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'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Health Services Research)
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 2, 142-148 p.Article in journal (Refereed) Published
Abstract [en]

Millions of calls are made to the telephone advisory services in primary health care in Sweden. The patients seem happy with the advice and counselling they receive, but little has been written about nurses' experiences of performing telephone advisory services. Yet, the nurses are expected to be patient, sensitive and have a broad knowledge of medicine, nursing and pedagogy. The aim of this study was to describe how nurses experience the patient encounter when performing telephone advisory services. A strategic sample of five nurses were interviewed and asked to describe how they experienced the central aspects of the patient encounter by telephone. The transcribed interviews were analysed by the Empirical Phenomenological Psychological method. The nurses' experience of the patient encounter when performing telephone advisory services can be characterized in terms of the conflicting demands of being both carer and gatekeeper. The constituents of these conflicting demands were: reading between the lines while pressed for time; educating patients for self-care while fearful of misinterpreting the situation; encountering patients' satisfaction and dissatisfaction. The conflicting demands of being both professional carer and gatekeeper caused stress among the nurses. The organization of the telephone advisory services seems to hinder high-quality care.

Place, publisher, year, edition, pages
2002. Vol. 16, no 2, 142-148 p.
Keyword [en]
telephone advisory service, patient encounter, conflicting demands, nurses' experiences, phenomenology
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-63235DOI: 10.1046/j.1471-6712.2002.00075.xISI: 000176748700006OAI: oai:DiVA.org:uu-63235DiVA: diva2:91146
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2011-09-26Bibliographically approved
In thesis
1. Gaining Professional Competence for Patient Encounters by Means of a New Understanding
Open this publication in new window or tab >>Gaining Professional Competence for Patient Encounters by Means of a New Understanding
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Swedish health care is currently facing problems, such as lack of financial resources, staff shortage and dissatisfaction among patients and professionals. Patients’ dissatisfaction was the point of departure for the present study, and one approach dealing with this problem was investigated. It was hypothesised that a patient-centred perspective could offer a possible solution. The aim of the study was to explore health care professionals’ and medical students’ understanding of their professional role and the patient encounter. A further goal was to determine whether these understandings could be developed by educational interventions. Students and professionals have been either interviewed or responded to a survey about their professional role and the patient encounter. Qualitative analysis was used. One group- and one individualised intervention were carried out. The participants’ understandings of their professional role were taken as the starting point for learning. The results showed that a minority of medical students and professionals in diabetes care had incorporated a patient-centred perspective. Nurses in telephone advisory services recognised the patients’ needs, but experienced conflicting demands of being both carer and gatekeeper. A non-optimal match between patients’ needs and what professionals understand as their role could cause some of the problems. Competence development could be achieved by taking the participants understanding of the professionals’ role and of the patient encounter as a starting point for reflection. The results have implications for changes in organisation and education in health care, to optimise outcomes of care. Time for reflection, mentoring and professional development is needed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2002. 91 p.
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1145
Medical sciences, competence development, diabetes care, educational interventions, medical students, patient encounters, phenomenography, phenomenology, professional role, telephone advisory services, MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Research subject
Health Care Research
urn:nbn:se:uu:diva-1975 (URN)91-554-5297-3 (ISBN)
Public defence
2002-05-14, Rudbecksalen, Uppsala, 13:15
Available from: 2002-04-22 Created: 2002-04-22 Last updated: 2010-06-16Bibliographically approved

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