The telenursing service deals with offering the public guidance as what to do with their health and illness concern. More specifically this service includes triage, support, advice, education, referral, information and coordination. To conduct telephone advice is a complicated task to perform and put specific demands of the nurse’s communication skills. The purpose of this study was to critically review the impact of telephone counseling focused on context of implementation, perspective, design and clinical relevance by a sample of studies within the field. The critical review focused on inconsistencies in the material. Strengths and weaknesses of the studies were explored, with emphasis on detecting areas of skill gaps. Twelve of thirteen studies were made in the context of telenursing. The thirteenth was conducted in the context of the emergency call. The most prominent approach was the study of callers´. Two of the articles were made with an inductive design, five with a deductive and the remaining six articles with a mixed design. The clinical relevance is attached to the callers´ perspective. The most salient dimension of the analyzed studies were studies of callers´ satisfaction with telephone advice, compliance to advice given and experiences of approaching a telenurse. The results reveal that when given advice are understood, satisfaction with the advice is obtained as well as good compliance and the caller feel looked after. However, the callers´ experience to ventilate their concerns, being listened to, while having "control" over the call is less explored. Moreover, the callers´ experience of being subject to advice by telephone seems to be further explored.

Η τεχνολογία τηλεπικοινωνιών αλλάζει ριζικά το σύστημα παράδοσης υγειονομικής περίθαλψης στην χώρα μας. Η Τηλενοσηλευτική, ως υποσύνολο της Τηλεϋγείας, παρουσιάζει τα μοναδικά νομικά, ρυθμιστικά, και επαγγελματικά ζητήματα για το επάγγελμα της νοσηλευτικής. Συγχρόνως, παρουσιάζει τις νέες προκλήσεις και τις γρήγορα επεκτάσιμες ευκαιρίες για τις νοσηλεύτες/τριες στην εφαρμογή της Τηλενοσηλευτικής. Η εστίαση αυτής της διπλωματικής είναι η εφαρμογή της Τηλενοσηλευτικής στην παροχή νοσηλείας για τους ασθενείς που βρίσκονται σε απομακρυσμένες περιοχές μακρυά από τον παροχέα. Δεν είναι μια διπλωματική που να απευθύνεται στην τεχνολογία - υλικό των υπολογιστών, το λογισμικό, τα συστήματα. Η διπλωματική αυτή είναι μια επιτομή των ερευνητικών συμπερασμάτων των ευρύτατα αναγνωρισμένων αρχών στον τομέα της Τηλευγείας. Γράφτηκε ως αναφορά για τους νοσηλευτές/τριες σπουδαστές, για τις ήδη εργαζόμενους νοσηλευτές/τριες που μπορεί να αποβλέπουν σε μια σταδιοδρομία στην εφαρμογή της Τηλεπρακτικής μέσα στον κλάδο του επαγγέλματός τους, και ωθεί τους εργαζόμενους νοσηλευτές/τριες στην συμμετοχή της Τηλενοσηλευτικής.. Παρέχει τις νομικές και πρακτικές οδηγίες για τους νοσηλευτές/ τριες στην παροχή της ασφαλέστερης και πιο αποτελεσματικής θεραπευτικής φροντίδας του ασθενή. Η Τηλενοσηλευτική είναι ένας αναδυόμενος και ραγδαία επεκταμένος ρόλος για το επάγγελμα του νοσηλευτή/τριας, και προσφέρει απεριόριστες ευκαιρίες για τα μέλη του επαγγέλματος. / Telecommunications technology is radically changing the health care delivery system in our country. Telenursing, as a subset of telehealth, presents unique legal, regulatory, and professional issues for the nursing profession. At the same time, it presents new challenges and rapidly expanding opportunities for nurses in Telenursing practices. The focus of this paper is the application of Telenursing in the provision of nursing care for patients at sites remote from the provider. It is not a paper about computer technology – hardware, software, systems. This paper is a compendium of the research findings of the most widely recognized authorities in the field of telehealth. It was written as a reference for student nurses, nurses in clinical practice who may be considering a career in telepractactice, and advanced practice nurses, who are most likely to be involved in Telenursing. It provides legal and practice guidelines for nurses in the delivery of the safest and most therapeutic patient care. Telenursing is an emerging and rapidly expanding role for the nursing profession, and offers unlimited opportunities for members of the profession.

Telenursing is a highly specialized area of nursing practice that has evolved in response to the advent of new technologies within the delivery of health care. Telenursing has been defined as “the use of communications and information technology [ICT’s] to deliver health and health care services and information over large and small distances (CRNBC, 2016). Telenurses use health information systems (HIS) in the form of a Clinical Decision Support System (CDSS) to assist callers with their health related concerns on a 24/7 basis. As decision making is an integral part of telenurse practice, particularly because they are using a CDSS while assessing the caller over the phone, it was important to understand the factors that influence the decision making process so as to better support telenurse practice in terms of education as well as other supports. This thesis identified those factors and used Rasmussen’s Decision Ladder as a model in order to provide a framework for telenursing. It was found that there were several factors identified that influenced how telenurses made decisions while using a CDSS. Additionally, the decision ladder was validated as a framework to describe telenurse practice. / Graduate

Introdução: A comunicação é o processo pelo qual ocorrem compreensão e compartilhamento de mensagens enviadas e recebidas, sendo que o conteúdo destas mensagens exerce influência no comportamento das pessoas envolvidas. Atualmente, a área da saúde tem utilizado ferramentas de cuidado à distância para prestar assistência aos pacientes em diversos contextos - a chamada Telessaúde. A influência desta modalidade de cuidado sobre a natureza e o conteúdo da comunicação deve ser muito bem compreendida, visto que o processo de comunicação humana adequado é essencial na assistência à saúde com qualidade. Objetivos: avaliar a percepção do profissional da saúde referente a elementos de Comunicação Humana no cuidado por Telessaúde. Os objetivos específicos foram: verificar que elementos de Comunicação Humana o enfermeiro e o médico identificam no cuidado por Telessaúde, e discutir, por meio dos achados, em que aspectos essa modalidade de cuidado pode impactar na comunicação interpessoal entre os profissionais de saúde e, consequentemente, na assistência aos pacientes. Método: pesquisa descritiva, com abordagem qualitativa, realizada com 20 profissionais que atuam em telessaúde no Brasil. Os dados foram coletados com médicos e enfermeiros por meio de sistema de vídeo ou áudio, no período de junho a outubro de 2014. O número de participantes foi determinado pela saturação de dados, conforme metodologia adotada. Os dados foram analisados pela proposta de análise de conteúdo de Bardin. Resultados: Dos discursos emergiram quatro categorias principais, sendo a maioria composta de subcategorias: Entendendo a importância da comunicação (Comunicação adequada é fundamental, pois interfere na conduta; Identificando as barreiras de comunicação); O relacionamento interpessoal interferindo na comunicação; Comunicando-se por meio da tecnologia (Tecnologia facilita a prática; Entendendo os fatores que dificultam a comunicação à distância; Identificar o não verbal por telessaúde é mais difícil) e Aprendendo o processo de comunicação (Não há dificuldades em comunicar-se; Importância do aprendizado da comunicação verbal e não verbal; Importância do aprendizado da telessaúde). Conclusão: Concluímos com este estudo que a comunicação interpessoal adequada na área da saúde é considerada primordial por médicos e enfermeiros que atuam em Telessaúde no Brasil porque acreditam interferir em sua conduta profissional. O relacionamento interpessoal é o principal fator de interferência nesse processo. A tecnologia tem facilitado a prática profissional, porém, do ponto de vista comunicacional, o cuidado à distância apresenta nuances que dificultam o processo de comunicação, principalmente devido à dificuldade de percepção do não verbal na assistência por telessaúde. Para superar estas dificuldades, médicos e enfermeiros concordam que a comunicação é uma competência que deve ser lecionada aos profissionais durante sua formação e, especificamente para atuação à distância, esta habilidade deve ser ensinada considerando as nuances que a distância pode trazer no processo comunicacional entre as pessoas. / Introduction: Communication is the process through which understanding and sharing of sent and received messages occur, considering that the content of these messages influences the behaviour of people involved. Nowadays, the health care segment has used distance care tools to serve patients in different contexts - the so-called Telehealth. The influence of this type of care on the nature and content of communication must be well understood, since the adequate process of human communication is essential in quality health assistance. Objectives: evaluate the perception of the health care professional regarding Human Communication elements in Telehealth care. The specific objectives were: verifying which elements of Human Communication the nurse and the doctor identify in Telehealth care, and dissussing, through findings, in which aspects this type of care can impact the interpersonal communication among health care professionals and, consequently, patients care. Method: descriptive research, with qualitative approach, performed with 20 professionals who work in Telehealth in Brazil. Data were collected from doctors and nurses through audio or video system, from June to October 2014. The number of participants was determined by saturation of data, according to adopted methodology. Data were analyzed by the content analysis proposal of Bardin. Results: From the discourses, four main categories emerged, and most are composed of subcategories: understanding the importance of communication (dequate communication is fundamental, because it interferes in behaviour; Identifying the limitations of communication); The interpersonal relationship interfering in the communication; Communicating through technology (Technologies facilitates practice; Understanding the factors that make distance communication difficult; Identifying the non-verbal through Telehealth is more difficult) and Learning the process of communication (There are no difficulties in communicating; The Importance of learnig verbal and non-verbal communication; The importance of Telehealth learning). Conclusion: We have concluded in this study that adequate interpersonal communication in health care is considered fundamental by doctors and nurses that work in Telehealth in Brazil because it is believed that it interferes with their professional behaviour. Interpersonal relationship is the main factor of interference in this process. Technology has facilitated professional practice, however, from a communicational perspective, distance health care presents nuances that make the process of communication difficult , maily due to the difficulty of perception of non-verbal aspects in Telehealth care. To overcome these difficulties, doctors and nurses agree that communication is a competence that must be taught to professionals during their professional education and, especifically to work at distance, this ability must be taught taking into consideration the nuances that distance may bring in the communication process among people.

Bakgrund: Telefonen är ett kommunikativ redskap som till fortsatt stor del användas idag, när personer ute i samhället behöver hälso-och sjukvårdsråd. Man kan definiera telefonrådgivning som praxis att tillhandahålla en komponent av telefonrådgivning som fokuserar på att bedöma, prioritera och referera till korrekt vårdnivå samt att identifiera orsaken och skyndsamheten av vårdsökarens behov. Svårigheter med telefonrådgivning för sjuksköterskor kan vara att man inte ser patienten som man samtalar med Syfte: Syftet var att belysa sjuksköterskors och distriktsköterskors erfarenheter av telefonrådgivning. Metod: En systematisk litteraturstudie genomfördes med databassökningar i Cinahl och Pubmed. Studien består av 12 vetenskapliga artiklar av kvalitativ, kvantitativ och mixmetod ansatts. Artiklarnas innehåll hade kritiskt granskat utifrån deras relevans mot syftet. Resultat: Tre övergripande kategorier framkom: Erfarenheter av kommunikation, Erfarenheter av krävande patientmöten och Erfarenheter av organisationen samt 12 subkategorier som belyser dessa svårigheter. Diskussion: I resultat så framkom det olika aspekter som telefonrådgivningssjuksköterskan fick hantera i samband med telefonrådgivningstillfället. Telefonrådgivningssjuksköterskans erfarenheter av att lyssna och ställa öppna medicinska frågor belystes som en bidragande faktor till att säkerhetsställa att korrekt information blivit utbytt mellan parterna. Det fanns många faktorer som kunde försvåra telefonrådgivningssamtalet så som krävande patienten men också telefonrådgivningssjuksköterskans egen arbetsmiljö. Slutsatser: Telefonrådgivningssjuksköterskornas erfarenheter av att arbeta med telefonrådgivning är att det förekommer många patientmöten som medför svårigheter för telefonrådgivningssjuksköterskan att hantera.

Introdução: A comunicação é o processo pelo qual ocorrem compreensão e compartilhamento de mensagens enviadas e recebidas, sendo que o conteúdo destas mensagens exerce influência no comportamento das pessoas envolvidas. Atualmente, a área da saúde tem utilizado ferramentas de cuidado à distância para prestar assistência aos pacientes em diversos contextos - a chamada Telessaúde. A influência desta modalidade de cuidado sobre a natureza e o conteúdo da comunicação deve ser muito bem compreendida, visto que o processo de comunicação humana adequado é essencial na assistência à saúde com qualidade. Objetivos: avaliar a percepção do profissional da saúde referente a elementos de Comunicação Humana no cuidado por Telessaúde. Os objetivos específicos foram: verificar que elementos de Comunicação Humana o enfermeiro e o médico identificam no cuidado por Telessaúde, e discutir, por meio dos achados, em que aspectos essa modalidade de cuidado pode impactar na comunicação interpessoal entre os profissionais de saúde e, consequentemente, na assistência aos pacientes. Método: pesquisa descritiva, com abordagem qualitativa, realizada com 20 profissionais que atuam em telessaúde no Brasil. Os dados foram coletados com médicos e enfermeiros por meio de sistema de vídeo ou áudio, no período de junho a outubro de 2014. O número de participantes foi determinado pela saturação de dados, conforme metodologia adotada. Os dados foram analisados pela proposta de análise de conteúdo de Bardin. Resultados: Dos discursos emergiram quatro categorias principais, sendo a maioria composta de subcategorias: Entendendo a importância da comunicação (Comunicação adequada é fundamental, pois interfere na conduta; Identificando as barreiras de comunicação); O relacionamento interpessoal interferindo na comunicação; Comunicando-se por meio da tecnologia (Tecnologia facilita a prática; Entendendo os fatores que dificultam a comunicação à distância; Identificar o não verbal por telessaúde é mais difícil) e Aprendendo o processo de comunicação (Não há dificuldades em comunicar-se; Importância do aprendizado da comunicação verbal e não verbal; Importância do aprendizado da telessaúde). Conclusão: Concluímos com este estudo que a comunicação interpessoal adequada na área da saúde é considerada primordial por médicos e enfermeiros que atuam em Telessaúde no Brasil porque acreditam interferir em sua conduta profissional. O relacionamento interpessoal é o principal fator de interferência nesse processo. A tecnologia tem facilitado a prática profissional, porém, do ponto de vista comunicacional, o cuidado à distância apresenta nuances que dificultam o processo de comunicação, principalmente devido à dificuldade de percepção do não verbal na assistência por telessaúde. Para superar estas dificuldades, médicos e enfermeiros concordam que a comunicação é uma competência que deve ser lecionada aos profissionais durante sua formação e, especificamente para atuação à distância, esta habilidade deve ser ensinada considerando as nuances que a distância pode trazer no processo comunicacional entre as pessoas. / Introduction: Communication is the process through which understanding and sharing of sent and received messages occur, considering that the content of these messages influences the behaviour of people involved. Nowadays, the health care segment has used distance care tools to serve patients in different contexts - the so-called Telehealth. The influence of this type of care on the nature and content of communication must be well understood, since the adequate process of human communication is essential in quality health assistance. Objectives: evaluate the perception of the health care professional regarding Human Communication elements in Telehealth care. The specific objectives were: verifying which elements of Human Communication the nurse and the doctor identify in Telehealth care, and dissussing, through findings, in which aspects this type of care can impact the interpersonal communication among health care professionals and, consequently, patients care. Method: descriptive research, with qualitative approach, performed with 20 professionals who work in Telehealth in Brazil. Data were collected from doctors and nurses through audio or video system, from June to October 2014. The number of participants was determined by saturation of data, according to adopted methodology. Data were analyzed by the content analysis proposal of Bardin. Results: From the discourses, four main categories emerged, and most are composed of subcategories: understanding the importance of communication (dequate communication is fundamental, because it interferes in behaviour; Identifying the limitations of communication); The interpersonal relationship interfering in the communication; Communicating through technology (Technologies facilitates practice; Understanding the factors that make distance communication difficult; Identifying the non-verbal through Telehealth is more difficult) and Learning the process of communication (There are no difficulties in communicating; The Importance of learnig verbal and non-verbal communication; The importance of Telehealth learning). Conclusion: We have concluded in this study that adequate interpersonal communication in health care is considered fundamental by doctors and nurses that work in Telehealth in Brazil because it is believed that it interferes with their professional behaviour. Interpersonal relationship is the main factor of interference in this process. Technology has facilitated professional practice, however, from a communicational perspective, distance health care presents nuances that make the process of communication difficult , maily due to the difficulty of perception of non-verbal aspects in Telehealth care. To overcome these difficulties, doctors and nurses agree that communication is a competence that must be taught to professionals during their professional education and, especifically to work at distance, this ability must be taught taking into consideration the nuances that distance may bring in the communication process among people.

Tele-intensive care collaboration in care of critically ill patients improves both the safety and quality of nursing care. However, the full benefits of the telemedicine service may not be realized unless tele-critical care nurses have the ability to communicate clearly with their remote nursing peers. The purpose of this DNP project was to create and validate an acronym style communication tool to assist the tele-critical care nurses with their communication. The relational coordination theory was the primary communication theory utilized for tool development. The tool creation phase of the project included informal observations and discussion with a convenience sample of 11 tele-critical care staff nurses. The formative feedback from this group helped to identify the episode of communication for which the tool was designed and suggested communication elements for inclusion. During the validation phase of this project, 9 volunteer experts evaluated the communication tool with a 5-point Likert scale survey. Descriptive statistics were used to analyze the survey results and provided summative feedback for validation of the tool. Mean scores between 3.44 and 4.44 demonstrated that the experts agreed with the applicability, relevance, and necessity of the tool. Feedback indicated the need for a pilot study implementing the tool to compare it with traditional communication practices and to evaluate its performance in clinical practice. This tool will be useful for future partnerships utilizing telemedicine. The project is socially significant because of its focus on communication and collaboration among healthcare providers in facilitating the patient experience and safety.

Introduktion: Hälso- och sjukvårdsrådgivning per telefon introducerades i Sverige på 30-talet. Efterfrågan på telefonrådgivning har ökat sedan dess. Målet är att uppringaren känner sig hörd och distriktssköterskan är trygg i sin bedömning. För att uppnå detta mål krävs en god kommunikation mellan de två. Syfte: Syftet med denna studie var att beskriva kommunikation mellan sjuksköterska och uppringare vid telefonrådgivning. Metod: Studiens syfte utforskades med hjälp av en systematisk litteraturstudie med en kvalitativ innehållsanalys. Studiens resultat baserades på tio artiklar från databaserna CINAHL, PubMed och en manuell sökning genom digital snowballing. Resultat: Flertalet faktorer som påverkar kommunikation mellan sjuksköterska och uppringare fanns. Dessa redovisas i tre huvudkategorier: Förståelse, Bemötande och Miljö. Slutsatser: Studiens resultat visar på att kommunikation är ett multifacetterat och invecklat begrepp. Då kommunikation sker mellan två människor är den levande och sensitiv för utomstående påverkan som miljö och individens känslor. Genom att sjuksköterskan känner till dessa faktorer ökar chansen för sjuksköterskan att kunna bemöta uppringaren med förståelse via telefon. Studien kan även utgöra ett underlag för vidare förbättringsarbeten inom olika organisationer. / Introduction: Health and medical advice via telephone was introduced in Sweden in the 1930s. The demand for telephone counseling has since then increased. The goal is for the caller to feel heard and the district nurse to be confident in her assessment. To achieve this goal, good communication between the two is required. Aim: The aim of this study was to describe the communication between the nurse and the caller during telephone counseling. Method: The aim of the study is explored using a systematic literature study with a qualitative content analysis. The study's results are based on ten articles from the databases CINAHL, PubMed and a manual search through digital snowballing. Results: A multitude of factors affecting communication between nurse and caller were discovered. These were summarized in three main categories: Comprehension, Nurse-patient relationship and Environment. Conclusions: The results of the study show that communication is multifaceted and complicated. As communication takes place between two people, it is vivid and sensitive to external influences such as environment and feelings. By the nurse knowing these factors, the chance for the nurse to receive the caller with understanding over the phone increases. The study can also form a basis for further improvement work within various organizations.

Introduktion: Hälso- och sjukvårdsrådgivning per telefon introducerades i Sverige på 30-talet. Efterfrågan på telefonrådgivning har ökat sedan dess. Målet är att uppringaren känner sig hörd och distriktssköterskan är trygg i sin bedömning. För att uppnå detta mål krävs en god kommunikation mellan de två. Syfte: Syftet med denna studie var att beskriva kommunikation mellan sjuksköterska och uppringare vid telefonrådgivning. Metod: Studiens syfte utforskades med hjälp av en systematisk litteraturstudie med en kvalitativ innehållsanalys. Studiens resultat baserades på tio artiklar från databaserna CINAHL, PubMed och en manuell sökning genom digital snowballing. Resultat: Flertalet faktorer som påverkar kommunikation mellan sjuksköterska och uppringare fanns. Dessa redovisas i tre huvudkategorier: Förståelse, Bemötande och Miljö. Slutsatser: Studiens resultat visar på att kommunikation är ett multifacetterat och invecklat begrepp. Då kommunikation sker mellan två människor är den levande och sensitiv för utomstående påverkan som miljö och individens känslor. Genom att sjuksköterskan känner till dessa faktorer ökar chansen för sjuksköterskan att kunna bemöta uppringaren med förståelse via telefon. Studien kan även utgöra ett underlag för vidare förbättringsarbeten inom olika organisationer. / Introduction: Health and medical advice via telephone was introduced in Sweden in the 1930s. The demand for telephone counseling has since then increased. The goal is for the caller to feel heard and the district nurse to be confident in her assessment. To achieve this goal, good communication between the two is required. Aim: The aim of this study was to describe the communication between the nurse and the caller during telephone counseling. Method: The aim of the study is explored using a systematic literature study with a qualitative content analysis. The study's results are based on ten articles from the databases CINAHL, PubMed and a manual search through digital snowballing. Results: A multitude of factors affecting communication between nurse and caller were discovered. These were summarized in three main categories: Comprehension, Nurse-patient relationship and Environment. Conclusions: The results of the study show that communication is multifaceted and complicated. As communication takes place between two people, it is vivid and sensitive to external influences such as environment and feelings. By the nurse knowing these factors, the chance for the nurse to receive the caller with understanding over the phone increases. The study can also form a basis for further improvement work within various organizations.

Omvårdnad på distans är ett växande område i västvärlden. Sjukvårdsrådgivning via telefon sysselsätter allt fler sjuksköterskor. Arbetet innebär att bedöma, hänvisa och ge råd i till inringare i hälso- och sjukvårdsfrågor. Syftet med studien var att undersöka sjuksköterskans erfarenhet av att arbeta med sjukvårdsrådgivning via telefon. Metoden var en litteraturstudie. Med inspiration av innehållsanalys bearbetades två kvantitativa och nio kvalitativa studier. Resultatet utmynnade i tre kategorier: Samtal och inringare, Omvårdnad och yrkesroll, Organisation och teknik. Kategorierna representerar olika delar av arbetsmiljön och arbetsvillkoren som en telefonsjuksköterska verkar inom. Telefonsjuksköterskorna upplevde att de trots distansen till inringaren arbetade med omvårdnad, detta genom sin röst och kommunikation. Avsaknad av synintryck försvårade samtalen, både i bedömningen och etiskt då telefonsjuksköterskan aldrig kunde vara säker på inringarens identitet. Resultatet visar på behov av ytterligare utbildning inför arbetet som telefonsjuksköterska. Forskning behövs kring användandet av det datoriserade beslutstödet samt innehållet, för att telefonsjuksköterskan ska kunna göra adekvata bedömningar och rätt hänvisningar. Kommunikation är det främsta verktyget i arbetet med sjukvårdsrådgivning via telefon, fortlöpande utbildning som fokuserar på detta bör erbjudas till telefonsjuksköterskor. / Telenursing is a growing concept within the western society. More nurses are employed by medical care hotlines. It involves estimating medical situations, referring, and giving counseling advice. The purpose of this study was to investigate nurses experiences with executing their profession over the phone. The method was a literature study, with inspiration drawn from content analysis. Two quantitative and nine qualitative studies were discussed and resulted in three categories: Calls and callers, Nursing and profession, Organizational structure and technique. These categories represent the various parts of the working environment and conditions that a telenurse operates within. Despite the physical distance to the caller, the telenurses still felt they were nursing, using their voices and communication. Lack of visual impressions can be a cause of obstruction for telenurses in judging the callers condition, but also in an ethical sense since the nurse could never be confident in the callers identity. The result of this study identifies a need for further education as a preparation to becoming a telenurse.Research is needed regarding the usage of computerized decision aid, to make adequatejudgements and thus giving the correct referrals. Communications is the key tool fortelenursing, and further education that focuses on improving this should be given to employees within the field.