Maria Romøren

• Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Alnes, Rigmor Grete Einang; Brøderud, Linn & Romøren, Maria [Show all 7 contributors for this article] (2026). Healthcare professionals’ experiences of advance care planning conversations with frail older adults admitted to acute geriatric hospital units: a nested qualitative study. BMC Health Services Research. 26. doi: 10.1186/s12913-026-15112-x. Full text in Research Archive Show summary

  Background: Advance care planning can support frail older adults, their next of kin, and healthcare professionals by clarifying patients’ values and preferences and improving communication toward the end of life. Despite these benefits, advance care planning remains underutilized, particularly among frail older adults with complex needs. Limited research has explored healthcare professionals’ experiences with initiating it in acute geriatric settings. As part of a broader research project focused on implementing advance care planning for older adults admitted to acute geriatric hospital units, this study aimed to explore healthcare professionals’ experiences with initiating these conversations. Methods: A qualitative sub-study, nested within a cluster randomized controlled trial, was conducted with implementation teams and other healthcare professionals from the six geriatric units in the intervention arm. They had recently started engaging in advance care planning with frail, acutely ill older patients and their next of kin. Data were collected through four focus groups and four dyadic interviews, involving a total of 24 participants. The data was analysed by using reflexive thematic analysis. Results: Four themes developed as perceived benefits: (1) Amplifies the patients’ voice, (2) Improves communication with next of kin, (3) Influences treatment decisions and may avoid overtreatment (4) Contributes to meaningful work. Two themes developed as perceived challenges: (1) Uncertainty regarding the ACP documentation, (2) ACP conversations require dedicated time and focus. Conclusion: This study revealed that advance care planning conversations in acute geriatric hospital units can amplify patients’ voices and promote their participation in decision-making. Discussions about existential topics appear beneficial and rewarding for patients, next of kin and healthcare professionals, both for in-moment and future decisions. Time constraints may have led to missed opportunities to initiate ACP conversations with patients before the end of life, while documentation issues may have limited their impact on continuity of care. Trial registration https://ClinicalTrials.gov Identifier NCT05681585. Registered 03.01.23.

• Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Alnes, Rigmor Grete Einang; Brøderud, Linn & Romøren, Maria [Show all 7 contributors for this article] (2026). Ethical challenges in acute geriatric care and advance care planning: a nested qualitative study. European Geriatric Medicine. ISSN 1878-7649. p. 1–11. doi: 10.1007/s41999-026-01563-2. Full text in Research Archive Show summary

  Purpose Ethical challenges are common in geriatrics, and moral dilemmas and conflicting interests can arise in advance care planning (ACP). Respecting the wishes of frail, acutely ill older patients while acting in their best interests can be challenging. This study was nested within a cluster randomized controlled trial aimed at implementing ACP in acute geriatric hospital units. The aim of this study was to explore clinicians’ experiences of ethical challenges in geriatric units before and during this implementation project. Methods Eight semi-structured interviews—four focus groups and four dyadic interviews—were conducted with a total of twenty-four participants, including implementation teams and other clinicians from the six intervention units. These participants had engaged in ACP with frail, acutely ill older patients and, preferably, their next of kin. The data were analyzed using Braun and Clarke’s reflexive thematic analysis. Results Four themes were developed: (1) navigating prognostic uncertainty while sustaining hope, (2) providing information that enables understanding and participation, (3) managing family disagreements and emotional strain, and (4) preserving dignity towards the end of life. The findings indicate that ethical challenges were often mitigated rather than intensified through ACP conversations. Conclusion Ethical challenges in acute geriatric care arose when patient autonomy was limited by cognitive impairment, unclear preferences, or family disagreement. Earlier preparation of patients and next of kin through ACP could facilitate early identification of potential disagreements and provide a stronger foundation for dialogue in acute situations.

• Skonnord, Trygve; Schei, Edvin; Brænd, Anja Maria; Bondevik, Gunnar Tschudi; Fossum, Guro Haugen & Rebnord, Ingrid Keilegavlen [Show all 9 contributors for this article] (2026). Patients' experiences of consultations involving medical students in general practice. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146. doi: 10.4045/tidsskr.25.0269. Full text in Research Archive Show summary

  Background and aim The aim of the study was to investigate patients' attitudes to and experiences of consultations in general practice where medical students acted as observers or conducted independent consultations. Participants were also asked about the advantages and disadvantages of student involvement. Material and method We conducted a cross-sectional study in which patients completed an online questionnaire in general practitioners' (GPs') waiting rooms, having been invited to participate by medical students in a clinical placement. The results are presented descriptively. Results A total of 2263 out of 5576 (41 %) invited patients participated. Of these, 1287/2263 (57 %) experienced consultations involving students. Of these, 890/1277 (70 %) reported that they valued the experience and 1009/1248 (81 %) agreed that it was a positive experience. Of the 847 patients who clearly recalled a consultation involving a student, 763/837 (91 %) reported feeling safe and 806/846 (95 %) felt they received adequate care. Interpretation Although the vast majority of patients in the study felt well cared for in consultations involving medical students in clinical placement in general practice, special attention should be paid to vulnerable patient groups.

• Norheim, Irene; Røssberg, Jan Ivar; Selle, Maria Lie; Woodberry, Kristen; O'Brien, Mary & Pedersen, Reidar [Show all 11 contributors for this article] (2026). Expressed emotions and caregiving appraisals among relatives of patients with psychotic disorders: a cross-sectional study. BMC Psychiatry. 26(1). doi: 10.1186/s12888-026-07868-7. Full text in Research Archive
• Norheim, Irene; Pedersen, Reidar; Selle, Maria Lie; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Show all 13 contributors for this article] (2025). Effectiveness of implementing family involvement on patient outcomes in individuals with psychotic disorders: a pragmatic cluster randomised controlled trial. BMC Psychiatry. 25(1). doi: 10.1186/s12888-025-07501-z. Full text in Research Archive Show summary

  Abstract Background The purpose of this sub-study, as part of the Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, was to examine the effectiveness of family interventions (FIs) implemented through an implementation support program (ISP) on patients’ outcomes. Methods The IFIP trial is a cluster randomised controlled trial where 15 Community Mental Health Centre units were randomly allocated either to the ISP, which included FIs as clinical interventions, implementation strategies, and implementation interventions, or to treatment as usual (TAU). In the control arm, patients could have access to FIs. Patients with psychotic disorders in both arms were asked to complete questionnaires at inclusion, 6- and 12 months. The primary outcome was patients’ difficulties in interpersonal relationships measured with the Relationships subscale of Behaviour and Symptom Identification scale. The secondary outcomes were patients’ mental health and functioning, perceived expressed emotions, recovery, and quality of life. Linear mixed-effects models were used to analyse differences in change over time between the two arms. Results We included 231 patients (135 from the intervention units; 96 from the control units). Except for the first 24% of the 6 months questionnaires, the 6- and 12-month data were collected during the COVID-19 pandemic. There were no significant differences in the primary outcome, difficulties in interpersonal relationships at 12 months, between the intervention and control arms (Cohen’s d = -0.19, p  = 0.2). The secondary outcomes showed less perceived criticism from the relatives (Perceived Criticism sub-score; d = − 0.4, p  = 0.01) and reduced difficulties in overall functioning (Health of the Nation Outcome Scale; d = − 0.29, p  = 0.01) in the intervention arm compared to the control arm at 12 months. Conclusion The FIs, implemented through the ISP, did not achieve significant decreases in patients’ difficulties with interpersonal relationships. However, this sub-study indicates that FIs in routine mental health practices can nurture a more positive family environment and enhance the patient’s process toward improved functioning. The complexity of the study design, and the restrictions due to COVID-19, may have diminished the implementation and effectiveness of the measured FIs for the patients. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 2019-02-28.

• Brøderud, Linn; Romøren, Maria; Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Thoresen, Lisbeth & Pedersen, Reidar (2025). Barriers and facilitators in implementing advance care planning for frail older patients acutely admitted to geriatric hospital units: a nested qualitative study. Frontiers in Health Services. 5. doi: 10.3389/frhs.2025.1646541. Full text in Research Archive Show summary

  Background: Appropriate communication with patients is increasingly crucial in a growing elderly population to prevent both over- and undertreatment. Advance care planning (ACP) is recognized as a valuable communication process for patients, their relatives and healthcare professionals that facilitates future care and medical decision-making. Despite its importance, the uptake remains low, particularly among frail, older patients in hospitals. Methods: This qualitative substudy is nested within a cluster randomized controlled trial. Data collection involved eight semi-structured interviews conducted in acute geriatric hospital units receiving our implementation support program, along with informal data from interactions with the units during the implementation process. The aim was to explore healthcare professionals' perspectives on the barriers and facilitators to ACP implementation and their experiences with the implementation support program. A semi-structured interview guide was used. The data was analyzed using content analysis. Results: Factors influencing ACP implementation were identified at three levels: a) the organizational level, b) the national level, and c) the clinical level. Participants recognized the critical role of timing, context, and patients' capacity. However, there was meaningful opportunities for ACP conversations in acute geriatric units. Overall, the experiences underscored the complex interplay of individual motivation and interest, organizational support, prioritization, available time and resources, and systemic factors that influence the integration of ACP into clinical practice, as well as the fact that research can act as both a barrier and a facilitator in implementation efforts. Discussion: This study illustrates the significant challenges in implementing ACP in acute hospital care. Despite a generally positive perception of ACP, its implementation was hindered by barriers such as overwhelming workload, production-oriented healthcare, the biomedical model, and lack of prioritization. These factors creates a cycle where short-term demands overshadow preventive and patient-centered interventions, limiting their perceived and documented benefits. Breaking this cycle will likely require targeted investment in the implementation of complex interventions.

• Westbye, Siri Færden; Romøren, Maria; Ahmed, Marc; Hermansen, Karin Berg; Brøderud, Linn & Wahl, Astrid Klopstad [Show all 9 contributors for this article] (2025). Measuring the level of implementation of advance care planning – a fidelity-based cross-sectional study. Frontiers in Health Services. 5. doi: 10.3389/frhs.2025.1629242. Full text in Research Archive Show summary

  Introduction Advance care planning (ACP) is supported by evidence, legal and ethical principles and ACP guidelines. However, this complex intervention is often poorly implemented. This article presents a novel fidelity scale to measure the implementation of ACP and reports the preliminary testing of the scale at baseline in a larger trial aiming at implementing ACP in hospitals in Norway. Method The research design conducted was a cross-sectional measurement of fidelity to guidelines, conducted in 12 geriatric hospital units in Norway recruited using purposive sampling. The sample size for the larger trial was determined, based on prior research, to be at least four clusters in each arm. Due to the possibility of unit drop-out during the project period and to secure sufficient power, we included six units in the intervention arm and six in the control arm. For the baseline measurement we developed an ACP fidelity scale including three subscales: implementation, quality and penetration rate, each with 4–11 items. We ensured face and content validity through input from relevant theories and research, experts and users. Items were scored from 1 to 5, with 1 indicating no implementation and 5 indicating full implementation. Data was analyzed using descriptive statistics, Cronbach's alpha and calculation of interrater reliability for the scales. Further psychometric testing could not be conducted at this stage due to the lack of variance in the items. Results The mean score for the implementation subscale was 1.213, with a median of 1, a standard deviation (SD) of 0.08, a standard error (SE) of 0.01, a variance of 0.01, and a range of 0.28 (minimum 1.14 and maximum 1.42). The scores in the subscale showed that none of the units had recommended implementation measures. Only a few professionals reported they had heard of ACP, but not the whole staff. Cronbach's alpha could not be estimated due to the lack of variation in the scores for this subscale. On the quality subscale, which assesses whether ACP is practiced in accordance with practice guidelines, the mean score was 1.11, the median was 1, the SD was 0.48, the SE was 0.06, the variance was 0.13, and the range was 1.27 (minimum 1 and maximum 2.27). The scores in this subscale showed that ACP was practiced sporadically by the palliative care team in only one unit, while the other staff did not engage in this practice at all. Cronbach's alpha for the subscale on quality was 0.887 (11 items) showing an acceptable internal consistency. For the penetration rate subscale, which measures how widespread the practice is, the mean score was 1.08, the median was 1, the SD was 0.28, the SE was 0.05, the variance was 0.08, and the range was from a minimum of 1 to a maximum of 2. Among the total number of admitted geriatric patients, only 10% had received ACP in only one of the 12 units. Also, for this subscale, the model for Cronbach's alpha could not be applied. There was little variation in the low measurements, thus the interrater reliability was high, reflected in the Intraclass Correlation Coefficient (ICC). The ICC was 0,916 [−0,721,0.976] for the implementation subscale, 1.00 for the quality subscale, and 1.00 for the penetration rate subscale. Conclusion Our findings indicate very low implementation of ACP in acute geriatric hospital units in Norway. The newly developed ACP fidelity scale has the potential to serve as an important tool for improving the quality of healthcare services for older patients. However, more data is needed to validate the psychometric properties of the scale. Our study should be considered as a preliminary study, and the scale should be used with caution as long as its properties are not well validated. Clinical Trial Registration ClinicalTrials.gov , NCT05681585.

• Hermansen, Karin Berg; Alnes, Rigmor Grete Einang; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Westbye, Siri Færden & Romøren, Maria [Show all 7 contributors for this article] (2025). Raising awareness and preparation for what may come: next of kin experiences of advance care planning with frail, home-dwelling older adults in geriatric units. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-12609-9. Full text in Research Archive Show summary

  Background Acutely ill and frail older adults and their next of kin are often poorly involved in planning of decisions regarding treatment and care during the final phase of life. Although advance care planning is a well-documented tool to strengthen patient autonomy and involve next of kin, it remains underused in hospital settings. We present a qualitative sub-study embedded in a cluster-randomized controlled trial, whose purpose was to implement advance care planning in Norwegian geriatric units. Frail, home dwelling older adults acutely admitted to geriatric hospital units were invited to participate in advance care planning together with their next of kin. The aim of this study was to explore next of kin experiences of advance care planning. Methods The study has a qualitative design, based on individual semi-structured interviews with 13 next of kin. A purposive sampling was used to select next of kin who had recently participated in advance care planning from five geriatric units in the intervention arm. The analysis was conducted using reflexive thematic analysis by Braun and Clarke. Results Four themes were developed from the analysis; (1) Being informed and involved through open communication; (2) Getting prepared for what’s to come; (3) The importance of the next of kin role in providing support and facilitation; (4) The need for documentation and collaboration across service levels. Conclusion Advance care planning appears to provide a sense of security among next of kin by addressing their information needs regarding the patient’s prognosis, encouraging discussions on possible courses of action, and clarifying the patient’s end-of-life preferences. Next of kin played a crucial role in supporting the patient’s autonomy, and they considered the hospital stay as an ideal time for advance care planning. Increased awareness of their role as next of kin seems to enhance agreement and trust when confronting challenging situations and existential questions. Trial registration ClinicalTrials.gov Identifier NTCT05681585. Registered 03.01.23.

• Brøderud, Linn; Førde, Reidun; Romøren, Maria; Wahl, Astrid Klopstad & Pedersen, Reidar (2025). Barriers and Facilitators to the Implementation of Advance Care Planning: A Qualitative Study at National and Organizational Levels. Journal of Evaluation In Clinical Practice. ISSN 1356-1294. 31(4). doi: 10.1111/jep.70131. Full text in Research Archive Show summary

  Background Aging population, enhanced medical opportunities, increased costs and emphasis on patient participation make advance care planning (ACP) important and it provides an evidence-based framework to ensure patient autonomy in future healthcare decisions. Despite the extensive international research literature supporting ACP, implementation seems challenging. Implementing complex interventions like ACP probably requires a system-wide approach. However, there is scarce research on the barriers and facilitators to ACP implementation as perceived at national and organizational levels. Aim To explore the barriers and facilitators affecting ACP implementation as perceived at national and organizational levels. Methods Fifteen in-depth individual interviews were conducted with stakeholders at national and organizational levels. A semi-structured interview guide was used, targeting overarching conditions and framework factors that could have an impact. Data was analysed using thematic analysis. Results Barriers to ACP implementation described by participants included: Lack of prioritization of ACP at all levels; paradigms and culture of healthcare delivery, personal barriers and attitudes, and lack of competence; lack of collaboration and documentation between levels of healthcare; and lack of systems, routines, time and resources within healthcare services. Facilitators included: Cultural change; support in priority setting; national guideline and incentives; management commitment and support; systems, routines and local implementation efforts; ACP capacity building, implementation competence, and ethical reflection; dissemination of the benefits of ACP, including public education; and better collaboration and communication between levels of healthcare. Conclusion There appear to be significant barriers and facilitators to ACP implementation as perceived at the national and organizational levels of healthcare. Although ACP implementation appears to require a combination of top-down and bottom-up initiatives, national and organizational barriers and facilitators seem important in setting priorities in clinical practice, with an emphasis on financial incentives. An overarching cultural change of healthcare delivery that supports interventions such as ACP appears to be critical for improved implementation.

• Romøren, Maria; Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita; Westbye, Siri Færden & Wahl, Astrid Klopstad [Show all 10 contributors for this article] (2024). Implementation of advance care planning in the routine care for acutely admitted patients in geriatric units: protocol for a cluster randomized controlled trial. BMC Health Services Research. 24. doi: 10.1186/s12913-024-10666-0. Full text in Research Archive Show summary

  Background Acutely ill and frail older adults and their next of kin are often poorly involved in treatment and care decisions. This may lead to either over- or undertreatment and unnecessary burdens. The aim of this project is to improve user involvement and health services for frail older adults living at home, and their relatives, by implementing advance care planning (ACP) in selected hospital wards, and to evaluate the clinical and the implementation interventions. Methods This is a cluster randomized trial with 12 hospital units. The intervention arm receives implementation support for 18 months; control units receive the same support afterwards. The ACP intervention consists of 1. Clinical intervention: ACP; 2. Implementation interventions: Implementation team, ACP coordinator, network meetings, training and supervision for health care personnel, documentation tools and other resources, and fidelity measurements with tailored feedback; 3. Implementation strategies: leadership commitment, whole ward approach and responsive evaluation. Fidelity will be measured three times in the intervention arm and twice in the control arm. Here, the primary outcome is the difference in fidelity changes between the arms. We will also include 420 geriatric patients with one close relative and an attending clinician in a triadic sub-study. Here, the primary outcomes are quality of communication and decision-making when approaching the end of life as perceived by patients and next of kin, and congruence between the patient’s preferences for information and involvement and the clinician’s perceptions of the same. For patients we will also collect clinical data and health register data. Additionally, all clinical staff in both arms will be invited to answer a questionnaire before and during the implementation period. To explore barriers and facilitators and further explore the significance of ACP, qualitative interviews will be performed in the intervention units with patients, next of kin, health care personnel and implementation teams, and with other stakeholders up to national level. Lastly, we will evaluate resource utilization, costs and health outcomes in a cost-effectiveness analysis. Discussion The project may contribute to improved implementation of ACP as well as valuable knowledge and methodological developments in the scientific fields of ACP, health service research and implementation science.

• Brunsvig-Engemoen, Fredrik; Romøren, Maria & Skjeie, Holgeir (2024). Samtaler med pasienter om døden – erfarne fastlegers refleksjoner og erfaringer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(13). doi: 10.4045/tidsskr.24.0093. Full text in Research Archive Show summary

  Bakgrunn Den aldrende befolkningen i Norge øker stadig, og kommunehelsetjenesten, inkludert fastlegene, har fått flere og mer komplekse oppgaver i å ivareta pasientene. Formålet med studien var å undersøke hvordan erfarne fastleger gjennomførte og reflekterte rundt samtaler med pasientene om døden. Materiale og metode Semistrukturerte dybdeintervjuer med ti erfarne fastleger, alle spesialister i allmennmedisin, ble analysert med tematisk tverrgående analyse. Resultater Nesten alle fastlegene anså det å snakke om døden med sine pasienter som en naturlig del av fastlegeoppgaven. Samtalene ble oppfattet som både utfordrende og meningsfulle. Det å ha nok tid til samtalen og det å kjenne pasientene over tid ble vurdert som verdifulle faktorer for gode samtaler. Fastlegene lette etter gylne øyeblikk for å ta opp temaet. Innholdet i samtalen kunne variere, fra konkrete symptomlindrende tiltak til det mer eksistensielle og filosofiske. De ga uttrykk for at de manglet formalkompetanse og baserte seg i stor grad på erfaring og tro på egne kommunikasjonsevner. Manglende avklaring av behandlingsintensitet fra spesialisttjenestens side ble av flere beskrevet som en hemmer for god initiering og gjennomføring av samtaler om døden. Fortolkning De fleste fastlegene i denne studien snakket med pasientene sine om døden og oppfattet det som en naturlig og nødvendig del av fastlegerollen.

• Ihle-Hansen, Hege Beate; Pedersen, Reidar; Westbye, Siri Færden; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita & Larsen, Marie Hamilton [Show all 9 contributors for this article] (2024). Patient preferences in geriatric wards, a survey of health care professionals’ practice, experience and attitudes. European Geriatric Medicine. ISSN 1878-7649. 15, p. 153–158. doi: 10.1007/s41999-023-00922-7. Full text in Research Archive Show summary

  Purpose We aimed to identify whether health care professionals (HCP) examine their patient and next-of-kin preferences, and to study whether medical decisions follow these preferences. Method A cross-sectional web-based survey was conducted with multidisciplinary HCP from 12 geriatric wards in the South-Eastern Norway Regional Health Authority. Results Of the 289 HCPs responding (response rate 61%), mean age 37.8 years (SD 11.3), 235 (81.3%) women, 12.4 (SD 9.6) years of experience and 67 (23.2%) medical doctors, only half report clarifying patients’ preferences. The majority reported that they did not inform, involve and treat in line with such preferences. However, 53% believe that HCP, patients and next-of-kin should make clinical decisions together. Discussion Our findings indicate a lack of engagement in conversation and inclusion of patient preferences when providing health interventions in geriatric wards. Measures for change of culture are needed.

• Norheim, Irene; Pedersen, Reidar; Selle, Maria; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Show all 12 contributors for this article] (2024). Implementation of guidelines on Family Involvement for persons with Psychotic disorders: a pragmatic cluster randomized trial. Effect on relatives’ outcomes and family interventions received. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1381007. Full text in Research Archive Show summary

  Background: Family interventions (FI) are recommended as part of the treatment for psychotic disorders, but the implementation in mental health services is generally poor. Recently, The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, demonstrated significant improvements in implementation outcomes at cluster-level. This sub-study aims to examine the effectiveness of the IFIP intervention on relatives’ outcomes and received FI. Methods: A cluster randomized controlled trial, was conducted in 15 Norwegian Community Mental Health Center (CMHC) units that were randomized to either the IFIP intervention, including implementation interventions and clinical interventions, or treatment as usual (TAU). The clinical interventions consisted of FI: basic family involvement and support (BFIS) to all patients and family psychoeducation (FPE) to as many as possible. Patients with psychotic disorders and their closest relative were invited to fill in questionnaires at inclusion and 6 months and 12 months follow-up. Received FI was reported by both relatives and clinicians. The relatives’ primary outcome was satisfaction with health service support, measured by the Carer well-being and support questionnaire part B (CWS-B). The relatives’ secondary outcomes were caregiver experiences, expressed emotions and quality of life. Patients’ outcomes will be reported elsewhere. Results: In total 231 patient/relative pairs from the CMHC units were included (135 intervention; 96 control).The relatives in the intervention arm received an increased level of BFIS (p=.007) and FPE (p < 0.05) compared to the relatives in the control arm, including involvement in crisis planning. The primary outcome for relatives’ satisfaction with health service support, showed a non-significant improvement (Cohen’s d = 0.22, p = 0.08). Relatives experienced a significant reduced level of patient dependency (Cohen’s d = -0.23, p = 0.03). Conclusion: The increased support from clinicians throughout FI reduced the relatives’ perceived level of patient dependency, and may have relieved the experience of responsibility and caregiver burden. The COVID-19 pandemic and the complex and pioneering study design have weakened the effectiveness of the IFIP intervention, underscoring possible potentials for further improvement in relatives’ outcomes. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03869177.

• Ihle-Hansen, Hege Beate; Ihle-Hansen, Håkon; Rostoft, Siri; Munkhaugen, John; Westbye, Siri Færden & Romøren, Maria [Show all 13 contributors for this article] (2024). Forhåndssamtaler om siste livsfase. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(13). doi: 10.4045/tidsskr.24.0105. Full text in Research Archive Show summary

  Bakgrunn: Det foreligger nye nasjonale faglige råd om forhåndssamtaler om siste livsfase. Trygghet i kommunikasjon er viktig for implementering. Formålet med denne studien var å kartlegge helsepersonells selvopplevde trygghet i kommunikasjon om fremtidig helsehjelp og pasientens ønsker i livets sluttfase. Materiale og metode: Helsepersonell ved tolv geriatriske enheter i Helse Sør-Øst besvarte en nettbasert spørreundersøkelse høsten 2022. De fire svaralternativene for selvrapportert trygghet – «lite trygg», «nokså trygg», «meget trygg» og «svært trygg» – er slått sammen til to kategorier: «begrenset trygghet» («lite trygg» og «nokså trygg») og «høy trygghet» («meget trygg» og «svært trygg»). Resultater: Vi fikk svar fra 289 av 470 (61,5 %) av de inviterte, med en gjennomsnittsalder på 37,8 ± 11,3 år, hvorav 217 av 289 (75 %) hadde mer enn fem års yrkeserfaring. Blant legene rapporterte 15 av 67 (22 %) begrenset trygghet i kommunikasjon om «fremtidig forverring av pasientens helsetilstand», 20 av 67 (30 %) om «livsforlengende behandling» og 13 av 67 (19 %) om «ønsker for livets sluttfase». For annet helsepersonell var tilsvarende responser 119 av 222 (54 %), 140 av 222 (63 %) og 109 av 222 (49 %). Fortolkning: Egenvurdert trygghet i kommunikasjon om fremtidig forverring, fremtidig helsehjelp og pasientens egne ønsker i livets sluttfase varierer, og er begrenset blant mye helsepersonell i geriatriske enheter. Det synes nødvendig med tiltak for å øke tryggheten i kommunikasjon og implementering av forhåndssamtaler i helsetjenesten. Hovedfunn: Blant leger oppga 20 av 67 (30 %) begrenset trygghet i kommunikasjon om «fremtidig helsehjelp», mens av annet helsepersonell svarte 140 av 222 (63 %) det samme. For kommunikasjon om «ønsker for livets siste fase» fant vi at 13 av 67 (19 %) av legene og 109 av 222 (49 %) av annet helsepersonell oppga begrenset trygghet.

• Harbin, Nicolay Jonassen; Haug, Jon Birger; Lindbæk, Morten; Akselsen, Per Espen & Romøren, Maria (2023). A Multifaceted Intervention and Its Effects on Antibiotic Usage in Norwegian Nursing Homes. Antibiotics. 12(9), p. 1–16. doi: 10.3390/antibiotics12091372. Full text in Research Archive
• Hestmark, Lars; Romøren, Maria; Hansson, Kristiane Myckland; Heiervang, Kristin Sverdvik & Pedersen, Reidar (2023). Clinicians’ perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study. Frontiers in Psychiatry. 14, p. 1–12. doi: 10.3389/fpsyt.2023.1175557. Full text in Research Archive Show summary

  Background: Family involvement in mental health care ranges from basic practices to complex interventions such as Family psychoeducation, the latter being a well-documented treatment for psychotic disorders. The aim of this study was to explore clinicians’ perceptions of the benefits and disadvantages of family involvement, including possible mediating factors and processes. Methods: Nested in a randomised trial, which purpose was to implement Basic family involvement and support and Family psychoeducation in Norwegian community mental health centres during 2019–2020, this qualitative study is based on eight focus groups with implementation teams and five focus groups with ordinary clinicians. Using a purposive sampling strategy and semi-structured interview guides, focus groups were audio-recorded, transcribed verbatim, and analysed with reflexive thematic analysis. Results: Four main themes were identified as perceived benefits: (1) Family psychoeducation—a concrete framework, (2) Reducing conflict and stress, (3) A triadic understanding, and (4) Being on the same team. Themes 2–4 formed an interconnected triad of mutually reinforcing elements and were further linked to three important clinician-facilitated sub-themes: a space for relatives’ experiences, emotions and needs; a space for patients and relatives to discuss sensitive topics and an open line of communication between clinician and relative. Although far less frequent, three main themes were identified as perceived disadvantages or challenges: (1) Family psychoeducation—occasional poor model fit or difficulties following the framework, (2) Getting more involved than usual, and (3) Relatives as a potentially negative influence—important nonetheless Conclusions: The findings contribute to the understanding of the beneficial processes and outcomes of family involvement, as well as the critical role of the clinician in achieving these and possible challenges. They could also be used to inform future quantitative research on mediating factors and implementation efforts.

• Hansson, Kristiane Myckland; Romøren, Maria; Hestmark, Lars; Heiervang, Kristin Sverdvik; Weimand, Bente Margrethe & Norheim, Irene [Show all 7 contributors for this article] (2023). “The most important thing is that those closest to you, understand you”: a nested qualitative study of persons with psychotic disorders’ experiences with family involvement. Frontiers in Psychiatry. 14. doi: 10.3389/fpsyt.2023.1138394. Full text in Research Archive Show summary

  Introduction Family interventions constitute effective treatment for persons with psychotic disorders. However, the active ingredients and beneficial processes of these interventions are insufficiently examined, and qualitative explorations of patients` experiences are lacking. This study was nested in a cluster randomised trial that implemented national guidelines on family involvement in Norwegian community mental health centres, including family psychoeducation and basic family involvement and support. The aim of this sub-study was to explore how patients with psychotic disorders experience systematic family involvement, and its significance. Methods We conducted semi-structured, individual interviews with 13 persons with a psychotic disorder after systematic family involvement. The participants were recruited through purposive sampling. Qualitative content analysis guided the analysis. Results Participants reported overall positive experiences with systematic family involvement. It was significant that the relatives increasingly understood more about psychosis and their situation, while they themselves also gained more insight into the relatives` situation. The participants emphasised the need to enable both patients and relatives to safely share experiences in a containing space, led by professionals. Shared understanding and awareness of each other’s situation further improved communication, coping with the illness, reduced stress, and stimulated a more caring family environment. The therapist seemed crucial to facilitate these beneficial communication processes, and also to provide continuous support to the relatives. Reported challenges included that the participants felt vulnerable in the initial phase, a need for tailored approaches, and too late start-up. Conclusion Findings from this study suggest that persons with psychotic disorders may benefit greatly from participating in systematic family involvement. This study also gives new insight into possible mediators of positive outcomes both for the patients and the relatives. Systematic family involvement should be implemented a standard approach in the early phase of the disease, using a step-wise and tailored process.

• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Show all 9 contributors for this article] (2023). Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 50(3), p. 520–533. doi: 10.1007/s10488-023-01255-0. Full text in Research Archive Show summary

  Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12–14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.

• Westbye, Siri Færden; Rostoft, Siri; Romøren, Maria; Thoresen, Lisbeth; Wahl, Astrid Klopstad & Pedersen, Reidar (2023). Barriers and facilitators to implementing advance care planning in naïve contexts - where to look when plowing new terrain? BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-04060-4. Full text in Research Archive Show summary

  Background Advance care planning (ACP) is a way of applying modern medicine to the principle of patient autonomy and ensuring that patients receive medical care that is consistent with their values, goals and preferences. Robust evidence supports the benefits of ACP, but it remains an underutilized resource in most countries. This paper goes from the naïve point of view, and seeks to identify the barriers and facilitators to implementation in unfamiliarized contexts and in a whole system approach involving the clinical, institutional and policy level to improve the implementation of ACP. Methods Qualitative interviews were chosen to enable an explorative, flexible design. Qualitative interviews were conducted with 40 health care professionals and chief physicians in hospitals and in municipalities. The thematic analysis was done following Braun and Clarke’s strategy for thematic analysis. Results The main reported barriers were the lack of time and space, a lack of culture and leadership legitimizing ACP, lack of common communication systems, and unclear responsibility about who should initiate, resulting in missed opportunities and overtreatment. Policy development, public and professional education, and standardization of documentation were reported as key to facilitate ACP and build trust across the health care system. Conclusions Progressively changing the education of health professionals and the clinical culture are major efforts that need to be tackled to implement ACP in unfamiliarized contexts, particularly in contexts where patient's wishes are not legally binding. This will need to be tackled through rectifying the misconception that ACP is only about death, and providing practical training for health professionals, as well as developing policies and legislation on how to include patients and caregivers in the planning of care.

• Harbin, Nicolay Jonassen; Lindbæk, Morten & Romøren, Maria (2022). Barriers and facilitators of appropriate antibiotic use in primary care institutions after an antibiotic quality improvement program – a nested qualitative study. BMC Geriatrics. 22(1). doi: 10.1186/s12877-022-03161-w. Full text in Research Archive Show summary

  Background Antibiotic prescribing by physicians in primary care institutions is common and affected by several factors. Diagnosis and treatment of infections in a nursing home (NH) resident is challenging, with the risk of both under- and overtreatment. Identifying barriers and facilitators of appropriate antibiotic prescribing in NHs and municipal acute care units (MACUs) is essential to ensure the most adequate antibiotic treatment possible and develop future antibiotic stewardship programs. Methods After implementing a one-year antibiotic quality improvement program, we conducted six semi-structured focus group interviews with physicians (n = 11) and nurses (n = 14) in 10 NHs and 3 MACUs located in the county of Østfold, Norway. We used a semi-structured interview guide covering multiple areas influencing antibiotic use to identify persistent barriers and facilitators of appropriate antibiotic prescribing after the intervention. The interviews were audio-recorded and transcribed verbatim. The content analysis was performed following the six phases of thematic analysis developed by Braun and Clarke. Results We identified thirteen themes containing barriers and facilitators of the appropriateness of antibiotic use in primary care institutions. The themes were grouped into four main levels: Barriers and facilitators 1) at the clinical level, 2) at the resident level, 3) at the next of kin level, and 4) at the organisational level. Unclear clinical presentation of symptoms and lack of diagnostic possibilities were described as essential barriers to appropriate antibiotic use. At the same time, increased availability of the permanent nursing home physician and early and frequent dialogue with the residents’ next of kin were emphasized as facilitators of appropriate antibiotic use. The influence of nurses in the decision-making process regarding infection diagnostics and treatment was by both professions described as profound. Conclusions Our qualitative study identified four main levels containing several barriers and facilitators of appropriate antibiotic prescribing in Norwegian NHs and MACUs. Diagnostic uncertainty, frequent dialogue with next of kin and organisational factors should be targeted in future antibiotic stewardship programs in primary care institutions. In addition, for such programs to be as effective as possible, nurses should be included on equal terms with physicians.

• Hansson, Kristiane Myckland; Romøren, Maria; Pedersen, Reidar; Weimand, Bente Margrethe; Hestmark, Lars & Norheim, Irene [Show all 9 contributors for this article] (2022). Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres - a nested qualitative study. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08489-y. Full text in Research Archive Show summary

  Background The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders. Methods We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis. Results Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals. Conclusions Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families.

• Hansson, Kristiane Myckland; Romøren, Maria; Weimand, Bente Margrethe; Heiervang, Kristin Sverdvik; Hestmark, Lars & Landeweer, Elleke [Show all 7 contributors for this article] (2022). The duty of confidentiality during family involvement: ethical challenges and possible solutions in the treatment of persons with psychotic disorders. BMC Psychiatry. 22(1), p. 1–13. doi: 10.1186/s12888-022-04461-6. Full text in Research Archive Show summary

  Background: Family involvement during severe mental illness is still poorly implemented, contrary to evidence-based recommendations. Confidentiality issues are among the most prominent barriers, with mental health professionals facing complex ethical, legal, and practical challenges. However, research focusing on this barrier is very sparse. Nested within a cluster-randomised trial to implement guidelines on family involvement for persons with psychotic disorders in community mental health centres, the aim of this sub-study was to explore ethical challenges related to the duty of confidentiality as experienced by mental health professionals, and to explore key measures that might contribute to improving the handling of such challenges. Methods: In total 75 participants participated in 21 semi-structured focus groups, including implementation team members at the initial and late phase of the intervention period and clinicians who were not on the implementation teams, at late phase of implementation. We used purposive sampling and manifest content analysis to explore participants’ experiences and change processes. Results: Ethical challenges related to the duty of confidentiality included 1) Uncertainty in how to apply the legislation, 2) Patient autonomy versus a less strict interpretation of the duty of confidentiality, 3) Patient alliance and beneficence versus a less strict interpretation of the duty of confidentiality, 4) How to deal with uncertainty regarding what relatives know about the patients’ illness, and 5) Relatives’ interests versus the duty of confidentiality. Measures to facilitate better handling of the duty of confidentiality included 1) Training and practice in family involvement, and 2) Standardisation of family involvement practices. Conclusion: When health professionals gained competence in and positive experiences with family involvement, this led to vital changes in how they interpreted and practiced the duty of confidentiality in their ethical reasoning and in clinical practice. Especially, the need to provide sufficient information to the patients about family involvement became evident during the study. To improve the handling of confidentiality issues, professionals should receive training in family involvement and confidentiality statutes followed by practice. Furthermore, family involvement should be standardised, and confidentiality guidelines should be implemented in the mental health services.

• Hestmark, Lars; Heiervang, Kristin S.; Pedersen, Reidar; Hansson, Kristiane Myckland; Ruud, Torleif & Romøren, Maria (2021). Family involvement practices for persons with psychotic disorders in community mental health centres – a cross-sectional fidelity-based study. BMC Psychiatry. 21, p. 1–11. doi: 10.1186/s12888-021-03300-4. Full text in Research Archive Show summary

  Background Family involvement for persons with psychotic disorders is supported by scientific evidence, as well as legal and ethical considerations, and recommended in clinical practice guidelines. This article reports a cross-sectional measurement of the level of implementation of such guidelines in fifteen community mental health centre units in Norway, and presents a novel fidelity scale to measure basic family involvement and support. The aim was to investigate current family involvement practices comprehensively, as a basis for targeted quality improvement. Methods We employed three fidelity scales, with 12–14 items, to measure family involvement practices. Items were scored from 1 to 5, where 1 equals no implementation and 5 equals full implementation. Data was analysed using descriptive statistics, a non-parametric test, and calculation of interrater reliability for the scales. Results The mean score was 2.33 on the fidelity scale measuring basic family involvement and support. Among patients with psychotic disorders, only 4% had received family psychoeducation. On the family psychoeducation fidelity assessment scale, measuring practice and content, the mean score was 2.78. Among the eight units who offered family psychoeducation, it was 4.34. On the general organizational index scale, measuring the organisation and implementation of family psychoeducation, the mean score was 1.78. Among the units who offered family psychoeducation, it was 2.46. As a measure of interrater reliability, the intra-class correlation coefficient was 0.99 for the basic family involvement and support scale, 0.93 for the family psychoeducation fidelity assessment scale and 0.96 for the general organizational index scale. Conclusions The implementation level of the national guidelines on family involvement for persons with psychotic disorders was generally poor. The quality of family psychoeducation was high, but few patients had received this evidence-based treatment. Our novel fidelity scale shows promising psychometric properties and may prove a useful tool to improve the quality of health services. There is a need to increase the implementation of family involvement practices in Norway, to reach a larger percentage of patients and relatives. Trial registration ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.

• Heen, Espen Kolstad; Romøren, Maria; Yassin, Amal A & Madar, Ahmed Ali (2021). Household Water is the Main Source of Iodine Consumption Among Women in Hargeisa, Somaliland: A Cross-Sectional Study. Journal of Nutrition. ISSN 0022-3166. doi: 10.1093/jn/nxab377. Full text in Research Archive Show summary

  Background: Iodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18-72 µg/L) in groundwater used for drinking and cooking, but the relationship with iodine intake is not characterized well. Objective: We aimed to investigate the contribution of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration and excretion (UIC, UIE) during 24 hours, and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38L/day (hydration-adjusted). Methods: The study sample comprised 118 nonpregnant, healthy women aged 15-69. All resided in Hargeisa; 27 breastfeeding. Data collection consisted of a 24-hour (24-h) urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household-water samples using the Sandell-Kolthoff reaction. Results: WIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P

• Heen, Espen Kolstad; Madar, Ahmed Ali; Yassin, Amal A & Romøren, Maria (2021). Estimates of fluid intake, urine output and hydration-levels in women from Somaliland: a cross-sectional study. Journal of Nutritional Science (JNS). doi: 10.1017/jns.2021.54. Full text in Research Archive Show summary

  The study objective was to measure fluid intake and associations with background characteristics and hydration biomarkers in healthy, free-living, non-pregnant women aged 15–69 years from Hargeisa city. We also wanted to estimate the proportion of euhydrated participants and corresponding biomarker cut-off values. Data from 136 women, collected through diaries and questionnaires, 24h urine samples and anthropometric measurements, were obtained with a cross-sectional, purposeful sampling from fifty-two school and health clusters, representing approximately 2250 women. The mean (95 % CI) 24 h total fluid intake (TFI) for all women was 2⋅04 (1⋅88, 2⋅20) litres. In multivariate regression with weight, age, parity and a chronic health problem, only weight remained a predictor (P 0.034, B 0.0156 (l/kg)). Pure water, Somali tea and juice from powder and syrup represented 49⋅3, 24⋅6 and 11⋅7 % of TFI throughout the year, respectively. Mean (95 % CI) 24 h urine volume (Uvol) was 1⋅28 (1⋅17, 1⋅39) litres. TFI correlated strongly with 24 h urine units (r 0.67) and Uvol (r 0.59). Approximately 40 % of the women showed inadequate hydration, using a threshold of urine specific gravity (Usg) of 1⋅013 and urine colour (Ucol) of 4. Five percent had Usg > 1⋅020 and concomitant Ucol > 6, indicating dehydration. TFI lower cut-offs for euhydrated, non-breast-feeding women were 1⋅77 litres and for breast-feeding, 2⋅13 litres. Euhydration cut-off for Uvol was 0⋅95 litre, equalling 9⋅2 urine units. With the knowledge of adverse health effects of habitual hypohydration, Somaliland women should be encouraged to a higher fluid intake.

• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin S.; Weimand, Bente; Ruud, Torleif & Norvoll, Reidun [Show all 11 contributors for this article] (2020). Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial. BMC Health Services Research. 20:934, p. 1–15. doi: 10.1186/s12913-020-05792-4. Full text in Research Archive Show summary

  Background: Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process. Methods: The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis. Discussion: This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science.

• Harbin, Nicolay Jonassen; Haug, Jon Birger; Romøren, Maria & Lindbæk, Morten (2020). Oral and parenteral antibiotic use in Norwegian nursing homes: are primary care institutions becoming our new local hospitals? JAC-Antimicrobial Resistance (JAC-AMR). 2(4), p. 1–8. doi: 10.1093/jacamr/dlaa093. Full text in Research Archive Show summary

  Abstract Background Norwegian nursing homes (NHs) have over the last 10 years increasingly applied the use of parenteral treatment, which in turn allows more broad-spectrum use of antibiotics. Previous studies from Norwegian NHs have for the most part not described parenteral formulations. Objectives To describe systemic antibiotic use in Norwegian NHs. Methods Thirty-seven NHs in the county of Østfold, Norway, were invited to participate in this retrospective cross-sectional study. Associated pharmacies provided sales data for systemic antibiotic use for the participating NHs for 1 year (October 2015 to October 2016). General institutional characteristics were collected through a questionnaire. Results Thirty-four NHs participated in the study. Mean use of antibiotics was 10.0 DDD/100 bed days (range 0.6–30.9 DDD/100 bed days). Oral antibiotics accounted for 83% and parenteral antibiotics for 17% of the total antibiotic use. Of parenteral antibiotics, ampicillin was most used (31.1%) followed by cefotaxime (17.7%) and penicillin G (16.6%). The proportion of antibiotics compliant with guideline recommendations was 60%. Being a short-term NH was associated with increased antibiotic use, with an unstandardized coefficient of 13.1 (95% CI 4.2–21.9; P = 0.005). Conclusions We found a high level of total and parenteral antibiotic use compared with previous studies from Norwegian NHs. Data showed wide variations in total antibiotic use and that only a moderate proportion of the antibiotic use was considered guideline compliant. This highlights the necessity of further implementation strategies regarding the national guidelines for antibiotic use in NHs.

• Klomstad, Kristin; Pedersen, Reidar; Førde, Reidun & Romøren, Maria (2018). Involvement in decisions about intravenous treatment for nursing home patients: Nursing homes versus hospital wards. BMC Medical Ethics. 19(34), p. 1–9. doi: 10.1186/s12910-018-0258-5. Full text in Research Archive Show summary

  Background Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient’s best interest, assessment of capacity to consent, and on the patient’s own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. Methods Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. Results The patients’ capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p < 0.001). The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. Conclusions This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. Trial registration ClinicalTrials.gov NCT01023763 (12/1/09) [The registration was delayed one month after study onset due to practical reasons].

• Romøren, Maria; Pedersen, Reidar & Førde, Reidun (2017). Én pasient, to verdener – samhandling mellom sykehjemsleger og sykehusleger. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(3), p. 193–197. doi: 10.4045/tidsskr.16.0099. Full text in Research Archive
• Romøren, Maria; Skaare, Dagfinn & Grude, Nils (2017). Klamydiatesting i praksis - rekvirenter og pasienter. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(19). doi: 10.4045/tidsskr.16.0709. Full text in Research Archive
• Romøren, Maria; Gjelstad, Svein & Lindbæk, Morten (2017). A structured training program for health workers in intravenous treatment with fluids and antibiotics in nursing homes: A modified stepped-wedge cluster-randomised trial to reduce hospital admissions. PLOS ONE. 12(9). doi: 10.1371/journal.pone.0182619. Full text in Research Archive Show summary

  Objectives Hospitalization is potentially detrimental to nursing home patients and resource demanding for the specialist health care. This study assessed if a brief training program in administrating intravenous fluids and antibiotics in nursing homes could reduce hospital transfers and ensure high quality care locally. Design A pragmatic and modified cluster randomized stepped-wedge trial with randomization on nursing home level. Participants 330 cases in 296 nursing home residents from 30 nursing homes were included. Cases were patients provided intravenous antibiotics or intravenous fluids, in nursing home or hospital. Primary outcome was localization of treatment, secondary outcomes were number of days treated, days of hospitalization among admitted patients, type of antibiotics used and 30-day mortality. Intervention The nursing homes sequentially received a one-day educational program for the health workers including theory and practical training in intravenous treatment of dehydration and infection, run by two skilled nurses. After completing the training program, the nursing homes had competence to provide intravenous treatment locally. Results The intervention had a highly significant effect on treatment in nursing homes (OR 8.35, 2.08 to 33.6; P<0.01, or RR 2.23, 1.48 to 2.56). The number treated in nursing homes was stable over time; the number treated in hospital gradually decreased (chi square for trend P< 0.001). Among patients receiving intravenous antibiotics in the nursing homes, 50 (46%) died within 30 days, compared to 30 (36%) treated in the hospital (P = 0.19). Among patients receiving intravenous fluids locally, 21 (19%) died within 30 days, compared to 2 (8%) in the hospital group (P = 0.34). Mortality was associated with reduced consciousness and elevated c-reactive protein. Conclusions A brief educational program delivered to nursing home personnel was feasible and effective in reducing acute hospital admissions from nursing homes for treatment of dehydration and infections.

• Nyborg, Gunhild; Brekke, Mette; Straand, Jørund; Gjelstad, Svein & Romøren, Maria (2017). Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria. BMC Geriatrics. 17:220, p. 1–11. doi: 10.1186/s12877-017-0608-z. Full text in Research Archive Show summary

  Background Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. Methods Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009–11 included residents’ demographic and clinical status and all medications, regular and on demand. Results 881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009). Conclusions Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs. The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population. Trial registration Retrospectively registered. Data obtained from clinical trial NCT01023763 registered with ClinicalTrials.gov 12/01/2009.

• Romøren, Maria; Pedersen, Reidar & Førde, Reidun (2016). How do nursing home doctors involve patients and next of kin in end-of-life decisions? A qualitative study from Norway. BMC Medical Ethics. 17(1). doi: 10.1186/s12910-016-0088-2. Full text in Research Archive Show summary

  Background Ethically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors’ descriptions of how they include the patient and next of kin in end-of-life decisions. Methods We performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation. Results The doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors were more concerned about the opinion of next of kin than ensuring the patient’s best interest. Conclusions Many end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient’s values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed.

• Fagan, Mark Stephan; Lindbæk, Morten; Grude, Nils; Reiso, Harald; Romøren, Maria & Skaare, Dagfinn [Show all 7 contributors for this article] (2015). Antibiotic resistance patterns of bacteria causing urinary tract infections in the elderly living in nursing homes versus the elderly living at home: an observational study. BMC Geriatrics. 15. doi: 10.1186/s12877-015-0097-x. Full text in Research Archive Show summary

  Background Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted. Methods This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community. Results There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64 %) and 2275 (64 %) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70 %) than in males 303 (39 %)(p < 0.05). Enterococcus faecalis was significantly less common in females 223(7 %) than males 137 (18 %) (p < 0.05). For females, there were lower resistance rates to ciprofloxacin among Escherichia coli (7 % vs 12 %; p < 0.05) and to mecillinam among Proteus mirabilis (3 % vs 12 %; p < 0.05). Conclusions Differences in resistance rates for patients in the nursing home do not warrant separate recommendations for empiric antibiotic therapy, but recommendations based on gender seem warranted.

• Horntvedt, May-Elin T; Romøren, Maria & Solvoll, Betty-Ann (2014). Ethical problems related to intravenous fluids in nursing homes. Nursing Ethics. ISSN 0969-7330. 21(8), p. 890–901. doi: 10.1177/0969733014521093. Full text in Research Archive
• Nordeng, Hedvig Marie Egeland; Lupattelli, Angela; Romøren, Maria & Koren, Gideon (2013). Neonatal outcomes after gestational exposure to nitrofurantoin. Obstetrics and Gynecology. ISSN 0029-7844. 121(2), p. 306–313. doi: 10.1097/AOG.0b013e31827c5f88. Full text in Research Archive
• Romøren, Maria; Lindbæk, Morten & Nordeng, Hedvig Marie Egeland (2012). Pregnancy outcome after gestational exposure to erythromycin - a population-based register study from Norway. British Journal of Clinical Pharmacology. ISSN 0306-5251. 74(6), p. 1053–1062. doi: 10.1111/j.1365-2125.2012.04286.x. Full text in Research Archive
• Mordal, Jon; Holm, Bjørn; Gossop, Michael; Romøren, Maria; Mørland, Jørg & Bramness, Jørgen Gustav (2011). Psychoactive substance use among patients admitted to an acute psychiatric ward: Laboratory findings and associations with clinical characteristics. Nordic Journal of Psychiatry. ISSN 0803-9488. 65(3), p. 208–215. doi: 10.3109/08039488.2010.527014. Full text in Research Archive
• Juvkam, kari Hilde; Moi, Harald & Romøren, Maria (2008). Gynekologiske infeksjoner. In Lindbæk, Morten (Eds.), Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593). Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP). ISSN 9788280811127. p. 102–105. Full text in Research Archive
• Juvkam, Kari Hilde; Moi, Harald & Romøren, Maria (2008). Vulvovaginal candida X72 (del av kap 7.7). In Lindbæk, Morten (Eds.), Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593). Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP). ISSN 9788280811127. p. 110–113. Full text in Research Archive
• Romøren, Maria; Juvkam, Kari Hilde & Moi, Harald (2008). Trichomoniasis X73, A78 (del av kap 7.7). In Lindbæk, Morten (Eds.), Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593). Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP). ISSN 9788280811127. p. 114–115. Full text in Research Archive
• Romøren, Maria; Juvkam, Kari Hilde & Moi, Harald (2008). Seksuelt overførbare infeksjoner (intro til kap 7.8). In Lindbæk, Morten (Eds.), Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593). Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP). ISSN 9788280811127. p. 116–119. Full text in Research Archive
• Romøren, Maria; Juvkam, Kari Hilde & Moi, Harald (2008). Gonoré X71, Y71 (del av kap 7.8). In Lindbæk, Morten (Eds.), Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593). Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP). ISSN 9788280811127. p. 120–123. Full text in Research Archive
• Moi, Harald; Romøren, Maria & Juvkam, Kari Hilde (2008). Bakteriell vaginose X84 (del av kap 7.7). In Lindbæk, Morten (Eds.), Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten (Helsedirektoratet bestillingsnummer IS-1593). Helsedirektoratet og Antibiotikasenteret for primærmedisin (ASP). ISSN 9788280811127. p. 106–109. Full text in Research Archive
• Romøren, Maria; Velauthapillai, M; Rahman, M; Sundby, J; Klouman, Elise & Hjortdahl, P (2007). Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach. Bulletin of the World Health Organization. ISSN 0042-9686. 85(4), p. 297–304. doi: 10.2471/BLT.06.031922. Full text in Research Archive
• Romøren, Maria; Sundby, Johanne; Velauthapillai, Manonmany; Rahman, Mafizur; Klouman, Elise & Hjortdahl, Per (2007). Chlamydia and gonorrhoea in pregnant Batswana women: time to discard the syndromic approach? BMC Infectious Diseases. 7. doi: 10.1186/1471-2334-7-27. Full text in Research Archive Show summary

  Background Chlamydia and gonorrhoea are major causes of morbidity among women in developing countries. Both infections have been associated with pregnancy-related complications, and case detection and treatment in pregnancy is essential. In countries without laboratory support, the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we measured the prevalence of chlamydia and gonorrhoea among antenatal care attendees in Botswana. We evaluated the syndromic approach for the detection of cervical infections in pregnancy, and determined if risk scores could improve the diagnostic accuracy. Methods In a cross-sectional study, 703 antenatal care attendees in Botswana were interviewed and examined, and specimens were collected for the identification of C trachomatis, N gonorrhoeae and other reproductive tract infections. Risk scores to identify attendees with cervical infections were computed based on identified risk factors, and their sensitivities, specificities, likelihood ratios and predictive values were calculated. Results The prevalence of chlamydia was 8%, and gonorrhoea was found in 3% of the attendees. Symptoms and signs of vaginal discharge did not predict cervical infection, and a syndromic approach failed to identify infected women. Age (youth) risk factor most strongly associated with cervical infection. A risk score with only sociodemographic factors had likelihood ratios equivalent to risk scores which incorporated clinical signs and microscopy results. However, all the evaluated risk scores were of limited value in the diagnosis of chlamydia and gonorrhoea. A cut-off set at an acceptable sensitivity to avoid infected antenatal care attendees who remained untreated would inevitably lead to considerable over-treatment. Conclusion Although in extensive use, the syndromic approach is unsuitable for diagnosing cervical infections in antenatal care attendees in Botswana. None of the evaluated risk scores can replace this management. Without diagnostic tests, there are no adequate management strategies for C trachomatis and N gonorrhoeae in pregnant women in Botswana, a situation which is likely to apply to other countries in sub-Saharan Africa. Screening for cervical infections in pregnant women is an essential public health measure, and rapid tests will hopefully be available in developing countries within a few years.

• Romøren, Maria; Hussein, Fatma; Steen, Tore W.; Velauthapillai, Man; Sundby, Johanne & Hjortdahl, Per [Show all 7 contributors for this article] (2007). Costs and health consequences of chlamydia management strategies among pregnant women in sub-Saharan Africa. Sexually Transmitted Infections. ISSN 1368-4973. 83, p. 558–566. doi: 10.1136/sti.2007.026930. Full text in Research Archive
• Romøren, Maria; Hjortdahl, Per & Sundby, Johanne (2004). Chlamydia and gonorrhoea in pregnancy: effectiveness of diagnosis and treatment in Botswana. Sexually Transmitted Infections. ISSN 1368-4973. 80(5), p. 395–400. Full text in Research Archive
• Romøren, Maria & Rahman, M (2004). Syphilis screening in the antenatal care: a cross-sectional study from Botswana. BMC International Health and Human Rights. 80, p. 395–400. Full text in Research Archive
• Boonstra, Eelco; Lindbæk, Morten; Klouman, Elise; Ngome, Enock; Romøren, Maria & Sundby, Johanne (2003). Syndromic management of sexually transmitted diseases in Botswana's primary health care: quality of care aspects. Tropical medicine & international health. ISSN 1360-2276. Jul(8(7)), p. 604–614. Full text in Research Archive

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• Brænd, Anja Maria; Fossum, Guro Haugen; Romøren, Maria; Eliassen, Knut Eirik Ringheim; Werner, Erik Lønnmark & Skonnord, Trygve (2026). Patient experiences with student consultations in Norwegian general practice: a questionnaire study. Full text in Research Archive
• Skonnord, Trygve; Schei, Edvin; Brænd, Anja Maria; Bondevik, Gunnar Tschudi; Fossum, Guro Haugen & Rebnord, Ingrid Keilegavlen [Show all 9 contributors for this article] (2025). Patients’ experiences of meeting a medical student. A cross-sectional study from general practitioners’ waiting rooms. Full text in Research Archive
• Skonnord, Trygve; Fossum, Guro Haugen; Romøren, Maria; Eliassen, Knut Eirik Ringheim; Werner, Erik Lønnmark & Brænd, Anja Maria (2025). The experience of meeting a medical student at the GP's office. Full text in Research Archive
• Romøren, Maria & Pedersen, Reidar (2024). Pårørendesamarbeid og taushetsplikten. Full text in Research Archive
• Romøren, Maria (2024). Forskning i Forhåndssamtaleprosjektet. Full text in Research Archive
• Norheim, Irene & Romøren, Maria (2024). Implementering av retningslinjer for familieinvolvering for personer med psykoselidelser. Resultater fra Bedre Pårørendesamarbeid (BPS)-studien. Full text in Research Archive Show summary

  Implementering av retningslinjer for familieinvolvering for personer med psykoselidelser: Resultater fra Bedre Pårørendesamarbeid (BPS)-studien Introduksjon: Familieinvolvering er en del av den evidensbaserte behandlingen for personer med psykoselidelser, men er underimplementert til tross for at nasjonale og internasjonale retningslinjer anbefaler familieinvolvering som førstevalgs behandling. BPS-studien hadde som mål å 1) utforske hvilke organisatoriske og kliniske hemmere og fremmere lokale implementeringsteam og klinikere opplevde (ved implementering av familieinvolvering), 2) vurdere om et implementeringsstøtteprogram (ISP) økte implementeringsgraden av retningslinjer for familieinvolvering, og 3) undersøke effekten av IPS på pårørendetilbud ved distriktpsykiatriske sentre (DPS), og på pasienter og pårørendes opplevde psykososiale helse, livskvalitet og tilfredshet med tjenestene. Metoder: En klyngerandomisert kontrollert multisenter studie ble utført ved 15 DPS enheter i Helse Sør-Øst. Rekrutterte enheter ble randomisert til intervensjon (ISP) eller kontrollgruppe. Deretter rekrutterte enhetene psykosepasienter og deres nærmeste pårørende til å delta i studien. Data ble innhentet gjennom fokusgruppeintervjuer med klinikere, forbedringsteam og ledere, intervjuer med pasienter og pårørende, fidelitymålinger, og spørreskjemaer til pasienter, pårørende og klinikere. Resultater: Det å gi opplæring i psykoedukativt familiesamarbeid (PEF) til ansatte, etablere rutiner for å tilby grunnleggende familieinvolvering til alle pasienter, og sikre at klinikere får erfaring med familieinvolvering, er viktige fremmere. Implementeringsgraden av retningslinjer for familieinvolvering og mengden av ulike typer familie- og støttekonsultasjoner, inkludert PEF, var signifikant større i intervensjonsgruppen enn i kontrollgruppen. Familieinvolvering bidro til felles forståelse, anerkjennelse og gjensidig dialog mellom pårørende, pasienter og klinikere. Resultatene fra 231 pasient-/pårørendepar er under arbeid. Konklusjon: Implementering av familieinvolvering i DPS enheter for personer med psykoselidelser er mulig gjennom en helhetlig tilnærming på flere nivåer, sikret av tydelig ledelsesforankring og engasjement i organisasjonen. Denne studien viser at god implementeringsstøtte er svært viktig for at helsetjenesten skal kunne tilby evidensbasert behandling. Resultatene kan ha overføringsverdi til pasienter med andre alvorlige psykiske lidelser og deres pårørende.

• Giske, Hanne Wilhelmsen; Norheim, Irene & Romøren, Maria (2024). Helsepersonell som lærer å utøve pårørendesamarbeid, erfarer nytten av det og bruker det. NAPHA Nasjonalt kompetansesenter for psykisk helsearbeid. Full text in Research Archive
• Romøren, Maria (2023). Implementering av forhåndssamtaler for geriatriske pasienter: En klynge-randomisert studie i Helse Sør-Øst. Full text in Research Archive
• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Show all 9 contributors for this article] (2023). Correction to: Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial (Administration and Policy in Mental Health and Mental Health Services Research, (2023), 50, 3, (520-533), 10.1007/s10488-023-01255-0). Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-023-01291-w. Full text in Research Archive
• Bakke, Mathilde Coraline Aarvold; Norheim, Irene & Romøren, Maria (2022). Forskning bidrar til utvikling og innovasjon i helsetjenestene. UiO web. Full text in Research Archive Show summary

  Forskning og fagutvikling har hatt stor betydning for innføring av systematisk pårørendesamarbeid i helsetjenestene, og for utvikling av en samtaleguide for helsepersonell.

• Romøren, Maria & Hansson, Kristiane Myckland (2021). Preliminary results from interviews with patients and relatives (their experiences with the intervention). Full text in Research Archive
• Pedersen, Reidar & Romøren, Maria (2021). Presentasjon "Implementing Advance Care Planning - A Cluster Randomised Controlled Study". Hvordan involvere fastlegene i forhåndssamtaler? Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Hestmark, Lars; Romøren, Maria & Heiervang, Kristin S. (2020). Veiledningsdag BPS. Full text in Research Archive
• Hansson, Kristiane Myckland; Pedersen, Reidar; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Nettverkssamling for forbedringsteam intervensjonsarm BPS. Full text in Research Archive
• Pedersen, Reidar; Heiervang, Kristin S.; Hansson, Kristiane Myckland; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Hestmark, Lars; Heiervang, Kristin S. & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Hestmark, Lars; Heiervang, Kristin S. & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Heiervang, Kristin S.; Hansson, Kristiane Myckland; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Heiervang, Kristin S.; Hestmark, Lars; Hansson, Kristiane Myckland & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Hestmark, Lars; Heiervang, Kristin S. & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Pedersen, Reidar; Hansson, Kristiane Myckland; Heiervang, Kristin S.; Hestmark, Lars & Romøren, Maria (2020). Veiledningsdag BPS. Full text in Research Archive
• Romøren, Maria & Norheim, Irene (2019). Bedre Pårørendesamarbeid (BPS): Et implementerings- og forskningsprosjekt om pårørendesamarbeid - status høst 2019. Full text in Research Archive
• Romøren, Maria (2019). Bedre Pårørendesamarbeid (BPS): Et implementerings- og forskningsprosjekt - status og planer for Vestfold. Full text in Research Archive
• Romøren, Maria & Norheim, Irene (2019). Bedre Pårørendesamarbeid (BPS): Et implementerings- og forskningsprosjekt om pårørendesamarbeid ved alvorlige psykiske lidelser. Full text in Research Archive
• Romøren, Maria & Pedersen, Reidar (2019). Bedre Pårørendesamarbeid (BPS): Et implementerings- og forskningsprosjekt - status og planer for Telemark. Full text in Research Archive
• Romøren, Maria (2019). Etiske utfordringer ved intravenøs behandling av sykehjemspasienter. Full text in Research Archive
• Pedersen, Reidar & Romøren, Maria (2018). Presentasjon prosjektet "Bedre pårørendesamarbeid". Full text in Research Archive
• Pedersen, Reidar & Romøren, Maria (2018). Presentasjon prosjektet Bedre pårørendesamarbeid. Full text in Research Archive
• Romøren, Maria (2018). A structured training program for health workers in intravenous treatment with fluids and antibiotics in nursing homes: A modified stepped-wedge cluster-randomized trial to reduce hospital admissions. Full text in Research Archive
• Romøren, Maria (2018). En pasient – to verdener. Sykehjemsleger og sykehuslegers beskrivelser av samhandling om sykehjemspasienter. Full text in Research Archive
• Romøren, Maria (2018). En pasient – to verdener: Sykehjemsleger og sykehuslegers beskrivelser av samhandling om sykehjemspasienter. Full text in Research Archive
• Dysthe, Bjørg Elise Tønnesen; Lødøen, Gjertrud; Romøren, Maria & Lindbæk, Morten (2018). Klamydiaepidemien som viste seg å være feilregistreringer. doi: 10.4045/tidsskr.17.0965. Full text in Research Archive
• Romøren, Maria; Førde, Reidun & Pedersen, Reidar (2017). En pasient - to verdener. p. 28–28. Full text in Research Archive
• Solvang, Fredrik & Romøren, Maria (2017). Dagsnytt 18: Debatt av artikkelen En pasient, to verdener (http://tidsskriftet.no/2017/02/originalartikkel/en-pasient-verdener-samhandling-mellom-sykehjemsleger-og-sykehusleger). [TV]. NRK. Full text in Research Archive
• Hanger, Mari Rian & Romøren, Maria (2017). Reduserte innleggelser hos pasienter på sykehjem. [Journal]. Dagens Medisin. Full text in Research Archive
• Dommerud, Tine & Romøren, Maria (2017). Ny behandling på sykehjem fører til kraftig reduksjon i innleggelser på sykehus. [Journal]. Aftenposten. Full text in Research Archive
• Romøren, Maria; Juvkam, kari Hilde & Moi, Harald (2015). Mycoplasma genitalium i allmennpraksis – bare en pille hvis det er ille? Utposten. ISSN 0800-5680. 6. Full text in Research Archive Show summary

  Retningslinjer skal være oversiktlige og tydelige, men ofte er virkeligheten betydelig mer komplisert – som for infeksjoner forårsaket av den seksuelt overførte bakterien Mycoplasma genitalium. Mange allmennleger har, med god grunn, spørsmål til hvordan man skal håndtere genital mycoplasmainfeksjon i praksis.

• Nordeng, Hedvig Marie Egeland; Romøren, Maria & Lindbæk, Morten (2010). Safety of macrolides during pregnancy – with special focus on erythromycin and congenital heart malformations. Full text in Research Archive
• Dommerud, Tine & Romøren, Maria (2010). Bedre med intravenøst på sykehjemmet. [Journal]. Dagens Medisin. Full text in Research Archive
• Romøren, Maria & Sundby, Johanne (2006). Where is the humility for the limitations of research? Clinical Infectious Diseases. ISSN 1058-4838. 42, p. 888–888. Full text in Research Archive
• Romøren, Maria (2004). Detection of curable sexually transmitted infections in antenatal care in Botswana. Full text in Research Archive Show summary

  DETECTION OF CURABLE STIS IN THE ANTENATAL CARE IN BOTSWANA Romøren M, Velauthapillai M, Hjortdahl P, Sundby J, Khulumani P, Rahman M. University of Oslo, Norway, National Health Laboratory and Ministry of Health, Gaborone, Botswana BACKGROUND: The burden of sexually transmitted infections (STIs) in Botswana is high. Many of the complications are pregnancy related, and diagnosis and treatment of STIs in pregnancy is important. As many infected women are asymptomatic, a substantial proportion of STIs in pregnancy remains undetected. Laboratory screening to identify the infections is one solution to this problem, and screening for syphilis in the antenatal care (ANC) program has been established in Botswana for many years. The aim of this study is to find the prevalence of selected curable STIs among pregnant women and to evaluate if screening of these STIs also should be integrated in the ANC program. METHODS: 703 ANC clients from all clinics in Gaborone were included in the study. The women were interviewed about demographic data, reproductive history and STI symptoms. A genital examination was performed with a special focus on abnormal vaginal discharge. High vaginal and cervical swabs were taken for laboratory analysis of the infections within the vaginal discharge syndrome. RESULTS 21 (3%) of the pregnant women had gonorrhoea, 53 (7%) chlamydia, 131 (19%) trichomoniasis, and 265 (38%) had bacterial vaginosis. All these are conditions important to treat in pregnancy, but less than half of the affected women had symptoms and signs that would lead to treatment by the syndromic management. CONCLUSION: We find a high prevalence of STIs among ANC clients in Gaborone, and the existing STI management in Botswana is not effective in this population. In the second phase of this study we will conduct a cost-effectiveness analysis of screening ANC clients for these infections. With the results from our cost analysis, we will be able to discuss whether laboratory screening of selected curable STIs should be considered as a supplement to the STD management of ANC clients in Botswana.

• Harbin, Nicolay Jonassen; Romøren, Maria & Lindbæk, Morten (2025). Promoting prudent antibiotic use in nursing homes in the municipalities. Universitetet i Oslo. ISSN 9788234807169. Full text in Research Archive Show summary

  To hamper further rise of antibiotic resistance, effective measures aiming to reduce unnecessary antibiotic use needs to be developed and implemented. Previous studies have concluded that there is potential for improved antibiotic use in nursing homes (NHs). This thesis explores antibiotic use and stewardship in Norwegian NHs through a multi-methods approach, including a descriptive baseline data analysis, a controlled multifaceted antibiotic improvement intervention, and a qualitative study of NH healthcare professionals’ perceptions on barriers and facilitators of prudent antibiotic use. The baseline analysis of 34 NHs showed wide variability in antibiotic use, with short-term NHs having significantly higher use. Penicillins were the most used antibiotic group while antibiotics used for urinary tract infections (UTIs) was the dominating indication group. Parenteral antibiotics accounted for 17% with a notable use of broad-spectrum agents. The intervention, which targeted both physicians and nurses and included academic detailing, audit and feedback, clinical guiding tools and targeted education, did not significantly lower overall antibiotic use compared to controls. However, it achieved a substantial 33% reduction in antibiotics for UTIs and a 19% decrease in methenamine use. Qualitative findings identified barriers and facilitators at multiple levels—organisational, clinical, resident, and next-of-kin, that influence prescribing behaviors. Increased professional knowledge and awareness, correct use of point-of-care tests and communication with next-of-kin were perceived as facilitators of prudent antibiotic use. The study confirmed the vital role of nurses in clinical decision-making, highlighting their integration into stewardship efforts. The findings of the thesis underscore the need for tailored implementation strategies, improved interprofessional collaboration, good dialogue with next-of-kin and better diagnostic resources to optimise antibiotic use in NHs.

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