title: Malpractice claims in Swedish telenursing: lessons learned from interviews with telenurses and managers.
abstract: BACKGROUND
  This study deals with serious malpractice claims within Swedish Healthcare Direct, the national telephone helpline in Sweden. At least 33 claims of malpractice have been filed since the service was created in 2003. Although a low number, consequences have been tragic. Research in Swedish telenursing on contributing systemic and organizational factors and consequences of malpractice claims is sparse.
  
  
  OBJECTIVE
  The objective was to explore the direct experience of telenurses' and call center managers' involvement in actual malpractice claims-with focus on factors that may have contributed to the claims-and on the consequences of the claims.
  
  
  METHODS
  Six telenurses and five managers agreed to participate in open-ended interviews. A directed content analysis approach was chosen to analyze the transcribed interview texts.
  
  
  RESULTS
  Stress, shiftwork, fatigue, multitasking, understaffing, and factors embedded in the system could have contributed to the malpractice claims. Safety management was treated locally, with no attempts at organizational reforms.
  
  
  CONCLUSIONS
  The solitary nature of the telenursing task emphasizes the importance of an organization, which works toward providing an environment where telenurses can feel safe and supported. This may require, in turn, a change in both organizational and professional attitudes toward safety and risk of error. The greatest hinder may be healthcare providers themselves. If the difficulties in recruiting participants for this study are any indication, reaching out to healthcare providers who remain silent may be the greatest challenge.
authors.affiliation: Marta Röing, PhD, is Researcher, Department of Public Health and Caring Sciences, Health Services Research, University of Uppsala, Sweden. Inger K. Holmström, PhD, RN, is Professor, School of Health, Division of Caring Sciences, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
authors.forename: Marta
authors.initials: M
authors.lastname: Röing
authors.forename: Inger K
authors.initials: IK
authors.lastname: Holmström
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D036262:Empirical Research; D005221:Fatigue / Q000523:psychology; D005260:Female; D015277:Hotlines / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008318:Malpractice; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D013315:Stress, Psychological / Q000523:psychology; D013548:Sweden; D055817:Telenursing; D016526:Workload / Q000523:psychology