Bakgrund: Telefonrådgivning är idag en stor del av distriktssköterskans arbetsuppgifter i primärvården. Det är en komplex arbetsuppgift som innebär ett vårdmöte via telefon där distriktssköterskan ska kunna bedöma vårdbehov, brådskandegrad, ge egenvårdsråd och samordna med andra vårdgivare. För att patienten ska få en så korrekt bedömning av sitt vårdbehov som det går är det viktigt att distriktssköterskan får relevant information. Syfte: Denna studie syftar till att beskriva distriktssköterskans erfarenheter av att arbeta i telefonrådgivning i primärvården. Metod: Studien är kvalitativ intervjustudie med en induktiv ansats. Nio distriktssköterskor intervjuades i tre fokusgruppsintervjuer. Resultat: Ur analysen framkom sex övergripande kategorier vilka benämndes; Telefonrådgivning kan vara en stor utmaning, Arbetsmiljön i telefonrådgivningen har betydelse för kvaliteten på samtalet, För och nackdelar med datoriserat beslutsstöd, Kunskap och erfarenhet underlättar telefonrådgivningen, Kvalitet på samtal och bedömningar är viktigt, Samtal med tredje part kan påverka utfallet av samtalet. Konklusion: Denna studie har synliggjort utmaningar i telefonrådgivning vilka kan utgöra risker för patientsäkerheten och den personcentrerade vården. Resultatet kan bidra till att undvika felbedömningar vilket ökar patientsäkerheten och ger samhällsnytta. / Background: Telephone counselling is today a major part of the duties for a district nurse in primary care. It is a complex task that incorporates a care meeting via telephone where the district nurse should be able to assess care needs, urgency, give self care advice and coordinate with other care providers. In order for the patient to get a correct assessment of their care needs as it is possible, it is important that the district nurse receive relevant information. Aim: This study aims to describe the experience of working in telephone counselling for a district nurse in primary care. Method: The study is a qualitative interview study with an inductive approach. Nine district nurses where interviewed in three focus group interviews. Result: Six general categories were identified from the analysis, which were named; Telephone counselling can be a major challenge, The working environment in telephone counselling is important for the quality of the call, Pros and cons of computerized decision support, Knowledge and experience facilitates telephone counselling, Quality at calls and assessments are important and Conversations with third parties can affect the outcome of the call. Conclusion: This study has highlighted challenges in telephone counselling which may pose risks to patient safety and person-centred care. The result can help to avoid misjudgements, which increases patient safety and benefits society.

This master’s thesis is focused on the problems of designing telephone lines which are 7 km long with a step of 1 km. The thesis contains a detailed description of the basic parameters of metallic transmission lines. There is also briefly mentioned the issue of interfering the transmission lines. The main part is devoted to a system design of artificial lines connection, including printed circuit board design. The next section deals with a design of prototype controlling. The last part verifies the activity of implemented artificial lines.

The subject of the thesis is the design of changes in the incentive system in the selected company. Through the analysis of company documents, questionnaires and structured interviews is analyzed the current incentive system and its effect on the level of staff motivation. On the basis of empirical research are elaborated concrete proposals to optimize employee performance, increase the level of staff motivation and thereby strengthening the company's position in the market.

This work is an introduction to the GSM system. Gives basic information about its structure, active elements, used protocols and signaling messages. It gives a propsal for structures for emulator of telephone exchange.

Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) sjukdom är ett växande problem världen över och kommer i framtiden att ställa primärvården inför utmaningar att kunna möta komplexa vårdbehov från den här patientgruppen. KOL innebär begränsningar i det dagliga livet och ger känslor av beroende vilket gör att många patienter är i behov av kontakt med primärvårdens vårdcentraler. Försämrad andning (exacerbation) är ofta anledning till att en patient med KOL ringer till vårdcentralen. Sjuksköterskan i telefonrådgivningen ställs inför utmaningar att kunna bedöma patientens försämrade andning. Syfte: Att beskriva sjuksköterskors erfarenheter att i telefonrådgivning på vårdcentralen bedöma andningsförsämring hos patienter med KOL och besluta om vidare åtgärd.  Metod: En kvalitativ studie har genomförts med individuella semistrukturerade intervjuer där elva sjuksköterskor som arbetar med telefonrådgivning på vårdcentral deltog. En kvalitativ innehållsanalys användes för analys av intervjutexterna  Resultat: Hur sjuksköterskorna erfor bedömningen av patienternas försämrade andning utmynnade i fyra huvudkategorier med tio underkategorier samt ett övergripande tema: Att utan sin kliniska blick bedöma andningsförsämring vid KOL innebär utmaningen att värdera patientens aktuella symtom, i förhållande till tidigare och ta beslut om åtgärd.  Slutsats: Ett centralt fynd i den här studien är att det finns utmaningar i telefonrådgivning för att bedöma andningssvårigheter hos patienter med KOL. Avsaknaden av den kliniska blicken i telefonrådgivning ställer krav på kompetens och kommunikativa färdigheter hos sjuksköterskan. Samtidigt finns det möjlighet att hitta stöd för sin bedömning i formella beslutstöd och kollegor för att möjliggöra ett adekvat beslutsfattande / Background: Chronic obstructive pulmonary disease (COPD) is a growing problem worldwide and will in the future pose primary care challenges to be able to meet complex care needs from this patient group. COPD means limitations in daily life and feelings of dependence, which means that many patients need contact with primary health care. Respiratory impairment (exacerbation) is often the reason why patients with COPD call the health care center. The nurse in the telephone counseling is faced with challenges to be able to assess the patient's respiratory impairment. Aim: To describe nurses' experiences of assessing respiratory impairment in patients with COPD in telephone counseling at the health care center and make further decision.Method: A study employed qualitative design using individual semi-structured interviews as data collection method with participation of eleven nurses working with telephone counseling at health care centers. A qualitative content analysis was used to analyze the interviews.Results: The way the nurses experienced the assessment of patients' respiratory impairment was revealed in terms of four main categories, ten subcategories and grasped by one overarching theme: Without visual contact, assessing respiratory impairment in patients with COPD presents a challenge to value the patient´s current symptoms, in relation to the past, and make decision. Conclusion: One core finding of this study is that there are challenges and difficulties in telephone counseling to assess respiratory impairment in patients with COPD. The lack of visual contact with the patients in telephone counseling places demands on the nurse's competence and communication skills. At the same time, nurses receive support for their assessment in decision-making tools and by colleagues.

The development and research of Artificial Intelligence have had a recent surge in recent years, which includes the medical field. Despite the new technology and tools available, the staff is still under a heavy workload. The goal of this thesis is to analyze the possibilities of a chatbot whose purpose is to assist the medical staff and provide safety for the patients by guaranteeing that they are being monitored. With the use of technologies such as Artificial Intelligence, Natural Language Processing, and Voice Over Internet Protocol, the chatbot can communicate with the patient. It will work as an assistant for the working staff and provide the information from the calls to the medical staff. With the answers provided from the call, the staff will not be needing to ask routine questions every time and can provide help more quickly. The chatbot is administrated through a web application where administrators can initiate calls and add patients to the database.

Background: Several European countries have demonstrated successful use of telephone screening tests for auditory function. The screening test consists of spoken three-digit sequences presented in a noise background. The speech-to-noise ratios of the stimuli are determined by an adaptive tracking method that converges on the level required to achieve 50% correct recognition.Purpose: A version of the three-digit telephone screening protocol for the United States was developed: the US National Hearing Test (NHT). The objective of the current study was to determine the sensitivity and specificity as well as the feasibility of the NHT for use within the Department of Veterans Affairs (VA).Research Design and Study Sample: Using a multisite study design with convenience sampling, we used the NHT to collect data from 693 participants (1379 ears) from three geographical areas of the United States (Florida, Tennessee, and California).Data Collection and Analysis: The NHT procedures were as follows: the participants (1) called a tollfree telephone number, (2) entered their assigned ear-specific identification code, (3) listened to 40-sets of digit triplets presented in speech-spectrum background noise, and (4) entered in the numbers that they heard on the telephone key pad. The NHT was performed on each ear, either at home or in a VA clinic. In addition to collecting data from the experimental task, we gathered demographic data and the data from other standard-of-care tests (i.e., audiometric thresholds and speech recognition tests in quiet and in noise).Results: A total of 505 participants completed the NHT at a VA clinic, whereas 188 completed the test at home. Although the ear-specific NHT and mean pure-tone threshold all correlated significantly (p < 0.001), there were more modest correlations in the low- and high-frequency ranges with the highest correlation seen with the 2000 Hz mean pure-tone threshold. When the NHT 50% point or threshold was compared with the three-frequency PTA at 500, 1000, and 2000 Hz, the sensitivity was 0.87 and specificity was 0.54. When comparing the NHT with the four-frequency PTA at 500, 1000, 2000, and 4000 Hz, the sensitivity was 0.81 and specificity increased to 0.65. The NHT also correlated strongly with other speech-in-noise measures.Conclusions: The NHT was found to correlate with other audiometric measures, including pure-tone thresholds and speech recognition tests in noise, at sufficiently high correlation values to support its use as a screening test of auditory function.

Bakgrund Psykisk ohälsa är en av vår tids stora folksjukdomar och som fortsätter att öka i samhället. Primärvården är ofta den första vårdkontakten för personer med psykisk ohälsa. Att möta patienten i telefonrådgivningen kan vara en utmanande och komplex uppgift, och innebär att under tidspress göra en bedömning endast utifrån tonläge och patientens berättelse. Syfte Syftet var att beskriva sjuksköterskors erfarenheter av telefonrådgivning inom primärvården med personer som drabbats av psykisk ohälsa. Metod Studien genomfördes i form av kvalitativ design med induktiv ansats. Data samlades in genom semistrukturerade intervjuer med 9 sjuksköterskor och distriktssköterskor på fyra olika vårdcentraler i Väst- och Mellansverige. Data analyserades utifrån kvalitativ innehållsanalys. Resultat Sjuksköterskor växer i sin yrkesroll genom att de kan lita på sin egen förmåga, de känner stöd från andra och hittar modet. De skapar en relation via telefon genom att fånga en helhet, att göra sitt bästa och genom att ha distans men en medkänsla. De uttrycker att de inte räcker till eftersom tidspress, orimliga förväntningar och brist på kunskap och kompetensresulterar i svårigheter för sjuksköterskorna. Slutsats Sjuksköterskor är i behov av ökad utbildning i psykisk ohälsa samt i kommunikation med dessa patienter. Resurser bör i framtiden läggas på att öka samverkan, rutiner och kunskap inom primärvården för att minska stress och arbetsbelastning för sjuksköterskor. Detta skulle ekonomiskt gynna samhället både på individnivå samt samhällsnivå. Då patienter fortare får hjälp kan rehabilitering påskyndas, tiden för sjukskrivning minskas och patienterna kan fortare återgå till arbete. Handledning och reflektion är också viktigt. / Background Mental illness is one of the major public diseases of our time and continues to increase in society. Primary care is often the first contact for the individuals that suffers from mental illness. Telephone counseling can be a challenging and complex task, which involves making assessments during time pressure based solely on patient's tone of voice and story. Aim The aim of this study was to describe district nurses' experiences of telephone counseling in primary care with people suffering from mental illness. Method The study had a qualitative design with an inductive approach. Data was collected through semi-structured interviews with 9 district nurses at four different health centers in western and central Sweden. The data was analyzed with the help of qualitative content analysis. Results District nurses grow in their professional role by being able to trust their own abilities, by support from others and by finding courage. They create a relationship over the phone by capture an overall picture, doing their best and by creating distance as well as compassion. They express a feeling of not “being enough” due to time pressure, unreasonable expectations, lack of knowledge and skills, leading to difficulties for the district nurses. Conclusion District nurses need increased education regarding mental illness and communication with these patients. In the future, resources should be invested in increasing collaboration, routines, and knowledge in primary care to reduce stress and workload for district nurses. This could lead to economic benefits on both a societal and individual level.

Bakgrund: Telefonrådgivning har använts som kommunikationssätt sedan 30-talet inom sjukvården. I nutid är telefonrådgivning ett väl etablerat och beprövat kommunikationsalternativ som brukas runt om i Sverige. Dock belyser forskning telefonrådgivning som en komplex arbetsuppgift. Inom oftalmologi finns det vidare sparsam forskning kring just ögonsjuksköterskans uppfattning av telefonrådgivning.  Syfte: Syftet var att undersöka ögonsjuksköterskans uppfattning av telefonrådgivning på ögonmottagning.  Metod: Metoden som användes var av kvalitativ design med en fenomenografisk ansats. Åtta ögonsjuksköterskor från södra Sverige som arbetade på ögonmottagning intervjuades enskilt. En fenomenografisk analysmetod valdes att användas för analysering av data.  Resultat: Analysen resulterade i tre beskrivningskategorier: (1) Relationens betydelse mellan ögonsjuksköterska och patient, (2) Aspekter som begränsar och underlättar bedömningen mellan ögonsjuksköterska och patient samt (3) Betydelsen av kunskap, stöd och erfarenhet för ögonsjuksköterskan. Slutsats: Det framkom olika begränsande och underlättande aspekter som påverkar bedömningen och mötet med patienten. Ögonsjuksköterskan uppfattade relationen med patienten som en central del i arbetet med telefonrådgivning. Likaså uppfattades stöd i olika former samt kunskapsutveckling och erfarenhet kring området som betydelsefullt. Resultatet visar, likt tidigare forskning, att telefonrådgivning är en mycket komplex arbetsuppgift. / Background: Telephone counseling has been used as a means of communication since the 1930s in healthcare. Today, telephone counseling is a well-established and proven communication alternative that is used around Sweden. However, research highlights telephone counseling as a complex task. In ophthalmology, there is also sparse research on the ophthalmic nurse´s perception of telephone counseling. Aim: The purpose was to investigate the ophthalmic nurse conception of telephone counseling at an eye clinic.Method: The method used was of qualitative design with a phenomenographic approach. Eight ophthalmic nurse´s from southern Sweden who worked at the eye clinic were interviewed individually. A phenomenographic analysis method was chosen to be used for data analysis. Results: The analysis resulted in three descriptive categories: (1) The importance of the relationship between the ophthalmic nurse and the patient, (2) Aspects that limit and facilitate the assessment between the ophthalmic nurse and the patient and (3) The importance of knowledge, support and experience for the ophthalmic nurse. Conclusion: Various limiting and facilitating aspects emerged that affect the assessment and the meeting with the patient. The ophthalmic nurse perceived the relationship with the patient as a central part of the work with telephone counseling. Likewise, support in various forms as well as knowledge development and experience in the area were perceived as significant. The results show, like previous research, that telephone counseling is a very complex task.

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