Clinical implications
Delstudie 3 syftade till att beskriva den autentiska kommunikationen mellan telefonsjuksköterskor och uppringare som hade förväntat sig en annan
vård-nivå än den telefonsjuksköterskan rekommenderade samt att undersöka kommunikationen. Resultatet visade hur telefonsjuksköterskorna främst använde slutna frågor och att de sällan följde upp uppringarens förståelse till givna råd. Det fanns även ett statistiskt signifikant samband mellan uppring-arens uttryck och oro och telefonsjuksköterskornas uttryck av kritik samt mellan uttryck av kritik mellan parterna. Delstudie 4 syftade till att beskriva karaktäristika avseende alla Lex Maria anmälda samtal (s.k. anmälningsä-renden) till 1177 inom tidsperioden 2003-2010, beskriva vad Socialstyrel-sens utredning avseende orsak visade, beskriva verksamheternas (1177’s) åtgärder avseende dessa Lex Maria anmälningar samt beskriva den auten-tiska kommunikationen mellan telefonsjuksköterskor och uppringare i dessa fall. Resultatet visade att 13/33 patienter avled samt att 12/33 blev inlagda på intensivvårdsavdelning. Socialstyrelsens utredningar visade att brister i kommunikationen var den vanligaste orsaken till Lex Maria anmälan. Den
vanligaste åtgärden var diskussion i arbetsgrupp samt utbildning av personal.
Kommunikationsanalys visade att det fanns ett statistisk signifikant samband mellan uppringarens uttryck av oro och telefonsjuksköterskans uttryck av förtröstan. Resultatet för delstudien visade även liknande kommunikations-mönster som beskrivits i delstudie 3. Telefonsjuksköterskors kommunikativa strategier är inte samstämmiga med Samtalsprocessen som de utbildas i inom 1177 och detta kan ses som ett potentiellt hot mot patientsäkerheten.
Sammanfattningsvis påvisar denna avhandling vikten av god kommuni-kation inom telefonrådgivning. Utbildning och träning inom kommunikommuni-kation för telefonsjuksköterskor kan bidra till att förbättra deras kommunikativa kompetens och därmed bidra till ökad patientsäkerhet. Genom att anpassa de datoriserade beslutstöden till att uppmuntra användarna att utforska anled-ningen till att uppringaren kontaktat 1177 samt att följa upp förståelsen till givna råd kan öka patientsäkerheten. Vårdgivarna bör också anta ett mer systematiskt angreppssätt i fråga om patientsäkerhetsfrågor samt säkerställa att telefonsjuksköterskorna ges förutsättningar att genomföra sitt arbete på säkrast möjliga sätt.
Acknowledgements
This work was carried out at the Department of Public Health and Caring Sciences at Uppsala University, and was financed by the Swedish Research Council; AFA; the Faculty of Medicine at Uppsala University; and the Uni-versity of Gävle.
Writing a thesis is not a one man’s (or woman’s) work but rather constitutes a journey of several years with the help of many people. I am deeply grateful to everyone who has helped me during these years. I particularly want to express my gratitude to the following people:
To all participants and managers in charge who participated and contributed material to the study: thank you for your support and co-operation.
Professor Inger Holmström, my main supervisor, for giving me the oppor-tunity to make this academic journey, and for believing in me and guiding me through these years. Your outstanding scientific knowledge and con-structive criticism have kept me on track and moved my thinking forward.
Your supervision has not only encouraged my independence but also taught me a lot, about scientific research as well as about myself, and I am truly grateful for this.
Associate Professor Ulrika Winblad, my co-supervisor, for your excellent scientific guidance and for always being full of energy and creative ideas.
Thank you for all our discussions and for contributing by casting new eyes on the material, seeing things in other ways and encouraging me to do so as well.
Associate Professor Maria Engström, my co-supervisor, always thoughtful and thorough. You have an unbeatable eye for clear structures as well as details. I have learned so much from you, and would like to express my deepest thanks to you for all your questions and for helping me see things in other ways. Your approach to supervision has improved my self-esteem and encouraged my independence.
To all former and present members of the Health Services Research Group (Mio Fredriksson, Roya Hakimnia, Elenor Kaminsky, Ragnar Stolt, David
Isaksson, Marta Roing, Jan Larsson, Finn Hjemblink, Urban Rosenqvist, Caroline Andersson, Linda Moberg, Madeleine Boll and Margareta Sanner).
Thank you for contributing to my work and for creating a friendly and crea-tive research atmosphere. Not to be forgotten is Helène Eriksson, for keeping everything together.
To “Maria’s” doctoral group at the University of Gävle (Annakarin Olsson, Heidi Hagerman, Ann-Sofi Östlund, Kerstin Stake-Nilsson and Eva Dahlqvist): thank you for the creative discussions, ideas and friendship.
Annakarin Olsson, fellow PhD student and workmate, thank you for always being there for me, supporting and encouraging me when I needed it. You are a true friend.
Thanks to all my colleagues at the Faculty of Health and Occupational Stud-ies at the University of Gävle, senior researchers and fellow doctoral stu-dents, for all your support during these years.
To Karen Williams and Judith Rinker Öhman, for excellent proof-reading of my articles and thesis.
To my parents, my father Tommy, mother Gunbritt and stepfather Christer, thank you for your encouragement and support, for always believing in me.
To my wonderful family, Mikael, Robin and Maja, thanks for always being there and reminding me of the world outside research. I love you so much.
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