Vivian Nystrøm

• Nystrøm, Vivian; Arto, Ohinmaa & Leonardsen, Ann-Chatrin Linqvist (2024). Patient pathways in primary health care – an interview study across various health care personnel in a Canadian and a Norwegian county. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11985-y. Full text in Research Archive Show summary

  Background. Due to demographic changes in the Western world governments emphasize the need for viable solutions, e.g. through decentralization of specialist health care services and better coordination within and between health care services. Both Norway and Canada have been through health care reforms and initiatives aiming to improve continuity and coordination of services. Organizational change to primary care in both countries encompasses both teambased service delivery involving allied health professionals, and new blended payment models. The objective of this study was to explore patient pathways in primary healthcare from various health personnel’s perspectives, and across various primary care organizations in Norway and Canada. Methods. The study had a qualitative design, including interviews with physicians, nurses and managers (n=19) in primary care, from a county in Norway and a region in Canada. Data were analyzed with a thematic approach, in line with recommendations from Braun & Clarke. Results. Three themes were identifed: 1) Structural challenges, 2) Towards a more specialized primary health care and 3) Dedication could improve continuity. Findings indicate that coordinating health care services was assumed diffcult due to diferent health care levels, funding systems, managements, electronic record systems and organizations. Hospitals were assumed more task oriented, while primary health care services were considered more care oriented, and this challenged the coordination across organizations. Primary care services were perceived to be more and more specialized, also representing a threat for coordination and continuity. Health care personnel in both countries perceived that dedicated personnel for each patient could improve information fow and continuity across services. Conclusions. Achieving continuity and coordination of health care services seems challenging. Integration strategies seem essential for reducing silo thinking and fragmentation of health care services.

• Nystrøm, Vivian & Olsen, Brita Fosser (2024). The effect of noise and light on sedation in critical care patients. A cross-sectional study of critical care nurses in three intensive care units in Norway. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. 19(1), p. 78–90. doi: 10.23865/inspira.v19.5894. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Nystrøm, Vivian; Slang, Renate; Olsen, Eilen Elisabeth & Trollnes, Anne Kristin Hole (2024). Digitalization in the Emergency Department—An Interview Study of Nurses’ Experiences in Norway. Nursing Reports. ISSN 2039-439X. 14(2), p. 1414–1423. doi: 10.3390/nursrep14020106. Full text in Research Archive Show summary

  Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses’ experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke’s six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses’ professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future.

• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2024). Patient experiences and clinical outcomes of admissions to municipal acute wards versus a hospital: A multicentre randomised controlled trial in Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), p. 659–667. doi: 10.1080/02813432.2024.2377727. Full text in Research Archive Show summary

  Background: In Norway, municipal acute wards (MAWs) were implemented as alternatives to hospitalisation. Evaluations of the quality of MAW services are lacking. The primary objective of this study was to compare patient experiences after admission to a MAW versus to a hospital. The secondary objective was to compare ‘readmissions’, ‘length of stay’, ‘self-assessed health-related quality of life’ as measured by the EuroQol 5 items 5 level (EQ-5D-5L) index, and ‘health status’ measured by the RAND-12, in patients admitted to a MAW versus a hospital. Methods: A multicentre randomised controlled trial (RCT), randomising patients to either MAW or hospital. Results: In total, 164 patients were enrolled in the study; 115 were randomised to MAW and 49 to hospital. There were no significant differences between the MAW and hospital groups regarding patient experience, which was rated positively in both groups. Patients in the MAW group reported significantly better physical health status as measured by the RAND-12 four to six weeks after admittance than those randomised to hospital (physical component summary score, 31.7 versus 27.1, p=0.04). The change in EQ-5D index score from baseline to four to six weeks after admittance was significantly greater among patients randomised to MAWs versus hospitals (0.20 versus 0.02, p=0.03). There were no other significant differences between the MAW and hospital groups. Conclusions: In this study, patient experiences and readmissions were similar, whether patients were admitted to a MAW or a hospital. The significant differences in health status and quality of life favouring the MAWs suggest that these healthcare services may be better for elderly patients. However, unfortunately we did not reach the planned sample size due to challenges in the data collection posed by the Covid-19 pandemic.

• Leonardsen, Ann-Chatrin Linqvist; Nystrøm, Vivian; Trollnes, Anne Kristin Hole; Slang, Renate & Olsen, Eilen Elisabeth (2024). Digitalization in the operating theatre- an interview study of operating room nurses’ and nurse anesthetists’ experiences in Norway. BMC Nursing. 23(1), p. 1–8. doi: 10.1186/s12912-024-02574-9. Full text in Research Archive Show summary

  Background; Digitalization in the health sector requires adaptive change in human attitudes and skills. The operating theatres have been introduced to digital innovations through centuries. The aim of this study was to explore operating room (OR) nurses’ and Nurse Anesthetists’ (NAs) experiences with digitalization in the operating theatre. Methods; The study had a qualitative design, using individual interviews with OR nurses and NAs at a Norwegian hospital. Data were analyzed using reflexive thematic analysis in-line with recommendations from Braun & Clarke. Results; Two themes were identified, namely (1) Impacting the work processes, and (2) Implications for patient safety. The OR nurses and NAs experienced that digitalization impacted on their work processes positively through making these smoother, but also negatively making the work processes vulnerable for disruptions, leading to a need for parallel actions. Digitalization was experienced to positively impact patient safety for example through making information more accessible. However, digital tools reduced focus on the patient, and then represented a risk to patient safety. Conclusion; OR nurses and NAs perceive that digitalization on one side may facilitate work processes and information flow. However, on the other side digitalization may steel focus on the patient. These aspects should be taken into consideration in quality improvement initiatives and when introducing new digital tools.

• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2022). Finding good alternatives to hospitalisation: a data register study in five municipal acute wards in Norway. BMC Health Services Research. 22, p. 1–12. doi: 10.1186/s12913-022-08066-3. Full text in Research Archive Show summary

  Background: In Norway, municipal acute wards (MAWs) have been implemented in primary healthcare since 2012. The MAWs were intended to offer decentralised acute medical care 24/7 for patients who otherwise would be admit‑ ted to hospital. The aim of this study was to assess whether the MAW represents the alternative to hospitalisation as intended, through 1) describing the characteristics of patients intended as candidates for MAWs by primary care physicians, 2) exploring the need for extended diagnostics prior to admission in MAWs, and 3) exploring factors asso‑ ciated with patients being transferred from the MAWs to hospital. Methods: The study was based on register data from five MAWs in Norway in the period 2014–2020. Results: In total, 16 786 admissions were included. The median age of the patients was 78 years, 60% were women, and the median length of stay was three days. Receiving oral medication (OR 1.23, 95% CI 1.09–1.40), and the MAW being located nearby the hospital (OR 2.29, 95% CI 1.92–2.72) were factors associated with patients admitted to MAW after extended diagnostics. Patients needing advanced treatment, such as oxygen therapy (OR 2.13, 95% CI 1.81–2.51), intravenous medication (OR 1.60, 95% CI 1.45–1.81), intravenous fluid therapy (OR 1.32, 95% CI 1.19–1.47) and MAWs with long travel distance from the MAW to the hospital (OR 1.46, 95% CI 1.22–1.74) had an increased odds for being transferred to hospital. Conclusions: Our findings indicate that MAWs do not represent the alternative to hospitalisation as intended. The results show that patients receiving extended diagnostics before admission to MAW got basic treatment, while patients in need of advanced medical treatment were transferred to hospital from a MAW. This indicates that there is still a potential to develop MAWs in order to fulfil the intended health service level

• Nystrøm, Vivian; Lurås, Hilde; Midlov, Patrik & Leonardsen, Ann-Chatrin Linqvist (2021). What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance. BMC Health Services Research. 21(1), p. 1–10. doi: 10.1186/s12913-021-06444-x. Full text in Research Archive Show summary

  Background Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. Methods The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. Results The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. Conclusions The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.

• Olsen, Brita Fosser & Nystrøm, Vivian (2020). Respiratorbehandling. In Gulbrandsen, Tove Anita & Stubberud, Dag-Gunnar (Ed.), Intensivsykepleie. Cappelen Damm AS. ISSN 9788202603748. p. 339–386. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Nystrøm, Vivian; Grimsrud, Inger-Johanne Sælid; Hauge, Linn Maria & Olsen, Brita Fosser (2020). Competence in caring for patients with respiratory insufficiency-A cross-sectional study. Intensive and Critical Care Nursing. ISSN 0964-3397. p. 1–8. doi: 10.1016/j.iccn.2020.102952. Full text in Research Archive
• Nystrøm, Vivian; Olsen, Brita Fosser & Brekke, Idunn (2020). Practised sedation in mechanically ventilated patients: A survey of nurses’ perceptions. The Nordic Journal of Nursing Research (NJNR). ISSN 2057-1585. 40(2), p. 105–112. doi: 10.1177/2057158519899548. Full text in Research Archive

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• Nystrøm, Vivian; Grøndahl, Vigdis Abrahamsen; Nordrum, Anne Marte Toft; Maintz, Corinna; Kornsæther, Hanne Holmgren & Foreman, Hege (2026). Tør du være syk utenfor sykehuset? – Høgskolen i Østfold. Full text in Research Archive
• Olsen, Brita Fosser & Nystrøm, Vivian (2025). Respiratorbehandling. In Stubberud, Dag-Gunnar & Solberg, Pål (Ed.), Intensivsykepleie. Cappelen Damm Akademisk. ISSN 9788202796983. p. 220–271. Full text in Research Archive Show summary

  Hvordan kan intensivsykepleieren ivareta de grunnleggende behovene til pasienter som er akutt og/eller kritisk syke? Bokas forfattere svarer gjennom å beskrive hvordan intensivsykepleierens spesialkompetanse kommer til uttrykk i profesjonens ulike funksjons- og ansvarsområder. I denne femte reviderte utgaven er fagstoffet oppdatert i tråd med ny nasjonal og internasjonal forskning og kunnskap. Målet er å styrke kompetansen for dermed å bidra til faglig forsvarlig helsehjelp og optimal pasientsikkerhet. I denne reviderte utgaven er det gjort pedagogiske grep blant annet i form av repetisjonsoppgaver om sentrale temaer i hvert kapittel. Boka er primært skrevet for studenter som tar videreutdanning eller masterstudium i intensivsykepleie. Den er egnet som oppslagsverk for sykepleiere som arbeider i akuttmottak, intensivavdelinger, overvåkingsavdelinger og postoperative avdelinger.

• Nystrøm, Vivian (2024). Legenes skepsis til kvaliteten og kompetansen på KAD er sannsynligvis ubegrunnet. [Internet]. Den Norske Legeforeningen. Full text in Research Archive
• Nystrøm, Vivian (2024). Forsker: – KAD-ene representerer et trygt og sikkert helsetjenestetilbud. [Internet]. Dagens Medisin. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Nystrøm, Vivian; Moger, Tron Anders & Lurås, Hilde (2024). Kommunale akuttavdelinger skulle bli et alternativ til sykehusinnleggelse- men legene stoler ikke på tilbudet. Full text in Research Archive
• Nystrøm, Vivian (2024). Digitale verktøy i intensivsykepleie. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist & Nystrøm, Vivian (2024). Kommunene er sentrale for å innfri ventetidsløftet. Full text in Research Archive
• Slang, Renate; Leonardsen, Ann-Chatrin Linqvist; Trollnes, Anne Kristin Hole & Nystrøm, Vivian (2023). Digitale verktøy i intensivsykepleie. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2023). Finding good alternatives to hospitalisation.A data register study in five municipal acute wards in Norway​. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Midlov, Patrik & Leonardsen, Ann-Chatrin Linqvist (2023). Tenk om det skjer noe i natt? Kommunale legers erfaringer med å henvise pasienter til kommunale akutte døgnenheter. Full text in Research Archive
• Nystrøm, Vivian; Lurås, Hilde; Moger, Tron Anders & Leonardsen, Ann-Chatrin Linqvist (2023). Patient experiences and clinical outcomes of admissions to municipal acute wards versus a hospital.A multicenter randomised controlled trial in Norway. Full text in Research Archive
• Nystrøm, Vivian (2021). Kommunale leger skeptiske til å legge pasienter inn på KAD. [Internet]. Dagens Medisin. Full text in Research Archive
• Nystrøm, Vivian (2021). Hva hvis noe skjer i natt? [Internet]. Legeforeningen.no. Full text in Research Archive
• Nystrøm, Vivian (2021). Finding good alternatives to hospitalization? A register study from five municipal acute wards in the southeastern part of Norway. Full text in Research Archive
• Nystrøm, Vivian (2021). Kommunale legers erfaringer med å henvise pasienter til kommunale akutte døgnenheter. Full text in Research Archive
• Nystrøm, Vivian (2021). Tenk om noe skjer i natt. Kommunale legers erfaringer med å henvise pasienter til kommunale akutte døgnenheter. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist & Nystrøm, Vivian (2020). Hvordan kan vi organisere akutte helsetjenester på en god måte? Sykepleien. ISSN 0039-7628. doi: 10.4220/Sykepleiens.2020.82265. Full text in Research Archive
• Bratli, Lene; Nystrøm, Vivian & Leonardsen, Ann-Chatrin Linqvist (2020). Hvordan kan sykepleiere kartlegge barns smerte? Tidsskriftet sykepleien. ISSN 0806-7511. p. 50–56. doi: 10.4220/SYKEPLEIENS.2020.80444. Full text in Research Archive
• Baastad, Sophie; Nystrøm, Vivian & Leonardsen, Ann-Chatrin Linqvist (2020). Bruk av dagbok hos intensivpasienter. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. p. 26–29. Full text in Research Archive
• Nystrøm, Vivian (2020). Kvalitet og effektivitet ved sykehus versus KAD. Full text in Research Archive
• Halvorsen, Hedda Teig; Hammer, Sandra Karoliussen; Nystrøm, Vivian & Leonardsen, Ann-Chatrin Linqvist (2019). Delirium hos intuberte intensivpasienter- intensivsykepleieres erfaringer. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. 4, p. 17–25. Full text in Research Archive
• Fjerdingby, Tine; Nystrøm, Vivian & Leonardsen, Ann-Chatrin Linqvist (2019). Mobilisering av intensivpasienter. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. 4, p. 12–16. Full text in Research Archive
• Skrøder, Ann Christin; Michalsen, Stine; Nystrøm, Vivian & Leonardsen, Ann-Chatrin Linqvist (2019). Hyperoksi hos premature. InspirA - Tidsskrift for anestesi- og intensivsykepleiere. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. Full text in Research Archive
• Winsvold, Therese; Eriksen, Mina; Nystrøm, Vivian & Leonardsen, Ann-Chatrin Linqvist (2019). Bruk av NIV til ekstuberte pasienter. Inspira – tidsskrift for anestesi-, operasjon- og intensivsykepleiere. ISSN 0809-9707. 3, p. 15–20. Full text in Research Archive
• Nystrøm, Vivian (2018). Smerte,sedasjon og delirhåndtering - et kvalitetsforbedringsprosjekt. Full text in Research Archive
• Nystrøm, Vivian (2016). Støy øker sederingsbehov. Full text in Research Archive
• Nystrøm, Vivian (2024). An Issue of Trust: Exploring Different Aspects of the Municipal Acute Ward as an Alternative to Hospitalization. Universitetet i Oslo. Full text in Research Archive Show summary

  The main aim of this PhD project was to provide knowledge about various aspects of the Municipal Acute Wards (MAWs) as an alternative to hospitalization. The PhD project included three studies: The first study explored 21 Primary Care Physicians’(PCPs) perspectives on the MAW as an alternative to hospitalization. Findings indicated that PCPs at the out-of-hours service were skeptical to refer patients to a MAW, due to lower medical competence and less diagnostic possibilities compared to in the hospital. However, they perceived that the “diagnostic loop” made it safer to refer patients to a MAW. The second study explored characteristics of 16 786 patients admitted to the MAWs in the period 2014-2020. This study showed that mainly older persons were admitted to the MAW. Patients treated in a MAW mainly needed basic medical treatment, care, and nursing. The results showed that patients were transferred to the hospital when they needed more advanced medical treatment, such as intravenous medication. The third study aimed to assess the quality of healthcare services in MAW compared to those in the hospital. In total, 164 patients were randomized to a hospital or a MAW. Findings from this study indicated that the patients experienced equally positive patient experiences after treatment in a MAW compared to in the hospital. There was a significant larger positive change in self-assessed health -related quality and self-assessed health status for patient allocated to a MAW. Findings in this thesis indicate that despite the PCPs skepticism, the MAWs may provide proper and quality healthcare services in the interface between specialist and primary healthcare. However, the results indicate that there may be a need to adjust the intentions with the MAWs in order to fulfil a future need in healthcare services.

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