Introduction
As people worldwide live longer, the number of older adults is steadily increasing. Projections indicate that from 2015 to 2050, the percentage of the global population aged over 60 years will almost double, increasing from 12 to 22% [1]. As life expectancy increases, so does the likelihood of frailty and illness [2]. This can lead to greater needs for assistance and increased demand for healthcare personnel. In 2022, it was estimated that the healthcare sector had a shortage of approximately 16,000 employees, with this number expected to grow [3]. In response to these challenges, welfare technology, including social alarms, has emerged as a crucial tool in enabling older persons to remain in their homes while ensuring timely access to care services [4].
Response centres are considered a vital part of the national structure for telecare in Norway. There has been increasing investment in social alarms with dedicated response services in Norwegian municipalities [5]. The response service can be defined as “. a service that receives, assesses, documents, and responds to alerts from welfare technology solutions used by the service recipient” [5]. At response centres, alarms triggered by patients pressing an alarm device are received by healthcare personnel, including registered nurses and assistant nurses. This creates a teleconnection between the response centre and the patient’s alarm equipment [6]. Healthcare personnel then perform triage to determine whether the call can wait until the next scheduled home care visit, requires additional supervision, or demands immediate medical intervention. According to the Norwegian Directorate of Health, the goal is for over 75% of inquiries to be resolved at response centres without requiring additional services. Additionally, it is recommended that at least 95% of all alerts received by the response service be answered within 60 s [5].
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Norwegian municipalities use various types of telemonitoring technology, with social alarms being the most common solution [7]. Research indicates that older persons living at home are positive about the use of technology [8], and many report that technology such as camera-based digital supervision and social alarms gives them an increased sense of security [9, 10]. However, the studies also point out that technology cannot replace human contact [8, 10]. In recent years, several international studies have described nurses’ experiences with telecare. Telecare can be defined as the use of communication technology to provide health and social care directly to the user [11]. It has been reported that telecare can help reduce the need for unnecessary hospital admissions [12], provide patients with greater independence, and enable them to remain at home [13]. The importance of nurses having adequate resources and support for using telecare is also emphasised [14]. However, there is limited knowledge about the experiences of nurses working in response centres within the Norwegian context. Most existing research on telecare focuses on healthcare personnel’s experiences with telecare for chronically ill users [15]. Several studies highlight the importance of tailoring services to individual users’ abilities, skills, and resources [15‐17]. Furthermore, one study has examined factors influencing collaboration between organisations within telecare, specifically regarding social alarms [18]. The identified challenges include limitations in information flow, ambiguous allocation of responsibilities among units and staff, and insufficient communication interfaces between response centres and home care services [18]. Another Norwegian study examined the use of social alarms among home-bound individuals with dementia and their caregivers, revealing a need for improved municipal routines in providing and following up on social alarms [19]. Additionally, a survey conducted across several Norwegian municipalities revealed that response centre services contribute to a reduction in false alarms for home care services. However, alarms are often used for unintended purposes, such as seeking information and assisting with toilet visits [20].
Despite numerous studies on telecare, a significant gap remains in understanding the specific experiences of nurses working in response centres who manage triggered alarms. These alarms act as central points of contact between individuals, both older and younger, and healthcare providers. However, little is known about how nurses handle these interactions in environments where direct patient observation is not possible. Thus, this study contributes by exploring the experiences of nurses at response centres. These insights can help enhance telecare practices, improve service quality, and ultimately support individuals in maintaining safe and independent lives at home.
Purpose of the study
This study aims to explore nurses’ experiences with patient interactions after triggered social alarms at response centres located in Norwegian municipalities, specifically addressing the following research question:
How do nurses working in response centres experience patient interactions after social alarms are triggered?
Methods
Study design
The study employs a qualitative research design, grounded in a phenomenological hermeneutical approach, which focuses on understanding and interpreting the lived experiences of the nurses. This design allows for an in-depth exploration of participants’ subjective experiences and meanings, emphasising the importance of context and individual perspectives [21].
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Setting and participants
Due to the limited number of response centres in Norway, providing detailed descriptions of the setting and participants must be approached with caution to ensure anonymity. Therefore, the descriptions of the setting, participants, and other contextual elements have been deliberately kept general while ensuring that sufficient detail is provided to understand the study’s context and findings.
Department managers from three response centres in southeastern Norway were contacted. They received both written and verbal information about the study, along with a request to assist in recruiting respondents. Two managers agreed to participate, while one declined due to capacity constraints. Initially, emails were sent to all nurses working at the response centres, inviting participation in the study. Managers were instructed to include registered nurses with at least one year of experience at a response centre to ensure relevant insights for the research question. Despite follow-up reminders, there were no responses. To address this, the managers of the response centres directly approached individual nurses, resulting in positive responses from five participants. The nurses were subsequently contacted, and interview schedules were arranged. All participants were female nurses aged 25–50 years, working full-time. Their nursing experience ranged from 4 to 22 years, with a median of 14 years.
Two response centres located in two large municipalities in the southern part of Norway participated in this study. They were both staffed by registered nurses and healthcare workers, managing alarms triggered by patients using a home-based system. Each patient had a strategically placed device in their residence and an alarm pendant or wristband for activation. When the alarm was triggered, a telephonic connection was established via speakers and a microphone in the home device, allowing communication between the patient and response centre staff. However, audio quality depended on the patient’s proximity to the device, and the system was limited to use within the home.
At the time of this study, the response centres had not adopted additional telecare technologies, such as sensors or video surveillance. The telecare employed was restricted to voice communication through the alarm system.
Data collection
Data were gathered through individual interviews using a semi-structured interview guide. The interview guide, comprising opening, main, follow-up, and concluding questions, was informed by relevant literature and field experience. It was pilot tested with a response centre nurse to ensure clarity and relevance. Examples of questions from the interview guide are provided in Table 1. Strategies to establish rapport included informal conversation to build familiarity, reducing stress by clarifying the purpose of the interviews, and ensuring participants felt reassured both during and after the interview process. Follow-up questions were frequently employed to gain an in-depth understanding of the nurses’ experiences. Further, participants’ responses were paraphrased during the interviews to ensure clarity and understanding. No formal validation was conducted after the interviews The interviews were conducted at the participants’ workplaces, recorded electronically, and transcribed verbatim. The interviews lasted an average of 50 min, ranging from 43 to 58 min.
Table 1
Examples of questions from the interview guide
What does the patient convey during the conversation? |
What types of communication are effective or ineffective? |
Is there a clear difference in the approach to the conversation when it takes place via a personal alarm compared to a regular phone call? |
How does the relationship influence the outcome of the conversation? |
Analysis
The data were analysed via content analysis as described by Graneheim and Lundman [22]. The interviews were repeatedly read by both authors to gain a comprehensive understanding of the content. Next, text describing nurses’ experiences at the response centres was extracted and divided into meaning units based on relevant words, sentences, or paragraphs within their context. These units were then condensed and labelled with codes. Similar codes were grouped into three categories and seven subcategories, representing the manifest content of the data. In the final step, the categories were seen in the light of the latent content the data collected represented. Based on this analysis, the categories were compiled into a single, overarching theme [22].
CAH and EKJ reviewed and discussed the codes, final categories, and theme throughout the process, addressing minor disagreements until consensus was achieved.
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Researchers’ preunderstanding
One of the researchers (EJ) had previous experience working at a response centre, providing insights into the complexity and challenges associated with this type of work, as well as the importance of proper competence. The other researcher (CAH) had experience with alarm use from working in home care services but had no direct experience with response centres. She held a preunderstanding that the work was likely affected by time pressure and a lack of specific competence.
To ensure objectivity and minimise potential bias, several strategies were employed. Reflexivity, a key aspect of qualitative inquiry, was rigorously applied throughout the study. For instance, during the analysis, some aspects of the preunderstandings were nuanced or challenged. While participants occasionally mentioned time constraints, it did not emerge as a dominant theme in their narratives. These insights prompted the researchers to re-evaluate their assumptions and adjust the focus of the analysis to better align with the data. Reflective memos were used to track initial assumptions and how they evolved as the analysis progressed. Regular discussions between the researchers helped identify and address potential biases, ensuring that interpretations remained grounded in the participants’ perspectives rather than preconceived notions, in line with the principles of rigorous qualitative research as outlined by Olmos-Vega et al. [23]. Additionally, peer debriefing sessions were held, during which an external expert reviewed the findings to ensure that they were firmly grounded in the data [24].
Ethical considerations
Ethical approval was obtained from the Norwegian Centre for Research Data (NSD) for assessment (ref. no. 60762) and the data were collected following the Helsinki Declaration [25]. Information about the project was provided both verbally and in writing, including details about the participants’ rights to anonymity and confidentiality, as well as their right to withdraw from the study without providing a reason. Written consent was obtained from all participants. The data were processed following the recommended procedures of the NSD. Confidentiality and anonymity were maintained throughout the study. Fictitious names for all respondents are used to further safeguard their identities.
Results
The analysis of the interviews resulted in one latent theme, Clinical judgment and managing uncertainty in practice, and three main categories: (1) Clinical expertise and patient familiarity in ensuring safety; (2) Decision-making processes and accountability; and (3) Communication barriers and practice disparities (Table 2). The categories and subcategories, derived through Graneheim and Lundman’s qualitative content analysis [22], capture key aspects of nurses’ experiences in response centres, offering nuanced insights into decision-making, accountability, communication, patient safety, and managing uncertainty in clinical practice.
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Table 2
Results
Latent theme | Clinical judgment and managing uncertainty in practice | ||
|---|---|---|---|
Categories | Clinical expertise and patient familiarity in ensuring safety | Decision-making processes and accountability | Communication barriers and practice discrepancies |
Subcategories | • Experience and knowledge as the basis for safety • Familiarity with patients as a means to enhance safety | • Assessment of appropriate care levels • Demanding decision-making responsibility | • Vague explanations • Technological limitations • Variation in practice standards |
Clinical judgment and managing uncertainty in practice
According to Graneheim and Lundman [22], a theme in a content analysis represents an underlying meaning that can be derived from, for example, the categories, or the latent content of the text. The theme captures the deeper, often implicit insights that emerge from the data. In this study, the three categories identified through the analysis each illustrate different aspects of how nurses’ decision-making processes and accountability concerning patient safety are shaped by a variety of factors. These include their professional experience, knowledge, and the challenges encountered in everyday practice. Specific challenges, such as uncertainty about patient needs, limitations in technology, and variations in clinical practice standards, all influence how decisions are made, and the level of responsibility nurses feel in ensuring patient safety. This analysis highlights how the complexity and uncertainty inherent in nursing practice shape clinical judgment, revealing the multifaceted nature of decision-making and accountability in this context.
Utilising clinical expertise to ensure patient safety
The findings indicated that nurses emphasised creating and maintaining a sense of security during interactions, both for patients and themselves.
Experience and knowledge as the basis for safety
The nurses highlighted a key challenge faced at response centres: the inability to directly observe patients. Assessments rely heavily on patient-reported information and auditory cues. It was agreed that experience and knowledge were pivotal in this role, providing the confidence needed for effective patient interactions. One nurse stated that her confidence was derived from years of experience in home care services:
“I feel quite secure because I have worked for so many years with this stuff, you know, from home care services and, especially in a large city, you encounter all sorts. In addition, then you’re there all alone. So usually, it turns out fine.” (Tirill).
Another nurse described leveraging her clinical experience to mentally visualise patient scenarios, particularly when responding to fall incidents. She explained,
“When they called in because of a fall, I visualised how to approach them upon arrival and what questions to ask. I used visual cues. That way, it did not become so vague in a sense. I do not know, perhaps I had to make it more concrete to empathise because it is very different when you’re holding a phone without seeing or knowing them.” (Line).
Line’s approach demonstrates how she utilised prior experiences in her assessments. However, another nurse spoke about how this method eventually generated experience that she drew upon:
“No, you cannot see them, and I found it very unusual the first time I came up here. Avoid looking at them, but it becomes a habit after you have done it a few times. Once you have been sitting here for a while you start to gain some experience.” (Ane).
These insights demonstrate the nurses’ ability to apply their clinical expertise and experiences effectively, even when they are restricted to telephone communication. Their experience and knowledge provided a foundation for navigating the challenges of remote patient assessments.
Familiarity with patients as a means to enhance safety
Several nurses found it easier to assess patients with whom they had established relationships through previous work experiences. One informant described it this way:
“When you have not seen or known them before, there are many observations you might miss. I have callers whom I have encountered in nursing care previously. I find it much easier to communicate, ask targeted questions, and quickly understand their needs, even when they’re not expressed clearly.” (Line).
Being familiar did not necessarily mean that they had met the patients in person; some nurses also mentioned becoming acquainted with certain patients through frequent activation of their social alarms:
“You get to know some patients over time, yeah. Therefore, with many of them, you know what it is about because you have had them on the alarm, these regulars, you could say. You know more about them.” (Ane).
Another nurse mentioned challenges in distinguishing symptoms requiring immediate help from those stemming from anxiety disorders in patients with mental health issues. She found it easier to manage such situations when familiar with the patient:
“…in a way, she was stressed and waited for her medications. Therefore, I tried to have a calming conversation, so we did not have to call in another nurse. Getting to know them truly helps in situations like that.” (Mari).
The nurses emphasised that building familiarity and trust with patients could facilitate calming conversations without the need for additional resources. They further highlighted the importance of understanding patients’ need to feel safe, recognising that their inquiries often extended beyond health concerns to encompass feelings of being alone and the reassurance that comes from having someone to call.
Decision-making processes and accountability
All the nurses discussed their responsibility in determining the appropriate level of service for patient care and how they managed this responsibility.
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Assessment of appropriate care levels
Several nurses described their role as “filtering” patients, ensuring that those in genuine need received help, whereas those who could wait were asked to do so.
“We have to pause and filter a bit for home care services too. We need to have some way to ensure that those who actually need help receive help. So those who can wait until the next day or, you know, things like that. Alternatively, they may need to contact others for help.” (Ane).
Assessing the appropriate service level was challenging, especially when patients provided vague explanations of their needs. To determine the right service level, some of the nurses used patient information and their voice as indicators. They also considered the frequency of alarms and patients’ relationships with home care services. Evaluating alarms triggered by patients without genuine needs or due to false activations was a common task:
“…our role is to refer patients appropriately. We filter out false alarms, those who can wait and will soon receive help. Sometimes they might ask, though rarely, ‘What time is it now?’ or they might accidentally trigger the alarm while getting dressed or other similar activities.” (Laila).
Time constraints could put pressure on their decision-making process, urging the nurses to quickly assess and prioritise the urgency of each call while still ensuring that they make the right decision:
“Obviously, things can be different if you see there are five calls in the queue. You think, okay, I need to clarify this as quickly as possible, but we must always be thorough enough to be sure if they need help or not.” (Mari).
The results indicate that various elements play a role in assessing the appropriate level of service, including patient information, the nature of the alarm, and time pressures.
Demanding decision-making responsibility
The nurses shared that assessing the severity of patient calls was a challenging responsibility, emphasising the importance of making accurate decisions:
“It is a crisis if we make mistakes - if we do not send help to someone who needs it, it is a deviation or an error, and it can have serious consequences.” (Mari).
Despite differences in the nurses’ experiences, there was a shared understanding that ambulance services should be contacted in cases of doubt. Even if the decision to dispatch an ambulance later proves unnecessary upon obtaining concrete measurements, it was not seen as a misjudgement but rather as an extra precaution in challenging cases:
“I would not call it a misjudgment, but I have sent ambulances to people who, when their vitals were checked, turned out to have nothing physically wrong with them.” (Line).
Communication barriers and practice discrepancies
The information nurses received from patients was influenced by patients’ communication abilities, available assessment tools, and the quality of the technology in use.
Vague explanations
Effective communication with patients was identified as a significant challenge. Some patients have difficulty articulating their needs or understanding instructions, which could lead to misinterpretations and delays in response.
“Some callers ask for help without specifying the issue. For example, they might say they feel unwell or simply that someone needs to come without a specific need. Quite often, it is somewhat unclear [what they mean] (…). One often feels like having a camera just to see things as they truly are” (Mari).
Older patients, individuals with anxiety, and those with cognitive impairments often activate alarms but struggle to articulate their needs. Differentiating between cognitive impairment and acute confusion poses particular challenges when dealing with unfamiliar patients:
“I find it most challenging to assess if they have cognitive impairment, an ongoing infection, or if they seem confused because of an emerging dementia. You cannot see them to evaluate; you must rely on what they say, sometimes hearing them faintly. It might be a dialect you do not understand well, and perhaps they cannot hear you well either. We always start by asking what they need help with. However, some cannot even explain that.” (Laila).
When patients could not explain their needs, nurses used closed questions requiring short answers, such as “Are you nauseous?“. However, the nurses found that serious conditions could be hidden behind the short explanations; for example, it could be a sign that the patient did not have the strength to talk much owing to illness.
Technological limitations
The nurses identified several technological challenges that significantly impacted their ability to provide effective care. Among these challenges, poor audio quality and connectivity issues are particularly pervasive. One nurse compared the sound quality to that of communicating over a walkie-talkie, where only one person could speak at a time. The nurses expressed frustration with the limitations of current systems, noting that these shortcomings sometimes led to unnecessary dispatches of emergency services.
One nurse stated that the most uncomfortable thing was when she could not understand what the patients wanted due to poor sound quality:
“What’s most uncomfortable is when you cannot quite grasp what they want, what you’re after, because of the sound and everything. Suddenly, you hear nothing.” (Tiril).
Moreover, poor sound quality frequently forces nurses to resort to calling patients on a regular phone line as an alternative means of communication:
“It is hard to distinguish sounds from the TV, radio, and the patient. Sometimes, it is easier to talk to them on the phone.” (Ane).
However, relying on phone calls poses its own challenges, as patients do not always answer, resulting in additional home care visits. Another significant issue was the placement of equipment, often situated far from the patient, leading to weak sound transmission that prevented nurses from accurately assessing the assistance needed:
“Often, it is difficult to hear because the patient might have fallen somewhere other than where the alarm is located, making it hard to determine exactly what they need help with.” (Tiril).
The nurses emphasised the critical need for clear and reliable audio communication tools to increase their ability to provide timely and appropriate care responses.
Variation in practice standards
The study revealed varying approaches to patient conversations between the two response centres. At one centre, nurses felt there was a lack of standardisation and relied heavily on their own experience:
“You have to ask questions based on what you have learned and experienced.” (Tiril).
In contrast, the other centre utilised a structured response procedure, supported by a poster featuring various assessment tools and reminders for vital signs and stroke indicators:
“For example, if they report chest pain, we have specific follow-up questions. If they have fallen, different questions are needed. However, I often find that they become impatient and urgently need assistance. Answering these questions is not always straightforward. Ideally, we ask, and we always do, but many are quite anxious. When they have fallen, they want help quickly” (Laila).
These assessment tools are also crucial for effective communication with ambulance services:
“When I contact the ambulance, I use ISBAR, which is very specific: who I am and why I am calling, the symptoms, what I know and do not know, along with contact details for those involved.” (Line).
Discussion
The findings from this study highlight nurses’ experiences at response centres when interacting with patients who have activated their social alarms. Key areas of focus include clinical expertise and patient familiarity in ensuring safety, decision-making processes and accountability, communication barriers, and practice discrepancies. This discussion aims to interpret these findings and place them within the broader context of relevant research.
Clinical expertise and patient familiarity in ensuring safety
Experience and knowledge as the basis for safety
A significant challenge identified by the nurses was the inability to directly observe patients, relying instead on patient-reported information and auditory cues on one side from the patients and experience and knowledge from themselves on the other hand. Some of the nurses highlighted how their extensive experience in home care allowed them to visualise and empathise with patients’ situations, enhancing their confidence and effectiveness in remote assessments. These insights illustrate the importance of leveraging clinical experience to navigate the complexities of remote patient assessments, a point supported by earlier research indicating the necessity of adequate competence in telecare [26, 27]. Despite the importance of competence and knowledge, demographic information revealed that none of the nurses in this study had completed specific educational or training programs in telecare methodologies. This aligns with research indicating that specialised training in telecare is often insufficient, which can hinder nurses’ ability to make well-informed decisions [28, 29]. However, the nurses did not express feeling inadequately competent during the interviews.
Familiarity with patients as a means to enhance safety
The findings highlighted the benefits of nurses having established relationships with patients. Familiarity, whether from previous in-person interactions or frequent alarm activations, allows nurses to communicate more effectively, ask targeted questions, and understand patients’ needs more clearly, thus improving triage and reducing the likelihood of unnecessary dispatches. Moreover, familiarity was particularly advantageous in managing patients with mental health issues, as noted by one nurse. Understanding patients’ backgrounds helps in distinguishing between symptoms requiring immediate help and those related to anxiety disorders. However, this reliance on familiarity can also introduce potential challenges. One concern is the possibility of cognitive bias in decision-making. Biases can potentially influence the quality of healthcare decisions [30]. Excessive familiarity with certain patients may lead nurses to make assumptions on the basis of prior interactions, potentially hindering accurate current assessments.
Decision-making processes and accountability
Assessment of appropriate care levels
The nurses found the lack of observations and physical contact challenging in their clinical assessments. However, this challenge can be alleviated by using imaging technology in various parts of healthcare [31]. The incorporation of advanced imaging technology in telecare settings can significantly enhance nurses’ ability to make clinical judgments by providing real-time visual data, compensating for the lack of physical contact and direct observation [32]. Nevertheless, the actual impact of imaging technology on patients and how video communication affects interactions between the caller and operator remain unclear [31].
Demanding decision-making responsibilities
All the nurses discussed their responsibilities in making accurate triage decisions. Nurses at response centres play a pivotal role in assessing the appropriate level of patient care services, serving as critical gatekeepers tasked with balancing capacity and service quality [33]. The findings show that nurses recognise the potentially serious consequences of incorrect decisions. A significant challenge was determining the appropriate service level when patient explanations were vague, documentation was sparse, and familiarity with the patient was limited. This challenge has also been underscored in previous studies [28]. Nurses in our study emphasised their practice of opting to send help in uncertain situations, even if it occasionally resulted in unnecessary dispatches. This practice aligns with findings from a study in emergency medical services, where the principle of “better safe than sorry” informed decisions in ambiguous scenarios [34]. Technological limitations and unclear communication further complicate the process of making well-informed decisions about the appropriate service level. This led to unnecessary physical visits instead of resolving the need for help at the response centres. Similar findings were observed in Bergen municipality’s Smart Care project, which also identified many unnecessary dispatches due to technical errors and difficulties in clarifying alerts at the response centre [32].
Communication barriers and practice discrepancies
Vague explanations
The study revealed that a recurring challenge for the nurses was obtaining clear and precise explanations from patients regarding why they had triggered the alarms. The patients were often unable to articulate the problem or provide vague explanations, making it difficult for nurses to assess the severity of the situation. This finding is consistent with previous research, which shows that patients may struggle to express what they need help with, indicating that various factors, such as language barriers, lack of nonverbal signals, and reduced cognitive function, can hinder telecommunication between nurses and patients [35‐37]. Difficulties in being understood can also lead to fear and agitation among patients, potentially exacerbating the situation. The issue of communication barriers, including language proficiency and clarity in patient explanations, remains a critical challenge. Addressing these barriers requires not only technological solutions but also cultural competence and communication training for nurses to manage diverse patient populations better [38].
Technological limitations
The study revealed significant technological challenges in communication with patients. Conversations were often choppy or unclear because the patient was in a different location from the speaker, transmitting sound to the response centres. Frequently, nurses opt to call patients by phone rather than continue the conversation via the alarm line because of poor sound quality. Technological failure is a well-documented issue in healthcare, affecting both the transmission of information between providers and the communication between providers and patients [39, 40]. However, this challenge is particularly concerning in situations where the patient may require urgent medical assistance. This shows that the reliance on technology, while beneficial, introduces new vulnerabilities. Technical failures, as noted in other research, can lead to significant delays and miscommunication, potentially compromising patient safety [40].
Variations in practice standards
Clinical decision support systems with predefined assessment criteria can be useful tools in decision-making processes [41], but in this study, only one response centre used such systems. These systems are common in other areas of healthcare, such as the Emergency Medical Communication Centre, where the Norwegian Index for Emergency Medical Assistance is used [42]. While clinical decision support systems have the potential to support decision-making processes, their effectiveness may be limited in scenarios involving aggressive or noncommunicative patients [43]. Moreover, a systematic review of medical triage revealed low evidence for the accuracy of triage systems, and emphasising the need for improvements [44]. Without standardised procedures, decision-making becomes more subjective, which can increase the risk of errors [30]. Additionally, the absence of standardised protocols across different response centres can lead to inconsistent care quality. On the other hand, complete standardisation may restrict the flexibility and clinical judgment required to manage complex and unique situations, which are common in telecare [17]. This highlights the need to explore how a balance can be achieved between structured frameworks and the ability to exercise clinical judgment.
This need for balance between structured frameworks and clinical judgment will further be influenced by the ongoing paradigm shift driven by advanced technologies, such as artificial intelligence (AI) and machine learning (ML). Trends indicate that the adoption of AI and ML in healthcare is increasing, suggesting that their integration into specific contexts, such as telecare response centres, will likely continue to evolve [45]. A recent systematic review highlighted that AI-assisted telehealth interventions are efficient and promising, underscoring the importance of finding supporting evidence to effectively implement these technologies in nursing [46].
Strengths and weaknesses of the study
One of the key strengths of this study is its focus on nurses’ experiences in managing social alarms at response centres, a critical area of healthcare service delivery that has received limited attention in the Norwegian context. The use of qualitative methods allowed for in-depth insights into nurses’ subjective experiences, shedding light on key aspects of remote patient management in telecare settings.
The small sample size reflects the limited number of nurses available at the response centres where we were granted access for interviews. While this homogenous sample (female nurses aged 25–50 years) limits transferability, it was sufficient for an in-depth exploration of the phenomenon, and the diverse levels of experience within the group provided valuable insights. According to the principle of ‘information power’ [47], the richness of the data rather than the number of participants determines the adequacy of the sample size in qualitative research, making the inclusion of five participants justifiable in this context.
The recruitment process through managers may have introduced selection bias, as participants may have been chosen for their ability to present the workplace positively or for their cooperative nature. Despite this, the interviews generated a rich dataset, with participants openly discussing both the challenges and positive aspects of their work environment.
We acknowledge that the researchers’ perspectives may influence data interpretation. To enhance transparency, we have included a section discussing our preconceptions and how they shaped our analysis.
While the study provides valuable insights into nurses’ perceptions, it does not include the voices of patients or their families. Future research should address this gap to better understand their experiences with telecare services and identify areas for improvement.
Conclusion
This study provides valuable insights into nurses’ experiences in response centres, underscoring the important role of clinical expertise and patient familiarity in ensuring patient safety. The findings emphasise how familiarity with patients can improve triage decisions, while also raising the potential for cognitive bias, highlighting the need for balanced and informed decision-making. Nurses also face significant challenges, including communication barriers—such as vague patient descriptions—and technological limitations, which can result in unnecessary dispatches. Standardised protocols could help reduce discrepancies in practice, yet flexibility remains essential to address the complexities of individual cases.
Further research is needed to validate these findings in larger and more diverse populations. Additionally, studies should investigate how these factors impact patient outcomes and overall service quality. Incorporating feedback from patients and their families in future research will also be essential for gaining a more comprehensive understanding of service quality. Such insights are vital in developing person-centred improvements in telecare services, which could enhance both operational efficiency and patient satisfaction.
Acknowledgements
The authors wish to thank the participants in this study.
Declarations
Ethics approval and consent to participate
Informed consent was obtained from all the participants before collecting data. The study obtained ethical approval from the Norwegian Centre for Research Data (ref. no. 60762).
Consent for publication
Not applicable to the study.
Use of artificial intelligence
This article has benefited from the proofreading and language refinement services provided by OpenAI’s ChatGPT-3.5.
Competing interests
The authors declare no competing interests.
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