Monitoring calls in telephone advice nursing : parents' and telenurses' experiences

Abstract

Background: Approximately 2 million of the 4.5 million calls made in 2016 to the 1177 healthcare advice line resulted in the telenurse providing self-care advice to the care seeker. In some of these calls, the care seekers were offered the possibility of receiving a monitoring call. In 2016, 275,000 monitoring calls were registered. A monitoring call is defined as when the telenurse monitors and supervises the course of the disease by telephone, i.e., the telenurse calls the care seeker back at regular intervals to follow the course of the disease and adapt the advice based on the care needs at the time of the call. In previous studies, the use of monitoring calls is mentioned as a method for telenurses to assess the need for care. An extended body of knowledge is needed concerning the phenomenon of monitoring calls. The overall aim in this thesis was therefore to increase knowledge of monitoring calls in telephone advice nursing from the perspective of care seekers and telenurses.

Methods: This thesis consists of two studies that illustrate the experience of monitoring calls from different perspectives: those of the care seekers and those of the telenurses. The thesis focuses on the context, which is typical for qualitative research. Two different sets of data were collected using interviews. In study I, ten parents (nine mothers and one father) were interviewed. In study II, 19 telenurses were interviewed. The data were analysed inductively in both studies using qualitative content analysis.

Findings: In study I, four main categories emerged: convenience, confirmation, support and guidance. In study II, the main category was: aiming at patient-safe self-care. The generic categories were focusing on the parent aiming at increasing their feeling of security, focusing on the child for patient safety, learning for parents and telenurses and relieving care. The parents’ sense of security seemed to involve a core sense of being able to care for a sick child at home; security often means feeling safe in a specific situation. Security was seen as fundamental in both study I and study II. The parents’ experienced that the monitoring call provided an opportunity to share their concerns about their child and the telenurses aimed to give the parents a feeling of security by calling them back. The telenurses described that working with a focus on patient safety was a factor in the monitoring call and that the calls contributed to good communication between themselves and the parents. The parents described a feeling of being taken seriously and that they experienced a sense of trust and security. It also seemed that the telenurses used monitoring calls for their own safety by following up on their previous advice and re-evaluating their assessment. Monitoring calls was perceived as a learning opportunity and an opportunity for feedback for both parents and telenurses. Relieving care was one of the aims of performing monitoring calls; the telenurses believed that parents should first try to perform self-care at home before going to a healthcare service. The parents seemed to perceive the monitoring call as a way to save time and it seemed to be more convenient for them to care for their sick child at home. The telenurses experienced, therefore, that by performing monitoring calls they reduced the need for visits to healthcare services.

Conclusions: The results show how people can receive expert self-care advice, support and guidance for care with the help of monitoring calls. Monitoring calls seemed to provide a sense of security for those seeking care and also seemed to increase patient safety. Monitoring calls also provides a learning situation for both parents and telenurses. The use of monitoring calls seems to be a patient-safe form of telephone advice nursing and contributes to sustainable healthcare.