Telephone advice nursing : callers’ perceptions, nurses’ experience of problems and basis for assessments

At a health care call center, care-seekers can consult telephone nurses 24 hours a day. Telephone advice nursing (TAN) includes triage, advice, support, education, referral, information and coordination. The overall aim of the thesis was to explore the core of TAN from different perspectives, the careseeker/patient, emergency medical dispatching and the telephone nurse. The first study described the telephone nurses' context of TAN at a health care call center. Calls from one week (n=2866) were registered and 203 callers were asked to answer a questionnaire, out of which 144 responded (71%). Altogether 20 different reasons for calling were found and in 47% of the calls were made on behalf of someone else. 49% received self-care advice and 85% stated in the questionnaire that they followed the nurses' advice. 95% stated that they received the help from the call center as they anticipated. To obtain a deeper understanding of how the callers perceived their contact with the call center, comments in two open-ended questions in the questionnaire were analyzed with qualitative content analysis in the second study. The comments were categorized in satisfactory and unsatisfactory and practical and emotional aspects. The findings highlighted the importance of receiving appropriate advice, being treated in a kindly manor and receiving a feeling of security through the consultation. In the third study an analysis of the complaints in emergency medical dispatching (EMD) filed with the Medical Responsibility Board, the Swedish National Board of Health and Welfare and Patient Advisory Committees revealed 54 cases between 1991 and 2000. The complaints were analyzed with focus on factors and circumstances that influenced misjudgments and in 19 out of the 21 complaints; the telephone assessments were made on the basis of second-hand information. Twenty-five telephone nurses participated in the fourth study in which the Delphi Method was used including three sets of questionnaires with the focus on problems with TAN. 24 problems were identified and the findings like 'second-hand consultations' and the 'loss of visual contact' highlighted the difficulty of assessments in TAN. In the fifth study seven telephone nurses were interview according to the "stimulated recall technique". Fourteen authentic calls were analyzed with a qualitative content analysis with the focus on what the nurses used as basis for their assessments. Findings show the that the nurses' basis are very broad, and information revealed both by verbal and nonverbal communication was used and the categories could be related to three contexts; nurse, careseeker and organization. In conclusion, the findings show that the assessment seems to be the core of TAN. The individual perspective also seems to be important, both from the care-seeker and telephone nurse point of view. Further, the nurses seem to use both verbal and nonverbal communication in their assessments, and should therefore in all situations strive for direct communication with the care-seeker