The primary-care nurse's dilemmas: a study of knowledge use and need during telephone consultations.

In Sweden (population 8 million) there are 20 million calls every year to receptionist nurses at health-care centres. The aim of this study was, first, to develop a general description of these telephone consultations in terms of the decision-making process and interpersonal communication. Second, the dilemmas that receptionist nurses encounter were to be recorded and analysed. A two-level video method was used. At the first level, a video recording of the consultation was used to draw a 'consultation map'. At the second level, the receptionist nurses reviewed and commented on the video-recording using a 'freeze frame' technique for stimulated recall and the comments were categorized. Analysis of the consultation maps showed that the receptionist nurses focused mainly on tasks related to medical diagnosis and management strategy, with less time spent on the patient's concerns, ideas and expectations. Analysis of the dilemmas showed that medical dilemmas were the most frequent, occurring in two consultations out of three. Dilemmas in the area of interpersonal communication frequently concerned distrust, either in what the patient presented, or in what the patient was said to have understood. The conclusions are that the receptionist nurses were oriented towards medical management, and that they employed an informing rather than counselling strategy. Measures must be considered to support the receptionist nurses in the medical decision-making process. Action research is suggested to apply these results in the development of the work-role of the receptionist nurse.