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Telephone Nursing: Stakeholder views and understandings from a paediatric and a gender perspective
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Hälso- och sjukvårdsforskning)
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Omvårdnad per telefon : Intressenters syn och förståelsefrån ett pediatrik- och ett genusperspektiv (Swedish)
Abstract [en]

‘First line healthcare’ is offered via telephone in many Western countries. The overall aim of this thesis is to describe Telephone Nursing (TN) from three viewpoints: telenurses, parents calling for their children, and operation managers. Four empirical studies were conducted. Telenurses described their work in five different ways: ‘Assess, refer and give advice to the caller’, ‘Support the caller’, ‘Strengthen the caller’, ‘Teach the caller’ and ‘Facilitate the caller’s learning’, which all constitute a TN ‘work map’. Authentic paediatric calls between parents and telenurses revealed that 73% of callers were mothers and children were aged between 5 days and 14.5 years. The top three contact reasons were ear and skin problems, and fever, with a median call length of 4.4 minutes. More than half of the calls resulted in referrals and 48% received self-care advice. The likelihood of fathers being given referrals as a result of their call was almost twice as high as that for mothers, while mothers were almost twice as likely to receive self-care advice as fathers. Parents described their degree of worry and trust that influenced their decisions whether to contact SHD or not. Their calls were carefully prepared, and the parent calling often depended on family routine. Parents reported to follow recommendations. Most relied upon their own intuition if further worried, but some indicated they would never seek healthcare unless it was recommended. Operation managers described four main goals of TN work: ‘create feelings of trust’, ‘achieve patient safety’, ‘assess, refer and give advice’, and ‘teach the caller’. Equitable healthcare was regarded as important, whereas health promotion was not considered as part of the goals.

Conclusion: The studied TN viewpoints present concordance and discrepancies. Paediatric health calls appear mostly to be a woman-to-woman activity. Telenurses’ increased gender competence might increase TN safety. For that matter, telenurses’ collaboration with parents and making parents aware of holding the ultimate responsibility for their child’s condition is important. Goals of TN work and their relationship with healthcare obligations such as equitable healthcare and health promotion need further clarification. The viewpoints described in this thesis may contribute to the development of TN.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 75 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 933
Keyword [en]
Children; Equitable Healthcare; Gender; Health Promotion; Managers; Paediatric; Paediatric Health Calls; Parents; Registered Nurses; Telenurse; Telephone Nursing; Qualitative Research
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
URN: urn:nbn:se:uu:diva-200204ISBN: 978-91-554-8746-1 (print)OAI: oai:DiVA.org:uu-200204DiVA: diva2:646194
Public defence
2013-10-25, Auditorium Minus, Gustavianum, Uppsala Universitet, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council, 522-2005-7461
Available from: 2013-10-02 Created: 2013-05-22 Last updated: 2017-03-13Bibliographically approved
List of papers
1. Telenurses' understanding of work: detective or educator?
Open this publication in new window or tab >>Telenurses' understanding of work: detective or educator?
2009 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 2, 382-390 p.Article in journal (Refereed) Published
Abstract [en]

AIM

This paper is a report of a study to describe the different ways of understanding work among a group of Swedish telenurses.

BACKGROUND

Telenursing is an expanding service in many western countries and telenursing work is likely to be understood in a variety of ways. The way in which a person understands work influences how work is performed. Telenursing demands high levels of competence.

METHOD

A qualitative interview study was conducted during 2004-2005. Twelve of the 20 telenurses working at a call centre in Sweden were interviewed, five of them twice because of organizational changes. The 17 interviews were analysed using a phenomenographic approach.

FINDINGS

Five different categories were identified in the data: (1) Assess, refer and give advice to the caller (2) Support the caller (3) Strengthen the caller (4) Teach the caller and (5) Facilitate the caller's learning. The first category can be seen as a base for telenursing work and was the only category used by some telenurses. The second category has components of traditional caring and the third is a coaching function. The fourth category contains a teaching component, but the fifth is the only category where the caller's learning is in focus. Telenurses who reported the fifth way also included all other ways of understanding work. Hence, this seems to be the most comprehensive way of understanding work.

CONCLUSION

The categories together constitute a telenursing 'workmap'. This 'workmap' can be used for reflection to expand telenurses' current understanding of work, and hence promote competence development. Telenurses need to be aware of their role in public health education.

Keyword
Communication, competence, health education, learning, phenomenography, support, telenursing, workmap
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-102283 (URN)10.1111/j.1365-2648.2008.04877.x (DOI)000262511300014 ()19040692 (PubMedID)
Funder
Swedish Research Council
Available from: 2009-05-06 Created: 2009-05-06 Last updated: 2017-12-13Bibliographically approved
2. Paediatric health calls to Swedish telenurses: a descriptive study of content and outcome
Open this publication in new window or tab >>Paediatric health calls to Swedish telenurses: a descriptive study of content and outcome
2010 (English)In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 16, no 8, 454-457 p.Article in journal (Refereed) Published
Abstract [en]

We collected data about telephone triage calls concerning children in Sweden. A sample of 110 paediatric calls were recorded. The transcribed data were analysed regarding word count, reasons for calling, results of calls, ages and gender of children, and gender of parents. The median call length was 4.4 min and the median child's age was 3.5 years. Mothers made 73% of calls, but mothers and fathers called to the same extent about daughters and sons, and regardless of age. The most common reasons for calls were ear problems, rash/wound or fever. In nearly half the calls, the telenurses provided self-care advice. Call length, word count or caller's part of word count did not differ according to gender of parents or children. However, mothers were more likely to receive self-care advice while fathers were more often referred to other health services by the telenurses. Telenurses might need to improve their gender competence, and more male telenurses in the service would potentially be beneficial to callers.

National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-134796 (URN)10.1258/jtt.2010.100110 (DOI)000285681600007 ()20921290 (PubMedID)
Funder
Swedish Research Council
Available from: 2010-12-01 Created: 2010-12-01 Last updated: 2017-12-12Bibliographically approved
3. "If I didn't trust Swedish Healthcare Direct, I would never call" - views of making pediatric health calls
Open this publication in new window or tab >>"If I didn't trust Swedish Healthcare Direct, I would never call" - views of making pediatric health calls
2013 (English)In: Clinical Nursing Studies, ISSN 2324-7959, Vol. 1, no 3, 57-69 p.Article in journal (Refereed) Published
Abstract [en]

The focus of the presented research is parents' expectations and experiences of calling Swedish Healthcare Direct (SHD)regarding pediatric health issues. Telenursing is a rapidly expanding service and SHD handles up to 2.4 million pediatrichealth calls yearly. Mothers make the majority of the calls and reportedly receive self-care advice more than fathers.Parents' views are important for the development and safe use of telenursing health services. The study is qualitative, withan exploratory and descriptive design. Twenty-one interviews with parents were analysed using content analysis.According to the interviewees, the decision to contact SHD or not is influenced by their degree of worry or trust in the service. Calls are carefully prepared, and who will call is often predetermined and affected by gender. Parents want to be given a chance to speak first in their communication with telenurses. They want to be listened to carefully and to be accorded respect, to have their needs fully explored and to have their concerns relieved. Most parents follow telenurses'recommendations, a few exclusively. Some primarily trust their own intuition. Learning is frequent, implying the publichealth potential of calls, not least for foreign-born callers. Exploring parents' expectations provides insight into parents'worries, potential to increase parents' learning and may develop their trust in telenurses' recommendations. Telenurses'awareness of gender impact can further develop the telenursing health service in providing safe care on equal terms for avulnerable patient group, children.

Keyword
Children, Communication, Gender, Interviews, Parents, Pediatric, Primary care, Telenursing
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-202853 (URN)10.5430/cns.v1n3p57 (DOI)
Available from: 2013-06-28 Created: 2013-06-28 Last updated: 2014-01-23Bibliographically approved
4. Goals of telephone nursing work - the managers' perspectives: a qualitative study on Swedish healthcare direct
Open this publication in new window or tab >>Goals of telephone nursing work - the managers' perspectives: a qualitative study on Swedish healthcare direct
Show others...
2014 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, 188- p.Article in journal (Refereed) Published
Abstract [en]

Background

Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD.

Methods

The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis.

Results

The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: ‘create feelings of trust’, ‘achieve patient safety’, ‘assess, refer and give advice’, and ‘teach the caller’. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given.

Conclusions

The interviewed managers mainly echoed the organisational goals of TN work. The managers’ expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems.

Keyword
Equitable Healthcare, Health promotion, Managers, Paediatric Health calls, Registered Nurses, Sweden, Telephone Nursing, Qualitative research
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-202857 (URN)10.1186/1472-6963-14-188 (DOI)000335530600001 ()
Available from: 2013-06-28 Created: 2013-06-28 Last updated: 2017-12-06Bibliographically approved

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