The faceless encounter: ethical dilemmas in telephone nursing.
OBJECTIVE
This paper aims to present the findings of a study designed to describe ethical dilemmas, in the form of conflicting values, norms and interests, which telenurses experience in their work.


BACKGROUND
Telephone nursing is an expanding part of health care. Telephone nurses in Sweden assess care needs, provide advice, support and information, and recommend and coordinate healthcare resources. Lately, ethical demands on healthcare professionals in general have increased. The reasons include new biomedical competence, an ageing population and constrained resources which have made priority setting a primary concern for doctors and nurses. When ethical problems arise, colleagues need open dialogue. Despite this, nurses lack such a dialogue.


METHODS
A purposeful sample of 12 female telenurses in Sweden was interviewed twice during 2004 and 2005. The transcribed interviews were analysed thematically.


RESULTS
Five themes were found: talking through a third party; discussing personal and sensitive problems over the phone; insufficient resources and the organization of health care; balancing callers' information needs with professional responsibility; and differences in judging the caller's credibility.


CONCLUSIONS
The present study has identified five different themes in which Swedish telenurses experience ethical dilemmas in their work. This shows how ethical dilemmas in various forms are present in telenursing. Questions of autonomy, integrity and prioritizing are particularly highlighted by the participating nurses. Telenurses in Sweden also experience new ethical demands due to a multicultural society. Although several of the identified dilemmas also occur in other areas of nursing we argue that these situations are particularly challenging in telenursing.


CONCLUSIONS
The work organization should provide opportunities for ethical competence-building, where ethical dilemmas in telenursing are highlighted and discussed. Such a strategy might lead to decreased moral uncertainty and distress among telenurses, with positive consequences for callers.
Holmström
Inger
I
Department of Public Health and Caring Sciences, Uppsala Science Park, Uppsala University, Uppsala, Sweden. inger.holmstrom@pubcare.uu.se
Höglund
Anna T
AT
D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003220:Conflict, Psychological; D018864:Cultural Diversity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology*; D009723:Nurse-Patient Relations / Q000941:ethics*; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000941:ethics / Q000523:psychology; D010353:Patient Education as Topic; D011340:Problem Solving; D017009:Professional Autonomy; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013548:Sweden; D017216:Telemedicine / Q000941:ethics / Q000458:organization & administration; D013689:Telephone / Q000941:ethics*; D035501:Uncertainty