Registered Nurses´ Views on Telephone Nursing for Patients with Respiratory Tract Infections in Primary Health Care – Everyday Challenges and Insufficient Support

Abstract

Background: Triage by registered nurses (RN) during office hours may be of great importance for the prescription of antibiotics according to guidelines. This, however, has hardly ever been the focus of scientific study. The aim of this study was to describe RNs' views on telephone consulting work with patients calling primary health care centers for respiratory tract infections.Methods: A descriptive and qualitative study was performed through interviews with twelve RNs in Sweden. Results: The RNs saw their daily work as a continuous challenge and reported that support structures were insufficient. The themes challenge and support were built on five categories. These were: the triage, assessment over the phone and to manage expectations, evidence-based knowledge and professional collaboration. The RN had to differentiate urgent cases from self-care advice, with a fear of maybe missing something serious. They described the difficulties in assessing both the symptoms and the person calling, relying only on what they were told, as well as managing patients’ expectations with special reference to patients with other cultural backgrounds. The RN described insufficient possibilities to keep up with an evidence-based knowledge, where decision support and guidelines were only partly known and used, while continuous medical education was not prioritized. Furthermore, professional collaboration was described as unstructured.Conclusions: The telephone triage in primary care health centres regarding common problems seems to be an invisible task, both for researchers, policy makers and the RNs themselves. The consequences may be decreased patient safety, occupational stress, and an increased workload for the RNs. Systematic work is needed to strengthen the different support structures.