<p>När en person söker en första kontakt med hälso- och sjukvården sker det oftast via ett telefonsamtal till vårdcentralen. Vid telefonsamtalet, som tas emot av en sjuksköterska, bedöms och åtgärdas vårdsökarens ärende. Sjukskrivningar är ett av många ärenden som hanteras. De senaste åren har hanteringen av sjukskrivningar i Svensk hälso- och sjukvård förändrats vilket har orsakat en minskning av antalet sjukskrivningar. Sjuksköterskor har i varierande grad deltagit i denna utveckling och denna studie vill synliggöra sjuksköterskans deltagande i vården av sjukskrivna på vårdcentralen.</p><p>Syftet var att beskriva sjuksköterskors erfarenheter av telefonrådgivning på vårdcentralen och speciellt hantering av sjukskrivningar. Studien är kvalitativ med induktiv ansats. Datainsamling har skett genom fokusgruppssamtal med 14 stycken sjuksköterskor som arbetar med telefonrådgivning på tre vårdcentraler. Insamlat material analyserades med kvalitativ innehållsanalys.</p><p>Gruppsamtalen visade att sjuksköterskors erfarenheter av telefonrådgivning är att arbetet är kvalificerat och stimulerande. Hanteringen av sjukskrivningar innefattar att göra bedömning, ge patienten information och bevaka patientens rättigheter. Hindrande och möjliggörande omständigheter påverkar sjuksköterskornas arbete och deras hantering. De hindrande omständigheterna kan ibland leda till att sjuksköterskan vill frånsäga sig ansvar. Studien har identifierat ett behov av att tydliggöra omvårdnadsansvaret för verksamma sjuksköterskor i telefonrådgivning på vårdcentral så att sjuksköterskans bedömningar i telefonrådgivningssituationen i högre grad baseras på omvårdnadens mål.</p> / <p>When a person seeks contact with community health services in Sweden it’s usually via a phone call to the primary health care centre. By the phone call, received by a nurse, the health seeker’s case is assessed and addressed. Sick leave is one of many cases being managed. In recent years, management of sick leave in Swedish primary health care has changed and decreased the number of sick leaves. However, nurses have in varying degrees, participated in this change. This study will visualize the nurse's participation in the care of patients on sick leave at the primary health care centre.</p><p>The aim was to describe nurses' experiences of telephone advisory services at the primary health care centre and especially the management of sick leaves. The study is qualitative with an inductive approach. Data collection was done through focus group discussions with 14 nurses working with telephone advisory services at three primary health care centres. Collected material was analyzed by qualitative content analysis.</p><p>The group discussions demonstrated nurses' experiences of telephone advisory services as qualified and stimulating. The specific management of sick leave was described as a combination of making assessment, providing patient information and monitoring the patient's rights. Obstructing and enabling circumstances affect nurses telephone advisory services and their management of sick leaves. The obstucitive cirumstances sometimes causes nurses wanting to abdicate responsibility. The study has identified a need to clarify the caring responsibility for nurses in telephone advice services so that nurse's assessments increasingly are based on caring goales.</p>

När en person söker en första kontakt med hälso- och sjukvården sker det oftast via ett telefonsamtal till vårdcentralen. Vid telefonsamtalet, som tas emot av en sjuksköterska, bedöms och åtgärdas vårdsökarens ärende. Sjukskrivningar är ett av många ärenden som hanteras. De senaste åren har hanteringen av sjukskrivningar i Svensk hälso- och sjukvård förändrats vilket har orsakat en minskning av antalet sjukskrivningar. Sjuksköterskor har i varierande grad deltagit i denna utveckling och denna studie vill synliggöra sjuksköterskans deltagande i vården av sjukskrivna på vårdcentralen. Syftet var att beskriva sjuksköterskors erfarenheter av telefonrådgivning på vårdcentralen och speciellt hantering av sjukskrivningar. Studien är kvalitativ med induktiv ansats. Datainsamling har skett genom fokusgruppssamtal med 14 stycken sjuksköterskor som arbetar med telefonrådgivning på tre vårdcentraler. Insamlat material analyserades med kvalitativ innehållsanalys. Gruppsamtalen visade att sjuksköterskors erfarenheter av telefonrådgivning är att arbetet är kvalificerat och stimulerande. Hanteringen av sjukskrivningar innefattar att göra bedömning, ge patienten information och bevaka patientens rättigheter. Hindrande och möjliggörande omständigheter påverkar sjuksköterskornas arbete och deras hantering. De hindrande omständigheterna kan ibland leda till att sjuksköterskan vill frånsäga sig ansvar. Studien har identifierat ett behov av att tydliggöra omvårdnadsansvaret för verksamma sjuksköterskor i telefonrådgivning på vårdcentral så att sjuksköterskans bedömningar i telefonrådgivningssituationen i högre grad baseras på omvårdnadens mål. / When a person seeks contact with community health services in Sweden it’s usually via a phone call to the primary health care centre. By the phone call, received by a nurse, the health seeker’s case is assessed and addressed. Sick leave is one of many cases being managed. In recent years, management of sick leave in Swedish primary health care has changed and decreased the number of sick leaves. However, nurses have in varying degrees, participated in this change. This study will visualize the nurse's participation in the care of patients on sick leave at the primary health care centre. The aim was to describe nurses' experiences of telephone advisory services at the primary health care centre and especially the management of sick leaves. The study is qualitative with an inductive approach. Data collection was done through focus group discussions with 14 nurses working with telephone advisory services at three primary health care centres. Collected material was analyzed by qualitative content analysis. The group discussions demonstrated nurses' experiences of telephone advisory services as qualified and stimulating. The specific management of sick leave was described as a combination of making assessment, providing patient information and monitoring the patient's rights. Obstructing and enabling circumstances affect nurses telephone advisory services and their management of sick leaves. The obstucitive cirumstances sometimes causes nurses wanting to abdicate responsibility. The study has identified a need to clarify the caring responsibility for nurses in telephone advice services so that nurse's assessments increasingly are based on caring goales.

Swedish health care is currently facing problems, such as lack of financial resources, staff shortage and dissatisfaction among patients and professionals. Patients’ dissatisfaction was the point of departure for the present study, and one approach dealing with this problem was investigated. It was hypothesised that a patient-centred perspective could offer a possible solution. The aim of the study was to explore health care professionals’ and medical students’ understanding of their professional role and the patient encounter. A further goal was to determine whether these understandings could be developed by educational interventions. Students and professionals have been either interviewed or responded to a survey about their professional role and the patient encounter. Qualitative analysis was used. One group- and one individualised intervention were carried out. The participants’ understandings of their professional role were taken as the starting point for learning. The results showed that a minority of medical students and professionals in diabetes care had incorporated a patient-centred perspective. Nurses in telephone advisory services recognised the patients’ needs, but experienced conflicting demands of being both carer and gatekeeper. A non-optimal match between patients’ needs and what professionals understand as their role could cause some of the problems. Competence development could be achieved by taking the participants understanding of the professionals’ role and of the patient encounter as a starting point for reflection. The results have implications for changes in organisation and education in health care, to optimise outcomes of care. Time for reflection, mentoring and professional development is needed.