title: Real nursing? The development of telenursing.
abstract: OBJECTIVE
  This paper is a report of a study to understand the impact of telenursing from the perspective of nurses involved in its provision, and in more traditional roles.
  
  
  BACKGROUND
  Nurse-led telephone helplines have recently been introduced across the United Kingdom, a major step in the development of nursing practice.
  
  
  METHODS
  A structured questionnaire was sent to all nurses working in the NHS Direct (National Health Service Direct) Wales telephone service (n = 111). Ninety-two completed questionnaires were returned (response rate 83 per cent). Two focus groups were conducted: one with telephone service nurses (n = 8) and one with other nurses (n = 5). The data were collected in 2002.
  
  
  RESULTS
  Respondents represented a highly educated workforce from a range of healthcare specialties. They reported that they joined the telephone service for improved salary and flexible working. Two-thirds reported improved job satisfaction. All focus group participants reported that the development of nursing skills was affected by the use of decision support software and the remote nature of the consultation. Participants reported opportunities for skill development, although the role could be stressful. All agreed that the service was popular with callers, but the nurses from outside raised concerns about whether telenursing was 'real' nursing and about the evidence base for the service and access by disadvantaged groups.
  
  
  CONCLUSIONS
  Differences between the groups reflect policy tensions between the need to develop new nursing skills, including the use of technology, to improve efficiency and recognition of the worth of hands-on nursing. These tensions must be addressed for the telephone service to function as part of an integrated healthcare system.
authors.affiliation: Centre for Health Information, Research and Evaluation, Swansea University, UK. h.a.snooks@swan.ac.uk
authors.forename: Helen A
authors.initials: HA
authors.lastname: Snooks
authors.forename: Anne M
authors.initials: AM
authors.lastname: Williams
authors.forename: Lesley J
authors.initials: LJ
authors.lastname: Griffiths
authors.forename: Julie
authors.initials: J
authors.lastname: Peconi
authors.forename: Jaynie
authors.initials: J
authors.lastname: Rance
authors.forename: Sherrill
authors.initials: S
authors.lastname: Snelgrove
authors.forename: Sharon
authors.initials: S
authors.lastname: Snelgrove
authors.forename: Srikant
authors.initials: S
authors.lastname: Sarangi
authors.forename: Paul
authors.initials: P
authors.lastname: Wainwright
authors.forename: Wai-Yee
authors.initials: WY
authors.lastname: Cheung
mesh_terms: D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009732:Nursing Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D013222:State Medicine / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000458:organization & administration*; D006113:United Kingdom