title: Telenurses' experiences of working with computerized decision support: supporting, inhibiting and quality improving.
abstract: OBJECTIVE
  This paper is a report of a study conducted to describe telenurses' experiences of working with computerized decision support systems and how such systems could influence their work.
  
  
  BACKGROUND
  Telenursing is an expanding service in many Western countries, and in recent years centralization of telenursing services has occurred in Sweden. In connection with this, the use of computerized decision support has increased.
  
  
  METHODS
  Eight Registered Nurses from three telephone advice call centres in Sweden who were using computerized decision support took part in semi-structured interviews in 2006. The data were analysed using qualitative content analysis.
  
  
  RESULTS
  The findings are presented as one theme and three categories. Telenurses experienced their work with a decision support system as supporting, inhibiting and quality improving. Based on two of the categories - 'supporting' and 'inhibiting' - a theme was revealed: being strengthened, but simultaneously controlled and inhibited. This theme represents the individual level. The telenurses found that the decision support system simplified their work, complemented their knowledge, gave them security and enhanced their credibility. They also described experiencing the system as incomplete, sometimes in conflict with their own opinions and controlling. The third category referred to the organizational level: the decision support system ensured the quality of telenursing.
  
  
  CONCLUSIONS
  Although the telenurses experienced computerized decision support as both supporting and inhibiting, they preferred working with it. They also described how a computerized decision support system cannot replace telenurses' knowledge and competence, and that it should be considered as complementary.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Sweden and Department of Caring Science and Sociology, University of Gävle, Sweden. annica.ernesater@pubcare.uu.se
authors.forename: Annica
authors.initials: A
authors.lastname: Ernesäter
authors.forename: Inger
authors.initials: I
authors.lastname: Holmström
authors.forename: Maria
authors.initials: M
authors.lastname: Engström
mesh_terms: D000328:Adult; D001292:Attitude to Computers; D002983:Clinical Competence / Q000592:standards*; D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D024802:Nurse's Role; D013548:Sweden; D055817:Telenursing / Q000592:standards*