The importance of interdisciplinarity in accommodating patient needs among Norwegian nurses

What is known on the subject: Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors. Mental health nurses often describe role confusion in relation to other health professionals. Opportunities for interdisciplinary communication with other professionals may benefit health care. What the paper adds to existing knowledge: The current large-scale study is the first to investigate whether mental health and SUD nurses' perceptions of their opportunities to accommodate patients' needs are related to interdisciplinarity in the treatment unit and a nursing role with clearly defined responsibilities. Strong interdisciplinarity was associated with greater perceived opportunities to accommodate patients' psychosocial, somatic, and economic and legal needs, while strictly defined nursing roles/responsibilities were related to weaker opportunities to do so. What are the implications of practice: The findings highlight the need to address how mental health and SUD nurses organize practice to meet patients' diverse needs Interdisciplinary teamwork could strengthen nurses' ability to address patient needs Finding the best possible balance of providing service in teams or individually could improve resource utilization at the same time as strengthening patient care, and making sure that the patients' various needs are met. Abstract: INTRODUCTION: Nurses' roles in specialist mental health and substance use disorder (SUD) treatment services are multidimensional and complex. Their responsibility, autonomy and interdisciplinary collaboration may be of importance for their perceived opportunities to accommodate patients' health needs. Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors, and included relatively small samples. The studies have also mainly been conducted in other sectors than the mental health and SUD nursing sectors. Aim/question: The aim of this study is to examine the associations between nurses' roles, interdisciplinarity and their perceived opportunities to accommodate patients' psychosocial, somatic and economic/legal needs. Method: A cross-sectional web-based questionnaire survey was conducted in a nationwide sample of Norwegian nurses in the mental health, SUD treatment and combined mental health and SUD treatment sectors. Of 5,501 contactable nurses (74% of the population), 1918 (35%) responded. Results: The results revealed that interdisciplinarity was significantly associated with greater perceived opportunity to accommodate patient needs, whereas strictly defined nursing roles/responsibilities were associated with less opportunity to accommodate these needs. Discussion/implication for practice: Facilitation of interdisciplinary collaboration may improve quality of care for patients in mental health and SUD treatment services.publishedVersio

Introducing TrønderMaaS : investigating business models, sustainability and users' acceptance of a MaaS system in Stjørdal and Trondheim region, Norway

publishedVersio

Comparative Analysis of Safety Performance Indicators Based on Inductive Loop Detector Data

Conflicts in traffic stream have been detected by different safety performance indicators. This study aims to empirically investigate the differences between different indicators in detecting rear-end conflicts and assessing the risk in an uninterrupted flow. Micro-level data of a 24-hr traffic stream (including 6,657 vehicles) were captured using inductive loop detectors installed on a rural freeway section. Different indicators (Time Headway (H), Time to Collision (TTC), Proportion of Stopping Distance (PSD), Deceleration Rate to Avoid Collision (DRAC) and Stopping Distance Index (SDI)) were used to measure each car following event in a bivalent state (safe/unsafe). Unsafe events associated with each indicator were detected and common unsafe events characterized by different indicators were identified. Temporal distributions of rear-end collision risks associated with each indicator at 15-min intervals were also compared. Finally, the 15-min risk values based on different indicators were categorized and compared across three levels (Low, Medium and High). Data mining and statistical techniques showed that while SDI is the single most conservative indicator, DRAC and TTC detect a few risky events but very equal ones. In almost all conflicts associated with TTC, headway is still lower than the critical threshold. However, there exist considerable risky events based on headway which are still safe according to TTC. Comparison of PSD and TTC also declares that almost all conflicts associated with TTC are also risky according to PSD

The role of social cognition in perceived thresholds for transport mode change

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Elsevier in Transport Policy on 18/09/2019.Available online: https://www.sciencedirect.com/science/article/pii/S0967070X18305560This article is based on a study that investigated social cognitive psychological factors associated with economic thresholds related to using public or other sustainable transport modes. A survey was conducted using a random sample of the Norwegian population living in the six largest urban regions (n = 1039). The respondents were asked to indicate the monthly increase in car taxes and fees that they would perceive necessary to make them use sustainable transport modes instead of their private car. The findings revealed that those who perceived themselves as definitive car users (strongly reluctant to change transport mode) reported low tolerance of push measures, low awareness of and ascription of responsibility for the consequences of car use, and weak environmental norms. Environmental norms, attitudes towards transport and push measure tolerance were the strongest predictors of the respondents belonging to either the lowest or the highest threshold groups. The authors conclude that measures aimed at increasing the costs of car use and improving the accessibility of public transport in urban areas could be supplemented by social cognitive factors.acceptedVersio

Predictors of Self-reported Crashes among Iranian Drivers: Exploratory Analysis of an Extended Driver Behavior Questionnaire

More than 16,500 people lose their lives each year due to traffic crashes in Iran, which reflects one of the highest road traffic fatality rates in the world. The aim of the present study is to investigate the factors structure of an extended Driver Behaviour Questionnaire (DBQ) and to examine the gender differences in the extracted factors among Iranian drivers. Further, the study tested the association between DBQ factors, demographic characteristics, and self-reported crashes. Based on Iranian driving culture, an extended (36 items) Internet-based version of the DBQ was distributed among Iranian drivers. The results of Exploratory Factor Analysis based on a sample of 632 Iranians identified a five-factor solution named “Speeding and Pushing Violations”, “Lapses and Errors”, “Violations Causing Inattention”, “Aggressive Violations” and “Traffic Violations” which account for 44.7 percent of the total variance. The results also revealed that females were more prone to Lapses and Errors, whereas males reported more violations than females. Logistic regression analysis identified Violations Causing Inattention, Speeding and Pushing Violations as predictors of self-reported crashes in a three-year period. The results were discussed in line with road traffic safety countermeasures suitable for the Iranian context.</p

Cross-cultural effects on drivers' hazard perception

Hazard perception tests are used in several developed countries as part of the driver licensing curriculum, however little research has been done in developing countries where road safety is a primary concern. We conducted a cross-cultural hazard perception study to examine the transferability of hazard perception skills between Malaysia and the UK, using hazard clips filmed in both countries. The results showed that familiarity with both the driving environment and type of hazard facilitated drivers' ability to discriminate hazards in a timely manner, although overall drivers viewed and responded to hazards largely similarly regardless of origin. Visual strategies also appeared to be moderated mainly by the immediate driving environment rather than driver origin. Finally, Malaysian drivers required a higher threshold of danger than UK drivers before they would identify a situation as hazardous, possibly reflecting the more hazardous road environment in Malaysia. We suggest that hazard perception testing in developing countries requires a test where performance cannot be confounded with differing thresholds for hazardousness

Shedding light on the psychological and behavioral determinants of travel mode choice: A meta-analysis

Mobility represents a relevant topic from the standpoint of environmental degradation, health-related consequences and social inclusion. Since private mobility is responsible for the greatest share of polluting emissions, it is necessary to gain deeper understanding of the mechanisms underpinning the choice of individuals to use either cars or alternative, environment-friendly transport modes. A meta-analysis on 58 primary studies is conducted to synthesize evidence on the determinants of travel mode choice, as regards both behavioral intentions and actual behaviors. Results suggest that, besides intentions, habits and past use represent the most relevant predictor, followed by constructs referring to the Theory of Planned Behavior framework. Environmental variables, on the other hand, play a relevant role in shaping behavioral intentions while their effect on actual behaviors is negligible, so that a deep intention behavior gap emerges. A moderator analysis is performed to explain the high heterogeneity in the results. Behaviors’ operationalization and measurement emerges as the moderator affecting heterogeneity of outcomes the most; trip purpose, sample type and year of the study also show a moderate effect on heterogeneity, while location does not appear to be a relevant moderator

Religiosity and alcohol use: Is religiosity important for abstention and consumption levels in the second half of life?

Objective: The aim of this study was to investigate the relative role of religiosity for alcohol abstention and consumption levels among individuals aged 40 years or above. Method: A two-wave prospective survey was conducted among Norwegians aged 40 to 80 years (Time 1 in 2002/2003, and Time 2 in 2007/2008). The analytical sample of the current study constituted those who responded to the questionnaire survey at both time points (n = 2671). Results: The findings showed that religiousity was strongly associated with abstention and less consumption while adjusting for demographics and health variables. The results also reflected that females and those with higher age were more likely to abstain from alcohol than males and those with lower age, respectively. Individuals with high education were less likely to abstain than those with basic education. Females and those with high age also reflected less alcohol consumption than males and individuals of lower age, respectively. Further, people who were married or with a registered partner consumed less alcohol than people who were not married or with a registered partner. High education and good physical health was associated with higher consumption. The main results were consistent across prospective and cross-sectional models. Conclusion: Religiosity seems to be important both for abstention and alcohol consumption levels in the second half of life

Patients with Substance Use Disorders An investigation of Relapse, Substance Use and Recovery

The main purpose of the present thesis was to investigate contextual and psychosocial factors with potential importance for relapse, substance use and perceptions of treatment and recovery processes among patients with substance addiction. The thesis is based on two different data materials. Studies I, II and III are based on a cross-sectional survey investigation carried out among a patient sample (N = 352) recruited from 16 treatment facilities for substance use disorders in Norway. Study IV is based on material established by semi-structured interviews of 13 patients recruited from six clinics in the central region of Norway. The included treatment facilities covered the majority of common specialised treatment approaches for substance use disorders in Norway. Most of the treatment facilities carried out psychosocial treatment for poly-substance use, and included short-term inpatient treatment lasting up to six months, long-term inpatient treatment exceeding six months, as well as open-ended outpatient treatment and Opioid Maintenance Treatment (OMT). The clinics have a broad approach to substance use disorders; they include interventions based on, for instance, cognitive therapy, motivational interviewing, family therapy, milieu therapy, methadone or buprenorphine maintenance and interventions in a therapeutic community. Several clinics also offered opportunities for physical activity and advice regarding economic issues and accommodation. Some clinics also collaborated with public services in the municipalities to establish work-related activities for their patients. The theoretical framework for the studies was stress models for substance use (i.e. the self-medication hypothesis and the life stress model). These models assert that substance use could be caused by psychological symptoms and social problems (i.e. psychosocial factors). The self-medication hypothesis argues that substance addiction is caused by a need to relieve psychological distress induced by psychological disorders. According to the life stress model of substance use, the probability of such use is regulated by the levels of stress experienced by the individuals and the presence of potential moderators such as social networks, social competence and resources. The behavioural choice theory for substance use was also relevant for the work in the present thesis. This theory argues that substance use and relapse could be interpreted as an overall lack of alternative rewarding activities to substance use. The behavioural choice theory asserts that substance use could be reduced or avoided by establishing competing activities to substance use such as occupational activities and education. Therefore, the studies also focused on contextual variables with potential importance for the everyday functioning of the individuals. Such variables could, for example, be occupational activities and social and material resources that the patients have at their disposal. Demographic characteristics, such as gender and age, were also considered relevant in this line of enquiry. However, it should be noted that the thesis did not specifically aim to validate these comprehensive theories and models. These theories and models constituted the theoretical basis and established the rationale for the empirical work. The thesis considers substance use disorders in a broad community psychological perspective. It was expected that the results would have implications both for clinical practice, aftercare strategies and preventive interventions. Study I examined the time interval from treatment discharge to potential relapses among the patients. Contextual and psychosocial factors related to a prolonged or reduced time interval after treatment to a relapse were also explored. The findings suggested that the relapse risk was very high during the first months after treatment. The results also showed that adolescents had higher probabilities of early relapses compared to older patients. Patients who experienced an early relapse after treatment were more likely to be unemployed and to use opioids or alcohol as their main substances. Patients who had been enrolled in several different treatment programmes that used various approaches had higher likelihood of early relapse compared to patients who had only been enrolled in one type of treatment programme. Inpatient treatment of long and short durability increased the time period from treatment discharge to relapse. Aftercare and treatment follow-up strategies should focus on the period of time of the early months after treatment discharge. An adequate countermeasure would be to facilitate work-related and educational activities for the patients before they have completed treatment. Focus on risk perception regarding substance use among adolescents could reduce the relapse risk among this specific demographic risk group. Clinicians could facilitate internal motivation for treatment among these patients. The higher relapse risk of adolescents also underlines the importance of early intervention for this group. Study II tested a hypothesised model where significant life events, interpersonal problems, psychological distress and self-efficacy predicted substance use. Differences in these associations according to gender were also examined. The results showed that both negative and positive life events had stronger relations to substance use behaviours among males. Psychological distress was strongly linked to substance use among both genders, but this relation was somewhat stronger among females. Interpersonal problems were associated with psychological distress, but a direct relation to substance use was not supported by the empirical data. The findings could justify the use of different clinical approaches when male and female patients are exposed to life stress. Male patients could benefit from learning adaptive behavioural coping strategies when they are confronted with major negative life events, whereas females could benefit from establishing or seeking out supportive social networks. The strong association between psychological distress and substance use implies that an increase in psychological competence of personnel in specialised treatment for substance use disorders could be beneficial. The aim of study III was to examine whether patients with high or low consumption levels of illicit substances or alcohol differed on specific dimensions of psychosocial symptom load operationalised by the Symptom Checklist-90- Revised (SCL-90-R) and Inventory of Interpersonal Problems – Circumplex (IIPC). The findings showed that the prevalence of psychosocial symptom load was higher in the groups with high consumption levels of illicit substances or alcohol. Further, the results showed that these differences were stronger for those who manifested high consumption levels of illicit substances compared to those who mainly had high consumption levels of alcohol. Very few patients had a high consumption level of both alcohol and illicit substances; the reason could be that patients who have high consumption levels of illicit substances are subjected to more discrediting attitudes and attributes than patients who mainly manifest severe alcohol consumption. This partly stems from the legal status of alcohol and the fact that alcohol is often consumed in acceptable contexts by the general public (e.g. restaurant and pubs). There is also the fact that patients with high alcohol consumption had more available resources than patients who mainly used illicit substances to consider. Differences in psychosocial distress related to levels of alcohol consumption were stronger for anxiety disorders, whereas variations concerning illicit substances related to several heterogeneous psychosocial symptoms. This could indicate that the sedative effects of alcohol serve important functions for patients with anxiety disorders. Patients who use illicit substances may be more sensitive to a high variety of negative emotional symptoms. There were few differences related to interpersonal problems between the consumption groups. This underlines that the relation between interpersonal problems and substance use could be of an indirect character. Study IV investigated contextual and psychosocial variables with potential relevance for how patients perceived processes related to treatment and recovery. Despite the fact that paper IV is located towards the end of the thesis, study IV was the first study conducted in the PhD project. Since this study indicated that contextual and psychosocial factors, such as therapeutic relations, social support and material resources, were important for patients' perceived recovery, the subsequent studies mainly focused on contextual and psychosocial variables in conjunction with relapse and substance use. Specifically, the results in paper IV showed that the patients focused on recovery in different domains related to psychological health, substance use, social functioning and the initiation of occupational activities. They also focused on the establishment of proper housing and economic improvements. The patients stressed the importance of therapeutic relationships and mutual support among patients in the clinics when they were asked about how they perceived processes related to treatment. They focused on the positive influences of trustful and respectful attitudes of the treatment personnel. According to the patients, treatment based in trust and respect between the caregivers and patients was important for the initiation of recovery processes. Both positive and negative influences of patient interactions were focused on by the patients. Patients reported that other patients at the clinics had convinced them to remain in the programmes when they were tempted to prematurely drop out or relapse to substance use. However, according to the patients who did not receive methadone or buprenorphine as part of their treatment, those who did receive methadone or buprenorphine had less motivation regarding the psychosocial components of the programme, and they felt that this negatively influenced the overall motivation in the whole group. Perhaps these patients should be treated separately. In summary, the findings supported that both contextual and psychosocial variables relate to relapse, substance use and perceptions of treatment and recovery among patients who have manifested substance use disorders. A practical implication is that many of the interventions needed to facilitate recovery among patients with substance use disorders could take place at the community level rather than be solely conducted within the context of specialised treatment facilities. Because relapse after treatment discharge is common among these patients, programme developers and decision-makers should focus on measuresthat could reduce the relapse risk among these patients. In line with the behavioural choice theory, Community Reinforcement Approaches (CRA) aimed at facilitating alternative competing activities (e.g. work, education and physical activity) to substance use could reduce the relapse risk after treatment. In addition, clinicians could teach patients how to identify relapse-preceding cues based on the relapse prevention model (e.g. intra-psychological negative affect or substance using individuals from the patients’ social environment). Moreover, the present thesis hasidentified patterns in the time intervals from treatment discharge to relapse. Some of the specific risk groups for relapse were also identified and countermeasures to reduce the relapse rates within these groups have been suggested. Previous researchhas tended to focus on the importance of psychiatric diagnoses for relapsNotwithstanding the potential importance of such diagnoses, further research couldalso take contextual and psychosocial variables into account. The present work contributed to the current literature in that it also focused on variables related tsocial and material resources in relation to relapse, substance use and perceptionsof treatment and recovery processes. Moreover, the results supported potential gender differences in the life stress models of substance use, as negative life events solely predicted substance use among males. Future research should gearlongitudinal studies to investigate gender differences in the relations between lifeevents, psychosocial distress, self-efficacy and substance use over time. Suchstudies could provide further insights into the dynamics of relapse and recoveryprocesses of this patient group. The results also showed that the social relationshipsestablished in the treatment programmes are important for the patients. The study based on semi-structured interviews suggests that these relationships are an integral part of patients' motivation and persistence in treatment. Research in the future could focus on the social conditions within the clinics and relate these variables topatient outcomes

Transport risk evaluations associated with past exposure to adverse security events in public transport

The current study aims to examine differences in risk evaluations according to whether individuals have been exposed to adverse security events in transport during the last five years. In addition, a path model is tested where risk evaluations predict intentions to use public transport and use of such transport in these groups. The results are based on a survey conducted in a randomly obtained representative sample of the Norwegian urban public (n = 1043). The results showed that individuals who had been exposed to adverse security events in public transport reported substantially higher risk perception of experiencing security issues in such transport than those who were not exposed. Exposed individuals also reported higher probability judgements and more worry of experiencing injury in public transport. The path model showed that high probability judgements of experiencing injury in public transport were related to a lower intention of using such transport, whereas corresponding worry in the private motorized sector predicted a stronger intention to use public transport. Demand for risk mitigation in the public transport sector was found to be more relevant for intentions to use public transport than similar demands in the private motorized sector. The path model and coefficients were not found to differ significantly according to exposure to security events in public transport. The findings are discussed in relation to the role of negative risk experiences for risk evaluations in transport