Phone triage nurses' assessment of respiratory tract infections - the tightrope walk between gatekeeping and service providing. A qualitative study.

Publisher: Taylor & Francis Country of Publication: United States NLM ID: 8510679 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1502-7724 (Electronic) Linking ISSN: 02813432 NLM ISO Abbreviation: Scand J Prim Health Care Subsets: MEDLINE

Publication: Philadelphia, PA : Taylor & Francis
Original Publication: Stockholm, Sweden : Almqvist & Wiksell Periodical Co., [1983-

Nurses* ; Respiratory Tract Infections*/diagnosis; Female ; Gatekeeping ; Humans ; Male ; Telephone ; Triage

Background: Phone nurses triage callers to Norwegian out-of-hours cooperatives to estimate the appropriate urgency and level of care for the caller. Many callers with mild symptoms of respiratory tract infections receive a doctor's consultation, which may lead to busy sessions and in turn impair clinical decisions.
Objective: This study explores how phone triage nurses assess callers with mild-to-moderate symptoms of respiratory tract infections and their views and experiences on triaging and counselling these callers.
Methods: We conducted four focus groups with 22 nurses (five men and 17 women aged 24-66 years) in three different locations in Norway. The interviews were transcribed verbatim and analysed by systematic text condensation.
Results: The informants were reluctant to call themselves gatekeepers. However, their description of their work indicates that they practice such a role. When nurses and callers disagreed about the right level of care, the informants sought consensus through strategies and negotiations. The informants described external factors such as organisational or financial issues as decisive for the population's use of out-of-hours services. They also described callers' characteristics, such as language deficiency and poor ability to describe symptoms, as determining their own clinical assessments.
Conclusions: Nurses perceive assessments of callers with respiratory tract infections as challenging. They need skills and time to reach a consensus with the callers and guide them to the right level of health care. This should be considered when planning nurse training and staffing of out-of-hours cooperatives.KEY-POINTSPhone triage nurses assess callers to the out-of-hours service and estimate the level of urgencyThis study explores how phone triage nurses assess callers with respiratory tract infections and their views and experiences on this taskThe nurses describe their professional role as a tightrope walk between gatekeeping and service providingThe nurses seek consensus with callers through strategies and negotiations.

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Keywords: Out-of-hours; nurses’ role; phone triage; primary health care; qualitative research; respiratory tract infections

Date Created: 20210401 Date Completed: 20210818 Latest Revision: 20220425

20250114

PMC8293966

10.1080/02813432.2021.1908715

33792485