Goals of telephone nursing work - the managers’ perspectives: a qualitative study on Swedish healthcare direct

BMC Health Services Research

Mio Fredriksson²  Jan Larsson²  Inger K Holmström¹  Marianne Carlsson³  Elenor Kaminsky² 

[1] Department of Public Health and Caring Sciences, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden;Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden;Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden

关键词: Qualitative research;    Telephone nursing;    Sweden;    Registered nurses;    Paediatric health calls;    Managers;    Health promotion;    Equitable healthcare;   

Others  :  1132675
DOI  :  10.1186/1472-6963-14-188

 received in 2013-03-27, accepted in 2014-04-15,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Kaminsky et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]The Ministry of Health and Social Affairs [Socialstyrelsen]: Swedish health care act 1982:763. Hälso- och sjukvårdslag 1982, 1982:763.
• [2]World Health Organization: The Ottawa Charter for Health Promotion. 1986. [cited 2014 April 1st]; Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ webcite
• [3]Kaminsky E, Carlsson M, Hoglund AT, Holmstrom I: Paediatric health calls to Swedish telenurses: a descriptive study of content and outcome. J Telemed Telecare 2010, 16(8):454-457.
• [4]Swedin B: Healthcare direct: telephone nursing in collaboration. Final report from the national inquiry into coordinated telephone nursing [Vårdråd direkt: sjukvårdsrådgivningar i samverkan. Slutrapport från Utredningen om nationellt samordnad sjukvårdsrådgivning]. Landstingsförbundet: Stockholm; 2003.
• [5]Ernesater A, Holmstrom I, Engstrom M: Telenurses' experiences of working with computerized decision support: supporting, inhibiting and quality improving. J Adv Nurs 2009, 65(5):1074-1083.
• [6]Monaghan R, Clifford C, McDonald P: Seeking advice from NHS direct on common childhood complaints: does it matter who answers the phone? J Adv Nurs 2003, 42(2):209-216.
• [7]Belman S, Chandramouli V, Schmitt BD, Poole SR, Hegarty T, Kempe A: An assessment of pediatric after-hours telephone care: a 1-year experience. Arch Pediatr Adolesc Med 2005, 159(2):145-149.
• [8]Bunn F, Byrne G, Kendall S: The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review. Br J Gen Pract 2005, 55(521):956-961.
• [9]Pettinari CJ, Jessopp L: "Your ears become your eyes": managing the absence of visibility in NHS Direct. J Adv Nurs 2001, 36(5):668-675.
• [10]Swedish Healthcare Direct 1177 [Sjukvårdsrådgivningen 1177]. 2014. [Cited 2014 April 1st]; Available from: http://www.1177.se/Uppsala-lan/Om-1177/1177-Sjukvardsradgivningen/?ar=True webcite
• [11]The National Board of Health and Welfare [Socialstyrelsen]: National guidelines for disease prevention methods 2011: use of tobaco, hazardous use of alcohol, insufficient physical activity and unhealthy eating habits: support for governance and management [Nationella riktlinjer för sjukdomsförebyggande metoder 2011: tobaksbruk, riskbruk av alkohol, otillräcklig fysisk aktivitet och ohälsosamma matvanor: stöd för styrning och ledning]. Stockholm: The National Board of Health and Welfare [Socialstyrelsen]; 2011.
• [12]The Swedish Society of Nursing [Svensk sjuksköterskeförening]: Strategi for nurses health promotion [Strategi för sjuksköterskans hälsofrämjande arbete]. 2008. [cited 2014 April 1st]; Available from: http://www.swenurse.se/Global/Publikationer/H%c3%a4lsofr%c3%a4mjande%20arbete-publikationer/Strategi.for.sjukskoterskans.halsoframjande.arbete.pdf webcite
• [13]ICN - International Council of Nurses: The ICN Code of Ethics for Nurses. 2005. [cited 2014 April 1st]; Available from: http://www.icn.ch/images/stories/documents/about/icncode_english.pdf webcite
• [14]The National Board of Health and Welfare [Socialstyrelsen]: Competence description for registered nurse [Kompetensbeskrivning för legitimerad sjuksköterska]. 2005. [cited 2014 April 1st]; Available from: http://www.socialstyrelsen.se/lists/artikelkatalog/attachments/9879/2005-105-1_20051052.pdf webcite
• [15]The Association for Telephone Counselling in Healthcare and Swedish Society of Nursing [Föreningen för telefonrådgivning inom hälso- och sjukvård TRIHS and Svensk sjuksköterskeförening]: Competence description for telenurses [Kompetensbeskrivning för telefonsjuksköterska]. 2011. [cited 2014 April 1st]; Available from: http://www.esh.se/fileadmin/erstaskondal/Alumni/vanforeningen/vanforeningen_kompetensbeskrivning_telefonsjukskoterska.pdf webcite
• [16]Kaminsky E, Rosenqvist U, Holmström I: Telenurses' understanding of work: detective or educator? J Adv Nurs 2009, 65(2):382-390.
• [17]The Ministry of Health and Social Affairs [Socialdepartementet]: A renewed Public Health Policy. Prop 2007, 08:110. [En förnyad folkhälsopolitik, Prop. 2007/08:110]. 2007
• [18]The National Board of Health and Welfare [Socialstyrelsen]: SOSFS 1997:8 General goals of the National Board of Health and Welfare [Socialstyrelsens allmänna råd]; Head Directors within Healthcare Services [Verksamhetschef inom hälso- och sjukvård]. 1997. [cited 2014 April 1st]; Available from: http://www.socialstyrelsen.se/publikationer1997/1997-10-8 webcite
• [19]Leppänen V: Power in telephone-advice nursing. Nurs Inq 2010, 17(1):15-26.
• [20]Andersson BM: Conceptions, conflicts and contradictions at the introduction of a Swedish health call centre. Sweden: Thesis University of Gothenburg; 2008.
• [21]Casey D: Nurses’ perceptions, understanding and experiences of health promotion. J Clin Nurs 2007, 16(6):1039-1049.
• [22]Purc-Stephenson RJ, Thrasher C: Nurses' experiences with telephone triage and advice: a meta-ethnography. J Adv Nurs 2010, 66(3):482-494.
• [23]Farquharson B, Allan J, Johnston D, Johnston M, Choudhary C, Jones M: Stress amongst nurses working in a healthcare telephone-advice service: relationship with job satisfaction, intention to leave, sickness absence, and performance. J Adv Nurs 2012, 68(7):1624-1635.
• [24]Bolton SC: Multiple roles? Nurses as managers in the NHS. Int J Public Sect Manage 2003, 16(2):122-130.
• [25]McConnell CR: The Health Care Professional as a Manager: Balancing Two Important Roles. Health Care Manag (Frederick) 2008, 27(3):277-284.
• [26]Paliadelis PS: The working world of nursing unit managers: responsibility without power. Aust Health Rev 2008, 32(2):256-264.
• [27]Winblad U: Do physicians care about patient choice? Soc Sci Med 2008, 67(10):1502-1511.
• [28]Patton MQ: Qualitative research & evaluation methods. 4th edition. London: SAGE; 2004.
• [29]Polit DF, Beck CT: Nursing research: generating and assessing evidence for nursing practice. 8th edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.
• [30]Clark JP: How to peer review a qualitative manuscript. In Peer Review in Health Sciences. Second edition. Edited by Godlee F, Jefferson T. London: BMJ Books; 2003:219-235.
• [31]The Ministry of Education and Research: The Act concerning the Ethical Review of Research Involving Humans (SFS 2003:460). 2003. [cited 2014 April 1st]; Available from: http://www.codex.uu.se/en/manniska5.shtml webcite
• [32]World Health Organization: World Medical Association Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. Bull World Health Organ 2001, 9(4):373-374.
• [33]Hsieh H-F, Shannon SE: Three Approaches to Qualitative Content Analysis. Qual Health Res 2005, 15(9):1277-1288.
• [34]Christensen T, Ivarsson WA: Organisational theory for public sector [Organisationsteori för offentlig sektor]. Malmö: Liber; 2005.
• [35]Johansson H, Weinehall L, Emmelin M: "It depends on what you mean": a qualitative study of Swedish health professionals' views on health and health promotion. BMC Health Serv Res 2009, 9(1):191. BioMed Central Full Text
• [36]Robinson S, Hill Y: The health promoting nurse. J Clin Nurs 1998, 7(3):232-238.
• [37]Fältholm Y, Jansson A: Telephone advisory services—nursing between organisational and occupational professionalism. N Technol Work Employ 2008, 23(1–2):17-29.
• [38]Eckes T: Trautner HM. Lawrence Erlbaum Associates: The developmental social psychology of gender; 2000.
• [39]Connell RW, Messerschmidt JW: Hegemonic masculinity. Gend Soc 2005, 19(6):829-859.
• [40]Höglund AT, Holmström I: It's easier to talk to a woman. Aspects Gend Swedish Telenursing J Clin Nurs 2008, 17(22):2979-2986.
• [41]Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004, 24(2):105-112.
• [42]Lincoln YS, Guba EG: Naturalistic inquiry. Beverly Hills, Calif: Sage Publications; 1985.
• [43]Hamberg K, Johansson E, Lindgren G, Westman G: Scientific rigour in qualitative research - examples from a study of women's health in family practice. Fam Pract 1994, 11(2):176-181.
• [44]Health Services Research in Europe: Health services research: helping tackle Europe's health care challenges. 2011. [cited 2014 April 1st]; Available from: http://www.healthservicesresearch.eu/mediaFiles/upload/publications/Policybrief-health-services-research.pdf webcite