Expert in nursing care but sometimes disrespected—Telenurses’ reflections on their work environment and nursing care

Wahlberg, Anna Carin; Björkman, Annica

doi:10.1111/jocn.14622

Cited by 16 publications

(43 citation statements)

References 35 publications

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“…Studies about interactional dilemmas are scarce, and knowledge is lacking on what strategies triage nurses apply when they experience absence of congruence. In one Swedish interview study about working environment, it was briefly mentioned that some triage nurses complied to the CDSS because they were afraid of making a wrong assessment (Wahlberg & Bjorkman, ). We also found that management demands were one of the aspects that influenced the choice for the working strategies.…”

Section: Discussionmentioning

confidence: 99%

“…In the few studies about interactional workability, which are not specifically about telephone triage nurses, the telemedicine setting both enabled and constrained the nurses' reasoning and decision-making (Barken et al, 2017;Murdoch et al, 2015). When the CDSS does not support the triage view study about working environment, it was briefly mentioned that some triage nurses complied to the CDSS because they were afraid of making a wrong assessment (Wahlberg & Bjorkman, 2018). We also found that management demands were one of the aspects that influenced the choice for the working strategies.…”

Section: Discussionmentioning

confidence: 99%

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Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Wouters

Zwart

Erkelens

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To understand clinical reasoning and decision‐making of triage nurses during telephone conversations with callers suspected of having acute cardiac events, and support from a computer decision support system (CDSS) herewith. Background In telephone triage, nurses assess the urgency of callers’ conditions with clinical reasoning, often supported by CDSS. The use of CDSS may trigger interactional workability dilemmas. Design Qualitative study using principles of a grounded theory approach following COREQ criteria for qualitative research. Methods Audio‐stimulated recall interviews were conducted amongst twenty‐four telephone triage nurses at nine out‐of‐hours primary care centres (OHS‐PC). Results Telephone triage nurses use clinical reasoning elements for urgency assessment. Typically in telephone triage, they interpret the vocal—but not worded—elements in communication (paralanguage) such as tone of voice and shortness of breath and create a mental image to compensate for lack of visual information. We confirmed that interactional workability dilemmas occur. Congruence, established when the CDSS supports the triage nurses’ decision‐making, is essential for the CDSS’ value. If congruence is absent, triage nurses may apply four working strategies: (a) tinker to make CDSS final recommendation align with their own assessment, (b) overrule the CDSS recommendation, (c) comply with the CDSS recommendation or (d) transfer responsibility to the GP. Conclusion Triage nurses who assess urgency may experience absence of congruence between the CDSS and their decision‐making. Awareness of how triage nurses reason and make decisions about urgency and what aspects influence their working strategies can help in achieving optimal triage of callers suspected of acute cardiac events at OHS‐PC. Relevance to clinical practice Triage nurses’ reasoning and their working strategies are vital for outcome of triage decisions. Understanding these processes is essential for CDSS developers and OHS‐PC managers, who should value how triage nurses interact with the CDSS, while they have the benefit of callers in mind.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Wouters

Zwart

Erkelens

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…The RNs not only wanted this from GPs, but also asked for support possibilities from colleagues and time for discussions within their own profession. These activities could decrease occupational stress and reduce feelings of loneliness in making telephone assessments [43]. At PHCCs with professional collaboration, i.e.…”

Section: Discussionmentioning

confidence: 99%

Registered nurses´ views on telephone nursing for patients with respiratory tract infections in primary healthcare – a qualitative interview study

et al. 2020

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Background: Telephone nursing in primary healthcare has been suggested as a solution to the increased demand for easy access to healthcare, increased number of patients with complex problems, and lack of general practitioners. Registered nurses' assessments may also be of great importance for antibiotic prescriptions according to guidelines. The aim of this study was to describe registered nurses' views of telephone nursing work with callers contacting primary healthcare centres regarding respiratory tract infections. Methods: A descriptive, qualitative study was performed through interviews with twelve registered nurses in Swedish primary healthcare. Results: The overarching themes for registered nurses' views on telephone nursing were captured in two themes: professional challenges and professional support. These included three and two categories respectively: Communicate for optimal patient information; Differentiate harmless from severe problems; Cope with caller expectations; Use working tools; and Use team collaboration. Optimal communication for sufficiently grasping caller symptoms and assess whether harmful or not, without visual input, was underlined. This generated fear of missing something serious. Professional support used in work, were for example guidelines and decision support tool. Colleagues and teamwork collaboration were requested, but not always offered, support for the interviewed registered nurses.

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“…Our studies so far have shown that telenurses experience problems when encountering care-seekers with mental illness problems, as they have nowhere to refer them (cloaked citation during review process). Telenursing is a complex form of nursing care (Snooks et al, 2008, Wahlberg & Bjorkman, 2018 which occurs within a controlled (Röing et al, 2013) and linear structure (Murdoch et al, 2015). The fact that the work procedure of TAN is guided by a CDSS (Ernesäter, Holmström, & Engström 2009) means that the nurses are obligated to reduce the caller's symptoms and problems to something that can be documented within the structure of the CDSS (Murdoch et al, 2015).…”

Section: Rationale and Aimmentioning

confidence: 99%

Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct

Björkman

Salzmann‐Erikson

2019

International Journal of Qualitative Studies on Health and Well

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Purpose: Our aim was to describe Swedish Healthcare Direct (SHD) and its features as a complex system. Methods: Qualitative interviews were conducted with 20 SHD telenurses, covering their experiences and skills when encountering and advising callers with mental illness. Complexity science was used as an a priori theoretical framework to enhance understanding of the complex nature of telenursing. Results: SHD was described as a complex system as nurses were constantly interacting with other agents and agencies. During these interactions, dynamic processes were found between the agents in which the nurses adapted to every new situation. They were constantly aware of their impact on the care-seekers, and perceived their encounters with callers with psychiatric illness as "balancing on a thin line". SHD was also described as both an authority and a dumping ground. The openness of the system did not give the nurses possibility to control the number of incoming calls and the callers' intentions. Conclusions: These new insights into SHD have important implications for organization developers and nursing management in terms of overcoming linear thinking.

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Expert in nursing care but sometimes disrespected—Telenurses’ reflections on their work environment and nursing care

Cited by 16 publications

References 35 publications

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Registered nurses´ views on telephone nursing for patients with respiratory tract infections in primary healthcare – a qualitative interview study

Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct

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