Educating Swedish telenurses to improve caller experience: Reflections on a pilot study

Abstract

Telenurses employed at Swedish Healthcare Direct offer triage recommendations and self-care advice to the general public over the telephone on a wide range of health problems. Their understanding of work and ability to communicate are essential for callers' adherence to recommendations and satisfaction with the service. This paper presents and reflects upon an educational intervention for Swedish telenurses which aimed to improve caller experience. Twelve telenurses participated. Six were randomised to an intervention group, the other six to a reference group. The nurses in the intervention group individually listened to, and reflected on their authentic calls together with one of the researchers on five to six separate occasions. Callers' experiences were surveyed using a postal questionnaire sent within 48 hours of their call, both before and after the intervention. Descriptive and comparative statistics as well as content analysis were used in the analysis of the questionnaires. The most striking finding was that the educational intervention did not seem to have any effect on outcomes of the telenurses calls. Other findings revealed that a large group of callers, about 20%, did not find the call useful and only 50% to 60% of the callers reported that they had learned something from the call. Callers' most frequent unfulfilled expectations centred on not being referred to a physician, and a perceived low level of competence among telenurses. The modest impact of the intervention on the services of telenursing may have been due to the participating nurses, the organisation, or the design of the intervention. Lessons have been learned that need to be taken into account in future and more large scale studies.

Telephone nursing in Sweden: A narrative literature review

“…The findings are a narrative description of the results of the included papers, and are presented in the order of the study research questions, as follows: (i) how TN is perceived by callers; (ii) how TN is perceived by telephone nurses and managers; and (iii) what characterizes calls. The results of one article (Holmström et al ) were applicable to two research questions, and are thus presented under two subheadings. Most studies had a descriptive or exploratory design, and a qualitative approach.…”

“…SHD could also be a source of learning for callers (Kaminsky et al ). However, in a quasi‐experimental study, Holmström et al () tested an educational intervention for RNs that promoted caller learning. Before the intervention, 57.7% of the callers in the reference group and 53.8% in the intervention group reported learning from their call.…”

“…Callers who received a lower recommendation of care than expected made a significantly lower rating on three questions concerning the nurse–caller encounter compared to the controls ( P = 0.030, P = 0.021, and P = 0.023). Callers' most frequent unfulfilled expectation, according to Holmström et al (), was to not have been referred to a physician (93/404 callers).…”

“…Holmström et al () tested and evaluated an educational intervention for telephone nurses to improve their pedagogic competence. The intervention was based on reflective practice and theories of professional competence development.…”