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

ABSTRACT

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.

KEYWORDS:

• Complexity
• nurses
• organizations
• qualitative
• telemedicine

Abbrivations

CDSS	=	Computerized decision support system
CHAOS	=	The Chaotic And Complex Work Life of Staff in the Healthcare System
HCP	=	Healthcare provider
SHD	=	Swedish Healthcare Direct
TAN	=	Telephone advice nursing

Acknowledgments

We are grateful to the participating telenurses for sharing their time and experiences. We would also like to thank Lisa Arvidsson, MSc, for attentive and thorough data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and supporting materials

Please contact the corresponding author for data requests.

Authors’ contributions

• Conception or design of the work – AB and MSE

• Data collection – research assistant with guidance from AB and MSE

• Data analysis and interpretation – AB and MSE

• Drafting the article – AB and MSE

• Critical revision of the article – AB and MSE

• Final approval of the version to be published – AB and MSE

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical approval was obtained from the Regional Ethical Review Board in Uppsala (ref: CLOAKED UNDER DOUBLE-BLIND REVIEW). All participants received verbal and written information about the study, and provided their signed informed consent.

Additional information

Funding

This study was funded by the Faculty of Health and Occupational Studies at the University of Gavle.

Notes on contributors

Annica Björkman

Annica Björkman, is a registered nurse specialized in primary health care in addition to holding a Pd.D. in medicine with the speciality in health care science. Her current research investigates telephone advice nurses work environment. Identifying important preconditions and obstacles within the telephone nurses work environment might lead to improved patient safety within this expanding part of health care.

Martin Salzmann-Erikson

Martin Salzmann-Erikson is a registered nurse specialized in psychiatric care in addition to holding a PhD in medicine with the specialty in health and caring science and also holding the position as an associate professor. He has published more than 60 peer-reviewed papers in international peer-reviewed journals and published two book chapters for nursing students on basic and advanced level. He has also published popular science articles, contributed to national and international conferences, and held lectures and symposia.