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  • 1.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Andersson, Kajsa
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Bergström, Jenny
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Increased Mental Illness and the Challenges This Brings for District Nurses in Primary Care Settings2018In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 39, no 12, p. 1023-1030Article in journal (Refereed)
    Abstract [en]

    Patients with mental illness generally make their initial healthcare contact via a registered nurse. Although studies show that encountering and providing care to care-seekers with mental illness might be a challenge, little research exists regarding Primary Care Nurses' (PCN) view of the challenges they face. The aim of this study was to qualitatively explore PCNs' reflections on encountering care-seekers with mental illness in primary healthcare settings. The results consist of three themes: constantly experiencing patients falling through the cracks, being restricted by lack of knowledge and resources, and establishing a trustful relationship to overcome taboo, shame, and guilt.

  • 2.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Nursing Department, Medicine and Health College, Lishui University, Lishui, China .
    Olsson, Annakarin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Wahlberg, Anna Carin
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Identified obstacles and prerequisites in telenurses’ work environment: a modified Delphi study2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, no 1, article id 357Article in journal (Refereed)
    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. 

  • 3.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Giving advice to callers with mental illness: adaptation among telenurses at Swedish Healthcare Direct2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1633174Article in journal (Refereed)
    Abstract [en]

    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.

  • 4.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    The bidirectional mistrust - callers’ online discussions about their experiences of using the national telephone advice service2018In: Internet Research, ISSN 1066-2243, Vol. 28, no 5, p. 1336-1350Article in journal (Refereed)
    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.

  • 5.
    Björkman, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Salzmann-Erikson, Martin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    When all other doors are closed: Telenurses' experiences of encountering care seekers with mental illnesses.2018In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 5, p. 1392-1400Article in journal (Refereed)
    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.

  • 6.
    Chen, Jian Hua
    et al.
    Department of Nursing, Medicine and Health College, Lishui University, Lishui, Zhejiang Province, China.
    Björkman, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Zou, Ji Hua
    Department of Nursing, Medicine and Health College, Lishui University, Lishui, Zhejiang Province, China.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Self–regulated learning ability, metacognitive ability, and general selfefficacy in a sample of nursing students: A cross-sectional and correlational study2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 37, p. 15-21Article in journal (Refereed)
    Abstract [en]

    The healthcare sector is fast-growing and knowledge-intensive, and to meet the demands associated with it, nursing students must have high levels of self-regulated learning (SRL), metacognition, and general self-efficacy (GSE). In this cross-sectional, correlational study, data were collected from 216 nursing students through a questionnaire. The aims were: 1) to describe the levels of SRL ability, metacognitive ability and GSE among second- and third-year nursing students; 2) to explore the relationships between the SRL ability, metacognitive ability and GSE of second- and third-year nursing students; 3) and to compare SRL ability, metacognitive ability and GSE between second- and third-year nursing students. Nursing students had moderate levels of SRL ability and metacognitive ability, but lower levels of GSE. Positive relationships between SRL ability, metacognitive ability, and GSE were observed. Third-year nursing students had a higher level of SRL ability but lower levels of GSE, compared to second-year students. In terms of metacognitive ability, no significant differences were observed between the student batches. Interventions are required for the improvement of nursing students’ SRL ability, metacognitive ability, and GSE.

  • 7.
    Engström, Maria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Ernesäter, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Fläckman, Birgitta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Mamhidir, Anna-Greta
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    District nurses' self-reported clinical activities, beliefs about and attitudes towards obesity management2013In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 26, no 4, p. 198-203Article in journal (Refereed)
    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.

  • 8.
    Ernesäter, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    National telephone advice nursing in Sweden: patient safety and communication2012Doctoral thesis, comprehensive summary (Other academic)
  • 9.
    Ernesäter, Annica
    Uppsala Universitet, inst. för folkhälso- och vårdvetenskap, .
    Telenurses' experiences of working with computerized decision support: How do we handle the content in Qualitative Content Analysis?2008In: The 5th Nordic Interdisciplinary Conference on Qualitative Methods in the Service of Health, 2008Conference paper (Refereed)
  • 10.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?2012In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, no 7, p. 379-383Article in journal (Refereed)
  • 11.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Holmström, Inger
    Mälardalens Högskola.
    Winblad, Ulria
    Uppsala Universiet.
    Identification of incident reporting within nurse-led national telephone triage in Sweden2010Conference paper (Refereed)
  • 12.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Holmström, Inger
    Winblad, Ulrika
    Comparison of malpractice claimed calls versus “normal calls” within Swedish HealthcareDirect – open-ended questions matters2014In: 12thInternational Conference on Communication in Healthcare (ICCH) Amsterdam- theNetherlands, 28 September to 1 October 2014, 2014Conference paper (Refereed)
  • 13.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Holmström, Inger
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Incident reporting in nurse-led national telephone triage in Sweden: The reported errors reveal a pattern that needs to be broken2010In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 16, no 5, p. 243-247Article in journal (Refereed)
    Abstract [en]

    We conducted a retrospective study of incident reports concerning the national, nurse-led telephone triage system in Sweden. The Swedish Health Care Direct organization (SHD) is staffed by registered nurses who act as telenurses and triage the callers' need for care, using a computerized decision support system. Data were collected during 2007 from all county councils that participated in the SHD and were analysed using content analysis. Incident reports were then compared concerning differences in reported categories and who reported the errors. The 426 incident reports included 452 errors. Of the analysed incident reports, 41% concerned accessibility problems, 25% incorrect assessment, 15% routines/guidelines, 13% technical problems and 6% information and communication. The most frequent outgoing incident reports (i.e. sent from SHD to other health-care providers) concerned accessibility problems and the most frequently incoming reports (i.e. sent to SHD from other health-care providers) concerned incorrect assessment. There was a significant difference (P < 0.001) between outgoing and incoming reports regarding the main category. Telenurses have limited possibilities for referring the caller to their primary health-care provider or specialist, which may cause them to over-triage or under-triage the callers' need for care. This over-triage or under-triage may in turn cause other health-care providers to report incorrect assessment to SHD. The implications for practice are that poor accessibility is a matter that should be addressed and that the reasons for incorrect assessment should be explored.

  • 14.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Holmström, Inger
    Mälardalens Högskola.
    Winbland, Ulrika
    Uppsala Universitet.
    Medical errors within Swedish national telephone advice nursing: what went wrong and why?2013Conference paper (Refereed)
  • 15.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Winblad Spångberg, Ulrika
    Uppsala universitet, Vårdvetenskap.
    Rahmqvist, M
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning.
    Communication challenges in Swedish telephone advice nursing: analysis of actual calls2011Manuscript (preprint) (Other academic)
  • 16.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science. Uppsala universitet.
    Winblad, Ulrika
    Uppsala universitet.
    Holmström, Inger
    Mälardalens Högskola, Uppsala universitet.
    A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish Healthcare Direct: a case–control study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 10, p. e005961-Article in journal (Refereed)
    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.

  • 17.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Nursing science.
    Winblad, Ulrika
    Uppsala Universitet.
    Holmström, Inger
    Örebro Universitet.
    Communication analysis of all malpractice claimed telephone calls to Swedish Health care Direct (SHD) during 2003-20112012In: / [ed] Kate Sampson, 2012Conference paper (Refereed)
  • 18.
    Ernesäter, Annica
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Winblad, Ulrika
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rahmqvist, Mikael
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Holmström, Inger K.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden .
    Telephone nurses' communication and response to callers' concern: a mixed methods study2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 29, p. 116-121Article in journal (Refereed)
    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.

  • 19.
    Ernesäter, Annica
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Holmström, Inger
    Folkhälso- och vårdvetenskap Uppsala Universitet.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Computerized decision support systems in telenursing: how it is perceived by telenurses2009In: Med-e-Tel 2009: proceedings, 2009, p. 409-410Conference paper (Refereed)
    Abstract [en]

    Telephone advice nursing (telenursing) is an expanding service in many Western countries and in recent year’s centralization of telenursing services has occurred in some countries. Telenursing is a complex and knowledge intensive health service were registered nurses (RN’s) individually triage callers need for further care, give self care advice or refer the caller to appropriate care giver. These telenurses have numerous patient encounters every day, regarding all ages of callers and questions presented to the telenurses addresses a broad variation of medical conditions.  

    Telenursing has shown to be appreciated by the population as well as cost efficient.

     In an attempt to ensure quality and safety within telenursing the use of computerized decision support systems (CDSS) increased since CDSS enables uniformity and consistency of advices given to callers.   

    Traditionally, telenurses have relied on clinical knowledge, collegial support and books when triaging callers and few studies describe how telenurses perceive CDSS in their daily work.

    Eight telenurses from three different telephone advice call centres, all using CDSS took part in semi-structured interviews in 2006. Data were analysed using qualitative content analysis.

    The aim of the study was to describe telenurses experiences of working with CDSS. Telenurses described that the CDSS had both positive and negative influences of their work. They described that the CDSS simplified their work, complemented their knowledge and gave them a sense of security. They also described how the CDSS contributed to quality improvement of telenursing. The negative aspects of the CDSS were described as being inhibited by the system. Telenurses described how they perceived the system as partly incomplete and controlling and that they sometimes disagreed with the measures presented by the system.

    These advantages and disadvantages perceived within the system can be connected to the concepts of usability: user-worthiness and user-friendliness. Software should be easy to learn, contain few errors and be easy to orient in, to enhance usability. Hence usability could be further improved in the present system.

    There might be a risk that the CDSS will mechanize and undermine the communication between callers and telenurses. It is important, in order to increase the telenurses’ professional competence and the feeling of tele-presence that callers not only are given a correct estimation of their conditions but also a sense of security and confirmation. Otherwise callers may seek emergency care solely because of insecurity and anxiety.

  • 20.
    Ernesäter, Annica
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Holmström, Inger
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Telenurses' experiences of working with computerized decision support: Supporting, inhibiting and quality improving2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 5, p. 1074-1083Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study conducted to describe telenurses' experiences of working with computerized decision support systems and how such systems could influence their work. Background. Telenursing is an expanding service in many Western countries, and in recent years centralization of telenursing services has occurred in Sweden. In connection with this, the use of computerized decision support has increased. Method. Eight Registered Nurses from three telephone advice call centres in Sweden who were using computerized decision support took part in semi-structured interviews in 2006. The data were analysed using qualitative content analysis. Findings. The findings are presented as one theme and three categories. Telenurses experienced their work with a decision support system as supporting, inhibiting and quality improving. Based on two of the categories -'supporting' and 'inhibiting'- a theme was revealed: being strengthened, but simultaneously controlled and inhibited. This theme represents the individual level. The telenurses found that the decision support system simplified their work, complemented their knowledge, gave them security and enhanced their credibility. They also described experiencing the system as incomplete, sometimes in conflict with their own opinions and controlling. The third category referred to the organizational level: the decision support system ensured the quality of telenursing. Conclusions. Although the telenurses experienced computerized decision support as both supporting and inhibiting, they preferred working with it. They also described how a computerized decision support system cannot replace telenurses'knowledge and competence, and that it should be considered as complementary.

  • 21.
    Holmberg, Jörgen
    et al.
    University of Gävle, Faculty of Education and Business Studies, Department of Educational sciences, Educational science, Curriculum studies.
    Masoumi, Davoud
    University of Gävle, Faculty of Education and Business Studies, Department of Educational sciences, Educational science, Curriculum studies.
    Elm, Annika
    University of Gävle, Faculty of Education and Business Studies, Department of Educational sciences, Educational science, Curriculum studies.
    Fransson, Göran
    University of Gävle, Faculty of Education and Business Studies, Department of Educational sciences, Educational science, Curriculum studies.
    Westelius, Claes
    University of Gävle, Faculty of Education and Business Studies, Department of Educational sciences, Educational science, Curriculum studies.
    Björkman, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Stake-Nilsson, Kerstin
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Toratti-Lindgren, Monique
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Teachers’ and students’ understanding and use of ICT for teaching and learning – Combining different perspectives and methodologies in research on technology-enhanced learning2017Conference paper (Refereed)
    Abstract [en]

    More than half of the 14,000 students currently studying at the University of Gävle (HiG) are enrolled in courses that are totally or partly online based.  In 2015, a university-wide project on technology enhanced learning (TEL) (Steffens et al 2015) was initiated. The project focuses on course and programme development and is divided into four sub-projects, all of which contribute to the overall goals of project.

    AIMS of the project

    The aims of the project are to: (a) restructure teaching facilities and integrate digital technologies, (b) develop technology supported teaching methods, (c) integrate campus and distance education, (d) enhance teachers' and students' digital skills and (f) increase collaboration with relevant external actors.

    These aims are achieved through the work of four project groups.

    The digital environment group's (1) main focus is on digital tools for learning and the physical arrangement of learning spaces. The collaboration group's (2) main focus is on the maintenance and development of collaborative relationships and connections with communities in higher education for e-learning. The education and professional development group (3) focuses on issues such as professional development, learning design and the implementation of ICT in different courses and subjects. The research group (4) focuses on different issues connected to TEL.

    One of the main principles of the project is that the above areas are interlinked and interdependent and that the different experiences and skills of each group and its members contribute to a broader perspective of TEL.

    This poster focuses on the research conducted by the project's research group. Taking a multidisciplinary approach, the research focuses on issues and aspects of teaching and learning in higher education that contribute to multifaceted knowledge. The overall aim of the research is to generate knowledge about how conditions for teaching and learning change when the use of technology increases. The four research studies that are initiated are described below.

    Study 1: Lecturers’ and students’ agency in encounters with digital media in higher education

    This research study focus on issues related to lecturers’ digital teaching practices and students’ digital technological use in their everyday lives and for learning purposes.

    Digital practices are defined as the different contexts in which lecturers teach and students participate in digital media (such as learning management systems, forums, communities etc.). Previous research shows that students’ own digital practices are not always made use of in higher education (Buzzard et al., 2011; Kelm, 2011).

    A controversial issue in the Swedish higher education context is the discourse on students as customers. The perception of students as customers and “buyers” of ready-packaged content from lecturers is problematic. This view of what higher education stands for clashes with traditional academic views emphasizing critical thinking, reflection, self-directed learning, collaborative and individual learning etc.

    In this study, the concept of agency is important in that it reflects “the capacity of actors to critically shape their own responsiveness to problematic situations” (Emirbayer & Mische, 1998, p. 971). In the different perceptions of students’ and lecturers’ tasks and roles in teaching and learning, especially in TEL, all the actors have to display agency in order to manoeuvre in the educational and digital contexts. Notably, agency is not something that people have, but is something that people achieve (Biesta & Tedder, 2006).

    Aim

    The aim of the research project is to study: (a) students’ use of digital technology in their everyday practices and in relation to teaching situations and (b) how lecturers’ agency is played out in teaching and learning when trying to facilitate TEL.

    Methodology

    In spring 2017 an online survey involving up to 200 students will be conducted in order to generate knowledge about (a) students’ everyday experiences of digital practices and how these are utilized in higher education and (b) how higher education challenges and develops students’ digital skills and knowledge. In the same period, interviews with lecturers at the university will be conducted in order to generate knowledge about lecturers’ (c) everyday teaching practices with digital technologies and (d) the perceived challenges and development of teaching in relation to their use.

    Study 2: Teachers’ understanding and enactment of practice in online and blended educational contexts

    The knowledge that teachers need to develop is referred to as a ‘didaktik’ knowledge in the German/European tradition (cf. Kansanen 2009) and as pedagogical content knowledge (PCK) in the Anglo-Saxon literature (Shulman 1986; 1987). However, in what Castells (2011) describes as a network society, teachers are faced with new challenges and opportunities. Koehler et al (2014) argue that teachers’ development and integration of a new knowledge domain is not simply a matter of adding this “technology knowledge” to existing knowledge, but involves a reframing and reconceptualization of their existing professional practices and knowledge. They refer to this amalgam knowledge as technological pedagogical content knowledge (TPACK). The TPACK framework has been widely accepted as a useful theoretical construct. However, there is a need for research on the development and manifestation of TPACK in different disciplinary contexts (Koehler et al 2014).

    Aim

    The aim of this sub-project is to study: a) how teachers reframe and reconceptualize their practices and the kind of knowledge that is needed in online contexts b) how teachers practices are manifested when ICT is used to create (intended) added pedagogical values in educational designs c) the characteristics of educational designs regarded as adding pedagogical value

    Methodology

    Three higher education teachers of different courses and subjects in three different departments participate in the study. A design-based research approach is applied, where one of the participating researchers engages in so-called design conversations with the teachers. As is characteristic of DBR, this researcher does not only observe and interview, but also acts as a “co-designer” on the understanding that the teachers are the context experts and the final decision makers (McKenney & Reeves 2012; Plomp & Nieveen 2013).

    The data consists of recorded design conversations, educational designs and the artefacts used in the educational designs, the researcher’s/co-designer’s field notes and recorded “field-note conversations” between the researcher/co-designer and the other researcher.

    Expected outcomes

    The study is expected to contribute knowledge about how teachers’ knowledge and practices are understood and manifested in online and mixed higher educational contexts.

    Study 3: Researching and developing student nurses’ drug calculation skills in an explorative design comprising digital technologies

    This study is partly experimental in nature. It focuses on the challenges involved in student nurses’ development of accurate drug calculation skills. Challenges like this are not specific to nurse education at the University of Gävle, but appear to be universal (cf. Wright, 2009). However, it has also been claimed that written drug calculation tests do not accurately evaluate the skills involved in drug calculation, in that they are decontextualized from healthcare settings (Wright, 2005; 2012). It has also been claimed that this problem is more imaginary than factual, given that in practice nurses have been shown to handle drug calculation well (Wright, 2009).

    Aim

    The aims of this sub-project are to: (a) deepen the understanding of the challenges and mistakes that student nurses make in drug calculation exams, why they occur and how they might be prevented, (b) explore how the teaching and examination of drug calculation can be made more effective and contextualized and whether digital technologies can help in this.

    Methodology

    A multiple design method is employed using empirical data from written examinations, analyses of the set tasks and interviews with student nurses.

    Expected outcomes

    It is expected that the study will contribute knowledge about why (some) student nurses find it difficult to pass exams and that sufficient knowledge will be developed to facilitate the exploration of an experimental design for teaching and learning that includes digital technologies.

    Study 4: Situating ICT in teacher education programmes at the University of Gävle

    Integrating ICT as an integral part of teacher education programmes has been addressed as the most significant factor in determining the future level of ICT use in teaching and learning practices (Davis, 2010). According to the Swedish Higher Education Act, ICT should be embedded across entire educational practices in teacher education programmes (Government Bill, 2009/10:89). Numerous teacher educationprogrammes have made extensive efforts to prepare and empower teacher education students’ ICT competences so that ICT-based technologies are seamlessly woven into the teaching and learning process. Most schools try to enhance teachers’ digital competences by in-service education and expect newly qualified teachers to be adequately trained to use digital technologies in their educational practices. However, in reality it would seem that many newly qualified teachers do not have the necessary skills for this (see Chigona, 2015; Koehler, Mishra, Akcaoglu, & Rosenberg, 2013). 

    Aims

    This study focuses on understanding why a large number of the newly qualified teachers in teacher education institution remain underprepared to use digital technologies in their educational practices, despite an increased investment in the provision of digital technologies in these institutions.

     Methodology

    In order to explore how digital technologies are integrated into teacher education in higher education institutions, a sequential explanatory multiple sources design consisting of two distinct phases will be implemented (Creswell, 2012). In this design, a number of course syllabi in a programme will be analyzed. Interviews with key actors, including students, teacher educators and gatekeepers, will be conducted in order to contextualize and deepen the analysis of the syllabi.

    Expected outcomes

    The study is expected to deepen the understanding of how student teachers are pedagogically trained in ICT in teacher education institutions.

    Concluding remarks

    The four research studies in the project investigate how students and teachers understand and use educational ICT. This is done by using different methodologies and from different perspectives. It is expected that the research studies will contribute to the broader and more inclusive project perspective by their specific aims and generate knowledge that will contribute to the multifaceted field of TEL.

    References

    1. Biesta, G. & Tedder, M. (2006). How is agency possible? Towards an ecological understanding of agency-as-achievement. Working paper 5, Learning Lives: Learning, Identity and Agency in the Life Course, University of Exeter, England.
    2. Buzzard, C., Crittenden, V.L., Crittenden, W.F. & McCarty, P. (2011). The Use of Digital Technologies in the Classroom: A Teaching and Learning Perspective. Journal of Marketing Education. 33 (2), 131-139.
    3. Buzzard, C., Crittenden, V.L., Crittenden, W.F. & McCarty, P. (2011). The Use of Digital Technologies in the Classroom: A Teaching and Learning Perspective. Journal of Marketing Education. 33 (2), 131-139.
    4. Castells, M. (2011) The Rise of the Network Society: The Information Age: Economy, Society, and Culture, 2nd edn (Vol. 1). Malden, MA: John Wiley & Sons. 
    5. Chigona, A. (2015). Pedagogical shift in the twenty-first century: Preparing teachers to teach with new technologies. Africa Education Review, 12(3), 478-492. doi:10.1080/18146627.2015.1110912
    6. Davis, N. (2010). Technology in Preservice Teacher Education. In P. Editors-in-Chief:  Penelope, B. Eva, E. B. Barry McGawA2 - Editors-in-Chief:  Penelope Peterson, & M. Barry (Eds.), International Encyclopedia of Education (Third Edition) (pp. 217-221). Oxford: Elsevier.
    7. Emirbayer, M., & Mische, A. (1998). What is agency? American Journal of Sociology, 103(4), 962-1023.
    8. Kansanen, P. (2009). The curious affair of pedagogical content knowledge. Orbis Scholae, 3(2), 5-18.
    9. Kelm, R. (2011). Social Media. It’s what students do. Business Communication Quarterly. 74, (4), 505-520.
    10. Koehler, M. J., Mishra, P., Akcaoglu, M., & Rosenberg, J. (2013). The technological pedagogical content knowledge framework for teachers and teacher educators. In R. Thyagarajan (Ed.), ICT integrated teacher education: A resource book. New Delhi, India: CEMCA.
    11. Koehler, M. J., Mishra, P., Kereluik, K., Shin, T. S., & Graham, C. R. (2014). The technological pedagogical content knowledge framework. In J.M. Spector, M.D. Merrill, J. Elen, & M.J. Bishop (Eds.), Handbook of research on educational communications and technology (pp. 101-111). Springer New York.
    12. McKenney, S., & Reeves, T. C. (2012). Conducting educational design research. London: Routledge.  
    13. Plomp, T. & Nieveen, N. (Eds.). (2013) Educational Design Research: Introduction and Illustrative Cases.  Enschede, Netherlands; SLO Netherlands Institute for Curriculum Development.
    14. Regeringens proposition, (2009/10:89) Regeringens proposition 2009/10:89 om lärarutbildning m.m. [Government Bill, 2009/10:89 regarding teacher education etc.]  (Stockholm, Gotab) (in Swedish).
    15. Shulman, L. S. (1986). Those who understand: Knowledge growth in teaching. Educational Researcher, 15, 4–14.
    16. Shulman, L. S. (1987). Knowledge and teaching: Foundations of the new reform. Harvard Educational Review, 57, 1–22.  
    17. Steffens, K., Bannan, B., Dalgarno, B., Bartolomé, A. R., Esteve-González, V., & Cela-Ranilla, J. M. (2015). Recent Developments in Technology- Enhanced Learning: A Critical Assessment. RUSC. Universities and Knowledge Society Journal, 12(2). pp. 73-86.
    18. Wright, K. (2005). An exploration into the most effective way to teach drug calculation skills to nursing students. Nurse Education Today, 25, 430–436. 
    19. Wright, K. (2009). The assessment and development of drug calculation skills in nurse education – A critical debate. Nurse Education Today, 29, 544–548. Doi: 10.1016/j.nedt.2008.08.019 
    20. Wright, K. (2012). Editorial. Drug calculation skills – Are we running scared? Nurse Education Today, *. Doi: 10.1016/j.nedt.2011.06.001 
  • 22.
    Kaminsky, Elenor
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Röing, Marta
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Björkman, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala.
    Holmström, Inger K.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Telephone Nursing in Sweden: a narrative literature review2017In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 19, no 3, p. 278-286Article, review/survey (Refereed)
    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.

  • 23.
    Rahmqvist, Mikael
    et al.
    Linköpings Universitet.
    Ernesäter, Annica
    Uppsala universitet.
    Holmström, Inger
    Uppsala universitet.
    Triage and patient satisfaction among callers in Swedish computer supported telephone advice nursing2011In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 17, no 7, p. 397-402Article in journal (Refereed)
  • 24.
    Salzmann-Erikson, Martin
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Björkman, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science.
    Mental illness in the population is increasing: a challenge for telephone advice nurses2017In: Journal of social service research, ISSN 0148-8376, E-ISSN 1540-7314, Vol. 43, no 3, p. 432-432Article in journal (Refereed)
    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.

  • 25.
    Wahlberg, Anna Carin
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Björkman, Annica
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Expert in nursing care but sometimes disrespected-Telenurses' reflections on their work environment and nursing care2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 21/22, p. 4203-4211Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe telenurses' reflections on their work environment and how it impacts on their nursing care.

    BACKGROUND: Telenursing is one of the largest healthcare settings in Sweden today; approximately 5.5 million care-seekers call the designated number-1177-each year. Telenursing is regarded as highly qualified nursing care, and providing care over the telephone is considered a complex form of nursing. Within other fields of nursing, the work environment has been shown to affect the outcome of care, patient safety, nurse job satisfaction and burnout.

    DESIGN: The study used a descriptive design and followed the COREQ checklist.

    METHODS: Twenty-four interviews were performed and analysed using qualitative content analysis.

    RESULTS: The main theme concerned "feeling like a nursing care expert but sometimes being disrespected." The telenurses reported that their work environment supported their work as nursing care experts via the telephone in some respects, but also hindered them. Appreciation and respect they received from the vast majority of callers positively impacted the work environment and contributed to work satisfaction. However, they also felt disrespected by both their employers and healthcare staff; they sometimes felt like a dumping ground. Receiving support from colleagues seemed invaluable in helping them feel like and be a nursing care expert.

    CONCLUSION: Work was perceived as cognitively demanding and sometimes exhausting, but appreciation from care-seekers and the feeling of being able to provide qualified nursing care made working as a telenurse worthwhile.

    RELEVANCE TO CLINICAL PRACTICE: If telenurses are to perform good nursing care over the telephone, managers must provide them with resources, for example, support, education and opportunities for recovery during shifts. It seems that the role of the 1177 service has not been properly implemented and accepted within the healthcare system, and politicians need to anchor its mission within the healthcare organisation.

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