Background: By training in speci c skills, healthcare personnel can learn how to systematically c... more Background: By training in speci c skills, healthcare personnel can learn how to systematically communicate with patients and their families in the best way possible. The 'Four Habits Model' (4HM) was developed by Kaiser Permanente in the United States, and is a method for eliciting and seeking understanding of the patient's perspective, demonstrating empathy in patient care, ensuring that patients understand and remember information they are given, and involving patients in treatment decisions. As of 2021, the 4HM course is a standard part of the internal training at seven Norwegian hospitals, both for doctors and as an interdisciplinary course. Objective: The purpose of the study was to investigate whether registered nurses (RNs) felt that the course had improved their communication skills and changed how they communicate with patients. Method: The study consisted of a descriptive cross-sectional study and a follow-up evaluation of self-e cacy in communication before and after a twoday interdisciplinary 4HM course. We used two di erent data collection methods: Sub-study 1: evaluation of 157 RNs from Baerum Hospital and Haukeland University Hospital via a questionnaire about self-e cacy in communication skills before and after participation in a 4HM course. Sub-study 2: a detailed online questionnaire completed 3-24 months after participation in a 4HM course. A total of 91 RNs from the two hospitals responded to the online questionnaire. Results: Analysis of both studies shows that the 4HM course improved the RNs' communication skills and led to changes in how they communicated with patients. The changes became an integral part of the RNs' practice and particularly related to being aware of the patient's perspective by asking openended questions, actively listening and structuring conversations with the patient. All four habits seem to be more or less equally useful. The RNs called for the course to be repeated and for implementation of the method to be more widespread. Conclusion: The ndings in this study show that a two-day interdisciplinary communication skills course covering 4HM improved RNs' communication skills, and consequently led to changes in how they communicated in the clinical setting. Communication has been described as the cornerstone of nursing (1) and something that permeates all elements of professional practice-from Kari Martinsen's description 'to see with the heart's eye' (2) to calls for greater patient involvement in decisions about their treatment (3).
Mitt hovedanliggende i denne oppgaven er å rette fokus mot to parallelle vitenskapsområder innenf... more Mitt hovedanliggende i denne oppgaven er å rette fokus mot to parallelle vitenskapsområder innenfor pedagogikken-didaktikk og laeringspsykologi. Jeg skal gjennom oppgaven, først presentere, og deretter kople, tankegods fra de to områdene sammen, og gjennom det se om det her er en sammenheng som vi bør ta hensyn til hvis vi skal komme videre innen forståelsen om undervisning og laering. Denne tanken er ikke ny. John Dewey uttrykte allerede i 1921 i boken "How we think" at: "Teaching and learning are correlative or corresponding processes, as much so as selling and bying. One might as well say he has sold when no-one has bought, as to say that he has thought when no-one has learned." (Dewey 1997: 29). En eksplisitt forståelse rundt en slik innfallsvinkel kan imidlertid, etter mitt syn, sies å ha glimret med sitt fravaer de siste 30 årene innen norsk pedagogikk. Oppgaven har anlagt og tatt utgangspunkt i følgende problemorientering eller problemstilling for å finne ut om en slik sammenkopling og fremstilling er fruktbar:
Preventive mental health intervention in secondary school: Learning outcome 6 and 12 months after... more Preventive mental health intervention in secondary school: Learning outcome 6 and 12 months after. A preventive program in mental health, "VIP", is targeted at students in secondary school. VIP aims at increasing understanding and recognition of mental problems and illness and at lowering thresholds for help seeking. We assessed the degree of achievement of the three above-mentioned goals by comparing students in a sample of schools in Akershus county (intervention group), with students in a sample of schools in Vestfold county (control group). In an earlier article we reported moderate to positive effects of VIP in the short term on "knowledge of mental disorders", "general knowledge of mental health", "ability to link symptoms to diagnosis", "general knowledge of mental health services", and "knowledge of specific community help facilities". In this study we investigated the extent to which the immediate effects remained 12 months after the intervention. This seems largely to be the case for students' general knowledge about issues related to mental health. On the other hand, it seems that a great deal of the effect on short-term knowledge of where help is to be found if the need arises, is lost in the course of a year's time.
Formålet med denne artikkelen er å undersøke om klientstyrt, resultatbasert terapi (PCOMS) kan øk... more Formålet med denne artikkelen er å undersøke om klientstyrt, resultatbasert terapi (PCOMS) kan øke brukerens muligheter til å delta i terapien. Forskning viser at bruk av PCOMS kan rette oppmerksomheten mot brukernes deltakelse i terapiprosessen ved å løfte frem deres stemmer og preferanser. Denne endringen i fokus ser ut til å øke graden av samarbeid i terapi og gjør det mulig for terapeuten å evaluere og justere terapiprosessen i henhold til tilbakemeldinger fra brukeren. Disse praksisene fremhever forbindelsen mellom PCOMS og brukerdeltakelse ved å den gir direkte tilbakemelding til fagfolk om brukerens erfaringer fra samarbeidet, forholdet til de profesjonelle og hjelpen de får. Forskning fremholder at PCOMS sikrer brukerens rettigheter, og gjør fagpersoner i stand til å gi mer brukerstyrt behandling. Fokus på å øke brukerens innflytelse i terapi stimulerer mulighetene til å jobbe med recovery. Artikkelen diskuterer hvordan PCOMS kan bidra til å øke recoveryprosessene i terapi.
In the research project in my doctoral thesis I wanted to test the effects of a short preventive ... more In the research project in my doctoral thesis I wanted to test the effects of a short preventive mental health program in secondary school. In 2007 there was established a longitudinal study with a test group and a control group (N=1671), built upon Solomon's design. Data was collected through questionnaires prior to intervention and at 1, 6, 12, and 24 months after the intervention. Effect sizes on the various indices are estimated in terms of (a) differences in improvements of total percentage scores and (b) Cohen's d. From t0 to t1, t2 and t3 the intervention group showed significantly greater progress in 6 out of 7 knowledge indexes, and 12 months after the intervention we found significant effects in reduction of mental health problems.
Mellom 15 og 20% av alle ungdommer i Norge har psykiske problemer som går ut over deres fungering... more Mellom 15 og 20% av alle ungdommer i Norge har psykiske problemer som går ut over deres fungeringsevne. Mellom 4 og 7% har så alvorlige plager at de trenger behandling. Mange tør ikke dele problemene med andre. VIP er et forebyggende program innenfor psykisk helse for elever i videregående skole. Målsetningen er å øke kunnskap om og evne til å gjenkjenne tegn på psykiske problemer og lidelser, og å senke terskelen for å søke hjelp. Vi vurderer her graden av måloppnåelse. Utvalget er 880 elever i Akershus der intervensjonen har blitt gjennomført, sammenliknet med 811 elever fra Vestfold fylke som ikke hadde intervensjonen. Opplysningene er innhentet gjennom spørreskjema før intervensjonen (t0), og 1 (t1), 6, 12 og 24 måneder etter intervensjonen. Ved hvert tidspunkt ble kunnskapen målt i prosent av maksimum skåre på et sett av indekser. Effektstørrelsen på de enkelte indeksene er estimert i (a) forskjeller i forbedring av prosentskåre og (b) Cohens d. Fra t0 til t1 hadde intervensjonsgruppen signifikant bedre kunnskapsutvikling innenfor "kjennskap til psykiske lidelser" (10,2% flere prosentenheter framgang, Cohens d = 0,58), "generell kunnskap om psykisk helse" (4,4%-0,30), "evne til kopling av symptomer til diagnoser" (3,1%-0,34), "kunnskap om hjelpeapparatet innenfor psykisk helse generelt" (11,6%-0,51) og "kunnskap om naermiljøets hjelpeapparat innenfor psykisk helse" (11,3%-0,74). Sammenliknet med effektstørrelsene i andre, tilsvarende studier (mellom 0,01 og 0,3 i Norge og mellom 0,26 og 0,57 i internasjonale undersøkelser) synes effekten av VIP å vaere god. Tatt i betraktning at kunnskap forvitrer og glemmes over tid, gjenstår det likevel å se om VIP-programmet får varige effekter av en størrelsesorden som er tilfredsstillende, sett i forhold til det programmet koster. Andersen BJ, Nord E. Effects of programs in school for preventing mental problems.
World hospitals and health services : the official journal of the International Hospital Federation, 2013
The author wanted to test the effects of preventive mental health programmes in schools and estab... more The author wanted to test the effects of preventive mental health programmes in schools and established a longitudinal study with a test group and a control group, using Solomon's method. Data was collected through questionnaires prior to intervention and at 1, 6, 12, and 24 months after the intervention. The size of the effect on the various indices were estimated in terms of (a) differences in improvement of total percentage scores and (b) Cohen's d. From to to t1, t2 and t3 the intervention group showed significantly greater progress in six out of seven knowledge indexes, and 12 months later we found significant effects on the level of mental health problems.
Abstract It has been claimed that the monitoring of ongoing psychotherapy is of crucial importanc... more Abstract It has been claimed that the monitoring of ongoing psychotherapy is of crucial importance for improving the quality of mental health care. This study investigated the effect of using the Norwegian version of the patient feedback system OQ®-Analyst using the Outcome Questionnaire-45.2. Patients from six psychiatric clinics in Southern Norway (N = 259) were randomized to feedback (FB) or no feedback (NFB). The main effect of feedback was statistical significant (p = .027), corroborating the hypothesis that feedback would improve the quality of services, although the size of the effect was small to moderate (d = 0.32). The benefits of feedback have to be considered against the costs of implementation.
The psychometric properties of OQ®-45 5.2.1 Reliability and validity 5.2.2 The representativeness... more The psychometric properties of OQ®-45 5.2.1 Reliability and validity 5.2.2 The representativeness of the samples 5.2.3 National experienced well-being and non-clinical means of the OQ-Total Score 5.2.4 The factor structure 5.3 The main issues from Paper 2. The effect of using the OQ®-Analyst in Norwegian psychiatric clinics 5.3.1 Difference between sites 5.3.2 Does feedback influence the number of sessions? 5.3.3 On-track versus not-on track cases 6 5.4 The main issues from Paper 3. How and When Feedback works: Is it the Signal? 5.4.1 The high proportion of not-on-track cases 5.4.2 Effect of the warning signal 5.4.3 Initial distress level 5.4.4 Early effect of feedback 5.4.5 Effect of feedback for not-on-track vs on-track cases 5.4.6 Therapist survey 5.4.7 The OQ®-Analyst system 5.5 Strengths and Limitations
Background: By training in speci c skills, healthcare personnel can learn how to systematically c... more Background: By training in speci c skills, healthcare personnel can learn how to systematically communicate with patients and their families in the best way possible. The 'Four Habits Model' (4HM) was developed by Kaiser Permanente in the United States, and is a method for eliciting and seeking understanding of the patient's perspective, demonstrating empathy in patient care, ensuring that patients understand and remember information they are given, and involving patients in treatment decisions. As of 2021, the 4HM course is a standard part of the internal training at seven Norwegian hospitals, both for doctors and as an interdisciplinary course. Objective: The purpose of the study was to investigate whether registered nurses (RNs) felt that the course had improved their communication skills and changed how they communicate with patients. Method: The study consisted of a descriptive cross-sectional study and a follow-up evaluation of self-e cacy in communication before and after a twoday interdisciplinary 4HM course. We used two di erent data collection methods: Sub-study 1: evaluation of 157 RNs from Baerum Hospital and Haukeland University Hospital via a questionnaire about self-e cacy in communication skills before and after participation in a 4HM course. Sub-study 2: a detailed online questionnaire completed 3-24 months after participation in a 4HM course. A total of 91 RNs from the two hospitals responded to the online questionnaire. Results: Analysis of both studies shows that the 4HM course improved the RNs' communication skills and led to changes in how they communicated with patients. The changes became an integral part of the RNs' practice and particularly related to being aware of the patient's perspective by asking openended questions, actively listening and structuring conversations with the patient. All four habits seem to be more or less equally useful. The RNs called for the course to be repeated and for implementation of the method to be more widespread. Conclusion: The ndings in this study show that a two-day interdisciplinary communication skills course covering 4HM improved RNs' communication skills, and consequently led to changes in how they communicated in the clinical setting. Communication has been described as the cornerstone of nursing (1) and something that permeates all elements of professional practice-from Kari Martinsen's description 'to see with the heart's eye' (2) to calls for greater patient involvement in decisions about their treatment (3).
Mitt hovedanliggende i denne oppgaven er å rette fokus mot to parallelle vitenskapsområder innenf... more Mitt hovedanliggende i denne oppgaven er å rette fokus mot to parallelle vitenskapsområder innenfor pedagogikken-didaktikk og laeringspsykologi. Jeg skal gjennom oppgaven, først presentere, og deretter kople, tankegods fra de to områdene sammen, og gjennom det se om det her er en sammenheng som vi bør ta hensyn til hvis vi skal komme videre innen forståelsen om undervisning og laering. Denne tanken er ikke ny. John Dewey uttrykte allerede i 1921 i boken "How we think" at: "Teaching and learning are correlative or corresponding processes, as much so as selling and bying. One might as well say he has sold when no-one has bought, as to say that he has thought when no-one has learned." (Dewey 1997: 29). En eksplisitt forståelse rundt en slik innfallsvinkel kan imidlertid, etter mitt syn, sies å ha glimret med sitt fravaer de siste 30 årene innen norsk pedagogikk. Oppgaven har anlagt og tatt utgangspunkt i følgende problemorientering eller problemstilling for å finne ut om en slik sammenkopling og fremstilling er fruktbar:
Preventive mental health intervention in secondary school: Learning outcome 6 and 12 months after... more Preventive mental health intervention in secondary school: Learning outcome 6 and 12 months after. A preventive program in mental health, "VIP", is targeted at students in secondary school. VIP aims at increasing understanding and recognition of mental problems and illness and at lowering thresholds for help seeking. We assessed the degree of achievement of the three above-mentioned goals by comparing students in a sample of schools in Akershus county (intervention group), with students in a sample of schools in Vestfold county (control group). In an earlier article we reported moderate to positive effects of VIP in the short term on "knowledge of mental disorders", "general knowledge of mental health", "ability to link symptoms to diagnosis", "general knowledge of mental health services", and "knowledge of specific community help facilities". In this study we investigated the extent to which the immediate effects remained 12 months after the intervention. This seems largely to be the case for students' general knowledge about issues related to mental health. On the other hand, it seems that a great deal of the effect on short-term knowledge of where help is to be found if the need arises, is lost in the course of a year's time.
Formålet med denne artikkelen er å undersøke om klientstyrt, resultatbasert terapi (PCOMS) kan øk... more Formålet med denne artikkelen er å undersøke om klientstyrt, resultatbasert terapi (PCOMS) kan øke brukerens muligheter til å delta i terapien. Forskning viser at bruk av PCOMS kan rette oppmerksomheten mot brukernes deltakelse i terapiprosessen ved å løfte frem deres stemmer og preferanser. Denne endringen i fokus ser ut til å øke graden av samarbeid i terapi og gjør det mulig for terapeuten å evaluere og justere terapiprosessen i henhold til tilbakemeldinger fra brukeren. Disse praksisene fremhever forbindelsen mellom PCOMS og brukerdeltakelse ved å den gir direkte tilbakemelding til fagfolk om brukerens erfaringer fra samarbeidet, forholdet til de profesjonelle og hjelpen de får. Forskning fremholder at PCOMS sikrer brukerens rettigheter, og gjør fagpersoner i stand til å gi mer brukerstyrt behandling. Fokus på å øke brukerens innflytelse i terapi stimulerer mulighetene til å jobbe med recovery. Artikkelen diskuterer hvordan PCOMS kan bidra til å øke recoveryprosessene i terapi.
In the research project in my doctoral thesis I wanted to test the effects of a short preventive ... more In the research project in my doctoral thesis I wanted to test the effects of a short preventive mental health program in secondary school. In 2007 there was established a longitudinal study with a test group and a control group (N=1671), built upon Solomon's design. Data was collected through questionnaires prior to intervention and at 1, 6, 12, and 24 months after the intervention. Effect sizes on the various indices are estimated in terms of (a) differences in improvements of total percentage scores and (b) Cohen's d. From t0 to t1, t2 and t3 the intervention group showed significantly greater progress in 6 out of 7 knowledge indexes, and 12 months after the intervention we found significant effects in reduction of mental health problems.
Mellom 15 og 20% av alle ungdommer i Norge har psykiske problemer som går ut over deres fungering... more Mellom 15 og 20% av alle ungdommer i Norge har psykiske problemer som går ut over deres fungeringsevne. Mellom 4 og 7% har så alvorlige plager at de trenger behandling. Mange tør ikke dele problemene med andre. VIP er et forebyggende program innenfor psykisk helse for elever i videregående skole. Målsetningen er å øke kunnskap om og evne til å gjenkjenne tegn på psykiske problemer og lidelser, og å senke terskelen for å søke hjelp. Vi vurderer her graden av måloppnåelse. Utvalget er 880 elever i Akershus der intervensjonen har blitt gjennomført, sammenliknet med 811 elever fra Vestfold fylke som ikke hadde intervensjonen. Opplysningene er innhentet gjennom spørreskjema før intervensjonen (t0), og 1 (t1), 6, 12 og 24 måneder etter intervensjonen. Ved hvert tidspunkt ble kunnskapen målt i prosent av maksimum skåre på et sett av indekser. Effektstørrelsen på de enkelte indeksene er estimert i (a) forskjeller i forbedring av prosentskåre og (b) Cohens d. Fra t0 til t1 hadde intervensjonsgruppen signifikant bedre kunnskapsutvikling innenfor "kjennskap til psykiske lidelser" (10,2% flere prosentenheter framgang, Cohens d = 0,58), "generell kunnskap om psykisk helse" (4,4%-0,30), "evne til kopling av symptomer til diagnoser" (3,1%-0,34), "kunnskap om hjelpeapparatet innenfor psykisk helse generelt" (11,6%-0,51) og "kunnskap om naermiljøets hjelpeapparat innenfor psykisk helse" (11,3%-0,74). Sammenliknet med effektstørrelsene i andre, tilsvarende studier (mellom 0,01 og 0,3 i Norge og mellom 0,26 og 0,57 i internasjonale undersøkelser) synes effekten av VIP å vaere god. Tatt i betraktning at kunnskap forvitrer og glemmes over tid, gjenstår det likevel å se om VIP-programmet får varige effekter av en størrelsesorden som er tilfredsstillende, sett i forhold til det programmet koster. Andersen BJ, Nord E. Effects of programs in school for preventing mental problems.
World hospitals and health services : the official journal of the International Hospital Federation, 2013
The author wanted to test the effects of preventive mental health programmes in schools and estab... more The author wanted to test the effects of preventive mental health programmes in schools and established a longitudinal study with a test group and a control group, using Solomon's method. Data was collected through questionnaires prior to intervention and at 1, 6, 12, and 24 months after the intervention. The size of the effect on the various indices were estimated in terms of (a) differences in improvement of total percentage scores and (b) Cohen's d. From to to t1, t2 and t3 the intervention group showed significantly greater progress in six out of seven knowledge indexes, and 12 months later we found significant effects on the level of mental health problems.
Abstract It has been claimed that the monitoring of ongoing psychotherapy is of crucial importanc... more Abstract It has been claimed that the monitoring of ongoing psychotherapy is of crucial importance for improving the quality of mental health care. This study investigated the effect of using the Norwegian version of the patient feedback system OQ®-Analyst using the Outcome Questionnaire-45.2. Patients from six psychiatric clinics in Southern Norway (N = 259) were randomized to feedback (FB) or no feedback (NFB). The main effect of feedback was statistical significant (p = .027), corroborating the hypothesis that feedback would improve the quality of services, although the size of the effect was small to moderate (d = 0.32). The benefits of feedback have to be considered against the costs of implementation.
The psychometric properties of OQ®-45 5.2.1 Reliability and validity 5.2.2 The representativeness... more The psychometric properties of OQ®-45 5.2.1 Reliability and validity 5.2.2 The representativeness of the samples 5.2.3 National experienced well-being and non-clinical means of the OQ-Total Score 5.2.4 The factor structure 5.3 The main issues from Paper 2. The effect of using the OQ®-Analyst in Norwegian psychiatric clinics 5.3.1 Difference between sites 5.3.2 Does feedback influence the number of sessions? 5.3.3 On-track versus not-on track cases 6 5.4 The main issues from Paper 3. How and When Feedback works: Is it the Signal? 5.4.1 The high proportion of not-on-track cases 5.4.2 Effect of the warning signal 5.4.3 Initial distress level 5.4.4 Early effect of feedback 5.4.5 Effect of feedback for not-on-track vs on-track cases 5.4.6 Therapist survey 5.4.7 The OQ®-Analyst system 5.5 Strengths and Limitations
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