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Björkman, A. & Salzmann-Erikson, M. (2018). The bidirectional mistrust - callers’ online discussions about their experiences of using the national telephone advice service. Internet Research, 28(5), 1336-1350
Open this publication in new window or tab >>The bidirectional mistrust - callers’ online discussions about their experiences of using the national telephone advice service
2018 (English)In: Internet Research, ISSN 1066-2243, Vol. 28, no 5, p. 1336-1350Article in journal (Refereed) Published
Abstract [en]

Purpose – The purpose of this paper is to explore and describe online communication about the experiencesand attitudes toward Swedish Healthcare Direct, a national telephone advice nursing (TAN) service.

Design/methodology/approach – A descriptive research design was adopted using a six-step netnographicmethod. Three Swedish forums were purposefully selected and data from the virtual discussions were collected.

Findings – Three themes emerged: expectancy and performativity of the nurses, absurdity in accessibilityand the scrutinizing game. The most prominent finding was the scrutinizing game, which included aspects ofbidirectional mistrust from both nurses and callers. Another salient finding was the attitudes that callers heldtoward nurses who used a technique interpreted as “passing the buck.”

Research limitations/implications – The use of a nethnographic method is novel in this area of research.Consequently, the body of knowledge has regarding telephone advise nursing service has significantly beenbroadened. A limitation in this study is that demographic data for the posters are not available.

Practical implications – Bidirectional distrust is an important issue that must be acknowledged by TANservices, since it might damage the service on a fundamental level. Healthcare providers, politicians, andresearchers should account for the power and availability of virtual discussions when seeking consumers’opinions and evaluating the quality of the care provided.

Originality/value – This analysis of the ongoing discussions that take place on the internet provides insightinto callers’ perceptions of a national TAN service. The bidirectional mistrust found from both the nurses andthe callers might be a threat to callers’ compliance with the advice given and their care-seeking behavior.

Keywords
Nursing, Antagonistic effects, Distrust, Cyber nursing, Internet forums, consumer attitudes
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-24102 (URN)10.1108/IntR-11-2016-0330 (DOI)000446476500010 ()2-s2.0-85054127428 (Scopus ID)
Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2018-11-23Bibliographically approved
Björkman, A. & Salzmann-Erikson, M. (2018). When all other doors are closed: Telenurses' experiences of encountering care seekers with mental illnesses.. International Journal of Mental Health Nursing, 27(5), 1392-1400
Open this publication in new window or tab >>When all other doors are closed: Telenurses' experiences of encountering care seekers with mental illnesses.
2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 5, p. 1392-1400Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe the telephone nurses' experiences of encountering callers with mental illnesses. Telenursing services are solely staffed with telenurses, who with the support of a decision support system (CDSS) independently triage callers based on the severity of the main symptoms presented by the care seeker. The system focuses on somatic symptoms, while information regarding mental health and mental illnesses is limited. Information about telenurses' experiences of encountering care seekers with mental illnesses is scarce, despite the increase in mental illnesses in the population. The study used a descriptive design with a qualitative approach. Twenty telenurses were interviewed, and the data were then analysed using inductive qualitative content analysis. The results are elaborated in the following three categories: (i) Experiences of encountering care seekers with mental illnesses; (ii) Experiences of facing difficulties and challenges; and (iii) Experiences of facing dissatisfaction and threats. Encountering care seekers with mental illnesses is metaphorically addressed as 'when all other doors are closed'. Encountering care seekers with mental illnesses was perceived as time-consuming and did not adequately correspond to the resources given by the service. Even though telenurses strive to achieve agreement, there is a collision between human needs and organizational structures. The study pinpoints the lack of resources for and education about mental illnesses and the limitations of the decision system, which needs to be updated in order to provide all care seekers care on equal terms.

Keywords
distance counselling, mental illness, nursing care, social support, telenursing
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hig:diva-26113 (URN)10.1111/inm.12438 (DOI)000443391700008 ()29383820 (PubMedID)2-s2.0-85041236949 (Scopus ID)
Funder
Tore Nilsons Stiftelse för medicinsk forskning
Available from: 2018-02-07 Created: 2018-02-07 Last updated: 2018-10-15Bibliographically approved
Björkman, A., Engström, M., Olsson, A. & Wahlberg, A. C. (2017). Identified obstacles and prerequisites in telenurses’ work environment: a modified Delphi study. BMC Health Services Research, 17(1), Article ID 357.
Open this publication in new window or tab >>Identified obstacles and prerequisites in telenurses’ work environment: a modified Delphi study
2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 357Article in journal (Refereed) Published
Abstract [en]

Background: Telenursing is an expanding part of healthcare, staffed with registered nurses whose work environment is typical of a call centre. Work-related stress has been shown to be a major problem in nurses’ work environments and of importance to the outcome of care, patient safety, nurse job satisfaction and burnout. Today, however, we have a limited understanding of and knowledge about the work environment for telenurses. The aim of the present study is to explore and reach consensus on perceived important obstacles and prerequisites in telenurses’ work environment.

Methods: A modified Delphi design, using qualitative as well as quantitative data sequentially through three phases, was taken. Data were initially collected via semi-structured interviews (Phase I) and later using a web survey (Phase II-III) between March 2015 and March 2016.

Results: The findings present a consensus view of telenurses’ experiences of important obstacles and prerequisites in their work environment. Central to the findings are the aspects of telenurses having a demanding work, cognitive fatigue and having no opportunity for recovery during the work shift was ranked as important obstacles. Highly ranked prerequisites for managing were being able to focus on one caller at a time, working in a calm and pleasant environment and having technical support 24/7.

Conclusions: Managers need to enable telenurses to experience control in their work, provided with possibilities to control their work and to recover during work; shortening work time could improve their work environment. Limited possibilities to perform work might contribute to feelings of stress and inability to perform work. 

Keywords
Delphi-study, Nursing, Telenursing, Work environment
National Category
Nursing Work Sciences
Identifiers
urn:nbn:se:hig:diva-24096 (URN)10.1186/s12913-017-2296-y (DOI)000403100900002 ()28521743 (PubMedID)2-s2.0-85019540444 (Scopus ID)
Projects
1177
Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2018-03-13Bibliographically approved
Salzmann-Erikson, M. & Björkman, A. (2017). Mental illness in the population is increasing: a challenge for telephone advice nurses [Letter to the editor]. Journal of social service research, 43(3), 432-432
Open this publication in new window or tab >>Mental illness in the population is increasing: a challenge for telephone advice nurses
2017 (English)In: Journal of social service research, ISSN 0148-8376, E-ISSN 1540-7314, Vol. 43, no 3, p. 432-432Article in journal, Letter (Refereed) Published
Abstract [en]

Mental illness is a term that includes everything from mild symptoms of anxiety and depression to more serious mental illnesses such as schizophrenia, depression, and suicide. Reports indicate a negative trend, where rates of mental illness in the population are increasing, especially among children and adolescents and among the elderly. This negative trend in Swedish society requires not only preventive measures to stem the negative trend but also ongoing community resources to assist, support, and advise people with mental illness who seek care.

Keywords
Mental illness, Telephone advice nursing
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-22899 (URN)10.1080/01488376.2016.1248879 (DOI)000401521700013 ()2-s2.0-85000460122 (Scopus ID)
Projects
Komplext_arbetsliv
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2018-03-13Bibliographically approved
Kaminsky, E., Röing, M., Björkman, A. & Holmström, I. K. (2017). Telephone Nursing in Sweden: a narrative literature review. Nursing and Health Sciences, 19(3), 278-286
Open this publication in new window or tab >>Telephone Nursing in Sweden: a narrative literature review
2017 (English)In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 19, no 3, p. 278-286Article, review/survey (Refereed) Published
Abstract [en]

elephone nursing services are expanding globally. Swedish Healthcare Direct is the largest healthcare provider in Sweden. This paper provides a comprehensive understanding of telephone nursing, as reflected by research on Swedish national telephone nursing, and discusses the findings in relation to international literature. A descriptive, mixed-studies literature review was conducted. Twenty-four articles from January 2003 to April 2015 were identified from PubMed, Scopus, and CINAHL, and included. The issues explored in this study are how telephone nursing is perceived by callers, telephone nurses, and managers, and what characterizes such calls. Callers value reassurance, support, respect and satisfaction and involvement in decisions can increase their adherence. The telephone nurses' perspective focused on problems and ethical dilemmas, communication, the decision support tool, and working tasks. The managers' perspective focused on nursing work goals and malpractice claims. Concerning call characteristics, authentic calls, incident reports, and threats to patient safety were considered. Telephone nursing seems safe, but gender can play a role in calls. Future research on caller access, equity, and efficiency, healthcare cost-effectiveness, distribution, and patient safety is needed.

Keywords
literature review, Sweden nursing, telephone communication, telephone nursing
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-23785 (URN)10.1111/nhs.12349 (DOI)000409188300002 ()28618087 (PubMedID)2-s2.0-85020716526 (Scopus ID)
Available from: 2017-03-21 Created: 2017-03-21 Last updated: 2018-03-13Bibliographically approved
Ernesäter, A., Engström, M., Winblad, U., Rahmqvist, M. & Holmström, I. K. (2016). Telephone nurses' communication and response to callers' concern: a mixed methods study. Applied Nursing Research, 29, 116-121
Open this publication in new window or tab >>Telephone nurses' communication and response to callers' concern: a mixed methods study
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2016 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 29, p. 116-121Article in journal (Refereed) Published
Abstract [en]

Aims

To describe telephone nurses’ and callers’ communication, investigate relationships within the dyad and explore telephone nurses’ direct response to callers’ expressions of concern

Background

Telephone nurses assessing callers’ need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.

Method

RIAS-and content analysis was performed on a criterion sampling of calls (n=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.

Results

Telephone nurses mainly ask close-ended questions, whilst open-ended questions are sparsely used. Relationships between callers’ expressions of Concern and telephone nurses responding with Disapprovalwere found. Telephone nurses mainly responded to concern with close-ended medical questions whilst exploration of callers’ reason for concern was sparse.

Conclusion

Telephone nurses’ reluctance to use open-ended questions and to follow up on callers’ understanding might be a threat to concordance, and a potential threat to patient safety.

Keywords
Telephone advice nursing, Communication, RIAS, triage, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-20603 (URN)10.1016/j.apnr.2015.04.012 (DOI)000370881800022 ()26856500 (PubMedID)2-s2.0-84963576509 (Scopus ID)
Projects
Nationellt samordnad telefonrådgivning utifrån ett patientsäkerhetsperspektiv
Available from: 2015-11-17 Created: 2015-11-17 Last updated: 2018-03-13Bibliographically approved
Ernesäter, A., Engström, M., Winblad, U. & Holmström, I. (2014). A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case–control study. BMJ Open, 4(10), e005961
Open this publication in new window or tab >>A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case–control study
2014 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 10, p. e005961-Article in journal (Refereed) Published
Abstract [en]

Objectives: The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting: In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. Participants: A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Results: Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. Conclusions: The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.

Keywords
telephone advice nursing, patient safety
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-17575 (URN)10.1136/bmjopen-2014-005961 (DOI)000344774500047 ()2-s2.0-84908123198 (Scopus ID)
Projects
Nationellt samordnad telefonrådgivning utifrån ett patientsäkerhetsperspektiv
Available from: 2014-09-21 Created: 2014-09-21 Last updated: 2018-03-13Bibliographically approved
Ernesäter, A., Engström, M., Holmström, I. & Winblad, U. (2014). Comparison of malpractice claimed calls versus “normal calls” within Swedish HealthcareDirect – open-ended questions matters. In: 12thInternational Conference on Communication in Healthcare (ICCH) Amsterdam- theNetherlands, 28 September to 1 October 2014: . Paper presented at 12th International Conference on Communication in Healthcare (ICCH), 28 September to 1 October 2014, Amsterdam, Netherlands.
Open this publication in new window or tab >>Comparison of malpractice claimed calls versus “normal calls” within Swedish HealthcareDirect – open-ended questions matters
2014 (English)In: 12thInternational Conference on Communication in Healthcare (ICCH) Amsterdam- theNetherlands, 28 September to 1 October 2014, 2014Conference paper, Poster (with or without abstract) (Refereed)
Keywords
patient safety, communication
National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-20122 (URN)
Conference
12th International Conference on Communication in Healthcare (ICCH), 28 September to 1 October 2014, Amsterdam, Netherlands
Available from: 2015-08-19 Created: 2015-08-19 Last updated: 2018-03-13Bibliographically approved
Engström, M., Skytt, B., Ernesäter, A., Fläckman, B. & Mamhidir, A.-G. (2013). District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management. Applied Nursing Research, 26(4), 198-203
Open this publication in new window or tab >>District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management
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2013 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 26, no 4, p. 198-203Article in journal (Refereed) Published
Abstract [en]

AIM:

To describe district nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management; and to examine associations between the variables.

BACKGROUND:

Obesity is increasing worldwide and primary care could play a central role in the management.

METHODS:

Questionnaire data were collected from 247 nurses in 33 centres.

RESULTS:

The most common activities performed weekly were; advice about physical activity (40.1%) and general lifestyle advice (34.8%). However, nearly one third seldom/never performed these activities. Approximately half seldom/never performed BMI assessment and even fewer waist circumference (78.1%). Values for the factors Importance of obesity and Personal effectiveness were skewed towards a positive view and Negative view close to neutral. Multivariate analysis revealed that nurses with specialized tasks, longer working experience and higher perceived personal effectiveness performed more clinical activities.

CONCLUSION:

Managers need to make efforts to engage all personnel in obesity management; and strategies to increase self-efficacy are called for.

National Category
Nursing
Identifiers
urn:nbn:se:hig:diva-14996 (URN)10.1016/j.apnr.2013.06.009 (DOI)000327804900008 ()2-s2.0-84887621343 (Scopus ID)
Available from: 2013-08-12 Created: 2013-08-12 Last updated: 2018-03-13Bibliographically approved
Ernesäter, A., Engström, M., Holmström, I. & Winbland, U. (2013). Medical errors within Swedish national telephone advice nursing: what went wrong and why?. In: : . Paper presented at Quality and Saftety in Health Care, London, April 16-19, 2013.
Open this publication in new window or tab >>Medical errors within Swedish national telephone advice nursing: what went wrong and why?
2013 (English)Conference paper, Poster (with or without abstract) (Refereed)
Identifiers
urn:nbn:se:hig:diva-15143 (URN)
Conference
Quality and Saftety in Health Care, London, April 16-19, 2013
Available from: 2013-09-06 Created: 2013-09-06 Last updated: 2018-03-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9513-3102

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