Hakimnia Roya, Holmström Inger K, Carlsson Marianne, Höglund Anna T
Department of Public Health and Caring Sciences, Uppsala, Sweden.
Department of Public Health and Caring Sciences, Uppsala, Sweden;
Int J Qual Stud Health Well-being. 2014 Jun 24;9:24255. doi: 10.3402/qhw.v9.24255. eCollection 2014.
Telenursing is an expanding service in most Western societies. Sweden is a front-line country, with all of its 21 counties connected to Swedish Healthcare Direct (SHD) 1177. The intention of the service is twofold: to make health care more efficient, while also making it more accessible and safe for patients. Previous research has shown, however, that the service is not used equitably. Gender, age, socio-economic, and ethnicity differences have been reported as determining factors for the use of the service and the advice given.
The aim of the study was to explore the communication between telenurses and callers in authentic calls to SHD 1177.
A qualitative method, using critical discourse analysis (CDA), was chosen. The approach was deductive, that is, the analysis was made in view of a predetermined framework of theory. Twenty calls were strategically chosen and included in the study.
The CDA resulted in five types of calls, namely a gatekeeping call, a gendered call, a call marked by impersonal traits, a call with voices of the life world, and finally a counter discourse call. The dominating patterns in the calls were of gatekeeping and biomedical character. Patterns of the societal gender order were found, in that representations of the reluctant male caller and the ideal female caller were identified, but also a call representing a counter discourse. The service seemed difficult to use for patients with low language proficiency.
Telenursing could potentially challenge inequalities in health care. However, the discourse of telenursing is dialectically related to neoliberal ideology and the ideology of medicine. It is also situated in a gendered context of ideal femininity and hegemonic masculinity. Through better awareness of gender biases and the callers' different resources for making themselves heard, the communication between telenurse and caller might become more equal and thereby better suitable for all callers.
远程护理在大多数西方社会是一项不断发展的服务。瑞典是前沿国家，其21个郡都接入了瑞典医疗直通（SHD）1177。该服务有双重目的：提高医疗效率，同时使患者更容易获得医疗服务并确保其安全。然而，先前的研究表明，该服务的使用并不公平。据报道，性别、年龄、社会经济和种族差异是使用该服务及所提供建议的决定因素。
本研究的目的是探讨远程护士与拨打SHD 1177热线的来电者之间在真实通话中的沟通情况。
选择了一种定性方法，即批判性话语分析（CDA）。该方法是演绎性的，也就是说，分析是基于预先确定的理论框架进行的。从策略上选择了20个通话并纳入研究。
CDA产生了五种通话类型，即把关通话、性别化通话、具有非个人特征的通话、具有生活世界声音的通话，以及最后一种反话语通话。通话中的主导模式具有把关和生物医学特征。发现了社会性别秩序模式，即识别出不情愿的男性来电者和理想的女性来电者的表现形式，同时也有一种代表反话语的通话。对于语言能力较低的患者来说，该服务似乎难以使用。
远程护理有可能挑战医疗保健中的不平等现象。然而，远程护理的话语与新自由主义意识形态和医学意识形态存在辩证关系。它也处于理想女性气质和霸权男性气质的性别背景中。通过更好地认识性别偏见以及来电者让自己被听到的不同资源，远程护士与来电者之间的沟通可能会变得更加平等，从而更适合所有来电者。
