/PTS.0000000000000369 (DOI)28234728 (PubMedID)2-s2.0-85013823022 (Scopus ID)
Available from: 2018-07-23 Created: 2018-07-23 Last updated: 2018-08-10Bibliographically approved
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, p. 51-61Article 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
Keywords
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)000426000400006 ()2-s2.0-84925046374 (Scopus ID)
Available from: 2015-03-11 Created: 2015-03-11 Last updated: 2018-04-17Bibliographically approved
Nilsen, P., Skagerström, J., Ericsson, C. & Schildmeijer, K. (2017). Många faktorer påverkar om patienter kan medverka till säkrare vård - Intervjustudie visar läkares och sjuksköterskors perspektiv. Läkartidningen, 114
Open this publication in new window or tab >>Många faktorer påverkar om patienter kan medverka till säkrare vård - Intervjustudie visar läkares och sjuksköterskors perspektiv
2017 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114Article in journal (Refereed) Published
Abstract [en]

Patient participation for safer health care - interviews with physicians and nurses

Patient participation to achieve safer care is an area of growing policy, research and health care management and practice interest. Patients are uniquely placed to observe their treatment, care and physical environment throughout their journey in the health care system. However, very few studies have investigated health care providers attitudes and beliefs concerning patient participation for improved patient safety. This study explored factors that acted as facilitators and/or barriers to patient participation for safer care, as perceived by physicians and nurses in Swedish health care. Interviews were conducted with 13 physicians and 11 nurses, using a purposeful sampling strategy to achieve a heterogeneous sample of providers. We identified nine categories of factors, many of which functioned as barriers to patient participation to achieve safer care.

Place, publisher, year, edition, pages
Stockholm, Sweden: Läkartidningen Förlag AB, 2017
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-145575 (URN)28350419 (PubMedID)
Available from: 2018-03-25 Created: 2018-03-25 Last updated: 2018-04-04Bibliographically approved
Skagerström, J., Ericsson, C. & Nilsen, P. (2017). Patient involvement for improved patient safety: A qualitative study of nurses’ perceptions and experiences. Nursing Open, 4(4), 230-239
Open this publication in new window or tab >>Patient involvement for improved patient safety: A qualitative study of nurses’ perceptions and experiences
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2017 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 4, no 4, p. 230-239Article in journal (Refereed) Published
Abstract [en]

Aim

To explore nurses’ perceptions and experiences of patient involvement relevant to patient safety.

Design

Qualitative design using individual semi-structured interviews.

Methods

Interviews with registered nurses (= 11) and nurse assistants (= 8) were conducted in 2015–2016. Nurses were recruited from five different healthcare units in Sweden. The material was analysed using conventional content analysis.

Results

The analysis resulted in four categories: healthcare professionals’ ways of influencing patient involvement for safer care; patients’ ways of influencing patient involvement for safer care; barriers to patient involvement for safer care; and relevance of patient involvement for safer care. The nurses expressed that patient involvement is a shared responsibility. They also emphasized that healthcare provider has a responsibility to create opportunities for the patient to participate. According to the nurses, involvement can be hindered by factors related to the patient, the healthcare provider and the healthcare system. However, respondents expressed that patient involvement can lead to safer care and benefits for individual patients.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2017
Keywords
barriers, determinants, facilitators, nurses, patient involvement, patient safety
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-145272 (URN)10.1002/nop2.89 (DOI)29085649 (PubMedID)
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-05-04Bibliographically approved
Nilsen, P., Ericsson, C., Skagerström, J. & Schildmeijer, K. (2017). Patientmedverkan från retorik till praktik [Letter to the editor]. Läkartidningen, 114
Open this publication in new window or tab >>Patientmedverkan från retorik till praktik
2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Stockholm, Sweden: Läkartidningen Förlag AB, 2017
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-146285 (URN)28675407 (PubMedID)
Available from: 2018-04-07 Created: 2018-04-07 Last updated: 2018-04-18Bibliographically 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, p. 555-565Article 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
Keywords
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, p. 135-144Article 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
Keywords
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
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