Exploring the communication between telenurse and caller—A critical discourse analysis

Abstract

BackgroundTelenursing is an expanding service in most Western societies. Sweden is a front-line country, with all of its 21 counties connected to Swedish Healthcare Direct (SHD) 1177. The intention of the service is twofold: to make health care more efficient, while also making it more accessible and safe for patients. Previous research has shown, however, that the service is not used equitably. Gender, age, socio-economic, and ethnicity differences have been reported as determining factors for the use of the service and the advice given.AimThe aim of the study was to explore the communication between telenurses and callers in authentic calls to SHD 1177.MethodologyA qualitative method, using critical discourse analysis (CDA), was chosen. The approach was deductive, that is, the analysis was made in view of a predetermined framework of theory. Twenty calls were strategically chosen and included in the study.ResultsThe CDA resulted in five types of calls, namely a gatekeeping call, a gendered call, a call marked by impersonal traits, a call with voices of the life world, and finally a counter discourse call. The dominating patterns in the calls were of gatekeeping and biomedical character. Patterns of the societal gender order were found, in that representations of the reluctant male caller and the ideal female caller were identified, but also a call representing a counter discourse. The service seemed difficult to use for patients with low language proficiency.ConclusionTelenursing could potentially challenge inequalities in health care. However, the discourse of telenursing is dialectically related to neoliberal ideology and the ideology of medicine. It is also situated in a gendered context of ideal femininity and hegemonic masculinity. Through better awareness of gender biases and the callers’ different resources for making themselves heard, the communication between telenurse and caller might become more equal and thereby better suitable for all callers.

Telephone nursing in Sweden: A narrative literature review

“…In line with the findings from the UK (Knowles et al ), SHD was difficult to use for patients with language problems (Hakimnia et al ). Knowles et al () conclude that TN could be problematic if some groups in the population are less likely to use it.…”

“…The remaining articles on communication covered gender and cultural constructions in dialogues. Hakimnia et al () identified five types of calls, which were grouped under three wider themes: a gatekeeping theme, a medicine‐focused theme, and a theme concerning gender. In gatekeeping calls, the focus was on directing callers to the appropriate level of care.…”

“…This highlighted the importance of observing callers' different resources for making them heard, and the need for an awareness of gender biases. Gender construction was noted to manifest itself (Höglund & Holmström ; Hakimnia et al ) when female callers were considered easier to talk to. Further, female subordination in families was stated to affect who actually makes the call.…”

“…To attain an equitable distribution of public health education, however, discriminating aspects must be observed (e.g. to welcome fathers, men, immigrants, and callers from deprived areas to TN services to the same extent as other citizens), because gender, age, and ethnicity have been proven to play a role in who calls SHD and in call outcomes (Kaminsky et al ; Hakimnia et al , ; Höglund & Holmström ). Female callers are of the majority, and seem to be predominant internationally, whereas calls from individuals in deprived areas are less common (Buja et al ; McAteer et al ).…”

Doing gender in the context of telenursing: Analyses of authentic calls to a telenursing site in Sweden

“…[11] The societal gender order has also been shown to be mirrored in calls to SHD, as representations of the reluctant male caller and the ideal feminine caller were identified by discourse analysis of authentic calls. [24] As for the actual calls, the mean call length in the whole study sample was 4 minutes and 30 seconds. For men, the mean call length was 4 minutes, and for women 4 minutes and 40 seconds, as previously mentioned.…”