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Nilsen, Per
Alternative names
Publications (10 of 153) 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)
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 4Article 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)29691246 (PubMedID)
Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2018-06-04Bibliographically 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
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, p. 1-9Article 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
Keywords
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, p. 689-699Article 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
Keywords
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, p. 1169-1177Article 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
Keywords
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
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